OB EXAM 3

Nurses need to know that when any woman is admitted to the hospital and is _____ to _____ weeks pregnant, she should receive antenatal glucocorticoids unless she has chorioamnionitis. Because these drugs require a 24-hour period to become effective, timely administration is essential.

ANS: 24; 34 Rationale: All women between 24 and 34 weeks of gestation who are at risk for preterm birth within 7 days should receive treatment with a single course of antenatal glucocorticoids.

Which factor is most likely to result in fetal hypoxia during a dysfunctional labor? A. Incomplete uterine relaxation B. Maternal fatigue and exhaustion C. Maternal sedation with narcotics D. Administration of tocolytic drugs

ANS: A Rationale: A high uterine resting tone, with inadequate relaxation between contractions, reduces maternal blood flow to the placenta and decreases fetal oxygen supply. B- Maternal fatigue usually does not decrease uterine blood flow. C- Maternal sedation will sedate the fetus but should not decrease blood flow. D- Tocolytic drugs decrease contractions. This will increase uterine blood flow.

In counseling a patient who has decided to relinquish her baby for adoption, the nurse should A. Affirm her decision while acknowledging her maturity in making it. B. Question her about her feelings regarding adoption. C. Tell her she can always change her mind about adoption. D. Ask her if anyone is coercing her into the decision to relinquish her baby.

ANS: A Rationale: A supportive, affirming approach by the nurse will strengthen the patient's resolve and help her to appreciate the significance of the event. The teen needs help in coping with her feelings about this decision. B- It is important for the nurse to support and affirm the decision the patient has made. This will strengthen the patient's resolve to follow through. Later the patient should be given an opportunity to express her feelings. C- This should not be an option after the baby is born and placed with the adoptive parents. D- It is important that the teenager is treated as an adult, with the assumption that she is capable of making an important decision on her own.

What is the priority nursing assessments for a woman receiving tocolytic therapy with terbutaline? A. Fetal heart rate, maternal pulse, and blood pressure B. Maternal temperature and odor of amniotic fluid C. Intake and output D. Maternal blood glucose

ANS: A Rationale: All assessments are important, but those most relevant to the medication include the fetal heart rate and maternal pulse, which tend to increase, and the maternal blood pressure, which tends to exhibit a wide pulse pressure. B- These are important if the membranes have ruptured, but they are not relevant to the medication. C- This is not an important assessment to monitor for side effects of terbutaline. D- This is not an important assessment to monitor for side effects of terbutaline.

Spontaneous termination of a pregnancy is considered to be an abortion if A. The pregnancy is less than 20 weeks. B. The fetus weights less than 1000 g. C. The products of conception are passed intact. D. No evidence exists of intrauterine infection.

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

A woman in preterm labor at 30 weeks of gestation receives two 12 mg doses of betamethasone intramuscularly. The purpose of this pharmacologic treatment is to A. Stimulate fetal surfactant production. B. Reduce maternal and fetal tachycardia associated with ritodrine administration. C. Suppress uterine contractions. D. Maintain adequate maternal respiratory effort and ventilation during magnesium sulfate therapy.

ANS: A Rationale: Antenatal glucocorticoids given as intramuscular injections to the mother accelerate fetal lung maturity. B- Inderal would be given to reduce the effects of ritodrine administration. C- Betamethasone has no effect on uterine contractions. D- Calcium gluconate would be given to reverse the respiratory depressive effects of magnesium sulfate therapy.

The priority nursing intervention when admitting a pregnant woman 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 Rationale: 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. B- The most important assessment is to check mother/fetal well-being. The blood levels can be obtained later. C- It is important to assess future bleeding, but the top priority is mother/fetal well-being. D- Monitoring uterine contractions is important, but not the top priority.

Approximately 12% to 26% of all clinically recognized pregnancies end in miscarriage. Which is the most common cause of spontaneous abortion? A. Chromosomal abnormalities B. Infections C. Endocrine imbalance D. Immunologic factors

ANS: A Rationale: At least 60% of pregnancy losses result from chromosomal abnormalities that are incompatible with life. B- Maternal infection may be a cause of early miscarriage. C- Endocrine imbalances such as hypothyroidism or diabetes are possible causes for early pregnancy loss. D- Women who have repeated early pregnancy losses appear to have immunologic factors the play a role in spontaneous abortion incidents.

Which assessment finding should convince the nurse to "hold" the next dose of magnesium sulfate? A. Absence of deep tendon reflexes B. Urinary output of 100 mL total for the previous 2 hours C. Respiratory rate of 14 breaths/min D. Decrease in blood pressure from 160/100 to 140/85

ANS: A Rationale: Because absence of deep tendon reflexes is a sign of magnesium toxicity, the next scheduled dose should not be administered. Calcium gluconate is the antidote that should be administered. B- An hourly output of less than 30 mL could indicate toxicity. C- A respiratory rate of less than 12 breaths/min could indicate toxicity. D- Decrease in blood pressure is an expected side effect of magnesium sulfate.

A common effect of both smoking and cocaine use on the pregnant woman is A. Vasoconstriction B. Increased appetite C. Changes in insulin metabolism D. Increased metabolism

ANS: A Rationale: Both smoking and cocaine use cause vasoconstriction, which results in impaired placental blood flow to the fetus. B- Both smoking and cocaine use decrease the appetite. C- Smoking and cocaine use do not change insulin metabolism. D- Smoking can increase metabolism.

When the pregnant diabetic experiences hypoglycemia while hospitalized, the nurse should have the patient A. Eat 6 saltine crackers. B. Drink 8 oz of orange juice with 2 tsp of sugar added. C. Drink 4 oz of orange juice followed by 8 oz of milk. D. Eat hard candy or commercial glucose wafers.

ANS: A Rationale: Crackers provide carbohydrates in the form of polysaccharides. B- Orange juice and sugar will increase the blood sugar, but not provide a slow-burning carbohydrate to sustain the blood sugar. C- Milk is a disaccharide and orange juice is a monosaccharide. This will provide an increase in blood sugar but will not sustain to level. D- This provides only monosaccharides.

Which substance results in craniofacial anomalies in the newborn if the mother abuses it during pregnancy? A. Alcohol B. Cocaine C. Heroin D. Tobacco

ANS: A Rationale: Craniofacial anomalies occur in newborns affected with fetal alcohol syndrome. These include short eyelid openings, flat midface and upper lip groove, thin upper lip, and microcephaly. Cocaine is associated with preterm birth. Heroin is associated with neonatal abstinence syndrome, which includes low birth weight. Tobacco is associated with prematurity, pneumonia, and developmental delays.

What order should the nurse expect for a patient admitted with a threatened abortion? A. Bed rest B. Ritodrine IV C. NPO D. Narcotic analgesia every 3 hours, prn

ANS: A Rationale: Decreasing the woman's activity level may alleviate the bleeding and allow the pregnancy to continue. B- Ritodrine is not the first drug of choice for tocolytic medications. C- There is no reason for having the woman NPO. At times dehydration may produce contractions, so hydration is important. D- Narcotic analgesia will not decrease the contractions. It may mask the severity of the contractions.

According to Beck's studies, what risk factor for postpartum depression (PPD) is likely to have the greatest effect on the woman's condition? A. Prenatal depression B. Single-mother status C. Low socioeconomic status D. Unplanned or unwanted pregnancy

ANS: A Rationale: Depressive symptoms during pregnancy or previous ppd are strong predictors for subsequent episodes of PPD. B- Single-mother status is a small-relation predictor for PPD. C- Low socioeconomic status is a small-relation predictor for PPD. D- An unwanted pregnancy may contribute to the risk for PPD; however, it does not pose as great an effect as prenatal depression.

Which measure may prevent mastitis in the breastfeeding mother? A. Initiating early and frequent feedings B. Nursing the infant for 5 minutes on each breast C. Wearing a tight-fitting bra D. Applying ice packs before feeding

ANS: A Rationale: Early and frequent feedings prevent stasis of milk, which contributes to engorgement and mastitis. B- Five minutes does not adequately empty the breast. This will produce stasis of the milk. C- A firm-fitting bra will support the breast, but not prevent mastitis. The breast should not be bound. D- Warm packs before feeding will increase the flow of milk.

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 Rationale: For Rh incompatibility to occur, the mother must be Rh negative and her fetus Rh positive. B- The husband's Rh factor is a concern only as it relates to the possible Rh factor of the fetus. C- If the fetus is Rh negative, the blood types are compatible and no problems should occur. D- 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.

In helping bereaved parents cope and move on, nurses should keep in mind that A. A perinatal or parental grief support group is more likely to be helpful if the needs of the parents are matched with the focus of the group. B. When pictures of the infant are taken for keepsakes, no close-ups should be taken of any congenital anomalies. C. No significant differences exist in grieving individuals from various cultures, ethnic groups, and religions. D. In emergency situations, nurses who are so disposed must resist the temptation to baptize the infant in the absence of a priest or minister.

ANS: A Rationale: For example, a religious-based group may not work for nonreligious parents. B- Close-up pictures of the baby must be taken as the infant was, congenital anomalies and all. C- Although death and grieving are events shared by all people, mourning rituals, traditions, and taboos vary by culture, ethnicity, and religion. Differences must be respected. D- Baptism for some religious groups can be performed by a layperson, such as a nurse, in an emergency situation when a priest is not available.

In assessing the knowledge of a pregestational woman with type 1 diabetes concerning changing insulin needs during pregnancy, the nurse recognizes that further teaching is warranted when the patient states A. "I will need to increase my insulin dosage during the first 3 months of pregnancy." B. "Insulin dosage will likely need to be increased during the second and third trimesters." C. "Episodes of hypoglycemia are more likely to occur during the first 3 months." D. "Insulin needs should return to normal within 7 to 10 days after birth if I am bottle feeding."

ANS: A Rationale: Insulin needs are reduced in the first trimester due to increased insulin production by the pancreas and increased peripheral sensitivity to insulin. B- This statement is accurate and signifies understanding. Insulin resistance begins as early as 14 to 16 weeks of gestation and continues to rise until it stabilizes during the last few weeks of pregnancy. C- This statement is correct. During the first trimester maternal blood glucose levels are reduced and the insulin response to glucose is enhanced therefore this is when an episode of hypoglycemia is most likely to occur. D- For the non-breastfeeding mother insulin levels return to normal within 7 to 10 days. Lactation utilized maternal glucose, therefore the mother's insulin requirements will remain low during lactation. On completion of weaning the mother's prepregnancy insulin requirement is reestablished.

With regard to anemia, nurses should be aware that A. It is the most common medical disorder of pregnancy. B. It can trigger reflex bradycardia. C. The most common form of anemia is caused by folate deficiency. D. Thalassemia is a European version of sickle cell anemia.

ANS: A Rationale: Iron deficiency anemia causes 75% of anemias in pregnancy. It is difficult to meet the pregnancy needs for iron through diet alone. B- Reflex bradycardia is a slowing of the heart in response to the blood flow increases immediately after birth. C- The most common form of anemia is iron deficiency anemia. D- Both thalassemia and sickle cell hemoglobinopathy are hereditary but not directly related or confined to geographic areas.

The perinatal nurse caring for the postpartum woman understands that late postpartum hemorrhage is most likely caused by A. Subinvolution of the uterus B. Defective vascularity of the decidua C. Cervical lacerations D. Coagulation disorders

ANS: A Rationale: Late PPH may be the result of subinvolution of the uterus. Recognized causes of subinvolution included retained placental fragments and pelvic infection. B- Although defective vascularity of the decidua may cause PPH, late PPH typically results from subinvolution of the uterus, pelvic infection, or retained placental fragments. C- Although cervical lacerations may cause PPH, late PPH typically results from subinvolution of the uterus, pelvic infection, or retained placental fragments. D- Although coagulation disorders may cause PPH, late PPH typically results from subinvolution of the uterus, pelvic infection, or retained placental fragments.

Which technique is least effective for the woman with persistent occiput posterior position? A. Lie supine and relax. B. Sit or kneel, leaning forward with support. C. Rock the pelvis back and forth while on hands and knees. D. Squat.

ANS: A Rationale: Lying supine increases the discomfort of "back labor." B- A sitting or kneeling position may help the fetal head to rotate to occiput anterior. C- Rocking the pelvis encourages rotation from occiput posterior to occiput anterior. D- Squatting aids both rotation and fetal descent.

The nurse should expect medical intervention for subinvolution to include A. Oral methylergonovine maleate (Methergine) for 48 hours B. Oxytocin intravenous infusion for 8 hours C. Oral fluids to 3000 mL/day D. Intravenous fluid and blood replacement

ANS: A Rationale: Methergine provides long-sustained contraction of the uterus. B- Oxytocin provides intermittent contractions. C- There is no correlation between dehydration and subinvolution. D- There is no indication that excessive blood loss has occurred.

Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the woman mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. The nurse identifies that the fetus is at greatest risk for A. Macrosomia B. Congenital anomalies of the central nervous system C. Preterm birth D. Low birth weight

ANS: A Rationale: Poor glycemic control later in pregnancy increases the rate of fetal macrosomia. B- Poor glycemic control during the preconception time frame and into the early weeks of the pregnancy is associated with congenital anomalies. C- Preterm labor or birth is more likely to occur with severe diabetes and is the greatest risk in women with pregestational diabetes. D- Increased weight, or macrosomia, is the greatest risk factor for this woman.

With regard to the association of maternal diabetes and other risk situations affecting mother and fetus, nurses should be aware that A. Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy. B. Hydramnios occurs approximately twice as often in diabetic pregnancies. C. Infections occur about as often and are considered about as serious in diabetic and nondiabetic pregnancies. D. Even mild to moderate hypoglycemic episodes can have significant effects on fetal well-being.

ANS: A Rationale: Prompt treatment of DKA is necessary to save the fetus and the mother. B- Hydramnios occurs 10 times more often in diabetic pregnancies. C- Infections are more common and more serious in pregnant women with diabetes. D- Mild to moderate hypoglycemic episodes do not appear to have significant effects on fetal well-being.

Prophylaxis of subacute bacterial endocarditis (SBE) is given before and after birth when a pregnant woman has A. Valvular disease B. Congestive heart disease C. Arrhythmias D. Postmyocardial infarction

ANS: A Rationale: Prophylaxis for intrapartum endocarditis and pulmonary infection may be provided for women who have mitral valve prolapse. B- Prophylaxis for intrapartum endocarditis is not indicated for a patient with congestive heart disease. C- Prophylaxis for intrapartum endocarditis is not necessary for a woman with underlying arrhythmias. D- A woman who is postmyocardial infarction does not require prophylaxis for intrapartum endocarditis.

Despite warnings, prenatal exposure to alcohol continues to far exceed exposure to illicit drugs. A diagnosis of Fetal Alcohol Syndrome is made when there are visible markers in each of three categories. Which is not a recognized category for diagnosis of FAS? A. Respiratory conditions B. Impaired growth C. CNS abnormality D. Craniofacial dysmorphologies

ANS: A Rationale: Respiratory difficulties are not a category of conditions that are related to FAS. Other abnormalities related to FAS include: organ deformities, genital malformations and kidney and urinary defects. B- Impaired growth is a visible marker for FAS. C- A CNS abnormality with neurologic and intellectual impairments is a category used to assist in the diagnosis of FAS. D- An infant with FAS manifests at least two craniofacial abnormalities such as microcephaly, short palpebral fissures, poorly developed philtrum, thin upper lip or flattening of the maxillary.

Which are significant barriers to receiving necessary treatment of substance abuse when pregnant? A. Social stigma, labeling, and guilt B. Financial barriers C. Mental and physical barriers D. Religious and spiritual barriers

ANS: A Rationale: Significant barriers to receiving necessary treatment for substance abuse when pregnant include social stigma, labeling, and guilt.

Early postpartum hemorrhage is defined as a blood loss greater than A. 500 mL in the first 24 hours after vaginal delivery B. 750 mL in the first 24 hours after vaginal delivery C. 1000 mL in the first 48 hours after cesarean delivery D. 1500 mL in the first 48 hours after cesarean delivery

ANS: A Rationale: The average amount of bleeding after a vaginal birth is 500 mL. B- The average amount of bleeding after a vaginal birth is 500 mL. C- Early postpartum hemorrhage occurs in the first 24 hours, not 48 hours. Blood loss after a cesarean averages 1000 mL. D- Early postpartum hemorrhage is within the first 24 hours. Late postpartum hemorrhage is 48 hours and later.

A woman has tested human immunodeficiency virus (HIV)-positive and has now discovered that she is pregnant. Which statement indicates that she understands the risks of this diagnosis? A. "Even though my test is positive, my baby might not be affected." B. "I know I will need to have an abortion as soon as possible." C. "This pregnancy will probably decrease the chance that I will develop AIDS." D. "My baby is certain to have AIDS and die within the first year of life."

ANS: A Rationale: The fetus is likely to test positive for HIV in the first 6 months until the inherited immunity from the mother wears off. Many of these babies will convert to HIV-negative status. B- With the newer drugs, the risk for infection of the fetus has decreased. C- The pregnancy will increase the chance of converting. D- With the newer drugs, the risk for infection of the fetus has decreased. Also, the life span of an infected newborn has increased.

When the nurse is alone with a battered patient, the patient seems extremely anxious and says, "It was all my fault. The house was so messy when he got home and I know he hates that." The best response by the nurse is A. "No one deserves to be hurt. It's not your fault. How can I help you?" B. "What else do you do that makes him angry enough to hurt you?" C. "He will never find out what we talk about. Don't worry. We're here to help you." D. "You have to remember that he is frustrated and angry so he takes it out on you."

ANS: A Rationale: The nurse should stress that the patient is not at fault. B- This is placing the blame on the woman. C- This is false reassurance. In order to assist the woman, many times the batterer will find out about the conversation. D- This is placing the blame on the woman and finding excuses for the batterer.

What is most likely to be a concern for the older mother? A. The importance of having enough rest and sleep B. Information about effective contraceptive methods C. Nutrition and diet planning D. Information about exercise and fitness

ANS: A Rationale: The woman who delays childbearing may have unique concerns, one of which is having less energy than younger mothers. B- The older mother usually has more financial means to search out effective contraceptive methods. C- The older mother is better off financially and can afford better nutrition. D- Information about exercise and fitness is readily available.

The perinatal nurse is caring for a woman in the immediate postbirth period. Assessment reveals that the woman is experiencing profuse bleeding. The most likely etiology for the bleeding is A. Uterine atony B. Uterine inversion C. Vaginal hematoma D. Vaginal laceration

ANS: A Rationale: Uterine atony is marked hypotonia of the uterus. It is the leading cause of postpartum hemorrhage. B- Uterine inversion may lead to hemorrhage, but it is not the most likely source of this patient's bleeding. Furthermore, if the woman was experiencing a uterine inversion, it would be evidenced by the presence of a large, red, rounded mass protruding from the introitus. C- A vaginal hematoma may be associated with hemorrhage. However, the most likely clinical finding would be pain, not the presence of profuse bleeding. D- A vaginal laceration may cause hemorrhage; however, it is more likely that profuse bleeding would result from uterine atony. A vaginal laceration should be suspected if vaginal bleeding continues in the presence of a firm, contracted uterine fundus.

The nurse is caring for a 37-year-old woman who is pregnant. What risk does the nurse expect in the fetus due to increased maternal age? A. Down syndrome B. Empty nest syndrome C. Fetal alcohol syndrome D. Sudden infant death syndrome

ANS: A Rationale: Women older than 35 years old do not have a different physical response to pregnancy but may have health status changes because of the normal aging process. These changes may be responsible for age-related pregnancy complications. Increased maternal age can increase the risk of genetic or chromosomal anomalies such as Down syndrome in the fetus. Empty nest syndrome is seen in parents whose children leave home, causing increased levels of depression. Fetal alcohol syndrome (FAS) is a consequence of prenatal alcohol intake. The causes of sudden infant death syndrome (SIDS) are often multifactorial or unknown.

Birth for the nulliparous woman with a fetus in a breech presentation is usually by A. Cesarean delivery B. Vaginal delivery C. Forceps-assisted delivery D. Vacuum extraction

ANS: A Rationale: presentation is almost always cesarean section. The greatest fetal risk in the vaginal delivery of breech presentation is that the head (largest part of the fetus) is the last to be delivered. The delivery of the rest of the baby must be quick so that the infant can breathe. B- The greatest fetal risk in the vaginal delivery of breech presentation is that the head (largest part of the fetus) is the last to be delivered. The delivery of the rest of the baby must be quick so the infant can breathe. C- The physician may assist rotation of the head with forceps. A cesarean birth may be required. D- Serious trauma to maternal or fetal tissues is likely if the vacuum extractor birth is difficult. Most breech births are difficult.

Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother? A. Hypoglycemia B. Hypercalcemia C. Hypobilirubinemia D. Hypoinsulinemia

ANS: A Rationale: The neonate is at highest risk for hypoglycemia because fetal insulin production is accelerated during pregnancy to metabolize excessive glucose from the mother. At birth, the maternal glucose supply stops and the neonatal insulin exceeds the available glucose, leading to hypoglycemia. B- Hypocalcemia is associated with preterm birth, birth trauma, and asphyxia, all common problems of the infant of a diabetic mother. C- Excess erythrocytes are broken down after birth, releasing large amounts of bilirubin into the neonate's circulation, which results in hyperbilirubinemia. D- Because fetal insulin production is accelerated during pregnancy, the neonate shows hyperinsulinemia.

Toxoplasmosis is a protozoal infection transmitted through organisms in raw and undercooked meat or through contact with contaminated cat feces. While providing education to the pregnant woman, the nurse evaluates the learning and understands that the patient requires further instruction when she states A. "I will be certain to empty the litter boxes regularly." B. "I won't eat raw eggs." C. "I had better wash all of my fruits and vegetables." D. "I need to be cautious when cooking meat."

ANS: A Rationale: The patient should avoid contact with materials that are possibly contaminated with cat feces while pregnant. This includes cat litter boxes, sand boxes, and garden soil. She should wash her hands thoroughly after working with soil or handling animals. B. The patient should avoid undercooked eggs and unpasteurized milk. C. All fruits and vegetables should be washed thoroughly before eating. D. Meat should be cooked thoroughly to an internal temperature of at least 160° F or as high as 180° F for poultry. All surfaces should be washed after they come into contact with uncooked meat. The patient should be instructed not to use the same utensils or cutting board for meat and produce.

Congenital anomalies can occur with the use of antiepileptic drugs, including (select all that apply) A. Cleft lip B. Congenital heart disease C. Neural tube defects D. Gastroschisis E. Diaphragmatic hernia

ANS: A, B, C Correct: Congenital anomalies that can occur with AEDs include cleft lip or palate, congenital heart disease, urogenital defects, limb reduction, mental retardation and neural tube defects. This is referred to assess fetal hydantoin syndrome. Incorrect: These congenital anomlaies are not associated with the use of AEDs.

Many teens wait until the second or even third trimester to seek prenatal care. The nurse should understand that the reasons behind this delay include (select all that apply) A. Lack of realization that they are pregnant B. Uncertainty as to where to go for care C. Continuing to deny the pregnancy D. A desire to gain control over their situation E. Wanting to hide the pregnancy as long as possible

ANS: A, B, C, E Correct Feedback: These are all valid reasons for the teen to delay seeking prenatal care. An adolescent often has little to no understanding of the increased physiologic needs that a pregnancy places on her body. Once care is sought, it is often sporadic and many appointments are missed. The nurse should formulate a diagnosis that assists the pregnant teen to receive adequate prenatal care. Incorrect: The opposite is true. Planning for her pregnancy and impending birth actually provides some sense of control for the teen and increases feelings of competency. Receiving praise from the nurse when she attends her prenatal appointments will reinforce the young woman's positive self-image.

Medications used to manage postpartum hemorrhage include (select all that apply) A. Pitocin B. Methergine C. Terbutaline D. Hemabate E. Magnesium sulfate

ANS: A, B, D Correct: Pitocin, Methergine, and Hemabate are all used to manage PPH. Incorrect: Terbutaline and magnesium sulfate are tocolytics; relaxation of the uterus causes or worsens PPH.

Throughout the world the rate of ectopic pregnancy has increased dramatically over the past 20 years. This is believed to be due primarily to scarring of the fallopian tubes as a result of pelvic infection, inflammation, or surgery. The nurse who suspects that a patient has early signs of ectopic pregnancy should be observing her for symptoms such as (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 Correct: A missed period or spotting can easily be mistaken by the patient as early signs of pregnancy. More subtle signs depend on exactly where the implantation occurs. The nurse must be thorough in her assessment because pain is not a normal symptom of early pregnancy. Incorrect: As the fallopian tube tears open and the embryo is expelled, the patient often exhibits severe pain accompanied by intraabdominal hemorrhage. This may progress to hypovolemic shock with minimal or even no external bleeding. In about half of women, shoulder and neck pain occurs due to irritation of the diaphragm from the hemorrhage.

Diabetes refers to a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin action, insulin secretion or both. Over time diabetes causes significant maternal changes in the microvascular and macrovascular circulations. These complications include (select all that apply) A. Atherosclerosis B. Retinopathy C. IUFD D. Nephropathy E. Neuropathy

ANS: A, B, D, E Correct: These structural changes are most likely to affect a variety of systems, including the heart, eyes, kidneys, and nerves. Incorrect: Intrauterine fetal death (stillbirth) remains a major complication of diabetes in pregnancy; however, this is a fetal complication.

Systemic lupus erythematosus is a chronic multisystem inflammatory disease that affects skin, joints, kidney, lungs, CNS, liver, and other organs. Maternal risks include (select all that apply) A. Premature rupture of membranes (PROM) B. Fetal death resulting in stillbirth C. Hypertension D. Preeclampsia E. Renal complications

ANS: A, C, D, E Correct: PROM, hypertension, preeclampsia, and renal complications are all maternal risks associated with SLE. Incorrect: Stillbirth and prematurity are fetal risks of SLE.

A patient who has undergone a D&C for early pregnancy loss is likely to be discharged the same day. The nurse must ensure that vital signs are stable, that bleeding has been controlled, and that the woman has adequately recovered from the administration of anesthesia. In order to promote an optimal recovery, discharge teaching should include (select all that apply) A. Iron supplementation B. Resumption of intercourse at 6 weeks post-procedure C. Referral to a support group if necessary D. Expectation of heavy bleeding for at least 2 weeks E. Emphasizing the need for rest

ANS: A, C, E Correct: The woman should be advised to consume a diet high in iron and protein. For many women, iron supplementation also is necessary. Acknowledge that the patient has experienced a loss, albeit early. She can be taught to expect mood swings and possibly depression. Referral to a support group, clergy, or professional counseling may be necessary. Discharge teaching should emphasize the need for rest. Incorrect: Nothing should be placed in the vagina for 2 weeks postprocedure. This includes tampons and vaginal intercourse. The purpose of this recommendation is to prevent infection. Should infection occur, antibiotics may be prescribed. The patient should expect a scant, dark discharge for 1 to 2 weeks. Should heavy, profuse, or bright bleeding occur she should be instructed to contact her provider.

During a postpartum checkup, a woman who experienced perinatal loss says, "My husband has been very caring and concerned about me since it occurred." What is the nurse's best response? A. "Life must go on.' B. "I am happy to hear that." C. "This happened for the best." D. "Keep going for the baby's sake."

ANS: B

A woman has a history of drug use and is screened for hepatitis B during the first trimester. What is an appropriate action? A. Provide a low-protein diet. B. Offer the vaccine. C. Discuss the recommendation to bottle-feed her baby. D. Practice respiratory isolation.

ANS: B Rationale: A person who has a history of high-risk behaviors should be offered the hepatitis B vaccine. A- Care is supportive and includes bed rest and a high protein, low fat diet. C- The first trimester is too early to discuss feeding methods with a woman in the high-risk category. D- Hepatitis B is transmitted through blood.

A postpartum patient is at increased risk for postpartum hemorrhage if she delivers a(n) A. 5-lb, 2-oz infant with outlet forceps B. 6.5-lb infant after a 2-hour labor C. 7-lb infant after an 8-hour labor D. 8-lb infant after a 12-hour labor

ANS: B Rationale: A rapid (precipitous) labor and delivery may cause exhaustion of the uterine muscle and prevent contraction. A- This woman is at risk for lacerations because of the forceps. C- This is a normal labor progression. Less than 3 hours is rapid and can produce uterine muscle exhaustion. D- This is a normal labor progression. Less than 3 hours is a rapid delivery and can cause the uterine muscles not to contract.

What instructions should be included in the discharge teaching plan to assist the patient in recognizing early signs of complications? A. Palpate the fundus daily to ensure that it is soft. B. Notify the physician of any increase in the amount of lochia or a return to bright red bleeding. C. Report any decrease in the amount of brownish red lochia. D. The passage of clots as large as an orange can be expected.

ANS: B Rationale: An increase in lochia or a return to bright red bleeding after the lochia has become pink indicates a complication. A- The fundus should stay firm. C- The lochia should decrease in amount. D- Large clots after discharge are a sign of complications and should be reported.

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

While providing care in an obstetric setting, the nurse should understand that postpartum care of the woman with cardiac disease A. Is the same as that for any pregnant woman B. Includes rest, stool softeners, and monitoring of the effect of activity C. Includes ambulating frequently alternating with active range of motion D. Includes limiting visits with the infant to once per day

ANS: B Rationale: Bed rest may be ordered, with or without bathroom privileges. Bowel movements without stress or strain for the woman are promoted with stool softeners, diet, and fluid. A- Care of the woman with cardiac disease in the postpartum period is tailored to the woman's functional capacity. C- The woman will be on bed rest to conserve energy and reduce the strain on the heart. D- Although the woman may need help caring for the infant, breastfeeding and infant visits are not contraindicated.

Which laboratory marker is indicative of disseminated intravascular coagulation (DIC)? A. Bleeding time of 10 minutes B. Presence of fibrin split products C. Thrombocytopenia D. Hyperfibrinogenemia

ANS: B Rationale: Degradation of fibrin leads to the accumulation of multiple fibrin clots throughout the body's vasculature. A- Bleeding time in DIC is normal. C- Low platelets may occur with but are not indicative of DIC because they may result from other coagulopathies. D- Hypofibrinogenemia occurs with DIC.

Why is adequate hydration important when uterine activity occurs before pregnancy is at term? A. Fluid and electrolyte imbalance can interfere with the activity of the uterine pacemakers. B. Dehydration may contribute to uterine irritability for some women. C. Dehydration decreases circulating blood volume, which leads to uterine ischemia. D. Fluid needs are increased because of increased metabolic activity occurring during contractions.

ANS: B Rationale: Dehydration may contribute to uterine irritability for some women. A- Fluid and electrolyte Imbalance can interfere with the activity of the uterine pacemakers. C- Dehydration decreases circulating blood volume, which leads to uterine ischemia. D- Fluids needs do not increase due to contractions.

During which phase of the cycle of violence does the batterer become contrite and remorseful? A. Battering phase B. Honeymoon phase C. Tension-building phase D. Increased drug-taking phase

ANS: B Rationale: During the honeymoon phase, the battered person wants to believe that the battering will never happen again, and the batterer will promise anything to get back into the home. During the battering phase violence actually occurs, and the victim feels powerless. During the tension-building phase, the batterer becomes increasingly hostile, swears, threatens, throws things, and pushes the battered. Often the batterer increases the use of drugs during the tension-building phase.

A woman delivered a 9-lb, 10-oz baby 1 hour ago. When you arrive to perform her 15-minute assessment, she tells you that she "feels all wet underneath." You discover that both pads are completely saturated and that she is lying in a 6-inch-diameter puddle of blood. What is your first action? A. Call for help. B. Assess the fundus for firmness. C. Take her blood pressure. D. Check the perineum for lacerations.

ANS: B Rationale: Firmness of the uterus is necessary to control bleeding from the placental site. The nurse should first assess for firmness and massage the fundus as indicated. A- The first action should be to assess the fundus. C- Assessing blood pressure is an important assessment with a bleeding patient, but the top priority is to control the bleeding. This is done by first assessing the fundus for firmness. D- If bleeding continues in the presence of a firm fundus, lacerations may be the cause.

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 convulsion C. Effects of magnesium sulfate D. Gastrointestinal upset

ANS: B Rationale: Headache and visual disturbances are due to increased cerebral edema. Epigastric pain indicates distention of the hepatic capsules and often warns that a convulsion is imminent. A- These are danger signs and should be treated. C- She has not been started on magnesium sulfate as a treatment yet. Also, these are not expected effects of the medication. D- These are danger signs showing increased cerebral edema and impending convulsion.

The nurse knows that a measure for preventing late postpartum hemorrhage is to A. Administer broad-spectrum antibiotics. B. Inspect the placenta after delivery. C. Manually remove the placenta. D. Pull on the umbilical cord to hasten the delivery of the placenta.

ANS: B Rationale: If a portion of the placenta is missing, the clinician can explore the uterus, locate the missing fragments, and remove the potential cause of late postpartum hemorrhage. A- Broad-spectrum antibiotics will be given if postpartum infection is suspected. C- Manual removal of the placenta increases the risk of postpartum hemorrhage. D. The placenta is usually delivered 5 to 30 minutes after birth of the baby without pulling on the cord. That can cause uterine inversion.

Which maternal condition always necessitates delivery by cesarean section? A. Partial abruptio placentae B. Total placenta previa C. Ectopic pregnancy D. Eclampsia

ANS: B Rationale: In total placenta previa, the placenta completely covers the cervical os. The fetus would die if a vaginal delivery occurred. A- 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. C- The most common ectopic pregnancy is a tubal pregnancy, which is usually detected and treated in the first trimester. D- Labor can be safely induced if the eclampsia is under control.

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 Rationale: Infection and subsequent scarring of the fallopian tubes prevents normal movement of the fertilized ovum into the uterus for implantation. A- Oral contraceptives do not increase the risk for ectopic pregnancies. C- Ovarian cysts do not cause scarring of the fallopian tubes. D- This will not cause scarring of the fallopian tubes, which is the main risk factor for ectopic pregnancies.

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 Rationale: Initially, the woman who is unable to down clear liquids by mouth requires IV therapy for correction of fluid and electrolyte imbalances. A- Corticosteroids have been used successfully to treat refractory hyperemesis gravidarum, but they are not the expected initial treatment for this disorder. C- Pyridoxine is vitamin B6, not an antiemetic. Promethazine, a common antiemetic, may be prescribed. D- 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.

Rupture of the amniotic sac before the onset of true labor, regardless of length of gestation is called premature rupture of membranes (PROM). The first priority for the nurse is to determine whether membranes are truly ruptured. Other explanations for this increase in fluid discharge include all except A. Urinary incontinence B. Leaking of amniotic fluid C. Loss of mucous plug D. An increase in vaginal discharge

ANS: B Rationale: Leaking of amniotic fluid is an indication of PROM. A- It is not uncommon for patients to mistake urinary incontinence for leakage of amniotic fluid. C- Loss of the mucous plug can lead a woman to believe that her membranes have ruptured when they have not. D- Late in pregnancy there may be an increase in vaginal discharge. This may be mistaken for rupture of membranes.

The patient who is being treated for endometritis is placed in Fowler's position because it A. Promotes comfort and rest B. Facilitates drainage of lochia C. Prevents spread of infection to the urinary tract D. Decreases tension on the reproductive organs

ANS: B Rationale: Lochia and infectious material are eliminated by gravity drainage. A- This may not be the position of comfort, but it does allow for drainage. C- Hygiene practice aids in preventing the spread of infection to the urinary tract. D- The position is to aid in the drainage of lochia and infectious material.

Which woman is at greatest risk for early postpartum hemorrhage? A. A primiparous woman (G 2 P 1 0 0 1) being prepared for an emergency cesarean birth for fetal distress B. A woman with severe preeclampsia on magnesium sulfate whose labor is being induced C. A multiparous woman (G 3 P 2 0 0 2) with an 8-hour labor D. A primigravida in spontaneous labor with preterm twins

ANS: B Rationale: Magnesium sulfate administration during labor poses a risk for PPH. Magnesium acts as a smooth muscle relaxant, thereby contributing to uterine relaxation and atony. A- Although many causes and risk factors are associated with PPH, this scenario does not pose risk factors or causes of early PPH. C- Although many causes and risk factors are associated with PPH, this scenario does not pose risk factors or causes of early PPH. D- Although many causes and risk factors are associated with PPH, this scenario does not pose risk factors or causes of early PPH.

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

A pregnant woman is being discharged from the hospital after placement of a cerclage because of a history of recurrent pregnancy loss secondary to an incompetent cervix. Discharge teaching should emphasize that A. Any vaginal discharge should be reported immediately to her care provider. B. The presence of any contractions, rupture of membranes, or severe perineal pressure should be reported. C. She will need to make arrangements for care at home, because her activity level will be restricted. D. She will be scheduled for a cesarean birth.

ANS: B Rationale: Nursing care should stress the importance of monitoring signs and symptoms of preterm labor. A- Vaginal bleeding needs to be reported to her primary care provider. C- Bed rest is an element of care. However, the woman may stand for periods of up to 90 minutes, which allows her the freedom to see her physician. Home uterine activity monitoring may be used to limit the woman's need for visits and to safely monitor her status at home. D- The cerclage can be removed at 37 weeks of gestation (to prepare for a vaginal birth), or a cesarean birth can be planned.

Preconception counseling is critical to the outcome of diabetic pregnancies because poor glycemic control before and during early pregnancy is associated with A. Frequent episodes of maternal hypoglycemia B. Congenital anomalies in the fetus C. Polyhydramnios D. Hyperemesis gravidarum

ANS: B Rationale: Preconception counseling is particularly important because strict metabolic control before conception and in the early weeks of gestation is instrumental in decreasing the risks of congenital anomalies. A- Frequent episodes of maternal hypoglycemia may occur during the first trimester (not before conception) as a result of hormone changes and the effects on insulin production and usage. C- Hydramnios occurs about 10 times more often in diabetic pregnancies than in nondiabetic pregnancies. Typically, it is seen in the third trimester of pregnancy. D- Hyperemesis gravidarum may exacerbate hypoglycemic events as the decreased food intake by the mother and glucose transfer to the fetus contribute to hypoglycemia.

For which of the infectious diseases can a woman be immunized? A. Toxoplasmosis B. Rubella C. Cytomegalovirus D. Herpesvirus type 2

ANS: B Rationale: Rubella is the only infectious disease for which a vaccine is available. A- There is no vaccine available for toxoplasmosis. C- There is no vaccine available for cytomegalovirus. D- There is no vaccine available for herpesvirus type 2.

A woman who is 6 months pregnant has sought medical attention, saying she fell down the stairs. What scenario would cause an emergency department nurse to suspect that the woman has been battered? A. The woman and her partner are having an argument that is loud and hostile. B. The has injuries on various parts of her body that are in different stages of healing. C. Examination reveals a fractured arm and fresh bruises. Her husband asks her about her pain. D. She avoids making eye contact and is hesitant to answer questions.

ANS: B Rationale: The battered woman often has multiple injuries in various stages of healing. A- This is not always an indication of battering. Many times the batterer will be attentive and refuse to leave the woman's bedside. C- With battering there are injuries in various stages of healing. D- It is more normal for the woman to have a flat affect.

An important independent nursing action to promote normal progress in labor is A- Assessing the fetus B- Encouraging urination about every 1 to 2 hours C- Limiting contact with the woman's partner D- Regulating intravenous fluids

ANS: B Rationale: The bladder can reduce room in the woman's pelvis that is needed for fetal descent and can increase her discomfort. A- Assessment of the fetus in an important task, but will not promote normal progression of labor. C- The woman needs her support system during labor, and contact should not be limited. D- Maintaining hydration is an important task, but it will not promote normal progression of labor.

A woman in labor at 34 weeks of gestation is hospitalized and treated with intravenous magnesium sulfate for 18 to 20 hours. When the magnesium sulfate is discontinued, which oral drug will probably be prescribed for at-home continuation of the tocolytic effect? A. Ritodrine B. Terbutaline C. Calcium gluconate D. Magnesium sulfate

ANS: B Rationale: The woman receiving decreasing doses of magnesium sulfate is often switched to oral terbutaline to maintain tocolysis. A- Ritodrine is the only drug approved by the FDA for tocolysis; however, it is rarely used because of significant side effects. C- Calcium gluconate reverses magnesium sulfate toxicity. The drug should be available for complications of magnesium sulfate therapy. D- Magnesium sulfate is usually given intravenously or intramuscularly. The patient must be hospitalized for magnesium therapy because of the serious side effects of this drug.

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 Rationale: This is an accurate statement. 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. A- Women should be instructed to use birth control for 1 year after treatment for a hydatidiform mole. Pregnancy raises hCG levels which increases the risk for choriocarcinoma. C- The rationale for avoiding pregnancy for 1 year is to ensure that carcinogenic cells are not present. D- Any contraceptive method except an IUD is acceptable.

A multiparous woman is admitted to the postpartum unit after a rapid labor and birth of a 4000 g infant. Her fundus is boggy, lochia is heavy, and vital signs are unchanged. The nurse has the woman void and massages her fundus, but her fundus remains difficult to find, and the rubra lochia remains heavy. The nurse should A. Continue to massage the fundus. B. Notify the physician. C. Recheck vital signs. D. Insert a Foley catheter.

ANS: B Rationale: Treatment of excessive bleeding requires the collaboration of the physician and the nurses. Do not leave the patient alone. A- The uterine muscle can be overstimulated by massage, leading to uterine atony and rebound hemorrhage. C- The nurse should call the clinician while a second nurse rechecks the vital signs. D- The woman has voided successfully, so a Foley catheter is not needed at this time.

In terms of the incidence and classification of diabetes, maternity nurses should know that A. Type 1 diabetes is most common. B. Type 2 diabetes often goes undiagnosed. C. There is only one type of gestational diabetes. D. Type 1 diabetes may become type 2 during pregnancy.

ANS: B Rationale: Type 2 often goes undiagnosed, because hyperglycemia develops gradually and often is not severe. A- Type 2, sometimes called adult onset diabetes, is the most common. C- There are 2 subgroups of gestational diabetes. Type GDM A1 is diet-controlled whereas Type GDM A2 is controlled by insulin and diet. D- People do not go back and forth between type 1 and type 2 diabetes.

A steady trickle of bright red blood from the vagina in the presence of a firm fundus suggests A. Uterine atony B. Lacerations of the genital tract C. Perineal hematoma D. Infection of the uterus

ANS: B Rationale: Undetected lacerations will bleed slowly and continuously. Bleeding from lacerations is uncontrolled by uterine contraction. A- The fundus is not firm with uterine atony. C- A hematoma would be internal. Swelling and discoloration would be noticed, but bright bleeding would not be. D- With an infection of the uterus there would be an odor to the lochia and systemic symptoms such as fever and malaise.

If the nurse suspects a uterine infection in the postpartum patient, she should assess the A. Pulse and blood pressure B. Odor of the lochia C. Episiotomy site D. Abdomen for distention

ANS: B Rationale: An abnormal odor of the lochia indicates infection in the uterus. A- The pulse may be altered with an infection, but the odor of the lochia will be an earlier sign and more specific. C- The infection may move to the episiotomy site if proper hygiene is not allowed. D- The abdomen becomes distended usually because of a decrease of peristalsis, such as after cesarean section.

The causes of preterm labor are not fully understood although many factors have been associated with early labor. These include (select all that apply) A- Singleton pregnancy B- History of cone biopsy C- Smoking D- Short cervical length E- Higher level of education

ANS: B, C, D Correct: A history of cone biopsy, smoking, and short cervical length are maternal risk factors for preterm labor. Others include chronic illness, DES exposure as a fetus, uterine abnormalities, obesity, previous preterm labor or birth, number of embryos implanted, preeclampsia, anemia, or infection. Incorrect: Uterine distention caused by multifetal pregnancy or hydramnios are risk factors for preterm labor. Low educational level, low socioeconomic status, little or no prenatal care, poor nutrition, or non-white ethnicity are all demographic risk factors for preterm labor and birth.

Approximately 82% of teen pregnancies are unintended. Seventy percent of teens have had sex by their 19th birthday. Factors that contribute to an increased risk for teen pregnancy include (select all that apply) A. High self-esteem B. Peer pressure C. Limited access to contraception D. Planning sexual activity E. Lack of role models

ANS: B, C, E Correct Feedback: Peer pressure to begin sexual activity is a contributing factor towards teenage pregnancy. Limited access to contraceptive devices and lack of accurate information about how to use these devices are also factors. Lack of appropriate role models, desire to alleviate or escape the present situation at home, along with feelings of invincibility, also contribute to teenage pregnancy. Incorrect: Low self-esteem and the consequent inability to set limits on sexual activity places the adolescent at risk for teen pregnancy. Ambivalence towards sexuality, and not planning intercourse, are more likely to result in teen pregnancy.

After a birth complicated by a shoulder dystocia, the infant's Apgar scores were 7 at 1 minute and 9 at 5 minutes. The infant is now crying vigorously. The nurse in the birthing room should A. Give supplemental oxygen with a small facemask. B. Encourage the parents to hold the infant. C. Palpate the infant's clavicles. D. Perform a complete newborn assessment.

ANS: C Because of the shoulder dystocia, the infant's clavicles may have been fractured. Palpation is a simple assessment to identify crepitus or deformity that requires follow-up. A- The Apgar indicates that no respiratory interventions are needed. B- The infant needs to be assessed for clavicle fractures before excessive movement. D- A complete newborn assessment is necessary for all newborns, but assessment of the clavicle is top priority for this infant.

Of adolescents who become pregnant, what percentage have had a previous birth? A. 10% B. 15% C. 19% D. 35%

ANS: C Rationale: 19% of pregnant adolescents have had one or more previous births.

The nurse should suspect uterine rupture if A. Fetal tachycardia occurs. B. The woman becomes dyspneic. C. Contractions abruptly stop during labor. D. Labor progresses unusually quickly.

ANS: C Rationale: A large rupture of the uterus will disrupt its ability to contract. A- Fetal tachycardia is a sign of hypoxia. With a large rupture, the nurse should be alert for the earlier signs. B- This is not an early sign of a rupture. D- Contractions will stop with a rupture.

A woman who is 32 weeks pregnant telephones the nurse at her obstetrician's office and complains of constant backache. She asks what pain reliever is safe for her to take. The best nursing response is A. "Back pain is common at this time during pregnancy because you tend to stand with a sway back." B. "Acetaminophen is acceptable during pregnancy; however, you should not take aspirin." C. "You should come into the office and let the doctor check you." D. "Avoid medication because you are pregnant. Try soaking in a warm bath or using a heating pad on low before taking any medication."

ANS: C Rationale: A prolonged backache is one of the subtle symptoms of preterm labor. Early intervention may prevent preterm birth. A- Back pain can also be a symptom of preterm labor and needs to be assessed. B- The woman needs to be assessed for preterm labor before providing pain relief. D- The woman needs to be assessed for preterm labor before providing pain relief.

When teaching the pregnant woman with class II heart disease, the nurse should A. Advise her to gain at least 30 lb. B. Explain the importance of a diet high in calcium. C. Instruct her to avoid strenuous activity. D. Inform her of the need to limit fluid intake.

ANS: C Rationale: Activity may need to be limited so that cardiac demand does not exceed cardiac capacity. A- Weight gain should be kept at a minimum with heart disease. B- Iron and folic acid intake is important to prevent anemia. D- Fluid intake should not be limited during pregnancy. She may also be put on a diuretic. Fluid intake is necessary to prevent fluid deficits.

Nursing measures that help prevent postpartum urinary tract infection include A. Promoting bed rest for 12 hours after delivery B. Discouraging voiding until the sensation of a full bladder is present C. Forcing fluids to at least 3000 mL/day D. Encouraging the intake of orange, grapefruit, or apple juice

ANS: C Rationale: Adequate fluid intake of 2500 to 3000 ml/day prevents urinary stasis, dilutes urine, and flushes out waste products. A- The woman should be encouraged to ambulate early. B- With pain medications, trauma to the area, and anesthesia, the sensation of a full bladder may be decreased. She needs to be encouraged to void frequently. D- Juices such as cranberry juice can discourage bacterial growth.

What factor found in maternal history should alert the nurse to the potential for a prolapsed umbilical cord? A. Oligohydramnios B. Pregnancy at 38 weeks of gestation C. Presenting part at station -3 D. Meconium-stained amniotic fluid

ANS: C Rationale: Because the fetal presenting part is positioned high in the pelvis and is not well applied to the cervix, a prolapsed cord could occur if the membranes rupture. A- Hydramnios puts the woman at high risk for a prolapsed umbilical cord. B- A very small fetus, normally preterm, puts the woman at risk for a prolapsed umbilical cord. D- Meconium-stained amniotic fluid shows that the fetus already has been compromised, but it does not increase the chance of a prolapsed cord.

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 Rationale: Calcium gluconate reverses the effects of magnesium sulfate. A- Stimulation will not increase the respirations. B- This will not be successful in reversing the effects of the magnesium sulfate. D- Increasing her IV fluids will not reverse the effects of the medication.

What condition indicates concealed hemorrhage in an abruptio placentae? A. Decrease in abdominal pain B. Bradycardia C. Hard, boardlike abdomen D. Decrease in fundal height

ANS: C Rationale: Concealed hemorrhage occurs when the edges of the placenta do not separate. The formation of a hematoma behind the placenta and subsequent infiltration of the blood into the uterine muscle results in a very firm, boardlike abdomen. A- Abdominal pain may increase. B- The patient will have shock symptoms that include tachycardia. D- The fundal height will increase as bleeding occurs.

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

The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the Pitocin infusion, 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. The nurse notifies the physician, because the lab results are indicative of A. Eclampsia B. Disseminated intravascular coagulation C. HELLP syndrome D. Rh incompatibility

ANS: C Rationale: HELLP syndrome is a laboratory diagnosis for a variant of severe preeclampsia that involves hepatic dysfunction characterized by hemolysis (H), elevated liver enzymes (EL), and low platelets (LP). A- Eclampsia is determined by the presence of seizures. B- DIC is a potential complication associated with HELLP syndrome. D- These are not clinical indications of Rh incompatibility.

To manage her diabetes appropriately and ensure a good fetal outcome, the pregnant woman with diabetes will need to alter her diet by A. Eating six small equal meals per day B. Reducing carbohydrates in her diet C. Eating her meals and snacks on a fixed schedule D. Increasing her consumption of protein

ANS: C Rationale: Having a fixed meal schedule will provide the woman and the fetus with a steadier blood sugar level, provide better balance with insulin administration, and help prevent complications. A- It is more important to have a fixed meal schedule than equal division of food intake. B- Approximately 45% of the food eaten should be in the form of carbohydrates. D- Having a fixed meal schedule will provide the woman and the fetus with a steadier blood sugar level, provide better balance with insulin administration, and help prevent complications.

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 Rationale: If the fetus is viable and near term, delivery is the only known "cure" for preeclampsia. A- Magnesium sulfate is one of the medications used to treat but not to cure preeclampsia. B- Antihypertensive medications are used to lower the dangerously elevated blood pressures in preeclampsia and eclampsia. D- Low doses of ASA (60 to 80 mg) have been administered to women at high risk for developing preeclampsia.

Anxiety disorders are the most common mental disorders that affect women. While providing care to the maternity patient, the nurse should be aware that one of these disorders is likely to be triggered by the process of labor and birth. This disorder is A. A phobia B. Panic disorder C. Posttraumatic stress disorder (PTSD) D. Obsessive-compulsive disorder (OCD)

ANS: C Rationale: In PTSD, women perceive childbirth as a traumatic event. They have nightmares and flashbacks about the event, anxiety, and avoidance of reminders of the traumatic event. A- Phobias are irrational fears that may lead a person to avoid certain objects, events, or situations. B- Panic disorders include episodes of intense apprehension, fear, and terror. Symptoms may manifest themselves as palpitations, chest pain, choking, or smothering. D- OCD symptoms include recurrent, persistent, and intrusive thoughts. The mother may repeatedly check and recheck her infant once he or she is born, even though she realizes that this is irrational. OCD is best treated with medications.

Which condition may be seen in an infant born to a client who consumed excessive alcohol during pregnancy? A. Respiratory distress B. Hypothyroidism C. Congenital abnormalities D. Skull fractures

ANS: C Rationale: Infants born to parents who are heavy alcohol drinkers are at risk for congenital abnormalities. Respiratory distress is not usually seen in an infant exposed to alcohol. Hypothyroidism is a genetic disorder not related to alcohol consumption. Skull fractures are sometimes caused during a difficult birth due to the pressure of the fetal skull against the maternal pelvis.

Nursing intervention for the pregnant diabetic is based on the knowledge that the need for insulin A. Increases throughout pregnancy and the postpartum period B. Decreases throughout pregnancy and the postpartum period C. Varies depending on the stage of gestation D. Should not change because the fetus produces its own insulin

ANS: C Rationale: Insulin needs decrease during the first trimester, when nausea, vomiting, and anorexia are a factor. They increase during the second and third trimesters, when the hormones of pregnancy create insulin resistance in maternal cells. A- Insulin needs decrease during the first trimester, when nausea, vomiting, and anorexia are a factor. B- Insulin needs increase during the second and third trimesters, when the hormones of pregnancy create insulin resistance in maternal cells. D- The insulin needs change during the pregnancy.

Which nursing measure is appropriate to prevent thrombophlebitis in the recovery period after a cesarean birth? A. Roll a bath blanket and place it firmly behind the knees. B. Limit oral intake of fluids for the first 24 hours. C. Assist the patient in performing gentle leg exercises. D. Ambulate the patient as soon as her vital signs are stable.

ANS: C Rationale: Leg exercises and passive range of motion promote venous blood flow and prevent venous stasis while the patient is still on bed rest. A- The blanket behind the knees will cause pressure and decrease venous blood flow. B- Limiting oral intake will produce hemoconcentration, which may lead to thrombophlebitis. D- The patient may not have full return of leg movements, and ambulating is contraindicated.

Nurses must be cognizant of the growing problem of methamphetamine use during pregnancy. When caring for a woman who uses methamphetamines, it is important for the nurse to be aware of which factor related to the abuse of this substance? A. Methamphetamine is a depressant. B. All methamphetamines are vasodilators. C. Methamphetamine users are extremely psychologically addicted. D. Rehabilitation is usually successful.

ANS: C Rationale: Methamphetamine users are extremely psychologically addicted. Typically these women display poor control over their behavior and a low threshold for pain. This substance is relatively inexpensive and easy to obtain. Methamphetamines are vasoconstrictors. The rate of relapse for methamphetamine users is very high.

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 Rationale: Methotrexate is an effective, nonsurgical treatment option for a hemodynamically stable woman whose ectopic pregnancy is unruptured and less than 4 cm in diameter. A- Methotrexate is not indicated or recommended as a treatment option for a complete hydatidiform mole. B- Methotrexate is not indicated or recommended as treatment option for missed abortions. D- Methotrexate is not indicated or recommended as a treatment option for abruptio placentae.

A woman who is older than 35 years may have difficulty achieving pregnancy, because A. Personal risk behaviors influence fertility. B. She has used contraceptives for an extended time. C. Her ovaries may be affected by the aging process. D. Pre-pregnancy medical attention is lacking.

ANS: C Rationale: Once the mature woman decides to conceive, a delay in becoming pregnant may occur because of the normal aging of the ovaries. A- The older adult participates in fewer risk behaviors than the younger adult. B- The problem is the age of the ovaries, not the past use of contraceptives. D- Pre-pregnancy medical care is available and encouraged.

Which patient situation presents the greatest risk for the occurrence of hypotonic dysfunction during labor? A. A primigravida who is 17 years old B. A 22-year-old multiparous woman with ruptured membranes C. A multiparous woman at 39 weeks of gestation who is expecting twins D. A primigravida woman who has requested no analgesia during her labor

ANS: C Rationale: Overdistention of the uterus in a multiple pregnancy is associated with hypotonic dysfunction because the stretched uterine muscle contracts poorly. A- A young primigravida usually will have good muscle tone in the uterus. This prevents hypotonic dysfunction. B- There is no indication that this woman's uterus is overdistended, which is the main cause of hypotonic dysfunction. D- A primigravida usually will have good uterine muscle tone, and there is no indication of an overdistended uterus.

To provide adequate postpartum care, the nurse should be aware that postpartum depression (PPD) A. Is the "baby blues" plus the woman has a visit with a counselor or psychologist B. Is more common among older, Caucasian women because they have higher expectations C. Is distinguished by pervasive sadness that lasts at least 2 weeks D. Will disappear on its own without outside help

ANS: C Rationale: PPD is characterized by a persistent depressed state. The woman is unable to feel pleasure or love although she is able to care for her infant. She often experiences generalized fatigue, irritability, little interest in food and sleep disorders. A- PPD is more serious and persistent than postpartum baby blues. B- PPD is more common among younger mothers and African-American mothers. D- Most women need professional help to get through PPD, including pharmacologic intervention.

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 Rationale: Pain in abruptio placentae occurs in response to increased pressure behind the placenta and within the uterus. Placenta previa manifests with painless vaginal bleeding. A- Both may have vaginal bleeding B- Rupture of membranes may occur with both conditions. D- Maternal vital signs may change with both if bleeding is pronounced.

Metabolic changes throughout pregnancy that affect glucose and insulin in the mother and the fetus are complicated but important to understand. Nurses should know that A. Insulin crosses the placenta to the fetus only in the first trimester, after which the fetus secretes its own. B. Women with insulin-dependent diabetes are prone to hyperglycemia during the first trimester, because they are consuming more sugar. C. During the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus. D. Maternal insulin requirements steadily decline during pregnancy.

ANS: C Rationale: Pregnant women develop increased resistance during the second and third trimesters. A- Insulin never crosses the placenta; the fetus starts making its own around the tenth week. B- As a result of normal metabolic changes during pregnancy, insulin-dependent women are prone to hypoglycemia (low levels). D- Maternal insulin requirements may doubt or quadruple by the end of pregnancy.

When helping the mother, father, and other family members actualize the loss of the infant, nurses should A. Use the words LOST or GONE rather than DEAD or DIED. B. Make sure the family understands that it is important to name the baby. C. If the parents choose to visit with the baby, apply lotion to the baby and wrap the infant in a pretty blanket. D. Set a firm time for ending the visit with the baby so that the parents know when to let go.

ANS: C Rationale: Presenting the baby in a nice way stimulates the parents' senses and provides pleasant memories of their baby. A- Nurses must use DEAD and DIED to assist the bereaved in accepting reality. B- Although naming the baby can be helpful, it is important not to create the sense that parents have to name the baby. In fact, some cultural taboos and religious rules prohibit the naming of an infant who has died. D- Parents need different time periods with their baby to say goodbye. Nurses need to be careful not to rush the process.

Which factor is known to increase the risk of gestational diabetes mellitus? A. Underweight before pregnancy B. Maternal age younger than 25 years C. Previous birth of large infant D. Previous diagnosis of type 2 diabetes mellitus

ANS: C Rationale: Previous birth of a large infant suggests gestational diabetes mellitus. A- Obesity (BMI of 30 or greater) creates a higher risk for gestational diabetes. B- A woman younger than 25 generally is not at risk for gestational diabetes mellitus. D- The person with type 2 diabetes mellitus already is a diabetic and will continue to be so after pregnancy. Insulin may be required during pregnancy because oral hypoglycemia drugs are contraindicated during pregnancy.

In planning for home care of a woman with preterm labor, the nurse needs to address which concern? A. Nursing assessments will be different from those done in the hospital setting. B. Restricted activity and medications will be necessary to prevent recurrence of preterm labor. C. Prolonged bed rest may cause negative physiologic effects. D. Home health care providers will be necessary.

ANS: C Rationale: Prolonged bed rest may cause adverse effects such as weight loss, loss of appetite, muscle wasting, weakness, bone demineralization, decreased cardiac output, risk for thrombophlebitis, alteration in bowel functions, sleep disturbance, and prolonged postpartum recovery. A- Nursing assessments will differ somewhat from those performed in the acute care setting, but this is not the concern that needs to be addressed. B- Restricted activity and medication may prevent preterm labor; however, not in all women. Additionally, the plan of care is individualized to meet the needs of each patient. D- Many women will receive home health nurse visits, but care is individualized for each woman.

A primigravida is being monitored in her prenatal clinic for preeclampsia. What finding should concern her nurse? 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 Rationale: Proteinuria is defined as a concentration of 1+ or greater via dipstick measurement. A dipstick value of 3+ should alert the nurse that additional testing or assessment should be made. A- Generally, hypertension is defined as a BP of 140/90 or an increase in systolic pressure of 30 mm Hg or 15 mm Hg diastolic pressure. B- Preeclampsia may be manifested as a rapid weight gain of more than 2 kg in 1 week. D- 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.

A pregnant woman who abuses cocaine admits to exchanging sex for her drug habit. This behavior puts her at a greater risk for A. Depression of the central nervous system B. Hypotension and vasodilation C. Sexually transmitted diseases D. Post-mature birth

ANS: C Rationale: Sex acts exchanged for drugs place the woman at increased risk for sexually transmitted diseases because of multiple partners and lack of protection. Cocaine is a central nervous system stimulant. Cocaine causes hypertension and vasoconstriction. Premature delivery of the infant is one of the most common problems associated with cocaine use during pregnancy.

The mother-baby nurse must be able to recognize what sign of thrombophlebitis? A. Visible varicose veins B. Positive Homans' sign C. Local tenderness, heat, and swelling D. Pedal edema in the affected leg

ANS: C Rationale: Tenderness, heat, and swelling are classic signs of thrombophlebitis that appear at the site of the inflammation. A- Varicose veins may predispose the woman to thrombophlebitis, but are not a sign. B- A positive Homans' sign may be caused by a strained muscle or contusion. D- Edema may be more involved than pedal.

A patient at 24 weeks of gestation says she has a glass of wine with dinner every evening. The nurse will counsel her to eliminate all alcohol intake, because A. A daily consumption of alcohol indicates a risk for alcoholism. B. She will be at risk for abusing other substances as well. C. The fetus is placed at risk for altered brain growth. D. The fetus is at risk for multiple organ anomalies.

ANS: C Rationale: The brain grows most rapidly in the third trimester and is most vulnerable to alcohol exposure during this time. A-This is not the major risk for the infant. B- This has not been proven. D- The major concerns are mental retardation, learning disabilities, high activity level, and short attention span.

A mother with mastitis is concerned about breastfeeding while she has an active infection. The nurse should explain that A. The infant is protected from infection by immunoglobulins in the breast milk. B. The infant is not susceptible to the organisms that cause mastitis. C. The organisms that cause mastitis are not passed to the milk. D. The organisms will be inactivated by gastric acid.

ANS: C Rationale: The organisms are localized in the breast tissue and are not excreted in the breast milk. A- The mother is just producing the immunoglobulin from this infection, so it is not available for the infant. B- Because of an immature immune system, infants are susceptible to many infections. However, this infection is in the breast tissue and is not excreted in the breast milk. D- The organism will not get into the infant's gastrointestinal system.

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 Rationale: The uterus in a hydatidiform molar pregnancy is often larger than would be expected on the basis of the duration of the pregnancy. A- Nausea increases in a molar pregnancy because of the increased production of hCG. B- A woman with a molar pregnancy may have early-onset pregnancy-induced hypertension. D- The history of bleeding is normally described as being brownish.

When a woman is diagnosed with postpartum psychosis, one of the main concerns is that she may A. Have outbursts of anger B. Neglect her hygiene C. Harm her infant D. Lose interest in her husband

ANS: C Rationale: Thoughts of harm to one's self or the infant are among the most serious symptoms of PPD and require immediate assessment and intervention. A- Although outbursts of anger is a symptom is attributable to PPD, the major concern would be the potential of harm to herself or to her infant. B- Neglect of personal hygiene is symptom is attributable to PPD; however, the major concern would be the potential of harm to herself or to her infant. D- Although this patient is likely to lose interest in her spouse, the major concern is the potential of harm to herself or to her infant.

What is a major barrier to health care for teen mothers? A. The hospital/clinic is within walking distance of the girl's home. B. The institution is open days, evenings, and Saturday by special arrangement. C. The teen must be prepared to see a different nurse or doctor or both at every visit. D. The health care workers have a positive attitude.

ANS: C Rationale: Whenever possible, the teen should be scheduled to see the same nurses and practitioners for continuity of care. If the hospital/clinic were within walking distance of the girl's home, it would prevent the teen from missing appointments because of transportation problems. If the institution were open days, evenings, and Saturday by special arrangement, this availability would be helpful for teens who work, go to school, or have other time-of-day restrictions. Scheduling conflicts are a major barrier to health care. A negative attitude is unfortunate, because it discourages families that would benefit most from consistent prenatal care.

A woman is having her first child. She has been in labor for 15 hours. Two hours ago, her vaginal examination revealed the cervix to be dilated to 5 cm and 100% effaced, and the presenting part was at station 0. Five minutes ago, her vaginal examination indicated that there had been no change. What abnormal labor pattern is associated with this description? A. Prolonged latent phase B. Protracted active phase C. Secondary arrest D. Protracted descent

ANS: C Rationale: With a secondary arrest of the active phase, the progress of labor has stopped. This patient has not had any anticipated cervical change, indicating an arrest of labor. A- In the nulliparous woman, a prolonged latent phase typically lasts more than 20 hours. B- A protracted active phase, the first or second stage of labor, would be prolonged (slow dilation). D- With protracted descent, the fetus would fail to descend at an anticipated rate during the deceleration phase and second stage of labor.

A primigravida at 40 weeks of gestation is having uterine contractions every 1.5 to 2 minutes and says that they are very painful. Her cervix is dilated 2 cm and has not changed in 3 hours. The woman is crying and wants an epidural. What is the likely status of this woman's labor? A. She is exhibiting hypotonic uterine dysfunction. B. She is experiencing a normal latent stage. C. She is exhibiting hypertonic uterine dysfunction. D. She is experiencing pelvic dystocia.

ANS: C Rationale: Women who experience hypertonic uterine dysfunction, or primary dysfunctional labor, often are anxious first-time mothers who are having painful and frequent contractions that are ineffective at causing cervical dilation or effacement to progress. A- With hypotonic uterine dysfunction, the woman initially makes normal progress into the active stage of labor and then the contractions become weak and inefficient or stop altogether. B- The contraction pattern seen in this woman signifies hypertonic uterine activity. D- Pelvic dystocia can occur whenever contractures of the pelvic diameters reduce the capacity of the bony pelvis, including the inlet, midpelvis, outlet, or any combination of these planes.

In caring for a pregnant woman with sickle cell anemia the nurse is aware that signs and symptoms of sickle cell crisis include A. Anemia B. Endometritis C. Fever and pain D. Urinary tract infection

ANS: C Rationale: Women with sickle cell anemia have recurrent attacks (crisis) of fever and pain, most often in the abdomen, joints and extremities. These attacks are attributed to vascular occlusion when RBCs assume the characteristic sickled shape. Crises are usually triggered by dehydration, hypoxia or acidosis. A- Therefore routine iron supplementation, even that found in prenatal vitamins should be avoided in order to prevent iron overload. B- Women with sickle cell trait usually are at greater risk for postpartum endometritis (uterine wall infection); however, this is not likely to occur in pregnancy and is not a sign of crisis. D- These women are at an increased risk for UITs; however, this is not an indication of sickle cell crisis.

What nursing intervention is important to implement when caring for a substance-abusing client? A. Nurses must confront the substance-abuse client and force him or her into treatment. B. Nurses should try to understand that substance abusers are just like any other client and should be treated the same. C. Nurses should get a nurse who is recovering from substance abuse to care for the substance-abuse client, so the nurse will understand the client. D. Nurses must understand that substance abuse is an illness and that the client deserves to be treated with patience, kindness, consistency, and firmness when necessary.

ANS: D

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 Rationale: A placenta previa that does not cover any part of the cervix is termed marginal. A- With a total placenta previa the placenta completely covers the os. B- 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. C- A complete previa is termed total. The placenta completely covers the internal cervical os.

The fetus in a breech presentation is often born by cesarean delivery because A. The buttocks are much larger than the head. B. Postpartum hemorrhage is more likely if the woman delivers vaginally. C. Internal rotation cannot occur if the fetus is breech. D. Compression of the umbilical cord is more likely.

ANS: D Rationale: After the fetal legs and trunk emerge from the woman's vagina, the umbilical cord can be compressed between the maternal pelvis and the fetal head if a delay occurs in the birth of the head. A- The head is the largest part of a fetus. B- There is no relationship between breech presentation and postpartum hemorrhage. C- Internal rotation can occur with a breech.

Which actions by the nurse may prevent infections in the labor and delivery area? A. Vaginal examinations every hour while the woman is in active labor B. Use of clean techniques for all procedures C. Cleaning secretions from the vaginal area by using back-to-front motion D. Keeping underpads and linens as dry as possible

ANS: D Rationale: Bacterial growth prefers a moist, warm environment. A- Vaginal examinations should be limited to decrease transmission of vaginal organisms into the uterine cavity. B- Use an aseptic technique if membranes are not ruptured; use a sterile technique if membranes are ruptured. C- Vaginal drainage should be removed with a front-to-back motion to decrease fecal contamination.

As a powerful central nervous system stimulant, which of these substances can lead to miscarriage, preterm labor, placental separation (abruption), and stillbirth? A. Heroin B. Alcohol C. PCP D. Cocaine

ANS: D Rationale: Cocaine is a powerful CNS stimulant. Effects on pregnancy associated with cocaine use include abruptio placentae, perterm labor, precipitous birth, and stillbirth. A- Heroin is an opiate. Its use in pregnancy is associated with preeclampsia, intrauterine growth restriction, miscarriage, premature rupture of membranes, infections, breech presentation, and preterm labor. B- The most serious effect of alcohol use in pregnancy is FAS. C- The major concerns regarding PCP use in pregnant women are its association with polydrug abuse and the neurobehavioral effects on the neonate.

If nonsurgical treatment for late postpartum hemorrhage is ineffective, which surgical procedure is appropriate to correct the cause of this condition? A. Hysterectomy B. Laparoscopy C. Laparotomy D. D&C

ANS: D Rationale: D&C allows examination of the uterine contents and removal of any retained placental fragments or blood clots. A- Hysterectomy is not indicated for this condition. A hysterectomy is the removal of the uterus. B- Laparoscopy is not indicated for this condition. A laparoscopy is the insertion of an endoscope through the abdominal wall to examine the peritoneal cavity. C- Laparotomy is not indicated for this condition. A laparotomy is a surgical incision into the peritoneal cavity to explore the peritoneal cavity.

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 Rationale: D&C is used to remove the products of conception from the uterus and can be used safely until week 14 of gestation. A- If all the products of conception have been passed (complete abortion), a D&C is not used. B- D&C is used to remove the products of conception from the uterus and can be done safely until week 14 of gestation. C- If the pregnancy is still viable (threatened abortion), a D&C is not used.

With regard to the care management of preterm labor, nurses should be aware that A- Because all women must be considered at risk for preterm labor and prediction is so hit-and-miss, teaching pregnant women the symptoms probably causes more harm through false alarms. B- Braxton Hicks contractions often signal the onset of preterm labor. C- Because preterm labor is likely to be the start of an extended labor, a woman with symptoms can wait several hours before contacting the primary caregiver. D- The diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical change.

ANS: D Rationale: Gestational age of 20 to 37 weeks, uterine contractions, and a thinning cervix are all indications of preterm labor. A- It is essential that nurses teach women how to detect the early symptoms of preterm labor. B- Braxton Hicks contractions resemble preterm labor contractions, but they are not true labor. C- Waiting too long to see a health care provider could result in essential medications' failing to be administered. Preterm labor is not necessarily long-term labor.

When caring for a postpartum woman experiencing hypovolemic shock, the nurse recognizes that the most objective and least invasive assessment of adequate organ perfusion and oxygenation is A. Absence of cyanosis in the buccal mucosa B. Cool, dry skin C. Diminished restlessness D. Decreased urinary output

ANS: D Rationale: Hemorrhage may result in hypovolemic shock. Shock is an emergency situation in which the perfusion of body organs may become severely compromised, and death may occur. The presence of adequate urinary output indicates adequate tissue perfusion. A- The assessment of the buccal mucosa for cyanosis can be subjective in nature. B- The presence of cool, pale, clammy skin is an indicative finding associated with hypovolemic shock. C- Hypovolemic shock is associated with lethargy, not restlessness.

A woman with preeclampsia has a seizure. The nurse's primary duty during the seizure is to 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 Rationale: If a patient becomes eclamptic, the nurse should stay with her and call for help. Nursing actions during a convulsion are directed towards ensuring a patent airway and patient safety. A- 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. B- Once the seizure has ended, it may be necessary to suction the patient's mouth. C- Oxygen would be administered after the convulsion has ended.

A laboring patient in the latent phase is experiencing uncoordinated, irregular contractions of low intensity. How should the nurse respond to complaints of constant cramping pain? A. "You are only 2 cm dilated, so you should rest and save your energy for when the contractions get stronger." B. "You must breathe more slowly and deeply so there is greater oxygen supply for your uterus. That will decrease the pain." C. "Let me take off the monitor belts and help you get into a more comfortable position." D. "I have notified the doctor that you are having a lot of discomfort. Let me rub your back and see if that helps."

ANS: D Rationale: Intervention is needed to manage the dysfunctional pattern. Offering support and comfort is important to help the patient cope with the situation. A- This statement is belittling the patient's complaints. Support and comfort are necessary. B- Breathing will not decrease the pain. C- It is important to get her into a more comfortable position, but fetal monitoring should continue.

Which action should be initiated to limit hypovolemic shock when uterine inversion occurs? A. Administer oxygen at 31 L/min by nasal cannula. B. Administer an oxytocic drug by intravenous push. C. Monitor fetal heart rate every 5 minutes. D. Restore circulating blood volume by increasing the intravenous infusion rate.

ANS: D Rationale: Intravenous fluids are necessary to replace the lost blood volume that occurs in uterine inversion. A- Administering oxygen will not prevent hypovolemic shock. B- Oxytocin drugs should not be given until the uterus is repositioned. C- A uterine inversion occurs during the third stage of labor.

What form of heart disease in women of childbearing years usually has a benign effect on pregnancy? A. Cardiomyopathy B. Rheumatic heart disease C. Congenital heart disease D. Mitral valve prolapse

ANS: D Rationale: Mitral valve prolapse is a benign condition that is usually asymptomatic. A- Cardiomyopathy produces congestive heart failure during pregnancy. B- Rheumatic heart disease can lead to heart failure during pregnancy. C- Some congenital heart diseases will produce pulmonary hypertension or endocarditis during pregnancy.

An appropriate nursing measure when a baby has an unexpected anomaly is to A. Remove the baby from the delivery area immediately. B. Tell the parents that the baby has to go to the nursery immediately. C. Inform the parents immediately that something is wrong. D. Explain the defect and show the baby to the parents as soon as possible.

ANS: D Rationale: Parents experience less anxiety when they are told about the defect as early as possible and are allowed to touch and hold the baby. A- The parents should be able to touch and hold the baby as soon as possible. B- This would raise anxiety levels of the parents; they should be told about the defect and allowed to see the baby. C- They should be told immediately, but they should be told about the defect and be allowed to see the infant.

Glucose metabolism is profoundly affected during pregnancy because A. Pancreatic function in the islets of Langerhans is affected by pregnancy. B. The pregnancy woman uses glucose at a more rapid rate than the nonpregnant woman. C. The pregnant woman increases her dietary intake significantly. D. Placental hormones are antagonistic to insulin, resulting in insulin resistance.

ANS: D Rationale: Placental hormones, estrogen, progesterone, and human placental lactogen (HPL) create insulin resistance. Insulin also is broken down more quickly by the enzyme placental insulinase. A- Pancreatic functioning is not affected by pregnancy. B- The glucose requirements differ because of the growing fetus. C- The pregnant woman should increase her intake by 200 calories a day.

One of the first symptoms of puerperal infection to assess for in the postpartum woman is A. Fatigue continuing for longer than 1 week B. Pain with voiding C. Profuse vaginal bleeding with ambulation D. Temperature of 38° C (100.4° F) or higher on 2 successive days starting 24 hours after birth

ANS: D Rationale: Postpartum or puerperal infection is any clinical infection of the genital canal that occurs within 28 days after miscarriage, induced abortion, or childbirth. The definition used in the United States continues to be the presence of a fever of 38° C (100.4° F) or higher on 2 successive days of the first 10 postpartum days, starting 24 hours after birth. A- Fatigue is a late finding associated with infection. B- Pain with voiding may indicate a UTI, but it is not typically one of the earlier symptoms of infection. C- Profuse lochia may be associated with endometritis, but it is not the first symptom associated with infection.

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

With shortened hospital stays, new mothers are often discharged before they begin to experience symptoms of the baby blues or postpartum depression. As part of the discharge teaching, the nurse can prepare the mother for this adjustment to her new role by instructing her regarding self-care activities to help prevent postpartum depression. The most accurate statement as related to these activities is to A. Stay home and avoid outside activities to ensure adequate rest. B. Be certain that you are the only caregiver for your baby in order to facilitate infant attachment. C. Keep feelings of sadness and adjustment to your new role to yourself. D. Realize that this is a common occurrence that affects many women.

ANS: D Rationale: Should the new mother experience symptoms of the baby blues, it is important that she be aware that this is nothing to be ashamed of. A- Although it is important for the mother to obtain enough rest, she should not distance herself from family and friends. Her spouse or partner can communicate the best visiting times so that the new mother can obtain adequate rest. It is also important that she not isolate herself at home by herself during this time of role adjustment. B- Even if breastfeeding, other family members can participate in the infant's care. If depression occurs, the symptoms can often interfere with mothering functions and this support will be essential. C- The new mother should share her feelings with someone else. It is also important that she not overcommit herself or feel as though she has to be "superwoman." A telephone call to the hospital warm line may provide reassurance with lactation issues and other infant care questions. Should symptoms continue, a referral to a professional therapist may be necessary.

When caring for a pregnant woman with suspected cardiomyopathy, the nurse must be alert for signs and symptoms of cardiac decompensation, which include A. A regular heart rate and hypertension B. An increased urinary output, tachycardia, and dry cough C. Shortness of breath, bradycardia, and hypertension D. Dyspnea; crackles; and an irregular, weak pulse

ANS: D Rationale: Signs of cardiac decompensation include dyspnea; crackles; an irregular, weak, rapid pulse; rapid respirations; a moist, frequent cough; generalized edema; increasing fatigue; and cyanosis of the lips and nail beds. A- These symptoms are not generally associated with cardiac decompensation. B- Of these symptoms, only tachycardia is indicative of cardiac decompensation. C- Of these symptoms, only dyspnea is indicative of cardiac decompensation.

Which clinical sign is not included in the classic symptoms of preeclampsia? A. Hypertension B. Edema C. Proteinuria D. Glycosuria

ANS: D Rationale: Spilling glucose into the urine is not one of the three classic symptoms of preeclampsia. A- The first indication of preeclampsia is usually an increase in the maternal blood pressure. B- The first sign noted by the pregnant woman is a rapid weight gain and edema of the hands and face. C-Proteinuria usually develops later than the edema and hypertension.

The most dangerous effect on the fetus of a mother who smokes cigarettes while pregnant is A. Genetic changes and anomalies B. Extensive central nervous system damage C. Fetal addiction to the substance inhaled D. Intrauterine growth restriction

ANS: D Rationale: The major consequences of smoking tobacco during pregnancy are low-birth-weight infants, prematurity, and increased perinatal loss.

A woman has delivered twins. The first twin was stillborn, and the second is in the intensive care nursery and is recovering quickly from respiratory distress. The woman is crying softly and says, "I wish my baby could have lived." What is the most therapeutic response? A. "Don't be sad. At least you have one healthy baby." B. "How soon do you plan to have another baby?" C. "I have a friend who lost a twin and she's doing just fine now." D. "I am so sorry about your loss. Would you like to talk about it?"

ANS: D Rationale: The nurse should recognize the woman's grief and its significance. A- This is denying the loss of the infant. B- This is denying the loss of the infant and her grief and belittling her feelings. C. This is belittling her feelings.

Which nursing action must be initiated first when evidence of prolapsed cord is found? A. Notify the physician. B. Apply a scalp electrode. C. Prepare the mother for an emergency cesarean delivery. D. Reposition the mother with her hips higher than her head.

ANS: D Rationale: The priority is to relieve pressure on the cord. Changing the maternal position will shift the position of the fetus so that the cord is not compressed. A- Trying to relieve pressure on the cord should be the first priority. B- Trying to relieve pressure on the cord should take priority over increasing fetal monitoring techniques. C- Emergency cesarean delivery may be necessary if relief of the cord is not accomplished.

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 Rationale: Vaginal examination of the cervix may result in perforation of the placenta and subsequent hemorrhage. A- Monitoring FHR and maternal vital signs is a necessary part of the assessment for this woman. B- Monitoring for bleeding and rupture of membranes is not contraindicated with this woman. C- Monitoring contractions is not contraindicated with this woman.

A woman who delivered her third child yesterday has just learned that her two school-age children have contracted chickenpox. What should the nurse tell her? A. The woman's two children should be treated with acyclovir before she goes home from the hospital. B. The baby will acquire immunity from the woman and will not be susceptible to chickenpox. C. The children can visit their mother and sibling in the hospital as planned but must wear gowns and masks. D. The woman must make arrangements to stay somewhere other than her home until the children are no longer contagious.

ANS: D Rationale: Varicella (chickenpox) is highly contagious. Although the baby inherits immunity from the mother, it would not be safe to expose either the mother or the baby. A- Acyclovir is used to treat varicella pneumonia. B- The baby is already born and has received the immunities. If the mother never had chicken pox, she cannot transmit the immunities to the baby. D- Varicella infection occurring in a newborn may be life threatening.

Which statement by a postpartum woman indicates that further teaching is not needed regarded thrombus formation? A. "I'll stay in bed for the first 3 days after my baby is born." B. "I'll keep my legs elevated with pillows." C. "I'll sit in my rocking chair most of the time." D. "I'll put my support stockings on every morning before rising."

ANS: D Rationale: Venous congestion begins as soon as the woman stands up. The stockings should be applied before she rises from the bed in the morning. A. As soon as possible, the woman should ambulate frequently. B. The mother should avoid knee pillows because they increase pressure on the popliteal space. C. Sitting in a chair with legs in a dependent position causes pooling of blood in the lower extremities.

A woman who had two previous cesarean births is in active labor, when she suddenly complains of pain between her scapulae. The nurse's priority action is to A. Reposition the woman with her hips slightly elevated. B. Observe for abnormally high uterine resting tone. C. Decrease the rate of nonadditive intravenous fluid. D. Notify the physician promptly and prepare the woman for surgery.

ANS: D Rationale: Pain between the scapulae may occur when the uterus ruptures, because blood accumulates under the diaphragm. This is an emergency that requires medical intervention. A- Repositioning the woman with her hips slightly elevated is the treatment for a prolapsed cord. That position in this scenario would cause respiratory difficulties. B- Observing for high uterine resting tones should have been done before the sudden pain. High uterine resting tones put the woman at high risk for uterine rupture. C- The woman is now at high risk for shock. Nonadditive intravenous fluids should be increased.

Which condition is a transient, self-limiting mood disorder that affects new mothers after childbirth? A. Postpartum depression B. Postpartum psychosis C. Postpartum bipolar disorder D. Postpartum blues

ANS: D Rationale: Postpartum blues or "baby blues" is a transient self-limiting disease that is believed to be related to hormonal fluctuations after childbirth. A- Postpartum depression is not the normal worries (blues) that many new mothers experience. Many caregivers believe that postpartum depression is underdiagnosed and underreported. B- Postpartum psychosis is a rare condition that usually surfaces within 3 weeks of delivery. Hospitalization of the woman is usually necessary for treatment of this disorder. C- Bipolar disorder is one of the two categories of postpartum psychosis, characterized by both manic and depressive episodes.

__________ is defined as long, difficult, or abnormal labor. It is caused by various conditions associated with the five factors affecting labor.

ANS: Dystocia Rationale: A dysfunctional labor may result from problems with the powers of labor, the passenger, the passage, the psyche or a combination of these.

Of all pregnant women being treated for depression, approximately one-third have a first occurrence during pregnancy. All pregnant and postpartum women should be screened for perinatal mood disorders by using the _________ Postnatal Depression Scale.

ANS: Edinburgh Rationale: The 10-item Edinburgh Postnatal Depression Scale accurately identifies depression in pregnant and postpartum women.

_______________ is the most common postpartum infection.

ANS: Endometritis Rationale: Endometritis usually begins as a localized infection at the placental site; however, can spread to involve the entire endometrium. Assessment for signs of endometritis may reveal a fever, elevated pulse, chills, anorexia, fatigue, pelvic pain, uterine tenderness or foul-smelling profuse lochia.

Should a postpartum complication such as hemorrhage occur, the nursing staff will spring into action to ensure that patient safety needs are met. This level of activity is very reassuring to both the new mother and her family members as they can see that the patient is receiving the best care. Is this statement true or false?

ANS: FALSE Rationale: On the contrary, the unusual activity of the hospital staff may make the mother and her family very anxious. Keeping the family informed is one of the most effective ways of reducing unnecessary anxiety. A comment such as, "I know that all of this activity must be frightening. She is bleeding a little more than we would like, and we are doing several things at once" would be very helpful.

TRUE/FALSE An increasing number of women are now becoming pregnant relatively late in their reproductive lives. The birth rate for women ages 40 to 44 has increased to the highest level in 40 years. Which advances in maternity care these women are at no greater risk for obstetric complications. Is this statement true or false?

ANS: FALSE Rationale: The older women it is definitely at an increased risk for obstetric complications, including spontaneous abortion, gestational diabetes, cesarean births, stillbirth, preeclampsia, placenta previa, abruption, preterm delivery, and low birth weight infants.

The nurse has been caring for a primiparous patient who is suspected of carrying a macrosomic infant. Pushing appears to have been effective so far; however, as soon as the head is born, it retracts against the perineum much like a turtle's head drawing into its shell. In evaluating the labor progress so far, the nurse is aware that this is normal with large infants and extra pushing efforts by the mother may be necessary. Is this statement true or false?

ANS: FALSE Rationale: This is often referred to as the "turtle sign" and is an indication of shoulder dystocia. Delayed or difficult birth of the shoulders may occur if they become impacted above the maternal symphysis pubis. This complication of birth requires immediate intervention because the umbilical cord is compressed and the chest cannot expand within the vagina. Any of several methods may be employed to relieve the impacted shoulders. Shoulder dystocia is unpredictable and although more common in large infants, can occur with a baby of any weight.

Diabetes mellitus is a medical condition that could adversely affect pregnancy. It's frequency is increasing along with obesity and abnormal lipid profiles. Women who have GDM in pregnancy have no greater risk of developing type 2 diabetes. Is this statement true or false?

ANS: FALSE Rationale: Women who develop GDM have a 35% to 60% likelihood of developing diabetes in the next 10 to 20 years. About 7% of all pregnancies are affected by GDM with higher rates among African Americans, Latinas, and American Indians.

TRUE/FALSE Society tends to minimize perinatal loss because of the prevailing belief that there are no barriers to getting pregnant and the expectation that once a woman is pregnant, a healthy, live infant will result. Is this statement true or false?

ANS: TRUE Rationale: Because of these perceptions, grieving parents often do not receive the support they need, and society often allows much too short a time for mothers to grieve (and even less for fathers).

Infant mortality for late preterm infants (34 to 36 weeks) is three times the rate of mortality for term infants. Is this statement true or false?

ANS: TRUE Rationale: This statement is correct. LPI infants may appear full term at birth; however, the appearance of the infant is deceiving. LPI infants have a mortality risk three times that of term infants for death from all causes.

Pulmonary embolism (PE) is a serious complication of deep vein thrombosis (DVT) and the leading cause of maternal mortality. As many as 15% to 25% of all DVTs lead to PEs if not recognized and treated. Is this statement true or false?

ANS: TRUE Rationale: This statement is correct. PE occurs with fragments of a blood clot dislodge and are carried to the lungs. Treatment is aimed at dissolving the clot and maintaining pulmonary circulation. Oxygen is used to decrease hypoxia, and narcotic analgesics are given to reduce pain and apprehension.

Hashimoto's thyroiditis is also known by the more common name of chronic lymphocytic thyroiditis and is the cause of most cases of hypothyroidism and women. Untreated hypothyroidism during pregnancy can adversely affect the child's mental development. Is this statement true or false?

ANS: TRUE Rationale: Thyroid-stimulating hormone levels should be tested either before pregnancy or early in pregnancy, and hypothyroidism should be corrected during the first trimester.

A nurse is caring for a patient in the active phase of labor. The woman's BOW spontaneously ruptures. Suddenly the woman complains of dyspnea and appears restless and cyanotic. Additionally, she becomes hypotensive and tachycardic. The nurse immediately suspects the presence of a(n) _____________.

ANS: amniotic fluid embolism Rationale: Anaphylactoid syndrome of pregnancy (ASP) is more commonly known as amniotic fluid embolism. This is a rare but devastating complication of pregnancy. It is characterized by the sudden, acute onset of hypoxia, hypotension or cardiac arrest, and coagulopathy. ASP can occur during labor, birth, or within 30 minutes after birth. This clinical presentation is similar to that observed in patients with anaphylactic or septic shock. In both of these conditions, a foreign substance is introduced into the circulation.

The antidote administered to reverse magnesium toxicity is ______________.

ANS: calcium gluconate Rationale: Calcium gluconate is the antidote necessary to reverse magnesium toxicity. The nurse caring for this patient should keep calcium gluconate in the room along with secured, syringes and needles.

The leading cause of life threatening perinatal infections in the United States is ________ (GBS).

ANS: group B streptococcus Rationale: This gram-positive bacteria is colonized in the rectum, anus, vagina, and urethra of pregnant and non-pregnant women. UTI, chorioamnionitis, and endometritis can occur during pregnancy. Transmission to the fetus can cause the most serious of infections. GBS testing of all women should be performed at 35 to 37 weeks of gestation and treatment with antibiotics should be initiated if indicated.

Recurrent spontaneous abortion refers to a condition in which a woman experiences three or more consecutive abortions or miscarriages. This is also known as ________ abortion.

ANS: habitual Rationale: Primary causes are believed to be genetic or chromosomal abnormalities of the fetus. For the mother who repeatedly aborts, the cause is often an anomaly of the reproductive tract such as bicornate uterus or incompetent cervix. Systemic illnesses such as lupus erythematosus and diabetes mellitus have been implicated in this condition as well. Treatment depends entirely on the cause and therefore varies between medical and surgical approaches.

The nurse is in the process of assessing the comfort level of her postpartum patient. Excess bleeding is not obvious; however, the new mother complains of deep, severe pelvic pain. The registered nurse (RN) has noted both skin and vital sign changes. This patient may have formed a(n) ________.

ANS: hematoma Rationale: Hematomas occur as a result of bleeding into loose connective tissue while the overlying tissue remains intact. A hematoma can develop after either a spontaneous or an instrumental vaginal delivery when blood vessels are injured. They are most likely to occur in the vulvar, vaginal, or retroperitoneal areas. The nurse should examine the vulva for a bulging mass or skin discoloration and intervene as necessary.

The standard of care for women who are dependent on heroin or other narcotics is ___________ maintenance treatment (MMT).

ANS: methadone Rationale: Methadone maintenance treatment should be offered as part of a comprehensive care program that includes behavior therapy and support services. MMT has been shown to decrease opioid and other drug abuse, decrease criminal activity, improve individual functioning, and decrease the HIV rate.

The condition in which the placenta is implanted in the lower uterine segment near or over the internal cervical os is _____________.

ANS: placenta previa Rationale: In placenta previa, the placenta is implanted in the lower uterine segment such that it completely or partially covers the cervix or is close enough to the cervix to cause bleeding when the cervix dilates or the lower uterine segment effaces.