maternity exam #1

A woman tells the nurse at a prenatal interview that she has quit smoking, only has a glass of wine with dinner, and has cut down on coffee to four cups a day. What response by the nurse will be most helpful in promoting a lifestyle change? a. "You have made some good progress toward having a healthy baby. Let's talk about the changes you have made." b. "You need to do a lot better than that. You are still hurting your baby." c. "Here are some pamphlets for you to study. They will help you find more ways to improve." d. "Those few things won't cause any trouble. Good for you."

A. "You have made some good progress toward having a healthy baby. Let's talk about the changes you have made."

3. Which of these is a secondary sexual characteristic? a. Female breast development b. Production of sperm c. Maturation of ova d. Secretion of gonadotropin-releasing hormone

ANS: A A secondary sexual characteristic is one not directly related to reproduction, such as development of the characteristic female body form. Production of sperm, maturation of ova, and secretion of hormones are all directly related to reproduction and not secondary sexual characteristics.

1. The nurse who suspects that a patient has early signs of ectopic pregnancy should be observing her for which symptoms? (Select all that apply.) a. Pelvic pain b. Abdominal pain c. Unanticipated heavy bleeding d. Vaginal spotting or light bleeding e. Missed period

ANS: A, B, D, E Early signs of ectopic pregnancy include pelvic pain, abdominal pain, spotting or light bleeding, and a woman's report of a "missed period." Heavy bleeding is a later sign and occurs after the tube has ruptured.

2. The anterior pituitary gland is responsible for producing which hormones? (Select all that apply.) a. Follicle-stimulating hormone (FSH) b. Luteinizing hormone (LH) c. Gonadotropin-releasing hormone (GnRH) d. Oxytocin e. Prolactin

ANS: A, B, E FSH and LH are both produced by the anterior pituitary gland. Both of these hormones assist in the stimulation and maturation of the ovarian follicle. Prolactin is also produced by the anterior pituitary and is required for milk production (lactogenesis) to occur. GnRH is produced by the hypothalamus and stimulates the release of FSH and LH. Oxytocin is produced by the posterior pituitary gland and is responsible for stimulating uterine contractions during birth

8. The breastfeeding woman whose recommended prepregnant caloric intake was 2000 calories per day needs how many calories per day to meet her current needs? a. 2300 b. 2500 c. 2750 d. 3000

ANS: B Feedback A 2300 calories is not enough calories to meet her needs. B The increase for a breastfeeding mother is 500 calories above her recommended prepregnant caloric intake. C 2750 calories may be too many calories and may lead to weight gain. D 3000 calories is too many for this mother and will lead to weight gain.

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

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

16. A patient with pregnancy-induced hypertension is admitted complaining of pounding headache, visual changes, and epigastric pain. Nursing care is based on the knowledge that these signs indicate a. Anxiety due to hospitalization b. Worsening disease and impending seizure c. Effects of magnesium sulfate d. Gastrointestinal upset

ANS: B Headache and visual disturbances are due to increased cerebral edema. Epigastric pain indicates distention of the hepatic capsules and often warns that a seizure is imminent. These sign are not due to anxiety or magnesium sulfate or related to gastrointestinal upset.

2. What assessment findings indicate to the nurses that a woman's preeclampsia should now be considered severe? (Select all that apply.) a. Urine output 40 mL/hour for the past 2 hours b. Serum creatinine 3.1 mg/dL c. Seeing "sparkly" things in the visual field d. Crackles in both lungs e. Soft, non-tender abdomen

ANS: B, C, D Signs of severe preeclampsia include elevated creatinine, seeing sparkles, and pulmonary edema (manifested by crackles). The urine output is above the minimum requirements, and a soft non-tender abdomen is a reassuring sign.

16. At approximately _____ weeks of gestation, lecithin is forming on the alveolar surfaces, the eyelids open, and the fetus measures approximately 27 cm crown to rump and weighs approximately 1110 g. a. 20 b. 24 c. 28 d. 30

ANS: C Feedback A These milestones would not be completed by 20 weeks of gestation. B These milestones in human development will not be completed at 24 weeks of gestation. C These are all milestones that occur at 28 weeks. D These specific milestones will be reached as early as 28 weeks, not 30 weeks of gestation.

14. The nurse is explaining how to assess edema to the nursing students working on the antepartum unit. Which score indicates edema of lower extremities, face, hands, and sacral area? a. +1 edema b. +2 edema c. +3 edema d. +4 edema

ANS: C Edema of the extremities, face, and sacral area is classified as +3 edema. Edema classified as +1 indicates minimal edema of the lower extremities. Marked edema of the lower extremities is termed +2 edema. Generalized massive edema (+4) includes accumulation of fluid in the peritoneal cavity.

7. In describing the size and shape of the nonpregnant uterus to a patient, the nurse would say it is approximately the size and shape of a a. cantaloupe. b. grapefruit. c. pear. d. large orange.

ANS: C The nonpregnant uterus is approximately 7.5 × 5.0 × 2.5 cm, which is close to the size and shape of a pear.

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

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

2. The major source of nutrients in the diet of a pregnant woman should be composed of a. Simple sugars b. Fats c. Fiber d. Complex carbohydrates

ANS: D Feedback A The most common simple carbohydrate is table sugar, which is a source of energy but does not provide any nutrients. B Fats provide 9 kcal in each gram, in contrast to carbohydrates and proteins, which provide only 4 kcal in each gram. C Fiber is supplied mainly by the complex carbohydrates. D Complex carbohydrates supply the pregnant woman with vitamins, minerals, and fiber.

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

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

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

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

The karyotype of a person is 47, XY, +21. This person is a a. Normal male b. Male with Down syndrome c. Normal female d. Female with Turner syndrome

B. male with down syndrome

How can a woman avoid exposing her fetus to teratogens? a. Update her immunizations during the first trimester of her pregnancy. b. Use saunas and hot tubs during the winter months only. c. Use only class A drugs during her pregnancy. d. Use alcoholic beverages only in the first and third trimesters of pregnancy

C. use only class A drugs during her pregnancy

___________ refers to the view that one's own culture's way of doing things is always the best.

Ethnocentrism Rationale: Although the United States is a culturally diverse nation, the prevailing practice of health care is based on the beliefs held by members of the dominant culture, primarily Caucasians of European descent. Cultural relativism is the opposite of ethnocentrism. It refers to learning about and applying the standards of another's culture.

The step of the nursing process in which the nurse determines the appropriate interventions for the identified nursing diagnosis is called: a. Assessment b. Planning c. Intervention d. Evaluation

ANS: B A During the assessment phase, data are collected. B The third step in the nursing process involves planning care for problems that were identified during assessment. C The intervention phase is when the plan of care is carried out. D The evaluation phase is determining whether the goals have been met.

20. What data on a patient's health history places her at risk for an ectopic pregnancy? a. Use of oral contraceptives for 5 years b. Recurrent pelvic infections c. Ovarian cyst 2 years ago d. Heavy menstrual flow of 4 days' duration

ANS: B Infection and subsequent scarring of the fallopian tubes prevents normal movement of the fertilized ovum into the uterus for implantation. Oral contraceptives, ovarian cysts, and heavy menstrual flows do not increase risk.

3. To increase the absorption of iron in a pregnant woman, the iron preparation should be given with a. Milk b. Tea c. Orange juice d. Coffee

ANS: C Feedback A The calcium and phosphorus in milk decrease iron absorption. B Tannin in the tea reduces the absorption of iron. C A vitamin C source may increase the absorption of iron. D A decreased intake of caffeine is recommended in pregnancy.

Which step in the nursing process identifies the basis or cause of the patient's problem? a. Intervention b. Expected outcome c. Nursing diagnosis d. Evaluation

ANS: C A Interventions are actions taken to meet the problem. B Expected outcome is a statement of the goal. C A nursing diagnosis states the problem and its cause ("related to"). D Evaluation determines whether the goal has been met.

Which nursing intervention is correctly written? a. Encourage turning, coughing, and deep breathing. b. Force fluids as necessary. c. Assist to ambulate for 10 minutes at 8 AM, 2 PM, and 6 PM. d. Observe interaction with infant.

ANS: C A This intervention does not state how often this procedure should be done. B "Force fluids" is not specific; it does not state how much. C Interventions may not be carried out unless they are detailed and specific. D This intervention is not detailed and specific.

21. What finding on a prenatal visit at 10 weeks might suggest a hydatidiform mole? a. Complaint of frequent mild nausea b. Blood pressure of 120/80 mm Hg c. Fundal height measurement of 18 cm d. History of bright red spotting for 1 day, weeks ago

ANS: C The uterus in a hydatidiform molar pregnancy is often larger than would be expected on the basis of the duration of the pregnancy. Many women have nausea in the first trimester. A woman with a molar pregnancy may have early-onset pregnancy-induced hypertension. The history of bleeding is normally described as being brownish.

What should the nurse expect to be problematic for a family whose religious affiliation is Jehovah's Witness? a. Immunizations b. Autopsy c. Organ donation d. Blood transfusion

ANS: D A Christian Science believers may seek exemption from immunizations. B Believers in Islam are opposed to organ donation. C Jehovah's Witness believers can make individual decisions about autopsy. D Jehovah's Witness believers are opposed to blood transfusions. They may accept alternatives to transfusions, such as non-blood plasma expanders.

According to Friedman's classifications, providing such physical necessities as food, clothing, and shelter is the _____ family function. a. Economic b. Socialization c. Reproductive d. Health care

ANS: D A The economic function provides resources but is not concerned with health care and other basic necessities. B The socialization function teaches the child cultural values. C The reproductive function is concerned with ensuring family continuity. D Physical necessities such as food, clothing, and shelter are considered part of health care.

4. When is the best time to determine gestational age based on biparietal diameter through ultrasound? a. First trimester only b. Second trimester only c. Any time d. Second half of pregnancy

ANS: D The biparietal diameter is used to determine gestational age during the second half of pregnancy.

A couple has been counseled for genetic anomalies. They ask you, "What is karyotyping?" Your best response is a. "Karyotyping will reveal if the baby's lungs are mature." b. "Karyotyping will reveal if your baby will develop normally." c. "Karyotyping will provide information about the gender of the baby and the number and structure of the chromosomes." d. "Karyotyping will detect any physical deformities the baby has."

C. "Karyotyping will provide information about the gender of the baby and the number and structure of the chromosomes."

Which question by the nurse will most likely promote sharing of sensitive information during a genetic counseling interview? a. "How many people in your family are mentally retarded or handicapped?" b. "What kinds of defects or diseases seem to run in the family?" c. "Did you know that you can always have an abortion if the fetus is abnormal?" d. "Are there any family members who have learning or developmental problems?"

D. "Are there any family members who have learning or developmental problems?"

Chromosomes are composed of genes, which are composed of DNA. Abnormalities are either numerical or structural in nature. Which abnormalities are structural? Select all that apply. a. Part of a chromosome is missing. b. The material within a chromosome is rearranged. c. One or more sets of chromosomes are added. d. Entire single chromosome is added. e. Two chromosomes adhere to each other.

A, B, E

The nurse is working in an OB/GYN office, where part of her duties include obtaining a patient's history and performing an initial assessment. Which woman is likely to be referred for genetic counseling after her first visit? a. A pregnant woman who will be 40 years or older when her infant is born b. A woman whose partner is 38 years of age c. A patient who carries a Y-linked disorder d. An anxious woman with a normal quadruple screening result

A. a pregnant woman who will be 40 years or older when her infant is born

A baby is born with blood type AB. The father is type A, and the mother is type B. The father asks why the baby has a blood type different from those of his parents. The nurse's answer should be based on the knowledge that a. Both A and B blood types are dominant. b. The baby has a mutation of the parents' blood types. c. Type A is recessive and links more easily with type B. d. Types A and B are recessive when linked together.

A. both A and B blood types are dominant

People who have two copies of the same abnormal autosomal dominant gene will usually be a. More severely affected by the disorder than will people with one copy of the gene b. Infertile and unable to transmit the gene c. Carriers of the trait but not affected with the disorder d. Mildly affected with the disorder

A. more severely affected by the disorder than will people with one copy of the gene

Both members of an expectant couple are carriers for phenylketonuria (PKU), an autosomal recessive disorder. In counseling them about the risk to their unborn child, the nurse should tell them that a. The child has a 25% chance of being affected. b. The child will be a carrier, like the parents. c. The child has a 50% chance of being affected. d. One of four of their children will be affected.

A. the child has a 25% chance of being affected

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

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

2. Low-income women may have deficient diets because of lack of financial resources and nutritional education. Simple carbohydrate foods are less expensive than other, more nutritious foods items. The diet may be high in calories but low in vitamins and minerals. A referral to ___________ may be helpful.

ANS: WIC The WIC program is administered by the USDA to provide nutritional assessment, counseling, and education to low-income women and children up to age 5 years who are at nutritional risk. The program also provides food vouchers for items such as milk, cheese, eggs, fruits, vegetables and whole grains. Eligibility is based on an income of 185% of the federal property level or less. Women are eligible for WIC during pregnancy and for 6 months after if formula feeding and for one year if breast-feeding.

1. While providing care to a patient early in pregnancy, the nurse learns that the patient consumes alcohol almost daily. Drinking alcohol during pregnancy has been associated with a condition known as _______________________ in the infant and should be avoided.

ANS: fetal alcohol syndrome Alcohol interferes with the absorption and use of protein, thiamine, folic acid, and zinc. It also impairs metabolism and often takes the place of food in the mother's diet. Vitamin and mineral supplementation is usually necessary for women who consumed alcohol before pregnancy because nutrient stores may be depleted.

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

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

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

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

1. A pregnant woman has the following assessments determined from a biophysical profile: reactive nonstress test, 3 fetal breathing movements within 30 minutes, 1 trunk movement in 30 minutes, opened and closed hand twice in 30 minutes, largest amniotic pocket of 1 cm. Calculate this woman's score. This woman's score is _____.

ANS: 8 The scoring is as follows for each criteria: 2-2-1-2-1 = 8.

23. Which nutritional recommendation about fluids is accurate? a. A woman's daily intake should be 8-10 cups b. Coffee should be limited to no more than 2 cups, but tea and cocoa can be consumed without worry. c. Of the artificial sweeteners, only aspartame has not been associated with any maternity health concerns. d. Water with fluoride is especially encouraged because it reduces the child's risk of tooth decay.

ANS: A Feedback A 8-10 cups is the standard for fluids; however, they should be the right fluids. B All beverages containing caffeine, including tea, cocoa, and some soft drinks, should be avoided or should be drunk only in limited amounts. C Artificial sweeteners, including aspartame, have no ill effects on the normal mother or fetus. However, mothers with phenylketonuria (PKU) should avoid aspartame. D No evidence indicates that prenatal fluoride consumption reduces childhood tooth decay. However, it still helps the mother.

14. What is a goal of a patient with the following nursing diagnosis: Imbalanced Nutrition: Less Than Body Requirements related to diet choices inadequate to meet nutrient requirements of pregnancy? a. Gain a total of 30 lb. b. Take daily supplements consistently. c. Decrease intake of snack foods. d. Increase intake of complex carbohydrates.

ANS: A Feedback A A weight gain of 30 lb is one indication that the patient has gained a sufficient amount for the nutritional needs of pregnancy. B A daily supplement is not the best goal for this patient. It does not meet the basic need of proper nutrition during pregnancy. C Decreasing snack foods may be the problem and should be assessed. However, assessing the weight gain is the best method of monitoring nutritional intake for this pregnancy. D Increasing the intake of complex carbohydrates is important for this patient, but monitoring the weight gain should be the end goal.

11. A pregnant patient would like to know a good food source of calcium other than dairy products. Your best answer is a. Legumes b. Yellow vegetables c. Lean meat d. Whole grains

ANS: A Feedback A Although dairy products contain the greatest amount of calcium, it also is found in legumes, nuts, dried fruits, and some dark green leafy vegetables. B Yellow vegetables are rich in vitamin A. C Lean meats are rich in protein and phosphorus. D Whole grains are rich in zinc and magnesium.

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

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

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

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

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

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

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

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

11. The placenta allows exchange of oxygen, nutrients, and waste products between the mother and fetus by a. Contact between maternal blood and fetal capillaries within the chorionic villi b. Interaction of maternal and fetal pH levels within the endometrial vessels c. A mixture of maternal and fetal blood within the intervillous spaces d. Passive diffusion of maternal carbon dioxide and oxygen into the fetal capillaries

ANS: A Feedback A Fetal capillaries within the chorionic villi are bathed with oxygen- and nutrient-rich maternal blood within the intervillous spaces. B The endometrial vessels are part of the uterus. There is no interaction with the fetal blood at this point. C Maternal and fetal blood do not normally mix. D Maternal carbon dioxide does not enter into the fetal circulation.

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

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

9. A new mother asks the nurse about the "white substance" covering her infant. The nurse explains that the purpose of vernix caseosa is to a. Protect the fetal skin from amniotic fluid. b. Promote normal peripheral nervous system development. c. Allow transport of oxygen and nutrients across the amnion. d. Regulate fetal temperature.

ANS: A Feedback A Prolonged exposure to amniotic fluid during the fetal period could result in breakdown of the skin without the protection of the vernix caseosa. B Normal peripheral nervous system development is dependent on nutritional intake of the mother. C The amnion is the inner membrane that surrounds the fetus. It is not involved in the oxygen and nutrient exchange. D The amniotic fluid aids in maintaining fetal temperature.

22. After you complete your nutritional counseling for a pregnant woman, you ask her to repeat your instructions so that you can assess her understanding of the instructions given. Which statement indicates that she understands the role of protein in her pregnancy? a. "Protein will help my baby grow." b. "Eating protein will prevent me from becoming anemic." c. "Eating protein will make my baby have strong teeth after he is born." d. "Eating protein will prevent me from being diabetic."

ANS: A Feedback A Protein is the nutritional element basic to growth. An adequate protein intake is essential to meeting the increasing demands of pregnancy. These demands arise from the rapid growth of the fetus; the enlargement of the uterus, mammary glands, and placenta; the increase in the maternal blood volume; and the formation of amniotic fluid. B Iron intake prevents anemia. C Calcium intake is needed for fetal bone and tooth development. D Glycemic control is needed in diabetics; protein is one nutritional factor to consider, but this is not the primary role of protein intake.

1. Which part of the mature sperm contains the male chromosomes? a. The head of the sperm b. The middle portion of the sperm c. X-bearing sperm d. The tail of the sperm

ANS: A Feedback A The head of the sperm contains the male chromosomes that will join the chromosomes of the ovum. B The middle portion of the sperm supplies energy for the tail's whip-like action. C If an X-bearing sperm fertilizes the ovum, the baby will be female. D The tail of the sperm helps propel the sperm toward the ovum.

20. The various systems and organs develop at different stages. Which statement is accurate? a. The cardiovascular system is the first organ system to function in the developing human. b. Hematopoiesis originating in the yolk sac begins in the liver at 10 weeks. c. The body changes from straight to C-shaped at 8 weeks. d. The gastrointestinal system is mature at 32 weeks.

ANS: A Feedback A The heart is developmentally complete by the end of the embryonic stage. B Hematopoiesis begins in the liver during the 6th week. C The body becomes C-shaped at 21 weeks. D The gastrointestinal system is complete at 36 weeks.

17. The recommended diet for pregnancy differs from the recommended diet for lactation, because a. Lactating women require more calories and protein. b. Pregnant women need more calcium. c. Lactating women require fewer vitamins. d. Pregnant women require more iron and protein.

ANS: A Feedback A The lactating woman needs 200 calories and 5 g of protein more than the pregnant woman. B Calcium needs are the same for pregnancy and lactation. C Vitamin needs are higher during pregnancy and lactation. D Protein requirements are higher during lactation.

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

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

2. One of the assessments performed in the delivery room is checking the umbilical cord for blood vessels. Which finding is considered within normal limits? a. Two arteries and one vein b. Two arteries and two veins c. Two veins and one artery d. One artery and one vein

ANS: A Feedback A The umbilical cord contains two arteries and one vein to transport blood between the fetus and the placenta. B This option is abnormal and may indicate other anomalies. C Any option other than two arteries and one vein is considered abnormal and requires further assessment. D The presence of one umbilical artery is considered an abnormal finding. This infant would require further assessment for other anomalies.

What part of the nursing process includes the collection of data on vital signs, allergies, sleep patterns, and feeding behaviors? a. Assessment b. Planning c. Intervention d. Evaluation

ANS: A A Assessment is the gathering of baseline data. B Planning is based on baseline data and physical assessment. C Implementation is the initiation and completion of nursing interventions. D Evaluation is the last step in the nursing process and involves determining whether the goals were met.

A woman who delivered her baby 6 hours ago complains of headache and dizziness. The nurse administers an analgesic but does not perform any assessments. The woman then has a grand mal seizure, falls out of bed, and fractures her femur. How would the actions of the nurse be interpreted in relation to standards of care? a. Negligent because the nurse failed to assess the woman for possible complications b. Negligent because the nurse medicated the woman c. Not negligent because the woman had signed a waiver concerning the use of side rails d. Not negligent because the woman did not inform the nurse of her symptoms as soon as they occurred

ANS: A A By not assessing the woman, the nurse failed to meet the established standards of care. The first element of negligence relates to whether the nurse has a duty to provide care to the woman. The care that the nurse provides must meet the established standards of care. B By not first assessing the woman, the nurse does not meet the established standards of care. C The nurse could be found negligent. D The nurse is responsible for assessing the woman.

A nurse determines that a child consistently displays predictable behavior and is regular in performing daily habits. Which temperament is the child displaying? a. Easy b. Slow-to-warm-up c. Difficult d. Shy

ANS: A A Children with an easy temperament are even tempered, predictable, and regular in their habits. They react positively to new stimuli. B The slow-to-warm-up temperament type prefers to be inactive and moody. C A high activity level and adapting slowly to new stimuli are characteristics of a difficult temperament. D Shyness is a personality type and not a characteristic of temperament.

Which response by the nurse to the woman's statement, "I'm afraid to have a cesarean birth," would be the most therapeutic? a. "What concerns you most about a cesarean birth?" b. "Everything will be OK." c. "Don't worry about it. It will be over soon." d. "The doctor will be in later, and you can talk to him."

ANS: A A Focusing on what the woman is saying and asking for clarification is the most therapeutic response. B This response belittles the woman's feelings. C This response will indicate that the woman's feelings are not important. D This response does not allow the woman to verbalize her feelings when she desires.

Home nursing care has experienced dramatic growth since 1990. The nurse who works in this setting must function independently within established protocols. Which statement related to nursing care of the child at home is most correct? a. The technology-dependent infant can safely be cared for at home. b. Home care increases readmissions to the hospital for a child with chronic conditions. c. There is increased stress for the family when a sick child is being cared for at home. d. The family of the child with a chronic condition is likely to be separated from their support system if the child is cared for at home.

ANS: A A Greater numbers of technology-dependent infants and children are now cared for at home. The numbers include those needing ventilator assistance, total parenteral nutrition, IV medications, apnea monitoring, and other device-assisted nursing care. B Optimal home care can reduce the rate of readmission to the hospital for children with chronic conditions. C Consumers often prefer home care because of the decreased stress on the family when the patient is able to remain at home. D When the child is cared for at home the family is less likely to be separated from their support system because of the need for hospitalization.

The level of practice a reasonably prudent nurse provides is called: a. The standard of care b. Risk management c. A sentinel event d. Failure to rescue

ANS: A A Guidelines for standards of care are published by various professional nursing organizations. The standard of care for neonatal nurses is set by the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN). The Society of Pediatric Nurses is the primary specialty organization that sets standards for the pediatric nurse. B Risk management identifies risks and establishes preventive practices, but it does not define the standard of care. C Sentinel events are unexpected negative occurrences. They do not establish the standard of care. D Failure to rescue is an evaluative process for nursing, but it does not define the standard of care.

The formula used to guide time-out as a disciplinary method is a. 1 minute per each year of the child's age b. To relate the length of the time-out to the severity of the behavior c. Never to use time-out for a child younger than 4 years d. To follow the time-out with a treat

ANS: A A It is important to structure time-out in a time frame that allows the child to understand why he or she has been removed from the environment. B Relating time to a behavior is subjective and is inappropriate when the child is very young. C Time-out can be used with the toddler. D Negative behavior should not be reinforced with a positive action.

Which principle of teaching should the nurse use to ensure learning in a family situation? a. Motivate the family with praise and positive reinforcement. b. Present complex subject material first, while the family is alert and ready to learn. c. Families should be taught by using medical jargon so they will be able to understand the technical language used by physicians. d. Learning is best accomplished using the lecture format.

ANS: A A Praise and positive reinforcement are particularly important when a family is trying to master a frustrating task, such as breastfeeding. B Learning is enhanced when the teaching is structured to present the simple tasks before the complex material. C Even though a family may understand English fairly well, they may not understand the medical terminology or slang terms. D A lively discussion stimulates more learning than a straight lecture, which tends to inhibit questions.

The mother of a 5-year-old female inpatient on the pediatric unit asks the nurse if she could provide information regarding the recommended amount of television viewing time for her daughter. The nurse responds that the appropriate amount of time a child should be watching television is: a. 1-2 hours per day b. 2-3 hours per day c. 3-4 hours per day d. 4 hours or more

ANS: A A The American Academy of Pediatrics (AAP, 2009) encourages all parents to monitor their children's media exposure and limit screen time to no more than 1 to 2 hours per day. The AAP also recommends that parents remove televisions and computers from their children's bedrooms and monitor programs that have sexual or violent content. B Two hours per day is the outer limit of media exposure according to the AAP. C Three to four hours per day is too much television per the AAP guidelines. In this situation, parents need to more carefully monitor the amount of television viewing time. D Watching television for 4 hours or more is an excessive amount of screen time per the AAP guidelines. In this situation, parents need to more carefully monitor the amount of television viewing time.

12. A nurse is assessing a woman receiving magnesium sulfate. The nurse assesses her deep tendon reflexes at 0 and 1+. What action by the nurse is best? a. Hold the magnesium sulfate. b. Ask the provider to order a 24-hour UA. c. Assess the woman's temperature. d. Take the woman's blood pressure.

ANS: A Absent or hypoactive deep tendon reflexes are indicative of magnesium sulfate toxicity. The nurse should hold the magnesium and notify the provider. There is no need for a 24- hour UA at this point. Temperature changes are not related to magnesium. Blood pressure can be assessed, but that is not the priority.

3. The nursing student learns that spontaneous termination of a pregnancy is considered to be an abortion if a. the pregnancy is less than 20 weeks. b. the fetus weighs less than 1000 g. c. the products of conception are passed intact. d. no evidence exists of intrauterine infection.

ANS: A An abortion is the termination of pregnancy before the age of viability (20 weeks). The weight of a fetus is not considered because some fetuses of an older age may have a low birth weight. A spontaneous abortion may be complete or incomplete. A spontaneous abortion may be caused by many problems, one being intrauterine infection.

27. The nurse learns that which is the most common cause of spontaneous abortion? a. Chromosomal abnormalities b. Infections c. Endocrine imbalance d. Immunologic factors

ANS: A Around 60% of pregnancy losses from spontaneous abortion in the first trimester result from chromosomal abnormalities that are incompatible with life. Maternal infection, endocrine imbalances, and immunologic factors may also be causes of early miscarriage.

7. The priority nursing intervention when admitting a pregnant woman who has experienced a bleeding episode in late pregnancy is to a. assess fetal heart rate (FHR) and maternal vital signs. b. perform a venipuncture for hemoglobin and hematocrit levels. c. place clean disposable pads to collect any drainage. d. monitor uterine contractions.

ANS: A Assessment of the FHR and maternal vital signs will assist the nurse in determining the degree of the blood loss and its effect on the mother and fetus. The blood levels can be obtained later. It is important to assess future bleeding and provide for comfort, but the top priority is mother/fetal well-being. Monitoring uterine contractions is important but not the top priority.

3. The nurse providing care for the pregnant woman understands that a factor indicating the need for fetal diagnostic procedures is a. maternal diabetes. b. maternal age older than 30 years. c. previous infant more than 3000 g at birth. d. weight gain of 25 pounds.

ANS: A Diabetes is a risk factor in pregnancy because of possible impairment of placental perfusion. Other indications for testing include a maternal age greater than 35 years, having had another infant weighing greater than 4000 g at birth, or excessive weight gain. A weight gain of 25 to 35 pounds is recommended for the woman who begins pregnancy at a normal weight.

13. The student nurse learns that follicle stimulating hormone is produced in which gland? a. Anterior pituitary b. Posterior pituitary c. Hypothalamus d. Adrenal glands

ANS: A Follicle stimulating hormone is produced in the anterior pituitary gland.

17. Rh incompatibility can occur if the woman is Rh negative and her a. fetus is Rh positive. b. husband is Rh positive. c. fetus is Rh negative. d. husband and fetus are both Rh negative.

ANS: A For Rh incompatibility to occur, the mother must be Rh negative and her fetus Rh positive. The husband's Rh factor is a concern only as it relates to the possible Rh factor of the fetus. If the fetus is Rh negative, the blood types are compatible and no problems should occur. If the fetus is Rh negative, the blood type with the mother is compatible. The husband's blood type does not enter into the problem.

1. Which man is most likely to have abnormal sperm formation resulting in infertility? a. A 20-year-old man with undescended testicles b. An uncircumcised 40-year-old man c. A 35-year-old man with previously treated sexually transmitted disease d. A 16-year-old adolescent who is experiencing nocturnal emissions

ANS: A For normal sperm formation, a man's testes must be cooler than his core body temperature. The cremaster muscle attached to each testicle causes the testes to rise closer to the body and become warmer or allow the testes to fall away from the body to become cooler. Circumcision does not prevent fertility. Scar tissue in the fallopian tubes as a result of a sexually transmitted disease can be a cause of infertility in women. Nocturnal emissions of seminal fluid are normal and expected in teenagers.

2. Which analysis of maternal serum may predict chromosomal abnormalities in the fetus? a. Multiple-marker screening b. Lecithin/sphingomyelin (L/S) ratio c. Biophysical profile d. Type and crossmatch of maternal and fetal serum

ANS: A Maternal serum can be analyzed for abnormal levels of alpha-fetoprotein, human chorionic gonadotropin, and estriol. This multiple-marker screening may predict chromosomal defects in the fetus. The L/S ratio is used to determine fetal lung maturity. A biophysical profile is used for evaluating fetal status during the antepartum period. Five variables are used, but none is concerned with chromosomal problems. The blood type and crossmatch will not predict chromosomal defects in the fetus.

18. A nurse is teaching a woman how to do "kick counts." What information about this assessment is most appropriate? a. Notify your provider if the baby's movement patterns change. b. Count the number of fetal movements over 2 hours. c. Call the OB triage area if there are fewer than 10 movements/hour. d. Have your partner verify your count at the same time you perform it.

ANS: A Since there is no consensus on how the mother should be taught to perform this assessment, it is more important that she become familiar with her baby's movements and patterns and notify the provider about any change from normal.

2. A nurse is teaching a woman about spinnbarkeit. The student nurse asks why the woman would need this information. What response by the nurse is most appropriate? a. To assist in becoming pregnant or preventing pregnancy b. To determine if she can breastfeed c. To assess risk for genetic defects in the fetus d. To find out if her ova are suitable for fertilization

ANS: A Spinnbarkeit refers to the elasticity of cervical mucosa. The woman can assess this to avoid or promote pregnancy. It does not refer to breastfeeding, genetics, or her ova status.

11. The average man is taller than the average woman at maturity because of a. a longer period of skeletal growth. b. earlier development of secondary sexual characteristics. c. earlier onset of growth spurt. d. starting puberty at an earlier age.

ANS: A The man's greater height at maturity is the combined result of beginning the growth spurt at a later age and continuing it for a longer period. Girls develop earlier than boys. Boys' growth spurts start at a later age. Girls start puberty approximately 6 months to 1 year earlier than boys.

1. A pregnant woman's biophysical profile score is 8. She asks the nurse to explain the results. The nurse's best response is a. "The test results are within normal limits." b. "Immediate delivery by cesarean birth is needed." c. "Further tests are needed to determine the meaning of this score." d. "We will inform you of your options within the next week."

ANS: A The normal biophysical score ranges from 8 to 10 points if the amniotic fluid volume is adequate. A normal score allows conservative treatment of high-risk patients. Delivery can be delayed if fetal well-being is indicated. An immediate delivery is not needed. The results of the biophysical profile are usually available immediately after the procedure is performed.

19. What order should the nurse expect for a patient admitted with a threatened abortion? a. Abstinence from sexual activity b. Pitocin IV c. NPO d. Narcotic analgesia every 3 hours, prn

ANS: A The woman may be counseled to avoid sexual activity with a threatened abortion. Activity restrictions were once recommended, but they have not shown effectiveness as treatment. Pitocin would be contraindicated. There is no reason for the woman to be NPO. In fact, hydration is important. Narcotic analgesia is not indicated.

1. A young female patient comes to the school nurse to discuss her irregular periods. In providing education regarding the female reproductive cycle, which phases of the ovarian cycle does the nurse include? (Select all that apply.) a. Follicular b. Ovulatory c. Luteal d. Proliferative e. Secretory

ANS: A, B, C The follicular phase is the period during which the ovum matures. It begins on day 1 and ends around day 14. The ovulatory phase occurs near the middle of the cycle, approximately 2 days before ovulation. After ovulation and under the influence of the luteinizing hormone, the luteal phase corresponds with the last 12 days of the menstrual cycle. The proliferative and secretory phases are part of the endometrial cycle. The proliferative phase takes place during the first half of the ovarian cycle when the ovum matures. The secretory phase occurs during the second half of the cycle when the uterus is prepared to accept the fertilized ovum. These are followed by the menstrual phase if fertilization does not occur.

1. Congenital disorders refer to those conditions that are present at birth. These disorders may be inherited and caused by environmental factors or maternal malnutrition. Toxic exposures have the greatest effect on development between 15 and 60 days of gestation. For the nurse to be able to conduct a complete assessment of the newly pregnant client, she should be knowledgeable regarding known human teratogens, which include (select all that apply) a. Infections b. Radiation c. Maternal conditions d. Drugs e. Chemicals

ANS: A, B, C, D Feedback Correct Exposure to radiation and a number of infections may result in profound congenital deformities. These include varicella, rubella, syphilis, parvovirus, CMV, and toxoplasmosis. Certain maternal conditions such as diabetes and PKU may also affect organs and other parts of the embryo during this developmental period. Drugs such as antiseizure medication and some antibiotics, as well as chemicals including lead, mercury, tobacco, and alcohol, also may result in structural and functional abnormalities. Incorrect Coffee is not considered a teratogen.

Today's nurse often assumes the role of teacher or educator. Patient teaching begins early in the childbirth process and continues throughout the postpartum period. Which strategies would be best to use for a nurse working with a teen mother? Select all that apply. a. Computer-based learning b. Videos c. Printed material d. Group discussion e. Models

ANS: A, B, C, D, E A number of factors influence learning at any age. One of the most significant considerations is developmental level. Teenage parents often have very different concerns and learn in a different way than older parents. Often grandparents are also involved in the rearing of these children and must be able to review and understand the material. There is a wealth of new information that may not have been available when they became parents.

1. A patient is at 6 weeks' gestation and is having a transvaginal ultrasound. While preparing the patient for this procedure, she expresses concerns over the necessity for this test. The nurse explains that this diagnostic test may be necessary to determine which of the following? (Select all that apply.) a. Multifetal gestation b. Bicornuate uterus c. Presence and location of pregnancy (intrauterine or elsewhere) d. Amniotic fluid volume e. Presence of ovarian cysts

ANS: A, B, C, E A transvaginal ultrasound done in the first trimester can detect multifetal gestations, bicornuate uterus, presence and location of pregnancy, and presence of ovarian cysts. Amniotic fluid volume is assessed during the second and third trimesters.

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

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

Many communities now offer the availability of free-standing birth centers to provide care for low-risk women during pregnancy, birth, and postpartum. When counseling the newly pregnant woman regarding this option, the nurse should be aware that this type of care setting includes which advantages? Select all that apply. a. Less expensive than acute-care hospitals b. Access to follow-up care for 6 weeks postpartum c. Equipped for obstetric emergencies d. Safe, home-like births in a familiar setting e. Staffing by lay midwives

ANS: A, B, D Correct Women who are at low risk and desire a safe, home-like birth are very satisfied with this type of care setting. The new mother may return to the birth center for postpartum follow-up care, breastfeeding assistance, and family planning information for 6 weeks postpartum. Because birth centers do not incorporate advanced technologies into their services, costs are significantly less than those for a hospital setting. The major disadvantage of this care setting is that these facilities are not equipped to handle obstetric emergencies. Should unforeseen difficulties occur, the woman must be transported by ambulance to the nearest hospital. Birth centers are usually staffed by certified nurse-midwives (CNMs); however, in some states lay midwives may provide this service.

In an effort to reduce prohibitive health care costs, many facilities have incorporated the use of unlicensed assistive personnel into their care delivery model. Nurses supervising these employees must be aware of what each such employee is competent to do within his or her scope of practice. Which tasks can be delegated with supervision? Select all that apply. a. Blood draws b. Medication administration c. Nursing assessment d. Housekeeping tasks e. Other diagnostic tests, such as electrocardiograms (ECGs or EKGs)

ANS: A, B, D, E With proper supervision and adequate instruction, unlicensed assistive personnel may perform all of these functions. In school settings, these personnel may be responsible for medication administration under the direction of the registered nurse (RN). The nurse is always responsible for patient assessments and must make critical judgments to ensure patient safety. Use of the expert nurse to complete housekeeping or other mundane tasks is not a good use of human resources.

The nurse is caring for a child from a Middle Eastern family. Which interventions should the nurse include in planning care? Select all that apply. a. Include the father in the decision making. b. Ask for a dietary consult to maintain religious dietary practices. c. Plan for a male nurse to care for a female patient. d. Ask the housekeeping staff to interpret if needed. e. Allow time for prayer.

ANS: A, B, E The man is typically the head of the household in Muslim families. So the father should be included in all decision making. Muslims do not eat pork and do not use alcohol. Many are vegetarians. The dietitian should be consulted for dietary preferences. Compulsory prayer is practiced several times throughout the day. The family should not be interrupted during prayer, and treatments should not be scheduled during this time. Muslim women often prefer a female health care provider because of laws of modesty; therefore, the female patient should not be assigned a male nurse. A housekeeping staff member should not be asked to interpret. When interpreters are used, they should be of the same country and religion, if possible, because of regional differences and hostilities.

2. Along with gas exchange and nutrient transfer, the placenta produces many hormones necessary for normal pregnancy. These include (select all that apply) a. Human chorionic gonadotropin (hCG) b. Insulin c. Estrogen d. Progesterone e. Testosterone

ANS: A, C, D Feedback Correct hCG causes the corpus luteum to persist and produce the necessary estrogens and progesterone for the first 6 to 8 weeks. Estrogens cause enlargement of the woman's uterus and breasts; cause growth of the ductal system in the breasts; and, as term approaches, play a role in the initiation of labor. Progesterone causes the endometrium to change, providing early nourishment. Progesterone also protects against spontaneous abortion by suppressing maternal reactions to fetal antigens and reduces unnecessary uterine contractions. Other hormones produced by the placenta include hCT, hCA, and a number of growth factors. Incorrect Human placental lactogen promotes normal nutrition and growth of the fetus and maternal breast development for lactation. This hormone decreases maternal insulin sensitivity and utilization of glucose, making more glucose available for fetal growth. If a Y chromosome is present in the male fetus, hCG causes the fetal testes to secrete testosterone necessary for the normal development of male reproductive structures.

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

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

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

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

2. The nurse teaches a student that indications for percutaneous umbilical cord sampling (PUBS) include which of the following? (Select all that apply.) a. Rh disease b. Fetal well-being c. Infection d. Lung maturity e. Karyotyping

ANS: A, C, E Rh disease, infection, and, infrequently, for karyotyping are all indications for PUBS. NST or BPP are used to determination fetal well-being. An amniocentesis is done in order to determine lung maturity.

13. Which pregnant adolescent is most at risk for a nutritional deficit during pregnancy? a. A 15-year-old of normal height and weight b. A 17-year-old who is 10 pounds underweight c. A 16-year-old who is 10 pounds overweight d. A 16-year-old of normal height and weight

ANS: B Feedback A A 15-year-old has special nutritional needs during pregnancy, but she is not at the highest risk for deficiency. B The adolescent who is pregnant and underweight is most at risk, because she is already deficient in nutrition and must now supply the nutritional intake for both herself and her fetus. C An overweight pregnant teen is at risk for deficiency, but is not at the highest risk. Being underweight is the most risky because she is already deficient. D A 16-year-old has special nutritional needs during pregnancy, but she is not at the highest risk for deficiency.

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

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

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

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

7. A woman is 16 weeks pregnant with her first baby. She asks how long it will be before she feels the baby move. The best answer is a. "You should have felt the baby move by now." b. "Within the next month, you should start to feel fluttering sensations." c. "The baby is moving, but you can't feel it yet." d. "Some babies are quiet, and you don't feel them move."

ANS: B Feedback A Because this is her first pregnancy, movement is felt toward the later part of the 17 to 20 weeks. This statement may be alarming to the woman. B Maternal perception of fetal movement usually begins 17 to 20 weeks after conception. C This is a true statement. The fetus's movements are not strong enough to be felt until 17 to 20 weeks; however, this statement does not answer the concern of the woman. D Fetal movement should be felt by 17 to 20 weeks. If movement is not felt by the end of that time, further assessment will be necessary.

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

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

16. In teaching the pregnant adolescent about nutrition, the nurse should a. Emphasize the need to eliminate common teen snack foods, because they are too high in fat and sodium. b. Determine the weight gain needed to meet adolescent growth and add 35 lb. c. Suggest that she not eat at fast-food restaurants, to avoid foods of poor nutritional value. d. Realize that most adolescents are unwilling to make dietary changes during pregnancy.

ANS: B Feedback A Changes in the diet should be kept at a minimum, and snacks should be included. Snack foods can be in included in moderation and other foods added to make up for the lost nutrients. B Adolescents should gain in the upper range of the recommended weight gain. They also need to gain weight that would be expected for their own normal growth. C Eliminating fast foods will make her appear different to her peers. She should be taught to choose foods that add needed nutrients. D Adolescents are willing to make changes; however, they still have the need to be like their peers.

9. The most important reason for evaluating the pattern of weight gain in pregnancy is to a. Prevent excessive adipose tissue deposits. b. Identify potential nutritional problems or complications of pregnancy. c. Assess the need to limit caloric intake in obese women. d. Determine cultural influences on the woman's diet.

ANS: B Feedback A Excessive adipose tissue may occur with excess weight gain, but it is not the reason for monitoring the weight gain pattern. B Deviations from the recommended pattern of weight gain may indicate nutritional problems or developing complications. C It is important to monitor the pattern of weight gain for developing complications. D The pattern of weight gain is not influenced by cultural influences.

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

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

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

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

25. Three servings of milk, yogurt, or cheese plus two servings of meat, poultry, or fish will adequately supply the recommended amount of protein for the pregnant woman. Many patients are concerned about the increased levels of mercury in fish and may be afraid to include this source of nutrients in their diet. Sound advice by the nurse to assist the patient in determining which fish is safe to consume includes a. Canned white tuna as a preferred choice b. Avoiding shark, swordfish, and mackerel c. Treating fish caught in local waterways as the safest d. Avoiding high levels of mercury in salmon and shrimp

ANS: B Feedback A High levels of mercury can harm the developing nervous system of the fetus. It is essential for the nurse to assist the patient in understanding the differences between numerous sources of this product. A pregnant patient can eat as much as 12 ounces a week of canned light tuna; however, canned white, albacore, or tuna steaks contain higher levels of mercury and should be limited to no more than 6 ounces per week. B As a precaution the pregnant patient should avoid eating all of these as well as the less common tilefish. C This is a common misconception. Pregnant women and mothers of young children should check with local advisories about the safety of fish caught by families and friends in nearby bodies of water. If no information is available, these fish sources should be avoided, limited to less than 6 ounces, or the only fish consumed that week. D Commercially caught fish that is low in mercury includes salmon, shrimp, pollock, or catfish. The pregnant patient may eat up to 12 ounces per week.

5. The upper uterus is the best place for the fertilized ovum to implant because it is here that the a. Placenta attaches most firmly b. Developing baby is best nourished c. Uterine endometrium is softer d. Maternal blood flow is lower

ANS: B Feedback A If the placenta attaches too deeply, it does not easily detach after birth. B The uterine fundus is richly supplied with blood and has the thickest endometrium, both of which promote optimal nourishment of the fetus. C Softness is not a concern with implantation; attachment and nourishment are the major concerns. D The blood supply is rich in the fundus, which allows for optimal nourishment of the fetus.

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

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

21. To prevent GI upset, patients should be instructed to take iron supplements a. On a full stomach b. At bedtime c. After eating a meal d. With milk

ANS: B Feedback A Iron supplements are best absorbed if they are taken when the stomach is empty. B Taking iron supplements at bedtime may reduce GI upset. C Iron supplements are best absorbed if they are taken when the stomach is empty. Iron can be taken at bedtime if abdominal discomfort occurs when it is taken between meals. D Bran, tea, coffee, milk, and eggs may reduce absorption. Iron can be taken at bedtime if abdominal discomfort occurs when it is taken between meals.

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

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

12. A patient is sent from the physician's office for assessment because of too little amniotic fluid. The nurse is aware that oligohydramnios can result in a. Excessive fetal urine secretion b. Newborn respiratory distress c. Central nervous system abnormality d. Gastrointestinal blockage

ANS: B Feedback A Oligohydramnios may be caused by a decreased in urine secretion. B Because an abnormally small amount of amniotic fluid restricts normal lung development, the infant may have inadequate respiratory function after birth, when the placenta no longer performs respiratory function. C Excessive amniotic fluid production may occur when the fetus has a central nervous system abnormality. D Excessive amniotic fluid production may occur when the gastrointestinal tract prevents normal ingestion of amniotic fluid.

14. Oogenesis, the process of egg formation, begins during fetal life in the female. Which statement related to ovum formation is correct? a. Two million primary oocytes will mature. b. At birth, all ova are contained in the female's ovaries. c. The oocytes complete their division during fetal life. d. Monthly, at least two oocytes mature.

ANS: B Feedback A Only 400 to 500 ova will mature during the approximately 35 years of a woman's reproductive life. B All of the cells that may undergo meiosis in a woman's lifetime are contained in the ovaries at birth. C The primary oocytes begin their first meiotic division during fetal life but remain suspended until puberty. D Every month, one primary oocyte matures and completes meiotic division yielding two unequal cells.

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

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

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

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

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

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

19. With regard to the structure and function of the placenta, the maternity nurse should be aware that a. As the placenta widens, it gradually thins to allow easier passage of air and nutrients. b. As one of its early functions, the placenta acts as an endocrine gland. c. The placenta is able to keep out most potentially toxic substances, such as cigarette smoke, to which the mother is exposed. d. Optimal blood circulation is achieved through the placenta when the woman is lying on her back or standing.

ANS: B Feedback A The placenta widens until week 20 and continues to grow thicker. B The placenta produces four hormones necessary to maintain the pregnancy. C Toxic substances such as nicotine and carbon monoxide readily cross the placenta into the fetus. D Optimal circulation occurs when the woman is lying on her side.

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

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

15. A patient who is in week 28 of gestation is concerned about her weight gain of 17 lb. The nurse's best response is a. "You should try to decrease your amount of weight gain for the next 12 weeks." b. "You have gained an appropriate amount for the number of weeks of your pregnancy." c. "You should not gain any more weight until you reach the third trimester." d. "You have not gained enough weight for the number of weeks of your pregnancy."

ANS: B Feedback A The woman has gained the appropriate amount of weight. It would be inappropriate to have her decrease her weight gain. B A woman in her 28th week of gestation should have gained between 17 and 20 lb. The normal pattern of weight gain is 2 to 3 lb total in the first trimester (by 13 weeks) and 1 lb per week after that. C Weight gain needs to be consistent during the last part of the pregnancy and should not be suppressed. D She has gained an appropriate amount of weight and should not increase the weight gain.

20. Which statement made by a lactating woman leads the nurse to believe that the woman might have lactose intolerance? a. "I always have heartburn after I drink milk." b. "If I drink more than a cup of milk, I usually have abdominal cramps and bloating." c. "Drinking milk usually makes me break out in hives." d. "Sometimes I notice that I have bad breath after I drink a cup of milk."

ANS: B Feedback A The woman with lactose intolerance is more likely to experience bloating and cramping, not heartburn. B One problem that can interfere with milk consumption is lactose intolerance, which is the inability to digest milk sugar because of a lack of the enzyme lactose in the small intestine. Milk consumption may cause abdominal cramping, bloating, and diarrhea in such people, although many lactose-intolerant individuals can tolerate small amounts of milk without symptoms. C A woman who breaks out in hives after consuming milk is more likely to have a milk allergy. D This woman should be advise to simply brush her teeth after consuming dairy products.

10. A woman who is 16 weeks pregnant asks the nurse, "Is it possible to tell by ultrasound if the baby is a boy or girl yet?" The best answer is a. "A baby's sex is determined as soon as conception occurs." b. "The baby has developed enough that we can determine the sex by examining the genitals through ultrasound." c. "Boys and girls look alike until approximately 20 weeks after conception, and then they begin to look different." d. "It might be possible to determine your baby's sex, but the external organs look very similar right now."

ANS: B Feedback A This is a true statement, but the external genitalia are similar in appearance until approximately the 12th week. B Although gender is determined at conception, the external genitalia of males and females look similar through the 9th week. By the 12th week, the external genitalia are distinguishable as male or female. C The external genitalia are similar in appearance until approximately 12 weeks, not 20 weeks. D The external genitalia are different at approximately week 12.

A pictorial tool that can assist the nurse in assessing aspects of family life related to health care is the a. Genogram b. Ecomap c. Life cycle model d. Human development wheel

ANS: B A A genogram (also known as a pedigree) is a diagram that depicts the relationships of family members over generations. B An ecomap is a pictorial representation of the family structures and their relationships with the external environment. C The life cycle model in no way illustrates a family genogram. This model focuses on stages that a person reaches throughout his or her life. D The human development wheel describes various stages of growth and development rather than a family's relationships to each other.

A nurse observes that parents discuss rules with their children when the children do not agree with the rules. Which style of parenting is being displayed? a. Authoritarian b. Authoritative c. Permissive d. Disciplinarian

ANS: B A A parent who expects children to follow rules without questioning is using an authoritarian parenting style. B A parent who discusses the rules with which children do not agree is using an authoritative parenting style. C A parent who does not consistently enforce rules and allows the child to decide whether he or she wishes to follow rules is using a permissive parenting style. D A disciplinarian style would be similar to the authoritarian style.

Which nursing intervention is an independent function of the nurse? a. Administering oral analgesics b. Teaching the woman perineal care c. Requesting diagnostic studies d. Providing wound care to a surgical incision

ANS: B A Administering oral analgesics is a dependent function; it is initiated by a physician and carried out by the nurse. B Nurses are now responsible for various independent functions, including teaching, counseling, and intervening in nonmedical problems. Interventions initiated by the physician and carried out by the nurse are called dependent functions. C Requesting diagnostic studies is a dependent function. D Providing wound care is a dependent function; it is usually initiated by the physician through direct orders or protocol.

Which family will most likely have the most difficulty coping with an ill child? a. A single-parent mother who has the support of her parents and siblings b. Parents who have just moved to the area and are living in an apartment while they look for a house c. The family of a child who has had multiple hospitalizations related to asthma and has adequate relationships with the nursing staff d. A family in which there is a young child and four older married children who live in the area

ANS: B A Although only one parent is available, she has the support of her extended family, which will assist her in adjusting to the crisis. B Parents in a new environment will have increased stress related to their lack of a support system. They have no previous experiences in the setting from which to draw confidence. C Because this family has had positive experiences in the past, family members can draw from those experiences and feel confident about the setting. D This family has an extensive support system that will assist the parents in adjusting to the crisis.

What characteristic would most likely be found in a Mexican-American family? a. Stoicism b. Close extended family c. Considering docile children weak d. Very interested in health-promoting lifestyles

ANS: B A Although stoicism may be present in any family, Mexican-American families tend to be more expressive. B Most Mexican-American families are very close, and it is not unusual for children to be surrounded by parents, siblings, grandparents, and godparents. It is important to respect this cultural characteristic and to see it as a strength, not a weakness. C Considering docile children weak is a characteristic of Native Americans. D Although everyone tends now to embrace more health-promoting lifestyles, they are more prominent in Anglo-Americans.

Which woman would be most likely to seek prenatal care? a. A 15-year-old who tells her friends, "I don't believe I'm pregnant." b. A 20-year-old who is in her first pregnancy and has access to a free prenatal clinic c. A 28-year-old who is in her second pregnancy and abuses drugs and alcohol d. A 30-year-old who is in her fifth pregnancy and delivered her last infant at home with the help of her mother and sister

ANS: B A Being in denial about the pregnancy will prevent her from seeking health care. B The patient who acknowledges the pregnancy early, has access to health care, and has no reason to avoid health care is most likely to seek prenatal care. C Substance abusers are less likely to seek health care. D Some women see pregnancy and delivery as a natural occurrence and do not seek health care.

The nurse who coordinates and manages a patient's care with other members of the health care team is functioning in the role of: a. Teacher b. Collaborator c. Researcher d. Advocate

ANS: B A Education is an essential role of today's nurse. The nurse functions as a teacher during prenatal care, during maternity care, and when teaching parents of children regarding normal growth and development. B The nurse collaborates with other members of the health care team, often coordinating and managing the patient's care. Care is improved by this interdisciplinary approach as nurses work together with dietitians, social workers, physicians, and others. C Nurses contribute to their profession's knowledge base by systematically investigating theoretic for practice issues and nursing. D A nursing advocate is one who speaks on behalf of another. As the health professional who is closest to the patient, the nurse is in an ideal position to humanize care and to intercede on the patient's behalf.

More than 100 different ethno-cultural groups reside within the United States, and numerous traditional health beliefs are observed among these groups. Traditional beliefs related to the maintenance of health are likely to include a. Avoidance of natural events such as a solar eclipse b. Practicing silence, meditation, and prayer c. Protection of the soul by avoiding envy or jealousy d. Understanding that a hex, spell, or the evil eye may cause illness or injury

ANS: B A Illness can be prevented by avoiding natural events such as a solar eclipse along with environmental factors such as bad air. B Mental and spiritual health is maintained by activities such as silence, meditation, and prayer. Many people view illness as punishment for breaking their religious code and adhere strictly to morals and religious practices to maintain health. C Phenomena such as accidental provocation of envy, jealousy, or hate of a friend or acquaintance may cause illness. D Agent such as hexes, spells, and the evil eye may strike a person (often a child) and causes injury, illness, or misfortunate.

Maternity nursing care that is based on knowledge gained through research and clinical trials is known as: a. Nurse sensitive indicators b. Evidence-based practice c. Case management d. Outcomes management

ANS: B A Nurse sensitive indicators are patient care outcomes particularly dependent on the quality and quantity of nursing care provided. B Evidence-based practice is based on knowledge gained from research and clinical trials. C Case management is a practice model that uses a systematic approach to identify specific patients, determine eligibility for care, and arrange access to services. D The determination to lower health care costs while maintaining the quality of care has led to a clinical practice model known as outcomes management.

A woman who is gravida 2 para 1 comes for a prenatal visit at 20 weeks of gestation. Her fundus is palpated 3 cm below the umbilicus. This finding is: a. appropriate for gestational age. b. lower than normal for gestational age. c. higher than normal for gestational age. d. a sign of impending complications.

ANS: B A The fundus should be at the umbilicus at 20 weeks, so this is an inappropriate height and needs further assessment. B By 20 weeks, the fundus should reach the umbilicus. C This is lower than expected at this date. D It may be a complication, but it may also be due to incorrect dating of the pregnancy.

The intrapartum woman sees no need for an admission fetal monitoring strip. If she continues to refuse, what is the first action the nurse should take? a. Consult the family of the woman. b. Notify the physician. c. Document the woman's refusal in the nurse's notes. d. Make a referral to the hospital ethics committee.

ANS: B A The patient must be allowed to make choices voluntarily without undue influence or coercion from others. B Patients must be allowed to make choices voluntarily without undue influence or coercion from others. The physician, especially if unaware of the patient's decision, should be notified immediately. The nurse should notify the physician of the refusal of the agency's protocol and document all aspects of the explanations given by the nurse, as well as any instructions from the physician. C Documentation is important, but it should not be the first action. D Fetal monitoring is not usually considered an ethical problem.

31. A woman is in the emergency department with severe abdominal pain. When her pregnancy test comes back positive, she yells "I can't be pregnant! I had a tubal ligation two months ago!" What action by the nurse is the priority? a. Provide emotional support to the woman. b. Facilitate an ultrasound examination. c. Call the lab to have them repeat the test. d. Administer an opioid pain medication.

ANS: B A failed tubal ligation is a risk factor for ectopic pregnancy. After a blood pregnancy test, a transvaginal ultrasound is needed to look for a gestational sac within the uterus. Of course the nurse provides emotional support, but that is not the priority. There is no need to repeat the test. Pain medications may be contraindicated if surgery is needed and consents have not yet been signed.

32. A woman who is 8 months pregnant is brought to the emergency department after a serious motor vehicle crash. Although she has no apparent injuries, she is admitted to the hospital. Her partner is upset and wants to know why she just can't come home. What response by the nurse is best? a. "This is standard procedure for all pregnant crash victims." b. "She needs to be monitored for some potential complications." c. "We may have to deliver the baby at any time now." d. "We are giving her medicine to keep her from laboring."

ANS: B After serious trauma, a woman may be admitted and observed because an abruptio placentae may take up to 24 hours to become apparent. Not all motor vehicle crash patients will need to be admitted. The baby may or may not need to be delivered at any time, but this statement will frighten the partner. There is no indication the patient is in labor.

5. The primary reason for evaluating alpha-fetoprotein (AFP) levels in maternal serum is to determine if the fetus has a. hemophilia. b. a neural tube defect. c. sickle cell anemia. d. a normal lecithin/sphingomyelin (L/S) ratio.

ANS: B An open neural tube allows a high level of AFP to seep into the amniotic fluid and enter the maternal serum. Hemophilia is a genetic defect and is best detected with chromosomal studies such as chorionic villus sampling or amniocentesis. Sickle cell is a genetic defect and is best detected with chromosomal studies such as chorionic villus sampling or amniocentesis. L/S ratios are determined with an amniocentesis, which is usually done in the third trimester.

9. A woman with severe preeclampsia is being treated with bed rest and intravenous magnesium sulfate. The drug classification of this medication is a. tocolytic. b. anticonvulsant. c. antihypertensive. d. diuretic.

ANS: B Anticonvulsant drugs act by blocking neuromuscular transmission and depress the central nervous system to control seizure activity. A tocolytic drug does slow the frequency and intensity of uterine contractions, but it is not used for that purpose in this scenario. Decreased peripheral blood pressure is a therapeutic response (side effect) of the anticonvulsant magnesium sulfate. Diuresis is a therapeutic response to magnesium sulfate.

1. The perinatal nurse is giving discharge instructions to a woman, status post suction and curettage secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next 12 months. The best response from the nurse is a. "If you get pregnant within 1 year, the chance of a successful pregnancy is very small. Therefore, if you desire a future pregnancy, it would be better for you to use the most reliable method of contraception available." b. "The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produces during pregnancy. If you were to get pregnant, it would make the diagnosis of this cancer more difficult." c. "If you can avoid a pregnancy for the next year, the chance of developing a second molar pregnancy is rare. Therefore, to improve your chance of a successful pregnancy, it is better not to get pregnant at this time." d. "Oral contraceptives are the only form of birth control that will prevent a recurrence of a molar pregnancy."

ANS: B Beta-hCG levels will be drawn for 1 year to ensure that the mole is completely gone. There is an increased chance of developing choriocarcinoma after the development of a hydatidiform mole. The goal is to achieve a "zero" hCG level. If the woman were to become pregnant, it may obscure the presence of the potentially carcinogenic cells. Any contraceptive method except an IUD is acceptable.

24. Which laboratory marker is indicative of disseminated intravascular coagulation (DIC)? a. Positive KB test b. Presence of fibrin split products c. Thrombocytopenia d. Positive drug screen

ANS: B Degradation of fibrin leads to the accumulation of multiple fibrin clots throughout the body's vasculature. The other lab tests are not indicative of DIC.

9. Which nursing intervention is necessary before a second trimester transabdominal ultrasound? a. Place the woman NPO for 12 hours. b. Instruct the woman to drink 1 to 2 quarts of water. c. Administer a soapsuds enema. d. Perform an abdominal prep.

ANS: B During the second trimester, a full bladder may be needed to displace the intestines and elevate the uterus for better visibility. If indicated, the woman should be instructed to drink several glasses of clear fluid an hour before the time of the examination and to delay urination until the examination is completed. Since she needs to fill her bladder, being NPO is not appropriate. Enemas and abdominal preps are not necessary for this procedure.

2. Which maternal condition always necessitates delivery by cesarean section? a. Partial abruptio placentae b. Total placenta previa c. Ectopic pregnancy d. Eclampsia

ANS: B In total placenta previa, the placenta completely covers the cervical os. The fetus would die if a vaginal delivery occurred. In a partial abruptio placentae, if the mother has stable vital signs and the fetus is alive, a vaginal delivery can be attempted. If the fetus has died, a vaginal delivery is preferred. The most common ectopic pregnancy is a tubal pregnancy, which is usually detected and treated in the first trimester. Labor can be safely induced if the eclampsia is under control.

29. The nurse caring for a woman hospitalized for hyperemesis gravidarum should expect that initial treatment involves a. corticosteroids to reduce inflammation. b. IV therapy to correct fluid and electrolyte imbalances. c. an antiemetic, such as pyridoxine, to control nausea and vomiting. d. enteral nutrition to correct nutritional deficits.

ANS: B Initially, the woman who is unable to down clear liquids by mouth requires IV therapy for correction of fluid and electrolyte imbalances. Corticosteroids are not the expected treatment for this disorder. Pyridoxine is vitamin B6, not an antiemetic. Promethazine, a common antiemetic, may be prescribed. In severe cases of hyperemesis gravidarum, enteral nutrition via a feeding tube may be necessary to correct maternal nutritional deprivation. This is not an initial treatment for this patient.

4. An abortion in which the fetus dies but is retained in the uterus is called ________ abortion. a. inevitable b. missed c. incomplete d. threatened

ANS: B Missed abortion refers to a dead fetus being retained in the uterus. An inevitable abortion means that the cervix is dilating with the contractions. An incomplete abortion means that not all of the products of conception were expelled. With a threatened abortion the woman has cramping and bleeding but not cervical dilation.

8. If a woman's menstrual cycle began on June 2 and normally lasts 28 days, ovulation would mostly likely occur on June a. 10 b. 16 c. 21 d. 29

ANS: B Ovulation occurs approximately 12 to 14 days after the beginning of the menstrual period in a 28-day cycle. In this woman, ovulation would most likely occur on June 16. June 10 would just be 8 days into the cycle and too early for ovulation. June 21 would be 18 days into the cycle. Ovulation should have already occurred at this point. June 29 would be 27 days into the cycle and almost time for the next period.

13. The purpose of initiating contractions in a CST is to a. determine the degree of fetal activity. b. apply a stressful stimulus to the fetus. c. identifying fetal acceleration patterns. d. increase placental blood flow.

ANS: B The CST involves recording the response of the FHR to stress induced by uterine contractions. The NST and biophysical profiles look at fetal movements. The NST looks at fetal heart accelerations with fetal movements. The CST records the fetal response to stress. It does not increase placental blood flow.

4. The nursing students learn that fertilization of the ovum takes place in which part of the fallopian tube? a. Interstitial portion b. Ampulla c. Isthmus d. Infundibulum

ANS: B The ampulla is the wider middle part of the tube lateral to the isthmus and is where fertilization occurs. It does not occur in the interstitial portion, isthmus, or infundibulum.

15. A nurse is preparing a woman for a nonstress test (NST). What nursing action is most appropriate? a. Position the woman on her left side. b. Seat the woman comfortably in a recliner. c. Have the woman to drink 1 liter of water prior to the test. d. Place conduction gel on the obese woman's abdomen.

ANS: B To correctly position the pregnant patient for an NST, the woman usually sits in a reclining chair. Alternatively she can be in a semi-Fowler position with a lateral tilt. This will optimize uterine perfusion and prevent supine hypotension. The woman does not need to drink water. Conduction gel is used in all NST tests.

3. A woman has several relatives who had gestational hypertension and wants to decrease her risk for it. What information does the nurse provide this woman? (Select all that apply.) a. There is no way to reduce risk factors for gestational hypertension. b. Losing weight before you get pregnant will help prevent it. c. Eating a diet high in protein and iron may help prevent it. d. The father contributes no risk factors for hypertension in pregnancy e. Waiting until you are 35 to get pregnant cuts the risk in half.

ANS: B, C There are many risk factors for gestational hypertension, including obesity and anemia. The woman can take action to address these factors prior to becoming pregnant. The father's risks include the first baby and having fathered other preeclamptic pregnancies. Maternal age >35 increases the risk.

The consequences technique will assist children to learn the direct result of their behavior. This technique can be used with children from toddler age to adolescence. If children learn to understand consequences, they are less likely to repeat the offending behavior. Consequences fall into which categories? Select all that apply. a. Corporal b. Natural c. Logical d. Unrelated e. Behavioral

ANS: B, C, D Natural consequences are those that occur spontaneously. For example, a child leaves a toy outside and it is lost. Logical consequences are those that are directly related to the misbehavior. If two children are fighting over a toy, the toy is removed and neither child has it. Unrelated consequences are purposely imposed; for example, the child is late for dinner so he or she is not allowed to watch television. Corporal punishment is not part of this behavioral approach and usually takes the approach of spanking the child. Corporal punishment is highly controversial and is strongly discouraged by the American Academy of Pediatrics. Behavior modification is another disciplinary technique that rewards positive behavior and ignores negative behavior.

1. Eating disorders include anorexia nervosa and bulimia. Many women with anorexia have amenorrhea and do not become pregnant where as women with bulimia or subclinical anorexia may become pregnant. These condition conditions are associated with (select all that apply) a. Food cravings b. Low birth weight c. Food aversions d. Electrolyte imbalance e. Small for gestational age infants

ANS: B, D, E Feedback Correct These conditions are associated with electrolyte imbalance, low birth weight, and small for gestational age infants. All women should be asked about eating disorders and nurses should watch for behaviors that may indicate disordered eating. Some women eat normally during pregnancy for the sake of the fetus, but others continue their previous dysfunctional eating patterns during pregnancy or in the early postpartum period. Incorrect Food cravings and aversions are normal for most women during pregnancy. Women may have a strong preference or strong dislike for certain foods. They're generally not harmful, and some, like aversion to alcohol, may be beneficial.

Optimal patient care relies on the nurse's expertise and clinical judgment; however, critical thinking (a component of nursing judgment) underlies the nursing process. The nurse who uses critical thinking understands that the steps of critical thinking include (select all that apply) a. Therapeutic communication b. Examining biases c. Setting priorities d. Managing data e. Evaluating other factors

ANS: B, D, E Correct The 5 steps of critical thinking include: recognizing assumptions, examining biases, analyzing the need for closure, managing data, and evaluating other factors. Incorrect Therapeutic communication is a skill that nurses must have to carry out the many roles expected with in the profession; however, it is not one of the steps of critical thinking. Setting priorities is part of the planning phase of the nursing process.

10. If a patient's normal prepregnancy diet contains 45 g of protein daily, how many more grams of protein should she consume per day during pregnancy? a. 5 b. 10 c. 26 d. 30

ANS: C Feedback A 5 g will not be enough to meet her protein needs during pregnancy. B 10 g will not be enough extra protein to meet her needs during pregnancy. C The recommended intake of protein for the pregnant woman is 71 g. D 30 g is more than is necessary and will add extra calories.

8. During a centering pregnancy group meeting, the nurse teaches patients that the fetal period is best described as one of a. Development of basic organ systems b. Resistance of organs to damage from external agents c. Maturation of organ systems d. Development of placental oxygen-carbon dioxide exchange

ANS: C Feedback A Basic organ systems are developed during the embryonic period. B The organs are always at risk for damage from external sources; however, the older the fetus, the more resistant the organs will be. The greatest risk is when the organs are developing. C During the fetal period, the body systems grow in size and mature in function to allow independent existence after birth. D The placental system is complete by week 12, but that is not the best description of the fetal period.

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

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

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

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

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

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

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

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

19. A pregnant woman's diet consists almost entirely of whole grain breads and cereals, fruits, and vegetables. The nurse should be most concerned about this woman's intake of a. Calcium b. Protein c. Vitamin B12 d. Folic acid

ANS: C Feedback A Depending upon the woman's food choices this diet may be adequate in calcium. B Protein needs can be sufficiently met by a vegetarian diet. C This diet is consistent with that followed by a strict vegetarian (vegan). Vegans consume only plant products. Because vitamin B12 is found in foods of animal origin, this diet is deficient in vitamin B12. D The nurse should be more concerned with the woman's intake of vitamin B12 due to her dietary restrictions. Folic acid needs can be met by enriched bread products.

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

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

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

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

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

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

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

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

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

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

3. The purpose of the ovum's zona pellucida is to a. Make a pathway for more than one sperm to reach the ovum. b. Allow the 46 chromosomes from each gamete to merge. c. Prevent multiple sperm from fertilizing the ovum. d. Stimulate the ovum to begin mitotic cell division.

ANS: C Feedback A Once one sperm has entered the ovum, the zona pellucida changes to prevent other sperm from entering. B Each gamete (sperm and ovum) has only 23 chromosomes. There will be 46 chromosomes when they merge. C Fertilization causes the zona pellucida to change its chemical composition so that multiple sperm cannot fertilize the ovum. D Mitotic cell division begins when the nuclei of the sperm and ovum unite.

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

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

17. Sally comes in for her first prenatal examination. This is her first child. She asks you (the nurse), "How does my baby get air inside my uterus?" The correct response is a. "The baby's lungs work in utero to exchange oxygen and carbon dioxide." b. "The baby absorbs oxygen from your blood system." c. "The placenta provides oxygen to the baby and excretes carbon dioxide into your bloodstream." d. "The placenta delivers oxygen-rich blood through the umbilical artery to the baby's abdomen."

ANS: C Feedback A The fetal lungs do not function for respiratory gas exchange in utero. B The baby does not simply absorb oxygen from a woman's blood system. Blood and gas transport occur through the placenta. C The placenta functions by supplying oxygen and excreting carbon dioxide to the maternal bloodstream. D The placenta delivers oxygen-rich blood through the umbilical vein, not artery.

7. When providing care to the prenatal patient, the nurse understands that pica is defined as a. Intolerance of milk products b. Iron deficiency anemia c. Ingestion of nonfood substances d. Episodes of anorexia and vomiting

ANS: C Feedback A This is termed lactose intolerance. B Pica may produce iron deficiency anemia if proper nutrition is decreased. C The practice of eating substances not normally thought of as food is called pica. Clay or dirt and solid laundry starch are the substances most commonly ingested. D Pica is not related to anorexia and vomiting.

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

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

Elective abortion is considered an ethical issue because: a. Abortion law is unclear about a woman's constitutional rights. b. The Supreme Court ruled that life begins at conception. c. A conflict exists between the rights of the woman and the rights of the fetus. d. It requires third-party consent.

ANS: C A Abortion laws are clear concerning a woman's constitutional rights. B The Supreme Court has not ruled on when life begins. C Elective abortion is an ethical dilemma because two opposing courses of action are available. The belief that induced abortion is a private choice is in conflict with the belief that elective pregnancy termination is taking a life. D Abortion does not require third-party consent.

Alternative and complementary therapies: a. Replace conventional Western modalities of treatment b. Are used by only a small number of American adults c. Allow for more patient autonomy d. Focus primarily on the disease an individual is experiencing

ANS: C A Alternative and complementary therapies are part of an integrative approach to health care. B An increasing number of American adults are seeking alternative and complementary health care options. C Many popular alternative healing modalities offer human-centered care based on philosophies that recognize the value of the patient's input and honor the individual's beliefs, values, and desires. D Alternative healing modalities offer a holistic approach to health, focusing on the whole person and not just the disease.

In general, healthy families are able to adapt to changes within the family unit; however, some factors add to the usual stress experienced by any family. The nurse is in a unique position to assess the child for symptoms of neglect. Which high-risk family situation places the child at the greatest risk for being neglected? a. Marital conflict and divorce b. Adolescent parenting c. Substance abuse d. A child with special needs

ANS: C A Although divorce is traumatic to children, research has shown that living in a home filled with conflict is also detrimental. In this situation conflict may arise and young children may be unable to verbalize their distress; however, the child is not likely to be neglected. B Teenage parenting often has a negative effect on the health and social outcomes of the entire family. Adolescent girls are at risk for a number of pregnancy complications, are unlikely to attain a high level of education, and are more likely to be poor. C Parents who abuse drugs or alcohol may neglect their children because obtaining and using the substance(s) may have a stronger pull on the parents than the care of their children. D When a child is born with a birth defect or has an illness that requires special care, the family is under additional stress. These families often suffer financial hardship as health insurance benefits quickly reach their maximum.

While reviewing the dietary-intake documentation of a 7-year-old Asian boy with a fractured femur, the nurse notes that he consistently refuses to eat the food on his tray. What assumption is most likely accurate? a. He is a picky eater. b. He needs less food because he is on bed rest. c. He may have culturally related food preferences. d. He is probably eating between meals and spoiling his appetite.

ANS: C A Although the child may be a picky eater, the key point is that he is from a different culture. The foods he is being served may seem strange to him. B Nutrition plays an important role in healing. Although the energy the child expends has decreased while on bed rest, he has increased needs for good nutrition. C When cultural differences are noted, food preferences should always be obtained. A child will often refuse to eat unfamiliar foods. D Although the nurse should determine whether the child is eating food the family has brought from home, the more important point is to determine whether he has food preferences.

The parent of a child who has had numerous hospitalizations asks the nurse for advice because her child has been having behavior problems at home and in school. In discussing effective discipline, what is an essential component? a. All children display some degree of acting out and this behavior is normal. b. The child is manipulative and should have firmer limits set on her behavior. c. Positive reinforcement and encouragement should be used to promote cooperation and the desired behaviors. d. Underlying reasons for rules should be given and the child should be allowed to decide which rules should be followed.

ANS: C A Behavior problems should not be disregarded as normal. B It would be incorrect to assume the child is being manipulative and should have firmer limits set on her behaviors. C Using positive reinforcement and encouragement to promote cooperation and desired behaviors is one of the three essential components of effective discipline. D Providing the underlying reasons for rules and giving the child a choice concerning which rules to follow constitute a component of permissive parenting and are not considered an essential component of effective discipline.

The maternity nurse should have a clear understanding of the correct use of a clinical pathway. One characteristic of clinical pathways is that they: a. Are developed and implemented by nurses b. Are used primarily in the pediatric setting c. Set specific time lines for sequencing interventions d. Are part of the nursing process

ANS: C A Clinical pathways are developed by multiple health care professionals and reflect interdisciplinary interventions. B They are used in multiple settings and for patients throughout the life span. C Clinical pathways measure outcomes of patient care. Each pathway outlines specific time lines for sequencing interventions. D The steps of the nursing process are assessment, diagnosis, planning, intervention, and evaluation.

A nurse is caring for a child with the religion of Christian Science. What intervention should the nurse include in the care plan for this child? a. Offer iced tea to the child who is experiencing deficient fluid volume. b. Inform the spiritual care department that the child has been admitted to the hospital. c. Allow parents to sign a form opting out of routine immunizations. d. Ask parents whether the child has been baptized.

ANS: C A Coffee and tea are declined as a drink. B When a Christian Science believer is hospitalized, a parent or patient may request that a Christian Science practitioner be notified as opposed to the hospital-assigned clergy. C Christian Science believers seek exemption from immunizations but obey legal requirements. D Baptism is not a ceremony for the Christian Science religion.

To evaluate the woman's learning about performing infant care, the nurse should: a. Demonstrate infant care procedures. b. Allow the woman to verbalize the procedure. c. Observe the woman as she performs the procedure. d. Routinely assess the infant for cleanliness.

ANS: C A Demonstration is an excellent teaching method, but not an evaluation method. B During verbalization of the procedure, the nurse may not pick up on techniques that are incorrect. It is not the best tool for evaluation. C The woman's ability to perform the procedure correctly under the nurse's supervision is the best method of evaluation. D This will not ensure that the proper procedure is carried out. The nurse may miss seeing unsafe techniques being used.

What is the primary role of practicing nurses in the research process? a. Designing research studies b. Collecting data for other researchers c. Identifying researchable problems d. Seeking funding to support research studies

ANS: C A Designing research studies is only one factor of the research process. B Data collection is one factor of research. C Nursing generates and answers its own questions based on evidence within its unique subject area. D Financial support is necessary to conduct research, but it is not the primary role of the nurse in the research process.

When planning a parenting class, the nurse should explain that the leading cause of death in children 1 to 4 years of age in the United States is: a. Premature birth b. Congenital anomalies c. Accidental death d. Respiratory tract illness

ANS: C A Disorders of short gestation and unspecified low birth weight make up one of the leading causes of death in neonates. B One of the leading causes of infant death after the first month of life is congenital anomalies. C Accidents are the leading cause of death in children ages 1 to 19 years. D Respiratory tract illnesses are a major cause of morbidity in children.

A traditional family structure in which male and female partners and their children live as an independent unit is known as a(n) _____ family. a. Extended b. Binuclear c. Nuclear d. Blended

ANS: C A Extended families include other blood relatives in addition to the parents. B A binuclear family involves two households. C Approximately two thirds of U.S. households meet the definition of a nuclear family. This is also known as the traditional family. D A blended family is reconstructed after divorce and involves the merger of two families.

Family-centered maternity care developed in response to: a. Demands by physicians for family involvement in childbirth b. The Sheppard-Towner Act of 1921 c. Parental requests that infants be allowed to remain with them rather than in a nursery d. Changes in pharmacologic management of labor

ANS: C A Family-centered care was a request by parents, not physicians. B The Sheppard-Towner Act provided funds for state-managed programs for mothers and children. C As research began to identify the benefits of early extended parent-infant contact, parents began to insist that the infant remain with them. This gradually developed into the practice of rooming-in and finally to family-centered maternity care. D The changes in pharmacologic management of labor were not a factor in family-centered maternity care.

Families who deal effectively with stress exhibit which behavior pattern? a. Focus on family problems b. Feel weakened by stress c. Expect that some stress is normal d. Feel guilty when stress exists

ANS: C A Healthy families focus on family strengths rather than on the problems and know that stress is temporary and may be positive. B If families are dealing effectively with stress, then weakening of the family unit should not occur. C Healthy families recognize that some stress is normal in all families. D Because some stress is normal in all families, feeling guilty is not reasonable. Guilt only immobilizes the family and does not lead to resolution of the stress.

As a result of changes in health care delivery and funding, a current trend seen in the pediatric setting is: a. Increased hospitalization of children b. Decreased number of children living in poverty c. An increase in ambulatory care d. Decreased use of managed care

ANS: C A Hospitalization for children has decreased. B Health care delivery has not altered the number of children living in poverty. C One effect of managed care has been that pediatric health care delivery has shifted dramatically from the acute care setting to the ambulatory setting. One of the biggest changes in health care has been the growth of managed care. The number of hospital beds being used has decreased as more care is given in outpatient settings and in the home. The number of children living in poverty has increased over the last decade. D Managed care has increased in order to control cost.

The United States ranks 25th in infant mortality rates of the world. Which factor has a significant impact on decreasing the mortality rate of infants? a. Resolving all language and cultural differences b. Enrolling the pregnant woman in the Medicaid program by the 8th month of pregnancy c. Ensuring early and adequate prenatal care d. Providing more women's shelters

ANS: C A Language and cultural differences are not infant mortality issues but must be addressed to improve overall health care. B Medicaid provides health care for poor pregnant women, but the process may take weeks to take effect. The 8th month is too late to apply and receive benefits for this pregnancy. C Because preterm infants form the largest category of those needing expensive intensive care, early pregnancy intervention is essential for decreasing infant mortality rates. This is especially important for women in high-risk groups, such as racial minorities, teenagers, and those living in poverty. D The women in shelters have the same difficulties in obtaining health care as do other poor people, particularly lack of transportation and inconvenient hours of the clinics.

The fastest-growing group of homeless people is: a. Men and women preparing for retirement b. Migrant workers c. Single women and their children d. Intravenous (IV) substance abusers

ANS: C A Most people contemplating retirement have made provisions. B Migrant workers may seek health care only when absolutely necessary; however, not all are homeless. C Pregnancy and birth, especially for a teenager, are important contributing factors for becoming homeless. D Not all substance abusers are homeless.

Determine the gravida and para for a woman who delivered triplets 2 years ago and is now pregnant again. a. Gravida 2 para 3 c. Gravida 2 para 1 b. Gravida 1 para 2 d. Gravida 1 para 3

ANS: C A Para refers to the outcome of the pregnancy, not the number of infants from the pregnancy. B She is pregnant now, so that would make her a gravida 2. She is a para 1 because she had one pregnancy that progressed to the age of viability. C The woman has had two pregnancies (gravida 2). Para refers to the outcome of the pregnancy rather than the number of infants from that pregnancy. D She is pregnant now and had one other pregnancy, making her a gravida 2, not 1. Para refers to the outcome of the pregnancy, not the number of infants.

When addressing the questions of a newly pregnant woman, the nurse can explain that the certified nurse-midwife is qualified to perform: a. Regional anesthesia b. Cesarean deliveries c. Vaginal deliveries d. Internal versions

ANS: C A Regional anesthesia must be performed by a physician. B Cesarean deliveries must be performed by a physician. C The nurse-midwife is qualified to deliver infants vaginally in uncomplicated pregnancies. D Internal versions must be performed by a physician.

Which setting for childbirth allows the least amount of parent-infant contact? a. Labor/delivery/recovery/postpartum room b. Birth center c. Traditional hospital birth d. Home birth

ANS: C A The labor/delivery/recovery/postpartum room setting allows increased parent-infant contact. B Birth centers are set up to allow an increase in parent-infant contact. C In the traditional hospital setting, the mother may see the infant for only short feeding periods, and the infant is cared for in a separate nursery. D Home births allow an increase in parent-infant contact.

A nurse assigned to a child does not know how to perform a treatment that has been prescribed for the child. What should the nurse's first action be? a. Delay the treatment until another nurse can do it. b. Make the child's parents aware of the situation. c. Inform the nursing supervisor of the problem. d. Arrange to have the child transferred to another unit.

ANS: C A The nurse could endanger the child by delaying the intervention until another nurse is available. B Telling the child's parents would most likely increase their anxiety and will not resolve the difficulty. C If a nurse is not competent to perform a particular nursing task, the nurse must immediately communicate this fact to the nursing supervisor or physician. D Transfer to another unit delays needed treatment and would create unnecessary disruption for the child and family.

To resolve family conflict, it is necessary to have open communication, accurate perception of the problem, and a(n) a. Intact family structure b. Arbitrator c. Willingness to consider the view of others d. Balance in personality types

ANS: C A The structure of a family may affect family dynamics, but it is still possible to resolve conflict without an intact family structure if all of the ingredients of conflict resolution are present. B Conflicts can be resolved without the assistance of an arbitrator. C Without the willingness of the members of a group to consider the views of others, conflict resolution cannot take place. D Most families have diverse personality types among their members. This diversity may make conflict resolution more difficult but should not impede it as long as the ingredients of conflict resolution are present.

Which situation reflects a potential ethical dilemma for the nurse? a. A nurse administers analgesics to a patient with cancer as often as the physician's order allows. b. A neonatal nurse provides nourishment and care to a newborn who has a defect that is incompatible with life. c. A labor nurse, whose religion opposes abortion, is asked to assist with an elective abortion. d. A postpartum nurse provides information about adoption to a new mother who feels she cannot adequately care for her infant.

ANS: C A There is no element of conflict for the nurse; therefore a dilemma does not exist. B There is no element of conflict for the nurse; therefore a dilemma does not exist. C A dilemma exists in this situation because the nurse is being asked to assist with a procedure that she or he believes is morally wrong. The other situations do not contain elements of conflict for the nurse. D There is no element of conflict for the nurse; therefore a dilemma does not exist.

Which patient situation fails to meet the first requirement of informed consent? a. The patient does not understand the physician's explanations. b. The physician gives the patient only a partial list of possible side effects and complications. c. The patient is confused and disoriented. d. The patient signs a consent form because her husband tells her to.

ANS: C A Understanding is an important element of the consent, but first the patient has to be competent to sign. B Full disclosure of information is an important element of the consent, but first the patient has to be competent to sign. C The first requirement of informed consent is that the patient must be competent to make decisions about health care. D Voluntary consent is an important element of the consent, but first the patient has to be competent to sign.

6. The student nurse is assessing a woman with abruptio placentae. The student reports to the registered nurse "I can't really palpate her abdomen, it's as hard as a board." What action by the nurse is the priority? a. Tell the student to document the findings. b. Have the student teach the woman relaxation techniques. c. Assess the woman's fundal height and vital signs. d. Administer a dose of opioid pain medication.

ANS: C A hard, board-like abdomen in this setting is characteristic of concealed hemorrhage. The nurse assesses the woman's fundal height (which will rise with bleeding) and vital signs to detect shock. Documentation occurs after interventions are complete. Relaxation techniques may help the woman cope with the situation, but anxiety is not the reason for the findings. The woman may or may not need pain medication, and if she is going to need surgery, she should not get opioids until consents are signed.

9. A patient states, "My breasts are so small, I don't think I will be able to breastfeed." The nurse's best response is a. "It may be difficult, but you should try anyway." b. "You can always supplement with formula." c. "Breast size is not related to the ability to breastfeed." d. "The ability to breastfeed depends on secretion of estrogen and progesterone."

ANS: C All women have approximately the same amount of glandular tissue to secrete milk, despite breast size. Saying that nursing will be difficult or that the woman can use formula does not provide the woman with accurate information. Increased estrogen decreases the production of milk.

12. A student nurse just read that up to 200 million sperm are deposited in the vagina with each ejaculation and asks the faculty why so many are needed. What response by the faculty is most accurate? a. Competition results in fewer genetic defects. b. Sperm are weak and die off quickly. c. Few sperm reach the fallopian tube and ova. d. Most sperm are not the correct shape.

ANS: C Although a huge quantity of sperm are released with each ejaculation, very few make it to the fallopian tube where an ovum may be waiting to be fertilized.

6. While working with the pregnant woman in her first trimester, the nurse is aware that chorionic villus sampling (CVS) can be performed during pregnancy as early as _____ weeks. a. 4 b. 8 c. 10 d. 12

ANS: C CVS is usually performed between 10 and 13 weeks of gestation to diagnose fetal chromosomal, metabolic, or DNA abnormalities.

25. A woman taking magnesium sulfate has respiratory rate of 10 breaths/min. In addition to discontinuing the medication, the nurse should a. vigorously stimulate the woman. b. instruct her to take deep breaths. c. administer calcium gluconate. d. increase her IV fluids.

ANS: C Calcium gluconate reverses the effects of magnesium sulfate. Stimulation, instruction on taking deep breaths, and increasing her fluid rate will not increase the respirations.

11. What is the purpose of amniocentesis for the patient hospitalized at 34 weeks with pregnancy-induced hypertension? a. Identification of abnormal fetal cells b. Detection of metabolic disorders c. Determination of fetal lung maturity d. Identification of sex of the fetus

ANS: C During the third trimester, amniocentesis is most often performed to determine fetal lung maturity. In pregnancy-induced hypertension, preterm delivery may be necessary because of changes in placental perfusion. It is not done to identify abnormal fetal cells, detect metabolic disorders, or identify the sex of the fetus.

8. A pregnant woman has been diagnosed with gestational hypertension and is crying. She asks the nurse if this means she has to take blood pressure medicine for the rest of her life. What answer by the nurse is best? a. "Yes, you will have hypertension for the rest of your life." b. "No, this always goes away after you deliver." c. "Maybe, we have to wait and see at your 6-week postpartum checkup." d. "I don't know. But if you need medicine you should take it."

ANS: C Gestational hypertension can last after delivery. If it has not resolved by postpartum week 6, it is considered chronic, and the woman will probably have to take medication. It may or may not resolve, but the nurse should not provide false reassurance or state that he or she does not know without finding more information. Telling the woman to take medicine if she needs it belittles her concerns.

10. What is the only known cure for preeclampsia? a. Magnesium sulfate b. Antihypertensive medications c. Delivery of the fetus d. Administration of acetylsalicylic acid (ASA) every day of the pregnancy

ANS: C If the fetus is viable and near term, delivery is the only known definitive treatment for preeclampsia. Magnesium sulfate is one of the medications used to treat but not to cure preeclampsia. Antihypertensive medications are used to lower the dangerously elevated blood pressures in preeclampsia and eclampsia. Low doses of ASA (81 mg) have been administered to women at high risk for developing preeclampsia.

5. Which 16-year-old female is most likely to experience secondary amenorrhea? a. A girl who is 5 ft 2 in, 130 lb b. A girl who is 5 ft 9 in, 150 lb c. A girl who is 5 ft 7 in, 96 lb d. A girl who is 5 ft 4 in, 120 lb

ANS: C Low body fat is a risk factor for secondary amenorrhea. The girl who is 5 ft 7 inches tall and only weighs 96 pounds has less body fat that the other girls and a higher likelihood of secondary amenorrhea.

28. Methotrexate is recommended as part of the treatment plan for which obstetric complication? a. Complete hydatidiform mole b. Missed abortion c. Unruptured ectopic pregnancy d. Abruptio placentae

ANS: C Methotrexate is an effective, nonsurgical treatment option for a hemodynamically stable woman whose ectopic pregnancy is unruptured and less than 3.5 cm in diameter. Methotrexate is not indicated or recommended as a treatment option for a complete hydatidiform mole, a missed abortion, or abruptio placentae.

17. A woman is scheduled for an ultrasound and is asking the nurse questions about this test. Which statement by the nurse regarding ultrasonography during pregnancy is most accurate? a. Ultrasonography uses infrared technology to create an image. b. Ultrasonography is only utilized as an adjunct to more invasive tests. c. Ultrasonography is not harmful to the fetus. d. Ultrasonography is not a component of biophysical profile testing.

ANS: C Most women look forward to the results of this test, which causes no harm to the fetus. Ultrasonography uses sound waves to create an image. As an adjunct to more invasive tests, ultrasonography can provide visual guidance for increased safety. It can be done as a standalone test. Ultrasonography is a component of biophysical profile testing.

23. The primary symptom present in abruptio placentae that distinguishes it from placenta previa is a. vaginal bleeding. b. rupture of membranes. c. presence of abdominal pain. d. changes in maternal vital signs.

ANS: C Pain in abruptio placentae occurs in response to increased pressure behind the placenta and within the uterus. Placenta previa manifests with painless vaginal bleeding, but both may have vaginal bleeding. Rupture of membranes may occur with both conditions. Maternal vital signs may change with both if bleeding is pronounced.

15. The prenatal clinic nurse monitored women for preeclampsia. If all four women were in the clinic at the same time, which one should the nurse see first? a. Blood pressure increase to 138/86 mm Hg b. Weight gain of 0.5 kg during the past 2 weeks c. A dipstick value of 3+ for protein in her urine d. Pitting pedal edema at the end of the day

ANS: C Proteinuria is defined as a concentration of 1+ or greater via dipstick measurement. A dipstick value of 3+ is indicative of severe preeclampsia and should alert the nurse that additional testing or assessment should be made. Generally, hypertension is defined as a BP of 140/90 or higher. Preeclampsia may be manifested as a rapid weight gain. Gaining 0.5 kg during the past 2 weeks does not qualify as rapid. Edema occurs in many normal pregnancies as well as in women with preeclampsia. Therefore, the presence of edema is no longer considered diagnostic of preeclampsia.

6. It is important for the nurse to understand that the levator ani is a(n) a. imaginary line that divides the true and false pelvis. b. basin-shaped structure at the lower end of the spine. c. collection of three pairs of muscles. d. division of the fallopian tube.

ANS: C The levator ani is a collection of three pairs of muscles that support internal pelvic structures and resist increases in intra-abdominal pressure. The linea terminalis is the imaginary line that divides the false pelvis from the true pelvis. The basin-shaped structure at the lower end of the spine is the bony pelvis. The fallopian tube divisions are the interstitial portion, isthmus, ampulla, and infundibulum.

14. A pregnant woman states "This test isn't my idea, but my husband insists." Which response by the nurse is most appropriate? a. "Don't worry. Everything will be fine." b. "Why don't you want to have this test?" c. "You're concerned about having this test?" d. "It's your decision."

ANS: C The nurse should clarify the statement and assist the patient in exploring her feelings about the test. Stating that everything will be fine is giving false reassurance and belittles the woman's concerns. "Why" questions usually put people on the defensive and are not therapeutic. Of course having the test is the woman's decision, but this closed statement does not encourage the woman to express her feelings.

7. The nurse's role in diagnostic testing is to provide a. advice to the couple. b. assistance with decision making. c. information about the tests. d. reassurance about fetal safety.

ANS: C The nurse should provide the couple with all necessary information about a procedure so that the couple can make an informed decision. The nurse's role is to inform, not to advise the couple. Decision making should always lie with the couple involved. Ensuring fetal safety is not possible with all of the diagnostic testing. To offer this is to give false reassurance to the parents.

13. The labor of a pregnant woman with preeclampsia is going to be induced. The nurse reviews the woman's latest laboratory test findings, which reveal a low platelet count, an elevated aspartate transaminase (AST) level, and a falling hematocrit. What action by the nurse is most important? a. Palpate the woman's abdomen for tenderness. b. Document findings and begin the Pitocin infusion. c. Instruct the woman to ask for help getting out of bed. d. Assess the woman's drinking history.

ANS: C This woman has HELLP syndrome, with is characterized by low platelet counts and hepatic dysfunction. She is at risk for bleeding, so the nurse instructs her to call for assistance in getting in and out of bed. The nurse does not palpate the abdomen even though the woman may complain of abdominal pain because of possible rupture of a subcapsular hematoma. The findings should be documented but the nurse should intervene based on the abnormal findings. The liver enzymes are not elevated because of alcohol intake.

4. Health teaching during routine prenatal care includes providing patients with the recommended weight gain during pregnancy. For a woman with a single fetus who begins pregnancy at a normal weight, this amount is _____ lb. a. 10 to 15 b. 15 to 20 c. 37 to 50 d. 28 to 40

ANS: D Feedback A A 10-lb weight gain is not sufficient to meet the needs of the pregnancy. B A 15- to 20-lb weight gain is recommended for women who are overweight before the pregnancy. C A 37- to 50-lb weight gain is recommended for women who are carrying twins. When women with a multifetal pregnancy gain the recommended amount of weight, they are less likely to deliver prior to 32 weeks and infants are more likely to weigh more than 2500 gm. D A weight gain of 28 to 40 lb is believed to reduce intrauterine growth retardation that may result from inadequate nutrition and also allows variations in individual needs. No precise weight gain is appropriate for every woman.

1. Which pregnant woman should restrict her weight gain during pregnancy? a. Woman pregnant with twins b. Woman in early adolescence c. Woman shorter than 62 inches or 157 cm d. Woman who was 20 pounds overweight before pregnancy

ANS: D Feedback A A higher weight gain in twin gestations may help prevent low birth weights. B Adolescents need to gain weight toward the higher acceptable range, which will provide for their own growth as well as for fetal growth. C In the past women of short stature were advised to restrict their weight gain; however, evidence to support these guidelines has not been found. D A weight gain of 5 to 9 kg will provide sufficient nutrients for the fetus. Overweight and obese women should be advised to lose weight prior to conception in order to achieve the best pregnancy outcomes.

13. When explaining twin conception, the nurse points out that dizygotic twins develop from a. A single fertilized ovum and are always of the same sex b. A single fertilized ovum and may be the same sex or different sexes c. Two fertilized ova and are the same sex d. Two fertilized ova and may be the same sex or different sexes

ANS: D Feedback A A single fertilized ovum that produces twins is called monozygotic. B Monozygotic twins are always the same sex. C Dizygotic twins are from two fertilized ova and may or may not be the same sex. D Dizygotic twins are two different zygotes, each conceived from a single ovum and a single sperm. They may be both male, both female, or one male and one female.

5. A pregnant woman's diet may not meet her need for folates. A good source of this nutrient is a. Chicken b. Cheese c. Potatoes d. Green leafy vegetables

ANS: D Feedback A Chicken is an excellent source of protein, but it is poor in folates. B Cheese is an excellent source of calcium, but it is poor in folates. C Potatoes contain carbohydrates and vitamins and minerals, but are poor in folates. D Sources of folates include green leafy vegetables, whole grains, fruits, liver, dried peas, and beans.

12. To determine the cultural influence on a patient's diet, the nurse should first a. Evaluate the patient's weight gain during pregnancy. b. Assess the socioeconomic status of the patient. c. Discuss the four food groups with the patient. d. Identify the food preferences and methods of food preparation common to that culture.

ANS: D Feedback A Evaluating a patient's weight gain during pregnancy should be included for all patients, not just for those who are culturally different. B The socioeconomic status of the patient may alter the nutritional intake, but not the cultural influence. C Teaching the food groups to the patient should come after assessing food preferences. D Understanding the patient's food preferences and how she prepares food will assist the nurse in determining whether the patient's culture is adversely affecting her nutritional intake.

18. The most basic information a maternity nurse should have concerning conception is a. Ova are considered fertile 48 to 72 hours after ovulation. b. Sperm remain viable in the woman's reproductive system for an average of 12 to 24 hours. c. Conception is achieved when a sperm successfully penetrates the membrane surrounding the ovum. d. Implantation in the endometrium occurs 6 to 10 days after conception.

ANS: D Feedback A Ova are considered fertile for approximately 24 hours after ovulation. B Sperm remain viable in the woman's reproductive system for an average of 2 to 3 days. C Penetration of the ovum by the sperm is called fertilization. Conception occurs when the zygote, the first cell of the new individual, is formed. D After implantation, the endometrium is called the decidua.

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

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

18. The traditional diet of Asian women includes little meat or dairy products and may be low in calcium and iron. The nurse can help the woman increase her intake of these foods by a. Emphasizing the need for increased milk intake during pregnancy b. Suggesting she eat more "hot" foods during pregnancy c. Telling her husband that she must increase her intake of fruits and vegetables for the baby's sake d. Suggesting she eat more tofu, bok choy, and broccoli

ANS: D Feedback A Since milk products are not part of the of this woman's diet, it should be respected and other alternatives offered. Also, lactose intolerance is common. B Pregnancy is considered "hot"; therefore the woman would eat "cold" foods. C Fruits and vegetables are "cold" foods and included in the diet. In family dynamics, however, the husband does not dictate to the wife in this culture. D The diet should be improved by increasing foods acceptable to the woman. These foods are common in the Asian diet and are good sources of calcium and iron.

6. One danger in using nonfood supplementation of nutrients is a. Increased absorption of all vitamins b. Development of pregnancy-induced hypertension (PIH) c. Increased caloric intake d. Toxic effects on the fetus

ANS: D Feedback A Supplements do not have better absorption than natural vitamins and minerals. B There is no relationship between supplements and PIH. C Supplements do not contain calories. D The use of supplements in addition to food may increase the intake of some nutrients to doses much higher than the recommended amounts. Overdoses of some nutrients have been shown to cause fetal defects.

15. Between 6 and 10 days after conception, the trophoblast secretes enzymes that enable it to burrow into the endometrium until the entire blastocyst is covered. This is termed implantation. Tiny projections then develop out of the trophoblast and extend into the endometrium. These projections are referred to as a. Decidua basalis b. Decidua capsularis c. Decidua vera d. Chorionic villi

ANS: D Feedback A The deciduas basalis is the portion of the endometrium where the chorionic villi tap into the maternal blood vessels. B The deciduas capsularis is the portion of the endometrium that covers the blastocyst. C The portion of the endometrium that lines the rest of the uterus is called deciduas vera. D These villi are vascular processes that obtain oxygen and nutrients from the maternal bloodstream and dispose of carbon dioxide and waste products into the maternal blood.

4. While teaching an early pregnancy class, the nurse explains that the morula is a a. Fertilized ovum before mitosis begins b. Flattened disc-shaped layer of cells within a fluid-filled sphere c. Double layer of cells that becomes the placenta d. Solid ball composed of the first cells formed after fertilization

ANS: D Feedback A The fertilized ovum is called the zygote. B This is the embryonic disc. It will develop into the baby. C The placenta is formed from two layers of cells: the trophoblast, which is the other portion of the fertilized ovum, and the deciduas, which is the portion of the uterus where implantation occurs. D The morula is so named because it resembles a mulberry. It is a solid ball of 12 to 16 cells that develops after fertilization.

6. Some of the embryo's intestines remain within the umbilical cord during the embryonic period because the a. Umbilical cord is much larger at this time than it will be at the end of pregnancy. b. Intestines begin their development within the umbilical cord. c. Nutrient content of the blood is higher in this location. d. Abdomen is too small to contain all the organs while they are developing.

ANS: D Feedback A The intestines remain within the umbilical cord only until approximately week 10. B Intestines begin their development within the umbilical cord, but only because the liver and kidneys occupy most of the abdominal cavity. All the intestines are within the abdominal cavity around week 10. C Blood supply is adequate in all areas. Intestines stay in the umbilical cord for approximately 10 weeks because they are growing faster than the abdomen. D The abdominal contents grow more rapidly than the abdominal cavity, so part of their development takes place in the umbilical cord. By 10 weeks, the abdomen is large enough to contain them.

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

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

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

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

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

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

24. Which vitamins or minerals can lead to congenital malformations of the fetus if taken in excess by the mother? a. Zinc b. Vitamin D c. Folic acid d. Vitamin A

ANS: D Feedback A Zinc is vital to good maternity and fetal health and is highly unlikely to be consumed in excess. Vitamin A, taken in excess, causes a number of problems. An analog of vitamin A appears in prescribed acne medications, which must not be taken during pregnancy. B Vitamin D is vital to good maternity and fetal health and is highly unlikely to be consumed in excess. Vitamin A, taken in excess, causes a number of problems. An analog of vitamin A appears in prescribed acne medications, which must not be taken during pregnancy. C Folic acid is vital to good maternity and fetal health and is highly unlikely to be consumed in excess. Vitamin A, taken in excess, causes a number of problems. An analog of vitamin A appears in prescribed acne medications, which must not be taken during pregnancy. D Zinc, vitamin D, and folic acid are vital to good maternity and fetal health and are highly unlikely to be consumed in excess. Vitamin A, taken in excess, causes a number of problems. An analog of vitamin A appears in prescribed acne medications, which must not be taken during pregnancy.

The nurse observes that when an 8-year-old boy enters the playroom, he often causes disruption by taking toys from other children. The nurse's best approach for this behavior is to a. Ban the child from the playroom. b. Explain to the children in the playroom that he is very ill and should be allowed to have the toys. c. Approach the child in his room and ask, "Would you like it if the other children took your toys from you?" d. Approach the child in his room and state, "I am concerned that you are taking the other children's toys. It upsets them and me."

ANS: D A Banning the child from the playroom will not solve the problem. The problem is his behavior, not the place where he exhibits it. B Illness is not a reason for a child to be undisciplined. When the child recovers, the parents will have to deal with a child who is undisciplined and unruly. C Children should not be made to feel guilty and to have their self-esteem attacked. D By the nurse's using "I" rather than the "you" message, the child can focus on the behavior. The child and the nurse can begin to explore why the behavior occurs.

Which statement is true about the characteristics of a healthy family? a. The parents and children have rigid assignments for all the family tasks. b. Young families assume the total responsibility for the parenting tasks, refusing any assistance. c. The family is overwhelmed by the significant changes that occur as a result of childbirth. d. Adults agree on the majority of basic parenting principles.

ANS: D A Healthy families remain flexible in their role assignments. B Members of a healthy family accept assistance without feeling guilty. C Healthy families can tolerate irregular sleep and meal schedules, which are common during the months after childbirth. D Adults in a healthy family communicate with each other so that minimal discord occurs in areas such as discipline and sleep schedules.

Family-centered care (FCC) describes safe, quality care that recognizes and adapts to both the physical and psychosocial needs of the family. Which nursing practice coincides with the principles of FCC? a. The newborn is returned to the nursery at night so that the mother can receive adequate rest before discharge. b. The father is encouraged to go home after the baby is delivered. c. All patients are routinely placed on the fetal monitor. d. The nurse's assignment includes both mom and baby and increases the nurse's responsibility for education.

ANS: D A In this model the infant usually stays with the mother in the labor/deliver/recovery (LDR) room throughout her hospital stay. B The father or other primary support person is encouraged to stay with the mother and infant, and many facilities provide beds so that they can remain through the night. C In this model the nurse uses selective technology rather than routine procedures. This includes electronic fetal monitoring and IV therapy. D Family-centered care increases the responsibilities of nurses. In addition to the physical care provided, nurses assume a major role in teaching, counseling, and supporting families.

The Women, Infants, and Children (WIC) program provides: a. Well-child examinations for infants and children living at the poverty level b. Immunizations for high-risk infants and children c. Screening for infants with developmental disorders d. Supplemental food supplies to low-income women who are pregnant or breastfeeding

ANS: D A Medicaid's Early and Periodic Screening, Diagnosis, and Treatment Program provides for well-child examinations and for treatment of any medical problems diagnosed during such checkups. B Children in the WIC program are often linked with immunizations, but that is not the primary focus of the program. C Public Law 99-457 provides financial incentives to states to establish comprehensive early intervention services for infants and toddlers with, or at risk for, developmental disabilities. D WIC is a federal program that provides supplemental food supplies to low-income women who are pregnant or breastfeeding and to their children until age 5 years.

Which goal is most appropriate for the collaborative problem of wound infection? a. The patient will have a temperature of 98.6° F within 2 days. b. The patient's fluid intake will be maintained at 1000 mL per 8 hours. c. The patient will not exhibit further signs of infection. d. The patient will be monitored to detect therapeutic response to antibiotic therapy.

ANS: D A Monitoring a patient's temperature is an independent nursing role. B Intake and output is an independent nursing role. C Monitoring for complications is an independent nursing role. D In a collaborative problem, the goal should be nurse oriented and reflect the nursing interventions of monitoring or observing. In collaborative problems, other team members are involved for other duties, such as prescribing antibiotics.

In most states, adolescents who are not emancipated minors must have the permission of their parents before: a. Treatment for drug abuse b. Treatment for sexually transmitted diseases (STDs) c. Accessing birth control d. Surgery

ANS: D A Most states allow minors to obtain treatment for drug or alcohol abuse without parental consent. B Most states allow minors to obtain treatment for STDs without parental consent. C In most states, minors are allowed access to birth control without parental consent. D If a minor receives surgery without proper informed consent, assault and battery charges against the care provider can result. This does not apply to an emancipated minor (a minor child who has the legal competency of an adult because of circumstances involving marriage, divorce, parenting of a child, living independently without parents, or enlistment in the armed services).

Which factor significantly contributed to the shift from home births to hospital births in the early 20th century? a. Puerperal sepsis was identified as a risk factor in labor and delivery. b. Forceps were developed to facilitate difficult births. c. The importance of early parental-infant contact was identified. d. Technologic developments became available to physicians.

ANS: D A Puerperal sepsis has been a known problem for generations. In the late 19th century, Semmelweis discovered how it could be prevented with improved hygienic practices. B The development of forceps to help physicians facilitate difficult births was a strong factor in the decrease of home births and increase of hospital births. Other important discoveries included chloroform, drugs to initiate labor, and the advancement of operative procedures such a cesarean birth. C Unlike home-births, early hospital births hindered bonding between parents and their infants. D Technological developments were available to physicians, not lay midwives.

What situation is most conducive to learning? a. A teacher who speaks very little Spanish is teaching a class of Latino students. b. A class is composed of students of various ages and educational backgrounds. c. An auditorium is being used as a classroom for 300 students. d. An Asian nurse provides nutritional information to a group of pregnant Asian women.

ANS: D A The ability to understand the language in which teaching is done determines how much the patient learns. Patients for whom English is not their primary language may not understand idioms, nuances, slang terms, informal usage of words, or medical words. The teacher should be fluent in the language of the student. B Developmental levels and educational levels influence how a person learns best. In order for the teacher to best present information, it is best for the class to be of the same levels. C A large class is not conducive to learning. It does not allow for questions, and the teacher is not able to see the nonverbal cues from the students to ensure understanding. D A patient's culture influences the learning process; thus a situation that is most conducive to learning is one in which the teacher has knowledge and understanding of the patient's cultural beliefs.

Which statement is true regarding the "quality assurance" or "incident" report? a. The report assures the legal department that no problem exists. b. Reports are a permanent part of the patient's chart. c. The nurse's notes should contain, "Incident report filed, and copy placed in chart." d. This report is a form of documentation of an event that may result in legal action.

ANS: D A The report is a warning to the legal department to be prepared for a potential legal action. B Incident reports are not a part of the patient's chart. C Incident reports are not mentioned in the nurse's notes. D Documentation on the chart should include all factual information regarding the woman's condition that would be recorded in any situation. Incident reports are not mentioned in the nurse's notes. The nurse completes an incident report when something occurs that might result in a legal action against the clinic or hospital or is a variance from the standard of care.

The capacity of the uterus in a term pregnancy is how many times its prepregnant capacity? a. 100 c. 300 b. 200 d. 500

ANS: D A This is too small for a normal pregnancy. B This is too small for a normal pregnancy. C This is too small for a normal pregnancy. D The prepregnant capacity of the uterus is about 10 mL, and it reaches 5000 mL (5 L) by the end of the pregnancy, which reflects a 500-fold increase.

10. The function of the cremaster muscle in men is to a. aid in voluntary control of excretion of urine. b. entrap blood in the penis to produce an erection. c. assist with transporting sperm. d. aid in temperature control of the testicles.

ANS: D A cremaster muscle is attached to each testicle. Its function is to bring the testicle closer to the body to warm it or allow it to fall away from the body to cool it, thus promoting normal sperm production. It is not involved in urination, causing an erection or assist in transporting sperm.

5. A placenta previa in which the placental edge just reaches the internal os is called a. total. b. partial. c. complete. d. marginal.

ANS: D A placenta previa that does not cover any part of the cervix is termed marginal. With a total placenta previa the placenta completely covers the os. With a partial previa the lower border of the placenta is within 3 cm of the internal cervical os but does not completely cover the os. A complete previa is termed total. The placenta completely covers the internal cervical os.

8. The nurse teaches a pregnant woman that which diagnostic test evaluates the effect of fetal movement on fetal heart activity? a. Contraction stress test (CST) b. Sonography c. Biophysical profile d. Nonstress test (NST)

ANS: D An NST evaluates the ability of the fetal heart to accelerate either spontaneously or in association with fetal movement. CST evaluates the fetal reaction to contractions. Sonographic examinations visualize the fetus and are done for various other reasons. The biophysical profile evaluates fetal status using many variables.

10. The major advantage of chorionic villus sampling (CVS) over amniocentesis is that it a. is not an invasive procedure. b. does not require hospitalization. c. has less risk of spontaneous abortion. d. is performed earlier in pregnancy.

ANS: D CVS is performed between 10 and 13 weeks of gestation, providing earlier results than amniocentesis, which is normally done during the second and third trimesters, although it can be done as early as 11 weeks if needed. The woman does not need hospitalization for this invasive procedure, and the risk of spontaneous abortion is about the same for both procedures.

18. In which situation is a dilation and curettage (D&C) indicated? a. Complete abortion at 8 weeks b. Incomplete abortion at 16 weeks c. Threatened abortion at 6 weeks d. Incomplete abortion at 10 weeks

ANS: D D&C is used to remove the products of conception from the uterus and can be used safely until week 14 of gestation. After that there is a greater risk of excessive bleeding, and this procedure may not be used. If all the products of conception have been passed (complete abortion), a D&C is not used. If the pregnancy is still viable (threatened abortion), a D&C is not used.

30. A woman with preeclampsia has a seizure. What action by the nurse takes priority? a. Insert an oral airway. b. Suction the mouth to prevent aspiration. c. Administer oxygen by mask. d. Stay with the patient and call for help.

ANS: D If a patient seizes, the nurse should stay with her and call for help. Nursing actions during a seizure are directed toward ensuring a patent airway and patient safety. Insertion of an oral airway during seizure activity is no longer the standard of care. The nurse should attempt to keep the airway patent by turning the patient's head to the side to prevent aspiration. Once the seizure has ended, it may be necessary to suction the patient's mouth. Oxygen may or may not be needed after the seizure has ended.

16. Which statement regarding various biochemical assessments used during pregnancy is correct? a. Chorionic villus sampling (CVS) is becoming more popular because it provides early diagnosis. b. Screening for maternal serum alpha-fetoprotein (MSAFP) levels is recommended between 10 and 12 weeks of gestation in order to give parents time to consider options. c. Percutaneous umbilical blood sampling (PUBS) is one of the multiple marker screen tests for Down syndrome. d. MSAFP is a screening tool only; it identifies candidates for more definitive procedures.

ANS: D MSAFP is a screening tool, not a diagnostic tool. Further diagnostic testing is indicated after an abnormal MSAFP. CVS does provide a rapid result, but it is declining in popularity because of advances in noninvasive screening techniques. MSAFP screening is recommended for all pregnant women. Screening is recommended between 15 and 20 weeks of gestation. Abnormal findings give parents time to have additional tests done.

26. A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Nursing care is based on the knowledge that a. bed rest and analgesics are the recommended treatment. b. she will be unable to conceive in the future. c. a D&C will be performed to remove the products of conception. d. hemorrhage is the major concern.

ANS: D Severe bleeding occurs if the fallopian tube ruptures. The recommended treatment is to remove the pregnancy before hemorrhaging. If the tube must be removed, her fertility will decrease but she will not be infertile. A D&C is done on the inside of the uterine cavity. The ectopic pregnancy is located within the tubes.

11. Which clinical sign is not included in the symptoms of preeclampsia? a. Hypertension b. Edema c. Proteinuria d. Glycosuria

ANS: D Spilling glucose into the urine is not one of the three classic symptoms of preeclampsia. Hypertension is usually the first sign noted. Edema occurs but is considered a non-specific sign. Edema can lead to rapid weight gain. Proteinuria should be assessed through a 24- hour UA.

12. An NST in which two or more fetal heart rate (FHR) accelerations of 15 beats per minute (bpm) or more occur with fetal movement in a 20-minute period is termed a. nonreactive. b. positive. c. negative. d. reactive.

ANS: D The NST is reactive (normal) when two or more FHR accelerations of at least 15 bpm (each with a duration of at least 15 seconds) occur in a 20-minute period. A nonreactive result means that the heart rate did not accelerate during fetal movement. Positive and negative are not results given with this test.

22. What routine nursing assessment is contraindicated in the patient admitted with suspected placenta previa? a. Monitoring FHR and maternal vital signs b. Observing vaginal bleeding or leakage of amniotic fluid c. Determining frequency, duration, and intensity of contractions d. Determining cervical dilation and effacement

ANS: D Vaginal examination of the cervix may result in perforation of the placenta and subsequent hemorrhage and is therefore contraindicated. Monitoring FHR and maternal vital signs is a necessary part of the assessment for this woman. Monitoring for bleeding and rupture of membranes is not contraindicated in this woman. Monitoring contractions is not contraindicated in this woman.

2. The evidence regarding the effects of caffeine on nutrition during pregnancy is conflicting and more research is needed. Until the time when there is more evidence on the effect of caffeine on the fetus, caffeine intake during pregnancy should be limited to 400 mg per day. Is this statement true or false?

ANS: F Caffeine intake should be limited to less than 200 mg per day. The nurse should discuss usual sources of caffeine with the patient. A 6-oz cup of brewed coffee contains about 103 mg, tea contains 36 mg, Cola beverages contain 35-50 mg/12 ounces and cocoa contain 4 mg/6 oz. Caffeine changes calcium, thiamine, and iron absorption or excretion.

In late 2010, the US Department of Health and Human Services launched a comprehensive, nationwide health promotion and disease prevention program. This program is well known as Healthy People 2010. Is this statement true or false?

ANS: F The program launched in late 2010 was Healthy People 2020. This was developed with input from widely diverse constituents. Healthy People 2020 expands on goals developed for Healthy People 2010. These include reducing health disparities and increasing access to health care. Two additional objectives are specifically directed to the health of children and adolescents.

2. The nurse is precepting a student who asks about fetal circulation. The nurse explains that the fetal circulatory shunts are still required after birth. Is this statement true or false?

ANS: False Fetal circulatory shunts are not needed after birth because the infant oxygenates blood in the lungs, metabolizes substances in the liver, and stops circulating blood to the placenta. As the infant breathes, blood flow to the lungs increases, pressure in the right-sided heart falls, and the foramen ovale closes.

2. Very fine hairs, called __________, appear first on the fetus's eyebrows and upper lip at 12 weeks of gestation. By 20 weeks, they cover the entire body. By 28 weeks, the scalp hair is longer than these fine hairs, which thin and may disappear by term gestation.

ANS: Lanugo By 20 weeks of gestation, the eyelashes, eyebrows, and scalp hair also begin to grow.

Parents of children with special needs often require specialized care and experience frequent hospitalizations. When caring for these families, the nurse should be aware that they may experience financial hardship due to their child's condition and require assistance in obtaining referrals to resources. Is this statement true or false?

ANS: T These families often suffer financial hardship, which can lead to issues related to coping and other strains on the family. Health insurance benefits may quickly reach their maximum. Even if the child is on special assistance for health care, one parent may have to remain home with the child rather than work outside of the home. Social work and financial or prescription assistance may all be necessary and appropriate sources of support.

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

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

1. Food continues to be the best source of nutrients for the pregnant patient. The exceptions are iron and folic acid, which may not be obtained in adequate amounts through normal food intake. Is this statement true or false?

ANS: T Vitamin and mineral supplements are not necessary, despite the fact that most prenatal providers order prenatal vitamins. Expectant mothers who are vegetarians, lactose-intolerant, or have special problems with nutrient absorption may need supplements other than iron and folic acid. A dietary assessment will determine a woman's actual needs. The nurse must carefully consider the patient's age, cultural background, and knowledge of nutrition when providing teaching regarding her diet.

1. When teaching contraception, the nurse must be able to effectively communicate the nuances of conception. An ovum has the capacity to be fertilized for only 24 hours, whereas a sperm may remain fertile for up to 80 hours. Is this statement true or false?

ANS: True Most sperm survive for no more than 1 or 2 days, although a few will remain fertile in the female reproductive tract for up to 80 hours. Conception requires correct timing for fertilization to occur. This information is important whether the patient is seeking to become pregnant or prevent pregnancy.

1. The ability of the fetus to survive outside the uterus is called ___________.

ANS: Viability In the past, the earliest age at which fetal survival could be expected was 28 weeks after conception. With modern technology and advancements in maternal and neonatal care, viability is now possible at 20 weeks after conception (22 weeks after last menstrual period [LMP], fetal weight of 500 g or more).

Mechanical forces that interfere with normal prenatal development include oligohydramnios and fibrous amniotic bands. A patient at 34 weeks of gestation has reported to the OB triage unit for assessment of oligohydramnios. The nurse assigned to care for this patient is aware that prolonged oligohydramnios may result in (select all that apply) a. Intrauterine limb amputations b. Clubfoot c. Delayed lung development d. Other fetal abnormalities e. Fetal deformations

B, C, D

You are a maternal-newborn nurse caring for a mother who just delivered a baby born with Down syndrome. What nursing diagnosis is the most essential in caring for the mother of this infant? a. Disturbed body image b. Interrupted family processes c. Anxiety d. Risk for injury

B. interrupted family processes

Which statement is true of multifactorial disorders? a. They may not be evident until later in life. b. They are usually present and detectable at birth. c. The disorders are characterized by multiple defects. d. Secondary defects are rarely associated with multifactorial disease.

B. they are usually present and detectable at birth

A 35-year-old woman has an amniocentesis performed to find out whether her baby has a chromosome defect. Which statement by this patient indicates that she understands her situation? a. "The doctor will tell me if I should have an abortion when the test results come back." b. "I know support groups exist for parents who have a baby with birth defects, but we have plenty of insurance to cover what we need." c. "When all the lab results come back, my husband and I will make a decision about the pregnancy." d. "My mother must not find out about all this testing. If she does, she will think I'm having an abortion."

C. "When all the lab results come back, my husband and I will make a decision about the pregnancy."

In practical terms regarding genetic health care, nurses should be aware that a. Genetic disorders equally affect people of all socioeconomic backgrounds, races, and ethnic groups. b. Genetic health care is more concerned with populations than individuals. c. The most important of all nursing functions is providing emotional support to the family during counseling. d. Taking genetic histories is the province of large universities and medical centers.

C. the most important of all nursing functions is providing emotional support to the family during counseling.

Which statement should a counselor make when telling a couple about the prenatal diagnosis of genetic disorders? a. Diagnosis can be obtained promptly through most hospital laboratories. b. Common disorders can quickly be diagnosed through blood tests. c. A comprehensive evaluation will result in an accurate diagnosis. d. Diagnosis may be slow and could be inconclusive.

D. diagnosis may be slow and could be inconclusive

A _________ family is one formed when single, divorced, or widowed parents bring children from a previous union into the new relationship.

blended These families must overcome differences in parenting styles and values to form a cohesive blended family. Often they wish to have children with each other in the new relationship. Differing expectations of the children's development and beliefs regarding discipline may lead to conflict. Older children often resent the introduction of a stepmother or stepfather.

Interventions, modalities, professions, theories, applications, or practices that are not currently part of the conventional medical system in North American culture are often referred to as ____________________ and ____________________ medicine.

complementary, alternative For many people such therapies are not considered alternative, because they are mainstream in their culture. Others combine them with traditional medical practices, thereby using an integrative approach. A continued concern is patient safety. Some patients who use these techniques may delay necessary care, and others may take herbal or other remedies that might become toxic when used in combination with prescription drugs or when taken in excess.