ATI Maternal Newborn (continue)

[Ch. 20 - Postpartum Disorders] A nurse on the postpartum unit is assessing a client who is being admitted with a suspected deep-vein thrombosis (DVT). Which of the following clinical findings should the nurse expect? (Select all that apply.) A. Calf tenderness to palpation B. Mottling of the affected extremity C. Elevated temperature D. Area of warmth E. Report of nausea

*A. CORRECT: A client report of calf tenderness to palpation is an expected finding in a client who has a DVT. *C. CORRECT: Elevated temperature is an expected finding in a client who has a DVT. *D. CORRECT: An area of warmth over the thrombus is an expected finding in a client who has a DVT. B. Mottling of the affected extremity is not an expected finding in a client who has a DVT. E. A report of nausea is not an expected finding in a client who has a DVT.

[Ch. 12 - Pain Management] A nurse is caring for a client who is in the second stage of labor. The client's labor has been progressing,and a vaginal delivery is expected in 20 min. The provider is preparing to administer lidocaine for pain relief and perform an episiotomy. The nurse should know that which of the following types of regional anesthetic block is to be administered? A. Pudendal B. Epidural C. Spinal D. Paracervical

*A. CORRECT: A pudendal block is a transvaginal injection of local anesthetic that anesthetizes the perineal area for the episiotomy and repair, and the expulsion of the fetus. B. Epidural blocks are administered during labor and allow the client to participate in the second stage while remaining comfortable. C. Spinal blocks are administered in the late second stage but most commonly preceding a cesarean birth. D. paracervical blocks are used early in labor to block pain of uterine contractions but are rarely used today.

[Ch. 20 - Postpartum Disorders] A nurse is caring for a client who is postpartum. The nurse should identify which of the following findings as an early indicator of hypovolemia caused by hemorrhage? A. Increasing pulse and decreasing blood pressure B. Dizziness and increasing respiratory rate C. Cool, clammy skin, and pale mucous membranes D. Altered mental status and level of consciousness

*A. CORRECT: A rising pulse rate and decreasing blood pressure are often the first indications B. Dizziness and increased respiratory rate are findings that occur in hypovolemia, but they are not the earliest indicators. C. Skin that is cool, clammy, and pale, along with pale mucous membranes, are changes that occur in the physical status of a client who has decreased blood volume, but they are not the first indicators of inadequate blood volume. D. Altered mental status and changes in level of consciousness are late manifestations of decreased blood volume,which leads to hypoxia and low oxygen saturation.

[Ch. 10 - Early Onset of Labor] A nurse is caring for a client who reports manifestations of preterm labor. Which of the following findings are risk factors of this condition? (Select all that apply). A. Urinary tract infection B. Multifetal pregnancy C. Hydramnios D. Diabetes mellitus E. Uterineabnormalities

*A. CORRECT: A urinary tract infection is a risk factor of preterm labor. *B. CORRECT: Multifetal pregnancy is a risk factor of preterm labor. *C. CORRECT: Hydramnios (excessive amniotic fluid) is a risk factor for preterm labor. *D. CORRECT: Diabetes mellitus is a risk factor of preterm labor. *E. CORRECT: Uterine abnormalities are a risk factor of preterm labor.

[Ch. 10 - Early Onset of Labor] A nurse is caring for a client who has a prescription for magnesium sulfate. The nurse should recognize that which of the following are contraindications for use of this medication? (Select all that apply.) A. Fetal distress B. Preterm labor C. Vaginal bleeding D. Cervical dilation greater than 6 cm E. Severe Gestational Hypertension

*A. CORRECT: Acute fetal distress is a complication that is a contraindication for use of magnesium sulfate therapy. *C. CORRECT: Vaginal bleeding is a complication that is a contraindication for magnesium sulfate therapy. *D. CORRECT: Cervical dilation greater than 6 cm is a complication that is a contraindication for magnesium sulfate therapy. B. preterm labor is an indication for use of magnesium sulfate. E. Severe gestational hypertension is an indication for the use of magnesium sulfate.

[Ch. 3 - Expected Physiological Changes During Pregnancy] A nurse is caring for a client who is pregnant and states that their last menstrual period was April 1st. Which of the following is the client's estimated date of delivery? A. January 8 B. January 15 C. February 8 D. February 15

*A. CORRECT: April 1st minus 3 months plus 7 days and 1 year equals an estimated date of delivery of January 8.

[Ch. 8 - Infections] A nurse is caring for a client who has gonorrhea. Which of the following medications should the nurse expect the provider will prescribe? A. Ceftriaxone B. Fluconazole C. Metronidazole D. Zidovudine

*A. CORRECT: Ceftriaxone IM or doxycycline orally for 7 days is prescribed for the treatment of gonorrhea. B. Fluconazole is used to treat candidiasis. C. Metronidazole is used in the treatment of bacterial vaginosis and trichomoniasis. D. Zidovudine is used to treat HIV/AIDS.

[Ch. 15 - Therapeutic Procedures to Assist with Labor and Delivery] A nurse educator in the labor and delivery unit is reviewing the use of chemical agents to promote cervical ripening with a group of newly licensed nurses. Which of the following statements by a nurse indicates understanding of the teaching? A. "They are tablets administered vaginally." B. "They act by absorbing fluid from tissues." C. "They promote dilation of the os." D. "They include an amniotomy."

*A. CORRECT: Chemical agents that promote cervical ripening include medications administered vaginally. B. Hygroscopic dilators, which are a mechanical method to promote cervical ripening, act by absorbing fluid from surrounding tissues to enlarge the cervical opening. C. Mechanical and physical methods promote cervical ripening by dilation. D. An amniotomy is a mechanical method to promote cervical ripening.

[Ch. 1 - Contraception] A nurse in a health clinic is reviewing contraceptive use with a group of clients. Which of the following client statements demonstrates understanding? A. "A water-soluble lubricant should be used with condoms." B. "A diaphragm should be removed 2 hours after intercourse." C. "Oral contraceptives can worsen a case of acne." D. "A contraceptive patch is replaced once a month."

*A. CORRECT: Condoms are used with water-soluble lubricants. B. A diaphragm should be removed no sooner than 6 hr and no later than 24 hr after intercourse. C. Acne is reduced when taking oral contraceptives. D. Contraceptive patches are replaced once a week.

[Ch. 20 - Postpartum Disorders] A nurse is caring for a client who has disseminated intravascular coagulation (DIC). Which of the following antepartum complications should the nurse understand is a risk factor for this condition? A. Preeclampsia B. Thrombophlebitis C. Placenta previa D. Hyperemesis gravidarum

*A. CORRECT: DIC can occur secondary in a client who has preeclampsia. B. Thrombophlebitis is not a risk factor for DIC. C. placenta previa is not a risk factor for DIC. D. Hyperemesis gravidarum is not a risk factor for DIC.

[Ch. 6 - Assessment of Fetal Well-Being] A nurse is caring for a client who is pregnant and is to undergo a contraction stress test (CST). Which of the following findings are indications for this procedure? (Select all that apply.) A. Decreased fetal movement B. Intrauterine growth restriction (IUGR) C. Postmaturity D. Placenta Previa E. Amniotic Fluid Emboli

*A. CORRECT: Decreased fetal movement is an indication for a CST. *B. CORRECT: IUGR is an indication for a CST. *C. CORRECT: postmaturity is an indication for a CST. D. placenta previa is a contraindication of a CST.E. Amniotic fluid emboli are a complication of an amniocentesis.

[Ch. 8 - Infections] A nurse is caring for a client who is in labor. The nurse should identify that which of the following infections can be treated during labor or immediately following birth? (Select all that apply.) A. Gonorrhea B. Chlamydia C. HIV D. Group B streptococcus beta-hemolytic E. TORCH infection

*A. CORRECT: Erythromycin is administered to the infant immediately following delivery to prevent Neisseria gonorrhoeae. *B. CORRECT: Erythromycin is administered to the infant immediately following delivery to prevent Chlamydia trachomatis. *C. CORRECT: Retrovir is prescribed to a client in labor who is HIV-positive. *D. CORRECT: Penicillin G or ampicillin may be prescribed to treat positive GBS. E. A TORCH infection can be treated during pregnancy depending upon the infection.

[Ch. 5 - Nutrition During Pregnancy] A nurse in a prenatal clinic is providing education to a client who is at 8 weeks of gestation. The client states, "I don't like milk." Which of the following foods should the nurse recommend as a good source of calcium? A. Dark green leafy vegetables B. Deep red or orange vegetables C. White breads and rice D. Meat, poultry, and fish

*A. CORRECT: Good sources of calcium for bone and teeth formation include low-oxalate, dark green leafy vegetables (kale, artichokes, turnip greens). B. Deep red or orange vegetables are good sources of vitamins C and A. C. White breads and rice do not contain high levels of calcium. D. Meat, poultry, and fish are sources of protein but do not contain high levels of calcium.

[Ch. 16 - Complications Related to the Labor Process] A nurse is caring for a client who is in active labor and reports severe back pain. During assessment, the fetus is noted to be in the occiput posterior position. Which of the following maternal positions should the nurse suggest to the client to facilitate normal labor progress? A. Hands and knees B. Lithotomy C. Trendelenburg D. Supine with a rolled towel under one hip

*A. CORRECT: Having the client assume a position on both hands and knees can help the fetus rotate from a posterior to an anterior position. B. The lithotomy position is when the client lies on the back with both knees elevated and does not facilitate labor progression. C. The Trendelenburg position requires the client to lie on the back and does not assist in the rotation of the fetus. D. The supine position with a rolled towel under one hip can assist in preventing vena cava syndrome but does not assist in the rotation of the fetus.

[Ch. 11 - Labor and Delivery Processes] A nurse is caring for a client having contractions every 8 min that are 30 to 40 seconds in duration. The client's cervix is 2 cm dilated, 50% effaced, and the fetus is at a -2 station with a FHR around 140/min. Which of the following stages and phases of labor is this client experiencing? A. First stage, latent phase B. First stage, active phase C. First stage, transition phase D. Second stage of labor

*A. CORRECT: In stage 1, latent phase, the cervix dilates from 0 to 3 cm, and contraction duration ranges from 30 to 45 seconds. B. In stage 1, active phase, the cervix dilates from 4 to 7 cm, and contraction duration ranges from 40 to 70 seconds. C. In stage 1, transition phase, the cervix dilates from 8 to 10 cm, and contraction duration ranges from 45 to 90 seconds. D. The second stage of labor consists of the expulsion of the fetus.

[Ch. 4 - Prenatal Care] A client who is at 7 weeks of gestation is experiencing nausea and vomiting in the morning. Which of the following information should the nurse include? A. Eat crackers or plain toast before getting out of bed. B. Awaken during the night to eat a snack. C. Skip breakfast and eat lunch after nausea has subsided. D. Eat a large evening meal.

*A. CORRECT: Nausea and vomiting during the first trimester might be relieved by eating crackers or plain toast prior to rising in the morning. B. Eating during the night can cause heartburn and does not relieve nausea and vomiting during the first trimester. C. Instruct the client to avoid an empty stomach for prolonged periods to reduce nausea and vomiting. D. Eating a large meal in the evening can cause heartburn and does not relieve morning nausea and vomiting.

[Ch. 2 - Infertility] A nurse in an infertility clinic is providing care to clients who have been unable to conceive for 18 months. Which of the following data should the nurse assess? (Select all that apply.) A. Occupation B. Menstrual history C. Childhood infectious diseases D. History of falls E. Recent blood transfusions

*A. CORRECT: Occupational hazards include exposure to teratogenic substances in the workplace (radiation, chemicals, herbicides, pesticides). B. CORRECT: Menstrual history can identify hormone-related patterns (anovulation, pituitary disorders, endometriosis). C. CORRECT: Childhood infectious diseases can identify the male partner having had the mumps. D. A history of falls is not a consideration in the assessment. E. A recent blood transfusion is not a consideration in the assessment.

[Ch. 15 - Therapeutic Procedures to Assist with Labor and Delivery] A nurse is caring for a client who is 42 weeks of gestation and is having an ultrasound. For which of the following conditions should the nurse plan for an amnioinfusion? (Select all that apply.) A. Oligohydramnios B. Hydramnios C. Fetal cord compression D. Hydration E. Fetal immaturity

*A. CORRECT: Oligohydramnios is an indication for an amnioinfusion because inadequate amniotic fluid can contribute to intrauterine growth restriction of the fetus, restrict fetal movement, and cause fetal distress during labor. *C. CORRECT: Oligohydramnios results in fetal cord compression, which decreases fetal oxygenation. Amnioinfusion prevents cord compression. B. Hydramnios is excessive amniotic fluid. D. Amnioinfusion does not increase hydration. IV fluids or oral intake would provide hydration. E. Fetal immaturity is not a reason for performing an amnioinfusion.

[Ch. 20 - Postpartum Disorders] A nurse educator on the postpartum unit is reviewing risk factors for postpartum hemorrhage with a group of nurses. Which of the following factors should the nurse include in the teaching? (Select all that apply.) A. Precipitous delivery B. Obesity C. Inversion of the uterus D. Oligohydramnios E. Retained Placental Fragments

*A. CORRECT: Rapid, precipitous delivery is a risk factor for postpartum hemorrhage. *C. CORRECT: Inversion of the uterus in a risk factor for postpartum hemorrhage. *E. CORRECT: Retained placental fragments is a risk factor for postpartum hemorrhage. B. Obesity is not a risk factor for postpartum hemorrhage. D. Oligohydramnios does not place a client at risk for postpartum hemorrhage.

[Ch. 8 - Infections] A nurse in an antepartum clinic is assessing a clientwho has a TORCH infection. Which of the following findings should the nurse expect? (Select all that apply.) A. Joint pain B. Malaise C. Rash D. Urinary frequency E. Tender lymph nodes

*A. CORRECT: TORCH infections are flu-like in presentation, such as joint pain. *B. CORRECT: TORCH infections are flu-like in presentation, such as malaise. *C. CORRECT: TORCH infections can include findings such as a rash. 8E. CORRECT: TORCH infections are flu-like in presentation, such as tender lymph nodes. D. Urinary frequency is not a clinical finding associated with a TORCH infection.

[Ch. 17 - Postpartum Physiological Adaptations] A nurse is performing a fundal assessment for a client who is 2 days postpartum and observes the perineal pad for lochia. The pad is saturated approximately 12 cm with lochia that is bright red and contains small clots. Which of the following findings should the nurse document? A. Moderate lochia rubra B. Excessive lochia serosa C. Light lochia rubra D. Scant lochia serosa

*A. CORRECT: The client has moderate lochia rubra containing small clots, which is an expected finding for the second day postpartum. B. Excessive lochia serosa is indicated by saturation of a perineal pad in 15 min or less, or pooling of blood under the buttocks. C. Light lochia rubra is a perineal pad that is saturated less than 10 cm with lochia. D. Scant lochia serosa (less than 2.5 cm on perineal pad) is pinkish brown in color and serosanguineous in consistency. It occurs on day 4 to 12 following delivery.

[Ch. 13 - Fetal Assessment During Labor] A nurse is caring for a client who is in labor and observes late decelerations on the electronic fetal monitor. Which of the following is the first action the nurse should take? A. Assist the client into the left-lateral position. B. Apply a fetal scalp electrode. C. Insert an IV catheter. D. perform a vaginal exam.

*A. CORRECT: The greatest risk to the fetus during late decelerations is uteroplacental insufficiency. The initial nursing action should be to place the client into the left- lateral position to increase uteroplacental perfusion. B. The application of a fetal scalp electrode will assist in the assessment of fetal well-being, but this is not the first action to take. C. Inserting an IV catheter is an intervention for late decelerations, but this is not the first action to take. D. The nurse may perform a vaginal exam to assess dilation, but this is not the first action to take.

[Ch. 2 - Infertility] A nurse in a clinic is caring for a client who is postoperative following a salpingectomy due to an ectopic pregnancy. Which of the following statements by the client requires clarification? A. "It is good to know that I won't have a tubal pregnancy in the future." B. "The doctor said that this surgery can affect my ability to get pregnant again." C. "I understand that one of my fallopian tubes had to be removed." D. "Ovulation can still occur because my ovaries were not affected."

*A. CORRECT: The risk of recurrence of an ectopic pregnancy is increased following an ectopic pregnancy. B. Infertility can occur as a result of an ectopic pregnancy. C. A salpingectomy involves the removal of a fallopian tube. D. A salpingectomy does not involve the removal of the ovaries.

[Ch. 14 - Nursing Care During Stages of Labor] A nurse is caring for a client in the third stage of labor. Which of the following findings indicate placental separation? (Select all that apply.) A. Lengthening of the umbilical cord B. Swift gush of clear amniotic fluid C. Softening of the lower uterine segment D.Appearance of dark blood from the vagina E. Fundus firm upon palpation

*A. CORRECT: The umbilical cord lengthens as the placenta is being expulsed. *D. CORRECT: A gush of dark blood from the introitus is an indication of placental separation. *E. CORRECT: The uterus contracts firmly B. A sudden gush of clear amniotic fluid occurs when membranes rupture. C. Softening of the lower uterine segment is not an indication of placental separation.

[Ch. 14 - Nursing Care During Stages of Labor] A nurse is caring for a client in the third stage of labor. Which of the following findings indicate placental separation? (Select all that apply.) A. Lengthening of the umbilical cord B. Swift gush of clear amniotic fluid C. Softening of the lower uterine segment D. Appearance of dark blood from the vagina E. Fundus firm upon palpation

*A. CORRECT: The umbilical cord lengthens as the placenta is being expulsed. *D. CORRECT: A gush of dark blood from the introitus is an indication of placental separation. *E. CORRECT: The uterus contracts firmly with placental separation. B. A sudden gush of clear amniotic fluid occurs when membranes rupture. C. Softening of the lower uterine segment is not an indication of placental separation.

[Ch. 8 - Infections] A nurse is admitting a client who is in labor and has HIV. Which of the following interventions should the nurse identify as contraindicated for this client? (Select all that apply.) A. Vacuum extractor B. Oxytocin infusion C. Forceps D. Cesarean birth E. Internal Fetal Monitoring

*A. CORRECT: The use of a vacuum extractor should be avoided for a client who is HIV positive due to risk of exposing the fetus to maternal blood. *C. CORRECT: The use of forceps during delivery should be avoided due to the risk of fetal bleeding. *E. CORRECT: Internal fetal monitoring should be avoided due to the risk of fetal bleeding. B. Oxytocin infusion is not contraindicated for this client. D. Cesarean birth is not contraindicated for this client.

[Ch. 12 - Pain Management] A nurse is caring for a client who is at 40 weeks of gestation and experiencing contractions every 3 to 5 min and becoming stronger. A vaginal exam reveals that the client's cervix is 3 cm dilated, 80% effaced, and -1 station. The client asks for pain medication. Which of the following actions should the nurse take? (Select all that apply.) A. Encourage use of patterned breathing techniques. B. Insert an indwelling urinary catheter. C. Administer opioid analgesic medication. D. Suggest application of cold. E. Provide ice chips.

*A. CORRECT: The use of patterned breathing techniques can assist with pain management at this time. *C. CORRECT: An opioid analgesic can be safely administered at this time. *D. CORRECT: The use of a non-pharmacological approach, such as the application of cold, is an appropriate intervention at this time. B. There is no indication for the insertion of an indwelling urinary catheter at this time. E. This action does not address the client's request for assistance with pain management.

[Ch. 13 - Fetal Assessment During Labor] A nurse is caring for a client who is in active labor. The cervix is dilated to 5 cm, and the membranes are intact. Based on the use of external electronic fetal monitoring, the nurse notes a FHR of 115 to 125/min with occasional increases up to 150 to 155/ min that last for 25 seconds and have moderate variability. There is no slowing of the FHR from the baseline. This client is exhibiting manifestations of which of the following? (Select all that apply.) A. Moderate variability B. FHR accelerations C. FHR decelerations D. Normal baseline FHR E. Fetal tachycardia

*A. CORRECT: There is moderate variability of 20/min. (6 to 25/min is expected reference range.) *B. CORRECT: FHR accelerations are present with increases up to 150 to 155/min lasting for 25 seconds. *D. CORRECT: There is a normal baseline FHR of 115 to 125/min that falls within the expected reference range of 110 to 160/min. C. There are no FHR decelerations because the FHR does not slow down. E. There is no evidence of fetal tachycardia because the FHR is within the expected reference range of 115 to 125/min.

[Ch. 17 - Postpartum Physiological Adaptations] A nurse is providing education to a client who is 2 hr postpartum and has perineal laceration. Which of the following information should the nurse include? (Select all that apply.) A. Use a perineal squeeze bottle to cleanse the perineum. B. Sit on the perineum while resting in bed. C. Apply a topical anesthetic cream or spray to the perineum. D. Wipe the perineum thoroughly with a back-and-forth motion. E. Apply cold or ice packs to the perineum.

*A. CORRECT: Use a perineal squeeze bottle filled with warm water to cleanse the perineum and *C. CORRECT: The application of a topical anesthetic cream or spray to the perineum will promote comfort.promote healing. *E. CORRECT: The application of cold or ice packs to the perineum will promote comfort and decrease swelling. B. Sitting supine on the perineum while resting in bed will apply more pressure to the area. Instead, the client should lay on one side when possible. D. The client should blot the perineum to dry it from front to back using toilet paper or wipes.

[Ch. 4 - Prenatal Care] A nurse is caring for a client who is pregnant and reviewing manifestations of complications the client should promptly report to the provider. Which of the following complications should the nurse include? A. Vaginal bleeding B. Swelling of the ankles C. Heartburn after eating D. Lightheadedness when lying on back

*A. CORRECT: Vaginal bleeding indicates a potential complication of the placenta such as placenta previa. Instruct the client to notify the provider immediately. B. Swelling of the ankles is a common occurrence during pregnancy and can be relieved by sitting with the legs elevated. C. Heartburn occurs during pregnancy due to pressure on the stomach by the enlarging uterus. It can be relieved by eating small meals. D. Supine hypotension can be experienced by the client who feels lightheaded or faint when lying on their back. Instruct the client about the side-lying position to remove pressure of the uterus on the vena cava.

[Ch. 15 - Therapeutic Procedures to Assist with Labor and Delivery] A nurse is caring for a client who has been in labor for 12 hr with intact membranes. The nurse performs a vaginal examination to ensure which of the following prior to the performance of the amniotomy? A. Fetal engagement B. Fetal lie C. Fetal attitude D. Fetal position

*A. CORRECT: prior to the performance of an amniotomy, it is imperative that the fetus is engaged at 0 station and at the level of the maternal ischial spines to prevent prolapse of the umbilical cord. B. Fetal lie pertains to the axis of the maternal spine in relation to the fetal spine and is determined by Leopold maneuvers. C. Fetal attitude is the relationship of the fetal extremities and chin to the fetal torso. It is determined by Leopold maneuvers. D. Fetal position refers to the direction of a reference point in the fetal presenting part to the maternal pelvis. It is not a criterion when performing an amniotomy.

[Ch. 13 - Fetal Assessment During Labor] A nurse is teaching a client about the benefits of internal fetal heart monitoring. Which of the following statements should the nurse include? (Select all that apply.) A. "It is considered a noninvasive procedure." B. "It can detect abnormal fetal heart tones early." C. "It can determine the amount of amniotic fluid you have." D. "It allows for accurate readings with maternal movement." E. "It can measure uterine contraction intensity."

*B. CORRECT: A benefit of internal fetal monitoring is that it can detect abnormal fetal heart tones early. *D. CORRECT: A benefit of internal fetal monitoring is that it allows for accurate readings with maternal movement which external monitoring needs adjusting when the client moves. *E. CORRECT: A benefit of internal fetal monitoring is that it can measure uterine contraction intensity which external monitoring cannot. A. A disadvantage of internal fetal monitoring is that it is an invasive procedure. C. Internal fetal monitoring cannot determine the amount of amniotic fluid.

[Ch. 17 - Postpartum Physiological Adaptations] A nurse is completing postpartum discharge teaching to a client who had no immunity to varicella and was given the varicella vaccine. Which of the following statements by the client indicates understanding of the teaching? A. "I will need to use contraception for 3 months before considering pregnancy." B. "I need a second vaccination at my postpartum visit." C. "I was given the vaccine because my baby is O-positive." D. "I will be tested in 3 months to see if I have developed immunity."

*B. CORRECT: A second varicella immunization is needed at 4 to 8 weeks following delivery by clients who had no history of immunity. A. A client is instructed to not get pregnant for 1 month following administration of varicella vaccine. C. Rho(D) immune globulin is administered to an Rh- negative client who has an Rh-positive newborn. D. A client requires testing for immunity at 3 months following administration of rubella vaccine and Rho(D) immune globulin.

[Ch. 6 - Assessment of Fetal Well-Being] A nurse is caring for a client who is in preterm labor and is scheduled to undergo an amniocentesis. The nurse should evaluate which of the following tests to assess fetal lung maturity? A. Alpha-fetoprotein (AFp) B. Lecithin/sphingomyelin (L/S) ratio C. Kleihauer-Betke test D. Indirect Coombs' test

*B. CORRECT: A test of the L/S ratio is done as a part of an amniocentesis to determine fetal lung maturity. A. AFP is a test to assess for fetal neural tube defects or chromosome disorders. C. A Kleihauer-Betke test is used to verify that fetal blood is present during a percutaneous umbilical blood sampling procedure. D. An indirect Coombs' test detects Rh antibodies in the mother's blood.

[Ch. 16 - Complications Related to the Labor Process] A nurse is caring for a client in active labor. When last examined 2 hr ago, the client's cervix was 3cm dilated, 100% effaced, membranes intact, and the fetus was at a -2 station. The client suddenly states, "My water broke." The monitor reveals a FHR of 80 to 85/min, and the nurse performs a vaginal examination, noticing clear fluid and a pulsing loop of umbilical cord in the client's vagina. Which of the following actions should the nurse perform first? A. Place the client in the Trendelenburg position. B. Apply pressure to the presenting part with the fingers. C. Administer oxygen at 10 L/min via a face mask. D. Initiate IV fluids.

*B. CORRECT: According to evidence-based practice apply pressure to the presenting part with the fingers. A. The nurse should place the client in the Trendelenburg position. However, another action/assessment is the priority. C. The nurse should administer oxygen at 10 L/min via a face mask. However, another action/assessment is the priority. D. The nurse should initiate IV fluids. However, another action/assessment is the priority.

[Ch. 2 - Infertility] A nurse is reviewing the medical record of a client who is to undergo hysterosalpingography. Which of the following data alert the nurse that the client is at risk for a complication related to this procedure? VITAL SIGNS Temperature 36.1° C (97° F) Heart rate 60/min HISTORYAND PHYSICAL Employed as a radiology technician Allergy to shrimp Tonsillectomy at age 18 LABORATORY FINDINGS Glucose 103 mg/dL Hgb 13.1 g/dL Total cholesterol 265 mg/dL MEDICATIONS Rosuvastatin Magnesium Oxide Mafenide Acetate A. Vital signs B. History and physical C. Laboratory findings D. Medications

*B. CORRECT: An allergy to seafood is a contraindication to the dye used in hysterosalpingography. A. An elevated heart rate or temperature could indicate infection, which would be a contraindication to the procedure. C. The client's total cholesterol is elevated, but this does not place the client at risk for a complication related to the procedure. D. There are no contraindications related to the medications the client is taking.

[Ch. 10 - Early Onset of Labor] A nurse is caring for a client who is receiving nifedipine for prevention of preterm labor. The nurse should monitor the client for which of the following manifestations? A. Blood-tinged sputum B. Dizziness C. Pallor D. Somnolence

*B. CORRECT: Dizziness and lightheadedness are associated with orthostatic hypotension, which occurs when taking nifedipine. A. Blood-tinged sputum production is an adverse effect associated with indomethacin. C. Facial flushing and heat sensation are adverse effects associated with nifedipine. D. Nervousness, jitteriness, and sleep disturbances are adverse effects associated with nifedipine.

[Ch. 4 - Prenatal Care] A client who is at 8 weeks of gestation tells the nurse "I am not sure I am happy about being pregnant." Which of the following responses should the nurse make? A. "I will inform the provider that you are having these feelings." B. "It is normal to have these feelings during the first few months of pregnancy." C. "You should be happy that you are going to bring new life into the world." D. "I am going to make an appointment with the counselor for you to discuss these thoughts."

*B. CORRECT: Feelings of ambivalence about pregnancy are normal during the first trimester. A. This is a nontherapeutic response by the nurse and does not acknowledge the client's concerns. C. This is a nontherapeutic response by the nurse and indicates disapproval. D. This is a nontherapeutic response by the nurse and does not acknowledge the client's feelings.

[Ch. 6 - Assessment of Fetal Well-Being] A nurse is reviewing findings of a client's biophysical profile (BPP). The nurse should expect which of the following variables to be included in this test? (Select all that apply.) A. Fetal weight B. Fetal breathing movement C. Fetal tone D. Fetal position E. Amniotic fluid volume

*B. CORRECT: Fetal breathing movements are included in the Bpp. *C. CORRECT: Fetal tone is included in the Bpp. *E. CORRECT: Amniotic fluid volume is included in the Bpp. A. Fetal weight is not one of the variables included in the Bpp. D. Fetal position is not included in the Bpp.

[Ch. 3 - Expected Physiological Changes During Pregnancy] A nurse is reviewing the health record of a client whois pregnant. The provider indicated the client exhibits probable signs of pregnancy. Which of the following findings should the nurse expect? (Select all that apply.) A. Montgomery's glands B. Goodell's sign C. Ballottement D. Chadwick's sign E. Quickening

*B. CORRECT: Goodell's sign is a probable sign of pregnancy. *C. CORRECT: Ballottement is a probable sign of pregnancy. *D. CORRECT: Chadwick's sign is a probable sign of pregnancy. A. Montgomery's glands are a presumptive sign of pregnancy. E. Quickening is a presumptive sign of pregnancy.

[Ch. 16 - Complications Related to the Labor Process] A nurse is caring for a client who is in labor and experiencing incomplete uterine relaxation between hypertonic contractions. The nurse should identify that this contraction pattern increases the risk for which of the following complications? A. Prolonged labor B. Reduced fetal oxygen supply C. Delayed cervical dilation D. Increased maternal stress

*B. CORRECT: Inadequate uterine relaxation results in reduced oxygen supply to the fetus. A. Precipitous labor, not prolonged labor, is often the result of hypertonic contractions and inadequate uterine relaxation between contractions. C. Hypertonic contractions and inadequate relaxation of the uterus between contractions does not delay cervical dilation. D. A contraction pattern of hypertonic contractions and inadequate relaxation between contractions will increase maternal distress, but this is not an adverse effect.

[Ch. 1 - Contraception] A nurse is teaching a client about potential adverse effects of implantable progestins. Which of the following adverse effects should the nurse include? (Select all that apply.) A. Tinnitus B. Irregular vaginal bleeding C. Weight gain D. Nausea E. Gingivalhyperplasia

*B. CORRECT: Irregular vaginal bleeding is a potential adverse effect of implantable progestins. *C. CORRECT: Weight gain is a potential adverse effect of implantable progestins. *D. CORRECT: Nausea is a potential adverse effect of implantable progestins. A. Tinnitus is not an adverse effect of implantable progestins. E. Gingival hyperplasia is not a potential adverse effect of implantable progestins.

[Ch. 15 - Therapeutic Procedures to Assist with Labor and Delivery] A nurse is caring for a client who is receiving oxytocin for induction of labor and has an intrauterine pressure catheter (IUpC) placed to monitor uterine contractions. For which of the following contraction patterns should the nurse discontinue the infusion of oxytocin? A. Frequency of every 2 min B. Duration of 90 to 120 seconds C. Intensity of 60 to 90 mm Hg D. Resting tone of 15 mm Hg

*B. CORRECT: Oxytocin is discontinued if uterine tachysystole occurs with contraction duration longer than 90 seconds. A. This contraction pattern does not require discontinuing the infusion of oxytocin. C. This contraction pattern does not require discontinuing the infusion of oxytocin. D. This contraction pattern does not require discontinuing the infusion of oxytocin.

[Ch. 11 - Labor and Delivery Processes] A nurse is completing an admission assessment fora client who is 39 weeks of gestation and reportsfluid leaking from the vagina for 2 days. Which of the following conditions is the client at risk for developing? A. Cord prolapse B. Infection C. Postpartum Hemorrhage D. Hydramnios

*B. CORRECT: Rupture of membranes for longer than 24 hr prior to delivery increases the risk that infectious organisms will enter the vagina and then eventually into the uterus. A. Although cord prolapse is a risk with rupture of membranes, it occurs when the fluid rushes out, rather than trickling or leaking out. C. The risk for postpartum hemorrhage by this client is not any greater than other clients who are pregnant.D. This client is more likely to have oligohydramnios or insufficient amniotic fluid, rather than hydramnios, or excess amniotic fluid.

[Ch. 12 - Pain Management] A nurse is caring for a client who is in active labor. The client reports lower-back pain. The nurse suspects that this pain is related to a persistent occiput posterior fetal position. Which of the following nonpharmacological nursing interventions should the nurse recommend to the client? A. Abdominal effleurage B. Sacral counterpressure C. Showering if not contraindicated D. Back rub and massage

*B. CORRECT: Sacral counterpressure to the lower back relieves the pressure exerted on the pelvis and spinal nerves by the fetus. A. Abdominal effleurage is an appropriate pain management technique but does not address the pressure on the pelvis due to the fetal position. C. A shower is an appropriate pain management strategy but does not address the pressure on the pelvis due to the fetal position. D. A back rub with massage is an appropriate pain management strategy but does not address the pressure on the pelvis due to the fetal position.

[Ch. 11 - Labor and Delivery Processes] A nurse is caring for a client who is 40 weeks of gestation and reports having large gush of fluid from the vagina while walking from the bathroom. Which of the following actions should the nurse take first? A. Examine the amniotic fluid for meconium. B. Check the FHR. C. Dry the client and make them comfortable. D. Apply a tocotransducer.

*B. CORRECT: The greatest risk to the client and fetusis umbilical cord prolapse, leading to fetal distress following rupture of membranes. The first action to take is to check the FHR for clinical findings of distress. A. Assess the color, clarity, odor, and amount of amniotic fluid, but this is not the first action to take. C. provide comfort by drying the client following rupture of the membranes, but this is not the first action to take. D. Apply a tocotransducer to the client's uterine contraction pattern after rupture of the membranes, but this is not the first action to take.

[Ch. 5 - Nutrition During Pregnancy] A nurse in a prenatal clinic is caring for four clients. Which of the following clients' weight gain should the nurse report to the provider? A. 1.8 kg (4 lb) weight gain and is in the first trimester B. 3.6 kg (8 lb) weight gain and is in the first trimester C. 6.8 kg (15 lb) weight gain and is in the second trimester D. 11.3 kg (25 lb) weight gain and is in the third trimester

*B. CORRECT: The nurse should be concerned about this client because they have exceeded the expected 3- to 4-lb weight gain of a client in the first trimester. A. This client has gained the appropriate weight of 3 to 4 lb for a client in the first trimester. C. This client has gained the appropriate weight of 3 to 4 lb. in the first trimester and approximately 1 lb per week in the second trimester. D. This client is within the recommended weight gain of 25 to 35 lb during the third trimester.

[Ch. 14 - Nursing Care During Stages of Labor] A nurse is caring for a client who is in the transition phase of labor and reports that they need to have a bowel movement with the peak of contractions. Which of the following actions should the nurse make? A. Assist the client to the bathroom. B. Prepare for an impending delivery. C. Prepare to remove a fecal impaction. D. Encourage the client to take deep, cleansing breaths.

*B. CORRECT: The urge to have a bowel movement indicates fetal descent and complete dilation. A. The urge to have a bowel movement indicates fetal descent and complete dilation. Assisting the client to the bathroom is not an appropriate action in view of the impending birth. C. The nurse cleanses the perineal area to remove fecal matter that can be expelled due to the descent of the fetus. The nurse does not prepare to remove an impaction. D. Deep cleansing breaths are encouraged between contractions. The client will be encouraged to push because the sensation of a bowel movement indicates complete dilation and fetal descent.

[Ch. 14 - Nursing Care During Stages of Labor] A nurse is caring for a client who is in the transition phase of labor and reports that they need to have a bowel movement with the peak of contractions. Which of the following actions should the nurse make? A. Assist the client to the bathroom. B. Prepare for an impending delivery. C. Prepare to remove a fecal impaction. D. Encourage the client to take deep, cleansing breaths.

*B. CORRECT: The urge to have a bowel movement indicates fetal descent and complete dilation. preparing for an imminent birth is appropriate. A. The urge to have a bowel movement indicates fetal descent and complete dilation. Assisting the client to the bathroom is not an appropriate action in view of the impending birth. C. The nurse cleanses the perineal area to remove fecal matter that can be expelled due to the descent of the fetus. The nurse does not prepare to remove an impaction. D. Deep cleansing breaths are encouraged between contractions. The client will be encouraged to push because the sensation of a bowel movement indicates complete dilation and fetal descent.

[Ch. 17 - Postpartum Physiological Adaptations] A nurse is assessing a postpartum client for fundal height, location, and consistency. The fundus is noted to be displaced laterally to the right, and there is uterine atony. The nurse should identify which of the following conditions as the cause of the uterine atony? A. Poor involution B. Urinary retention C. Hemorrhage D. Infection

*B. CORRECT: Urinary retention can result in a distention of the bladder. A distended bladder can cause uterine atony and lateral displacement from the midline. A. Poor involution is the result of uterine atony and does not cause it. C. Hemorrhage is the result of uterine atony and does not cause it. D. Infection does not cause uterine displacement or atony and would be characterized by foul-smelling vaginal discharge and elevated temperature.

[Ch. 2 - Infertility] A nurse in a clinic is caring for a group of female clients who are being evaluated for infertility. Which of the following clients should the nurse anticipate the provider will refer to a genetic counselor? A. A client whose sister has alopecia B. A client whose partner has Von Willebrand disease C. A client who has an allergy to sulfa D. A client who had rubella 3 months ago

*B. CORRECT: Von Willebrand disease is a genetic bleeding disorder and warrants a client being referred to a genetic counselor. A. Alopecia is a nonhereditary disorder and does not warrant referral to a genetic counselor. C. Allergy to sulfa is a nonhereditary condition and does not warrant referral to a genetic counselor. D. A recent episode of rubella in a nonpregnant female does not warrant a referral to a genetic counselor.

[Ch. 13 - Fetal Assessment During Labor] A nurse is performing Leopold maneuvers on a client who is in labor. Which of the following techniques should the nurse use to identify the fetal lie? A. Apply palms of both hands to sides of uterus. B. Palpate the fundus of the uterus. C. Grasp lower uterine segment between thumb and fingers. D. Stand facing client's feet with fingertips outlining cephalic prominence.

*B. CORRECT: palpating the fundus of the uterus identifies the fetal part that is present, indicating the fetal lie (longitudinal or transverse). A. Using the palms of the hands on the sides of the uterus to identify the fetal back and small body parts verifies the presenting part. C. The descent of the presenting part into the pelvis is determined by gently grasping the lower uterine segment between the thumb and fingers. D. Fetal attitude is identified by facing the client's feet and outlining the cephalic prominence (fe

[Ch. 2 - Infertility] A nurse is caring for a couple who is being evaluated for infertility. Which of the following statements by the nurse indicates understanding of the infertility assessment process? A. "You will need to see a genetic counselor as part of the assessment." B. "It is usually the female who is having trouble, so the male doesn't have to be involved." C. "The male is the easiest to assess, and the provider will usually begin there." D. "Think about adopting first because there are many babies that need good homes."

*C. CORRECT: A sperm analysis is one of the first steps in the infertility assessment process and can identify a causeof infertility in a less invasive and costly manner. A. A referral to a genetic counselor occurs if there is a reason to suspect birth defects or other physiological concerns. It is not included in all infertility assessment processes. B. Factors affecting males and females can affect fertility. Both partners should be evaluated. D. Adoption is an option for the infertile couple after identifying a possible cause for the infertility.

[Ch. 14 - Nursing Care During Stages of Labor] A nurse is caring for a client and partner during the second stage of labor. The client's partner asks the nurse to explain how to know when crowning occurs. Which of the following responses should the nurse make? A. "The placenta will protrude from the vagina." B. "Your partner will report a decrease in the intensity of contractions." C. "The vaginal area will bulge as the baby's head appears." D. "Your partner will report less rectal pressure."

*C. CORRECT: Crowning is bulging of the perineum and the appearance of the fetal head. A. The appearance of the placenta occurs after crowning and the birth of the neonate. B. Crowning occurs with an increase in the intensity of contractions and the urge to push. D. Crowning occurs with an increase in rectal pressure as the fetal head descends onto the perineum.

[Ch. 14 - Nursing Care During Stages of Labor] A nurse is caring for a client and partner during the second stage of labor. The client's partner asks the nurse to explain how to know when crowning occurs. Which of the following responses should the nurse make? A. "The placenta will protrude from the vagina." B. "Your partner will report a decrease in the intensity of contractions." C. "The vaginal area will bulge as the baby's head appears." D. "Your partner will report less rectal pressure."

*C. CORRECT: Crowning is bulging of the perineum and the appearance of the fetal head. A. The appearance of the placenta occurs after crowning and the birth of the neonate. B. Crowning occurs with an increase in the intensity of contractions and the urge to push. D. Crowning occurs with an increase in rectal pressure as the fetal head descends onto the perineum.

[Ch. 17 - Postpartum Physiological Adaptations] During ambulation to the bathroom, a postpartum client experiences a gush of dark red blood that soon stops. On assessment, a nurse finds the uterus to be firm, midline, and at the level of the umbilicus. Which of the following findings should the nurse interpret this data as being? A. Evidence of a possible vaginal hematoma B. An indication of a cervical or perineal laceration C. A normal postural discharge of lochia D. Abnormally excessive lochia rubra flow

*C. CORRECT: Lochia typically trickles from the vaginal opening but flows more steadily during uterine contractions. Massaging the uterus or ambulation can result in a gush of lochia with the expression of clots and dark blood that has been pooled in the vagina, but it should soon decrease back to a trickle of bright red lochia in the early puerperium. A. A client who has a vaginal hematoma is expected to report excessive pain or vaginal pressure. B. Excessive spurting of bright red blood from the vagina indicates a possible cervical or perineal laceration. D. Excessive blood loss consists of one pad saturated in 15 min or less or the pooling of blood under the buttocks, which is not affected by the client's postural changes.

[Ch. 12 - Pain Management] A nurse is caring for a client following the administration of an epidural block and is preparing to administer an IV fluid bolus. The client's partner asks about the purpose of the IV fluids. Which of the following statements should the nurse make? A. "It is needed to promote increased urine output." B. "It is needed to counteract respiratory depression." C. "It is needed to counteract hypotension." D. "It is needed to prevent oligohydramnios."

*C. CORRECT: Maternal hypotension can occur following an epidural block and can be offset A. Urinary output is not affected by an epidural block. B. Oxygen is administered to counteract respiratory depression that can occur following an epidural block. by administering an IV fluid bolus. D. Oligohydramnios does not occur as a result of an epidural block.

[Ch. 16 - Complications Related to the Labor Process] A nurse is caring for a client who is at 42 weeks of gestation and in active labor. Which of the following findings is the fetus at risk for developing? A. Intrauterine growth restriction B. Hyperglycemia C. Meconium aspiration D. Polyhydramnios

*C. CORRECT: Postterm neonates are at risk for aspiration of meconium. A. Intrauterine growth restriction occurs earlier in the pregnancy and not at this point. B. A postterm neonate is at risk for hypoglycemia, not hyperglycemia. D. Postterm pregnancies result in oligohydramnios, not polyhydramnios.

[Ch. 15 - Therapeutic Procedures to Assist with Labor and Delivery] A nurse is caring for a client who had no prenatal care, is Rh-negative, and will undergo an external version at 38 weeks of gestation. Which of the following medications should the nurse plan to administer prior to the version? A. Prostaglandin gel B. Magnesium sulfate C. Rho(D) immune globulin D. Oxytocin

*C. CORRECT: Rho(D) immune globulin is administered to an Rh-negative client at 28 weeks of gestation. Because this client had no prenatal care, it should be givenprior to the version to prevent isoimmunization. A. prostaglandin gel is a cervical ripening agent and is not administered prior to an external version. B. Magnesium sulfate is a tocolytic, which can be administered prior to the version. However, because the client had no prenatal care and is Rh-negative, there is another medication to anticipate administering. D. Oxytocin is administered to increase contraction frequency, intensity and duration. It is not administered prior to an external version.

[Ch. 1 - Contraception] A nurse is instructing a client who is taking an oral contraceptive about manifestations to report to the provider. Which of the following manifestations should the nurse include? A. Reduced menstrual flow B. Breast tenderness C. Shortness of breath D. Increased appetite

*C. CORRECT: Shortness of breath can indicate a pulmonary embolus or myocardial infarction and should be reported to the provider immediately. A. Reduced menstrual flow is a common adverse effect of oral contraceptives and usually subsides after a few months of use. B. Breast tenderness is a common adverse effect of oral contraceptives and usually subsides after a few months of use. D. Increased appetite is a common adverse effect of oral contraceptive and does not have to be reported to the provider.

[Ch. 4 - Prenatal Care] A nurse is teaching a group of clients who are pregnant about measures to relieve backache during pregnancy. Which of the following measures should the nurse include? (Select all that apply.) A. Avoid any lifting. B. Perform Kegel exercises twice a day. C. Perform the pelvic rock exercise every day. D. Use proper body mechanics. E. Avoid constrictive clothing.

*C. CORRECT: The pelvic rock or tilt exercise stretches the muscles of the lower back and helps relieve lower-back pain. *D. CORRECT: The use of proper body mechanics prevents back injury due to the incorrect use of muscles when lifting. A. Lifting can be done by using the legs rather than the back. B. Kegel exercises are done to strengthen the perineal muscles and do not relieve backache. E. Avoiding constrictive clothing helps prevent urinary tract infections, vaginal infections, varicosities, and edema of the lower extremities.

[Ch. 11 - Labor and Delivery Processes] A nurse is caring for a client who is in active labor, irritable, and reports the urge to have a bowel movement. The client vomits and states, "I've had enough. I can't do this anymore." Which of the following stages of labor is the client experiencing? A. Second stage B. Fourth stage C. Transition phase D. Latent phase

*C. CORRECT: The transition phase of labor occurs when the client becomes irritable, feels rectal pressure similar to the need to have a bowel movement,and can become nauseous with emesis. A. The second stage of labor occurs with the expulsion of the fetus. B. The fourth stage of labor is the recovery period, following the delivery of the placenta. D. The latent phase of labor occurs in stage one and coincides with mild contractions. The client is more relaxed, talkative, and eager for labor to progress.

[Ch. 14 - Nursing Care During Stages of Labor] A nurse is caring for a client who is in the first stage of labor and is encouraging the client to void every 2 hr. Which of the following statements should the nurse make? A. "A full bladder increases the risk for fetal trauma." B. "A full bladder increases the risk for bladder infections." C. "A distended bladder will be traumatized by frequent pelvic exams." D. "A distended bladder reduces pelvic space needed for birth."

*D. CORRECT: A distended bladder reduces pelvic space, impedes fetal descent, and places the bladder at risk for trauma during the labor process. A. A full bladder does not place the fetus at risk for trauma. B. Urinary stasis, which occurs due to long periods between voiding, increases the risk for bladder infections. C. The urethra can be traumatized by frequent pelvic exams.

[Ch. 13 - Fetal Assessment During Labor] A nurse is reviewing the electronic monitor tracing of a client who is in active labor. A fetus receives more oxygen when which of the following appears on the tracing? A. Peak of the uterine contraction B. Moderate variability C. FHR acceleration D. Relaxation between uterine contractions

*D. CORRECT: A fetus is most oxygenated during the relaxation period between contractions. During contractions, the arteries to the uteroplacental intervillous spaces are compressed, resulting in a decrease in fetal circulation and oxygenation. A. Compression of the arteries to the uteroplacental intervillous spaces is most acute at the peak (acme) of the uterine contraction, resulting in a decrease in fetal circulation and oxygenation. B. Moderate variability indicates fluctuations in the fetal heart and is not an indication the fetus is receiving more oxygen. C. FHR accelerations indicate an intact fetal CNS and is not an indication the fetus is receiving more oxygen.

[Ch. 16 - Complications Related to the Labor Process] A nurse is caring for a client who is in labor. With the use of Leopold maneuvers, it is noted that the fetus is in a breech presentation. For which of the following possible complications should the nurse observe? A. Precipitous labor B. Premature rupture of membranes C. Postmaturity syndrome D. Prolapsed umbilical cord

*D. CORRECT: A prolapsed umbilical cord is a potential complication for a fetus in a breech presentation. A. Breech presentation would most likely cause dystocia (prolonged, difficult labor) rather than a precipitous labor. B. Breech presentation has no effect on rupture of the membranes. C. Breech presentation is not associated with postmaturity syndrome.

[Ch. 10 - Early Onset of Labor] A nurse is providing care for a client who is in preterm labor at 32 weeks of gestation. Which of the following medications should the nurse anticipate the provider will prescribe to hasten fetal lung maturity? A. Calcium gluconate B. Indomethacin C. Nifedipine D. Betamethasone

*D. CORRECT: Betamethasone is a glucocorticoid given to clients in preterm labor to hasten surfactant production. A. Calcium gluconate is administered as an antidote for magnesium sulfate toxicity. B. Indomethacin is an NSAID used to suppress preterm labor by blocking prostaglandin production. C. Nifedipine is a calcium channel blocker used to suppress uterine contractions.

[Ch. 5 - Nutrition During Pregnancy] A nurse in a clinic is teaching a client of childbearing age about recommended folic acid supplements. Which of the following defects can occur in the fetus or neonate as a result of folic acid deficiency? A. Iron deficiency anemia B. Poor bone formation C. Macrosomic fetus D. Neural tube defects

*D. CORRECT: Neural tube defects are caused by folic acid deficiency. Food sources of folic acid include fresh green leafy vegetables, liver, peanuts, cereals, and whole-grain breads. A. Iron deficiency anemia is the result of a lack of iron- rich dietary sources (meat, chicken, fish). B. Calcium deficiency can result in poor bone and teeth formation. C. Maternal obesity can lead to a macrosomic fetus.

[Ch. 5 - Nutrition During Pregnancy] A nurse is reviewing a new prescription for iron supplements with a client who is at 8 weeks of gestation and has iron deficiency anemia. Which of the following beverages should the nurse instruct the client to take the iron supplements with? A. Ice water B. Low-fat or whole milk C. Tea or coffee D. Orange juice

*D. CORRECT: Orange juice contains vitamin C, which aids in the absorption of iron. A. Water does not promote absorption of iron, but drinking plenty of water can prevent constipation, which isan adverse effect of iron supplements. B. Milk interferes with iron absorption. C. Caffeine, found in tea and coffee, can interfere with iron absorption. The client should consume no more than 200 mg/day because it increases the risk of spontaneous abortion or fetal intrauterine growth restriction.

[Ch. 12 - Pain Management] A nurse is caring for a client who is using patterned breathing during labor. The client reports numbness and tingling of the fingers. Which ofthe following actions should the nurse take? A. Administer oxygen via nasal cannula at 2 L/min. B. Apply a warm blanket. C. Assist the client to a side-lying position. D. Place an oxygen mask over the client's nose and mouth.

*D. CORRECT: The client is experiencing hyperventilation caused by low blood levels of pCO2. placing an oxygen mask over the client's nose and mouth or having the client breathe into a paper bag will reduce the intake of oxygen, allowing the pCO2 to rise and alleviate the numbness and tingling. A. The client is experiencing hyperventilation caused by low levels of blood pCO2. Supplying additional oxygen will not resolve this issue. B. The client is experiencing hyperventilation caused by low levels of blood pCO2. Applying a warm blanket will not resolve this issue. C. The client is experiencing hyperventilation caused by low blood levels of pCO2. Assisting the client to a side-lying position will not resolve this issue.

[Ch. 1 - Contraception] A nurse in an obstetrical clinic is teaching a client about using an IUD for contraception. Which of the following statements by the client indicates an understanding of the teaching? A. "An IUD should be replaced annually during a pelvic exam." B. "I cannot get an IUD until after I've had a child." C. "I should plan on regaining fertility 5 months after the IUD is removed." D. "I will check to be sure the strings of the IUD are still present after my periods."

*D. CORRECT: The client should check for presence of IUD strings following each menstruation to ensure the device is still present. A change in the length of the strings should be reported to the provider. A. An IUD will be replaced every 3 to 5 years, dependent upon the type of IUD used. B. Clients do not have to have given birth prior to the insertion of an IUD. It will be necessary for the client to have a negative pregnancy test prior to insertion of the IUD. C. Fertility will resume immediately following removal of the IUD.

[Ch. 10 - Early Onset of Labor] A nurse is reviewing discharge teaching with a client who has premature rupture of membranes at 26 weeks of gestation. Which of the following instructions should the nurse include in the teaching? A. Use a condom with sexual intercourse. B. Avoid bubble bath solution when taking a tub bath. C. Wipe from the back to front when performing perineal hygiene. D. Keep a daily record of fetal kick counts

*D. CORRECT: The client should record daily fetal kick counts. A. The client who has ruptured membranes should not insert anything into the vagina. B. Instruct the client to avoid tub baths and take showers. C. Instruct the client to wipe from front to back when performing perineal hygiene.

[Ch. 8 - Infections] A nurse manager is reviewing ways to prevent a TORCH infection during pregnancy with a group of newly licensed nurses. Which of the following statements by a nurse indicates understanding of the teaching? A. "Obtain an immunization against rubella early in pregnancy." B. "Seek prophylactic treatment if cytomegalovirus is detected during pregnancy." C. "A client should avoid crowded places during pregnancy." D. "A client should avoid consuming undercooked meat while pregnant."`

*D. CORRECT: Toxoplasmosis, a TORCH infection, is contracted by consuming undercooked meat. A. Immunization against rubella is contraindicated during pregnancy due to the risk of fetal congenital anomalies. B. There is no treatment for cytomegalovirus. C. A TORCH infection cannot be transmitted by being in areas where large crowds are present.

[Ch. 11 - Labor and Delivery Processes] A client calls a provider's office and reports having contractions for 2 hr that increased with activity and did not decrease with rest and hydration. The client denies leaking of vaginal fluid but did notice blood when wiping after voiding. Which of the following manifestations is the client experiencing? A. Braxton Hicks contractions B. Rupture of membranes C. Fetal descent D. True contractions

*D. CORRECT: True contractions do not go away with hydration or walking. They are regular in frequency, duration,and intensity and become stronger with walking. A. Braxton Hicks contractions decrease with hydration and walking. B. Rupture of membranes would be indicated by the presence of a gush of fluid that is unrelated to the client's activity. C. Fetal descent is the downward movement of the fetus in the birth canal and cannot be evaluated based on the client's report.

[Ch. 14 - Nursing Care During Stages of Labor] A nurse is planning care for a newly admitted client who reports, "I am in labor and I have been having vaginal bleeding for 2 weeks." Which of the following should the nurse include in the plan of care? A. Inspect the introitus for a prolapsed cord. B. Perform a test to identify the ferning pattern. C. Monitor station of the presenting part. D. Defer vaginal examinations.

*D. CORRECT: Vaginal examinations should not be performed until placenta previa or abruptio placentae has been ruled out as the cause of vaginal bleeding. A. Active vaginal bleeding is not an indication of ruptured membranes. Therefore, do not anticipate cord prolapse. B. A test for ferning is performed if there is suspected amniotic fluid and there is no indication of ruptured membranes. C. Station is monitored by vaginal examination, which should not be performed if there is vaginal bleeding, which can be related to placenta previa or abruptio placentae.

[Ch. 14 - Nursing Care During Stages of Labor] A nurse is planning care for a newly admitted client who reports, "I am in labor and I have been having vaginal bleeding for 2 weeks." Which of the following should the nurse include in the plan of care? A. Inspect the introitus for a prolapsed cord. B. Perform a test to identify the ferning pattern. C. Monitor station of the presenting part. D. Defer vaginal examinations.

*D. CORRECT: Vaginal examinations should not be performed until placenta previa or abruptio placentae has beenruled out as the cause of vaginal bleeding. A. Active vaginal bleeding is not an indication of ruptured membranes. Therefore, do not anticipate cord prolapse. B. A test for ferning is performed if there is suspected amniotic fluid and there is no indication of ruptured membranes. C. Station is monitored by vaginal examination, which should not be performed if there is vaginal bleeding, which can be related to placenta previa or abruptio placentae.

[Ch. 20 - Postpartum Disorders] A nurse is planning care for a client who is postpartum and has thrombophlebitis. Which of the following nursing interventions should the nurse include in the plan of care? A. Apply cold compresses to the affected extremity. B. Massage the affected extremity. C. Allow the client to ambulate. D. Measure leg circumferences.

*D. CORRECT: plan to measure the circumference of the leg to assess for changes in the client's condition. A. Plan to apply warm compresses to the affected extremity. B. Do not massage the affected extremity. This action can result in dislodgement of the clot. C. Encourage the client to rest with the affected extremity elevated.

[Ch. 5 - Nutrition During Pregnancy] A nurse is reviewing postpartum nutrition needs with a group of clients who have begun breastfeeding their newborns. Which of the following statements by a member of the group indicates an understanding of the teaching? A. "I am glad I can have my morning coffee." B. "I should take folic acid to increase my milk supply." C. "I will continue adding 330 calories per day to my diet." D. "I will continue my calcium supplements because I don't like milk."

*D. CORRECT: postpartum clients who are at risk for inadequate dietary calcium should continue taking calcium supplements during lactation. A. Clients who are breastfeeding should avoid caffeine intake because it affects iron absorption and infant weight gain. B. Folic acid does not increase milk production.C. Clients who are breastfeeding require an additional 450 to 500 calories per day to support adequate nutrition.

[Ch. 3 - Expected Physiological Changes During Pregnancy] A nurse in a prenatal clinic is caring for a client who is in the first trimester of pregnancy. The client's health record includes this data: G3 T1 P0 A1 L1 (3-1-0-1-1). How should the nurse interpret this information? (Select all that apply.) A. Client has delivered one newborn at term. B. Client has experienced no preterm labor. C. Client has been through active labor. D. Client has had two prior pregnancies. E. Client has one living child.

3 PREGNANCIES 1 TO TERM NONE PRETERM 1 ABORTION 1 LIVING *A. CORRECT: T1 indicates the client has delivered one newborn at term. *D. CORRECT: G3 indicates the client has had two prior pregnancies and the client is currently pregnant. *E. CORRECT: L1 indicates the client has one living child. B. P0 indicates the client has had no preterm deliveries. C. A1 indicates the client has had one miscarriage.

[Ch. 1 - Contraception] A nurse in a clinic is teaching a client about a new prescription for medroxyprogesterone. Which of the following information should the nurse include in the teaching? (Select all that apply.) A. "Weight fluctuations can occur." B. "You are protected against STIs." C. "You should increase your intake of calcium." D. "You should avoid taking antibiotics." E. "Irregular vaginal spotting can occur."

A. CORRECT: Weight fluctuations can occur when taking medroxyprogesterone. C. CORRECT: Clients should take calcium and vitamin D to prevent loss of bone density, which canoccur when taking medroxyprogesterone. E. CORRECT: Medroxyprogesterone can cause irregular vaginal bleeding. B. Medroxyprogesterone does not provide protection against STIs. D. Antibiotics are not contraindicated when taking medroxyprogesterone.

[Ch. 3 - Expected Physiological Changes During Pregnancy] A nurse in a prenatal clinic is caring for a client who is pregnant and experiencing episodes of maternal hypotension. The client asks the nurse what causes these episodes. Which of the following responses should the nurse make? A. "This is due to an increase in blood volume." B. "This is due to pressure from the uterus on the diaphragm." C. "This is due to the weight of the uterus on the vena cava." D. "This is due to increased cardiac output."

C. CORRECT: Maternal hypotension occurs when the client is lying in the supine position and the weight of the gravid uterus places pressure on the vena cava, decreasing venous blood flow to the heart. A. An increase in blood volume during pregnancy results in cardiac hypertrophy. B. pressure from the gravid uterus on the diaphragm might cause the client to experience shortness of breath. D. An increase in cardiac output during pregnancy results in cardiac hypertrophy.

[Ch. 3 - Expected Physiological Changes During Pregnancy] A nurse in a clinic receives a phone call from a client who would like to be tested in the clinic to confirm a pregnancy. Which of the following information should the nurse provide to the client? A. "You should wait until 4 weeks after conception to be tested." B. "You should be off any medications for 24 hours prior to the test." C. "You should be NPO for at least 8 hours prior to the test." D. "You should collect urine from the first morning void."

D. CORRECT: Urine pregnancy tests should be done on a first-voided morning specimen to provide the most accurate results. A. The production of hCG can be detected as early as 7 to 8 days before expected menses. B. Do not advise the client to stop taking medications in preparation for pregnancy tests. Review the client's medications to determine whether they can affect the results. C. Do not advise the client to remain NpO prior to pregnancy testing. Blood tests are not affected by food or fluid intake.