N412 OB Final Quiz

12. When is a prophylactic cerclage for an incompetent cervix usually placed (in weeks of gestation)? a. 12 to 14 b. 6 to 8 c. 23 to 24 d. After 24

: A A prophylactic cerclage is usually placed at 12 to 14 weeks of gestation. The cerclage is electively removed when the woman reaches 37 weeks of gestation or when her labor begins. Six to 8 weeks of gestation is too early to place the cerclage. Cerclage placement is offered if the cervical length falls to less than 20 to 25 mm before 23 to 24 weeks. Although no consensus has been reached, 24 weeks is used as the upper gestational age limit for cerclage placement.

23. A client at 39 weeks of gestation has been admitted for an external version. Which intervention would the nurse anticipate the provider to order? a. Tocolytic drug b. Contraction stress test (CST) c. Local anesthetic d. Foley catheter

: A A tocolytic drug will relax the uterus before and during the version, thus making manipulation easier. CST is used to determine the fetal response to stress. A local anesthetic is not used with external version. Although the bladder should be emptied, catheterization is not necessary.

9. A woman is undergoing a nipple-stimulated CST. She is having contractions that occur every 3 minutes. The fetal heart rate (FHR) has a baseline heart rate of approximately 120 beats per minute without any decelerations. What is the correct interpretation of this test? a. Negative b. Positive c. Satisfactory d. Unsatisfactory

: A Adequate uterine activity necessary for a CST consists of three contractions in a 10-minute time frame. If no decelerations are observed in the FHR pattern with the contractions, then the findings are considered to be negative. A positive CST indicates the presence of repetitive late FHR decelerations. The terms satisfactory or unsatisfactory are not applicable.

10. Which substance, when abused during pregnancy, is the most significant cause of cognitive impairment and dysfunction in the infant? a. Alcohol b. Tobacco c. Marijuana d. Heroin

: A Alcohol abuse during pregnancy is recognized as one of the leading causes of neurodevelopmental disorders in the United States. Alcohol is a teratogen; maternal ethanol abuse during gestation can lead to identifiable fetal alcohol spectrum disorders that include alcohol-related neurodevelopmental disorders. Cigarette smoking is linked to adverse pregnancy outcomes; the risk for placenta previa, placenta abruption, and premature rupture of membranes is twice that of nonsmokers. Marijuana is the most common illicit drug used by pregnant women. Marijuana crosses the placenta, and its use during pregnancy can result in shortened gestation and a higher incidence of IUGR. Heroin crosses the placenta and often results in IUGR, stillbirth, and congenital anomalies.

6. Which alteration in the FHR pattern would indicate the potential need for an amnioinfusion? a. Variable decelerations b. Late decelerations c. Fetal bradycardia d. Fetal tachycardia

: A Amnioinfusion is used during labor to either dilute meconium-stained amniotic fluid or supplement the amount of amniotic fluid to reduce the severity of variable FHR decelerations caused by cord compression. Late decelerations are unresponsive to amnioinfusion. Amnioinfusion is not appropriate for the treatment of fetal bradycardia and has no bearing on fetal tachycardia.

14. Which information is the highest priority for the nurse to comprehend regarding the BPP? a. BPP is an accurate indicator of impending fetal well-being. b. BPP is a compilation of health risk factors of the mother during the later stages of pregnancy. c. BPP consists of a Doppler blood flow analysis and an amniotic fluid index (AFI). d. BPP involves an invasive form of an ultrasonic examination.

: A An abnormal BPP score is one indication that labor should be induced. The BPP evaluates the health of the fetus, requires many different measures, and is a noninvasive procedure.

18. What is the correct definition of a spontaneous termination of a pregnancy (abortion)? a. Pregnancy is less than 20 weeks. b. Fetus weighs less than 1000 g. c. Products of conception are passed intact. d. No evidence exists of intrauterine infection.

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

8. A client asks her nurse, My doctor told me that he is concerned with the grade of my placenta because I am overdue. What does that mean? What is the nurses best response? a. Your placenta changes as your pregnancy progresses, and it is given a score that indicates how well it is functioning. b. Your placenta isnt working properly, and your baby is in danger. c. We need to perform an amniocentesis to detect if you have any placental damage. d. Dont worry about it. Everything is fine.

: A An explanation of what is meant by the grade of my placenta is the most appropriate response. If the client desires further information, the nurse can explain that calcium deposits are significant in postterm pregnancies, and ultrasonography can also be used to determine placental aging. Although stating that the clients placenta is not working properly and that the baby is in danger may be a valid response, it does not reflect therapeutic communication techniques and is likely to alarm the client. An ultrasound, not amniocentesis, is the method of assessment used to determine placental maturation. Telling the client not to worry is not appropriate and discredits her concerns.

2. A 39-year-old primigravida woman believes that she is approximately 8 weeks pregnant, although she has had irregular menstrual periods all her life. She has a history of smoking approximately one pack of cigarettes a day; however, she tells the nurse that she is trying to cut down. Her laboratory data are within normal limits. What diagnostic technique would be useful at this time? a. Ultrasound examination b. Maternal serum alpha-fetoprotein (MSAFP) screening c. Amniocentesis d. Nonstress test (NST)

: A An ultrasound examination could be performed to confirm the pregnancy and to determine the gestational age of the fetus. An MSAFP screening is performed at 16 to 18 weeks of gestation; therefore, it is too early in the womans pregnancy to perform this diagnostic test. An amniocentesis is performed if the MSAFP levels are abnormal or if fetal or maternal anomalies are detected. An NST is performed to assess fetal well-being in the third trimester.

4. A woman in preterm labor at 30 weeks of gestation receives two 12-mg intramuscular (IM) doses of betamethasone. What is the purpose of this pharmacologic intervention? a. To stimulate fetal surfactant production b. To reduce maternal and fetal tachycardia associated with ritodrine administration c. To suppress uterine contractions d. To maintain adequate maternal respiratory effort and ventilation during magnesium sulfate therapy

: A Antenatal glucocorticoids administered as IM injections to the mother accelerate fetal lung maturity. Propranolol (Inderal) is given to reduce the effects of ritodrine administration. Betamethasone has no effect on uterine contractions. Calcium gluconate is given to reverse the respiratory depressive effects of magnesium sulfate therapy.

21. What is the highest priority nursing intervention when admitting a pregnant woman who has experienced a bleeding episode in late pregnancy? a. Assessing FHR and maternal vital signs b. Performing a venipuncture for hemoglobin and hematocrit levels c. Placing clean disposable pads to collect any drainage d. Monitoring uterine contractions

: A Assessment of the FHR and maternal vital signs will assist the nurse in determining the degree of the blood loss and its effect on the mother and fetus. The most important assessment is to check the well-being of both the mother and the fetus. The blood levels can be obtained later. Assessing future bleeding is important; however, the top priority remains mother/fetal well-being. Monitoring uterine contractions is important but not a top priority.

15. Which description most accurately describes the augmentation of labor? a. Is part of the active management of labor that is instituted when the labor process is unsatisfactory b. Relies on more invasive methods when oxytocin and amniotomy have failed c. Is a modern management term to cover up the negative connotations of forcepsassisted birth d. Uses vacuum cups

: A Augmentation is part of the active management of labor that stimulates uterine contractions after labor has started but is not progressing satisfactorily. Augmentation uses amniotomy and oxytocin infusion, as well as some more gentle, noninvasive methods. Forceps-assisted births are less common than in the past and not considered a method of augmentation. A vacuum-assisted delivery occurs during childbirth if the mother is too exhausted to push. Vacuum extraction is not considered an augmentation methodology.

8. The client is being induced in response to worsening preeclampsia. She is also receiving magnesium sulfate. It appears that her labor has not become active, despite several hours of oxytocin administration. She asks the nurse, Why is this taking so long? What is the nurses most appropriate response? a. The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor. b. I dont know why it is taking so long. c. The length of labor varies for different women. d. Your baby is just being stubborn.

: A Because magnesium sulfate is a tocolytic agent, its use may increase the duration of labor. The amount of oxytocin needed to stimulate labor may be more than that needed for the woman who is not receiving magnesium sulfate. The nurse should explain to the client the effects of magnesium sulfate on the duration of labor. Although the length of labor varies for different women, the most likely reason this womans labor is protracted is the tocolytic effects of magnesium sulfate. The behavior of the fetus has no bearing on the length of labor.

10. Of these psychosocial factors, which has the least negative effect on the health of the mother and/or fetus? a. Moderate coffee consumption b. Moderate alcohol consumption c. Cigarette smoke d. Emotional distress

: A Birth defects in humans have not been related to caffeine consumption. Pregnant women who consume more than 300 mg of caffeine daily may be at increased risk for miscarriage or IUGR. Although the exact effects of alcohol in pregnancy have not been quantified, it exerts adverse effects on the fetus including fetal alcohol syndrome, fetal alcohol effects, learning disabilities, and hyperactivity. A strong, consistent, causal relation has been established between maternal smoking and reduced birth weight. Childbearing triggers profound and complex physiologic and psychologic changes on the mother. Evidence suggests a relationship between emotional distress and birth complications.

9. A nurse is discussing the storage of breast milk with a mother whose infant is preterm and in the special care nursery. Which statement indicates that the mother requires additional teaching? a. I can store my breast milk in the refrigerator for 3 months. b. I can store my breast milk in the freezer for 3 months. c. I can store my breast milk at room temperature for 4 hours. d. I can store my breast milk in the refrigerator for 3 to 5 days.

: A Breast milk for the hospitalized infant can be stored in the refrigerator for only 8 days, not for 3 months. Breast milk can be stored in the freezer for 3 months, in a deep freezer for 6 months, or at room temperature for 4 hours. Human milk for the healthy or preterm hospitalized infant can be kept in the refrigerator for up to 8 days or in the freezer for up to 3 months, but only for 4 hours or less at room temperature.

10. A new mother asks the nurse what the experts say about the best way to feed her infant. Which recommendation of the American Academy of Pediatrics (AAP) regarding infant nutrition should be shared with this client? a. Infants should be given only human milk for the first 6 months of life. b. Infants fed on formula should be started on solid food sooner than breastfed infants. c. If infants are weaned from breast milk before 12 months, then they should receive cows milk, not formula. d. After 6 months, mothers should shift from breast milk to cows milk.

: A Breastfeeding and human milk should also be the sole source of milk for the first 12 months, not for only the first 6 months. Infants should be started on solids when they are ready, usually at 6 months, whether they start on formula or breast milk. If infants are weaned from breast milk before 12 months, then they should receive iron-fortified formula, not cows milk.

MSC: Client Needs: Physiologic Integrity 11. Which statement is the best rationale for recommending formula over breastfeeding? a. Mother has a medical condition or is taking drugs that could be passed along to the infant via breast milk. b. Mother lacks confidence in her ability to breastfeed. c. Other family members or care providers also need to feed the baby. d. Mother sees bottle feeding as more convenient.

: A Breastfeeding is contraindicated when mothers have certain viruses, tuberculosis, are undergoing chemotherapy, or are using or abusing drugs. Some women lack confidence in their ability to produce breast milk of adequate quantity or quality. The key to encouraging these mothers to breastfeed is anticipatory guidance beginning as early as possible during the pregnancy. A major barrier for many women is the influence of family and friends. She may view formula feeding as a way to ensure that the father and other family members can participate. Each encounter with the family is an opportunity for the nurse to educate, dispel myths, and clarify information regarding the benefits of breastfeeding. Many women see bottle feeding as more convenient and less embarrassing than breastfeeding. They may also see breastfeeding as incompatible with an active social life. Although modesty issues related to feeding the infant in public may exist, these concerns are not legitimate reasons to formula-feed an infant. Often, the decision to formula feed rather than breastfeed is made without complete information regarding the benefits of breastfeeding.

11. Which intervention is most important when planning care for a client with severe gestational hypertension? a. Induction of labor is likely, as near term as possible. b. If at home, the woman should be confined to her bed, even with mild gestational hypertension. c. Special diet low in protein and salt should be initiated. d. Vaginal birth is still an option, even in severe cases.

: A By 34 weeks of gestation, the risk of continuing the pregnancy may be considered greater than the risks of a preterm birth. Strict bed rest is controversial for mild cases; some women in the hospital are even allowed to move around. Diet and fluid recommendations are essentially the same as for healthy pregnant women, although some authorities have suggested a diet high in protein. Women with severe gestational hypertension should expect a cesarean delivery.

29. A new mother asks whether she should feed her newborn colostrum, because it is not real milk. What is the nurses most appropriate answer? a. Colostrum is high in antibodies, protein, vitamins, and minerals. b. Colostrum is lower in calories than milk and should be supplemented by formula. c. Giving colostrum is important in helping the mother learn how to breastfeed before she goes home. d. Colostrum is unnecessary for newborns.

: A Colostrum is important because it has high levels of the nutrients needed by the neonate and helps protect against infection. Supplementation is not necessary and will decrease stimulation to the breast and decrease the production of milk. It is important for the mother to feel comfortable in this role before discharge; however, the importance of the colostrum to the infant is the top priority. Colostrum provides immunities and enzymes necessary to cleanse the gastrointestinal system, among other things.

22. Which order should the nurse expect for a client admitted with a threatened abortion? a. Bed rest b. Administration of ritodrine IV c. Nothing by mouth (nil per os [NPO]) d. Narcotic analgesia every 3 hours, as needed

: A Decreasing the womans activity level may alleviate the bleeding and allow the pregnancy to continue. Ritodrine is not the first drug of choice for tocolytic medications. Having the woman placed on NPO is unnecessary. At times, dehydration may produce contractions; therefore, hydration is important. Narcotic analgesia will not decrease the contractions and may mask the severity of the contractions.

3. The nurse sees a woman for the first time when she is 30 weeks pregnant. The client has smoked throughout the pregnancy, and fundal height measurements now are suggestive of intrauterine growth restriction (IUGR) in the fetus. In addition to ultrasound to measure fetal size, what is another tool useful in confirming the diagnosis? a. Doppler blood flow analysis b. Contraction stress test (CST) c. Amniocentesis d. Daily fetal movement counts

: A Doppler blood flow analysis allows the examiner to study the blood flow noninvasively in the fetus and the placenta. It is a helpful tool in the management of high-risk pregnancies because of IUGR, diabetes mellitus, multiple fetuses, or preterm labor. Because of the potential risk of inducing labor and causing fetal distress, a CST is not performed on a woman whose fetus is preterm. Indications for an amniocentesis include diagnosis of genetic disorders or congenital anomalies, assessment of pulmonary maturity, and the diagnosis of fetal hemolytic disease, not IUGR. Fetal kick count monitoring is performed to monitor the fetus in pregnancies complicated by conditions that may affect fetal oxygenation. Although this may be a useful tool at some point later in this womans pregnancy, it is not used to diagnose IUGR.

1. What is the most likely cause for early decelerations in the fetal heart rate (FHR) pattern? a. Altered fetal cerebral blood flow b. Umbilical cord compression c. Uteroplacental insufficiency d. Spontaneous rupture of membranes

: A Early decelerations are the fetus response to fetal head compression; these are considered benign, and interventions are not necessary. Variable decelerations are associated with umbilical cord compression. Late decelerations are associated with uteroplacental insufficiency. Spontaneous rupture of membranes has no bearing on the FHR unless the umbilical cord prolapses, which would result in variable or prolonged bradycardia.

2. A pregnant woman wants to breastfeed her infant; however, her husband is not convinced that there are any scientific reasons to do so. The nurse can give the couple printed information comparing breastfeeding and bottle feeding. Which statement regarding bottle feeding using commercially prepared infant formulas might influence their choice? a. Bottle feeding using a commercially prepared formula increases the risk that the infant will develop allergies. b. Bottle feeding helps the infant sleep through the night. c. Commercially prepared formula ensures that the infant is getting iron in a form that is easily absorbed. d. Bottle feeding requires that multivitamin supplements be given to the infant.

: A Exposure to cows milk poses a risk of developing allergies, eczema, and asthma. Newborns should be fed during the night, regardless of the feeding method. Iron is better absorbed from breast milk than from formula. Commercial formulas are designed to meet the nutritional needs of the infant and to resemble breast milk. No supplements are necessary.

2. Which clinical finding or intervention might be considered the rationale for fetal tachycardia to occur? a. Maternal fever b. Umbilical cord prolapse c. Regional anesthesia d. Magnesium sulfate administration

: A Fetal tachycardia can be considered an early sign of fetal hypoxemia and may also result from maternal or fetal infection. Umbilical cord prolapse, regional anesthesia, and the administration of magnesium sulfate will each more likely result in fetal bradycardia, not tachycardia.

16. Which client would not be a suitable candidate for internal EFM? a. Client who still has intact membranes b. Woman whose fetus is well engaged in the pelvis c. Pregnant woman who has a comorbidity of obesity d. Client whose cervix is dilated to 4 to 5 cm

: A For internal EFM, the membranes must have ruptured and the cervix must be dilated at least 2 to 3 cm. The presenting part must be low enough to allow placement of the spiral electrode necessary for internal EFM. The accuracy of EFM is not affected by maternal size. However, evaluating fetal well-being using external EFM may be more difficult on an obese client. The client whose cervix is dilated to 4 to 5 cm is indeed a candidate for internal monitoring.

13. The nurse should be cognizant of which statement regarding the unique qualities of human breast milk? a. Frequent feedings during predictable growth spurts stimulate increased milk production. b. Milk of preterm mothers is the same as the milk of mothers who gave birth at term. c. Milk at the beginning of the feeding is the same as the milk at the end of the feeding. d. Colostrum is an early, less concentrated, less rich version of mature milk.

: A Growth spurts (at 10 days, 3 weeks, 6 weeks, and 3 months) usually last 24 to 48 hours, after which the infants resume normal feeding. The milk of mothers of preterm infants is different from that of mothers of full-term infants to meet the needs of these newborns. Milk changes composition during feeding. The fat content of the milk increases as the infant feeds. Colostrum precedes mature milk and is more concentrated and richer in proteins and minerals (but not fat).

7. Parents have been asked by the neonatologist to provide breast milk for their newborn son, who was born prematurely at 32 weeks of gestation. The nurse who instructs them regarding pumping, storing, and transporting the milk needs to assess their knowledge of lactation. Which statement is valid? a. Premature infants more easily digest breast milk than formula. b. A glass of wine just before pumping will help reduce stress and anxiety. c. The mother should only pump as much milk as the infant can drink. d. The mother should pump every 2 to 3 hours, including during the night.

: A Human milk is the ideal food for preterm infants, with benefits that are unique, in addition to those benefits received by full-term, healthy infants. Greater physiologic stability occurs with breastfeeding, compared with formula feeding. Consumption of alcohol during lactation is approached with caution. Excessive amounts can have serious effects on the infant and can adversely affect the mothers milk ejection reflex. To establish an optimal milk supply, the most appropriate instruction for the mother should be to pump 8 to 10 times a day for 10 to 15 minutes on each breast.

17. A woman with severe preeclampsia has been receiving magnesium sulfate by intravenous infusion for 8 hours. The nurse assesses the client and documents the following findings: temperature of 37.1 C, pulse rate of 96 beats per minute, respiratory rate of 24 breaths per minute, BP of 155/112 mm Hg, 3+ DTRs, and no ankle clonus. The nurse calls the provider with an update. The nurse should anticipate an order for which medication? a. Hydralazine b. Magnesium sulfate bolus c. Diazepam d. Calcium gluconate

: A Hydralazine is an antihypertensive medication commonly used to treat hypertension in severe preeclampsia. Typically, it is administered for a systolic BP higher than 160 mm Hg or a diastolic BP higher than 110 mm Hg. An additional bolus of magnesium sulfate may be ordered for increasing signs of CNS irritability related to severe preeclampsia (e.g., clonus) or if eclampsia develops. Diazepam is sometimes used to stop or shorten eclamptic seizures. Calcium gluconate is used as the antidote for magnesium sulfate toxicity. The client is not currently displaying any signs or symptoms of magnesium toxicity.

19. Which information regarding to injuries to the infants plexus during labor and birth is most accurate? a. If the nerves are stretched with no avulsion, then they should completely recover in 3 to 6 months. b. Erb palsy is damage to the lower plexus. c. Parents of children with brachial palsy are taught to pick up the child from under the axillae. d. Breastfeeding is not recommended for infants with facial nerve paralysis until the condition resolves.

: A If the nerves are stretched with no avulsion, then they should recover completely in 3 to 6 months. However, if the ganglia are completely disconnected from the spinal cord, then the damage is permanent. Erb palsy is damage to the upper plexus and is less serious than brachial palsy. Parents of children with brachial palsy are taught to avoid picking up the child under the axillae or by pulling on the arms. Breastfeeding is not contraindicated, but both the mother and the infant will need help from the nurse at the start.

16. The exact cause of preterm labor is unknown but believed to be multifactorial. Infection is thought to be a major factor in many preterm labors. Which type of infection has not been linked to preterm birth? a. Viral b. Periodontal c. Cervical d. Urinary tract

: A Infections that increase the risk of preterm labor and birth are bacterial and include cervical, urinary tract, periodontal, and other bacterial infections. Therefore, early, continual, and comprehensive participation by the client in her prenatal care is important. Recent evidence has shown a link between periodontal infections and preterm labor. Researchers recommend regular dental care before and during pregnancy, oral assessment as a routine part of prenatal care, and scrupulous oral hygiene to prevent periodontal infections.

3. While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the FHR for five sequential contractions begins to decelerate late in the contraction, with the nadir of the decelerations occurring after the peak of the contraction. What is the nurses first priority? a. Change the womans position. b. Notify the health care provider. c. Assist with amnioinfusion d. Insert a scalp electrode.

: A Late FHR decelerations may be caused by maternal supine hypotension syndrome. These decelerations are usually corrected when the woman turns onto her side to displace the weight of the gravid uterus from the vena cava. If the fetus does not respond to primary nursing interventions for late decelerations, then the nurse should continue with subsequent intrauterine resuscitation measures and notify the health care provider. An amnioinfusion may be used to relieve pressure on an umbilical cord that has not prolapsed. The FHR pattern associated with this situation most likely will reveal variable decelerations. Although a fetal scalp electrode will provide accurate data for evaluating the well-being of the fetus, it is not a nursing intervention that will alleviate late decelerations nor is it the nurses first priority.

18. An infant at 26 weeks of gestation arrives intubated from the delivery room. The nurse weighs the infant, places him under the radiant warmer, and attaches him to the ventilator at the prescribed settings. A pulse oximeter and cardiorespiratory monitor are placed. The pulse oximeter is recording oxygen saturations of 80%. The prescribed saturations are 92%. What is the nurses most appropriate action at this time? a. Listening to breath sounds, and ensuring the patency of the endotracheal tube, increasing oxygen, and notifying a physician b. Continuing to observe and making no changes until the saturations are 75% c. Continuing with the admission process to ensure that a thorough assessment is completed d. Notifying the parents that their infant is not doing well

: A Listening to breath sounds and ensuring the patency of the endotracheal tube, increasing oxygen, and notifying a physician are appropriate nursing interventions to assist in optimal oxygen saturation of the infant. Oxygen saturation should be maintained above 92%, and oxygenation status of the infant is crucial. The nurse should delay other tasks to stabilize the infant. Notifying the parents that the infant is not doing well is not an appropriate action. Further assessment and intervention are warranted before determining fetal status.

21. Which analysis of maternal serum may predict chromosomal abnormalities in the fetus? a. Multiple-marker screening b. L/S ratio c. BPP d. Blood type and crossmatch of maternal and fetal serum

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

25. Which nursing intervention would result in an increase in maternal cardiac output? a. Change in position b. Oxytocin administration c. Regional anesthesia d. IV analgesic

: A Maternal supine hypotension syndrome is caused by the weight and pressure of the gravid uterus on the ascending vena cava when the woman is in a supine position. This position reduces venous return to the womans heart, as well as cardiac output, and subsequently reduces her blood pressure. The nurse can encourage the woman to change positions and to avoid the supine position. Oxytocin administration, regional anesthesia, and IV analgesic may reduce maternal cardiac output.

9. A pregnant woman was admitted for induction of labor at 43 weeks of gestation with sure dates. A nonstress test (NST) in the obstetricians office revealed a nonreactive tracing. On artificial rupture of membranes, thick meconium-stained fluid was noted. What should the nurse caring for the infant after birth anticipate? a. Meconium aspiration, hypoglycemia, and dry, cracked skin b. Excessive vernix caseosa covering the skin, lethargy, and RDS c. Golden yellow to green-stained skin and nails, absence of scalp hair, and an increased amount of subcutaneous fat d. Hyperglycemia, hyperthermia, and an alert, wide-eyed appearance

: A Meconium aspiration, hypoglycemia, and dry, cracked skin are consistent with a postmature infant. Excessive vernix caseosa, lethargy, and RDS are consistent with a very premature infant. The skin may be meconium stained, but the infant will most likely have long hair and decreased amounts of subcutaneous fat. Postmaturity with a nonreactive NST is indicative of hypoxia. Signs and symptoms associated with fetal hypoxia are hypoglycemia, temperature instability, and lethargy.

15. Which neonatal complications are associated with hypertension in the mother? a. Intrauterine growth restriction (IUGR) and prematurity b. Seizures and cerebral hemorrhage c. Hepatic or renal dysfunction d. Placental abruption and DIC

: A Neonatal complications are related to placental insufficiency and include IUGR, prematurity, and necrotizing enterocolitis. Seizures and cerebral hemorrhage are maternal complications. Hepatic and renal dysfunction are maternal complications of hypertensive disorders in pregnancy. Placental abruption and DIC are conditions related to maternal morbidity and mortality.

14. A nurse providing couplet care should understand the issue of nipple confusion. In which situation might this condition occur? a. Breastfeeding babies receive supplementary bottle feedings. b. Baby is too abruptly weaned. c. Pacifiers are used before breastfeeding is established. d. Twins are breastfed together.

: A Nipple confusion can result when babies go back and forth between bottles and breasts, especially before breastfeeding is established in 3 to 4 weeks; bottle feeding and breastfeeding require different skills. Abrupt weaning can be distressing to the mother and/or baby but should not lead to nipple confusion. Pacifiers used before breastfeeding is established can be disruptive but do not lead to nipple confusion. Breastfeeding twins require some logistical adaptations but should not lead to nipple confusion.

10. What are the legal responsibilities of the perinatal nurses? a. Correctly interpreting FHR patterns, initiating appropriate nursing interventions, and documenting the outcomes b. Greeting the client on arrival, assessing her status, and starting an IV line c. Applying the external fetal monitor and notifying the health care provider d. Ensuring that the woman is comfortable

: A Nurses who care for women during childbirth are legally responsible for correctly interpreting FHR patterns, initiating appropriate nursing interventions based on those patterns, and documenting the outcomes of those interventions. Greeting the client on arrival, assessing her, and starting an IV line are activities that should be performed when any client arrives to the maternity unit. The nurse is not the only one legally responsible for performing these functions. Applying the external fetal monitor and notifying the health care provider is a nursing function that is part of the standard of care for all obstetric clients and falls within the registered nurses scope of practice. Everyone caring for the pregnant woman should ensure that both she and her support partner are comfortable.

10. During the assessment of a preterm infant, the nurse notices continued respiratory distress even though oxygen and ventilation have been provided. In this situation, which condition should the nurse suspect? a. Hypovolemia and/or shock b. Excessively cool environment c. Central nervous system (CNS) injury d. Pending renal failure

: A Other symptoms might include hypotension, prolonged capillary refill, and tachycardia, followed by bradycardia. Intervention is necessary. Preterm infants are susceptible to temperature instability. The goal of thermoregulation is to provide a neutral thermal environment. Hypoglycemia is likely to occur if the infant is attempting to conserve heat. CNS injury is manifested by hyperirritability, seizures, and abnormal movements of the extremities. Urine output and testing of specific gravity are appropriate interventions for the infant with suspected renal failure. This neonate is unlikely to be delivered with respiratory distress.

13. Which statement best describes a normal uterine activity pattern in labor? a. Contractions every 2 to 5 minutes b. Contractions lasting approximately 2 minutes c. Contractions approximately 1 minute apart d. Contraction intensity of approximately 500 mm Hg with relaxation at 50 mm Hg

: A Overall contraction frequency generally ranges from two to five contractions per 10 minutes of labor, with lower frequencies during the first stage and higher frequencies observed during the second stage. Contraction duration remains fairly stable throughout the first and second stages, ranging from 45 to 80 seconds, generally not exceeding 90 seconds. Contractions 1 minute apart are occurring too often and would be considered an abnormal labor pattern. The intensity of uterine contractions generally ranges from 25 to 50 mm Hg in the first stage of labor and may rise to more than 80 mm Hg in the second stage.

2. A 3.8-kg infant was vaginally delivered at 39 weeks after a 30-minute second stage. A nuchal cord was found at delivery. After birth, the infant is noted to have petechiae over the face and upper back. Which information regarding petechiae is most accurate and should be provided to the parents? a. Are benign if they disappear within 48 hours of birth b. Result from increased blood volume c. Should always be further investigated d. Usually occur with a forceps-assisted delivery

: A Petechiae, or pinpoint hemorrhagic areas, acquired during childbirth may extend over the upper portion of the trunk and face. These lesions are benign if they disappear within 2 days of childbirth and no new lesions appear. Petechiae may result from decreased platelet formation. In this situation, the presence of petechiae is most likely a soft-tissue injury resulting from the nuchal cord at birth. Unless the lesions do not dissipate in 2 days, alarming the family is not necessary. Petechiae usually occur with a breech presentation vaginal birth.

3. Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the client mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. This fetus is at the greatest risk for which condition? a. Macrosomia b. Congenital anomalies of the central nervous system c. Preterm birth d. Low birth weight

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

19. What is the most common medical complication of pregnancy? a. Hypertension b. Hyperemesis gravidarum c. Hemorrhagic complications d. Infections

: A Preeclampsia and eclampsia are two noted deadly forms of hypertension. A large percentage of pregnant women will have nausea and vomiting, but a relatively few will have the severe form called hyperemesis gravidarum. Hemorrhagic complications are the second most common medical complication of pregnancy; hypertension is the most common. Infection is a risk factor for preeclampsia.

14. In caring for the woman with DIC, which order should the nurse anticipate? a. Administration of blood b. Preparation of the client for invasive hemodynamic monitoring c. Restriction of intravascular fluids d. Administration of steroids

: A Primary medical management in all cases of DIC involves a correction of the underlying cause, volume replacement, blood component therapy, optimization of oxygenation and perfusion status, and continued reassessment of laboratory parameters. Central monitoring would not be initially ordered in a client with DIC because it could contribute to more areas of bleeding. Management of DIC would include volume replacement, not volume restriction. Steroids are not indicated for the management of DIC.

9. Which statement concerning the complication of maternal diabetes is the most accurate? a. Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy. b. Hydramnios occurs approximately twice as often in diabetic pregnancies than in nondiabetic pregnancies. c. Infections occur about as often and are considered about as serious in both diabetic and nondiabetic pregnancies. d. Even mild-to-moderate hypoglycemic episodes can have significant effects on fetal well-being.

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

9. What nursing diagnosis is the most appropriate for a woman experiencing severe preeclampsia? a. Risk for injury to mother and fetus, related to central nervous system (CNS) irritability b. Risk for altered gas exchange c. Risk for deficient fluid volume, related to increased sodium retention secondary to the administration of magnesium sulfate d. Risk for increased cardiac output, related to the use of antihypertensive drugs

: A Risk for injury is the most appropriate nursing diagnosis for this client scenario. Gas exchange is more likely to become impaired, attributable to pulmonary edema. A risk for excess, not deficient, fluid volume, related to increased sodium retention, is increased, and a risk for decreased, not increased, cardiac output, related to the use of antihypertensive drugs, also is increased.

9. With regard to hemorrhagic complications that may occur during pregnancy, what information is most accurate? a. An incompetent cervix is usually not diagnosed until the woman has lost one or two pregnancies. b. Incidences of ectopic pregnancy are declining as a result of improved diagnostic techniques. c. One ectopic pregnancy does not affect a womans fertility or her likelihood of having a normal pregnancy the next time. d. Gestational trophoblastic neoplasia (GTN) is one of the persistently incurable gynecologic malignancies.

: A Short labors and recurring losses of pregnancy at progressively earlier gestational ages are characteristics of reduced cervical competence. Because diagnostic technology is improving, more ectopic pregnancies are being diagnosed. One ectopic pregnancy places the woman at increased risk for another one. Ectopic pregnancy is a leading cause of infertility. Once invariably fatal, GTN now is the most curable gynecologic malignancy.

3. A premature infant with respiratory distress syndrome (RDS) receives artificial surfactant. How does the nurse explain surfactant therapy to the parents? a. Surfactant improves the ability of your babys lungs to exchange oxygen and carbon dioxide. b. The drug keeps your baby from requiring too much sedation. c. Surfactant is used to reduce episodes of periodic apnea. d. Your baby needs this medication to fight a possible respiratory tract infection.

: A Surfactant can be administered as an adjunct to oxygen and ventilation therapy. With the administration of an artificial surfactant, respiratory compliance is improved until the infant can generate enough surfactant on his or her own. Surfactant has no bearing on the sedation needs of the infant. Surfactant is used to improve respiratory compliance, including the exchange of oxygen and carbon dioxide. The goal of surfactant therapy in an infant with RDS is to stimulate the production of surfactant in the type 2 cells of the alveoli. The clinical presentation of RDS and neonatal pneumonia may be similar. The infant may be started on broad-spectrum antibiotics to treat infection.

16. Which information is an important consideration when comparing the CST with the NST? a. The NST has no known contraindications. b. The CST has fewer false-positive results when compared with the NST. c. The CST is more sensitive in detecting fetal compromise, as opposed to the NST. d. The CST is slightly more expensive than the NST.

: A The CST has several contraindications. The NST has a high rate of false-positive results and is less sensitive than the CST but relatively inexpensive.

7. A pregnant woman arrives at the birth unit in labor at term, having had no prenatal care. After birth, her infant is noted to be small for gestational age with small eyes and a thin upper lip. The infant also is microcephalic. Based on her infants physical findings, this woman should be questioned about her use of which substance during pregnancy? a. Alcohol b. Cocaine c. Heroin d. Marijuana

: A The description of the infant suggests fetal alcohol syndrome, which is consistent with maternal alcohol consumption during pregnancy. Fetal brain, kidney, and urogenital system malformations have been associated with maternal cocaine ingestions. Heroin use in pregnancy frequently results in intrauterine growth restriction (IUGR). The infant may have a shrill cry and sleep-cycle disturbances and may exhibit with poor feeding, tachypnea, vomiting, diarrhea, hypothermia or hyperthermia, and sweating. Studies have found a higher incidence of meconium staining in infants born of mothers who used marijuana during pregnancy.

13. In caring for an immediate postpartum client, the nurse notes petechiae and oozing from her intravenous (IV) site. The client would be closely monitored for which clotting disorder? a. DIC b. Amniotic fluid embolism (AFE) c. Hemorrhage d. HELLP syndrome

: A The diagnosis of DIC is made according to clinical findings and laboratory markers. A physical examination reveals unusual bleeding. Petechiae may appear around a blood pressure cuff on the womans arm. Excessive bleeding may occur from the site of slight trauma such as venipuncture sites. These symptoms are not associated with AFE, nor is AFE a bleeding disorder. Hemorrhage occurs for a variety of reasons in the postpartum client. These symptoms are associated with DIC. Hemorrhage would be a finding associated with DIC and is not a clotting disorder in and of itself. HELLP syndrome is not a clotting disorder, but it may contribute to the clotting disorder DIC.

25. Which nursing intervention should be immediately performed after the forceps-assisted birth of an infant? a. Assessing the infant for signs of trauma b. Administering prophylactic antibiotic agents to the infant c. Applying a cold pack to the infants scalp d. Measuring the circumference of the infants head

: A The infant should be assessed for bruising or abrasions at the site of application, facial palsy, and subdural hematoma. Prophylactic antibiotics are not necessary with a forceps delivery. A cold pack would place the infant at risk for cold stress and is contraindicated. Measuring the circumference of the head is part of the initial nursing assessment.

14. 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

: A 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, thus leading to hypoglycemia. Hypocalcemia is associated with preterm birth, birth trauma, and asphyxia, all common problems of the infant of a diabetic mother. Excess erythrocytes are broken down after birth, and large amounts of bilirubin are released into the neonates circulation, with resulting hyperbilirubinemia. Because fetal insulin production is accelerated during pregnancy, hyperinsulinemia develops in the neonate.

20. A pregnant womans BPP score is 8. She asks the nurse to explain the results. How should the nurse respond at this time? a. The test results are within normal limits. b. Immediate delivery by cesarean birth is being considered. c. Further testing will be performed to determine the meaning of this score. d. An obstetric specialist will evaluate the results of this profile and, within the next week, will inform you of your options regarding delivery.

: A The normal biophysical score ranges from 8 to 10 points if the amniotic fluid volume is adequate. A normal score allows conservative treatment of high-risk clients. Delivery can be delayed if fetal well-being is indicated. Scores less than 4 should be investigated, and delivery could be initiated sooner than planned. The results of the BPP are usually available immediately after the procedure is performed. Since this score is within normal range, no further testing is required at this time.

28. What is the correct placement of the tocotransducer for effective EFM? a. Over the uterine fundus b. On the fetal scalp c. Inside the uterus d. Over the mothers lower abdomen

: A The tocotransducer monitors uterine activity and should be placed over the fundus, where the most intensive uterine contractions occur. The tocotransducer is for external use.

20. A pregnant womans amniotic membranes have ruptured. A prolapsed umbilical cord is suspected. What intervention would be the nurses highest priority? a. Placing the woman in the knee-chest position b. Covering the cord in sterile gauze soaked in saline c. Preparing the woman for a cesarean birth d. Starting oxygen by face mask

: A The woman is assisted into a modified Sims position, Trendelenburg position, or the knee-chest position in which gravity keeps the pressure of the presenting part off the cord. Although covering the cord in sterile gauze soaked saline, preparing the woman for a cesarean, and starting oxygen by face mark are appropriate nursing interventions in the event of a prolapsed cord, the intervention of top priority would be positioning the mother to relieve cord compression.

23. Part of the nurses role is assisting with pushing and positioning. Which guidance should the nurse provide to her client in active labor? a. Encourage the womans cooperation in avoiding the supine position. b. Advise the woman to avoid the semi-Fowler position. c. Encourage the woman to hold her breath and tighten her abdominal muscles to produce a vaginal response. d. Instruct the woman to open her mouth and close her glottis, letting air escape after the push.

: A The woman should maintain a side-lying position. The semi-Fowler position is the recommended side-lying position with a lateral tilt to the uterus. Encouraging the woman to hold her breath and tighten her abdominal muscles is the Valsalva maneuver, which should be avoided. Both the mouth and glottis should be open, allowing air to escape during the push.

30. The client has delivered by urgent caesarean birth for fetal compromise. Umbilical cord gases were obtained for acid-base determination. The pH is 6.9, partial pressure of carbon dioxide (PCO2) is elevated, and the base deficit is 11 mmol/L. What type of acidemia is displayed by the infant? a. Respiratory b. Metabolic c. Mixed d. Turbulent

: A These findings are evidence of respiratory acidemia. Metabolic acidemia is expressed by a pH <7.20, normal carbon dioxide pressure, and a base excess of 12 mmol/L. Mixed acidemia is evidenced by a pH <7.20, elevated carbon dioxide pressure, and a base excess of 12 mmol/L. There is no such finding as turbulent acidemia.

11. During a prenatal examination, a woman reports having two cats at home. The nurse informs her that she should not be cleaning the litter box while she is pregnant. The client questions the nurse as to why. What is the nursesmost appropriate response? a. Your cats could be carrying toxoplasmosis. This is a zoonotic parasite that can infect you and have severe effects on your unborn child. b. You and your baby can be exposed to the HIV in your cats feces. c. Its just gross. You should make your husband clean the litter boxes. d. Cat feces are known to carry Escherichia coli, which can cause a severe infection in you and your baby.

: A Toxoplasmosis is a multisystem disease caused by the protozoal Toxoplasma gondii parasite, commonly found in cats, dogs, pigs, sheep, and cattle. Approximately 30% of women who contract toxoplasmosis during gestation transmit the disease to their offspring. Clinical features ascribed to toxoplasmosis include hydrocephalus or microcephaly, chorioretinitis, seizures, or cerebral calcifications. HIV is not transmitted by cats. Although cleaning the litter boxes is just gross, this statement is not appropriate, fails to answer the clients question, and is not the nurses best response. E. coli is found in normal human fecal flora and is not transmitted by cats.

6. What is the most important nursing action in preventing neonatal infection? a. Good handwashing b. Isolation of infected infants c. Separate gown technique d. Standard Precautions

: A Virtually all controlled clinical trials have demonstrated that effective handwashing is responsible for the prevention of health careassociated infection in nursery units. Overcrowding must be avoided in nurseries, and infants with infectious processes should be isolated. Separate gowns should be worn in caring for each infant in the special care nursery. Soiled linens should be disposed of in an appropriate manner. Measures to be taken include Standard Precautions, careful and thorough cleaning, frequent replacement of used equipment, and disposal of excrement and linens in an appropriate manner. Ideally infants should remain with their mothers.

25. What is the most important nursing action in preventing neonatal infection? a. Good handwashing b. Isolation of infected infants c. Separate gown technique d. Standard Precautions

: A Virtually all controlled clinical trials have demonstrated that effective handwashing is responsible for the prevention of nosocomial infection in nursery units. Measures to be taken include Standard Precautions, careful and thorough cleaning, frequent replacement of used equipment, and disposal of excrement and linens in an appropriate manner. Overcrowding must be avoided in nurseries. However, the most important nursing action for preventing neonatal infection is effective handwashing.

18. A nurse caring for a woman in labor should understand that absent or minimal variability is classified as either abnormal or indeterminate. Which condition related to decreased variability is considered benign? a. Periodic fetal sleep state b. Extreme prematurity c. Fetal hypoxemia d. Preexisting neurologic injury

: A When the fetus is temporarily in a sleep state, minimal variability is present. Periodic fetal sleep states usually last no longer than 30 minutes. A woman in labor with extreme prematurity may display a FHR pattern of minimal or absent variability. Abnormal variability may also be related to fetal hypoxemia and metabolic acidemia. Congenital anomalies or a preexisting neurologic injury may also result in absent or minimal variability. Other possible causes might be central nervous system (CNS) depressant medications, narcotics, or general anesthesia.

23. NEC is an acute inflammatory disease of the gastrointestinal mucosa that can progress to perforation of the bowel. Approximately 2% to 5% of premature infants succumb to this fatal disease. Care is supportive; however, known interventions may decrease the risk of NEC. Which intervention has the greatest effect on lowering the risk of NEC? a. Early enteral feedings b. Breastfeeding c. Exchange transfusion d. Prophylactic probiotics

: B A decrease in the incidence of NEC is directly correlated with exclusive breastfeeding. Breast milk enhances the maturation of the gastrointestinal tract and contains immune factors that contribute to a lower incidence or severity of NEC, Crohn disease, and celiac illness. The NICU nurse can be very supportive of the mother in terms of providing her with equipment to pump breast milk, ensuring privacy, and encouraging skin-to-skin contact with the infant. Early enteral feedings of formula or hyperosmolar feedings are a risk factor known to contribute to the development of NEC. The mother should be encouraged to pump or feed breast milk exclusively. Exchange transfusion may be necessary; however, it is a known risk factor for the development of NEC. Although still early, a study in 2005 found that the introduction of prophylactic probiotics appeared to enhance the normal flora of the bowel and therefore decrease the severity of NEC when it did occur. This treatment modality is not as widespread as encouraging breastfeeding; however, it is another strategy that the care providers of these extremely fragile infants may have at their disposal.

24. What is a maternal indication for the use of vacuum-assisted birth? a. Wide pelvic outlet b. Maternal exhaustion c. History of rapid deliveries d. Failure to progress past station 0

: B A mother who is exhausted may be unable to assist with the expulsion of the fetus. The client with ac wide pelvi outlet will likely not require vacuum extraction. With a rapid delivery, vacuum extraction is not necessary. A station of 0 is too high for a vacuum-assisted birth.

18. The client being cared for has severe preeclampsia and is receiving a magnesium sulfate infusion. Which new finding would give the nurse cause for concern? a. Sleepy, sedated affect b. Respiratory rate of 10 breaths per minute c. DTRs of 2 d. Absent ankle clonus

: B A respiratory rate of 10 breaths per minute indicates the client is experiencing respiratory depression from magnesium toxicity. Because magnesium sulfate is a CNS depressant, the client will most likely become sedated when the infusion is initiated. DTRs of 2 and absent ankle clonus are normal findings.

19. The nurse is explaining the benefits associated with breastfeeding to a new mother. Which statement by the nurse would provide conflicting information to the client? a. Women who breastfeed have a decreased risk of breast cancer. b. Breastfeeding is an effective method of birth control. c. Breastfeeding increases bone density. d. Breastfeeding may enhance postpartum weight loss.

: B Although breastfeeding delays the return of fertility, it is not an effective birth control method. Women who breastfeed have a decreased risk of breast cancer, an increase in bone density, and a possibility of faster postpartum weight loss.

13. The nurse should be cognizant of which condition related to skeletal injuries sustained by a neonate during labor or childbirth? a. Newborns skull is still forming and fractures fairly easily. b. Unless a blood vessel is involved, linear skull fractures heal without special treatment. c. Clavicle fractures often need to be set with an inserted pin for stability. d. Other than the skull, the most common skeletal injuries are to leg bones.

: B Approximately 70% of neonatal skull fractures are linear. Because the newborn skull is flexible, considerable force is required to fracture it. Clavicle fractures need no special treatment. The clavicle is the bone most often fractured during birth.

14. A number of methods can be used for inducing labor. Which cervical ripening method falls under the category of mechanical or physical? a. Prostaglandins are used to soften and thin the cervix. b. Labor can sometimes be induced with balloon catheters or laminaria tents. c. Oxytocin is less expensive and more effective than prostaglandins but creates greater health risks. d. Amniotomy can be used to make the cervix more favorable for labor.

: B Balloon catheters or laminaria tents are mechanical means of ripening the cervix. Ripening the cervix, making it softer and thinner, increases the success rate of induced labor. Prostaglandin E1 is less expensive and more effective than oxytocin but carries a greater risk. Amniotomy is the artificial rupture of membranes, which is used to induce labor only when the cervix is already ripe.

8. What three measures should the nurse implement to provide intrauterine resuscitation? a. Call the provider, reposition the mother, and perform a vaginal examination. b. Turn the client onto her side, provide oxygen (O2) via face mask, and increase intravenous (IV) fluids. c. Administer O2 to the mother, increase IV fluids, and notify the health care provider. d. Perform a vaginal examination, reposition the mother, and provide O2 via face mask.

: B Basic interventions for the management of any abnormal FHR pattern include administering O2 via a nonrebreather face mask at a rate of 8 to 10 L/min, assisting the woman onto a side-lying (lateral) position, and increasing blood volume by increasing the rate of the primary IV infusion. The purpose of these interventions is to improve uterine blood flow and intervillous space blood flow and to increase maternal oxygenation and cardiac output. The term intrauterine resuscitation is sometimes used to refer to these interventions. If these interventions do not quickly resolve the abnormal FHR issue, then the primary provider should tbeelyimmedia notified.

10. The nurse who elects to work in the specialty of obstetric care must have the ability to distinguish between preterm birth, preterm labor, and low birth weight. Which statement regarding this terminology is correct? a. Terms preterm birth and low birth weight can be used interchangeably. b. Preterm labor is defined as cervical changes and uterine contractions occurring between 20 and 37 weeks of gestation. c. Low birth weight is a newborn who weighs below 3.7 pounds. d. Preterm birth rate in the United States continues to increase.

: B Before 20 weeks of gestation, the fetus is not viable (miscarriage); after 37 weeks, the fetus can be considered term. Although these terms are used interchangeably, they have different meanings: preterm birth describes the length of gestation (before 37 weeks), regardless of the newborns weight; low birth weight describes only the infants weight at the time of birth (2500 g or less), whenever it occurs. Low birth weight is anything below 2500 g or approximately pounds. In 2011, the preterm birth rate in the United States was 11.7 %; it has dropped every year since 2008.

12. An 18-year-old client who has reached 16 weeks of gestation was recently diagnosed with pregestational diabetes. She attends her centering appointment accompanied by one of her girlfriends. This young woman appears more concerned about how her pregnancy will affect her social life than her recent diagnosis of diabetes. A number of nursing diagnoses are applicable to assist in planning adequate care. What is the most appropriate diagnosis at this time? a. Risk for injury, to the fetus related to birth trauma b. Deficient knowledge, related to diabetic pregnancy management c. Deficient knowledge, related to insulin administration d. Risk for injury, to the mother related to hypoglycemia or hyperglycemia

: B Before a treatment plan is developed or goals for the outcome of care are outlined, this client must come to an understanding of diabetes and the potential effects on her pregnancy. She appears more concerned about changes to her social life than adopting a new self-care regimen. Risk for injury to the fetus related to either placental insufficiency or birth trauma may come later in the pregnancy. At this time, the client is having difficulty acknowledging the adjustments that she needs to make to her lifestyle to care for herself during pregnancy. The client may not yet be on insulin. Insulin requirements increase with gestation. The importance of glycemic control must be part of health teaching for this client. However, she has not yet acknowledged that changes to her lifestyle need to be made and may not participate in the plan of care until understanding takes place.

2. A perinatal nurse is giving discharge instructions to a woman, status postsuction, and curettage secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next 12 months. What is the bestresponse by the nurse? 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, then 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, not getting pregnant at this time is best. d. Oral contraceptives are the only form of birth control that will prevent a recurrence of a molar pregnancy.

: B Betahuman chorionic gonadotropin (beta-hCG) hormone levels are drawn for 1 year to ensure that the mole is completely gone. The chance of developing choriocarcinoma after the development of a hydatidiform mole is increased. Therefore, the goal is to achieve a zero human chorionic gonadotropin (hCG) level. If the woman were to become pregnant, then it may obscure the presence of the potentially carcinogenic cells. Women should be instructed to use birth control for 1 year after treatment for a hydatidiform mole. The rationale for avoiding pregnancy for 1 year is to ensure that carcinogenic cells are not present. Any contraceptive method except an intrauterine device (IUD) is acceptable.

5. A client with maternal phenylketonuria (PKU) has come to the obstetrical clinic to begin prenatal care. Why would this preexisting condition result in the need for closer monitoring during pregnancy? a. PKU is a recognized cause of preterm labor. b. The fetus may develop neurologic problems. c. A pregnant woman is more likely to die without strict dietary control. d. Women with PKU are usually mentally handicapped and should not reproduce.

: B Children born to women with untreated PKU are more likely to be born with mental retardation, microcephaly, congenital heart disease, and low birth weight. Maternal PKU has no effect on labor. Women without dietary control of PKU are more likely to miscarry or bear a child with congenital anomalies. Screening for undiagnosed maternal PKU at the first prenatal visit may be warranted, especially in individuals with a family history of the disorder, with low intelligence of an uncertain cause, or who have given birth to microcephalic infants.

11. In appraising the growth and development potential of a preterm infant, the nurse should be cognizant of the information that is best described in which statement? a. Tell the parents that their child will not catch up until approximately age 10 years (for girls) to age 12 years (for boys). b. Correct for milestones, such as motor competencies and vocalizations, until the child is approximately 2 years of age. c. Know that the greatest catch-up period is between 9 and 15 months postconceptual age. d. Know that the length and breadth of the trunk is the first part of the infant to experience catch-up growth.

: B Corrections are made with a formula that adds gestational age and postnatal age. Whether a girl or boy, the infant experiences catch-up body growth during the first 2 to 3 years of life. Maximum catch-up growth occurs between 36 and 40 weeks of postconceptual age. The head is the first to experience catch-up growth.

11. Which laboratory marker is indicative of DIC? a. Bleeding time of 10 minutes b. Presence of fibrin split products c. Thrombocytopenia d. Hypofibrinogenemia

: B Degradation of fibrin leads to the accumulation of multiple fibrin clots throughout the bodys vasculature. Bleeding time in DIC is normal. Low platelets may occur but are not indicative of DIC because they may be the result from other coagulopathies. Hypofibrinogenemia occurs with DIC.

7. Parents have asked the nurse about organ donation after that infants death. Which information regarding organ donation is important for the nurse to understand? a. Federal law requires the medical staff to ask the parents about organ donation and then to contact their states organ procurement organization (OPO) to handle the procedure if the parents agree. b. Organ donation can aid grieving by giving the family an opportunity to see something positive about the experience. c. Most common donation is the infants kidneys. d. Corneas can be donated if the infant was either stillborn or alive as long as the pregnancy went full term.

: B Evidence indicates that organ donation can promote healing among the surviving family members. The federal Gift of Life Act made state OPOs responsible for deciding whether to request a donation and for making that request. The most common donation is the cornea. For cornea donation, the infant must have been born alive at 36 weeks of gestation or later.

12. A new client and her partner arrive on the labor, delivery, recovery, and postpartum (LDRP) unit for the birth of their first child. The nurse applies the electronic fetal monitor (EFM) to the woman. Her partner asks you to explain what is printing on the graph, referring to the EFM strip. He wants to know what the babys heart rate should be. What is the nurses best response? a. Dont worry about that machine; thats my job. b. The babys heart rate will fluctuate in response to what is happening during labor. c. The top line graphs the babys heart rate, and the bottom line lets me know how strong the contractions are. d. Your physician will explain all of that later.

: B Explaining what indicates a normal FHR teaches the partner about fetal monitoring and provides support and information to alleviate his fears. Telling the partner not to worry discredits his feelings and does not provide the teaching he is requesting. Telling the partner that the graph indicates how strong the contractions are provides inaccurate information and does not address the partners concerns about the FHR. The EFM graphs the frequency and duration of the contractions, not their intensity. Nurses should take every opportunity to provide teaching to the client and her family, especially when information is requested.

3. What information regarding a fractured clavicle is most important for the nurse to take into consideration when planning the infants care? a. Prone positioning facilitates bone alignment. b. No special treatment is necessary. c. Parents should be taught range-of-motion exercises. d. The shoulder should be immobilized with a splint.

: B Fractures in newborns generally heal rapidly. Except for gentle handling, no accepted treatment for a fractured clavicle exists. Movement should be limited, and the infant should be gently handled. Performing range-of-motion exercises on the infant is not necessary. A fractured clavicle does not require immobilization with a splint.

22. With regard to infants who are SGA and intrauterine growth restriction (IUGR), the nurse should be aware of which information? a. In the first trimester, diseases or abnormalities result in asymmetric IUGR. b. Infants with asymmetric IUGR have the potential for normal growth and development. c. In asymmetric IUGR, weight is slightly larger than SGA, whereas length and head circumference are somewhat less than SGA. d. Symmetric IUGR occurs in the later stages of pregnancy.

: B IUGR is either symmetric or asymmetric. The symmetric form occurs in the first trimester; infants who are SGA have reduced brain capacity. The asymmetric form occurs in the later stages of pregnancy. Weight is less than the 10th percentile; head circumference is greater than the 10th percentile. Infants with asymmetric IUGR have the potential for normal growth and development.

7. An MSAFP screening indicates an elevated level of alpha-fetoprotein. The test is repeated, and again the level is reported as higher than normal. What is the next step in the assessment sequence to determine the well-being of the fetus? a. PUBS b. Ultrasound for fetal anomalies c. BPP for fetal well-being d. Amniocentesis for genetic anomalies

: B If MSAFP findings are abnormal, then follow-up procedures include genetic counseling for families with a history of NTD, repeated MSAFP screenings, an ultrasound examination, and possibly amniocentesis. Indications for the use of PUBS include prenatal diagnosis of inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection, determination of the acid-base status of fetuses with IUGR, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus. A BPP is a method of assessing fetal well-being in the third trimester. Before an amniocentesis, the client would have an ultrasound for direct visualization of the fetus.

28. Which instruction should the nurse provide to reduce the risk of nipple trauma? a. Limit the feeding time to less than 5 minutes. b. Position the infant so the nipple is far back in the mouth. c. Assess the nipples before each feeding. d. Wash the nipples daily with mild soap and water.

: B If the infants mouth does not cover as much of the areola as possible, the pressure during sucking will be applied to the nipple, thus causing trauma to the area. Stimulating the breast for less than 5 minutes will not produce the extra milk the infant may need and will also limit access to the higher-fat hindmilk. Assessing the nipples for trauma is important; however, this action alone will not prevent sore nipples. Soap can be drying to the nipples and should be avoided during breastfeeding.

17. Which maternal condition always necessitates delivery by cesarean birth? a. Marginal placenta previa b. Complete placenta previa c. Ectopic pregnancy d. Eclampsia

: B In complete placenta previa, the placenta completely covers the cervical os. A cesarean birth is the acceptable method of delivery. The risk of fetal death occurring is due to preterm birth. If the previa is marginal (i.e., 2 cm or greater away from the cervical os), then labor can be attempted. A cesarean birth is not indicated for an ectopic pregnancy. Labor can be safely induced if the eclampsia is under control.

5. A premature infant never seems to sleep longer than an hour at a time. Each time a light is turned on, an incubator closes, or people talk near her crib, she wakes up and inconsolably cries until held. What is the correct ngnuorssiinsgbdegiainning with ineffective coping, related to? a. Severe immaturity b. Environmental stress c. Physiologic distress d. Behavioral responses

: B Ineffective coping, related to environmental stress is the most appropriate nursing diagnosis for this infant. Light and sound are known adverse stimuli that add to an already stressed premature infant. The nurse must closely monitor the environment for sources of overstimulation. Although the infant may be severely immature in this case, she is responding to environmental stress. Physiologic distress is the response to environmental stress. The result is stress cues such as increased metabolic rate, increased oxygen and caloric use, and depression of the immune system. The infants behavioral response to the environmental stress is crying. The appropriate nursing diagnosis reflects the cause of this response.

6. The nurse who is caring for a woman hospitalized for hyperemesis gravidarum would expect the initial treatment to involve what? a. Corticosteroids to reduce inflammation b. Intravenous (IV) therapy to correct fluid and electrolyte imbalances c. Antiemetic medication, such as pyridoxine, to control nausea and vomiting d. Enteral nutrition to correct nutritional deficits

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

23. The breastfeeding mother should be taught a safe method to remove the breast from the babys mouth. Which suggestion by the nurse is most appropriate? a. Slowly remove the breast from the babys mouth when the infant has fallen asleep and the jaws are relaxed. b. Break the suction by inserting your finger into the corner of the infants mouth. c. A popping sound occurs when the breast is correctly removed from the infants mouth. d. Elicit the Moro reflex to wake the baby and remove the breast when the baby cries.

: B Inserting a finger into the corner of the babys mouth between the gums to break the suction avoids trauma to the breast. The infant who is sleeping may lose grasp on the nipple and areola, resulting in chewing on the nipple that makes it sore. A popping sound indicates improper removal of the breast from the babys mouth and may cause cracks or fissures in the breast. Most mothers prefer the infant to continue to sleep after the feeding. Gentle wake-up techniques are recommended.

20. Which characteristic correctly matches the type of deceleration with its likely cause? a. Early decelerationumbilical cord compression b. Late decelerationuteroplacental insufficiency c. Variable decelerationhead compression d. Prolonged decelerationunknown cause

: B Late deceleration is caused by uteroplacental insufficiency. Early deceleration is caused by head compression. Variable deceleration is caused by umbilical cord compression. Prolonged deceleration has a variety of either benign or critical causes.

12. Which finding would indicate to the nurse that the grieving parents have progressed to the reorganization phase of grieving? a. The parents say that they feel no pain. b. The parents are discussing sex and a future pregnancy, even if they have not yet sorted out their feelings. c. The parents have abandoned those moments of bittersweet grief. d. The parents questions have progressed from Why? to Why us?

: B Many couples have conflicting feelings about sexuality and future pregnancies. A little pain is always present, certainly beyond the first year when recovery begins to peak. Bittersweet grief describes the brief grief response that occurs with reminders of a loss, such as anniversary dates. Most couples never abandon these reminders. Recovery is ongoing. Typically, a couples search for meaning progresses from Why? in the acute phase to Why me? in the intense phase to What does this loss mean to my life? in the reorganizational phase.

19. What is the correct terminology for an abortion in which the fetus dies but is retained within the uterus? a. Inevitable abortion b. Missed abortion c. Incomplete abortion d. Threatened abortion

: B Missed abortion refers to the retention of a dead fetus in the uterus. An inevitable abortion means that the cervix is dilating with the contractions. An incomplete abortion means that not all of the products of conception were expelled. With a threatened abortion, the woman has cramping and bleeding but no cervical dilation.

11. A new mother with a thyroid disorder has come for a lactation follow-up appointment. Which thyroid disorder is a contraindication for breastfeeding? a. Hyperthyroidism b. PKU c. Hypothyroidism d. Thyroid storm

: B PKU is a cause of mental retardation in infants; mothers with PKU pass on phenylalanine and therefore should elect not to breastfeed. A woman with either hyperthyroidism or hypothyroidism would have no particular reason not to breastfeed. A thyroid storm is a complication of hyperthyroidism and is not a contraindication to breastfeeding.

16. In contrast to placenta previa, what is the most prevalent clinical manifestation of abruptio placentae? a. Bleeding b. Intense abdominal pain c. Uterine activity d. Cramping

: B Pain is absent with placenta previa and may be agonizing with abruptio placentae. Bleeding may be present in varying degrees for both placental conditions. Uterine activity and cramping may be present with both placental conditions.

17. The nurse is planning the care for a laboring client with diabetes mellitus. This client is at greater risk for which clinical finding? a. Oligohydramnios b. Polyhydramnios c. Postterm pregnancy d. Chromosomal abnormalities

: B Polyhydramnios or amniotic fluid in excess of 2000 ml is 10 times more likely to occur in the client with diabetes mellitus rather than in nondiabetic pregnancies. This complication places the mother at risk for premature rupture of membranes, premature labor, and postpartum hemorrhage. Prolonged rupture of membranes, IUGR, intrauterine fetal death, and renal agenesis (Potter syndrome) place the client at risk for developing oligohydramnios. Anencephaly, placental insufficiency, and perinatal hypoxia contribute to the risk for postterm pregnancy. Maternal age older than 35 years and balanced translocation (maternal and paternal) are risk factors for chromosomal abnormalities.

20. In caring for the preterm infant, what complication is thought to be a result of high arterial blood oxygen level? a. NEC b. ROP c. BPD d. Intraventricular hemorrhage (IVH)

: B ROP is thought to occur as a result of high levels of oxygen in the blood. NEC is caused by the interference of blood supply to the intestinal mucosa. Necrotic lesions occur at that site. BPD is caused by the use of positive pressure ventilation against the immature lung tissue. IVH results from the rupture of the fragile blood vessels in the ventricles of the brain and is most often associated with hypoxic injury, increased blood pressure, and fluctuating cerebral blood flow.

4. A 41-week pregnant multigravida arrives at the labor and delivery unit after a NST indicated that her fetus could be experiencing some difficulties in utero. Which diagnostic tool yields more detailed information about the condition of the fetus? a. Ultrasound for fetal anomalies b. Biophysical profile (BPP) c. MSAFP screening d. Percutaneous umbilical blood sampling (PUBS)

: B Real-time ultrasound permits a detailed assessment of the physical and physiologic characteristics of the developing fetus and a cataloging of normal and abnormal biophysical responses to stimuli. The BPP is a noninvasive, dynamic assessment of a fetus that is based on acute and chronic markers of fetal disease. An ultrasound for fetal anomalies would most likely have occurred earlier in the pregnancy. It is too late in the pregnancy to perform an MSAFP. Furthermore, it does not provide information related to fetal well-being. Indications for PUBS include prenatal diagnosis or inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection, determination of the acid-base status of the fetus with IUGR, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus.

19. Necrotizing enterocolitis (NEC) is an inflammatory disease of the gastrointestinal mucosa. The signs of NEC are nonspecific. What are generalized signs and symptoms of this condition? a. Hypertonia, tachycardia, and metabolic alkalosis b. Abdominal distention, temperature instability, and grossly bloody stools c. Hypertension, absence of apnea, and ruddy skin color d. Scaphoid abdomen, no residual with feedings, and increased urinary output

: B Some generalized signs of NEC include decreased activity, hypotonia, pallor, recurrent apnea and bradycardia, decreased oxygen saturation values, respiratory distress, metabolic acidosis, oliguria, hypotension, decreased perfusion, temperature instability, cyanosis, abdominal distention, residual gastric aspirates, vomiting, grossly bloody stools, abdominal tenderness, and erythema of the abdominal wall. The infant may display hypotonia, bradycardia, and metabolic acidosis.

1. A new mother recalls from prenatal class that she should try to feed her newborn daughter when she exhibits feeding readiness cues rather than waiting until the baby is frantically crying. Which feeding cue would indicate that the baby is ready to eat? a. Waves her arms in the air b. Makes sucking motions c. Has the hiccups d. Stretches out her legs straight

: B Sucking motions, rooting, mouthing, and hand-to-mouth motions are examples of feeding readiness cues. Waving her arms in the air, having the hiccups, and stretching out her extremities are not typical feeding readiness cues.

2. Which nursing intervention is paramount when providing care to a client with preterm labor who has received terbutaline? a. Assess deep tendon reflexes (DTRs). b. Assess for dyspnea and crackles. c. Assess for bradycardia. d. Assess for hypoglycemia.

: B Terbutaline is a beta2-adrenergic agonist that affects the mothers cardiopulmonary and metabolic systems. Signs of cardiopulmonary decompensation include adventitious breath sounds and dyspnea. An assessment for dyspnea and crackles is important for the nurse to perform if the woman is taking magnesium sulfate. Assessing DTRs does not address the possible respiratory side effects of using terbutaline. Since terbutaline is a beta2-adrenergic agonist, it can lead to hyperglycemia, not hypoglycemia. Beta2-adrenergic agonist drugs cause tachycardia, not bradycardia.

17. During labor a fetus displays an average FHR of 135 beats per minute over a 10-minute period. Which statement best describes the status of this fetus? a. Bradycardia b. Normal baseline heart rate c. Tachycardia d. Hypoxia

: B The baseline FHR is measured over 10 minutes; a normal range is 110 to 160 beats per minute. Bradycardia is a FHR less than 110 beats per minute for 10 minutes or longer. Tachycardia is a FHR higher than 160 beats per minutes for 10 minutes or longer. Hypoxia is an inadequate supply of oxygen; no indication of hypoxia exists with a baseline FHR in the normal range.

14. A client is diagnosed with having a stillborn infant. At first, she appears stunned by the news, cries a little, and then asks the nurse to call her mother. What is the proper term for the phase of bereavement that this client is experiencing? a. Anticipatory grief b. Acute distress c. Intense grief d. Reorganization

: B The immediate reaction to news of a perinatal loss or infant death encompasses a period of acute distress. Disbelief and denial can occur. However, parents also feel very sad and depressed. Intense outbursts of emotion and crying are normal. However, a lack of affect, euphoria, and calmness may occur and may reflect numbness, denial, or personal ways of coping with stress. Anticipatory grief applies to the grief related to a potential loss of an infant. The parent grieves in preparation of the infants possible death, although he or she clings to the hope that the child will survive. Intense grief occurs in the first few months after the death of the infant. This phase encompasses many different emotions, including loneliness, emptiness, yearning, guilt, anger, and fear. Reorganization occurs after a long and intense search for meaning. Parents are better able to function at work and home, experience a return of self-esteem and confidence, can cope with new challenges, and have placed the loss in perspective

17. A new father is ready to take his wife and newborn son home. He proudly tells the nurse who is discharging them that within the next week he plans to start feeding the infant cereal between breastfeeding sessions. Which information should the nurse provide regarding this feeding plan? a. Feeding solid foods before your son is 4 to 6 months old may decrease your sons intake of sufficient calories. b. Feeding solid foods between breastfeeding sessions before your son is 4 to 6 months old will lead to an early cessation of breastfeeding. c. Your feeding plan will help your son sleep through the night. d. Feeding solid foods before your son is 4 to 6 months old will limit his growth.

: B The introduction of solid foods before the infant is 4 to 6 months of age may result in overfeeding and decreased intake of breast milk. The belief that feeding solid foods helps infants sleep through the night is untrue. The proper balance of carbohydrate, protein, and fat for an infant to grow properly is in the breast milk or formula.

7. A newborn was admitted to the neonatal intensive care unit (NICU) after being delivered at 29 weeks of gestation to a 28-year-old multiparous, married, Caucasian woman whose pregnancy was uncomplicated until the premature rupture of membranes and preterm birth. The newborns parents arrive for their first visit after the birth. The parents walk toward the bedside but remain approximately 5 feet away from the bed. What is the nurses most appropriate action? a. Wait quietly at the newborns bedside until the parents come closer. b. Go to the parents, introduce him or herself, and gently encourage them to meet their infant. Explain the equipment first, and then focus on the newborn. c. Leave the parents at the bedside while they are visiting so that they have some privacy. d. Tell the parents only about the newborns physical condition and caution them to avoid touching their baby.

: B The nurse is instrumental in the initial interactions with the infant. The nurse can help the parents see the infant rather than focus on the equipment. The importance and purpose of the apparatus that surrounds their infant also should be explained to them. Parents often need encouragement and recognition from the nurse to acknowledge the reality of the infants condition. Parents need to see and touch their infant as soon as possible to acknowledge the reality of the birth and the infants appearance and condition. Encouragement from the nurse is instrumental in this process. Telling the parents to avoid touching their baby is inappropriate and unhelpful.

2. A newborn in the neonatal intensive care unit (NICU) is dying as a result of a massive infection. The parents speak to the neonatologist, who informs them of their sons prognosis. When the father sees his son, he says, He looks just fine to me. I cant understand what all this is about. What is the most appropriate response or reaction by the nurse at this time? a. Didnt the physician tell you about your sons problems? b. This must be a difficult time for you. Tell me how youre doing. c. Quietly stand beside the infants father. d. Youll have to face up to the fact that he is going to die sooner or later.

: B The phase of intense grief can be very difficult, especially for fathers. Parents should be encouraged to share their feelings during the initial steps in the grieving process. This father is in a phase of acute distress and is reaching out to the nurse as a source of direction in his grieving process. Shifting the focus is not in the best interest of the parent. Nursing actions may help the parents actualize the loss of their infant through a sharing and verbalization of their feelings of grief. Telling the father that his son is going to die sooner or later is dispassionate and an inappropriate statement on the part of the nurse.

4. A 26-year-old pregnant woman, gravida 2, para 1-0-0-1, is 28 weeks pregnant when she experiences bright red, painless vaginal bleeding. On her arrival at the hospital, which diagnostic procedure will the client most likely have performed? a. Amniocentesis for fetal lung maturity b. Transvaginal ultrasound for placental location c. Contraction stress test (CST) d. Internal fetal monitoring

: B The presence of painless bleeding should always alert the health care team to the possibility of placenta previa, which can be confirmed through ultrasonography. Amniocentesis is not performed on a woman who is experiencing bleeding. In the event of an imminent delivery, the fetus is presumed to have immature lungs at this gestational age, and the mother is given corticosteroids to aid in fetal lung maturity. A CST is not performed at a preterm gestational age. Furthermore, bleeding is a contraindication to a CST. Internal fetal monitoring is also contraindicated in the presence of bleeding.

11. During a follow-up home visit, the nurse plans to evaluate whether parents have progressed to the second stage of grieving (phase of intense grief). Which behavior would the nurse not anticipate finding? a. Guilt, particularly in the mother b. Numbness or lack of response c. Bitterness or irritability d. Fear and anxiety, especially about getting pregnant again

: B The second phase of grieving encompasses a wide range of intense emotions, including guilt, anger, bitterness, fear, and anxiety. What the nurse would hope not to see is numbness or unresponsiveness, which indicates that the parents are still in denial or shock.

4. A 26-year-old primigravida has come to the clinic for her regular prenatal visit at 12 weeks. She appears thin and somewhat nervous. She reports that she eats a well-balanced diet, although her weight is 5 pounds less than it was at her last visit. The results of laboratory studies confirm that she has a hyperthyroid condition. Based on the available data, the nurse formulates a plan of care. Which nursing diagnosis is most appropriate for the client at this time? a. Deficient fluid volume b. Imbalanced nutrition: less than body requirements c. Imbalanced nutrition: more than body requirements d. Disturbed sleep pattern

: B This clients clinical cues include weight loss, which supports a nursing diagnosis of Imbalanced nutrition: less than body requirements. No clinical signs or symptoms support a nursing diagnosis of deficient fluid volume. This client reports weight loss, not weight gain. Although the client reports nervousness, the most appropriate nursing diagnosis, based on the clients other clinical symptoms, is Imbalanced nutrition: less than body requirements.

8. A pregnant woman at 29 weeks of gestation has been diagnosed with preterm labor. Her labor is being controlled with tocolytic medications. She asks when she might be able to go home. Which response by the nurse is most accurate? a. After the baby is born. b. When we can stabilize your preterm labor and arrange home health visits. c. Whenever your physician says that it is okay. d. It depends on what kind of insurance coverage you have.

: B This clients preterm labor is being controlled with tocolytics. Once she is stable, home care may be a viable option for this type of client. Care of a client with preterm labor is multidisciplinary and multifactorial; the goal is to prevent delivery. In many cases, this goal may be achieved at home. Managed care may dictate an earlier hospital discharge or a shift from hospital to home care. Insurance coverage may be one factor in client care, but ultimately, client safety remains the most important factor.

7. In terms of the incidence and classification of diabetes, which information should the nurse keep in mind when evaluating clients during their ongoing prenatal appointments? a. Type 1 diabetes is most common. b. Type 2 diabetes often goes undiagnosed. c. GDM means that the woman will receive insulin treatment until 6 weeks after birth. d. Type 1 diabetes may become type 2 during pregnancy.

: B Type 2 diabetes often goes undiagnosed because hyperglycemia gradually develops and is often not severe. Type 2, sometimes called adult-onset diabetes, is the most common type of diabetes. GDM refers to any degree of glucose intolerance first recognized during pregnancy; insulin may or may not be needed. People do not go back and forth between type 1 and type 2 diabetes.

13. Which clinical finding is a major use of ultrasonography in the first trimester? a. Amniotic fluid volume b. Presence of maternal abnormalities c. Placental location and maturity d. Cervical length

: B Ultrasonography can detect certain uterine abnormalities such as bicornuate uterus, fibroids, and ovarian cysts. Amniotic fluid volume, placental location and maturity, and cervical length are not available via ultrasonography until the second or third trimester.

4. What is the most likely cause for variable FHR decelerations? a. Altered fetal cerebral blood flow b. Umbilical cord compression c. Uteroplacental insufficiency d. Fetal hypoxemia

: B Variable FHR decelerations can occur at any time during the uterine contracting phase and are caused by compression of the umbilical cord. Altered fetal cerebral blood flow results in early decelerations in the FHR. Uteroplacental insufficiency results in late decelerations in the FHR. Fetal hypoxemia initially results in tachycardia and then bradycardia if hypoxia continues.

5. A laboring woman with no known risk factors suddenly experiences spontaneous ROM. The fluid consists of bright red blood. Her contractions are consistent with her current stage of labor. No change in uterine resting tone has occurred. The fetal heart rate (FHR) begins to decline rapidly after the ROM. The nurse should suspect the possibility of what condition? a. Placenta previa b. Vasa previa c. Severe abruptio placentae d. Disseminated intravascular coagulation (DIC)

: B Vasa previa is the result of a velamentous insertion of the umbilical cord. The umbilical vessels are not surrounded by Wharton jelly and have no supportive tissue. The umbilical blood vessels thus are at risk for laceration at any time, but laceration occurs most frequently during ROM. The sudden appearance of bright red blood at the time of ROM and a sudden change in the FHR without other known risk factors should immediately alert the nurse to the possibility of vasa previa. The presence of placenta previa most likely would be ascertained before labor and is considered a risk factor for this pregnancy. In addition, if the woman had a placenta previa, it is unlikely that she would be allowed to pursue labor and a vaginal birth. With the presence of severe abruptio placentae, the uterine tonicity typically is tetanus (i.e., a boardlike uterus). DIC is a pathologic form of diffuse clotting that consumes large amounts of clotting factors, causing widespread external bleeding, internal bleeding, or both. DIC is always a secondary diagnosis, often associated with obstetric risk factors such as the hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome. This woman did not have any prior risk factors.

23. Which nursing intervention is necessary before a first-trimester transabdominal ultrasound? a. Place the woman on nothing by mouth (nil per os [NPO]) for 12 hours. b. Instruct the woman to drink 1 to 2 quarts of water. c. Administer an enema. d. Perform an abdominal preparation.

: B When the uterus is still in the pelvis, visualization may be difficult. Performing a first-trimester transabdominal ultrasound requires the woman to have a full bladder, which will elevate the uterus upward and provide a better visualization of the fetus; therefore, being NPO is not appropriate. Neither an enema nor an abdominal preparation is necessary for this procedure.

15. Near the end of the first week of life, an infant who has not been treated for any infection develops a copper-colored maculopapular rash on the palms and around the mouth and anus. The newborn is displaying signs and symptoms of which condition? a. Gonorrhea b. Herpes simplex virus (HSV) infection c. Congenital syphilis d. HIV

: C A copper-colored maculopapular rash is indicative of congenital syphilis with lesions that may extend over the trunk and extremities. This rash is not an indication that the neonate has contracted gonorrhea. Rather, the neonate with gonorrheal infection might have septicemia, meningitis, conjunctivitis, and scalp abscesses. Infants affected with the HSV display growth restriction, skin lesions, microcephaly, hypertonicity, and seizures. Typically, the HIV-infected neonate is asymptomatic at birth. Most often the infant develops an opportunistic infection and rapid progression of immunodeficiency.

19. In the past, factors to determine whether a woman was likely to develop a high-risk pregnancy were primarily evaluated from a medical point of view. A broader, more comprehensive approach to high-risk pregnancy has been adopted today. Four categories have now been established, based on the threats to the health of the woman and the outcome of pregnancy. Which category should not be included in this group? a. Biophysical b. Psychosocial c. Geographic d. Environmental

: C A geographic category is correctly referred to as sociodemographic risk. These factors stem from the mother and her family. Ethnicity may be one of the risks to pregnancy; however, it is not the only factor in this category. Low income, lack of prenatal care, age, parity, and marital status also are included. Biophysical is one of the broad categories used for determining risk. These include genetic considerations, nutritional status, and medical and obstetric disorders. Psychosocial risks include smoking, caffeine, drugs, alcohol, and psychologic status. All of these adverse lifestyles can have a negative effect on the health of the mother or fetus. Environmental risks are risks that can affect both fertility and fetal development. These include infections, chemicals, radiation, pesticides, illicit drugs, and industrial pollutants.

15. Which preexisting factor is known to increase the risk of GDM? 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

: C A previous birth of a large infant suggests GDM. Obesity (body mass index [BMI] of 30 or greater) creates a higher risk for gestational diabetes. A woman younger than 25 years is not generally at risk for GDM. The person with type 2 diabetes mellitus already has diabetes and thus will continue to have it after pregnancy. Insulin may be required during pregnancy because oral hypoglycemia drugs are contraindicated during pregnancy.

15. A woman arrives at the emergency department with complaints of bleeding and cramping. The initial nursing history is significant for a last menstrual period 6 weeks ago. On sterile speculum examination, the primary care provider finds that the cervix is closed. The anticipated plan of care for this woman would be based on a probable diagnosis of which type of spontaneous abortion? a. Incomplete b. Inevitable c. Threatened d. Septic

: C A woman with a threatened abortion has spotting, mild cramps, and no cervical dilation. A woman with an incomplete abortion would have heavy bleeding, mild-to-severe cramping, and cervical dilation. An inevitable abortion demonstrates the same symptoms as an incomplete abortion: heavy bleeding, mild-to-severe cramping, and cervical dilation. A woman with a septic abortion has malodorous bleeding and typically a dilated cervix.

14. The nurse is evaluating a neonate who was delivered 3 hours ago by vacuum-assisted delivery. The infant has developed a cephalhematoma. Which statement is most applicable to the care of this neonate? a. Intracranial hemorrhage (ICH) as a result of birth trauma is more likely to occur in the preterm, low-birth-weight infant. b. Subarachnoid hemorrhage (the most common form of ICH) occurs in term infants as a result of hypoxia. c. In many infants, signs of hemorrhage in a full-term infant are absent and diagnosed only through laboratory tests. d. Spinal cord injuries almost always result from vacuum-assisted deliveries.

: C Abnormalities in lumbar punctures or red blood cell counts, for instance, or in visuals on computed tomographic (CT) scans might reveal a hemorrhage. ICH as a result of birth trauma is more likely to occur in the full-term, large infant. Subarachnoid hemorrhage in term infants is a result of trauma; in preterm infants, it is a result of hypoxia. Spinal cord injuries are almost always from breech births; however, spinal cord injuries are rare today because cesarean birth is used for breech presentation.

20. While discussing the societal impacts of breastfeeding, the nurse should be cognizant of the benefits and educate the client accordingly. Which statement as part of this discussion would be incorrect? a. Breastfeeding requires fewer supplies and less cumbersome equipment. b. Breastfeeding saves families money. c. Breastfeeding costs employers in terms of time lost from work. d. Breastfeeding benefits the environment.

: C Actually, less time is lost to work by breastfeeding mothers, in part because infants are healthier. Breastfeeding is convenient because it does not require cleaning or transporting bottles and other equipment. It saves families money because the cost of formula far exceeds the cost of extra food for the lactating mother. Breastfeeding uses a renewable resource; it does not need fossil fuels, advertising, shipping, or disposal.

5. At 35 weeks of pregnancy, a woman experiences preterm labor. Although tocolytic medications are administered and she is placed on bed rest, she continues to experience regular uterine contractions and her cervix is beginning to dilate and efface. What is an important test for fetal well-being at this time? a. PUBS b. Ultrasound for fetal size c. Amniocentesis for fetal lung maturity d. NST

: C Amniocentesis is performed to assess fetal lung maturity in the event of a preterm birth. The fluid is examined to determine the lecithin to sphingomyelin (L/S) ratio. Indications for PUBS include prenatal diagnosis or inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection, determination of the acid-base status of the fetus with IUGR, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus. Determination of fetal size by ultrasound is typically performed during the second trimester and is not indicated in this scenario. An NST measures the fetal response to fetal movement in a noncontracting mother.

6. A woman with worsening preeclampsia is admitted to the hospitals labor and birth unit. The physician explains the plan of care for severe preeclampsia, including the induction of labor, to the woman and her husband. Which statement by the husband leads the nurse to believe that the couple needs further information? a. I will help my wife use the breathing techniques that we learned in our childbirth classes. b. I will give my wife ice chips to eat during labor. c. Since we will be here for a while, I will call my mother so she can bring the two boys2 years and 4 years of ageto visit their mother. d. I will stay with my wife during her labor, just as we planned.

: C Arranging a visit with their two children indicates that the husband does not understand the importance of the quiet, subdued environment that is needed to prevent his wifes condition from worsening. Implementing breathing techniques is indicative of adequate knowledge related to pain management during labor. Administering ice chips indicates an understanding of nutritional needs during labor. Staying with his wife during labor demonstrates the husbands support for his wife and is appropriate.

15. A client in the third trimester has just undergone an amniocentesis to determine fetal lung maturity. Which statement regarding this testing is important for the nurse in formulating a care plan? a. Because of new imaging techniques, an amniocentesis should have been performed in the first trimester. b. Despite the use of ultrasonography, complications still occur in the mother or infant in 5% to 10% of cases. c. Administration of Rho(D) immunoglobulin may be necessary. d. The presence of meconium in the amniotic fluid is always a cause for concern.

: C As a result of the possibility of fetomaternal hemorrhage, administration of Rho(D) immunoglobulin is the standard of practice after amniocentesis for women who are Rh negative. Amniocentesis is possible after the 14th week of pregnancy when the uterus becomes an abdominal organ. Complications occur in less than 1% of cases; many have been minimized or eliminated through the use of ultrasonography. Meconium in the amniotic fluid before the beginning of labor is not usually a problem.

27. As the nurse assists a new mother with breastfeeding, the client asks, If formula is prepared to meet the nutritional needs of the newborn, what is in breast milk that makes it better? What is the nurses best response? a. More calories b. Essential amino acids c. Important immunoglobulins d. More calcium

: C Breast milk contains immunoglobulins that protect the newborn against infection. The calorie count of formula and breast milk is approximately the same. All the essential amino acids are in both formula and breast milk; however, the concentrations may differ. Calcium levels are higher in formula than in breast milk, which can cause an excessively high renal solute load if the formula is not properly diluted.

21. What is the primary purpose for the use of tocolytic therapy to suppress uterine activity? a. Drugs can be efficaciously administered up to the designated beginning of term at 37 weeks gestation. b. Tocolytic therapy has no important maternal (as opposed to fetal) contraindications. c. The most important function of tocolytic therapy is to provide the opportunity to administer antenatal glucocorticoids. d. If the client develops pulmonary edema while receiving tocolytic therapy, then intravenous (IV) fluids should be given.

: C Buying time for antenatal glucocorticoids to accelerate fetal lung development may be the best reason to use tocolytic therapy. Once the pregnancy has reached 34 weeks, however, the risks of tocolytic therapy outweigh the benefits. Important maternal contraindications to tocolytic therapy exist. Tocolytic-induced edema can be caused by IV fluids.

22. While working with the pregnant client in her first trimester, what information does the nurse provide regarding when CVS can be performed (in weeks of gestation)? a. 4 b. 8 c. 10 d. 14

: C CVS can be performed in the first or second trimester, ideally between 10 and 13 weeks of gestation. During this procedure, a small piece of tissue is removed from the fetal portion of the placenta. If performed after 9 completed weeks of gestation, then the risk of limb reduction is no greater than in the general population.

20. What condition indicates concealed hemorrhage when the client experiences abruptio placentae? a. Decrease in abdominal pain b. Bradycardia c. Hard, boardlike abdomen d. Decrease in fundal height

: C 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. Abdominal pain may increase. The client will have shock symptoms that include tachycardia. As bleeding occurs, the fundal height increases.

6. A woman arrives for evaluation of signs and symptoms that include a missed period, adnexal fullness, tenderness, and dark red vaginal bleeding. On examination, the nurse notices an ecchymotic blueness around the womans umbilicus. What does this finding indicate? a. Normal integumentary changes associated with pregnancy b. Turner sign associated with appendicitis c. Cullen sign associated with a ruptured ectopic pregnancy d. Chadwick sign associated with early pregnancy

: C Cullen sign, the blue ecchymosis observed in the umbilical area, indicates hematoperitoneum associated with an undiagnosed ruptured intraabdominal ectopic pregnancy. Linea nigra on the abdomen is the normal integumentary change associated with pregnancy and exhibits a brown pigmented, vertical line on the lower abdomen. Turner sign is ecchymosis in the flank area, often associated with pancreatitis. A Chadwick sign is a blue-purple cervix that may be seen during or around the eighth week of pregnancy.

2. During a prenatal visit, the nurse is explaining dietary management to a woman with pregestational diabetes. Which statement by the client reassures the nurse that teaching has been effective? a. I will need to eat 600 more calories per day because I am pregnant. b. I can continue with the same diet as before pregnancy as long as it is well balanced. c. Diet and insulin needs change during pregnancy. d. I will plan my diet based on the results of urine glucose testing.

: C Diet and insulin needs change during the pregnancy in direct correlation to hormonal changes and energy needs. In the third trimester, insulin needs may double or even quadruple. The diet is individualized to allow for increased fetal and metabolic requirements, with consideration of such factors as prepregnancy weight and dietary habits, overall health, ethnic background, lifestyle, stage of pregnancy, knowledge of nutrition, and insulin therapy. Energy needs are usually calculated on the basis of 30 to 35 calories per kilogram of ideal body weight. Dietary management during a diabetic pregnancy must be based on blood, not urine, glucose changes.

4. An infant is to receive gastrostomy feedings. Which intervention should the nurse institute to prevent bloating, gastrointestinal reflux into the esophagus, vomiting, and respiratory compromise? a. Rapid bolusing of the entire amount in 15 minutes b. Warm cloths to the abdomen for the first 10 minutes c. Slow, small, warm bolus feedings over 30 minutes d. Cold, medium bolus feedings over 20 minutes

: C Feedings by gravity are slowly accomplished over 20- to 30-minute periods to prevent adverse reactions. Rapid bolusing would most likely lead to the adverse reactions listed. Temperature stability in the newborn is critical. Applying warm cloths to the abdomen would not be appropriate because the environment is not thermoregulated. In addition, abdominal warming is not indicated with feedings of any kind. Small feedings at room temperature are recommended to prevent adverse reactions.

24. In which clinical situation would the nurse most likely anticipate a fetal bradycardia? a. Intraamniotic infection b. Fetal anemia c. Prolonged umbilical cord compression d. Tocolytic treatment using terbutaline

: C Fetal bradycardia can be considered a later sign of fetal hypoxia and is known to occur before fetal death. Bradycardia can result from placental transfer of drugs, prolonged compression of the umbilical cord, maternal hypothermia, and maternal hypotension. Intraamniotic infection, fetal anemia, and tocolytic treatment using terbutaline would most likely result in fetal tachycardia.

25. How many kilocalories per kilogram (kcal/kg) of body weight does a breastfed term infant require each day? a. 50 to 65 b. 75 to 90 c. 95 to 110 d. 150 to 200

: C For the first 3 months, the infant needs 110 kcal/kg/day. At ages 3 to 6 months, the requirement is 100 kcal/kg/day. This level decreases slightly to 95 kcal/kg/day from 6 to 9 months and increases again to 100 kcal/kg/day until the baby reaches 12 months.

2. The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the oxytocin (Pitocin) infusion, the nurse reviews the womans latest laboratory test findings, which reveal a platelet count of 90,000 mm3 , an elevated aspartate aminotransaminase (AST) level, and a falling hematocrit. The laboratory results are indicative of which condition? a. Eclampsia b. Disseminated intravascular coagulation (DIC) syndrome c. Hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome d. Idiopathic thrombocytopenia

: C HELLP syndrome is a laboratory diagnosis for a variant of severe preeclampsia that involves hepatic dysfunction characterized by hemolysis (H), elevated liver (EL) enzymes, and low platelets (LP). Eclampsia is determined by the presence of seizures. DIC is a potential complication associated with HELLP syndrome. Idiopathic thrombocytopenia is the presence of low platelets of unknown cause and is not associated with preeclampsia.

17. To manage her diabetes appropriately and to ensure a good fetal outcome, how would the pregnant woman with diabetes alter her diet? a. Eat six small equal meals per day. b. Reduce the carbohydrates in her diet. c. Eat her meals and snacks on a fixed schedule. d. Increase her consumption of protein.

: C Having a fixed meal schedule will provide the woman and the fetus with a steady blood sugar level, provide a good balance with insulin administration, and help prevent complications. Having a fixed meal schedule is more important than the equal division of food intake. Approximately 45% of the food eaten should be in the form of carbohydrates.

10. Which statement regarding the laboratory test for glycosylated hemoglobin Alc is correct? a. The laboratory test for glycosylated hemoglobin Alc is performed for all pregnant women, not only those with or likely to have diabetes. b. This laboratory test is a snapshot of glucose control at the moment. c. This laboratory test measures the levels of hemoglobin Alc, which should remain at less than 7%. d. This laboratory test is performed on the womans urine, not her blood.

: C Hemoglobin Alc levels greater than 7% indicate an elevated glucose level during the previous 4 to 6 weeks. This extra laboratory test is for diabetic women and defines glycemic control over the previous 4 to 6 weeks. Glycosylated hemoglobin level tests are performed on the blood.

14. With regard to an eventual discharge of the high-risk newborn or the transfer of the newborn to a different facility, which information is essential to provide to the parents? a. Infants stay in the NICU until they are ready to go home. b. Once discharged to go home, the high-risk infant should be treated like any healthy term newborn. c. Parents of high-risk infants need special support and detailed contact information. d. If a high-risk infant and mother need to be transferred to a specialized regional center, then waiting until after the birth and until the infant is stabilized is best.

: C High-risk infants can cause profound parental stress and emotional turmoil. Parents need support, special teaching, and quick access to various resources available to help them care for their baby. Parents and their high-risk infant should get to spend a night or two in a predischarge room, where care for the infant is provided away from the NICU. Simply because high-risk infants are eventually discharged does not mean they are normal, healthy babies. Follow-up by specialized practitioners is essential. Ideally, the mother and baby are transported with the fetus in utero; this reduces neonatal morbidity and mortality.

12. Which statement regarding the nutrient needs of breastfed infants is correct? a. Breastfed infants need extra water in hot climates. b. During the first 3 months, breastfed infants consume more energy than formulafed infants. c. Breastfeeding infants should receive oral vitamin D drops daily during at least the first 2 months. d. Vitamin K injections at birth are not necessary for breastfed infants.

: C Human milk contains only small amounts of vitamin D. All infants who are breastfed should receive 400 International Units of vitamin D each day. Neither breastfed nor formula-fed infants need to be fed water, not even in very hot climates. During the first 3 months, formula-fed infants consume more energy than breastfed infants and therefore tend to grow more rapidly. Vitamin K shots are required for all infants because the bacteria that produce it are absent from the babys stomach at birth.

18. An infant was born 2 hours ago at 37 weeks of gestation and weighs 4.1 kg. The infant appears chubby with a flushed complexion and is very tremulous. The tremors are most likely the result of what condition? a. Birth injury b. Hypocalcemia c. Hypoglycemia d. Seizures

: C Hypoglycemia is common in the macrosomic infant. Signs of hypoglycemia include jitteriness, apnea, tachypnea, and cyanosis.

4. Which conditions are infants of diabetic mothers (IDMs) at a higher risk for developing? a. Iron deficiency anemia b. Hyponatremia c. Respiratory distress syndrome d. Sepsis

: C IDMs are at risk for macrosomia, birth trauma, perinatal asphyxia, respiratory distress syndrome, hypoglycemia, hypocalcemia, hypomagnesemia, cardiomyopathy, hyperbilirubinemia, and polycythemia. IDMs are not at risk for anemia, hyponatremia, or sepsis.

25. The indirect Coombs test is a screening tool for Rh incompatibility. If the titer is greater than , amniocentesis may be a necessary next step. a. 1:2 b. 1:4 c. 1:8 d. 1:12

: C If the maternal titer for Rh antibodies is greater 1:8, then an amniocentesis is indicated to determine the level of bilirubin in the amniotic fluid. This testing will determine the severity of fetal hemolytic anemia.

12. A nurse practicing in the perinatal setting should promote kangaroo care regardless of an infants gestational age. Which statement regarding this intervention is most appropriate? a. Kangaroo care was adopted from classical British nursing traditions. b. This intervention helps infants with motor and CNS impairments. c. Kangaroo care helps infants interact directly with their parents and enhances their temperature regulation. d. This intervention gets infants ready for breastfeeding.

: C Kangaroo care is skin-to-skin holding in which the infant, dressed only in a diaper, is placed directly on the parents bare chest and then covered. The procedure helps infants interact with their parents and regulates their temperature, among other developmental benefits. Kangaroo care was established in Bogota, Colombia, assists the infant in maintaining an organized state, and decreases pain perception during heelsticks. Even premature infants who are unable to suckle benefit from kangaroo care. This practice fosters increased vigor and an enhanced breastfeeding experience as the infant matures.

15. Which information should the nurse provide to a breastfeeding mother regarding optimal self-care? a. She will need an extra 1000 calories a day to maintain energy and produce milk. b. She can return to prepregnancy consumption patterns of any drinks as long as she gets enough calcium. c. She should avoid trying to lose large amounts of weight. d. She must avoid exercising because it is too fatiguing.

: C Large weight loss releases fat-stored contaminants into her breast milk, and it also involves eating too little and/or exercising too much. A breastfeeding mother needs to add only 200 to 500 extra calories to her diet to provide the extra nutrients for her infant. However, this is true only if she does not drink alcohol, limits coffee to no more than two cups (including caffeine in chocolate, tea, and some sodas, too), and carefully reads the herbal tea ingredients. Although she needs her rest, moderate exercise is healthy.

9. The nurse who provides care to clients in labor must have a thorough understanding of the physiologic processes of maternal hypotension. Which outcome might occur if the interventions for maternal hypotension are inadequate? a. Early FHR decelerations b. Fetal arrhythmias c. Uteroplacental insufficiency d. Spontaneous rupture of membranes

: C Low maternal blood pressure reduces placental blood flow during uterine contractions, resulting in fetal hypoxemia. Maternal hypotension does not result in early FHR decelerations nor is it associated with fetal arrhythmias. Spontaneous rupture of membranes is not a result of maternal hypotension.

12. What is the primary purpose for magnesium sulfate administration for clients with preeclampsia and eclampsia? a. To improve patellar reflexes and increase respiratory efficiency b. To shorten the duration of labor c. To prevent convulsions d. To prevent a boggy uterus and lessen lochial flow

: C Magnesium sulfate is the drug of choice used to prevent convulsions, although it can generate other problems. Loss of patellar reflexes and respiratory depression are signs of magnesium toxicity. Magnesium sulfate can also increase the duration of labor. Women are at risk for a boggy uterus and heavy lochial flow as a result of magnesium sulfate therapy.

3. The nurse is preparing to administer methotrexate to the client. This hazardous drug is most often used for which obstetric complication? a. Complete hydatidiform mole b. Missed abortion c. Unruptured ectopic pregnancy d. Abruptio placentae

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

8. A new mother wants to be sure that she is meeting her daughters needs while feeding the baby commercially prepared infant formula. The nurse should evaluate the mothers knowledge about appropriate infant feeding techniques. Which statement by the client reassures the nurse that correct learning has taken place? a. Since reaching 2 weeks of age, I add rice cereal to my daughters formula to ensure adequate nutrition. b. I warm the bottle in my microwave oven. c. I burp my daughter during and after the feeding as needed. d. I refrigerate any leftover formula for the next feeding.

: C Most infants swallow air when fed from a bottle and should be given a chance to burp several times during and after the feeding. Solid food should not be introduced to the infant for at least 4 to 6 months after birth. A microwave should never be used to warm any food to be given to an infant. The heat is not distributed evenly, which may pose a risk of burning the infant. Any formula left in the bottle after the feeding should be discarded because the infants saliva has mixed with it.

10. Which options for saying good-bye would the nurse want to discuss with a woman who is diagnosed with having a stillborn girl? a. The nurse should not discuss any options at this time; plenty of time will be available after the baby is born. b. Would you like a picture taken of your baby after birth? c. When your baby is born, would you like to see and hold her? d. What funeral home do you want notified after the baby is born?

: C Mothers and fathers may find it helpful to see their infant after delivery. The parents wishes should be respected. Interventions and support from the nursing and medical staff after a prenatal loss are extremely important in the healing of the parents. The initial intervention should be directly related to the parents wishes concerning seeing or holding their dead infant. Although information about funeral home notification may be relevant, this information is not the most appropriate option at this time. Burial arrangements can be discussed after the infant is born.

17. Providing care for the neonate born to a mother who abuses substances can present a challenge for the health care team. Nursing care for this infant requires a multisystem approach. What is the first step in the provision of care for the infant? a. Pharmacologic treatment b. Reduction of environmental stimuli c. Neonatal abstinence syndrome (NAS) scoring d. Adequate nutrition and maintenance of fluid and electrolyte balance

: C NAS describes the cohort of symptoms associated with drug withdrawal in the neonate. The NAS system evaluates CNS, metabolic, vasomotor, respiratory, and gastrointestinal (GI) disturbances. This evaluation tool enables the health care team to develop an appropriate plan of care. The infant is scored throughout his or her length of stay, and the treatment plan is adjusted accordingly. Pharmacologic treatment is based on the severity of the withdrawal symptoms, which are determined by using a standard assessment tool. Medications of choice are morphine, phenobarbital, diazepam, or diluted tincture of opium. Swaddling, holding, and reducing environmental stimuli are essential in providing care to the infant who is experiencing withdrawal. These nursing interventions are appropriate for the infant who displays CNS disturbances. Poor feeding is one of the GI symptoms common to this client population. Fluid and electrolyte balance must be maintained, and adequate nutrition provided. These infants often have a poor suck reflex and may need to be fed via gavage.

27. The nurse observes a sudden increase in variability on the ERM tracing. Which class of medications may cause this finding? a. Narcotics b. Barbiturates c. Methamphetamines d. Tranquilizers

: C Narcotics, barbiturates, and tranquilizers may be causes of decreased variability; whereas methamphetamines may cause increased variability.

14. Women with mild gestational hypertension and mild preeclampsia can be safely managed at home with frequent maternal and fetal evaluation. Complete or partial bed rest is still frequently ordered by some providers. Which complication is rarely the result of prolonged bed rest? a. Thrombophlebitis b. Psychologic stress c. Fluid retention d. Cardiovascular deconditioning

: C No evidence has been found that supports the practice of bed rest to improve pregnancy outcome. Fluid retention is not an adverse outcome of prolonged bed rest. The woman is more likely to experience diuresis with accompanying fluid and electrolyte imbalance and weight loss. Prolonged bed rest is known to increase the risk for thrombophlebitis. Psychologic stress is known to begin on the first day of bed rest and continue for the duration of the therapy. Therefore, restricted activity, rather than complete bed rest, is recommended. Cardiovascular deconditioning is a known complication of bed rest.

11. Which information should nurses provide to expectant mothers when teaching them how to evaluate daily fetal movement counts (DFMCs)? a. Alcohol or cigarette smoke can irritate the fetus into greater activity. b. Kick counts should be taken every hour and averaged every 6 hours, with every other 6-hour stretch off. c. The fetal alarm signal should go off when fetal movements stop entirely for 12 hours. d. A count of less than four fetal movements in 1 hour warrants future evaluation.

: C No movement in a 12-hour period is cause for investigation and possibly intervention. Alcohol and cigarette smoke temporarily reduce fetal movement. The mother should count fetal activity (kick counts) two or three times daily for 60 minutes each time. A count of less than 3 in 1 hour warrants further evaluation by a NST.

10. The management of the pregnant client who has experienced a pregnancy loss depends on the type of miscarriage and the signs and symptoms. While planning care for a client who desires outpatient management after a first-trimester loss, what would the nurse expect the plan to include? a. Dilation and curettage (D&C) b. Dilation and evacuation (D&E) c. Misoprostol d. Ergot products

: C Outpatient management of a first-trimester loss is safely accomplished by the intravaginal use of misoprostol for up to 2 days. If the bleeding is uncontrollable, vital signs are unstable, or signs of infection are present, then a surgical evacuation should be performed. D&C is a surgical procedure that requires dilation of the cervix and scraping of the uterine walls to remove the contents of pregnancy. This procedure is commonly performed to treat inevitable or incomplete abortion and should be performed in a hospital. D&E is usually performed after 16 weeks of pregnancy. The cervix is widely dilated, followed by removal of the contents of the uterus. Ergot products such as Methergine or Hemabate may be administered for excessive bleeding after miscarriage.

26. Which action by the mother will initiate the milk ejection reflex (MER)? a. Wearing a firm-fitting bra b. Drinking plenty of fluids c. Placing the infant to the breast d. Applying cool packs to her breast

: C Oxytocin, which causes the MER reflex, increases in response to nipple stimulation. A firm bra is important to support the breast; however, it will not initiate the MER reflex. Drinking plenty of fluids is necessary for adequate milk production, but adequate intake of water alone will not initiate the MER reflex. Cool packs to the breast will decrease the MER reflex.

13. Which statement most accurately describes complicated grief? a. Occurs when, in multiple births, one child dies and the other or others live b. Is a state during which the parents are ambivalent, as with an abortion c. Is an extremely intense grief reaction that persists for a long time d. Is felt by the family of adolescent mothers who lose their babies

: C Parents showing signs of complicated grief should be referred for counseling. Multiple births, in which not all of the babies survive, create a complicated parenting situation but not complicated bereavement. Abortion can generate complicated emotional responses, but these responses do not constitute complicated bereavement. Families of lost adolescent pregnancies may have to deal with complicated issues, but these issues are not complicated bereavement.

8. A number of metabolic changes occur throughout pregnancy. Which physiologic adaptation of pregnancy will influence the nurses plan of care? 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.

: C Pregnant women develop increased insulin resistance during the second and third trimesters. Insulin never crosses the placenta; the fetus starts making its own around the 10th week. As a result of normal metabolic changes during pregnancy, insulin-dependent women are prone to hypoglycemia (low levels). Maternal insulin requirements may double or quadruple by the end of pregnancy.

7. Prostaglandin gel has been ordered for a pregnant woman at 43 weeks of gestation. What is the primary purpose of prostaglandin administration? a. To enhance uteroplacental perfusion in an aging placenta b. To increase amniotic fluid volume c. To ripen the cervix in preparation for labor induction d. To stimulate the amniotic membranes to rupture

: C Preparations of prostaglandin E1 and E2 are effective when used before labor induction to ripen (i.e., soften and thin) the cervix. Uteroplacental perfusion is not altered by the use of prostaglandins. The insertion of prostaglandin gel has no effect on the level of amniotic fluid. In some cases, women will spontaneously begin laboring after the administration of prostaglandins, thereby eliminating the need for oxytocin. It is not common for a womans membranes to rupture as a result of prostaglandin use.

5. When assisting the mother, father, and other family members to actualize the loss of an infant, which action is most helpful? a. Using the words lost or gone rather than dead or died b. Making sure the family understands that naming the baby is important c. Ensuring the baby is clothed or wrapped if the parents choose to visit with the baby d. Setting a firm time for ending the visit with the baby so that the parents know when to let go

: C Presenting the baby as nicely as possible stimulates the parents senses and provides pleasant memories of their baby. Baby lotion or powder can be applied, and the baby should be wrapped in a soft blanket, clothed, and have a cap placed on his or her head. Nurses must use the words dead and died to assist the bereaved in accepting the reality. Although naming the baby can be helpful, creating the sense that the parents have to name the baby is not important. In fact, some cultural taboos and religious rules prohibit the naming of an infant who has died. Parents need different times with their baby to say good-bye. Nurses need to be careful not to rush the process.

13. For clinical purposes, the most accurate definition of preterm and postterm infants is defined as what? a. Preterm: Before 34 weeks of gestation if the infant is appropriate for gestational age (AGA); before 37 weeks if the infant is small for gestational age (SGA) b. Postterm: After 40 weeks of gestation if the infant is large for gestational age (LGA); beyond 42 weeks if the infant is AGA c. Preterm: Before 37 weeks of gestation and postterm beyond 42 weeks of gestation; no matter the size for gestational age at birth d. Preterm: Before 38 to 40 weeks of gestation if the infant is SGA; postterm, beyond 40 to 42 weeks gestation if the infant is LGA

: C Preterm and postterm are strictly measures of timebefore 37 weeks and beyond 42 weeks, respectivelyregardless of the size for gestational age.

1. In planning for home care of a woman with preterm labor, which concern should the nurse need to address? a. Nursing assessments are different from those performed in the hospital setting. b. Restricted activity and medications are necessary to prevent a recurrence of preterm labor. c. Prolonged bed rest may cause negative physiologic effects. d. Home health care providers are necessary.

: C 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. Nursing assessments differ somewhat from those performed in the acute care setting, but this concern does not need to be addressed. Restricted activity and medications may prevent preterm labor but not in all women. In addition, the plan of care is individualized to meet the needs of each client. Many women receive home health nurse visits, but care is individualized for each woman.

21. Which information related to a prolonged deceleration is important for the labor nurse to understand? a. Prolonged decelerations present a continuing pattern of benign decelerations that do not require intervention. b. Prolonged decelerations constitute a baseline change when they last longer than 5 minutes. c. A disruption to the fetal oxygen supply causes prolonged decelerations. d. Prolonged decelerations require the customary fetal monitoring by the nurse.

: C Prolonged decelerations are caused by a disruption in the fetal oxygen supply. They usually begin as a reflex response to hypoxia. If the disruption continues, then the fetal cardiac tissue, itself, will become hypoxic, resulting in direct myocardial depression of the FHR. Prolonged decelerations can be caused by prolonged cord compression, uteroplacental insufficiency, or perhaps sustained head compression. Prolonged decelerations lasting longer than 10 minutes are considered a baseline change that may require intervention. A prolonged deceleration is a visually apparent decrease (may be either gradual or abrupt) in the FHR of at least 15 beats per minute below the baseline and lasting longer than 2 minutes but shorter than 10 minutes. Nurses should immediately notify the physician or nurse-midwife and initiate appropriate treatment of abnormal patterns when they see prolonged decelerations.

1. A primigravida is being monitored at the prenatal clinic for preeclampsia. Which finding is of greatest concern to the nurse? a. Blood pressure (BP) increase to 138/86 mm Hg b. Weight gain of 0.5 kg during the past 2 weeks c. Dipstick value of 3+ for protein in her urine d. Pitting pedal edema at the end of the day

: C Proteinuria is defined as a concentration of 1+ or greater via dipstick measurement. A dipstick value of 3+ alerts the nurse that additional testing or assessment should be performed. A 24-hour urine collection is preferred over dipstick testing attributable to accuracy. Generally, hypertension is defined as a BP of 140/90 mm Hg or an increase in systolic pressure of 30 mm Hg or diastolic pressure of 15 mm Hg. Preeclampsia may be demonstrated as a rapid weight gain of more than 2 kg in 1 week. 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.

24. Which type of formula is not diluted with water, before being administered to an infant? a. Powdered b. Concentrated c. Ready-to-use d. Modified cows milk

: C Ready-to-use formula can be poured directly from the can into the babys bottle and is good (but expensive) when a proper water supply is not available. Formula should be well mixed to dissolve the powder and make it uniform in consistency. Improper dilution of concentrated formula may cause malnutrition or sodium imbalances. Cows milk is more difficult for the infant to digest and is not recommended, even if it is diluted.

4. A pregnant woman has been receiving a magnesium sulfate infusion for treatment of severe preeclampsia for 24 hours. On assessment, the nurse finds the following vital signs: temperature 37.3 C, pulse rate 88 beats per minute, respiratory rate 10 breaths per minute, BP 148/90 mm Hg, absent deep tendon reflexes (DTRs), and no ankle clonus. The client complains, Im so thirsty and warm. What is the nurses immediate action? a. To call for an immediate magnesium sulfate level b. To administer oxygen c. To discontinue the magnesium sulfate infusion d. To prepare to administer hydralazine

: C Regardless of the magnesium level, the client is displaying the clinical signs and symptoms of magnesium toxicity. The first action by the nurse should be to discontinue the infusion of magnesium sulfate. In addition, calcium gluconate, the antidote for magnesium, may be administered. Hydralazine is an antihypertensive drug commonly used to treat hypertension in severe preeclampsia. Typically, hydralazine is administered for a systolic BP higher than 160 mm Hg or a diastolic BP higher than 110 mm Hg.

17. The nurse is teaching a client with preterm premature rupture of membranes (PPROM) regarding self-care activities. Which activities should the nurse include in her teaching? a. Report a temperature higher than 40 C. b. Tampons are safe to use to absorb the leaking amniotic fluid. c. Do not engage in sexual activity. d. Taking frequent tub baths is safe.

: C Sexual activity should be avoided because it may induce preterm labor. A temperature higher than 38 C should be reported. To prevent the risk of infection, tub baths should be avoided and nothing should be inserted into the vagina. Further, foul-smelling vaginal fluid, which may be a sign of infection, should be reported.

8. A woman who is 30 weeks of gestation arrives at the hospital with bleeding. Which differential diagnosis would not bcaebalpepfloi r this client? a. Placenta previa b. Abruptio placentae c. Spontaneous abortion d. Cord insertion

: C Spontaneous abortion is another name for miscarriage; it occurs, by definition, early in pregnancy. Placenta previa is a well-known reason for bleeding late in pregnancy. The premature separation of the placenta (abruptio placentae) is a bleeding disorder that can occur late in pregnancy. Cord insertion may cause a bleeding disorder that can also occur late in pregnancy.

20. Which statement most accurately describes the HELLP syndrome? a. Mild form of preeclampsia b. Diagnosed by a nurse alert to its symptoms c. Characterized by hemolysis, elevated liver enzymes, and low platelets d. Associated with preterm labor but not perinatal mortality

: C The acronym HELLP stands for hemolysis (H), elevated liver (EL) enzymes, and low platelets (LP). The HELLP syndrome is a variant of severe preeclampsia and is difficult to identify because the symptoms are not often obvious. The HELLP syndrome must be diagnosed in the laboratory. Preterm labor is greatly increased; therefore, so is perinatal mortality.

8. An infant is being discharged from the NICU after 70 days of hospitalization. The infant was born at 30 weeks of gestation with several conditions associated with prematurity, including RDS, mild bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP), requiring surgical treatment. During discharge teaching, the infants mother asks the nurse if her baby will meet developmental milestones on time, as did her son who was born at term. What is the nurses most appropriate response? a. Your baby will develop exactly like your first child. b. Your baby does not appear to have any problems at this time. c. Your baby will need to be corrected for prematurity. d. Your baby will need to be followed very closely.

: C The age of a preterm newborn is corrected by adding the gestational age and the postnatal age. The infants responses are accordingly evaluated against the norm expected for the corrected age of the infant. The baby is currently 40 weeks of postconceptional age and can be expected to be doing what a 40-week-old infant would be doing. Although predicting with complete accuracy the growth and development potential of each preterm infant is impossible, certain measurable factors predict normal growth and development. The preterm infant experiences catch-up body growth during the first 2 to 3 years of life. Development needs to be evaluated over time. The growth and developmental milestones are corrected for gestational age until the child is approximately years old.

6. A 30-year-old gravida 3, para 2-0-0-2 is at 18 weeks of gestation. Which screening test should the nurse recommend be ordered for this client? a. BPP b. Chorionic villi sampling c. MSAFP screening d. Screening for diabetes mellitus

: C The biochemical assessment MSAFP test is performed from week 15 to week 20 of gestation (weeks 16 to 18 are ideal). A BPP is a method of biophysical assessment of fetal well-being in the third trimester. Chorionic villi sampling is a biochemical assessment of the fetus that should be performed from the 10th to 12th weeks of gestation. Screening for diabetes mellitus begins with the first prenatal visit.

5. A primigravida at 40 weeks of gestation is having uterine contractions every to 2 minutes and states 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 womans 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 precipitous labor.

: C The contraction pattern observed in this woman signifies hypertonic uterine activity. Typically, uterine activity in this phase occurs at 4- to 5-minute intervals lasting 30 to 45 seconds. Women who experience hypertonic uterine dysfunction, or primary dysfunctional labor, are often anxious first-time mothers who are having painful and frequent contractions that are ineffective at causing cervical dilation or effacement to progress. With hypotonic uterine dysfunction, the woman initially makes normal progress into the active stage of labor; then the contractions become weak and inefficient or stop altogether. Precipitous labor is one that lasts less than 3 hours from the onset of contractions until time of birth.

15. By understanding the four mechanisms of heat transfer (convection, conduction, radiation, and evaporation), the nurse can create an environment for the infant that prevents temperature instability. Which significant symptoms will the infant display when experiencing cold stress? a. Decreased respiratory rate b. Bradycardia, followed by an increased heart rate c. Mottled skin with acrocyanosis d. Increased physical activity

: C The infant has minimal-to-no fat stores. During times of cold stress, the skin becomes mottled and acrocyanosis develops, progressing to cyanosis. Even if the infant is being cared for on a radiant warmer or in an isolette, the nurses role is to observe the infant frequently to prevent heat loss and to respond quickly if signs and symptoms of cold stress occur. The respiratory rate increases, followed by periods of apnea. The infant initially tries to conserve heat and burns more calories, after which the metabolic system goes into overdrive. In the preterm infant who is experiencing heat loss, the heart rate initially increases, followed by periods of bradycardia. In the term infant, increased physical activity is the natural response to heat loss. However, in a term infant who is experiencing respiratory distress or in a preterm infant, physical activity is decreased.

21. In assisting the breastfeeding mother to position the baby, which information regarding positioning is important for the nurse to keep in mind? a. The cradle position is usually preferred by mothers who had a cesarean birth. b. Women with perineal pain and swelling prefer the modified cradle position. c. Whatever the position used, the infant is belly to belly with the mother. d. While supporting the head, the mother should push gently on the occiput.

: C The infant naturally faces the mother, belly to belly. The football position is usually preferred after a cesarean birth. Women with perineal pain and swelling prefer the side-lying position because they can rest while breastfeeding. The mother should never push on the back of the head. It may cause the baby to bite, hyperextend the neck, or develop an aversion to being brought near the breast.

8. For an infant experiencing symptoms of drug withdrawal, which intervention should be included in the plan of care? a. Administering chloral hydrate for sedation b. Feeding every 4 to 6 hours to allow extra rest between feedings c. Snugly swaddling the infant and tightly holding the baby d. Playing soft music during feeding

: C The infant should be snugly wrapped to reduce self-stimulation behaviors and to protect the skin from abrasions. Phenobarbital or diazepam may be administered to decrease central nervous system (CNS) irritability. The infant should be fed in small, frequent amounts and burped well to diminish aspiration and maintain hydration. The infant should not be stimulated (such as with music), because stimulation will increase activity and potentially increase CNS irritability.

1. An infant at 36 weeks of gestation has increasing respirations (80 to 100 breaths per minute with significant substernal retractions). The infant is given oxygen by continuous nasal positive airway pressure (CPAP). What level of partial pressure of arterial oxygen (PaO2) indicates hypoxia? a. 67 mm Hg b. 89 mm Hg c. 45 mm Hg d. 73 mm Hg

: C The laboratory value of PaO2 of 45 mm Hg is below the range for a normal neonate and indicates hypoxia in this infant. The normal range for PaO2 is 60 to 80 mm Hg; therefore, PaO2 levels of 67 and 73 mm Hg fall within the normal range, and a PaO2 of 89 mm Hg is higher than the normal range.

5. A breastfeeding woman develops engorged breasts at 3 days postpartum. What action will help this client achieve her goal of reducing the engorgement? a. Skip feedings to enable her sore breasts to rest. b. Avoid using a breast pump. c. Breastfeed her infant every 2 hours. d. Reduce her fluid intake for 24 hours.

: C The mother should be instructed to attempt feeding her infant every 2 hours while massaging the breasts as the infant is feeding. Skipping feedings may cause further swelling and discomfort. If the infant does not adequately feed and empty the breast, then the mother may pump to extract the milk and relieve some of the discomfort. Dehydration further irritates swollen breast tissue.

3. During the initial acute distress phase of grieving, parents still must make unexpected and unwanted decisions about funeral arrangements and even naming the baby. What is the nurses role at this time? a. To take over as much as possible to relieve the pressure b. To encourage the grandparents to take over c. To ensure that the parents, themselves, approve the final decisions d. To leave them alone to work things out

: C The nurse is always the clients advocate. Nurses can offer support and guidance and yet leave room for the same from grandparents. In the end, however, nurses should let the parents make the final decisions. For the nurse to be able to present options regarding burial and autopsy, among other issues, in a sensitive and respectful manner is essential. The nurse should assist the parents in any way possible; however, taking over all arrangements is not the nurses role. Grandparents are often called on to help make the difficult decisions regarding funeral arrangements or the disposition of the body because they have more life experiences with taking care of these painful, yet required arrangements. Some well-meaning relatives may try to take over all decision-making responsibilities. The nurse must remember that the parents, themselves, should approve all of the final decisions. During this time of acute distress, the nurse should be present to provide quiet support, answer questions, obtain information, and act as a client advocate.

15. What is a distinct advantage of external EFM? a. The ultrasound transducer can accurately measure short-term variability and beatto-beat changes in the FHR. b. The tocotransducer can measure and record the frequency, regularity, intensity, and approximate duration of uterine contractions. c. The tocotransducer is especially valuable for measuring uterine activity during the first stage of labor. d. Once correctly applied by the nurse, the transducer need not be repositioned even when the woman changes positions.

: C The tocotransducer is valuable for measuring uterine activity during the first stage of labor and is especially true when the membranes are intact. Short-term variability and beat-to-beat changes cannot be measured with this technology. The tocotransducer cannot measure and record the intensity of uterine contractions. The transducer must be repositioned when the woman or the fetus changes position.

23. Which finding on a prenatal visit at 10 weeks of gestation 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

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

13. The American College of Obstetricians and Gynecologists (ACOG) has developed a comprehensive list of risk factors associated with the development of preeclampsia. Which client exhibits the greatest number of these risk factors? a. 30-year-old obese Caucasian with her third pregnancy b. 41-year-old Caucasian primigravida c. 19-year-old African American who is pregnant with twins d. 25-year-old Asian American whose pregnancy is the result of donor insemination

: C Three risk factors are present in the 19-year-old African-American client. She has AfricanAmerican ethnicity, is at the young end of the age distribution, and has a multiple pregnancy. In planning care for this client, the nurse must frequently monitor her BP and teach her to recognize the early warning signs of preeclampsia. The 30-year-old obese Caucasian client has only has one known risk factor: obesity. Age distribution appears to be U-shaped, with women younger than 20 years of age and women older than 40 years of age being at greatest risk. Preeclampsia continues to be more frequently observed in primigravidas; this client is a multigravida woman. Two risk factors are present for the 41-year-old Caucasian primigravida client. Her age and status as a primigravida place her at increased risk for preeclampsia. Caucasian women are at a lower risk than are African-American women. The 25-year-old Asian-American client exhibits only one risk factor. Pregnancies that result from donor insemination, oocyte donation, and embryo donation are at an increased risk of developing preeclampsia.

12. Which statement related to cephalopelvic disproportion (CPD) is the least accurate? a. CPD can be related to either fetal size or fetal position. b. The fetus cannot be born vaginally. c. CPD can be accurately predicted. d. Causes of CPD may have maternal or fetal origins.

: C Unfortunately, accurately predicting CPD is not possible. Although CPD is often related to excessive fetal size (macrosomia), malposition of the fetal presenting part is the problem in many cases, not true CPD. When CPD is present, the fetus cannot fit through the maternal pelvis to be born vaginally. CPD may be related to either fetal origins such as macrosomia or malposition or maternal origins such as a too small or malformed pelvis.

6. At a 2-month well-baby examination, it was discovered that an exclusively breastfed infant had only gained 10 ounces in the past 4 weeks. The mother and the nurse develop a feeding plan for the infant to increase his weight gain. Which change in dietary management will assist the client in meeting this goal? a. Begin solid foods. b. Have a bottle of formula after every feeding. c. Have one extra breastfeeding session every 24 hours. d. Start iron supplements.

: C Usually the solution to slow weight gain is to improve the feeding technique. Position and the latch-on technique are evaluated, and adjustments are made. Adding a feeding or two within a 24-hour period might help. Solid foods should not be introduced to an infant for at least 4 to 6 months. Bottle feeding may cause nipple confusion and may limit the supply of milk. Iron supplements have no bearing on weight gain.

5. The nurse providing care for a high-risk laboring woman is alert for late FHR decelerations. Which clinical finding might be the cause for these late decelerations? a. Altered cerebral blood flow b. Umbilical cord compression c. Uteroplacental insufficiency d. Meconium fluid

: C Uteroplacental insufficiency results in late FHR decelerations. Altered fetal cerebral blood flow results in early FHR decelerations. Umbilical cord compression results in variable FHR decelerations. Meconium-stained fluid may or may not produce changes in the FHR, depending on the gestational age of the fetus and whether other causative factors associated with fetal distress are present.

6. A woman is having her first child. She has been in labor for 15 hours. A vaginal examination performed 2 hours earlier revealed the cervix to be dilated to 5 cm and 100% effaced, and the presenting part of the fetus was at station 0; however, another vaginal examination performed 5 minutes ago indicated no changes. What abnormal labor pattern is associated with this description? a. Prolonged latent phase b. Protracted active phase c. Secondary arrest d. Protracted descent

: C With a secondary arrest of the active phase, the progress of labor has stopped. This client has not had any anticipated cervical change, indicating an arrest of labor. In the nulliparous woman, a prolonged latent phase typically lasts longer than 20 hours. A protracted active phase, the first or second stage of labor, is prolonged (slow dilation). With a protracted descent, the fetus fails to descend at an anticipated rate during the deceleration phase and second stage of labor.

12. A primigravida has just delivered a healthy infant girl. The nurse is about to administer erythromycin ointment in the infants eyes when the mother asks, What is that medicine for? How should the nurse respond? a. It is an eye ointment to help your baby see you better. b. It is to protect your baby from contracting herpes from your vaginal tract. c. Erythromycin is prophylactically given to prevent a gonorrheal infection. d. This medicine will protect your babys eyes from drying out over the next few days.

: C With the prophylactic use of erythromycin, the incidence of gonococcal conjunctivitis has declined to less than 0.5%. Eye prophylaxis is administered at or shortly after birth to prevent ophthalmia neonatorum. Erythromycin has no bearing on enhancing vision, is used to prevent an infection caused by gonorrhea, not herpes, and is given to prevent infection, not for lubrication.

18. According to demographic research, which woman is least likely to breastfeed and therefore most likely to need education regarding the benefits and proper techniques of breastfeeding? a. Between 30 and 35 years of age, Caucasian, and employed part time outside the home b. Younger than 25 years of age, Hispanic, and unemployed c. Younger than 25 years of age, African-American, and employed full time outside the home d. 35 years of age or older, Caucasian, and employed full time at home

: C Women least likely to breastfeed are typically younger than 25 years of age, have a lower income, are less educated, are employed full time outside the home, and are African-American.

13. A woman with gestational diabetes has had little or no experience reading and interpreting glucose levels. The client shows the nurse her readings for the past few days. Which reading signals the nurse that the client may require an adjustment of insulin or carbohydrates? a. 75 mg/dl before lunch. This is low; better eat now. b. 115 mg/dl 1 hour after lunch. This is a little high; maybe eat a little less next time. c. 115 mg/dl 2 hours after lunch. This is too high; it is time for insulin. d. 50 mg/dl just after waking up from a nap. This is too low; maybe eat a snack before going to sleep.

: D 50 mg/dl after waking from a nap is too low. During hours of sleep, glucose levels should not be less than 60 mg/dl. Snacks before sleeping can be helpful. The premeal acceptable range is 60 to 99 mg/dl. The readings 1 hour after a meal should be less than 129 mg/dl. Two hours after eating, the readings should be less than 120 mg/dl.

19. Which definition of an acceleration in the fetal heart rate (FHR) is accurate? a. FHR accelerations are indications of fetal well-being when they are periodic. b. FHR accelerations are greater and longer in preterm gestations. c. FHR accelerations are usually observed with breech presentations when they are episodic. d. An acceleration in the FHR presents a visually apparent and abrupt peak.

: D Acceleration of the FHR is defined as a visually apparent abrupt (only to peak 30 seconds) increase in the FHR above the baseline rate. Periodic accelerations occur with uterine contractions and are usually observed with breech presentations. Episodic accelerations occur during fetal movement and are indications of fetal well-being. Preterm accelerations peak at 10 beats per minute above the baseline and last for at least 10 seconds.

1. A family is visiting two surviving triplets. The third triplet died 2 days ago. What action indicates that the family has begun to grieve for the dead infant? a. Refers to the two live infants as twins b. Asks about the dead triplets current status c. Brings in play clothes for all three infants d. Refers to the dead infant in the past tense

: D Accepting that the infant is dead (in the past tense of the word) demonstrates an acceptance of the reality and that the family has begun to grieve. Parents of multiples are challenged with the task of parenting and grieving at the same time. Referring to the two live infants as twins does not acknowledge an acceptance of the existence of their third child. Bringing in play clothes for all three infants indicates that the parents are still in denial regarding the death of the third triplet. The death of the third infant has imposed a confusing and ambivalent induction into parenthood for this couple. If the two live infants are referred to as twins and/or if play clothes for all three infants are still considered, then the family is clearly still in denial regarding the death of one of the triplets.

8. Which statement is the most appropriate for the nurse to make when caring for bereaved parents? a. This happened for the best. b. You have an angel in heaven. c. I know how you feel. d. What can I do for you?

: D Acknowledging the loss and being open to listening is the best action that the nurse can do. No bereaved parent would find the statement This has happened for the best to be comforting in any way, and it may sound judgmental. Nurses must resist the impulse to speak about the afterlife to people in pain. They should also resist the temptation to give advice or to use clichs. Unless the nurse has lost a child, he or she does not understand how the parents feel.

3. A postpartum woman telephones the provider regarding her 5-day-old infant. The client is not scheduled for another weight check until the infant is 14 days old. The new mother is worried about whether breastfeeding is going well. Which statement indicates that breastfeeding is effective for meeting the infants nutritional needs? a. Sleeps for 6 hours at a time between feedings b. Has at least one breast milk stool every 24 hours c. Gains 1 to 2 ounces per week d. Has at least six to eight wet diapers per day

: D After day 4, when the mothers milk comes in, the infant should have six to eight wet diapers every 24 hours. Typically, infants sleep 2 to 4 hours between feedings, depending on whether they are being fed on a 2- to 3-hour schedule or cluster-fed. The infants sleep pattern is not an indication whether the infant is breastfeeding well. The infant should have a minimum of three bowel movements in a 24-hour period. Breastfed infants typically gain 15 to 30 g/day.

7. The nurse who elects to practice in the area of womens health must have a thorough understanding of miscarriage. Which statement regarding this condition is most accurate? a. A miscarriage is a natural pregnancy loss before labor begins. b. It occurs in fewer than 5% of all clinically recognized pregnancies. c. Careless maternal behavior, such as poor nutrition or excessive exercise, can be a factor in causing a miscarriage. d. If a miscarriage occurs before the 12th week of pregnancy, then it may be observed only as moderate discomfort and blood loss.

: D Before the sixth week, the only evidence might be a heavy menstrual flow. After the 12th week, more severe pain, similar to that of labor, is likely. Miscarriage is a natural pregnancy loss, but it occurs, by definition, before 20 weeks of gestation, before the fetus is viable. Miscarriages occur in approximately 10% to 15% of all clinically recognized pregnancies. Miscarriages can be caused by a number of disorders or illnesses outside the mothers control or knowledge.

21. Which condition might premature infants who exhibit 5 to 10 seconds of respiratory pauses, followed by 10 to 15 seconds of compensatory rapid respiration, be experiencing? a. Suffering from sleep or wakeful apnea b. Experiencing severe swings in blood pressure c. Trying to maintain a neutral thermal environment d. Breathing in a respiratory pattern common to premature infants

: D Breathing in a respiratory pattern is called periodic breathing and is common to premature infants. This pattern may still require nursing intervention of oxygen and/or ventilation. Apnea is the cessation of respirations for 20 seconds or longer and should not be confused with periodic breathing.

18. A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. Which finding indicates that preterm labor is occurring? a. Estriol is not found in maternal saliva. b. Irregular, mild uterine contractions are occurring every 12 to 15 minutes. c. Fetal fibronectin is present in vaginal secretions. d. The cervix is effacing and dilated to 2 cm.

: D Cervical changes such as shortened endocervical length, effacement, and dilation are predictors of imminent preterm labor. Changes in the cervix accompanied by regular contractions indicate labor at any gestation. Estriol is a form of estrogen produced by the fetus that is present in plasma at 9 weeks of gestation. Levels of salivary estriol have been shown to increase before preterm birth. Irregular, mild contractions that do not cause cervical change are not considered a threat. The presence of fetal fibronectin in vaginal secretions between 24 and 36 weeks of gestation could predict preterm labor, but it has only a 20% to 40% positive predictive value. Of more importance are other physiologic clues of preterm labor such as cervical changes.

6. Which clinical findings would alert the nurse that the neonate is expressing pain? a. Low-pitched crying; tachycardia; eyelids open wide b. Cry face; flaccid limbs; closed mouth c. High-pitched, shrill cry; withdrawal; change in heart rate d. Cry face; eyes squeezed; increase in blood pressure

: D Crying and an increased heart rate are manifestations indicative of pain in the neonate. Typically, infants tightly close their eyes when in pain, not open them wide. In addition, infants may display a rigid posture with the mouth open and may also withdraw limbs and become tachycardic with pain. A high-pitched, shrill cry is associated with genetic or neurologic anomalies.

16. The nurse has evaluated a client with preeclampsia by assessing DTRs. The result is a grade of 3+. Which DTR response most accurately describes this score? a. Sluggish or diminished b. Brisk, hyperactive, with intermittent or transient clonus c. Active or expected response d. More brisk than expected, slightly hyperactive

: D DTRs reflect the balance between the cerebral cortex and the spinal cord. They are evaluated at baseline and to detect changes. A slightly hyperactive and brisk response indicates a grade 3+ response.

17. When providing an infant with a gavage feeding, which infant assessment should be documented each time? a. Abdominal circumference after the feeding b. Heart rate and respirations before feeding c. Suck and swallow coordination d. Response to the feeding

: D Documentation of a gavage feeding should include the size of the feeding tube, the amount and quality of the residual from the previous feeding, the type and quantity of the fluid instilled, and the infants response to the procedure. Abdominal circumference is not measured after a gavage feeding. Although vital signs may be obtained before feeding, the infants response to the feeding is more important. Similarly, some older infants may be learning to suck; the most important factor to document would still be the infants response to the feeding, including the attempts to suck.

29. What physiologic change occurs as the result of increasing the infusion rate of nonadditive IV fluids? a. Maintaining normal maternal temperature b. Preventing normal maternal hypoglycemia c. Increasing the oxygen-carrying capacity of the maternal blood d. Expanding maternal blood volume

: D Filling the mothers vascular system increases the amount of blood available to perfuse the placenta and may correct hypotension. Increasing fluid volume may alter the maternal temperature only if she is dehydrated. Most IV fluids for laboring women are isotonic and do not provide extra glucose. Oxygen-carrying capacity is increased by adding more red blood cells.

11. The nurse is performing an assessment on a client who thinks she may be experiencing preterm labor. Which information is the most important for the nurse to understand and share with the client? a. Because all women must be considered at risk for preterm labor and prediction is so variable, teaching pregnant women the symptoms of preterm labor 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. Diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical change.

: D Gestational age of 20 to 37 weeks, uterine contractions, and a cervix that is 80% effaced or dilated 2 cm indicates preterm labor. It is essential that nurses teach women how to detect the early symptoms of preterm labor. Braxton Hicks contractions resemble preterm labor contractions, but they are not true labor. Waiting too long to see a health care provider could result in essential medications failing to be administered. Preterm labor is not necessarily longterm labor.

7. The client has been on magnesium sulfate for 20 hours for the treatment of preeclampsia. She just delivered a viable infant girl 30 minutes ago. What uterine findings does the nurse expect to observe or assess in this client? a. Absence of uterine bleeding in the postpartum period b. Fundus firm below the level of the umbilicus c. Scant lochia flow d. Boggy uterus with heavy lochia flow

: D High serum levels of magnesium can cause a relaxation of smooth muscle such as the uterus. Because of this tocolytic effect, the client will most likely have a boggy uterus with increased amounts of bleeding. All women experience uterine bleeding in the postpartum period, especially those who have received magnesium therapy. Rather than scant lochial flow, however, this client will most likely have a heavy flow attributable to the relaxation of the uterine wall caused by magnesium administration.

3. A woman with preeclampsia has a seizure. What is the nurses highest priority during a seizure? a. To insert an oral airway b. To suction the mouth to prevent aspiration c. To administer oxygen by mask d. To stay with the client and call for help

: D If a client becomes eclamptic, then the nurse should stay with the client and call for help. Nursing actions during a convulsion are directed toward ensuring a patent airway and client safety. Insertion of an oral airway during seizure activity is no longer the standard of care. The nurse should attempt to keep the airway patent by turning the clients head to the side to prevent aspiration. Once the seizure has ended, it may be necessary to suction the clients mouth. Oxygen is administered after the convulsion has ended.

13. Which statement related to the induction of labor is most accurate? a. Can be achieved by external and internal version techniques b. Is also known as a trial of labor (TOL) c. Is almost always performed for medical reasons d. Is rated for viability by a Bishop score

: D Induction of labor is likely to be more successful with a Bishop score of 9 or higher for first-time mothers or 5 or higher for veterans. Version is the turning of the fetus to a better position by a physician for an easier or safer birth. A TOL is the observance of a woman and her fetus for several hours of active labor to assess the safety of vaginal birth. Two thirds of cases of induced labor are elective and not done for medical reasons.

22. When would an internal version be indicated to manipulate the fetus into a vertex position? a. Fetus from a breech to a cephalic presentation before labor begins b. Fetus from a transverse lie to a longitudinal lie before a cesarean birth c. Second twin from an oblique lie to a transverse lie before labor begins d. Second twin from a transverse lie to a breech presentation during a vaginal birth

: D Internal version is used only during a vaginal birth to manipulate the second twin into a presentation that allows it to be vaginally born. For internal version to occur, the cervix needs to be completely dilated.

7. Which FHR finding is the most concerning to the nurse who is providing care to a laboring client? a. Accelerations with fetal movement b. Early decelerations c. Average FHR of 126 beats per minute d. Late decelerations

: D Late decelerations are caused by uteroplacental insufficiency and are associated with fetal hypoxemia. Late FHR decelerations are considered ominous if they are persistent and left uncorrected. Accelerations with fetal movement are an indication of fetal well-being. Early decelerations in the FHR are associated with head compression as the fetus descends into the maternal pelvic outlet; they are not generally a concern during normal labor. An FHR finding of 126 beats per minute is normal and not a concern.

14. The nurse is using intermittent auscultation (IA) to locate the fetal heartbeat. Which statement regarding this method of surveillance is accurate? a. The nurse can be expected to cover only two or three clients when IA is the primary method of fetal assessment. b. The best course is to use the descriptive terms associated with EFM when documenting results. c. If the heartbeat cannot be immediately found, then a shift must be made to EFM. d. Ultrasound can be used to find the FHR and to reassure the mother if the initial difficulty is a factor.

: D Locating fetal heartbeats often takes time. Mothers can be verbally reassured and reassured by viewing the ultrasound pictures if that device is used to help locate the heartbeat. When used as the primary method of fetal assessment, IA requires a nurse-to-client ratio of one to one. Documentation should use only terms that can be numerically defined; the usual visual descriptions of EFM are inappropriate.

18. Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy. Which statement regarding monitoring techniques is the most accurate? a. Chorionic villus sampling (CVS) is becoming more popular because it provides early diagnosis. b. MSAFP screening is recommended only for women at risk for NTDs. c. PUBS is one of the triple-marker tests for Down syndrome. d. MSAFP is a screening tool only; it identifies candidates for more definitive diagnostic procedures.

: D MSAFP is a screening tool, not a diagnostic tool. CVS provides a rapid result, but it is declining in popularity because of advances in noninvasive screening techniques. An MSAFP screening is recommended for all pregnant women. MSAFP screening, not PUBS, is part of the triple-marker tests for Down syndrome.

11. The perinatal nurse realizes that an FHR that is tachycardic, bradycardic, has late decelerations, or loss of variability is nonreassuring and is associated with which condition? a. Hypotension b. Cord compression c. Maternal drug use d. Hypoxemia

: D Nonreassuring FHR patterns are associated with fetal hypoxemia. Fetal bradycardia may be associated with maternal hypotension. Variable FHR decelerations are associated with cord compression. Maternal drug use is associated with fetal tachycardia.

16. What bacterial infection is definitely decreasing because of effective drug treatment? a. Escherichia coli infection b. Tuberculosis c. Candidiasis d. Group B streptococci (GBS) infection

: D Penicillin has significantly decreased the incidence of GBS infection. E. coli may be increasing, perhaps because of the increasing use of ampicillin (resulting in a more virulent E. coli resistant to the drug). Tuberculosis is increasing in the United States and in Canada. Candidiasis is a fairly benign fungal infection.

2. On day 3 of life, a newborn continues to require 100% oxygen by nasal cannula. The parents ask if they may hold their infant during his next gavage feeding. Considering that this newborn is physiologically stable, what response should the nurse provide? a. Parents are not allowed to hold their infants who are dependent on oxygen. b. You may only hold your babys hand during the feeding. c. Feedings cause more physiologic stress; therefore, the baby must be closely monitored. I dont think you should hold the baby. d. You may hold your baby during the feeding.

: D Physical contact with the infant is important to establish early bonding. The nurse as the support person and teacher is responsible for shaping the environment and making the caregiving responsive to the needs of both the parents and the infant. Allowing the parents to hold their baby is the most appropriate response by the nurse. Parental interaction by holding should be encouraged during gavage feedings; nasal cannula oxygen therapy allows for easy feedings and psychosocial interactions. The parent can swaddle the infant or provide kangaroo care while gavage feeding their infant. Both swaddling and kangaroo care during feedings provide positive interactions for the infant and help the infant associate feedings with positive interactions.

16. Which physiologic alteration of pregnancy most significantly affects glucose metabolism? a. Pancreatic function in the islets of Langerhans is affected by pregnancy. b. Pregnant women use glucose at a more rapid rate than nonpregnant women. c. Pregnant women significantly increase their dietary intake. d. Placental hormones are antagonistic to insulin, thus resulting in insulin resistance.

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

9. Human immunodeficiency virus (HIV) may be transmitted perinatally or during the postpartum period. Which statement regarding the method of transmission is most accurate? a. Only in the third trimester from the maternal circulation b. From the use of unsterile instruments c. Only through the ingestion of amniotic fluid d. Through the ingestion of breast milk from an infected mother

: D Postnatal transmission of the HIV through breastfeeding and breast milk may occur. Transmission of the HIV from the mother to the fetus may occur through the placenta at various gestational ages. Transmission of the HIV from the use of unsterile instruments is highly unlikely; most health care facilities must meet sterility standards for all instrumentation.

19. Which assessment is least likely to be associated with a breech presentation? a. Meconium-stained amniotic fluid b. Fetal heart tones heard at or above the maternal umbilicus c. Preterm labor and birth d. Postterm gestation

: D Postterm gestation is not likely to occur with a breech presentation. The presence of meconium in a breech presentation may be a result of pressure on the fetal wall as it traverses the birth canal. Fetal heart tones heard at the level of the umbilical level of the mother are a typical finding in a breech presentation because the fetal back would be located in the upper abdominal area. Breech presentations often occur in preterm births.

16. When evaluating the preterm infant, the nurse understands that compared with the term infant, what information is important for the nurse to understand? a. Few blood vessels visible through the skin b. More subcutaneous fat c. Well-developed flexor muscles d. Greater surface area in proportion to weight

: D Preterm infants have greater surface area in proportion to their weight. More subcutaneous fat and well-developed muscles are indications of a more mature infant.

24. A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Which information assists the nurse in developing the plan of care? 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 primary concern.

: D Severe bleeding occurs if the fallopian tube ruptures. The recommended treatment is to remove the pregnancy before rupture to prevent hemorrhaging. If the tube must be removed, then the womans fertility will decrease; however, she will not be infertile. A D&C is performed on the inside of the uterine cavity. The ectopic pregnancy is located within the tubes.

6. Parents are often asked if they would like to have an autopsy performed on their infant. Nurses who are assisting parents with this decision should be aware of which information? a. Autopsies are usually covered by insurance. b. Autopsies must be performed within a few hours after the infants death. c. In the current litigious society, more autopsies are performed than in the past. d. Some religions prohibit autopsy.

: D Some religions prohibit autopsies or limit the choice to the times when it may help prevent further loss. The cost of the autopsy must be considered; it is not covered by insurance and can be very expensive. There is no rush to perform an autopsy unless evidence of a contagious disease or maternal infection is present at the time of death. The rate of autopsies is declining, in part because of a fear by medical facilities that errors by the staff might be revealed, resulting in litigation.

4. A nurse caring for a family during a loss might notice that a family member is experiencing survivor guilt. Which family member is most likely to exhibit this guilt? a. Siblings b. Mother c. Father d. Grandparents

: D Survivor guilt is sometimes felt by grandparents because they feel that the death is out of order; they are still alive, while their grandchild has died. They may express anger that they are alive and their grandchild is not. The siblings of the expired infant may also experience a profound loss. A young child will respond to the reactions of the parents and may act out. Older children have a more complete understanding of the loss. School-age children are likely to be frightened, whereas teenagers are at a loss on how to react. The mother of the infant is experiencing intense grief at this time. She may be dealing with questions such as, Why me? or Why my baby? and is unlikely to be experiencing survival guilt. Realizing that fathers can be experiencing deep pain beneath their calm and quiet appearance and may need help acknowledging these feelings is important. This need, however, is not the same as survivor guilt.

9. The obstetric provider has informed the nurse that she will be performing an amniotomy on the client to induce labor. What is the nurses highest priority intervention after the amniotomy is performed? a. Applying clean linens under the woman b. Taking the clients vital signs c. Performing a vaginal examination d. Assessing the fetal heart rate (FHR)

: D The FHR is assessed before and immediately after the amniotomy to detect any changes that might indicate cord compression or prolapse. Providing comfort measures, such as clean linens, for the client is important but not the priority immediately after an amniotomy. The womans temperature should be checked every 2 hours after the rupture of membranes but not the priority immediately after an amniotomy. The woman would have had a vaginal examination during the procedure. Unless cord prolapse is suspected, another vaginal examination is not warranted. Additionally, FHR assessment provides clinical cues to a prolapsed cord.

24. How does the nurse document a NST during which two or more FHR accelerations of 15 beats per minute or more occur with fetal movement in a 20-minute period? a. Nonreactive b. Positive c. Negative d. Reactive

: D The NST is reactive (normal) when two or more FHR accelerations of at least 15 beats per minute (each with a duration of at least 15 seconds) occur in a 20-minute period. A nonreactive result means that the heart rate did not accelerate during fetal movement. A positive result is not used with NST. CST uses positive as a result term. A negative result is not used with NST. CST uses negative as a result term.

22. Nurses should be able to teach breastfeeding mothers the signs that the infant has correctly latched on. Which client statement indicates a poor latch? a. I feel a firm tugging sensation on my nipples but not pinching or pain. b. My baby sucks with cheeks rounded, not dimpled. c. My babys jaw glides smoothly with sucking. d. I hear a clicking or smacking sound.

: D The clicking or smacking sound may indicate that the baby is having difficulty keeping the tongue out over the lower gum ridge. The mother should hope to hear the sound of swallowing. The tugging sensation without pinching is a good sign. Rounded cheeks are a positive indicator of a good latch. A smoothly gliding jaw also is a good sign.

4. A primiparous woman is delighted with her newborn son and wants to begin breastfeeding as soon as possible. How should the client be instructed to position the infant to facilitate correct latch-on? a. The infant should be positioned with his or her arms folded together over the chest. b. The infant should be curled up in a fetal position. c. The woman should cup the infants head in her hand. d. The infants head and body should be in alignment with the mother.

: D The infants head and body should be in correct alignment with the mother and the breast during latch-on and feeding. The infant should be facing the mother with his arms hugging the breast. The babys body should be held in correct alignment (i.e., ears, shoulder, and hips in a straight line) during feedings. The mother should support the babys neck and shoulders with her hand and not push on the occiput.

16. A newly delivered mother who intends to breastfeed tells her nurse, I am so relieved that this pregnancy is over so that I can start smoking again. The nurse encourages the client to refrain from smoking. However, this new mother is insistent that she will resume smoking. How will the nurse adapt her health teaching with this new information? a. Smoking has little-to-no effect on milk production. b. No relationship exists between smoking and the time of feedings. c. The effects of secondhand smoke on infants are less significant than for adults. d. The mother should always smoke in another room.

: D The new mother should be encouraged not to smoke. If she continues to smoke, she should be encouraged to always smoke in another room, removed from the baby. Smoking may impair milk production. When the products of tobacco are broken down, they cross over into the breast milk. Tobacco also results in a reduction of the antiinfective properties of breast milk. Research supports the conclusion that mothers should not smoke within 2 hours before a feeding (AAP Committee on Drugs, 2001). The effects of secondhand smoke on infants include excessive crying, colic, upper respiratory infections, and an increased risk of sudden infant death syndrome (SIDS).

24. Because of the premature infants decreased immune functioning, what nursing diagnosis should the nurse include in a plan of care for a premature infant? a. Delayed growth and development b. Ineffective thermoregulation c. Ineffective infant feeding pattern d. Risk for infection

: D The nurse needs to understand that decreased immune functioning increases the risk for infection. Growth and development, thermoregulation, and feeding may be affected, although only indirectly.

5. A pregnant woman at 37 weeks of gestation has had ruptured membranes for 26 hours. A cesarean section is performed for failure to progress. The fetal heart rate (FHR) before birth is 180 beats per minute with limited variability. At birth the newborn has Apgar scores of 6 and 7 at 1 and 5 minutes and is noted to be pale and tachypneic. Based on the maternal history, what is the most likely cause of this newborns distress? a. Hypoglycemia b. Phrenic nerve injury c. Respiratory distress syndrome d. Sepsis

: D The prolonged rupture of membranes and the tachypnea (before and after birth) suggest sepsis. A differential diagnosis can be difficult because signs of sepsis are similar to noninfectious problems such as anemia and hypoglycemia. Phrenic nerve injury is usually the result of traction on the neck and arm during childbirth and is not applicable to this situation. The earliest signs of sepsis are characterized by lack of specificity (e.g., lethargy, poor feeding, irritability), not respiratory distress syndrome.

22. In which situation would the nurse be called on to stimulate the fetal scalp? a. As part of fetal scalp blood sampling b. In response to tocolysis c. In preparation for fetal oxygen saturation monitoring d. To elicit an acceleration in the FHR

: D The scalp can be stimulated using digital pressure during a vaginal examination. Fetal scalp blood sampling involves swabbing the scalp with disinfectant before a sample is collected. The nurse stimulates the fetal scalp to elicit an acceleration of the FHR. Tocolysis is relaxation of the uterus. Fetal oxygen saturation monitoring involves the insertion of a sensor.

9. After giving birth to a stillborn infant, the woman turns to the nurse and says, I just finished painting the babys room. Do you think that caused my baby to die? What is the nurses most appropriate response? a. Thats an old wives tale; lots of women are around paint during pregnancy, and this doesnt happen to them. b. Thats not likely. Paint is associated with elevated pediatric lead levels. c. Silence. d. I can understand your need to find an answer to what caused this. What else are you thinking about?

: D The statement I can understand your need to find an answer to what caused this. What else are you thinking about? is very appropriate for the nurse. It demonstrates caring and compassion and allows the mother to vent her thoughts and feelings, which is therapeutic in the process of grieving. The nurse should resist the temptation to give advice or to use clichs in offering support to the bereaved. In addition, trying to give bereaved parents answers when no clear answers exist or trying to squelch their guilt feeling does not help the process of grieving. Silence would probably increase the mothers feelings of guilt. One of the most important goals of the nurse is to validate the experience and feelings of the parents by encouraging them to tell their stories and then listening with care. The nurse should encourage the mother to express her thoughts.

3. In evaluating the effectiveness of magnesium sulfate for the treatment of preterm labor, which finding alerts the nurse to possible side effects? a. Urine output of 160 ml in 4 hours b. DTRs 2+ and no clonus c. Respiratory rate (RR) of 16 breaths per minute d. Serum magnesium level of 10 mg/dl

: D The therapeutic range for magnesium sulfate management is 4 to 7.5 mg/dl. A serum magnesium level of 10 mg/dl could lead to signs and symptoms of magnesium toxicity, including oliguria and respiratory distress. Urine output of 160 ml in 4 hours, DTRs of 2+, and a RR of 16 breaths per minute are all normal findings.

12. In comparing the abdominal and transvaginal methods of ultrasound examination, which information should the nurse provide to the client? a. Both require the woman to have a full bladder. b. The abdominal examination is more useful in the first trimester. c. Initially, the transvaginal examination can be painful. d. The transvaginal examination allows pelvic anatomy to be evaluated in greater detail.

: D The transvaginal examination allows pelvic anatomy to be evaluated in greater detail than the abdominal method and also allows intrauterine pregnancies to be diagnosed earlier. The abdominal examination requires a full bladder; the transvaginal examination requires an empty one. The transvaginal examination is more useful in the first trimester; the abdominal examination works better after the first trimester. Neither the abdominal nor the transvaginal method of ultrasound examination should be painful, although the woman will feel pressure as the probe is moved during the transvaginal examination.

26. The nurse is evaluating the EFM tracing of the client who is in active labor. Suddenly, the FHR drops from its baseline of 125 down to 80 beats per minute. The mother is repositioned, and the nurse provides oxygen, increased IV fluids, and performs a vaginal examination. The cervix has not changed. Five minutes have passed, and the FHR remains in the 80s. What additional nursing measures should the nurse take next? a. Call for help. b. Insert a Foley catheter. c. Start administering Pitocin. d. Immediately notify the care provider.

: D To relieve an FHR deceleration, the nurse can reposition the mother, increase IV fluids, and provide oxygen. If oxytocin is infusing, then it should be discontinued. If the FHR does not resolve, then the primary care provider should be immediately notified. Inserting a Foley catheter is an inappropriate nursing action. If the FHR were to continue in a nonreassuring pattern, then a cesarean section could be warranted, which would require a Foley catheter. However, the physician must make that determination. The administration of Pitocin may place additional stress on the fetus.

5. A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes, dark red vaginal bleeding, and a tense, painful abdomen. Which clinical change does the nurse anticipate? a. Eclamptic seizure b. Rupture of the uterus c. Placenta previa d. Abruptio placentae

: D Uterine tenderness in the presence of increasing tone may be the earliest sign of abruptio placentae. Women with preeclampsia are at increased risk for an abruption attributable to decreased placental perfusion. Eclamptic seizures are evidenced by the presence of generalized tonic-clonic convulsions. Uterine rupture exhibits hypotonic uterine activity, signs of hypovolemia, and, in many cases, the absence of pain. Placenta previa exhibits bright red, painless vaginal bleeding.

10. Which statement best describes chronic hypertension? a. Chronic hypertension is defined as hypertension that begins during pregnancy and lasts for the duration of the pregnancy. b. Chronic hypertension is considered severe when the systolic BP is higher than 140 mm Hg or the diastolic BP is higher than 90 mm Hg. c. Chronic hypertension is general hypertension plus proteinuria. d. Chronic hypertension can occur independently of or simultaneously with preeclampsia.

: D Women with chronic hypertension may develop superimposed preeclampsia, which increases the morbidity for both the mother and the fetus. Chronic hypertension is present before pregnancy or diagnosed before the 20 weeks of gestation and persists longer than 6 weeks postpartum. Chronic hypertension becomes severe with a diastolic BP of 110 mm Hg or higher. Proteinuria is an excessive concentration of protein in the urine and is a complication of hypertension, not a defining characteristic.

1. A pregnant woman is being discharged from the hospital after the placement of a cervical cerclage because of a history of recurrent pregnancy loss, secondary to an incompetent cervix. Which information regarding postprocedural care should the nurse emphasize in the discharge teaching? a. Any vaginal discharge should be immediately reported to her health care provider. b. The presence of any contractions, rupture of membranes (ROM), or severe perineal pressure should be reported. c. The client will need to make arrangements for care at home, because her activity level will be restricted. d. The client will be scheduled for a cesarean birth.

ANS: B Nursing care should stress the importance of monitoring for the signs and symptoms of preterm labor. Vaginal bleeding needs to be reported to her primary health care provider. 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 womans need for visits and to monitor her status safely at home. The cerclage can be removed at 37 weeks of gestation (to prepare for a vaginal birth), or a cesarean birth can be planned.

1. Preconception counseling is critical in the safe management of diabetic pregnancies. Which complication is commonly associated with poor glycemic control before and during early pregnancy? a. Frequent episodes of maternal hypoglycemia b. Congenital anomalies in the fetus c. Hydramnios d. Hyperemesis gravidarum

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

1. A macrosomic infant is born after a difficult forceps-assisted delivery. After stabilization, the infant is weighed, and the birth weight is 4550 g (9 lb, 6 oz). What is the nurses first priority? a. Leave the infant in the room with the mother. b. Immediately take the infant to the nursery. c. Perform a gestational age assessment to determine whether the infant is large for gestational age. d. Frequently monitor blood glucose levels, and closely observe the infant for signs of hypoglycemia.

ANS: D Regardless of gestational age, this infant is macrosomic (defined as fetal weight more than 4000 g) and is at high risk for hypoglycemia, which affects many macrosomic infants. Blood glucose levels should be frequently monitored, and the infant should be closely observed for signs of hypoglycemia. Close observation can be achieved in the mothers room with nursing interventions. However, depending on the condition of the infant, observation may be more appropriate in the nursery.

1. A woman arrives at the clinic seeking confirmation that she is pregnant. The following information is obtained: She is 24 years old with a body mass index (BMI) of 17.5. She admits to having used cocaine several times during the past year and occasionally drinks alcohol. Her blood pressure is 108/70 mm Hg. The family history is positive for diabetes mellitus and cancer. Her sister recently gave birth to an infant with a neural tube defect (NTD). Which characteristics places this client in a high-risk category? a. Blood pressure, age, BMI b. Drug and alcohol use, age, family history c. Family history, blood pressure (BP), BMI d. Family history, BMI, drug and alcohol abuse

ANS: D The womans family history of an NTD, her low BMI, and her drug and alcohol use abuse are high risk factors of pregnancy. The womans BP is normal, and her age does not put her at risk. Her BMI is low and may indicate poor nutritional status, which is a high risk.