OB Final Prep Mladenka

An ethical dilemma unique to perinatal nursing is the: Select one: a. Embryo/fetal rights b. Intensive use of technology to maintain life c. Limited access to care d. Ethnicity disparities in health care

Embryo/fetal rights

A pregnant client at 20 weeks' gestation comes to the clinic for her prenatal visit. Which of the following client statements would indicate a need for further assessment? Select one: a. "I hate it when the baby moves." b. "I've started calling my mom every day." c. "My partner and I can't stop talking about the baby." d. "I still don't know much time I'm going to take off work after the baby comes."

a. "I hate it when the baby moves." Read pp 302-305 Experiencing quickening as unpleasant may be a sign of maladaptation to pregnancy and needs further assessment by the nurse.

The perinatal nurse explains to the student nurse that ____ is the leading cause of neonatal death in the United States. Select one: a. Sudden Infant Death Syndrome b. Respiratory distress of newborns c. Effects of maternal complications d. Congenital malformations

D. Congenital Malformations The leading causes of neonatal deaths (in order) are: 1) congenital malformations; 2) low birth weight; and 3) sudden infant death syndrome. Read page 6

23 y/o Amy delivered a baby 2 months ago and presents to the clinic with complaint of stool coming out of her vagina for the past week. The nurse suspects recto-vaginal fistula. What is the next most appropriate question the nurse should ask Amy? Select one: a. "Did you deliver your baby vaginally?" b. "How big was your baby?" c. "Are you sure it is stool?" d. "How long has this been going on?"

a. "Did you deliver your baby vaginally?" The patient's symptoms are consistent with an anal fistula, which may be caused by vaginal childbirth and subsequent injury to the surrounding anal tissues.

The nurse is teaching the parents of a female baby how to change a baby's diapers. Which of the following should be included in the teaching? Select one: a. Always wipe the perineum from front to back. b. Use an antibiotic ointment at the first sign of diaper rash c. Put powder on the buttocks every time the baby stools. d. Weigh every diaper in order to assess for hydration.

a. Always wipe the perineum from front to back Clean female genitals by washing from front to back to decrease the risk of cystitis

Menorrhagia may result from (select all that apply): a. Anovulatory cycle b. Metritis c. Anorexia d. Emotional distress

a. Anovulatory cycle b. Metritis Menorrhagia is menstrual bleeding excessive in number of days and amount of blood. It may result from an anovulatory cycle, fibroids, inflammatory or infectious disease such as metritis or salpingitis, endometrial issues, or intrauterine device (IUD)

54 y/o Janice has a history of blood clots in her legs when she used birth control pills. Her hot flashes are "driving me crazy". What alternative comfort measures might be appropriate for Janice? (Select all that apply). Select one or more: a. Avoid triggers that bring about hot flashes b. Take an compound estrogen pill once a week. c. Wear layered clothing d. Avoid heavy blankets at night

a. Avoid triggers that bring about hot flashes c. Wear layered clothing d. Avoid heavy blankets at night See box on page 139

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

a. CPD can be accurately predicted 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.

Which of the following statements is true about menopause? Select one: a. No menses or spotting for 1 year b. Mood changes are unusual in perimenopause c. All women have hot flushes in menopause d. Average age of menopause in US women is 56-58 y/o

a. No menses or spotting for 1 year

Which of the following are true regarding interpreter services? Select all that apply. Select one or more: a. Direct questions to the patient, not the interpreter. b. Create environment of respect and privacy. c. It is not necessary to worry about different dialects of a patient's native language when using interpreters. d. Never have a patient's child serve as an interpreter.

a. Direct questions to the patient, not the interpreter b. Create environment of respect and privacy Read pg. 22

Through a vaginal examination, the nurse determines that a woman is 4 cm dilated. The external fetal monitor shows uterine contractions every 3 1⁄2 to 4 minutes. The nurse reports this as what stage of labor? Select one: a. First stage, active phase b. Third stage c. First stage, latent phase d. Second stage, latent phase

a. First stage, active phase Read Table 19-1 This maternal progress indicates that the woman is in the active phase of the first stage of labor. During the latent phase of the first stage of labor, the expected maternal progress is 0 to 3 cm dilation with contractions every 5 to 30 minutes. During the transition phase of the first stage of labor, the expected maternal progress is 8 to 10 cm dilation with contractions every 2 to 3 minutes. During the latent phase of the second stage of labor, the woman is completely dilated and experiences a restful period of "laboring down."

Which of the following are management options for couples faced with infertility challenges, depending of the cause? (Select all that apply). Select one or more: a. assisted reproductive technology procedures b. Medication c. remain child-free d. adoption

a. assisted reproductive technology procedures b. Medication c. remain child-free d. adoption

Which of the following are functions of the placenta? (Select all that apply) Select one or more: a. provides O2 and nutrients to the fetus b. provides constant thermal environment c. produces hormones, such as progesterone, that helps to relax the uterus d. cushions the fetus e. removes CO2 and fetal waste products

a. provides O2 and nutrients to the fetus c. produces hormones, such as progesterone, that helps to relax the uterus e. removes CO2 and fetal waste products See pp 270-273 and powerpoint

16 year old Emily lives in Blackfoot, ID. She has a boyfriend but does not want to have a baby for at least 10 years. She wants an effective, easy birth control method and denies medical problems. She has periods every 4-6 weeks. The nurse would recommend which of the following methods to Emily? (Select all that apply). Select one or more: a. the implant b. hormonal IUD c. bilateral tubal ligation d. natural family planning

a. the implant b. hormonal IUD

The perinatal nurse explains to the student nurse that in the fetal circulation, the lowest level of oxygen concentration is found in _________________. Select one: a. the umbilical arteries. b. the descending aorta. c. the foramen ovale d. the umbilical vein.

a. the umbilical arteries. See pp 273-274

A nurse is reviewing concepts relative to fetal circulation. Which factor should the nurse identify as not affecting fetal circulation during labor? Select one: a. Uterine contractions b. Fetal position c. Umbilical cord blood flow d. Maternal BP

b. Fetal position Maternal position may affect fetal circulation; however, fetal position is unlikely to disturb umbilical blood flow. Uterine contractions during labor tend to decrease circulation and subsequent perfusion. Most healthy fetuses are well able to compensate for this stress and exposure to increased pressure while moving passively through the birth canal during labor. Maternal blood pressure is likely to have a significant effect on fetal circulation. Compression of the cord and reduction of umbilical blood flow do affect fetal circulation.

16 y/o Susie presents to the clinic, wanting a pregnancy test. What questions would be appropriate for the professional nurse to ask Susie prior to completing the pregnancy test? Select one or more: a. Are you excited that you might be pregnant? b. What is the first day of your last menstrual period? c. Does your mother know you are wanting a pregnancy test? d. Have you been using birth control? e. Have you done a home pregnancy test?

b. What is the first day of your last menstrual period? d. Have you been using birth control? e. Have you done a home pregnancy test?

New screening mammogram recommendations by ACOG include which of the following? Select one: a. Only women with increased risk for breast begin screening mammogram at age 40 b. Women should talk to their health care provider to decide the best age to begin screening mammograms c. All women after 55 y/o should have annual screening mammograms d. All women begin screening mammogram at 40 years old

b. Women should talk to their health care provider to decide the best age to begin screening mammograms Women ages 40 to 44 should have the choice to start annual breast cancer screening with mammograms (x-rays of the breast) if they wish to do so. However, this screening increases radiation exposure to average women unneccesarily so it is recommended women discuss with their provider the best time to start screening. Women age 45 to 54 should get mammograms every year. Women 55 and older should switch to mammograms every 2 years, or can continue yearly screening.

Which of the following is an example of presymptomatic testing? Select one: a. newborn screening test b. genetic test for huntington's chorea c. genetic test for breast cancer d. genetic test for cystic fibrosis

b. genetic test for huntington's chorea See p 33 of text and powerpoint presentation

On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. What is the nurse's highest priority at this time? Select one: a. Calling the woman's primary health care provider b. Massaging the woman's fundus c. Beginning an intravenous (IV) infusion of Ringer's lactate solution d. Assessing the woman's vital signs

b. massaging the woman's fundus The nurse should first assess the uterus for atony by massaging the womans fundus. Uterine tone must be established to prevent excessive blood loss. The nurse may begin an IV infusion to restore circulatory volume, but this would not be the first action.

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

b. no special treatment is necessary 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.

Zita is 39 y/o G21002 who is 7 weeks pregnant. For which of the following is she at increased risk? Select one: a. cephalo-pelvic disportion (CPD) b. offspring with chromosomal defect c. postpartum hemorrhage d. anemia

b. offspring with chromosomal defect Most birth defects occur in the first 3 months of pregnancy when the organs are forming.

Angie is an ER nurse. Her patient complains of a 'painless sore down there' for the last 5 days. The physician diagnoses syphilis and asks Angie to look up the medication to treat the patient. Angie knows the best resource to find this information is: Select one: a. the 2001 STD book in the ER b. the CDC's STDs Treatment Guidelines 2015 c. her current drug book d. an STD website

b. the CDC's STDs Treatment Guidelines 2015

The nurse is explaining to 20 y/o Dana about symptoms that need to be reported to her health care provider. These include which of the following? (select all that apply). Select one or more: a. occasional headaches relieved with rest and hydration b. vaginal bleeding c. Fever d. absence of fetal movements after quickening

b. vaginal bleeding c. Fever d. absence of fetal movements after quickening See pg. 314

A NICU nurse is caring for a full-term neonate being treated for group B streptococcus (GBS). The mother of the neonate is crying and shares that she cannot understand how her baby became infected. The best response by the nurse is: Select one: a. "Newborns are more susceptible to infections due to an immature immune system. Would you like additional information on the newborn immune system?" b. "The infection was transmitted to your baby during the birthing process. Do you have a history of sexual transmitted infections?" c. "Approximately 15% to 40% of women have no symptoms but are carriers of group B streptococcus which is found in the vaginal and lower intestinal areas. What other questions do you have regarding your baby's health?" d. "I see that this is very upsetting for you. I will come back later and answer your questions."

c. "Approximately 15% to 40% of women have no symptoms but are carriers of group B streptococcus which is found in the vaginal and lower intestinal areas. What other questions do you have regarding your baby's health?" a. Correct information, but does not fully address the woman's concern. b. Correct, but GBS is not a sexually transmitted disease. c. Correct. This response answers her questions and allows her to ask additional questions about her baby's health. d. Acknowledges that she is upset but does not provide immediate information.

Health promotion includes contraception for which of the following reasons? a. Child spacing and planned pregnancies do not improve perinatal outcomes. b. Achieving desired family size does not enable a better sharing of resources. c. Contraception can positively affect future health. d. Unplanned pregnancies are always welcomed.

c. Contraception can positively affect future health. See p 70

The nurse takes the history of a client, G2 P1, at her first prenatal visit. The client is referred to a genetic counselor, due to her previous child having a diagnosis of ____. Select one: a. Unilateral amblyopia b. Subdural hematoma c. Sickle cell anemia d. Glomerular nephritis

c. Sickle cell anemia Sickle cell anemia is an autosomal recessive illness. This client needs to be seen by a genetic counselor.

Which client is at greatest risk for early PPH? Select one: a. Muliparous woman (G 3, P 2-0-0-2) with an 8-hour labor b. Primigravida in spontaneous labor with preterm twins c. Woman with preeclampsia on magnesium sulfate whose labor is being induced d. Primiparous woman (G 2, P 1-0-0-1) being prepared for an emergency cesarean birth for fetal distress

c. Woman with preeclampsia on magnesium sulfate whose labor is being induced Magnesium sulfate administration during labor poses a risk for PPH. Magnesium acts as a smooth muscle relaxant, thereby contributing to uterine relaxation and atony. A primiparous woman being prepared for an emergency cesarean birth for fetal distress, a multiparous woman with an 8-hour labor, and a primigravida in spontaneous labor with preterm twins do not indicate risk factors or causes of early PPH.

For which of the following conditions is colposcopy used to further evaluate need for intervention? (Select all that apply). Select one or more: a. bacterial vaginosis b. uterine fibroids c. cervical cancer d. vaginal cancer e. uterine cancer

c. cervical cancer d. vaginal cancer

Anna wants to know if her baby has Trisomy 18 as early in the pregnancy as possible. She is 8 weeks pregnant. Her physician will suggest which of the following diagnostic test? Select one: a. sequential integrated test b. amniocentesis c. chorionic villi sampling (CVS) d. Noninvasive prenatal screening test

c. chorionic villi sampling (CVS)

Which of the following can provide contraception and protection against sexually transmitted infections? (Select all that apply). Select one or more: a. natural family planning b. birth control pills c. condoms d. abstinence e. diaphragm f. intrauterine devices

c. condoms d. abstinence

A woman has preinvasive cancer of the cervix. Which modality would the nurse discuss as an available option for a client with this condition? Select one: a. hysterectomy b. internal radiation c. cryosurgery d. colposcopy

c. cryosurgery Cryosurgery, laser surgery, and loop electrosurgical excision procedure (LEEP) are several techniques used to treat preinvasive lesions. Colposcopy is the examination of the cervix with a stereoscopic binocular microscope that magnifies the view of the cervix. This examination would have already been performed as part of the diagnosis of preinvasive cancer of the cervix. A hysterectomy is performed if the cancer has extended beyond the cervix. Women with positive pelvic nodes (indicating invasive cancer) usually receive whole pelvis irradiation.

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. is an extremely intense grief reaction that persists for a long time 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.

Which of the following pharmacological pain relief methods does the woman give herself? Select one: a. Sublimaze through the IV b. Nubain by mouth c. nitrous oxide by mask d. Epidural

c. nitrous oxide by mask

The nurse is providing information to 17 y/o Kendra on STD prevention. Which of the following would the nurse NOT include in their counseling to reduce risk for getting an STD? Select one: a. mutual monogamy b. kissing with no breaks in skin c. oral sex without a barrier d. sexual fantasy

c. oral sex without a barrier Some STDs can be transmitted through oral sex without a barrier. See Table 7.1 pg 123

Folic acid 400mcg a day is recommended to all women of reproductive age for which of the following reasons? Select one: a. reduces a woman's risk for osteoporosis and heart disease b. reduces risk for learning disabilities of the baby c. prevents spina bifida and abdominal defects of the baby d. prevents complications during pregnancy e. reduces a woman's risk for certain cancers

c. prevents spina bifida and abdominal defects of the baby

Combination oral contraceptives, the vaginal ring and the patch contain two hormones. Which of the following is the primary hormone that stops ovulation? Select one: a. estrogen b. testosterone c. progesterone d. hCG

c. progesterone

Which of the following vaginitis conditions is a sexually transmitted infection? Select one: a. atrophic vaginitis b. bacterial vaginosis c. trichomonas vaginitis d. monolial vaginitis

c. trichomonas vaginitis Read pg. 138 Trichomonas vaginits is almost always an STI and is a common cause of vaginitis (5-50% of all vaginitis).

The nurse suspects that her postpartum client is experiencing hemorrhagic shock. Which observation indicates or would confirm this diagnosis? Select one: a. Calm mental status b. Cool, dry skin c. Absence of cyanosis in the buccal mucosa d. Urinary output of less than 30ml/hr

d. Urinary output of less than 30ml/hr Hemorrhage may result in hemorrhagic shock. Shock is an emergency situation during which the perfusion of body organs may become severely compromised, and death may occur. The presence of adequate urinary output indicates adequate tissue perfusion. The assessment of the buccal mucosa for cyanosis can be subjective. The presence of cool, pale, clammy skin is associated with hemorrhagic shock. Hemorrhagic shock is associated with lethargy, not restlessness.

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 nurse's first priority? a. Perform a gestational age assessment to determine whether the infant is large for gestational age. b. Immediately take the infant to the nursery. c. Leave the infant in the room with the mother d.Frequently monitor blood glucose levels, and closely observe the infant for signs of hypoglycemia.

d.Frequently monitor blood glucose levels, and closely observe the infant for signs of hypoglycemia. This infant is macrosomic (more than 4000 g) and is at high risk for hypoglycemia. Blood glucose levels should be monitored frequently, and the infant should be observed closely for signs of hypoglycemia. Observation may occur in the nursery or in the mother's room, depending on the condition of the fetus. Regardless of gestational age, this infant is macrosomic.

Match the condition or trait with the appropriate mode of inheritance (more than one mode may be used and not all are used). hemophilia Marfans syndrome cleft lip ovarian cancer sickle cell anemia

hemophilia ~X linked recessive inheritance Marfans syndrome ~autosomal dominant inheritance cleft lip ~multifactorial inheritance ovarian cancer ~multifactorial inheritance sickle cell anemia ~autosomal recessive inheritance

Match the definition with the correct term. this/these function(s) to inhibit cell growth and division cycle physical feature or psychological trait the number of autosomes in humans a pictorial analysis of an individual's chromosomes

this/these function(s) to inhibit cell growth and division cycle ~Tumor suppressor genes physical feature or psychological trait ~Phenotype the number of autosomes in humans ~22 a pictorial analysis of an individual's chromosomes ~Karyotype

Which of the following cancers has no accurate screening test for secondary prevention? Select one: a. Ovarian cancer b. Breast cancer c. Uterine cancer d. Cervical cancer

a. Ovarian cancer

Yolanda is 28 weeks pregnant. Her blood type is O negative. What will the nurse discuss with her at this prenatal visit? Select one: a. AFP/Maternal Serum Screen b. Testing for GBS. c. The need for a Rhogam injection. d. Ultrasound examination

c. The need for a Rhogam injection. Read handout on Rhogam Rhogam is given to pregnant women who are Rh negative to prevent complications in future pregnancies.

According to professional standards (the Association of Women's Health, Obstetric and Neonatal Nurses [AWHONN], 2007), which action(s) cannot be performed by the nonanesthetist registered nurse who is caring for a woman with epidural anesthesia? (Select all that apply). Select one or more: a. Initiating epidural anesthesia b. Stopping the infusion, and initiating emergency measures c. Replacing empty infusion bags with the same medication and concentrate d. Monitoring the status of the woman and fetus e. Inject medication through the epidural catheter

a. Initiating epidural anesthesia e. Inject medication through the epidural catheter Read p 407 and Box 17-6 Only qualified, licensed anesthesia care providers are permitted to insert a catheter, initiate epidural anesthesia, verify catheter placement, inject medication through the catheter, or alter the medication or medications including type, amount, or rate of infusion. The nonanesthetist nurse is permitted to monitor the status of the woman, the fetus, and the progress of labor. Replacement of the empty infusion bags or syringes with the same medication and concentration is permitted. If the need arises, the nurse may stop the infusion, initiate emergency measures, and remove the catheter if properly educated to do so. Complications can require immediate interventions. Nurses must be prepared to provide safe and effective care during an emergency situation.

To accurately measure the neonate's head, the nurse places the measuring tape around the head: Select one: a. Just above the ears and eyebrows b. Middle of the ear and over the eyes c. Middle of the ear and over the bridge of the nose d. Just below the ears and over the upper lip

a. Just above the ears and eyebrows This is the standard measurement for the diameter of the head.

A healthy, full-term baby boy is scheduled for a circumcision. Nursing actions prior to the procedure include which of the following? (Select all that apply.) Select one or more: a. Obtain written consent from the parents b. Administer acetaminophen PO 1 hour before procedure per provider order. c. Feed the neonate glucose water 30 minutes before the procedure. d. Verify that the neonate has voided

a. Obatin written consent from the parents b. Administer acetaminophen PO 1 hour before procedure per provider order. d. Verify that the neonate has voided Nursing actions include obtaining written consent, administering acetaminophen as per provider order, and ensuring the neonate has voided; neonate should not eat 2-3 hours prior to the procedure to avoid risk of vomiting and aspiration

Most women with uncomplicated pregnancies can use the nurse as their primary source for nutritional information. However, the nurse or midwife may need to refer a client to a registered dietitian for in-depth nutritional counseling. Which conditions would require such a consultation? (Select all that apply.) Select one or more: a. Obesity b. Preexisting or gestational illness such as diabetes c. Adolescents d. Multifetal pregnancy

a. Obesity b. Preexisting or gestational illness such as diabetes Read pgs. 358-359

Which of the following is effective treatment for dysmenorrhea? (Select all that apply).

a. Oral contraceptive pills b. NSAIDs

A nurse working in a prenatal clinic is caring for a woman who asks advice on foods that are high in vitamin C because "I hate oranges." The nurse states that 1 cup of which of the following raw foods will meet the patient's daily vitamin C needs? Select one: a. Strawberries b. Asparagus c. Iceberg lettuce d. Cucumber

a. Strawberries Read table 15-1

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

a. The most important function of tocolytic therapy is to provide the opportunity to administer antenatal glucocorticoids. 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.

A pregnant woman's WBC result is 15,000mm3 . What is the nurse's action based on this result?

b. Check differential since result is a normal finding for a pregnant woman. Normal range in pregnancy for WBC is 5,000-15,000.

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

b. Hypoxemia Read pp 364-368 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.

What is (are) the most critical nursing action(s) in caring for the newborn immediately after the birth? (Select all that apply). a. Administering eye drops and vitamin K b. Keeping the airway clear c. Drying and warming the newborn. d. Fostering parent-newborn attachment

b. Keeping the airway clear ~If only one answer were allowed this would be it; since more than one answer is allowed, drying and warming the neonate are also top priority. c. Drying and warming the newborn. ~Warming by putting baby on mother's abdomen and covered with warm blanket, or baby is wrapped in warm blanket.

Pulmonary changes during pregnancy include which of the following/ (Select all that apply). Select one or more: a. Cardiac output increases by 30 to 50% b. Tidal volume increases by 33% c. Oxygen consumption increases by 20-40% d. Total lung capacity increases by 30%

c. Oxygen consumption increases by 20-40% Read Table 13-3

A primigravida patient is 39 weeks pregnant. Which of the following symptoms would the nurse expect the patient to exhibit? Select one: a. Nausea b. Dysuria c. Urinary frequency d. Headaches not relieved with analgesic

c. Urinary frequency Read page 294 Urinary frequency recurs at the end of the third trimester. As the uterus enlarges, it again compresses the bladder causing urinary frequency.

Alisson tells the nurse she is concerned her health insurance company will raise her premiums if they find out her baby tests positive for a single gene mutation, such as cystic fibrosis. The nurse tells Alisson about which of the following laws that protects her from such genetic discrimination? Select one: a. Genetic Protection Act (GPA) b. There is no such law c. HIPAA d. Genetic Information Non-discrimination Act (GINA)

d. Genetic Information Non-discrimination Act (GINA) See powerpoint presentation

Mary asks the nurse why does she have to have a speculum exam during her first prenatal visit? The nurse's best answer is: Select one: a. It enables the provider to inspect your vulva and vaginal os. b. It enables the provider to percuss your cervix and uterus c. It allows the provider to palpate the size of your uterus d. It enables the provider to inspect your cervix and vaginal walls.

d. It enables the provider to inspect your cervix and vaginal walls.

Abruptio placenta is a risk factor for amniotic fluid embolism. Select one: True False

True

Which of the following is considered to be a "reassuring" or Category 1 Fetal Heart Rate (FHR) pattern? Select one: a. Baseline rate of 110-160; moderate variability; presence of accelerations; absence of decelerations b. Baseline rate of 120; absent variability; presence of accelerations; early decelerations present c. Baseline rate of 150-200; moderate variability; occasional accelerations; variable decelerations d. Baseline rate of 100-150; minimal variability; presence of accelerations; occasional decelerations

a. Baseline rate of 110-160; moderate variability; presence of accelerations; absence of decelerations A "reassuring" or Category 1 FHR pattern is defined as: baseline rate of 110-160 beats per minute (bpm); moderate variability; presence of accelerations; absence of decelerations.

A woman presents to the clinic complaining of nausea and LMP was 2 months ago. Her pregnancy test is positive. The nurse takes the following information from the patient about her history of pregnancy. She miscarried at 8 weeks; delivered her second baby at 39 weeks and she is alive; delivered her second baby at 32 weeks and he is doing well; and had a stillbirth at 17 weeks. The nurse would document her pregnancy history as: Select one: a. G5T1P1A2L2 b. G4T1P1A2L2 c. G4T1P1A1L2 d. G5T2P1A1L2

a. G5T1P1A2L2 She is pregnant with her fifth pregnancy, had two pregnancies end prior to 20 weeks (A);had 1 deliver at 32 weeks (P); and one deliver at 39 weeks (T). Read pages 283-284 and Table 13-1

Pain should be regularly assessed in all newborns. If the infant is displaying physiologic or behavioral cues that indicate pain, then measures should be taken to manage the pain. Which interventions are examples of nonpharmacologic pain management techniques? (Select all that apply.) Select one or more: a. Skin-to-skin contact with the mother b. Acetaminophen c. Nonnutritive sucking d. Swaddling e. Sucrose

a. Skin-to-skin contact with the mother c. Nonnutritive sucking d. Swaddling e. Sucrose Swaddling, nonnutritive sucking, skin-to-skin contact with the mother, and sucrose are all appropriate nonpharmacologic techniques used to manage pain in neonates. Acetaminophen is a pharmacologic method of treating pain.

Susie is 9 weeks pregnant (based on her last menstrual period) on her first prenatal visit. She tells the nurse she smoked marijuana approx 2 months ago but denies any use since then. She asks "will this hurt my baby?" The nurse's best response is: Select one: a. "That would have been during the most vulnerable time for fetal development so yes, there might be risk to your baby." b. "Based on your last menstrual period, the risk of harm to your baby from smoking marijuana at that time is very low." c. "Yes, your baby might have significant birth defects from smoking marijuana at that time." d. "I do not know. You will need to talk to your physician about that."

b. "Based on your last menstrual period, the risk of harm to your baby from smoking marijuana at that time is very low." 2 months = 8 weeks. Based on this information, implantation had not occurred yet; therefore, risk to fetus very low.

Which nursing action is most appropriate to correct a boggy uterus that is displaced above and to the right of the umbilicus? Select one: a. Notify the physician of an impending hemorrhage. b. Assist the client in emptying her bladder. c. Administer pitocin d. Assess the blood pressure and pulse.

b. Assist the client in emptying her bladder Urinary retention can cause overdistention of the urinary bladder, which lifts and displaces the uterus. If uterus is displaced to the left consider hemorrhage as cause.

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? Select one: a. Seizures b. Hypoglycemia c. Birth injury d. Hypocalcemia

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

Which of the following findings, seen in pregnant women in the third trimester, would the nurse consider to be within normal limits? Select one: a. Diplopia b. Pyrosis c. Bradycardia d. Oliguria

b. Pyrosis See page 298

A woman who is 39 weeks pregnant expresses fear about her impending labor and how she will manage. What is the nurse's ideal response? Select one: a. "Labor is scary to think about, but the actual experience isn't." b. "You can have an epidural. You won't feel anything." c. "It's normal to be anxious about labor. Let's discuss what makes you afraid." d. "Don't worry about it. You'll do fine."

c. "It's normal to be anxious about labor. Let's discuss what makes you afraid." best answer to address her individual fears. Read Chap 19

Which of the following is true regarding dizygotic twins? Select one: a. The fetuses share one amnion. b. The fetuses share one chorion. c. Each fetus has their own placenta. d. Each fetus has their own uterus.

c. Each fetus has their own placenta Dizygotic twins occur when two eggs are fertilized by two separate sperm. This results in two placenta and different genotypes. Dizygotic twins are also known as fraternal or non-identical twins. They are the most common type of twins.

The nurse is working in a prenatal clinic caring for a patient at 13 weeks' gestation, G21001. Which of the following findings should the nurse highlight for the nurse midwife? a. Body mass index of 23 b. Blood pressure of 100/60 c. Hematocrit of 29% d. Pulse rate of 76 bpm

c. Hematocrit of 29% The nurse needs to tell the provider this information Normal HCT 36-45% Less than 32% in pregnancy = anemia

Allison is 32 weeks pregnant presents to L&D and tells the nurse she has not felt her baby move in 48 hours. The nurse begins electronic fetal monitoring and notes the baby's heart rate is in the 130's. The nurse contacts Allison's physician to obtain an order for which of the following tests? Select one: a. Fetal fibronectin b. Leopolds Maneuvers c. Non stress Test d. Biophysical profile e. Multiple Marker Screening Test

c. Non stress test

In caring for a primiparous woman in labor, one of the factors to evaluate is uterine activity. This is referred to as the ____ of labor. Select one: a. Passenger b. Passage c. Powers d. Psyche

c. Powers Powers refer to the involuntary uterine contractions (UCs) of labor the the voluntary pushing or bearing down that combine to propel and deliver the fetus and placenta. Read pp 372-375

A woman has come to the clinic for preconception counseling because she wants to start trying to get pregnant in the next few months. Which guidance should she expect to receive? a. "Discontinue all contraception now." b. "Lose weight so that you can gain more during pregnancy." c. "You may take any medications you have been taking regularly." d. "Make sure that you include adequate folic acid in your diet."

d. "Make sure you include adequate folic acid in your diet."

What is the risk for all pregnancies to have a fetus with minor birth defects? Select one: a. Less than 1% b. 5-9% c. 3-4% d. 10-15%

d. 10-15% (In real life it is actually 3-4% based on Boston Children's hospital data, but quizlet and her quiz say 10-15%)

Trina is 16 y/o and presents to the clinic with complaint of symptoms consistent with endometriosis. She does not want to get pregnant for several years. Which of the following treatments will the physician probably implement? Select one: a. GnRH agonist b. Surgery c. Danazol d. OCPs

d. OCPs She does not want to get pregnant right now, she is a teenager, OCPs have relatively fewer side effects than the other medications, and they can be effective.

All pregnant women should be instructed to recognize and report potential complications for each trimester of pregnancy. Match the sign or symptom with a possible cause. Severe backache and flank pain Epigastric pain in late pregnancy Glycosuria Severe vomiting in early pregnancy Decreased fetal movement

Severe backache and flank pain ~ Kidney infection or stones Epigastric pain in late pregnancy ~ Hypertension, preeclampsia Glycosuria ~Gestational diabetes Severe vomiting in early pregnancy ~ Hyperemesis gravidarum Decreased fetal movement ~ Fetal jeopardy or intrauterine fetal death

Endometriosis is an infection that usually starts at the placental site Select one: True False

True

Four babies have just been admitted into the neonatal nursery. Which of the babies should the nurse assess first? a. The baby with respirations 52, oxygen saturation 98% b. The baby with Apgar 9/9, weight 2960 grams c. The baby with temperature 96.3°F, length 17 inches d. The baby with glucose 60 mg/dL, heart rate 132

c. The baby with temperature 96.3°F, length 17 inches Axillary temperature below 97.7°F is a sign of cold stress and must be treated immediately

Contraindications for induction of labor include: Select one or more: a. Abnormal fetal position b. Post-term pregnancy c. Pre-eclampsia d. Placental abnormalities

a. Abnormal fetal position d. Placental abnormalities

A nurse is reviewing diet with a pregnant woman in her second trimester. Which of the following foods should the nurse advise the patient to avoid consuming during her pregnancy? Select one: a. Brie cheese b. Bartlett pears c. Sweet potatoes d. Grilled lamb

a. Brie cheese Avoid soft cheeses to avoid listeriosis, which can cause harm to the fetus. Read p 361

The nurse is educating Marissa on exercise during pregnancy. Which of the following should the nurse include in their education? (select all that apply).

a. You should be able to easily talk or sing while exercising b. Stay hydrated during exercise

A pregnant woman was admitted for induction of labor at 43 weeks of gestation with sure dates. A nonstress test (NST) in the obstetrician's 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? (Select all that apply). A.hypoglycemia B.meconium aspiration C.increased amount of subcutaneous fat D.excessive vernix caseosa covering the skin E. absence of scalp hair F.dry, cracked skin

a.hypoglycemia b.meconium aspiration f.dry cracked skin Meconium aspiration, hypoglycemia, and dry, cracked skin are consistent with a postmature infant. Excessive vernix caseosa covering the skin, lethargy, and respiratory distress syndrome would be consistent with a very premature infant. The skin may be meconium stained, but the infant would most likely have longer hair and decreased amounts of subcutaneous fat. Postmaturity with a nonreactive NST would indicate hypoxia. Signs and symptoms associated with fetal hypoxia are hypoglycemia, temperature instability, and lethargy

A pregnant woman informs the nurse that her last normal menstrual period was on July 6, 2017. Using Naegele's rule, which of the following would the nurse determine to be the patient's estimated date of delivery (EDC)? Select one: a. January 9, 2018 b. April 13, 2018 c. April 20, 2018 d. September 6, 2018

b. April 13, 2018 Subtract 3 months, add 7 days, add 1 year if necessary

A woman presents to a prenatal clinic appointment at 10 weeks' gestation, in the first trimester of pregnancy. Which of the following symptoms would be considered a normal finding at this point in pregnancy? Select one: a. Occipital headache b. Fatigue c. Diarrhea d. Leg cramps

b. Fatigue See Table 13-2

Which STD can be prevented by a vaccine and reduce a person's risk for certain types of cancer? Select one: a. Hepatitis B b. Human papilloma virus c. Herpes simplex virus d. Gonorrhea

b. Human papilloma virus Read pg. 131

Which of the following findings, seen in pregnant women in the first trimester, would the nurse consider to be within normal limits? Select one: a. Diplopia b. Leukorrhea c. Bradycardia d. Oliguria

b. Leukorrhea See page 289

Which of the following health risks can have a negative impact on a pregnancy? (Select all that apply). Select one or more: a. Regular exercise b. Obesity c. Negative Family History for Genetic Disorders d. Maternal diabetes

b. Obesity d. Maternal diabetes see p. 58

Which of the following screens for cervical cancer? (Select all that apply). Select one or more: a. herpes simplex 1 and 2 b. high risk HPV test c. pap smear test d. chlamydia

b. high risk HPV test c. pap smear test Pap smear test and high risk HPV tests are used to screen cervical cancer. Other STD testing is not done for cervical cancer screening.

Which of the following tests should never be performed during the first trimester? Select one: a. Noninvasive Prenatal Screening test b. Maternal screening test for cystic fibrosis c. Contraction Stress test d. Ultrasound

c. Contraction Stress test

Which client is at greatest risk for early PPH? Select one: a. Primiparous woman (G 2, P 1-0-0-1) being prepared for an emergency cesarean birth for fetal distress b. Multiparous woman (G 3, P 2-0-0-2) with an 8-hour labor c. Woman with severe preeclampsia on magnesium sulfate whose labor is being induced d. Primigravida in spontaneous labor with preterm twins

c. Woman with sever preeclampsia on magnesium sulfate whose labor is being induced Magnesium sulfate administration during labor poses a risk for PPH. Magnesium acts as a smooth muscle relaxant, thereby contributing to uterine relaxation and atony. A primiparous woman being prepared for an emergency cesarean birth for fetal distress, a multiparous woman with an 8-hour labor, and a primigravida in spontaneous labor with preterm twins do not indicate risk factors or causes of early PPH.

After the Nurse Practitioner treats a 25 y/o's Bartholin cyst with incision and drainage procedure (I&D), the nurse is providing take-home instructions. The patient asks, "Will this happen again?" The nurse's best response is: Select one: a. "I cannot answer that question for you. Let me have the NP come and talk to you." b. "If you take your antibiotics and not get an infection, recurrence is rare. Let's talk about how to prevent infection." c. "No, since it is drained it won't come back." d. "Bartholin cysts can recur. There is another procedure that can be done to reduce risk for recurrence.Would you like to talk to the NP about it?"

d. "Bartholin cysts can recur. There is another procedure that can be done to reduce risk for recurrence. Would you like to talk to the NP about it?" Bartholin cysts are benign lesions of the vulva. If the cyst is symptomatic or infected, surgical incision and drainage may provide relief. If cysts recur or bother you, a marsupialization procedure may help. Your doctor places stitches on each side of a drainage incision to create a permanent opening less than 1/4-inch (about 6-millimeter) long. An inserted catheter may be placed to promote drainage for a few days after the procedure and to help prevent recurrence.

The laboratory results for a postpartum woman are as follows: blood type, A; Rh status, positive; rubella non-immune (titer 1:8 or enzyme immunoassay [EIA] 0.8); hematocrit, 30%. How should the nurse best interpret these data? Select one: a. Rh immune globulin is necessary within 72 hours of childbirth. b. Kleihauer-Betke test should be performed. c. Blood transfusion is necessary. d. Rubella vaccine should be administered.

d. Rubella vaccine should be administered This clients rubella titer indicates that she is not immune and needs to receive a vaccine.

The positive signs of pregnancy are: Select one: a. All physiological and anatomical changes of pregnancy b. All subjective signs of pregnancy c. All those physiological changes perceived by the woman herself d. The objective signs of pregnancy that can only be attributed to the fetus

d. The objective signs of pregnancy that can only be attributed to the fetus See page 285

A pregnant woman at 33 weeks of gestation is brought to the birthing unit after a minor automobile accident. The client is experiencing no pain and no vaginal bleeding, her vital signs are stable, and the FHR is 132 beats per minute with variability. What is the nurse's highest priority? Select one: a. Monitoring her for 24 hours b. Obtaining a physician's order to discharge her home c. Monitoring the woman for a ruptured spleen d. Using continuous EFM for a minimum of 4 hours

d. Using contiuous EFM for a minimum of 4 hours Monitoring the external FHR and contractions is recommended after blunt trauma in a viable gestation for a minimum of 4 hours, regardless of injury severity. Fetal monitoring should be initiated as soon as the woman is stable.

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? Select one: a. Early FHR decelerations b. Fetal arrhythmias c. Spontaneous rupture of membranes d. Uteroplacental insufficiency

d. Uteroplacental insufficiency 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.

A group of nurses are discussing the emergence of human sex trafficking as a serious health problem. What term can the nurses use as an equivalent concept? Select one: a. Prostitution. b. Licensed sexual act c. Modern-day slavery d. Sex games.

c. Modern-day slavery Read pg 96-97

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 saturation of 80%. The prescribed saturations are 92%. What are the nurse's most appropriate actions at this time? (Select all that apply) A. increase oxygen B. ensure patency of the endotracheal tube C. notify parents that their infant is not doing well D. listen to breath sounds E. call physician F. complete the admission process and thorough assessment G. continue to observe until saturations are 75%

A. increase oxygen B. ensure patency of the endotracheal tube D. listen to breath sounds E. call physician Listening to breath sounds and ensuring the patency of the endotracheal tube, increasing oxygen, and notifying a physician appropriate nursing interventions to assist in optimal oxygen saturation of the infant. Oxygenation of the infant is crucial. O2 saturation should be maintained above 92%. 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 determination of fetal status

Which minerals and vitamins are usually recommended as a supplement in a pregnant client's diet? Select one: a. Iron b. Water-soluble vitamins C and B c. Fat-soluble vitamins A and D d. Zinc

a. Iron Read pg. 362

The clinic nurse is aware that the pregnant woman's blood volume increases by: Select one: a. 20% to 25% b. 30% to 35% c. 40% to 45% d. 50% to 55%

c. 40% to 45% Read Table 13-4 and pp 290-293

A woman in the 34th week of pregnancy reports that she is very uncomfortable because of heartburn. Which recommendation would be appropriate for this client? a. Substitute other calcium sources for milk in her diet. b. Lie down after each meal. c. Reduce the amount of fiber she consumes. d. Eat several small meals daily.

d. Eat several small meals a day Read page 362

A new father wants to know what medication was put into his infant's eyes and why it is needed. How does the nurse explain the purpose of the erythromycin (Ilotycin) ophthalmic ointment? Select one: a. Erythromycin (Ilotycin) ophthalmic ointment destroys an infectious exudate caused by Staphylococcus that could make the infant blind. b. Erythromycin (Ilotycin) prevents potentially harmful exudate from invading the tear ducts of the infant's eyes, leading to dry eyes. c. This ointment prevents the infant's eyelids from sticking together and helps the infant see. d. This ophthalmic ointment prevents gonorrheal infection of the infant's eyes, potentially acquired from the birth canal.

d. This ophthalmic ointment prevents gonorrheal infection of the infant's eyes, potentially acquired from the birth canal. The nurse should explain that prophylactic erythromycin ophthalmic ointment is instilled in the eyes of all neonates to prevent gonorrheal and chlamydial infection that potentially could have been acquired from the birth canal. This prophylactic ophthalmic ointment is not instilled to prevent dry eyes and has no bearing on vision other than to protect against infection that may lead to vision problems.

Which substance used during pregnancy causes vasoconstriction and decreased placental perfusion, resulting in maternal and neonatal complications? Select one: a. Alcohol b. Chocolate c. Caffeine d. Tobacco

d. Tobacco Smoking in pregnancy is known to cause a decrease in placental perfusion and is the cause of low-birth-weight infants. Prenatal alcohol exposure is the single greatest preventable cause of mental retardation. Alcohol use during pregnancy can cause high blood pressure, miscarriage, premature birth, stillbirth, and anemia. Caffeine may interfere with certain medications and worsen arrhythmias. Chocolate, particularly dark chocolate, contains caffeine that may interfere with certain medications.

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

d. Tocolytic drug 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.

Match the prenatal test to the appropriate purpose or correct fact. 1 hour GTT Noninvasive prenatal screening test GBS testing Sequential integrated screening

1 hour GTT ~ Screening test for gestational diabetes Noninvasive prenatal screening test ~ Tests for cell-free fetal DNA in maternal blood GBS testing ~ Test to determine if prophylactic antibiotic is indicated during labor Sequential integrated screening ~ Involves 2 blood tests and an ultrasound

Infants born between 34 0/7 and 36 6/7 weeks of gestation are called late- preterm infants because they have many needs similar to those of preterm infants. Because they are more stable than early-preterm infants, they may receive care that is similar to that of a full-term baby. These infants are at increased risk for which conditions? (Select all that apply.) A. Cardiac distress B. Problems with thermoregulation C. Sepsis D. Hyperbilirubinemia E. Hyperglycemia

B. Problems with thermoregulation C. Sepsis D. Hyperbilirubinemia Thermoregulation problems, hyperbilirubinemia, and sepsis are all conditions related to immaturity and warrant close observation. After discharge the infant is at risk for rehospitalization related to these problems. AWHONN launched the Near-Term Infant Initiative to study the problem and ways to ensure that these infants receive adequate care. The nurse should ensure that this infant is feeding adequately before discharge and that parents are taught the signs and symptoms of these complications.Late-preterm infants are also at increased risk for respiratory distress and hypoglycemia.

The perinatal nurse explains to the student nurse that a goal of the Healthy People 2020 is to: Select one:

Increase proportion of infants who are breastfed. Read box 1-2 A goal of Healthy People 2020 is to increase the proportion of infants who are breastfed from 74% to 81.9%.

The nurse is preparing to teach an antepartum client with GDM the correct method of administering an intermediate-acting insulin, such as neutral protamine Hagedorn (NPH), with a short-acting insulin (regular). In the correct order from 1 through 6, match the step number with the action needed to teach the client self-administration of this combination of insulin. Inject air equal to the dose of NPH insulin into the vial, and remove the syringe Check the insulin bottles for the expiration date. Gently rotate the insulin to mix it, and wipe the stopper. Without adding air, withdraw the correct dose of NPH insulin. Wash hands. Inject air equal to the dose of regular insulin into the vial, and withdraw the medication

Inject air equal to the dose of NPH insulin into the vial, and remove the syringe... Step 4 Check the insulin bottles for the expiration date... Step 2 Gently rotate the insulin to mix it, and wipe the stopper... Step 3 Without adding air, withdraw the correct dose of NPH insulin... Step 6 Wash hands... Step 1 Inject air equal to the dose of regular insulin into the vial, and withdraw the medication... Step 5

The clinic nurse understands the meaning of the following terms related to pregnancy care. Match these terms with the definitions listed below: Mother's experience that her baby has 'dropped' into the pelvis Passive movement of the unengaged fetus Stretch marks Blotchy, brownish hyperpigmentation of the skin over the cheeks, nose and forehead. Pigmented line extending from the symphysis pubis to the top of the fundus

Mother's experience that her baby has 'dropped' into the pelvis ~ Lightening Passive movement of the unengaged fetus ~ Ballottement Stretch marks ~ Striae Gravidarum Blotchy, brownish hyperpigmentation of the skin over the cheeks, nose and forehead. ~ Melasma Pigmented line extending from the symphysis pubis to the top of the fundus ~ Linea nigra

PPH may be sudden and result in rapid blood loss. The nurse must be alert to the symptoms of hemorrhage and hypovolemic shock and be prepared to act quickly to minimize blood loss. Astute assessment of the client's circulatory status can be performed with noninvasive monitoring. Match the type of noninvasive assessment that the nurse would perform with the appropriate clinical manifestation or body system. Observation Measurement Auscultation Palpation Inspection

Observation = Presence or absence of anxiety Measurement = Pulse oximetry Auscultation = Heart pulses Palpation = Arterial pulses Inspection = skin color, temperature, and turgor

Ultrasound can be used in antepartum care for which of the following assessments? (Select all that apply). Select one or more: a. fetal growth b. placental position and function c. gestational age d. adjunct use in chorionic villi sampling (CVS)

a. fetal growth b. placental position and function c. gestational age d. adjunct use in chorionic villi sampling (CVS)

According to the CDC, which of the following are significant causes of maternal death in the United States? (Select all that apply). Select one or more: a. infection b. ski accidents c. hemorrhage d. cardio-vascular disease e. hypertensive disorders f. street drug use

a. infection c. hemorrhage d. cardio-vascular disease e. hypertensive disorders Embolism (20 percent) Hemorrhage (17 percent) Pre-eclampsia and eclampsia (16 percent) Infection (13 percent) Cardiomyopathy (8 percent)

The parents of a newborn ask the nurse how much the newborn can see. The parents specifically want to know what type of visual stimuli they should provide for their newborn. What information provided by the nurse would be most useful to these new parents? Select one: a. "Infants can track their parents' eyes and can distinguish patterns; they prefer complex patterns." b. "Infants can see very little until approximately 3 months of age." c. "The infant's eyes must be protected. Infants enjoy looking at brightly colored stripes." d. "It's important to shield the newborn's eyes. Overhead lights help them see better."

a. "Infants can track their parents' eyes and can distinguish patterns; they prefer complex patterns." Telling the parents that infants can track their parents' eyes and can distinguish patterns is an accurate statement. Development of the visual system continues for the first 6 months of life. Visual acuity is difficult to determine, but the clearest visual distance for the newborn appears to be 19 cm. Infants prefer to look at complex patterns, regardless of the color. They prefer low illumination and withdraw from bright lights.

During preconception counseling, the clinic nurse explains that the time period when the fetus is most vulnerable to the effects of teratogens occurs from: Select one: a. 2 to 8 weeks b. 4 to 12 weeks c. 5 to 10 weeks d. 6 to 15 weeks

a. 2 to 8 weeks The period of organogenesis lasts from approximately the second until the eighth week of gestation during which time the embryo undergoes rapid growth and differentiation. During organogenesis, the embryo is extremely vulnerable to teratogens such as medications, alcohol, tobacco, caffeine, illegal drugs, radiation, heavy metals, and maternal (TORCH) infections. Structural fetal defects are most likely to occur during this period because exposure to teratogens either before or during a critical period of development of an organ can cause a malformation. See Figure 12-7 in text and powerpoint

A nurse who is discussing serving sizes of foods with a new prenatal patient who does not drink milk. The nurse would state that which of the following is equal to 1 (one) serving from the dairy food group? Select all that apply. Select one or more: a. 3 cups of dried beans b. 1/2 cup tofu c. 3oz of trout d. 1 cup of collards

a. 3 cups of dried beans d. 1 cup of collards Read Box 15.2 pg 306 3 cups of dried beans and 1 cup of collards are equal to one cup of milk. 1 cup of tofu would equal 1 cup of milk. 3 oz of sardines or 4 1/2 oz can of salmon (if bones are eaten) would equal 1 cup of milk, not trout.

A first-time mother is concerned about the type of medications she will receive during labor. The client is in a fair amount of pain and is nauseated. In addition, she appears to be very anxious. The nurse explains that opioid analgesics are often used along with sedatives. How should the nurse phrase the rationale for this medication combination? Select one: a. "Sedatives enhance the effect of the pain medication." b. "The two medications, together, reduce complications." c. "The two medications work better together, enabling you to sleep until you have the baby." d. "This is what your physician has ordered for you."

a. "Sedatives enhance the effect of the pain medication." Read pp 392-395 Sedatives may be used to reduce the nausea and vomiting that often accompany opioid use. In addition, some ataractic drugs reduce anxiety and apprehension and potentiate the opioid analgesic affects. A potentiator may cause two drugs to work together more effectively, but it does not ensure zero maternal or fetal complications. Sedation may be a related effect of some ataractic drugs; however, sedation is not the goal. Furthermore, a woman is unlikely to be able to sleep through transitional labor and birth. Although the physician may have ordered the medication, "This is what your physician has ordered for you" is not an acceptable comment for the nurse to make.

A client is in early labor, and her nurse is discussing the pain relief options she is considering. The client states that she wants an epidural "no matter what!" What is the nurse's best response? Select one: a. "The type of analgesia or anesthesia used is determined, in part, by the stage of your labor and the method of birth. It is really too early." b. "You may only have an epidural if you are going to deliver vaginally." c. "I'll make sure you get your epidural now." d. "You may only have an epidural if your physician allows it."

a. "The type of analgesia or anesthesia used is determined, in part, by the stage of your labor and the method of birth. It is really too early." To avoid suppressing the progress of labor, pharmacologic measures for pain relief are generally not implemented until labor has advanced to the active phase of the first stage and the cervix is dilated approximately 4 to 5 cm. A plan of care is developed for each woman that addresses her particular clinical and nursing problems. The nurse collaborates with the primary health care provider and the laboring woman in selecting features of care relevant to the woman and her family. The decision whether to use an epidural to relieve labor pain is multifactorial. The nurse should not make a blanket statement guaranteeing the client one pharmacologic option over another until a complete history and physical examination has been obtained. A physician's order is required for pharmacologic options for pain management. However, expressing this requirement is not the nurse's best response. An epidural is an effective pharmacologic pain management option for many laboring women. It can also be used for anesthesia control if the woman undergoes an operative delivery.

A healthy 60-year-old African-American woman regularly receives health care at her neighborhood clinic. She is due for a mammogram. At her first visit, her health care provider is concerned about the 3-week wait at the neighborhood clinic and made an appointment for her to have a mammogram at a teaching hospital across town. She did not keep her appointment and returned to the clinic today to have the nurse check her blood pressure. What is the most appropriate statement for the nurse to make to this client? Select one: a. "Would you like me to make an appointment for you to have your mammogram here?" b. "I'm concerned that you missed your appointment; let me make another one for you." c. "Do you have transportation to the teaching hospital so that you can get your mammogram?" d. "It's very dangerous to skip your mammograms; your breasts need to be checked."

a. "Would you like me to make an appointment for you to have your mammogram here?" Offering to make an appointment for the client at the neighborhood location is nonjudgmental and gives her options as to where she may have her mammogram. Furthermore, it is an innocuous way to investigate the reasons the client missed her previous appointment. Mortality rates from breast cancer remain high for African-American women. Rather than reminding this woman that she has missed her appointment, discussing the evidence behind the recommendations for a mammogram might be preferable for the nurse. The nurse can offer to reschedule should the client agree to return for the test. Telling the client that it is dangerous to skip mammograms can be perceived as judgmental and derogatory and may alienate and embarrass the client.

A client is warm and asks for a fan in her room for her comfort. The nurse enters the room to assess the mother and her infant and finds the infant unwrapped in his crib with the fan blowing over him on high. The nurse instructs the mother that the fan should not be directed toward the newborn and that the newborn should be wrapped in a blanket. The mother asks why. How would the nurse respond? Select one: a. "Your baby may lose heat by convection, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped, and should prevent cool air from blowing on him." b. "Your baby may lose heat by conduction, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped, and should prevent cool air from blowing on him." c. "Your baby will easily get cold stressed and needs to be bundled up at all times." d. "Your baby may lose heat by evaporation, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped, and should prevent cool air from blowing on him."

a. "Your baby may lose heat by convection, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped, and should prevent cool air from blowing on him." Convection is the flow of heat from the body surface to cooler ambient air. Because of heat loss by convection, all newborns in open bassinets should be wrapped to protect them from the cold. Conduction is the loss of heat from the body surface to cooler surfaces, not air, in direct contact with the newborn. Evaporation is a loss of heat that occurs when a liquid is converted into a vapor. In the newborn, heat loss by evaporation occurs as a result of vaporization of moisture from the skin. Cold stress may occur from excessive heat loss; however, this does not imply that the infant will become stressed if not bundled at all times. Furthermore, excessive bundling may result in a rise in the infant's temperature.

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

a. 12 to 14 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.

The time from fertilization to implantation is _____ days. Select one: a. 6-10 b. 4-7 c. 10-15 d. 1-3

a. 6-10 See p 267 and powerpoint

Which of the following are milestones in the care of mothers and babies? (Select all that apply). Select one or more: a. abortion is legalized b. folic acid is recommended to prevent neural tube defects c. HIV vaccine is available d. FDA approves birth control pill for men

a. Abortion is legalized b. Folic acid is recommended to prevent neural tube defects See Box 1-1, pg. 2

Which term is an accurate description of the process by which people retain some of their own culture while adopting the practices of the dominant society? a. Acculturation b. Assimilation c. Ethnocentrism d. Cultural relativism

a. Acculturation Pg. 19-21 Acculturation is the process by which people retain some of their own culture while adopting the practices of the dominant society. This process takes place over the course of generations. Assimilation is a loss of cultural identity. Ethnocentrism is the belief in the superiority of one's own culture over the cultures of others. Cultural relativism recognizes the roles of different cultures.

Nurses can help their clients by keeping them informed about the distinctive stages of labor. Which description of the phases of the first stage of labor is accurate? Select one: a. Active: Moderate, regular contractions; 6- to 10-cm dilation b. Transition: Very strong but irregular contractions; 8- to 10-cm dilation; duration of 1 to 2 hours c. Latent: Mild, regular or irregular contractions; no dilation; bloody show d. Lull: No contractions; dilation stable; duration of 20 to 60 minutes

a. Active: Moderate, regular contractions; 6- to 10-cm dilation Read Table 19-1 pg 382

Postoperative nursing care and education for a woman who had an abdominal hysterectomy includes (select all that apply): Select one or more: a. Administering hormone therapy as per provider orders. b. Assessing vaginal bleeding c. Instructing the woman vaginal intercourse until she has followup visit with surgeon. d. Instructing the woman to resume activities as comfort level permits.

a. Administering hormone therapy as per provider orders. b. Assessing vaginal bleeding c. Instructing the woman vaginal intercourse until she has followup visit with surgeon. d. Instructing the woman to resume activities as comfort level permits.

Tobacco use during pregnancy is associated with adverse effects on the unborn infant such as intrauterine growth restriction, preterm births, and respiratory problems. By race, which has the highest percentages of smokers? Select one: a. American Indian and Alaskan Natives b. Asian or Pacific Islanders c. Non-Hispanic blacks d. Non-Hispanic whites

a. American Indian and Alaskan Natives -36% of American Indian and Native American women are cigarette smokers. 4.3% of Asian or Pacific Islander women are cigarette smokers. 17.1% of non-Hispanic black women are cigarette smokers. 19.6% of non-Hispanic white women are cigarette smokers.

A couple who has been attempting to become pregnant for 5 years is seeking assistance from an infertility clinic. The nurse assesses the clients' emotional responses to their infertility. Which of the following responses would the nurse expect to find? (Select all that apply.) Select one or more: a. Anger at others who have babies. b. Feelings of failure because they cannot make a baby. c. Sexual excitement because they want to conceive a baby. d. Guilt on the part of one partner because he or she is unable to give the other a baby.

a. Anger at others who have babies. c. Feelings of failure because they cannot make a baby. d. Guilt on the part of one partner because he or she is unable to give the other a baby. Infertility can be seen as a crisis in the couple's lives and relationship. The diagnosis and treatment of infertility can cause anger with others who have babies, feelings of failure, and feelings of guile. Sexual dysfunction can occur based on the type of infertility testing required and the method of treatment.

Which intervention by the nurse would reduce the risk of abduction of the newborn from the hospital? Select one: a. Applying an electronic and identification bracelet to the mother and the infant b. Carrying the infant when transporting him or her in the halls c. Restricting the amount of time infants are out of the nursery d. Instructing the mother not to give her infant to anyone except the one nurse assigned to her that day

a. Applying an electronic and identification bracelet to the mother and the infant A measure taken by many facilities is to band both the mother and the baby with matching identification bracelets and band the infant with an electronic device that will sound an alarm if the infant is removed from the maternity unit. It is impossible for one nurse to be on call for one mother and baby for the entire shift; therefore, parents need to be able to identify the nurses who are working on the unit. Infants should always be transported in their bassinette for both safety and security reasons. All maternity unit nursing staff should have unique identification bracelets in comparison with the rest of the hospital. Infants should remain with their parents and spend as little time in the nursery as possible.

A thorough abuse assessment screen should be completed on all female clients. This screen should include which components? Select all that apply. Select one or more: a. Asking the client if she has been forced to perform sexual acts b. Asking the client if she has ever been slapped, kicked, punched, or physically hurt by her partner c. Asking the client if she is afraid of her partner d. Asking the client what she did wrong to elicit the abuse

a. Asking the client if she has been forced to perform sexual acts b. Asking the client if she has ever been slapped, kicked, punched, or physically hurt by her partner c. Asking the client if she is afraid of her partner Read pg. 88-89 Asking the client if she has been slapped, kicked, punched, or physically hurt by her partner, if she is afraid of her partner, or if she has been forced to perform sexual acts are questions that should be posed to all clients. If any physical injuries are present, then they should be marked on a form that indicates their locations on the body. Implying that a client did something wrong can be very emotionally damaging. Many victims of violence are not aware that they are in an abusive relationship. They may not respond to questions about abuse. Using general descriptive words such as "slap," "kick," or "punch" to elicit information is best.

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

a. Assessing FHR and maternal vital signs 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.

Which of the following providers would be best for Lisa (7 weeks pregnant) to receive prenatal care services? She is a G40211 with a history of preterm births, one stillbirth, one cesarean section, and high blood pressure during pregnancy. Select one: a. Direct Entry Midwife b. Doula c. Physician d. Lay Midwife

c. Physician She has a history of high risk pregnancy

The perinatal nurse providing care to a laboring woman recognizes a Category II fetal heart rate tracing. The most appropriate initial action for uterine resuscitation is to: a. Assist the laboring woman to change her position b. Decrease the intravenous solution c. Request that the physician/certified nurse-midwife come to the hospital STAT d. Document the fetal heart rate and variability

a. Assist the laboring woman to change her position Category II tracings are indeterminate and call for increased vigilance. The initial step in intrauterine resuscitation is a change in maternal position. If no improvement is seen in the FHR tracing, other resuscitation measures are indicated such as IV fluid bolus and the use of oxygen. Following resuscitation, document all findings and interventions. Keep obstetric providers aware of nursing actions and results.

The nurse is developing a plan of care for a client who is in the "taking-in" phase after delivering a healthy baby boy. Which of the following should the nurse include in the plan? a. Assist the woman in selecting a nutritious meal plan. b. Teach baby care skills like diapering. c. Discuss the pros and cons of circumcision. d. Counsel her regarding future sexual encounters.

a. Assist the woman in selecting a nutritious meal plan The "taking-in" phase is a period of dependent behaviors and occurs during the first 24-48 hours. Assisting her in ordering her meals allows her to focus on her comfort while acknowledging her decreased ability to make decisions. Teaching infant skills is probably more appropriate during the "taking-hold" phase. "Letting go" phase would include resumption of sexual intimacy. See Table 22-4

The perinatal nurse describes infant feeding cues to a new mother. These feeding cues include (select all that apply): Select one or more: a. Awake and alert b. Mouth movements c. Moving the hand to the mouth d. Yawning

a. Awake and alert b. Mouth movements c. Moving the hand to the mouth The infant demonstrates readiness for feeding when he or she is awake and alert, makes hand-to-mouth or hand-to-hand movements, exhibits sucking or licking, exhibits rooting, and demonstrates increased activity with the arms and legs flexed and the hands in a fist.

The nurse knows that a FHR monitor printout indicates a Category III abnormal fetal heart rate pattern when: Select one: a. Baseline variability is minimal or absent with decelerations. b. FHR mirrors the uterine contractions. c. Occasional periodic accelerations occur. d. Baseline variability is 6 to 25 bpm with decelerations

a. Baseline variability is minimal or absent with decelerations. Read Box 18-1 Minimal or absent baseline variability may be an indication of fetal hypoxia. This answer describes early decelerations that are not an indication of fetal intolerance of labor. Periodic accelerations are a sign of fetal well-being. A baseline variability of 6 to 25 bpm is normal.

The symptoms of mild to moderate urinary incontinence can be successfully decreased by a number of strategies. Which of these should the nurse instruct the client to use first? Select one: a. Bladder training and pelvic muscle exercises or Kegels b. Surgery c. Pelvic floor support devices d. Medications

a. Bladder training and pelvic muscle exercises or Kegels Pelvic muscle exercises, known as Kegel exercises, along with bladder training can significantly decrease or entirely relieve stress incontinence in many women.

Which of the following is an indication for the administration of methylergonovine (Methergine)? Select one: a. Boggy uterus that does not respond to massage and oxytocin therapy b. Woman with a large hematoma c. Woman with a deep vein thrombosis d. Woman with severe postpartum depression

a. Boggy uterus that does not respond to massage and oxytocin therapy Methergine is administered IM or IV in the presence of postpartum hemorrhage due to uterine atony or subinvolution when fundal massage and oxytocin therapy are ineffective. Always check BP before administration and notify provider before injection if elevated as Methergine can increase BP.

The nursery nurse notes the presence of diffuse edema on a baby girl's head. Review of the birth record indicates that her mother experienced a prolonged labor and difficult childbirth. By the second day of life, the edema has disappeared. The nurse documents the following condition in the infant's chart. Select one: a. Caput succedaneum b. Cephalhematoma c. Subperiosteal hemorrhage d. Epstein pearls

a. Caput succedaneum Caput succedaneum is localized soft tissue edema of the scalp; feels spongy; may cross suture lines; results from prolonged pressure of the head against the maternal cervix during labor; resolves within the first week of life.

For which of the following reproductive cancers is high risk HPV infection thought to be primarily responsible? (Select all that apply). Select one or more: a. Cervical cancer b. vaginal cancer c. Endometrial cancer d. vulvar cancer e. Ovarian cancer

a. Cervical cancer b. vaginal cancer d. vulvar cancer HPV infection causes nearly all cervical cancers. HPV is associated with less common cancers, including anal cancer, vulvar and vaginal cancers in women, and penile cancer in men

The nurse is caring for a client in early labor. Membranes ruptured approximately 4 hours earlier. What should the nurse implement to detect potential complication? Select one: a. Check temperature for intrauterine infection b. Check fetal heart monitoring for precipitous labor c. Check Blood Pressure for supine hypotension d. Check temperature for vaginal infection

a. Check temperature for intrauterine infection Read Chap 19; membranes have been ruptured x 4 HOURS- the longer membranes are ruptured, the greater risk for uterine infection- not vaginal infection. Uterine infection is dangerous for the mother and baby. Membranes ruptured x 4 hours does not increase risk for precipitous labor. Fetal heart monitoring is important after rupture of membranes to make sure heart rate remains WNL - remember, baby's heart rate can become tachycardic when maternal fever occurs. One of the major causes of maternal fever is infection.

A postpartum woman has been diagnosed with postpartum psychosis and will shortly be admitted to the psychiatric unit. Which of the following actions should the nurse perform to ensure safety for both mother and infant? Select one: a. Closely monitor all mother infant interactions b. Maintain client on strict bed rest c. Restrict visitation to her partner d. Carefully monitor toileting

a. Closely monitor all mother infant interactions It is essential that a client diagnosed with postpartum (PP) psychosis not be left alone with her infant. There is no need for a client with PP psychosis to be on strict bed rest. Visitation is not usually restricted to the woman's partner. There is no need to monitor the client's toileting.

A client in late middle age who is certain she is not pregnant tells the nurse during an office visit that she has urinary problems, as well as sensations of bearing down and of something in her vagina. What condition would the nurse suspect based upon this report? Select one: a. Cystocele and/or rectocele b. Uterine prolapse c. Pelvic relaxation d. Genital fistulas

a. Cystocele and/or rectocele Uterine displacement can be caused by congenital or acquired weakness of the pelvic support structures and is known as pelvic relaxation. Cystoceles are protrusions of the bladder downward into the vagina; rectoceles are herniations of the anterior rectal wall through a relaxed or ruptured vaginal fascia. Both can produce a bearing-down sensation with urinary dysfunction. They occur more often in older women who have borne children.

A client states that she does not eat red meat. Which foods should the nurse encourage this woman to consume in greater amounts to increase her iron intake? (Select all that apply). Select one or more: a. Dark green leafy vegetables b. Liver c. Dried fruits d. Eggs

a. Dark green leafy vegetables b. Liver c. Dried fruits Read Table 15-1 and page 301 Food sources for iron include: Liver, meats, whole grain or enriched breads and cereals, dark green leafy vegetables, legumes, dried fruits.

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? Select one: a. Disseminated Intravascular Coagulation (DIC) b. Hemorrhage c. HELLP syndrome d. Amniotic fluid embolism (AFE)

a. Disseminated Intravascular Coagulation (DIC) 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.

Which is the most accurate description of PPD without psychotic features? Select one: a. Distinguishable by irritability b. Postpartum baby blues requiring the woman to visit with a counselor or psychologist c. Condition that is more common among older Caucasian women because they have higher expectations d. Condition that disappears without outside help

a. Distinguishable by irritability PPD is characterized by an intense pervasive sadness along with labile mood swings and is more persistent than postpartum baby blues. PPD, even without psychotic features, is more serious and persistent than postpartum baby blues. PPD is more common among younger mothers and African-American mothers. Most women need professional help to get through PPD, including pharmacologic intervention. (Mladenka changed this question because I can't find the exact one anywhere, so the original question correct answer is: "Distinguishable by pervasive sadness along with mood swings". That is where this explanation comes from)

To provide culturally competent care to an Asian-American family, which question should the nurse include during the assessment interview? Select one: a. "Do you prefer hot or cold beverages?" b. "Do you want some milk to drink?" c. "Do you want music playing while you are in labor?" d. "Do you have a name selected for the baby?"

a. Do you prefer hot or cold beverages? See Table 2-2, pg 26-27 Asian-Americans often prefer warm beverages. Milk is usually excluded from the diet of this population. Asian-American women typically labor in a quiet environment. Delaying naming the child is not uncommon for Asian-American families.

The nurse should be aware of what important information regarding systemic analgesics administered during labor? Select one: a. Effects on the fetus and newborn can include decreased alertness and delayed sucking. b. Intramuscular (IM) administration is preferred over IV administration. c. Systemic analgesics cross the maternal blood-brain barrier as easily as they do the fetal blood-brain barrier. d. IV patient-controlled analgesia (PCA) results in increased use of an analgesic.

a. Effects on the fetus and newborn can include decreased alertness and delayed sucking. Read pages 342-345 The effects of analgesics depend on the specific drug administered, the dosage, and the timing. Systemic analgesics cross the fetal blood-brain barrier more readily than the maternal blood-brain barrier. IV administration is preferred over IM administration because the drug acts faster and more predictably. PCA results in a decrease in the use of an analgesic.

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 nursing diagnosis beginning with "ineffective coping, related to"? Select one: a. Environmental stress b. Severe immaturity c. Behavioral responses d. Physiologic distress

a. Environmental stress "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 infant's behavioral response to the environmental stress is crying. The appropriate nursing diagnosis reflects the cause of this response.

The clinic nurse uses Leopold maneuvers to determine the fetal lie, presentation, and position. The nurse's hands are placed on the maternal abdomen to gently palpate the fundal region of the uterus. This action is best described as the: Select one: a. First maneuver b. Second maneuver c. Third maneuver d. Fourth maneuver

a. First maneuver Read Box 19-5

Which finding on a prenatal visit at 10 weeks of gestation might suggest a hydatidiform mole? (Select all that apply). a. Fundal height measurement of 18 cm b. Blood pressure of 120/80 mm Hg c. Complaint of severe nausea d. History of bright red spotting for 1 day, weeks ago

a. Fundal height measurement of 18 cm c. Complaint of severe nausea 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.

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

a. Good handwashing or hand hygiene 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.

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? Select one: a. Grandparents b. Mother c. Siblings d. Father

a. Grandparents 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.

A group of nurses are discussing trends in health care. What would the nurses identify as not being a trend in the delivery of health care in the United States? Select one: a. Greater emphasis has been placed on curing disease and disability than on preventing them. b. Hospital-based nurses are increasingly involved in follow-up care after discharge c. Hospital stays for many conditions have been shortened. d. Acute care is increasingly provided through home-based services

a. Greater emphasis has been placed on curing disease and disability than on preventing them Prevention now is emphasized. Hospitalization has been shortened to reduce cost. Acute care is increasingly done at home. Nurses now are more involved in postdischarge follow-up care.

A nurse is providing breast care education to a client after mammography. Which information regarding fibrocystic changes in the breast is important for the nurse to share? Select one: a. Healthy women with fibrocystic breast disease find lumpiness with pain and tenderness in varying degrees in the breast tissue during menstrual cycles. b. Fibrocystic breast disease is a disease of the milk ducts and glands in the breasts c. It is a premalignant disorder characterized by lumps found in the breast tissue. d. Lumpiness is accompanied by tenderness after menses.

a. Healthy women with fibrocystic breast disease find lumpiness with pain and tenderness in varying degrees in the breast tissue during menstrual cycles. Fibrocystic changes are palpable thickenings in the breast usually associated with pain and tenderness. The pain and tenderness fluctuate with the menstrual cycle. Fibrocystic changes are not premalignant changes; this information is inaccurate. Tenderness most often occurs before menses.

A woman in the active phase of the first stage of labor is using a shallow pattern of breathing, which is approximately twice the normal adult breathing rate. She starts to complain about feeling lightheaded and dizzy and states that her fingers are tingling. Which intervention should the nurse immediately initiate? Select one: a. Help her breathe into a paper bag. b. Administer oxygen via a mask or nasal cannula. c. Tell the woman to slow her pace of her breathing. d. Contact the woman's physician.

a. Help her breathe into a paper bag. She is experiencing respiratory alkolosis and breathing into a paper bag enables her to rebreathe carbon dioxide and replace bicarbonate ions. Read p 387 Other rationale: This woman is experiencing the side effects of hyperventilation, which include the symptoms of lightheadedness, dizziness, tingling of the fingers, or circumoral numbness. Having the woman breathe into a paper bag held tightly around her mouth and nose may eliminate respiratory alkalosis and enable her to rebreathe carbon dioxide and replace the bicarbonate ion.

Which preexisting factor is known to increase the risk of GDM? Select one: a. History of previous pregnancy resulting in the birth of large infant b. Previous diagnosis of type 2 diabetes mellitus c. Underweight before pregnancy d. Maternal age younger than 25 years

a. History of previous pregnancy resulting in the birth of large infant 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 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? Select one: a. Hydralazine b. Magnesium sulfate bolus c. Calcium gluconate d. Diazepam

a. Hydralazine 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.

The nurse should be cognizant of which physiologic effect of pain? a. Predominant pain of the first stage of labor is visceral pain that is located in the lower portion of the abdomen. b. Referred pain is the extreme discomfort experienced between contractions. c. Pain during the third stage is a somewhat milder version of the pain experienced during the second stage. d. Somatic pain of the second stage of labor is more generalized and related to fatigue.

a. Predominant pain of the first stage of labor is visceral pain that is located in the lower portion of the abdomen. p. 381 Predominant pain comes from cervical changes, the distention of the lower uterine segment, and uterine ischemia. Referred pain occurs when the pain that originates in the uterus radiates to the abdominal wall, lumbosacral area of the back, iliac crests, and gluteal area. Second-stage labor pain is intense, sharp, burning, and localized. Third-stage labor pain is similar to that of the first stage.

If a woman is at risk for thrombus and is not ready to ambulate, which nursing intervention would the nurse use? (Select all that apply.) Select one or more: a. Immediately notifying the physician if a positive Homans sign occurs b. Promoting bed rest c. Having her flex, extend, and rotate her feet, ankles, and legs d. Having her sit in a chair e. Putting her in antiembolic stockings (thromboembolic deterrent [TED] hose) and/or sequential compression device (SCD) boots

a. Immediately notify the physician if positive Homan's sign occurs C. Having her flex, extend, and rotate her feet, ankles, and legs e. Putting her in antiembolic stockings (throboembolic deterrent [TED] hose) and/or sequential compression device (SCD) boots Sitting immobile in a chair does not help; bed exercise and prophylactic footwear might. TED hose and SCD boots are recommended. The client should be encouraged to ambulate with assistance, not remain in bed. Bed exercises are useful. A positive Homans sign (calf muscle pain or warmth, redness, tenderness) requires the physicians immediate attention.

The nurse expects which maternal cardiovascular finding(s) during labor? (Select all that apply). Select one or more: a. Increased cardiac output b. Increased white blood cell (WBC) count c. Decreased pulse rate d. Decreased blood pressure

a. Increased cardiac output b. Increased white blood cell (WBC) count Read p 379 and Box 16-2 During each contraction, 400 ml of blood is emptied from the uterus into the maternal vascular system, which increases cardiac output by approximately 10% to 15% during the first stage of labor and by approximately 30% to 50% in the second stage of labor. The heart rate increases slightly during labor. The WBC count can increase during labor. During the first stage of labor, uterine contractions cause systolic readings to increase by approximately 10 mm Hg. During the second stage, contractions may cause systolic pressures to increase by 30 mm Hg and diastolic readings to increase by 25 mm Hg.

The clinic nurse advocates for smoking cessation. Potential harmful effects of tobacco use include (select all that apply): Select one or more: a. Infertility impairment b. Fetal Alcohol Syndrome c. Insomnia d. Low birth weight of the fetus

a. Infertility impairment d. Low birth weight of the fetus Read pg. 60 Nurses can help to improve the fetal environment by educating women about the dangers of direct and passive smoking during pregnancy. Effects of tobacco use during pregnancy are well documented and predispose to premature rupture of the membranes, preterm labor, placental abruption, placenta previa, and infants who are low birth weight or small for gestational age (SGA). Smoking impairs fertility in both men and women.

A woman gave birth to a 3200 g baby girl with an estimated gestational age of 40 weeks. The baby is 1 hour of age. In preparation for administration of Vitamin K to the infant, the nurse will explain to the parents that an injection of this medication: Select one: a. Influences the activation of coagulation factors to prevent delayed clotting and hemorrhagic disease b. Prevents high levels of unconjugated bilirubin in the newborn's blood c. Prevents the excessive loss of RBCs d. Aids the liver in regulation of blood glucose

a. Influences the activation of coagulation factors to prevent delayed clotting and hemorrhagic disease Vitamin K (phytonadione) influences the activation of coagulation factors II, VII, IX, and X. After birth, the neonate experiences a decrease in Vitamin K and is at risk for delayed clotting and for hemorrhage. An injection of Vitamin K is given as a prophylaxis to decreased the risk of bleeding.

A mother of a 10-day-old infant calls the clinic and reports that her baby is having loose, green stools. The mother is breastfeeding her infant. Which of the following is the best nursing action? Select one: a. Instruct the woman to bring her infant to the clinic. b. Instruct the woman to decrease the amount of feeding for 24 hours and to call if the stools continue to be loose. c. Explain that this is a normal stool pattern. d. Instruct the woman to eat a bland diet for the next 24 hours and call back if the stools continue to be loose and green.

a. Instruct the woman to bring her infant to the clinic. Instruct parents to notify the health care provider if stools are runny and green and/or if newborn/infant has less than 6 wet diapers per day.

In contrast to placenta previa, what is the most prevalent clinical manifestation of Grade 3 abruptio placentae? Select one: a. Intense abdominal pain b. Intermittent uterine contractions c. Bleeding d. Cramping

a. Intense abdominal pain 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.

The nurse is working with a 36-year-old, married client, with 6 children who smokes. The woman states, "I don't expect to have any more kids, but I hate the thought of being sterile." Which of the following contraceptive methods would be best for the nurse to recommend to this client? Select one: a. Intrauterine contraceptive device (IUD) b. Contraceptive patch c. Bilateral tubal ligation d. Birth control pills with estrogen and progestin

a. Intrauterine contraceptive device (IUD) Intrauterine contraception device (IUD) is the recommended method for this patient. IUD has a low failure rate and provides long-term contraception for 3-10 years. Bilateral tubal ligation (BTL) is a surgical procedure which results in sterilization. Due to her history of smoking, neither birth control pills with estrogen nor contraceptive patch is recommended due to the increased risks for blood clots, heart disease, and strokes, also associated with smoking.

Which is true regarding breast cyst? Select one: a. It can be tender or not b. It requires surgery for diagnosis c. It is usually fixed and hard d. Removal is the best treatment

a. It can be tender or not A smooth, easily movable round or oval lump with distinct edges (which typically, though not always, indicates it's benign) Nipple discharge that may be clear, yellow, straw colored or dark brown. Breast pain or tenderness in the area of the breast lump. Not all women experience symptoms.

Secondary amenorrhea results from (select all that apply): a. Pregnancy b. Polycystic ovary syndrome c. Uncontrolled diabetes d. Emotional distress

a. Pregnancy b. PCOS c. Uncontrolled diabetes d. Emotional distress Secondary amenorrhea is no menses in 6 months in a woman who has had normal menstrual cycles. May result from: lack of ovarian production, pregnancy, polycystic ovary syndrome, nutritional and endocrine disturbances, uncontrolled diabetes, heavy athletic activity, or emotional distress. Nutritional disturbances, such as anorexia, and emotional distress can cause secondary amenorrhea. See page 121

Jennifer is 3 hours postpartum following the vaginal delivery of a 9lb 15oz baby girl. Estimated blood loss at delivery was 800 ml. The RN is aware that Jennifer experienced an early-postpartum hemorrhage. Select the appropriate nursing actions for the care of this patient. (Select all that apply.) a. Maintain IV site in case fluids/medication for PPH are indicated b. Frequent fundal assessment to prevent uterine atony and further blood loss c. Assess for displaced uterus secondary to overdistended bladder. d. Assess lochia for amount and for clots

a. Maintain IV site in case fluids/medication for PPH are indicated b. Frequent fundal assessment to prevent uterine atony and further blood loss c. Assess for displaced uterus secondary to overdistended bladder. d. Assess lochia for amount and for clots PPH is blood loss greater than 500 ml for vaginal deliveries and 1000 ml for cesarean with a 10% drop in hemoglobin and/or hematocrit. Unfortunately, postpartum women may not show signs/symptoms of PPH until about 1/3 of entire blood volume is lost. RNs must frequently assess uterine tone, location, and position as well as blood loss amount and characteristics (slow, steady, sudden, massive, presence of clots, possible distended bladder). Keeping the IV site intact will allow immediate access to fluids and/or medications should PPH worsen.

Which of the following nursing interventions are important in the prenatal care of the woman with prenatal depression? (Select all of the following). Select one or more: a. Maintain a caring relationship b. Educate the woman about depression and plan of care c. Counsel her on the importance of medication if the woman refuses it. d. Recommend she see a psychiatrist for management

a. Maintain a caring relationship b. Educate the woman about depression and plan of care

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

a. Maternal fever Read table 18-3 and p365 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.

Indications for a primary cesarean birth are often nonrecurring. Therefore, a woman who has had a cesarean birth with a low transverse scar may be a candidate for vaginal birth after cesarean (VBAC). Which clients would be less likely to have a successful VBAC? (SATA) Select one or more: a. Maternal obesity (BMI >30) b. Estimated fetal weight <4000g c. Lengthy interpregnancy interval d. African-American race e. Delivery at a rural hospital

a. Maternal obesity d. African-American race e. Delivery at a rural hospital Indications for a low success rate for a VBAC delivery include a short interpregnancy interval, non-Caucasian race, gestational age longer than 40 weeks, maternal obesity, preeclampsia, fetal weight greater than 4000 g, and delivery at a rural or private hospital.

A nurse is assessing a pregnant client who has had bariatric surgery. Which assessment factors would pose the highest nutritional concerns for this client based on her surgical history? Select one or more: a. Monitoring of B vitamins b. Amount of weight loss that has occurred post procedure. c. Monitoring of iron levels d. Monitoring of calcium levels e. Amount of weight gain during pregnancy

a. Monitoring of B vitamins c. Monitoring of Iron levels d. Monitoring of calcium levels e. Amount of weight gain during pregnancy The impact of bariatric surgery on pregnancy can be substantial in that surgical procedures can lead to deficiencies of both macro and micro nutrients. It is important to monitor this client with regard to iron levels, B vitamins (folate, vitamin B12), calcium and vitamin D. It is also important to monitor weight gain during pregnancy for these clients are at risk to have preterm and small for gestational age infants. Although, the amount of weight loss is important, it would not be considered to be the highest nutritional concern.

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? Select one: a. More brisk than expected, slightly hyperactive b. Sluggish or diminished c. Brisk, hyperactive, with intermittent or transient clonus d. Active or expected response

a. More brisk than expected, slightly hyperactive 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.

For which of the following conditions is Daily Fetal Movement Count indicated? (Select all that apply). Select one or more: a. Mother with low amniotic fluid volume or oligohydraminos b. Mother with diabetes during pregnancy c. Pregnant woman who is older than 35 years with no complications d. Mother who complains of headaches during pregnancy that are relieved with Tylenol

a. Mother with low amniotic fluid volume or oligohydraminos b. Mother with diabetes during pregnancy

Which diagnostic test is used to confirm a suspected diagnosis of breast cancer? Select one: a. Needle-localization biopsy b. Mammogram c. Ultrasound d. Magnetic resonance imaging (MRI)

a. Needle-localization biopsy When a suspicious mammogram is noted or a lump is detected, diagnosis is confirmed by either a core-needle biopsy or a needle-localization biopsy. Mammography is a clinical screening tool that may aid in the early detection of breast cancers. Transillumination, thermography, and ultrasound breast imaging are being explored as methods for detecting early breast carcinoma. An MRI is useful in women with masses that are difficult to find (occult breast cancer).

Which of the following is true about twin pregnancy? Select one: a. Pregnant women with twins usually require more surveillance during their pregnancy compared to women with singleton pregnancy. b. Pregnant women with twins should gain weight as recommended for women with a singleton pregnancy. c. The cesarean section rate for women with a singleton pregnancy is more than that for women with a twin pregnancy. d. There is no more risk of complications during a twin pregnancy as compared to a singleton pregnancy.

a. Pregnant women with twins usually require more surveillance during their pregnancy compared to women with singleton pregnancy.

Cellulitis with or without abscess formation is a fairly common condition. The nurse is providing education for a client whose presentation to the emergency department includes an infection of the breast. Which information should the nurse share with this client? (Select all that apply.) Select one or more: a. Nipple piercing may be the cause of a recent infection b. Obesity, smoking, and diabetes are risk factors. c. Breast is pale in color and cool to the touch. d. Treatment for cellulitis or breast infection will include antibiotics. e. Methicillin- resistant Streptococcusaureus is the most common pathogen.

a. Nipple piercing may be the cause of a recent infection b. Obesity, smoking, and diabetes are risk factors. d. Treatment for cellulitis or breast infection will include antibiotics The at-risk population for breast infection shares characteristics such as large breasts, obesity, previous surgeries, sebaceous cysts, smoking, diabetes, and recent nipple piercing. The most common pathogen isStaphylococcus aureus. Presentation of cellulitis of the breast includes pain, reddening, and warmth to the touch; treatment includes antibiotics and/or aspiration.

Researchers have found a number of common risk factors that increase a woman's chance of developing a breast malignancy. It is essential for the nurse who provides care to women of any age to be aware of which risk factors? (Select all that apply.) Select one or more: a. Nulliparity or first pregnancy after age 40 years b. Late menarche c. Age d. Family history e. Early menopause

a. Nulliparity or first pregnancy after age 40 years c. Age d. Family history Family history, race, and nulliparity or the first pregnancy after age 40 years are known risk factors for the development of breast cancer. Others risk factors include age, personal history of cancer, high socioeconomic status, sedentary lifestyle, hormone replacement therapy, recent use of oral contraceptives, never having breastfed a child, and drinking more than one alcoholic beverage per day. Early menarche and late menopause are not risk factors for breast malignancy.

25 year old Susan (G0000) is thinking about getting pregnant this next year, but wants an effective method right now. She currently uses condoms. She denies medical problems. Which of the following birth control methods are most appropriate for the nurse to discuss with Susan? (Select all that apply). Select one or more: a. Oral contraceptive pills b. the birth control patch c. Condoms (continue) d. The implant e. Copper IUD (Paragard)

a. Oral contraceptive pills b. the birth control patch c. Condoms (continue) Long-acting contraception is not the best choice for a woman who desires pregnancy within one year. More appropriate methods include birth control pills and the patch, and the vaginal ring as they are not long acting and are reversible once the woman stops using them. Condoms are short acting with no hormones.

25 year old Susan (G0000) is thinking about getting pregnant in this next year, but wants an effective method right now. She currently uses condoms. She denies medical problems. Which of the following birth control methods are most appropriate for the nurse to discuss with Susan? a. Oral contraceptive pills b. The implant c. Continue condoms d. Birth control patch e. Copper IUD (Paraguard)

a. Oral contraceptive pills c. Continue condoms d. Birth control patch

A woman has requested an epidural block for her pain. She is 5 cm dilated and 100% effaced. The baby is in a vertex position and is engaged. The nurse increases the woman's IV fluid for a preprocedural bolus. Before the initiation of the epidural, the woman should be informed regarding the disadvantages of an epidural block. Which concerns should the nurse share with this client? (Select all that apply.) a. Orthostatic hypotension and dizziness may occur. b. Blood loss is not excessive. c. Hypertension may occur. d. Ability to move freely is limited. e. Higher body temperature may occur.

a. Orthostatic hypotension and dizziness may occur. d. Ability to move freely is limited. e. Higher body temperature may occur. Read Box 17-5 The woman's ability to move freely and to maintain control of her labor is limited, related to the use of numerous medical interventions (IV lines and electronic fetal monitoring [EFM]). Significant disadvantages of an epidural block include the occurrence of orthostatic hypotension, dizziness, sedation, and leg weakness. Women who receive an epidural block have a higher body temperature (38° C or higher), especially when labor lasts longer than 12 hours, and may result in an unnecessary neonatal workup for sepsis. An advantage of an epidural block is that blood loss is not excessive. Other advantages include the following: the woman remains alert and able to participate, good relaxation is achieved, airway reflexes remain intact, and only partial motor paralysis develops.

Which medications are used to manage PPH? (Select all that apply.) Select one or more: a. Oxytocin b. Magnesium sulfate c. Hemabate d. Methergine e. Terbutaline

a. Oxytocin c. Hemabate d. Methergine (OHM... like the meditation sound) Oxytocin, Methergine, and Hemabate are medications used to manage PPH. Terbutaline and magnesium sulfate are tocolytic medications that are used to relax the uterus, which would cause or worsen PPH.

The induction of labor is considered an acceptable obstetric procedure if it is in the best interest to deliver the fetus. The charge nurse on the labor and delivery unit is often asked to schedule clients for this procedure and therefore must be cognizant of the specific conditions appropriate for labor induction. What are appropriate indications for induction? (SATA) Select one or more: a. Postterm pregnancy b. Maternal fatigue and frustration at 38 weeks gestation c. Rupture of membranes at or near term d. Fetal death e. Convenience of the woman or her physician

a. Postterm pregnancy c. Rupture of membranes at or near term d. Fetal death The conditions listed are all acceptable indications for induction. Other conditions include intrauterine growth restriction (IUGR), maternal-fetal blood incompatibility, hypertension, and placental abruption. Elective inductions for the convenience of the woman or her provider are not recommended; however, they have become commonplace. Factors such as rapid labors and living a long distance from a health care facility may be valid reasons in such a circumstance. Elective delivery should not occur before 39 weeks of completed gestation.

A pregnant woman who has a history of cesarean births is requesting to have a vaginal birth after cesarean (VBAC). In which of the following situations should the nurse advise the patient that her request may be declined? Select one: a. Previous uterine surgery b. Flexed fetal attitude c. Previous low flap uterine incisions d. Positive vaginal candidiasis

a. Previous uterine surgery Contraindications for trial of labor after cesarean (TOLAC) leading to VBAC include vertical uterine incision, previous uterine surgery, previous uterine rupture, pelvic abnormalities, complications preventing vaginal delivery, lack of personnel required for operative delivery

What is the nurse's understanding of the appropriate role of primary and secondary powers? Select one: a. Primary powers are responsible for the effacement and dilation of the cervix. b. Scarring of the cervix caused by a previous infection or surgery may make the delivery a bit more painful, but it should not slow or inhibit dilation c. Effacement is generally well ahead of dilation in women giving birth for the first time; they are closer together in subsequent pregnancies. d. Pushing in the second stage of labor is more effective if the woman can breathe deeply and control some of her involuntary needs to push, as the nurse directs.

a. Primary powers are responsible for the effacement and dilation of the cervix. Read pp. 372-375 The primary powers are responsible for dilation and effacement; secondary powers are concerned with expulsion of the fetus. Effacement is generally well ahead of dilation in first-time pregnancies; they are closer together in subsequent pregnancies. Scarring of the cervix may slow dilation. Pushing is more effective and less fatiguing when the woman begins to push only after she has the urge to do so.

The perinatal nurse notes a rapid decrease in the fetal heart rate that does not recover immediately following an amniotomy. The most likely cause of this obstetrical emergency is: Select one: a. Prolapsed umbilical cord b. Vasa previa c. oligohydramnios d. Placental abruption

a. Prolapsed umbilical cord Amniotomy is the artificial rupture of membranes (AROM) to induce or augment labor. This is a common procedure seen in obstetrics. Risks associated with amniotomy include umbilical cord prolapse when the presenting part is not engaged. Vasa previa or rupture of fetal vessels unsupported by the placenta is a very rare situation and usually results in rapid fetal exsanguination in the presence of bloody fluid seen following AROM.

Which of the competencies are most relevant to nurses in maternity and women's health? (Select all that apply). Select one or more: a. Provide patient with accurate and appropriate genetic and genomic information b. Collect a thorough family history to include at least 3 generations. c. Provide patient with genomic information without considering their cultural and religious beliefs d. Refer patient to professional genetic counseling for all of their questions regarding genetics and genomics. e. Determines referral of patient to the physician to discussed genetic concerns.

a. Provide patient with accurate and appropriate genetic and genomic information b. Collect a thorough family history to include at least 3 generations. See p 32 of text and powerpoint presentation Nursing competencies include: ~Construct a pedigree from collected family history using standardized symbols and terminology ~ Develop a plan of care that incorporates genetic and genomic assessment info ~Recognize when one's own attitudes and values related to genetic and genomic science may affect care ~Provide clients with credible, accurate, appropriate, and current genetic and genomic information, resources, services, and technologies to facilitate decision making. ~ Demonstrate in practice the importance of tailoring genetic and genomic info and services to clients based on their culture, religion, knowledge level, literacy, and preferred language. ~ Assess client's knowledge, perceptions, and responses to genetic and genomic info. ~ Facilitate referrals for specialized genetic and genomic services for clients PRN

An infant admitted to the newborn nursery has a blood glucose level of 55 mg/dL. Which of the following actions should the nurse perform at this time? Select one: a. Provide the baby with routine feedings. b. Assess the baby's blood pressure. c. Place the baby under the infant warmer. d. Monitor the baby's urinary output.

a. Provide the baby with routine feedings Neonatal hypoglycemia is defined as <40mg/dL; 55mg/dL is a normal glucose value requiring no treatment

Which of the following lab tests are routinely performed on pregnant women? (Select all that apply). Select one or more: a. Rubella titer b. Syphilis test c. Blood type d. 3 hr GTT e. Genetic testing for cystic fibrosis

a. Rubella titer b. Syphilis test c. Blood type

Which signs and symptoms should a woman immediately report to her health care provider? (Select all that apply.) Select one or more: a. Rupture of membranes b. Vaginal bleeding c. Urinary frequency d. Heartburn accompanied by severe headache e. Decreased libido

a. Rupture of membranes b. Vaginal bleeding d. Heartburn accompanied by severe headache Read p 314- box

The induction of labor is considered an acceptable obstetric procedure if it is in the best interest to deliver the fetus. The charge nurse on the labor and delivery unit is often asked to schedule clients for this procedure and therefore must be cognizant of the specific conditions appropriate for labor induction. What are appropriate indications for induction? (Select all that apply) Select one or more: a. Rupture of membranes at or near term b. Convenience of the woman or her physician c. Fetal death d. Postterm pregnancy e. Maternal fatigue and frustration at 38 weeks gestation

a. Rupture of membranes at or near term c. Fetal death d. Postterm pregnancy Read pp 779-780 in textbook and Box 32-7 The conditions listed are all acceptable indications for induction. Other conditions include intrauterine growth restriction (IUGR), maternal-fetal blood incompatibility, hypertension, and placental abruption. Elective inductions for the convenience of the woman or her provider are not recommended; however, they have become commonplace. Factors such as rapid labors and living a long distance from a health care facility may be valid reasons in such a circumstance. Elective delivery should not occur before 39 weeks of completed gestation.

Which factors influence cervical dilation? (Select all that apply.) Select one or more: a. Scarring of the cervix b. Size of the woman c. Force of the presenting fetal part against the cervix d. Pressure applied by the amniotic sac e. Strong uterine contractions

a. Scarring of the cervix c. Force of the presenting fetal part against the cervix d. Pressure applied by the amniotic sac e. Strong uterine contractions Read pp. 374-375 Dilation of the cervix occurs by the drawing upward of the musculofibrous components of the cervix, which is caused by strong uterine contractions. Pressure exerted by the amniotic fluid while the membranes are intact or by the force applied by the presenting part can also promote cervical dilation. Scarring of the cervix as a result of a previous infection or surgery may slow cervical dilation. Pelvic size or the size of the woman does not affect cervical dilation.

What is the primary difference between the labor of a nullipara and that of a multipara? Select one: a. Total duration of labor b. Sequence of labor mechanisms c. Amount of cervical dilation d. Level of pain experienced

a. Total duration of labor Read Table 19-1 In a first-time pregnancy, descent is usually slow but steady; in subsequent pregnancies, descent is more rapid, resulting in a shorter duration of labor. Cervical dilation is the same for all labors. Level of pain is individual to the woman, not to the number of labors she has experienced. The sequence of labor mechanisms is the same with all labors.

A group of nurses are discussing the concept of pain experience during labor. Which statement should the nurses identify as correct? Select one: a. Sensory pain for nulliparous women often is greater than for multiparous women during early labor. b. Women with a history of substance abuse experience more pain during labor. c. Affective pain for nulliparous women usually is less than for multiparous women throughout the first stage of labor. d. Multiparous women have more fatigue from labor and therefore experience more pain.

a. Sensory pain for nulliparous women often is greater than for multiparous women during early labor. Sensory pain is greater for nulliparous women because their reproductive tract structures are less supple. Affective pain is greater for nulliparous women during the first stage but decreases for both nulliparous and multiparous women during the second stage. Women with a history of substance abuse experience the same amount of pain as those without such a history. Nulliparous women have longer labors and therefore experience more fatigue.

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 newborn's distress? Select one: a. Sepsis b. Hypoglycemia c. Respiratory distress syndrome d. Phrenic nerve injury

a. Sepsis 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.

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

a. Serum magnesium level of 10 mg/dl 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.

Many clients are concerned about the increased levels of mercury in fish and may be reluctant to include this source of nutrients in their diet. What is the best advice for the nurse to provide? Select one: a. Shark, swordfish, and mackerel should be avoided. b. Canned white tuna is a preferred choice. c. Fish caught in local waterways is the safest. d. Salmon and shrimp contain high levels of mercury.

a. Shark, swordfish, and mackerel should be avoided. Read Safety alert box page 306 As a precaution, the pregnant client should avoid eating shark, swordfish, and mackerel, as well as the less common tilefish. High levels of mercury can harm the developing nervous system of the fetus. Assisting the client in understanding the differences between numerous sources of mercury is essential for the nurse. A pregnant client may eat as much as 12 ounces a week of canned light tuna; however, canned white, albacore, or tuna steaks contain higher levels of mercury and should be limited to no more than 6 ounces per week. Pregnant women and mothers of young children should check with local advisories about the safety of fish caught by families and friends in nearby bodies of water. If no information is available, then these fish sources should be avoided, limited to less than 6 ounces per week, or the only fish consumed that week. Commercially caught fish that is low in mercury includes salmon, shrimp, pollock, or catfish. The pregnant client may eat up to 12 ounces of commercially caught fish per week. Additional information on levels of mercury in commercially caught fish is available at www.cfsan.fda.gov.

What family form tends to be the most socially vulnerable? Select one: a. Single-parent family b. Married-blended family c. Nuclear family d. Extended family

a. Single-parent family Read pg. 18-19

Which client(s) should the nurse report to the health care provider? (Select all that apply). Select one or more: a. Small dimple located in the upper outer quadrant of the right breast b. Left breast slightly smaller than right breast c. Eversion (elevation) of both nipples d. One 2-3mm sized mobile, nontender mass in lower outer quadrant of left breast

a. Small dimple located in the upper outer quadrant of the right breast d. One 2-3mm sized mobile, nontender mass in lower outer quadrant of left breast A small dimple is an abnormal finding and should be further evaluated. Nipple retraction and a dimpling or pitting of the skin is suggestive of a locally advanced, aggressive form of breast cancer. In many women, one breast is smaller than the other, and eversion of both nipples is a normal finding. Faintly visible venous network is also a normal finding.

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

a. Surfactant improves the ability of your baby's lungs to exchange oxygen and carbon dioxide Surfactant can be administered as an adjunct to oxygen and ventilation therapy. With administration of 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 respiratory distress syndrome (RDS) is to stimulate 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.

Amy is a 20 year old sexually active woman (G0000) who wants an effective birth control method. She denies any medical problems. Which of the following would the nurse not recommend to Amy? Select one: a. essure b. intrauterine device c. oral contraceptive pills d. the implant

a. essure Key-word is NOT recommended - Essure is permanent, non-reversible

Which statement correctly describes the nurse's responsibility related to electronic fetal monitoring (EFM)? Select one: a. Teach the woman and her family about the monitoring equipment and discuss any questions they have b. Report abnormal findings to the care provider before initiating corrective actions. c. Inform the support person that the nurse will be responsible for all comfort measures when the electronic equipment is in place. d. Document the frequency, duration, and intensity of contractions measured by the external device.

a. Teach the woman and her family about the monitoring equipment and discuss any questions they have. Nurses are expected to independently assess, interpret, and intervene related to interpretations of electronic fetal monitoring (EFM). Nurses are expected to provide information and explanations to patients and their families in order to relieve anxiety and answer questions. Nurses are expected to share information with obstetric providers to insure clear communication. EFM is a means to information regarding fetal response to labor but does not take the place of nursing and support person interactions. Remember that external devices cannot measure uterine intensity/pressure during a contraction but can provide information on frequency and duration.

A nurse working with an infertile couple has made the following nursing diagnosis: Sexual dysfunction related to decreased libido. Which of the following assessments is the likely reason for this diagnosis? Select one: a. The couple has established a set schedule for their sexual encounters. b. The couple has been married for more than 8 years. c. The couple lives with one set of parents. d. The couple has close friends who gave birth within the last year.

a. The couple has established a set schedule for their sexual encounters. Pregnancy occurs with ovulation; sexual intercourse outside the time of ovulation will not result in conception.

In follow-up appointments or visits with parents and their new baby, it is useful if the nurse can identify infant behaviors that can either facilitate or inhibit attachment. What is an inhibiting behavior? Select one: a. The infant seeks attention from any adult in the room. b. The infant clings to the parents. c. The infant cries only when hungry or wet. d. The infant's activity is somewhat predictable.

a. The infant seeks attention from any adult in the room Parents want to be the focus of the infant's existence, just as the infant is the focus of their existence. Facilitating and inhibiting behaviors build or discourage bonding (attitudes); they do not reflect any value judgments on what might be healthy or unhealthy. The infant who shows no preference for his or her parents over other adults is exhibiting an inhibiting behavior. An infant who cries only when hungry or wet is exhibiting a facilitating behavior. An infant who has a predictable attention span is exhibiting a facilitating behavior. The infant who clings to his or her parents, enjoys being cuddled and held, and is easily consoled is displaying facilitating behaviors.

A couple is undergoing an infertility workup. The semen analysis indicates a decreased number of sperm and immature sperm. Which of the following factors can have a potential effect on sperm maturity? (Select all that apply.) Select one or more: a. The man rides a bike to and from work each day. b. The man takes a calcium channel blocker for the treatment of hypertension. c. The man drinks 6 cups of coffee a day. d. The man was treated for prostatitis 12 months ago and has been symptom free since

a. The man rides a bike to and from work each day. b. The man takes a calcium channel blocker for the treatment of hypertension.

The nurse caring for a newborn checks the record to note clinical findings that occurred before her shift. Which finding related to the renal system would be of increased significance and require further action? Select one: a. The pediatrician should be notified if the newborn has not voided in 24 hours b. Weight loss from fluid loss and other normal factors should be made up in 4 to 7 days. c. Breastfed infants will likely void more often during the first days after birth. d. Brick dust or blood on a diaper is always cause to notify the physician.

a. The pediatrician should be notified if the newborn has not voided in 24 hours A newborn who has not voided in 24 hours may have any of a number of problems, some of which deserve the attention of the pediatrician. Formula-fed infants tend to void more frequently in the first 3 days; breastfed infants will void less during this time because the mother's breast milk has not yet come in. Brick dust may be uric acid crystals; blood spotting could be attributable to the withdrawal of maternal hormones (pseudomenstruation) or a circumcision. The physician must be notified only if the cause of bleeding is not apparent. Weight loss from fluid loss might take 14 days to regain.

A client at 34 weeks of gestation seeks guidance from the nurse regarding personal hygiene. Which information should the nurse provide? Select one or more: a. The perineum should be wiped from front to back. b. Expectant mothers should use specially treated soap to cleanse the nipples. c. Tub bathing is permitted even in late pregnancy unless membranes have ruptured. d. Bubble bath and bath oils are permissible because they add an extra soothing and cleansing action to the bath.

a. The perineum should be wiped from front to back. c. Tub bathing is permitted even in late pregnancy unless membranes have ruptured. Read page 317 The primary danger from taking baths is falling in the tub. The perineum should be wiped from front to back. Bubble baths and bath oils should be avoided because they may irritate the urethra. Soap, alcohol, ointments, and tinctures should not be used to cleanse the nipples because they remove protective oils. Warm water is sufficient.

Which of the following is correct regarding endometriosis? Select one: a. The physical symptoms of endometriosis can affect the woman's mental health. b. The abnormal tissue bleeds into surrounding tissue during the secretory stage of the menstrual cycle. c. Endometriosis causes severe headaches. d. Metronidazole is used to treat endometriosis.

a. The physical symptoms of endometriosis can affect the woman's mental health. The physical symptoms of endometriosis can have an effect on the woman's mental health; she may experience anger and grief related to loss of fertility and the pain related to this condition can interfered with her social activities. Dyspareunia can have an effect of intimate relationships.

Which of the following are ethical issues regarding genetics/genomics? (Select all that apply). Select one or more: a. fairness and use of genetic information b. privacy and confidentiality of genetic information c. discrimination, psychological impact, and stigmatization regarding one's genome d. informed consent in reproductive issues and genetic testing

a. fairness and use of genetic information b. privacy and confidentiality of genetic information c. discrimination, psychological impact, and stigmatization regarding one's genome d. informed consent in reproductive issues and genetic testing See pp 34 of text and powerpoint presentation

With regard to the estimation and interpretation of the recurrence of risks for genetic disorders, nurses should be aware that: Select one: a. The risk factor remains the same no matter how many affected children are already in the family. b. Disorders involving maternal ingestion of drugs carry a one in four chance of being repeated in the second child. c. An autosomal recessive disease carries a one in eight risk that the second child will also have the disorder. d. With a dominant disorder, the likelihood of the second child also having the condition is 100%.

a. The risk factor remains the same no matter how many affected children are already in the family. In a dominant disorder, the likelihood of recurrence in subsequent children is 50% (one in two). An autosomal recessive disease carries a one in four chance of recurrence. Subsequent children would be at risk only if the mother continued to use drugs; the rate of risk would be difficult to calculate. Each pregnancy is an independent event. The risk factor (e.g., one in two, one in four) remains the same for each child, no matter how many children are born to the family.

One of the most important components of the physical assessment of the pregnant client is the determination of BP. Consistency in measurement techniques must be maintained to ensure that the nuances in the variations of the BP readings are not the result of provider error. Which techniques are important in obtaining accurate BP readings? (Select all that apply.) Select one or more: a. The same arm should be used for every reading b. The client should be seated c. The client's arm should be placed at the level of the heart. d. The cuff should cover a minimum of 60% of the upper arm. e. An electronic BP device should be used.

a. The same arm should be used for every reading b. The client should be seated c. The client's arm should be placed at the level of the heart. BP readings are easily affected by maternal position. Ideally, the client should be seated. An alternative position is left lateral recumbent with the arm at the level of the heart. The arm should always be held in a horizontal position at approximately the level of the heart. The same arm should be used at every visit. The manual sphygmomanometer is the most accurate device. If manual and electronic devices are used in the care setting, then the nurse must use caution when interpreting the readings. A proper size cuff should cover at least 80% of the upper arm or be approximately 1.5 times the length of the upper arm.

Which of the following would the nurse explain to the patient about fertilization? (Select all that apply). Select one or more: a. The sperm must travel up the correct fallopian tube to fertilize the egg b. The best place for fertilization to occur is in the ampulla of the fallopian tube c. After fertilization, the chromosomes combine for a total of 46 d. After the sperm enters the egg, the egg becomes impenetrable to other sperm

a. The sperm must travel up the correct fallopian tube to fertilize the egg b. The best place for fertilization to occur is in the ampulla of the fallopian tube c. After fertilization, the chromosomes combine for a total of 46 d. After the sperm enters the egg, the egg becomes impenetrable to other sperm See pp 267-268 and powerpoint

A couple who has sought infertility counseling has been told that the man's sperm count is very low. The nurse advises the couple that spermatogenesis is impaired when which of the following occur? Select one: a. The testes are overheated. b. The vas deferens is ligated. c. The prostate gland is enlarged. d. alcohol use

a. The testes are overheated Spermatogenesis occurs in the testes. Hightemperatures harm the development of thesperm.

A gravida, G4 P1203, fetal heart rate 150s, is 14 weeks pregnant, fundal height 1 cm above the symphysis. She denies experiencing quickening. Which of the following nursing conclusions made by the nurse is correct? Select one: a. The woman is experiencing a normal pregnancy. b. The woman may be having difficulty accepting this pregnancy. c. The woman must see a nutritionist as soon as possible. d. The woman will likely miscarry the conceptus.

a. The woman is experiencing a normal pregnancy

Women who are obese are at risk for several complications during pregnancy and birth. Which of these would the nurse anticipate with an obese client? (SATA) Select one or more: a. Thromboembolism b. Hypertension c. Cesarean birth d. Wound infection e. Breech presentation

a. Thromboembolism b. Hypertension c. Cesarean birth d. Wound infection A breech presentation is not a complication of pregnancy or birth for the client who is obese. Venous thromboembolism is a known risk for obese women. Therefore, the use of thromboembolism-deterrent (TED) hose and sequential compression devices may help decrease the chance for clot formation. Women should also be encouraged to ambulate as soon as

A woman who has recently given birth complains of pain and tenderness in her leg. On physical examination, the nurse notices warmth and redness over an enlarged, hardened area. Which condition should the nurse suspect, and how will it be confirmed? Select one: a. Thrombophlebitis; using real-time and color Doppler ultrasound b. von Willebrand disease (vWD); noting whether bleeding times have been extended c. Idiopathic or immune thrombocytopenic purpura (ITP); drawing blood for laboratory analysis d. Disseminated intravascular coagulation (DIC); asking for laboratory tests

a. Thrombophlebitis; using real-time and color Doppler ultrasound Pain and tenderness in the extremities, which show warmth, redness, and hardness, is likely thrombophlebitis. A Doppler ultrasound examination is a common noninvasive way to confirm the diagnosis. A diagnosis of DIC is made according to clinical findings and laboratory markers. With DIC, a physical examination will reveal symptoms that may include unusual bleeding, petechiae around a blood pressure cuff on the womans arm, and/or excessive bleeding from the site of a slight trauma such as a venipuncture site. Symptoms of vWD, a type of hemophilia, include recurrent bleeding episodes, prolonged bleeding time, and factor VIII deficiency. A risk for PPH exists with vWD but does not exhibit a warm or reddened area in an extremity. ITP is an autoimmune disorder in which the life span of antiplatelet antibodies is decreased. Increased bleeding time is a diagnostic finding, and the risk of postpartum uterine bleeding is increased.

What is the rationale for the administration of an oxytocic (e.g., Pitocin, Methergine) after expulsion of the placenta? Select one: a. To stimulate uterine contraction b. To facilitate rest and relaxation c. To relieve pain d. To prevent infection

a. To stimulate uterine contraction Read Box 19-13 Oxytocics stimulate uterine contractions, which reduce blood loss after the third stage of labor. Oxytocics are not used to treat pain, do not prevent infection, and do not facilitate rest and relaxation.

Which statement should the nurse identify as not being accurate regarding multifetal pregnancy? Select one: a. Twin pregnancies come to term with the same frequency as single pregnancies. b. The mother should be counseled to increase her nutritional intake and gain more weight. c. The expectant mother often experiences anemia because the fetuses have a greater demand for iron. d. Backache and varicose veins are often more pronounced.

a. Twin pregnancies come to term with the same frequency as single pregnancies. Twin pregnancies often end in prematurity; serious efforts should be made to bring the pregnancy to term. A woman with a multifetal pregnancy often experiences anemia because of the increased demands of two fetuses; this issue should be monitored closely throughout her pregnancy. The client may need nutrition counseling to ensure that she gains more weight than what is needed for a singleton birth. The considerable uterine distention in multifetal pregnancy is likely to cause backache and leg varicosities; maternal support hose should be recommended.

Which nursing assessment indicates that a woman who is in second-stage labor is almost ready to give birth? Select one: a. Vulva bulges and encircles the fetal head b. Bloody mucous discharge increases. c. Membranes rupture during a contraction. d. Fetal head is felt at 0 station during the vaginal examination.

a. Vulva bulges and encircles the fetal head A bulging vulva that encircles the fetal head describes crowning, which occurs shortly before birth. Birth of the head occurs when the station is +4. A 0 station indicates engagement. Bloody show occurs throughout the labor process and is not an indication of an imminent birth. ROM can occur at any time during the labor process and does not indicate an imminent birth.

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

a. Whatever the position used, the infant is "belly to belly" with the mother. 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.

The nurse is about to elicit the rooting reflex on a newborn baby. Which of the following responses should the nurse expect to see? Select one: a. When the cheek of the baby is touched, the newborn turns toward the side that is touched. b. When the lateral aspect of the sole of the baby's foot is stroked, the toes extend and fan outward. c. When the baby is suddenly lowered or startled, the neonate's arms straighten outward and the knees flex. d. When the newborn is supine and the head is turned to one side, the arm on that same side extends.

a. When the cheek of the baby is touched, the newborn turns toward the side that is touched. An infant exhibits Rooting reflex when the neonate turns his head toward the direction of the stimulus and opens his mouth. Choice 2 is the Babinski reflex; Choice 3 is the Startle or Moro reflex; Choice 4 is the Tonic Neck reflex

What information should the nurse understand fully regarding rubella and Rh status? Select one: a. Women should be warned that the rubella vaccination is teratogenic and that they must avoid pregnancy for at least 1 month after vaccination b. Breastfeeding mothers cannot be vaccinated with the live attenuated rubella virus. c. Rh immunoglobulin is safely administered intravenously because it cannot harm a nursing infant. d. Rh immunoglobulin boosts the immune system and thereby enhances the effectiveness of vaccinations.

a. Women should be warned that the rubella vaccination is teratogenic and that they must avoid pregnancy for at least 1 month after vaccination Women should understand that they must practice contraception for at least 1 month after being vaccinated. Because the live attenuated rubella virus is not communicable in breast milk, breastfeeding mothers can be vaccinated. Rh immunoglobulin is administered intramuscular (IM); it should never be administered to an infant. Rh immunoglobulin suppresses the immune system and therefore might thwart the rubella vaccination.

Sally is 34 weeks pregnant and has a biophysical profile score of 8. She asks the nurse what does that mean? The nurse's best response is: a. Your baby has low risk for having a problem having enough oxygen in her body and your doctor will probably want to do the test again soon. I will call your doctor. b. Since you are more than 36 weeks, it is best to deliver your baby as she may have chronic asphyxia. I will call your doctor. c. Your baby is in danger of dying and you will probably need to deliver ASAP. I will call your doctor. d. Your baby may be having some problems and your doctor may want to check to see if it is safe to deliver her soon. I will call your doctor.

a. Your baby has low risk for having a problem having enough oxygen in her body and your doctor will probably want to do the test again soon. I will call your doctor. The normal biophysical score ranges from 8 to 10 points if the amniotic fluid volume is adequate. A normal score allows conservative treatment of high-risk patients. Birth can be delayed if fetal well-being is an issue. Scores less than 4 would be investigated, and birth could be initiated sooner than planned. This score is within normal range, and no further testing is required at this time. The results of the biophysical profile are usually available immediately after the procedure is performed.

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? Select one: a. Breathing in a respiratory pattern common to premature infants b. Suffering from sleep or wakeful apnea c. Experiencing severe swings in blood pressure d. Trying to maintain a neutral thermal environment

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

According to the CDC, all women under the age of 26 years old should be tested for which of the following STDs? Select one: a. chlamydia b. Zika c. HPV d. Gonorrhea

a. chlamydia Read page 124 Sexually active women ages 20-24 have the highest rate of infection. CDC recommends yearly screening of all sexually active women under age 25 and women over 25 who are at high risk (i.e. new or multiple partners).

Which of the following is true regarding infertility? (Select all that apply). Select one or more: a. infertility is defined as the inability to achieve pregnancy after a year of unprotected intercourse b. anovulation can cause primary and/or secondary infertiity c. infertility effects approx 5% of reproductive-age couples d. approx 60% of infertility problems are related to the female factors

a. infertility is defined as the inability to achieve pregnancy after a year of unprotected intercourse b. anovulation can cause primary and/or secondary infertiity

Augmentation of labor: Select one: a. is part of the active management of labor instituted when the labor process is unsatisfactory and uterine contractions are ineffective. b. Relies on more invasive methods when oxytocin and amniotomy have failed c. Is elective induction of labor d. Is an operative vaginal delivery that uses vacuum cups

a. is part of the active management of labor instituted when the labor process is unsatisfactory and uterine contractions are ineffective. 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.

Which of the following are true regarding chlamydial infection in young women? (Select all that apply). Select one or more: a. it can increase risk for infertility and ectopic pregnancy b. Women ages 15-24 have the highest rates of infection c. it is not curable d. women can have it and have no symptoms

a. it can increase risk for infertility and ectopic pregnancy b. Women ages 15-24 have the highest rates of infection d. women can have it and have no symptoms see pp 149-150 of text

The CHOICE Project removed 3 key barriers to contraception for many women. These included which of the following? Select one or more: a. lack of access to preferred method b. state laws that restrict methods c. cost d. knowledge deficit e. parental permission

a. lack of access to preferred method c. cost d. knowledge deficit The project provided no-cost reversible contraception to participants for 2-3 years with the goal of increasing uptake of long-acting reversible contraception and decreasing unintended pregnancy in the area.

Which of the following are common symptoms for gonorrhea? Select all that apply. Select one or more: a. pelvic pain b. rectal discharge c. no symptoms d. painful ulcer(s)

a. pelvic pain b. rectal discharge c. no symptoms see p 124 of text Women are often asymptomatic. Symptoms may include purulent endocervical discharge, menstrual irregularities, pelvic pain that is chronic or acute, longer more painful menses, dysuria. If anal infection, purulent anal discharge, rectal pain, blood in the stool, itching/fullness/pressure of the rectum. Painful ulcers are more symptomatic of herpes or painless chancers of syphilis.

What is the primary rationale for skin to skin contact for the healthy infant with the mother immediately after birth? Select one: a. positively effects body temperature and maternal-infant bonding b. Increases blood supply to the hands and feet c. reduces risk for infection and dyspnea d. Stimulates crying and lung expansion

a. positively effects body temperature and maternal-infant bonding Read p 406 The unwrapped infant should be placed on the woman's bare chest or abdomen, then covered with a warm blanket. Skin-to-skin contact keeps the newborn warm, prevents neonatal infection, enhances physiologic adjustment to extrauterine life, and fosters early breastfeeding.

Yolanda is 6 weeks pregnant by dates and is considering abortion. What options might be appropriate for her at this point? (Select all that apply). Select one or more: a. surgical abortion with aspiration b. it is too late for her to have an abortion c. medical abortion with mifepristone and misopristol d. emergency contraception

a. surgical abortion with aspiration c. medical abortion with mifepristone and misoprostol Methotrexate is a cytotoxic drug that causes early abortion by preventing fetal cell division. Prostaglandins are also used for early abortion and work by dilating the cervix and initiating uterine wall contractions. Vacuum aspiration is used for abortions in the first trimester.

Pre-surgical nursing care for the woman who is going to have a hysterectomy for ovarian cancer includes which of the following? (Select all that apply). Select one or more: a. teach post-op routine care such as need for early ambulation b. ensure lab results are available to the surgeon prior to surgery c. administer enema if ordered d. Sips of water for hydration e. identification band is in place

a. teach post-op routine care such as need for early ambulation b. ensure lab results are available to the surgeon prior to surgery c. administer enema if ordered e. identification band is in place

Which of the following is the most effective contraception? Select one: a. the implant b. oral contraceptive pills c. natural family planning d. the vaginal ring e. condoms

a. the implant watch PowerPoint presentation

Which of the following STDs poses the least danger for the fetus of a mother who has the infection? Select one: a. trichomonas vaginalis b. syphilis c. gonorrhea d. herpes simplex virus

a. trichomonas vaginalis

Which classification of placental separation is not recognized as an abnormal adherence pattern? Select one: a. Placenta increta b. Placenta accreta c. Placenta percreta d. Placenta abruptio

d. Placenta abruptio premature separation of the placenta as opposed to partial or complete adherence. This classification occurs between the 20th week of gestation and delivery in the area of the decidua basalis. Symptoms include localized pain and bleeding.

Which statement by a newly delivered woman indicates that she knows what to expect regarding her menstrual activity after childbirth? Select one: a. "My first menstrual cycle will be heavier than normal and then will be light for several months after." b. "My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles." c. "I will not have a menstrual cycle for 6 months after childbirth." d. "My first menstrual cycle will be lighter than normal and then will get heavier every month thereafter."

b. "My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles." My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles is an accurate statement and indicates her understanding of her expected menstrual activity. She can expect her first menstrual cycle to be heavier than normal, which occurs by 3 months after childbirth, and the volume of her subsequent cycles will return to prepregnant levels within three to four cycles.

Which statement by the client would lead the nurse to believe that labor has been established? Select one: a. "My baby dropped, and I have to urinate more frequently now." b. "The contractions in my uterus are getting stronger and closer together." c. "My bag of waters just broke but I have no pain." d. "I passed some thick, pink mucus when I urinated this morning."

b. "The contractions in my uterus are getting stronger and closer together." Regular, strong contractions with the presence of cervical change indicate that the woman is experiencing true labor. Although the loss of the mucous plug (operculum) often occurs during the first stage of labor or before the onset of labor, it is not the indicator of true labor. Spontaneous rupture of membranes often occurs during the first stage of labor; however, it is not an indicator of true labor. The presenting part of the fetus typically

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 nurse's most appropriate response? Select one: a. "Your baby is just being stubborn." b. "The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor." c. "I don't know why it is taking so long." d. "The length of labor varies for different women."

b. "The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor." 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.

Your pregnant patient is in her first trimester and is scheduled for an ultrasound. When explaining the rationale for early pregnancy ultrasound, the best response is: Select one: a. "The test will help to determine the baby's position." b. "The test will help to determine how many weeks you are pregnant." c. "The test will help to determine if your baby is growing appropriately." d. "The test will help to determine if you have a boy or girl."

b. "The test will help to determine how many weeks you are pregnant." Fetal growth and size are fairly consistent during the first trimester and are a reliable indicator of the weeks of gestation.

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 son's prognosis. When the father sees his son, he says, "He looks just fine to me. I can't understand what all this is about." What is the most appropriate response or reaction by the nurse at this time? a."Didn't the physician tell you about your son's problems?" b."This must be a difficult time for you. Tell me how you're doing." c.Quietly stand beside the infant's father. d."You'll have to face up to the fact that he is going to die sooner or later."

b. "This must be a difficult time for you. Tell me how you're doing." 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.

A woman gave birth to an infant boy 10 hours ago. Where does the nurse expect to locate this woman's fundus? Select one: a. 2 centimeters below the umbilicus b. 1 centimeter above the umbilicus c. Nonpalpable abdominally d. Midway between the umbilicus and the symphysis pubis

b. 1 cm above the umbilicus The fundus descends approximately 1 to 2 cm every 24 hours. Within 12 hours after delivery the fundus may be approximately 1 cm above the umbilicus. By the sixth postpartum week the fundus is normally halfway between the symphysis pubis and the umbilicus. The fundus should be easily palpated using the maternal umbilicus as a reference point.

A 27-year-old pregnant woman had a preconceptual body mass index (BMI) of 54. What is this client's total recommended weight gain during pregnancy? Select one: a. 25- 35 pounds b. 11-20 pounds c. 15- 25 pounds d. 28-40 pounds

b. 11-20 pounds Read Table 15-2 11-20 pounds is recommended for a BMI over 30. Weight gain of 25-35 pounds is recommended for bmi in normal range of 18.5-24.9. Weight gain of 15-25 pounds is recommended for bmi in overweight or high of 25-29.9. Weight gain of 28-40 pounds is recommended for bmi in underweight range of less than 18.

Which woman is at the greatest risk for psychologic complications after hysterectomy? Select one: a. 62-year-old widow who has three friends who have had uncomplicated hysterectomies b. 19-year-old woman who had a ruptured uterus after giving birth to her first child c. 55-year-old woman who has been having abnormal bleeding and pain for 3 years d. 46-year-old woman who has had three children and has just been promoted at work

b. 19-year-old woman who had a ruptured uterus after giving birth to her first child The 19-year-old woman is still in her childbearing years. Often the uterus is related to self-concept in women in this age group, and they may feel that sexual functioning is related to having a uterus. The 55-year-old woman is past her childbearing years and has had bleeding and pain for 3 years. The hysterectomy may be well received as a method of pain relief. The 46-year-old woman has a family and positive events occurring in her life (job promotion).

At 1 minute after birth a nurse assesses an infant and notes a heart rate of 80 beats per minute, some flexion of extremities, a weak cry, grimacing, and a pink body but blue extremities. Which Apgar score does the nurse calculate based upon these observations and signs? Select one: a. 7 b. 5 c. 4 d. 6

b. 5 Each of the five signs the nurse notes scores a 1 on the Apgar scale, for a total of 5. A score of 4 is too low for this infant. A score of 6 is too high for this infant. A score of 7 is too high for an infant with this presentation.

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

b. 95 to 110 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.

A perinatal nurse assesses a term newborn for respiratory functioning. The nurse knows that which of the following conditions is normal for newborns? Select one: a. A respiratory rate of 60 to 80 breaths per minute b. A breathing pattern that is often shallow, diaphragmatic, and irregular c. Periodic episodes of apnea d. Retractions of the chest wall

b. A breathing pattern that is often shallow, diaphragmatic, and irregular Expected findings when assessing the neonate's respiratory system include 30-60 breaths per minute; slightly irregular,diaphragmatic/abdominalbreathing; increase in rate when crying; decrease in rate when sleeping. Abnormal findings include periods of apnea >15 seconds; tachypnea;respirations <30 per minute

Which of the following actions, if demonstrated by a nursing student, could lead to dismissal from the health program? (Select all that apply.) Select one or more: a. A student nurse offers her phone number to a client so that they can remain in touch b. A nursing student posts pictures of clinical site experiences on her Facebook page. c. Student nurses share their thoughts about their clinical site experiences on Twitter. d. Nursing students go out for lunch following a clinical rotation to a local restaurant while still in uniform.

b. A nursing student posts pictures of clinical site experiences on her Facebook page. c. Student nurses share their thoughts about their clinical site experiences on Twitter. Although a nursing student can provide a phone number to a patient so that they remain in touch, the student should be aware of the limits of the relationship while in nursing school. Nursing students going out to lunch following a clinical experience while in uniform would not pose a problem as long as they maintained their professional demeanor and did not discuss clinical events. Posting of images related to clinical experiences on a Facebook page would make the student liable for violation of privacy. Sharing of thoughts related to clinical experiences on social media may result in dismissal from a health program if a student nurse provides information that results in violation of the HIPAA (Health Insurance Portability and Accountability Act) Privacy Rule.

A nurse is reviewing the Human Genome Project. Which key finding should the nurse identify? Select one: a. Human genes produce only one protein per gene; other mammals produce three proteins per gene b. All human beings are 99.9% identical at the DNA level. c. There is an infinite number of gene pairs that make up the genome. d. Single-gene testing will become a standardized test for all pregnant women in the future.

b. All human beings are 99.9% identical at the DNA level. Approximately 20,500 genes make up the human genome; this is only twice as many as make up the genomes of roundworms and flies. Human beings are 99.9% identical at the DNA level. Most human genes produce at least three proteins. Single-gene testing (e.g., alpha-fetoprotein) is already standardized for prenatal care.

While developing an intrapartum care plan for the client in early labor, which psychosocial factors would the nurse recognize upon the client's pain experience? (Select all that apply.) Select one or more: a. Intervention of caregivers b. Anxiety and fear c. Previous experiences with pain d. Support systems e. Culture

b. Anxiety and fear c. Previous experiences with pain d. Support systems e. Culture Read pp 382-383 Culture: A woman's sociocultural roots influence how she perceives, interprets, and responds to pain during childbirth. Some cultures encourage loud and vigorous expressions of pain, whereas others value self-control. The nurse should avoid praising some behaviors (stoicism) while belittling others (noisy expression). Anxiety and fear: Extreme anxiety and fear magnify the sensitivity to pain and impair a woman's ability to tolerate it. Anxiety and fear increase muscle tension in the pelvic area, which counters the expulsive forces of uterine contractions and pushing efforts. Previous experiences with pain: Fear and withdrawal are a natural response to pain during labor. Learning about these normal sensations ahead of time helps a woman suppress her natural reactions of fear regarding the impending birth. If a woman previously had a long and difficult labor, she is likely to be anxious. She may also have learned ways to cope and may use these skills to adapt to the present labor experience. Support systems: An anxious partner is less able to provide help and support to a woman during labor. A woman's family and friends can be an important source of support if they convey realistic and positive information about labor and delivery. Although the intervention of caregivers may be necessary for the well-being of the woman and her fetus, some interventions add discomfort to the natural pain of labor (i.e., fetal monitor straps, IV lines).

The clinic nurse recognizes that pregnant women who are in particular need of support are those who (select all that apply): Select one or more: a. Are experiencing a second pregnancy b. Are awaiting genetic testing results c. Are experiencing a first pregnancy d. Are trying to conceal this pregnancy as long as possible

b. Are awaiting genetic testing results c. Are experiencing a first pregnancy d. Are trying to conceal this pregnancy as long as possible A second pregnancy is not an indication of a woman in need of additional support. A support system may be lacking for women who are trying to conceal a pregnancy or for women who are trying to keep the news of their pregnancy from relatives or friends until results from genetic tests are known. These individuals may need additional support from their nurses and other health-care providers, as they are placed in a powerless situation while awaiting results and face a pregnancy that may be in jeopardy.

What is the rationale for evaluating the plantar crease within a few hours of birth? a. Creases will be less prominent after 24 hours. b. As the skin dries, the creases will become more prominent. c. Heel sticks may be required. d. Newborn has to be footprinted.

b. As the skin dries, the creases will become more prominent. As the infants skin begins to dry, the creases will appear more prominent, and the infants gestation could be misinterpreted.

Women who are obese are at risk for several complications during pregnancy and birth. Which of these would the nurse anticipate with an obese client? (Select all that apply.) Select one or more: a. Breech presentation b. Cesarean birth c. Hypertension d. Wound infection e. Thromboembolism

b. Cesarean birth c. Hypertension d. Wound infection e. Thromboembolism A breech presentation is not a complication of pregnancy or birth for the client who is obese. Venous thromboembolism is a known risk for obese women. Therefore, the use of thromboembolism-deterrent (TED) hose and sequential compression devices may help decrease the chance for clot formation. Women should also be encouraged to ambulate as soon as possible. In addition to having an increased risk for complications with a cesarean birth, in general, obese women are also more likely to require an emergency cesarean birth. Many obese women have a pannus (i.e., large roll of abdominal fat) that overlies a lower transverse incision made just above the pubic area. The pannus causes the area to remain moist, which encourages the development of infection. Obese women are more likely to begin pregnancy with comorbidities such as hypertension and type 2 diabetes.

When a nulliparous woman telephones the hospital to report that she is in labor, what guidance should the nurse provide or information should the nurse obtain? Select one: a. Tell the woman to stay home until her membranes rupture. b. Ask the woman to describe why she believes she is in labor. c. Arrange for the woman to come to the hospital for labor evaluation. d. Emphasize that food and fluid intake should stop.

b. Ask the woman to describe why she believes she is in labor. Assessment begins at the first contact with the woman, whether by telephone or in person. By asking the woman to describe her signs and symptoms, the nurse can begin her assessment and gather data. The initial nursing activity should be to gather data about the woman's status. The amniotic membranes may or may not spontaneously rupture during labor. The client may be instructed to stay home until the uterine contractions become strong and regular. Before instructing the woman to come to the hospital, the nurse should initiate her assessment during the telephone interview. After this assessment has been made, the nurse may want to discuss the appropriate oral intake for early labor, such as light foods or clear liquids, depending on the preference of the client or her primary health care provider.

The obstetric nurse is preparing the client for an emergency cesarean birth, with no time to administer spinal anesthesia. The nurse is aware of and prepared for the greatest risks of administering general anesthesia to the client. What are these risks? (Select all that apply) Select one or more: a. Uterine relaxation b. Aspiration of stomach contents c. Respiratory depression of the neonate d. Difficulty or inability to intubate e. Respiratory depression of the mother f. Inadequate muscle relaxation

b. Aspiration of stomach contents d. Difficulty or inability to intubate Read page 352-353 Note: Difficulty or inability to intubate is mentioned in the book and is more common in obese patients... Other rationale: Aspiration of acidic gastric contents with possible airway obstruction is a potentially fatal complication of general anesthesia. Respirations can be altered during general anesthesia, and the anesthesiologist will take precautions to maintain proper oxygenation. Uterine relaxation can occur with some anesthesia but can be monitored and prevented. Inadequate muscle relaxation can be improved with medication.

Breast pain occurs in many women during their perimenopausal years. Which information is (are) a priority for the nurse to share with the client? (Select all that apply). Select one or more: a. Breast pain is an early indication of cancer. b. Assess for prior trauma or possible infection c. Pain is almost always an indication of a solid mass. d. Distinguishing between cyclical and noncyclical pain is important.

b. Assess for prior trauma or possible infection d. Distinguishing between cyclical and noncyclical pain is important. Breast pain is unusual in breast cancer. Solid masses are generally benign and described as smooth, round, mobile, and painless. Distinguishing between cyclical and noncyclical pain is important to determine whether the cause is hormonal. Idiopathic pain is most often treated with nonsteroidal antiinflammatory medications.

The nurse is performing an initial assessment of a client in labor. What is the appropriate terminology for the relationship of the fetal body parts to one another? Select one: a. Presentation b. Attitude c. Lie d. Position

b. Attitude pp. 367-370 Attitude is the relationship of the fetal body parts to one another. Lie is the relationship of the long axis (spine) of the fetus to the long axis (spine) of the mother. Presentation refers to the part of the fetus that enters the pelvic inlet first and leads through the birth canal during labor at term. Position is the relationship of the presenting part of the fetus to the four quadrants of the mother's pelvis.

Which statement related to fetal positioning during labor is correct and important for the nurse to understand? Select one: a. Position is a measure of the degree of descent of the presenting part of the fetus through the birth canal. b. Birth is imminent when the presenting part is at +4 to +5 cm below the ischial spines. c. The largest transverse diameter of the presenting part is the suboccipitobregmatic diameter. d. Engagement is the term used to describe the beginning of labor.

b. Birth is imminent when the presenting part is at +4 to +5 cm below the ischial spines. p. 379 The station of the presenting part should be noted at the beginning of labor to determine the rate of descent. Position is the relationship of the presenting part of the fetus to the four quadrants of the mother's pelvis; station is the measure of degree of descent. The largest diameter is usually the biparietal diameter. The suboccipitobregmatic diameter is the smallest, although one of the most critical. Engagement often occurs in the weeks just before labor in nulliparous women and before or during labor in multiparous women.

During the assessment of the newborn at 3 hours of age, the perinatal nurse documents the presence on the infant's scalp of a unilateral, well-defined mass which does not cross the suture lines. The mother's chart indicates a prolonged labor with use of a vacuum extractor. The RN identifies this finding as: Select one: a. Caput succedaneum b. Cephalohematoma c. Molding d. Intraventricular hemorrhage

b. Cephalohematoma Cephalohematoma is hematoma formation between the periosteum and skull with unilateral swelling. It appears within a few hours of birth and can increase in size over the next few days. It has a well-defined outline and does not cross suture lines.

The nurse has received a report regarding a client in labor. The woman's last vaginal examination was recorded as 3 cm, 30%, and -2. What is the nurse's interpretation of this assessment? Select one: a. Cervix is effaced 3 cm and dilated 30%; the presenting part is 2 cm below the ischial spines. b. Cervix is dilated 3 cm and effaced 30%; the presenting part is 2 cm above the ischial spines. c. Cervix is effaced 3 cm and dilated 30%; the presenting part is 2 cm above the ischial spines. d. Cervix is dilated 3 cm and effaced 30%; the presenting part is 2 cm below the ischial spines.

b. Cervix is dilated 3 cm and effaced 30%; the presenting part is 2 cm above the ischial spines. Read pp 370-375 The sterile vaginal examination is recorded as centimeters of cervical dilation, percentage of cervical dilation, and the relationship of the presenting part to the ischial spines (either above or below). For this woman, the cervix is dilated 3 cm and effaced 30%, and the presenting part is 2 cm above the ischial spines. The first interpretation of this vaginal examination is incorrect; the cervix is dilated 3 cm and is 30% effaced. However, the presenting part is correct at 2 cm above the ischial spines. The remaining two interpretations of this vaginal examination are incorrect. Although the dilation and effacement are correct at 3 cm and 30%, the presenting part is actually 2 cm above the ischial spines.

A pregnant client asks the nurse why she should attend childbirth classes. The nurse's response would be based on which of the following information? Select one: a. Attending childbirth class is a good way to make new friends. b. Childbirth classes will help new families develop skills to meet the challenges of childbirth and parenting. c. Attending childbirth classes will help a pregnant woman have a shorter labor. d. Childbirth classes will help a pregnant woman decrease her chance of having a cesarean delivery.

b. Childbirth classes will help new families develop skills to meet the challenges of childbirth and parenting.

Which statement is not an expected outcome for the client who attends a reputable childbirth preparation program? Select one: a. Childbirth preparation programs prepare a support person to help during labor. b. Childbirth preparation programs guarantee a pain-free childbirth. c. Childbirth preparation programs increase the woman's sense of control. d. Childbirth preparation programs teach distraction techniques.

b. Childbirth preparation programs guarantee a pain-free childbirth p. 385 All methods try to increase a woman's sense of control, prepare a support person, and train the woman in physical conditioning, which includes breathing techniques. These programs cannot, and reputable ones do not, promise a pain-free childbirth. Increasing a woman's sense of control is the goal of all childbirth preparation methods. Preparing a support person to help in labor is a vitally important component of any childbirth education program. The coach may learn how to touch a woman's body to detect tense and contracted muscles. The woman then learns how to relax in response to the gentle stroking by the coach. Distraction techniques are a form of care that are effective to some degree in relieving labor pain and are taught in many childbirth programs. These distractions include imagery, feedback relaxation, and attention-focusing behaviors.

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? Select one: a. Know that the greatest catch-up period is between 9 and 15 months postconceptual age. b. Correct for milestones, such as motor competencies and vocalizations, until the child is approximately 2 years of age. c. Know that the length and breadth of the trunk is the first part of the infant to experience catch-up growth. d. 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. 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.

Jane's husband Brian has begun to put on weight. What is this a possible sign of? a. Culturalism syndrome b. Couvade syndrome c. Moratorium phase d. Attachment

b. Couvade syndrome Read p 305 "Sympathetic pregnancy" , is a proposed condition in which a partner experiences some of the same symptoms and behavior as an expectant mother.

Information provided by the nurse that addresses the function of the amniotic fluid is that the amniotic fluid helps the fetus to maintain a normal body temperature and also: Select one: a. Facilitates asymmetrical growth of the fetal limbs b. Cushions the fetus from mechanical injury c. Promotes development of muscle tone d. Produces stool in the fetal intestines

b. Cushions the fetus from mechanical injury Amniotic fluid is contained within the amniotic sac. Amniotic fluid acts as a cushion for the fetus, allows freedom of fetal movement and symmetrical growth, provides for oral fluid and excretion of water, acts as a barrier to infection, allows for lung development, and provides a consistent thermal environment. See page 270 and powerpoint

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

b. Dipstick value of 3+ for protein in her urine 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.

A woman seeks care at an infertility clinic. Which of the following tests may this woman undergo to determine what, if any, infertility problem she may have? (Select all that apply.) Select one or more: a. Chorionic villus sampling b. Endometrial biopsy c. Hysterosalpingogram d. Serum FSH analysis

b. Endometrial biopsy c. Hysterosalpingogram d. Serum FSH analysis Common diagnostic tests to determine infertility include: screening for STIs, assessment of hormonal levels (TSH, FSH, LH), assessment for ovulatory dysfunction, detection of LH surge, endometrial biopsy, hysterosalpingogram, and laparoscopy to visualize pelvic structures.. Chorionic Villus Sampling is aspiration of a small amount of placental tissue for genetic testing.

Which stage of labor varies the most in length? Select one: a. Second b. First c. Third d. Fourth

b. First Read p. 328 The first stage of labor is considered to last from the onset of regular uterine contractions to the full dilation of the cervix. The first stage is significantly longer than the second and third stages combined. In a first-time pregnancy, the first stage of labor can take up to 20 hours. The second stage of labor lasts from the time the cervix is fully dilated to the birth of the fetus. The average length is 20 minutes for a multiparous woman and 50 minutes for a nulliparous woman. The third stage of labor lasts from the birth of the fetus until the placenta is delivered. This stage may be as short as 3 minutes or as long as 1 hour. The fourth stage of labor, recovery, lasts approximately 2 hours after the delivery of the placenta.

The nurse is using the New Ballard Scale to determine the gestational age of a newborn. Which assessment finding is consistent with a gestational age of 40 weeks? Select one: a. Abundant lanugo b. Flexed posture c. Faint red marks on the soles of the feet d. Smooth, pink skin with visible veins

b. Flexed posture Term infants typically have a flexed posture. Abundant lanugo; smooth, pink skin with visible veins; and faint red marks are usually observed on preterm infants.

As the tocodynamometer (Toco) is placed on the laboring patient's abdomen, the nurse explains that this monitoring device provides information on which of the following? Select one: a. Fetal heart rate b. Frequency of contractions c. Intensity of contractions d. Progress of labor

b. Frequency of contractions Uterine contractions are measured via a tocodynamometer (Toco) which is an external uterine monitor. The Toco measures the frequency and duration of uterine contractions but cannot measure uterine pressure/intensity. Uterine pressure/intensity can be estimated by palpation during contractions or through the use of an internal monitor such as an intrauterine pressure catheter (IUPC).

A woman's position is an important component of the labor progress. Which guidance is important for the nurse to provide to the laboring client? Select one: a. In a sitting or squatting position, abdominal muscles of the laboring client will have to work harder. b. Frequent changes in position help relieve fatigue and increase the comfort of the laboring client. c. The supine position, which is commonly used in the United States, increases blood flow. d. The laboring client positioned on her hands and knees ("all fours" position) is hard on the woman's back.

b. Frequent changes in position help relieve fatigue and increase the comfort of the laboring client. Read page 375 Frequent position changes relieve fatigue, increase comfort, and improve circulation. Blood flow can be compromised in the supine position; any upright position benefits cardiac output. The "all fours" position is used to relieve backache in certain situations. In a sitting or squatting position, the abdominal muscles work in greater harmony with uterine contractions.

A nurse is providing information to a client in labor with regard to tactile approaches to comfort management. Which option should the nurse include in the plan of care? Select one: a. Either hot or cold applications may provide relief, but they should never be used together in the same treatment. b. Hand and foot massage may be especially relaxing in advanced labor, when a woman's tolerance for touch is limited. c. Acupuncture can be performed by a skilled nurse with just a little training. d. Therapeutic touch (TT) uses handheld electronic stimulators that produce sympathetic vibrations.

b. Hand and foot massage may be especially relaxing in advanced labor, when a woman's tolerance for touch is limited. The woman and her partner should experiment with massage before labor to see what might work best. Therapeutic touch is a laying-on of hands technique that claims to redirect energy fields in the body.

Mary G10000 is 12 weeks pregnant in October. She is not sure if she wants the flu shot. What is the best message the nurse should include in their education for Mary? Select one: a. If pregnant women get the flu, they can get sick, require hospitalization and possibly die. It is really up to you to get the flu shot. b. If pregnant women get the flu, they can get seriously ill, require hospitalization and possibly die. We recommend you get the flu shot because it is a safe protective action to avoid these bad outcomes. c. If pregnant women get the flu, they usually don't get seriously ill. The flu shot is a good idea for women to get. d. If pregnant women get the flu, they get a little ill. It is OK if you choose not to get flu shot even if it is safe.

b. If pregnant women get the flu, they can get seriously ill, require hospitalization and possibly die. We recommend you get the flu shot because it is a safe protective action to avoid these bad outcomes. Influenza vaccination is an essential element of prepregnancy, prenatal, and postpartum care because influenza can result in serious illness, including a higher chance of progressing to pneumonia, when it occurs during the antepartum or postpartum period. In addition to hospitalization, pregnant women with influenza are at increased risk of intensive care unit admission and adverse perinatal and neonatal outcomes. The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices and the American College of Obstetricians and Gynecologists recommend that all adults receive an annual influenza vaccine and that women who are or will be pregnant during influenza season receive an inactivated influenza vaccine as soon as it is available.

Which infant is most likely to express Rh incompatibility? Select one: a. Infant who is Rh positive and a mother who is Rh positive b. Infant of an Rh-negative mother and a father who is Rh positive and homozygous for the Rh factor c. Infant of an Rh-negative mother and a father who is Rh positive and heterozygous for the Rh factor d. Infant who is Rh negative and a mother who is Rh negative

b. Infant of an Rh-negative mother and a father who is Rh positive and homozygous for the Rh factor If the mother is Rh negative and the father is Rh positive and homozygous for the Rh factor, then all the offspring of this union will be Rh positive. Only Rh-positive offspring of an Rh-negative mother are at risk for Rh incompatibility. Only the Rh-positive offspring of an Rh-negative mother are at risk. If the mother is Rh negative and the father is Rh positive and heterozygous for the factor, a 50% chance exists that each infant born of this union will be Rh positive, and a 50% chance exists that each will be born Rh negative. No risk for incompatibility exists if both the mother and the infant are Rh positive.

What is the most critical physiologic change required of the newborn after birth? Select one: a. Maintenance of a stable temperature b. Initiation and maintenance of respirations c. Full function of the immune defense system d. Closure of fetal shunts in the circulatory system

b. Initiation and maintenance of respirations The most critical adjustment of a newborn at birth is the establishment of respirations. The cardiovascular system changes significantly after birth as a result of fetal respirations, which reduce pulmonary vascular resistance to the pulmonary blood flow and initiate a chain of cardiac changes that support the cardiovascular system. After the establishment of respirations, heat regulation is critical to newborn survival. The infant relies on passive immunity received from the mother for the first 3 months of life.

Because a full bladder prevents the uterus from contracting normally, nurses intervene to help the woman spontaneously empty her bladder as soon as possible. If all else fails, what tactic might the nurse use? Select one: a. Asking the physician to prescribe analgesic agents b. Inserting a sterile catheter c. Placing oil of peppermint in a bedpan under the woman d. Pouring water from a squeeze bottle over the woman's perineum

b. Inserting a sterile catheter Invasive procedures are usually the last to be tried, especially with so many other simple and easy methods available (e.g., water, peppermint vapors, pain pills). Pouring water over the perineum may stimulate voiding. It is easy, noninvasive, and should be tried first. The oil of peppermint releases vapors that may relax the necessary muscles. It, too, is easy, noninvasive, and should be tried early on. If the woman is anticipating pain from voiding, then pain medications may be helpful. Other nonmedical means should be tried first, but medications still come before the insertion of a catheter.

Which of the following is true about CRISPR? Select all that apply. Select one or more: a. It is a lab technique that improves DNA replication. b. It involves a lab technique to precisely cut DNA sequences. c. It is lab technology that could improve outcomes in single-gene conditions in the future. d. It is new lab technology to improve prenatal screening. e. It is lab technology that could improve outcomes in multifactorial diseases in the future.

b. It involves a lab technique to precisely cut DNA sequences. c. It is lab technology that could improve outcomes in single-gene conditions in the future. Read article on Moodle

Which of the following is true regarding physiologic jaundice? (Select all that apply). Select one or more: a. It is recommended the mother stop breastfeeding until jaundice resolves b. Jaundice is more common in preterm infants c. Jaundice is noted 24 hours after birth d. Jaundice persists longer than 14 days of life in a term infant e. Jaundice is noted within 24 hours after birth

b. Jaundice is more common in preterm infants c. Jaundice is noted 24 hours after birth Physiologic jaundice becomes visible when the serum bilirubin reaches a level of 5 mg/dl or higher when the baby is approximately 3 days old. This finding is within normal limits for the newborn. Pathologic jaundice, not physiologic jaundice, occurs during the first 24 hours of life and is caused by blood incompatibilities that result in excessive destruction of erythrocytes; this condition must be investigated. Breast milk jaundice occurs in one third of breastfed infants at 2 weeks and is caused by an insufficient intake of fluids.

Hypothyroidism occurs in 2 to 3 pregnancies per 1000. Because severe hypothyroidism is associated with infertility and miscarriage, it is not often seen in pregnancy. Regardless of this fact, the nurse should be aware of the characteristic symptoms of hypothyroidism. Which do they include? (Select all that apply.) Select one or more: a. Weight loss b. Lethargy c. Decrease in exercise capacity d. Hot flashes e. Cold intolerance

b. Lethargy c. Decrease in exercise capacity e. Cold intolerance Symptoms include weight gain, lethargy, decrease in exercise capacity, and intolerance to cold. Other presentations might include constipation, hoarseness, hair loss, and dry skin. Thyroid supplements are used to treat hyperthyroidism in pregnancy.

Which of the following hormones basically signal the brain to release the egg during the menstrual cycle? (Select all that apply). Select one or more: a. Progesterone b. Luteinizing hormone c. Follicle-stimulating hormone d. Prostaglandins

b. Luteinizing hormone c. Follicle-stimulating hormone see pp 52-54

A married couple lives in a single-family house with their newborn son and the husband's daughter from a previous marriage. Based on this information, what family form best describes this family? Select one: a. Nuclear family b. Married-blended family c. Same-sex family d. Extended family

b. Married-blended family Read pp. 17-18 Married-blended families are formed as the result of divorce and remarriage. Unrelated family members join to create a new household. Members of an extended family are kin or family members related by blood, such as grandparents, aunts, and uncles. A nuclear family is a traditional family with male and female partners along with the children resulting from that union. A same-sex family is a family with homosexual partners who cohabit with or without children.

Karen, a G2 P2, experienced a precipitous birth 90 minutes ago. Her infant is 4200 grams and a repair of a second-degree laceration was needed following the birth. As part of the nursing assessment, the nurse discovers that Karen's uterus is boggy. Furthermore, it is noted that Karen's vaginal bleeding has increased. What is the nurse's most appropriate actions? Select one or more: a. Assess vital signs including blood pressure and pulse. b. Massage the uterine fundus with continual lower segment support. c. Measure and document each perineal pad changed in order to assess blood loss. d. Assess for bladder distention and encourage patient to void.

b. Massage the uterine fundus with continual lower segment support. d. Assess for bladder distention and encourage patient to void Read pp 487-488 for details- most appropriate actions with boggy uterus and increased lochia are uterine massage and assess bladder for distention. The other actions are implemented AFTER re-establishing uterine tone, which could include emptying the bladder (by voiding or straight catheterization)

A woman in labor has just received an epidural block. What is the most important nursing intervention at this time? Select one: a. Monitor the fetus for possible tachycardia. b. Monitor the maternal blood pressure for possible hypotension. c. Monitor the maternal pulse for possible bradycardia. d. Limit parenteral fluids.

b. Monitor the maternal blood pressure for possible hypotension. Read box 17-6 The most important nursing intervention for a woman who has received an epidural block is for the nurse to monitor the maternal blood pressure frequently for signs of hypotension. IV fluids are increased for a woman receiving an epidural to prevent hypotension. The nurse also observes for signs of fetal bradycardia and monitors for signs of maternal tachycardia, secondary to hypotension.

The clinic nurse reviews the complete blood count results for a 30-year-old woman who is now 33 weeks' gestation. Tamara's hemoglobin value is 11.2 g/dL, and her hematocrit is 38%. The clinic nurse interprets these findings as: a. Normal adult values b. Normal pregnancy values for the third trimester c. Increased adult values d. Increased values for 33 weeks gestation.

b. Normal pregnancy values for the third trimester Normal values in pregnancy are Hemoglobin >11 and Hematocrit >33%

The Valsalva maneuver can be described as the process of making a forceful bearing-down attempt while holding one's breath with a closed glottis and a tightening of the abdominal muscles. When is it appropriate to instruct the client to use this maneuver? Select one: a. During the second stage to enhance the movement of the fetus b. Not at all c. During the third stage to help expel the placenta d. During the fourth stage to expel blood clots

b. Not at all Spontaneous, open glottis pushing has been shown to facilitate positive maternal and neonatal outcomes Other Rationale: The client should not be instructed to use this maneuver. This process stimulates the parasympathetic division of the autonomic nervous system and produces a vagal response (decrease in heart rate and blood pressure.) An alternative method includes instructing the client to perform open-mouth and open-glottis breathing and pushing.

As part of their teaching function at discharge, nurses should educate parents regarding safe sleep. Based on the most recent evidence, which information is incorrect and should be discussed with parents? Select one: a. Avoid loose bedding, water beds, and beanbag chairs. b. Keep the infant away from secondhand smoke. c. Place the infant on his or her abdomen to sleep d. Prevent exposure to people with upper respiratory tract infections.

c. Place the infant on his or her abdomen to sleep

Under which circumstance should the nurse assist the laboring woman into a hands-and-knees position? Select one: a. Membranes have ruptured. b. Occiput of the fetus is in a posterior position. c. Fetus is at or above the ischial spines. d. Fetus is in a vertex presentation.

b. Occiput of the fetus is in a posterior position Read Box 19-8 The hands-and-knees position is effective in helping to rotate the fetus from a posterior to an anterior position. Many women experience the irresistible urge to push when the fetus is at the level of the ischial spines. In some cases, this urge is felt before the woman is fully dilated. The woman should be instructed not to push until complete cervical dilation has occurred. No one position is correct for childbirth. The two most common positions assumed by women are the sitting and side-lying positions. The woman may be encouraged into a hands-and-knees position if the umbilical cord prolapsed when the membranes ruptured.

The nurse is taking care a client who has been sexually assaulted. Which of the following lab tests would the nurse expect the physician to order? Select all that apply. Select one or more: a. Fecal occult blood testing b. Oral swab DNA testing c. Gonorrhea culture d. Screening test for hepatitis B e. Chemistry profile and complete blood count f. Serum blood pregnancy test

b. Oral swab DNA testing d. Screening test for hepatitis B f. Serum blood pregnancy test Read pg. 95 Lab tests can include oral swabs for the survivor's DNA to distinguish her DNA from the suspects; a urine or blood pregnancy test; blood tests for hepatitis B virus; and oral or blood tests for HIV. Cultures for gonorrhea, chlamydia, and syphillis are not recommended because women are treated prophylactically and testing will not change treatment.

The nurses working at a newly established birthing center have begun to compare their performance in providing maternal-newborn care against clinical standards. This comparison process is most commonly known as what? Select one: a. Best practices network b. Outcomes-oriented practice c. Evidence-based practice d. Clinical benchmarking

b. Outcomes-oriented practice Read pg. 11 Outcomes-oriented practice measures the effectiveness of the interventions and quality of care against benchmarks or standards. The term best practice refers to a program or service that has been recognized for its excellence. Clinical benchmarking is a process used to compare one's own performance against the performance of the best in an area of service. The term evidence-based practice refers to the provision of care based on evidence gained through research and clinical trials.

A first-time dad is concerned that his 3-day-old daughter's skin looks "yellow." In the nurse's explanation of physiologic jaundice, what fact should be included? Select one: a. Physiologic jaundice occurs during the first 24 hours of life. b. Physiologic jaundice becomes visible when serum bilirubin levels peak between the second and fourth days of life c. Physiologic jaundice is caused by blood incompatibilities between the mother and the infant blood types. d. Physiologic jaundice is also known as breast milk jaundice.

b. Physiologic jaundice becomes visible when serum bilirubin levels peak between the second and fourth days of life Physiologic jaundice becomes visible when the serum bilirubin reaches a level of 5 mg/dl or higher when the baby is approximately 3 days old. This finding is within normal limits for the newborn. Pathologic jaundice, not physiologic jaundice, occurs during the first 24 hours of life and is caused by blood incompatibilities that result in excessive destruction of erythrocytes; this condition must be investigated. Breast milk jaundice occurs in one third of breastfed infants at 2 weeks and is caused by an insufficient intake of fluids.

The baseline FHR is the average rate during a 10-minute segment. Changes in FHR are categorized as periodic or episodic. These patterns include both accelerations and decelerations. The labor nurse is evaluating the client's most recent 10-minute segment on the monitor strip and notes a late deceleration. Which is likely to have caused this change? (Select all that apply.) Select one or more: a. Compression of the fetal head b. Placental abruption c. Spontaneous fetal movement d. Cord around the baby's neck e. Maternal supine hypotension

b. Placental abruption e. Maternal supine hypotension Read Box 18-5 Late decelerations are almost always caused by uteroplacental insufficiency. Insufficiency is caused by uterine tachysystole, maternal hypotension, epidural or spinal anesthesia, IUGR, intraamniotic infection, or placental abruption. Spontaneous fetal movement, vaginal examination, fetal scalp stimulation, fetal reaction to external sounds, uterine contractions, fundal pressure, and abdominal palpation are all likely to cause accelerations of the FHR. Early decelerations are most often the result of fetal head compression and may be caused by uterine contractions, fundal pressure, vaginal examination, and the placement of an internal electrode. A variable deceleration is likely caused by umbilical cord compression, which may happen when the umbilical cord is around the baby's neck, arm, leg, or other body part or when a short cord, a knot in the cord, or a prolapsed cord is present.

Which woman has the highest risk for endometrial cancer? Select one: a. Woman who has an intrauterine device (IUD) b. Postmenopausal woman with hypertension c. Woman who has been on birth control pills for 15 years d. Perimenopausal woman who has a cystocele

b. Postmenopausal woman with hypertension Endometrial cancer is most often seen in postmenopausal women between the ages of 50 and 65 years. Hypertension is a risk factor associated with the development of this malignancy. The use of an IUD does not increase a womans risk for endometrial cancer. A client who has been on birth control for 15 years is not at increased risk for endometrial cancer; the birth control contraceptives might actually offer some protection. The development of a cystocele will not increase a womans risk for endometrial cancer.

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? Select one: a. The mother should pump every 2 to 3 hours, including during the night. b. Premature infants more easily digest breast milk than formula. c. A glass of wine just before pumping will help reduce stress and anxiety. d. The mother should only pump as much milk as the infant can drink.

b. Premature infants more easily digest breast milk than formula. 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.

Supportive care of the infant with neonatal abstinence syndrome (NAS) include both pharmacologic and nonpharmacologic therapy. Nonpharmacologic therapy would include which of the following (select all that apply): Select one or more: a. Use of oral morphine and methadone b. Quiet environment with low lighting and use of soft voices c. Swaddling, clustering care, use of pacifiers to promote "self-soothing" d. Clonidine for infants who do not respond to a single agent

b. Quiet environment with low lighting and use of soft voices c. Swaddling, clustering care, use of pacifiers to promote "self-soothing" Nonpharmacologic therapy includes quiet environment, low lighting, soft voices, clustering care, swaddling, pacifier use, frequent small feedings, and vertical rocking.

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? Select one: a. Brings in play clothes for all three infants b. Refers to the dead infant in the past tense c. Refers to the two live infants as twins d. Asks about the dead triplet's current status

b. Refers to the dead infant in the past tense 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.

A primigravida woman at 42 weeks' gestation received Prepidil (dinoprostone) for induction 12 hours ago. The Bishop score is now 3. Which of the following actions by the nurse is appropriate? Select one: a. Perform Nitrazine analysis of the amniotic fluid. b. Report the lack of progress to the obstetrician. c. Place the woman on her left side. d. Ask the provider for an order for oxytocin.

b. Report the lack of progress to the obstetrician. Prepidil is indicated for cervical ripening, the process of physical softening and opening of the cervix. Cervical status is the most important predictor of successful induction of labor. Cervical status is assessed before induction of labor using the Bishop score. A score of 6 or more is considered favorable for successful induction of labor.

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

b. Respiratory distress syndrome IDMs are at risk for macrosomia, birth injury, perinatal asphyxia, respiratory distress syndrome, hypoglycemia, hypocalcemia, hypomagnesemia, cardiomyopathy, hyperbilirubinemia, and polycythemia. They are not at risk for anemia, hyponatremia, or sepsis.

A primigravida at 40 weeks of gestation is having uterine contractions every 1 1/2 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 woman's labor? Select one: a. She is experiencing a normal latent stage b. She is exhibiting hypertonic uterine dysfunction c. She is experiencing precipitous labor d. She is exhibiting hypotonic uterine dysfunction

b. She is exhibiting hypertonic uterine dysfunction 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.

The client is undergoing treatment for ovarian cancer. Which common nutritional problems are related to gynecologic cancers and the treatment thereof? (Select all that apply.) Select one or more: a. Nausea and vomiting b. Stomatitis c. Constipation d. Increased Appetite e. Diarrhea

b. Stomatitis c. Constipation e. Diarrhea Altered taste, stomatitis, constipation, anorexia, diarrhea, and nausea and vomiting are all possible nutritional complications related to gynecologic cancers and their treatment. The nurse must assess accordingly and adapt the clients plan of care. To ensure recovery, these women should consume a diet high in iron and protein, drink plenty of fluids, and eat foods high in vitamins C, B, and K.

Which of the following are among the top 5 causes of death in women in the U.S.? Select all that apply. Select one or more: a. Childbirth b. Stroke c. Depression d. Heart Disease

b. Stroke d. Heart Disease see p. 57 Box 4.2 Top ten are: 1. Heart disease 2. Cancer 3. Chronic lower respiratory diseases 4. Stroke 5. Alzheimer's disease 6. Unintentional injuries 7. Diabetes 8. Influenza and pneumonia 9. Kidney disease 10. Septicemia

Documentation of abuse can be useful to women later in court, should they elect to press charges. It is of key importance for the nurse to document accurately at the time that the client is seen. Which entry into the medical record would be the least helpful to the court? Select one: a. Clear and legible written documentation b. Summary of information (e.g., "The client is a battered woman.") c. Accurate description of the client's demeanor d. Photographs of injuries

b. Summary of information (e.g., "The client is a battered woman.") Read Box 5-2 A statement such as, "The client is a battered woman" lacks the supporting factual information and will render the report inadmissible. More appropriate documentation would include exact statements from the woman in quotations (e.g., "My husband kicked me in the stomach"). The time and date of the examination should also be included.

A pregnant woman is at 38 weeks of gestation. She wants to know whether there are any signs that "labor is getting close to starting." Which finding is an indication that labor may begin soon? Select one: a. Urinary retention b. Surge of energy c. Weight gain of 1.5 to 2 kg (3 to 4 lb) d. Increase in fundal height

b. Surge of energy Box 16-1 Women speak of having a burst of energy before labor. The woman may lose 0.5 to 1.5 kg, as a result of water loss caused by electrolyte shifts that, in turn, are caused by changes in the estrogen and progesterone levels. When the fetus descends into the true pelvis (called lightening), the fundal height may decrease. Urinary frequency may return before labor.

The perinatal nurse observes the new mother watching her baby daughter closely, touching her face, and asking many questions about infant feeding. This stage of mothering is best described as: Select one: a. Taking in b. Taking hold c. Taking charge d. Taking time

b. Taking hold As the mother's physical condition improves, she begins to take charge and enters the taking-hold phase where she assumes care for herself and her infant. At this time, the mother eagerly wants information about infant care and shows signs of bonding with her infant. During this phase, the nurse should closely observe mother-infant interactions for signs of poor bonding, and if present, implement actions to facilitate attachment. see Table 22-4

Which of the following nursing actions are directed at assisting men in their transition to fatherhood? (Select all that apply.) Select one or more: a. Encourage the woman to take on the major responsibility for infant care. b. Talk to the couple about their expectations of the parenting role. c. Praise the father for his interactions with his infant. d. Provide information on infant care and behavior to both parents.

b. Talk to the couple about their expectations of the parenting role. c. Praise the father for his interactions with his infant. d. Provide information on infant care and behavior to both parents. It is important to first have the couple discuss with each other their expectations of the fathering role. Once this has occurred, then the woman and nurse need to support the man in his role of infant care. Both parents need to receive information about infant care and infant behaviors, and both parents need to be praised for their interactions with their baby.

What is one of the initial signs and symptoms of puerperal infection in the postpartum client? Select one: a. Profuse vaginal lochia with ambulation b. Temperature of 38*C (100.4*F) or higher on 2 successive days c. Pain with voiding d. Fatigue continuing for longer than 1 week

b. Temperature of 38*C (100.4*F) or higher on 2 successive days 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.

A nurse is providing education to a support group of women newly diagnosed with breast cancer. It is important for the nurse to discuss which factor related to breast cancer with the group? Select one: a. Breast cancer is the leading cause of cancer death in women. b. The exact cause of breast cancer remains unknown. c. In the United States, 1 in 10 women will develop breast cancer in her lifetime. d. Genetic mutations account for 50% of women who will develop breast cancer.

b. The exact cause of breast cancer remains unknown. The exact cause of breast cancer is unknown. Between 15% and 20% of these cancers are related to genetic mutations. Breast cancer is the second leading cause of cancer death in woman ages 45 to 55 years. One in eight women in the United States will develop breast cancer in her lifetime.

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? Select one: a. Women with PKU are usually mentally handicapped and should not reproduce. b. The fetus may develop intellectual disability and/or growth impairment c. A pregnant woman is more likely to die without strict dietary control. d. PKU is a recognized cause of preterm labor.

b. The fetus may develop intellectual disability and/or growth impairment 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.

Another common pregnancy-specific condition is pruritic urticarial papules and plaques of pregnancy (PUPPP). A client asks the nurse why she has developed this condition and what can be done. What is the nurse's best response? Select one: a. The rate of hypertension decreases with PUPPP. b. The goal of therapy is to relieve discomfort. c. This common pregnancy-specific condition is associated with a poor fetal outcome. d. PUPPP is associated with decreased maternal weight gain.

b. The goal of therapy is to relieve discomfort. PUPPP is associated with increased maternal weight gain, increased rate of twin gestation, and hypertension. It is not, however, associated with poor maternal or fetal outcomes. The goal of therapy is simply to relieve discomfort. Antipruritic topical medications, topical steroids, and antihistamines usually provide relief. PUPPP usually resolves before childbirth or shortly thereafter.

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

b. The tocotransducer is especially valuable for measuring uterine activity during the first stage of labor. Read pp 414-416 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.

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

b. This laboratory test measures the levels of hemoglobin Alc, which should remain at less than 7% Hemoglobin Alc levels greater than 7% indicate an elevated glucose level during the previous 4 to 6 weeks.

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? Select one: a. Inevitable b. Threatened c. Incomplete d. Septic

b. Threatened 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.

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, "I'm so thirsty and warm." What is the nurse's immediate action? Select one: a. Call the physician b. To discontinue the magnesium sulfate infusion c. To administer oxygen d. To call for an immediate magnesium sulfate level

b. To discontinue the magnesium sulfate infusion 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.

What is the primary purpose for magnesium sulfate administration for clients with preeclampsia and eclampsia? Select one: a. To lower blood pressure b. To prevent convulsions c. To prevent a boggy uterus and lessen lochial flow d. To improve patellar reflexes and increase respiratory efficiency

b. To prevent convulsions 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.

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

b. To stay with the client and call for help 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.

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 pharmacological intervention? a. To maintain adequate maternal respiratory effort and ventilation during magnesium sulfate therapy. b. To stimulate fetal surfactant production. c. To reduce maternal and fetal tachycardia associated with ritodrine administration. d. To suppress uterine contractions

b. To stimulate fetal surfactant production. 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.

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? Select one: a. Internal fetal monitoring b. Transvaginal ultrasound for placental location c. Amniocentesis for fetal lung maturity d. Contraction stress test (CST)

b. Transvaginal ultrasound for placental location The symptoms, bright red and painless vaginal bleeding, indicate placental previa. An ultrasound can confirm this diagnosis.

A nurse is monitoring an obstetric client who is in early labor. Which of the following findings would be a cause for concern if observed by the nurse? (Select all that apply.) Select one or more: a. General flexion attitude b. Transverse Lie c. Vertex presenting part d. Biparietal diameter of greater than 9.25cm e. Android pelvis

b. Transverse Lie d. Biparietal diameter of greater than 9.25cm e. Android pelvis A biparietal diameter at term is typically noted as 9.25 cm, and the finding of a greater measurement would cause a concern related to the mode of delivery. A transverse lie would also cause a concern relative to the mode of delivery because a cesarean section would be indicated. An android pelvis would cause a concern related to the mode of delivery. A vertex presenting part and a general flexion attitude are normal findings and would not cause concern.

A 25-year-old gravida 3, para 2 client gave birth to a 9-pound, 7-ounce boy, 2 hours ago after augmentation of labor with oxytocin (Pitocin). She presses her call light, and asks for her nurse right away, stating "I'm bleeding a lot." What is the most likely cause of postpartum hemorrhaging in this client? Select one: a. Retained placental fragments b. Uterine atony c. Unrepaired vaginal lacerations d. Puerperal infection

b. Uterine atony This woman gave birth to a macrosomic infant after oxytocin augmentation. Combined with these risk factors, uterine atony is the most likely cause of bleeding 4 hours after delivery. Although retained placental fragments may cause postpartum hemorrhaging, it is typically detected within the first hour after delivery of the placenta and is not the most likely cause of the hemorrhaging in this woman. Although unrepaired vaginal lacerations may also cause bleeding, it typically occurs in the period immediately after birth. Puerperal infection can cause subinvolution and subsequent bleeding that is, however, typically detected 24 hours postpartum.

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. Umbilical cord compression b. Uteroplacental insufficiency c. Meconium in fluid d. Altered cerebral blood flow

b. Uteroplacental insufficiency Read Box 18-5 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.

The perinatal nurse understands that the purpose of the surgical "time-out" is to: Select one: a. Confirm that the surgeon is ready to begin b. Verify that it is the correct patient and planned procedure c. Verify that anesthesia is adequate d. Confirm that the neonatal team is in attendance

b. Verify that it is the correct patient and planned procedure Surgical "time-out" is performed by the entire surgical team and the patient prior to the administration of anesthesia. The purpose is to validate correct patient and planned procedure.

A pregnant woman's diet consists almost entirely of whole grain breads and cereals, fruits, and vegetables. Which dietary requirement is the nurse most concerned about? Select one: a. Protein b. Vitamin B12 c. Folic Acid d. Calcium

b. Vitamin B12 See pp 350-354 of text. B12 is not naturally found in these foods. Protein, calcium, and folic acid (Box 15-1) are. A pregnant womans diet is consistent with that followed by a strict vegetarian (vegan). Vegans consume only plant products. Because vitamin B12 is found in foods of animal origin, this diet is deficient in vitamin B12. Depending on the womans food choices, a pregnant womans diet may be adequate in calcium. Protein needs can be sufficiently met by a vegetarian diet. The nurse should be more concerned with the womans intake of vitamin B12 attributable to her dietary restrictions. Folic acid needs can be met by enriched bread products.

Which clinical sign indicates that the client has reached the second stage of labor? Select one: a. Cervix cannot be felt during a vaginal examination. b. Woman experiences a strong urge to bear down. c. Amniotic membranes rupture. d. Presenting part of the fetus is below the ischial spines.

b. Woman experiences a strong urge to bear down Read textbook pages 399-400 and Box 19-10 **The key to this question is "clinical sign"... Cervix assessment is an objective sign the nurse assesses, not a clinical sign. Rationale: During the descent phase of the second stage of labor, the woman may experience an increase in the urge to bear down. The ROM has no significance in determining the stage of labor. The second stage of labor begins with full cervical dilation. Many women may have an urge to bear down when the presenting fetal part is below the level of the ischial spines. This urge can occur during the first stage of labor, as early as with 5 cm dilation.

Sally is in her third trimester and has begun to sing and talk to the fetus. Sally is probably exhibiting signs of: Select one: a. Mental illness b. Delusions c. Attachment d. Crisis

c. Attachment Read pgs. 302-304

Which symptom described by a client is characteristic of premenstrual syndrome (PMS)? Select one: a. "I have nausea and headaches after my period starts, and they last 2 to 3 days." b. "I have lower abdominal pain beginning on the third day of my menstrual period." c. "I feel irritable and moody a week before my period is supposed to start." d. "I have abdominal bloating and breast pain after a couple days of my period."

c. "I feel irritable and moody a week before my period is supposed to start." PMS is a cluster of physical, psychologic, and behavioral symptoms that begin in the luteal phase of the menstrual cycle and resolve within a couple of days of the onset of menses. PMS begins in the luteal phase and resolves as menses occurs. It does not start after menses has begun. This complaint is associated with PMS. However, the timing reflected in this statement is inaccurate. PMS begins in the luteal phase and resolves as menses occurs. It does not start after menses has begun. Abdominal bloating and breast pain are likely to occur a few days prior to menses, not after it has begun.

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

Sandy G21001 is 41 weeks pregnant and present to L&D for induction. The physician orders Pitocin to be infused at 2mU/min. The IV bag is LR 1000mL with 10 units of pitocin. The infusion pump delivers ___ mL/hour. How will the nurse program the infusion pump to deliver the medication as ordered? Select one: a. 30mL/hr b. 18mL/hr c. 12mL/hr d. 6mL/hr

c. 12mL/hr

A nurse is reviewing spinal and epidural (block) anesthesia use during labor. Which statement should the nurse identify as being accurate? Select one: a. This type of anesthesia is commonly used for cesarean births but is not suitable for vaginal births b. Spinal and epidural blocks are never used together. c. A high incidence of postbirth headache is seen with spinal blocks. d. Epidural blocks allow the woman to move freely.

c. A high incidence of postbirth headache is seen with spinal blocks. The headaches may be prevented or mitigated to some degree by a number of methods. An autologous epidural blood patch is the most rapid, reliable, and beneficial relief measure for a spinal headache. Spinal blocks may be used for vaginal births, but the woman must be assisted through labor. Epidural blocks limit the woman's ability to move freely. Combined use of spinal and epidural blocks is becoming increasingly popular

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? Select one: a. Scaphoid abdomen, no residual with feedings, and increased urinary output b. Hypertonia, tachycardia, and metabolic alkalosis c. Abdominal distention, temperature instability, and grossly bloody stools d. Hypertension, absence of apnea, and ruddy skin color

c. Abdominal distention, temperature instability, and grossly bloody stools 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. Hypotension, apnea, and pallor are signs of NEC, as are abdominal distention, residual gastric aspirates, and oliguria.

A postmenopausal woman has been diagnosed with two leiomyomas (fibroids). Which clinical finding is most commonly associated with the presence of leiomyomas? Select one: a. Diarrhea b. Weight loss c. Abnormal uterine bleeding d. Acute abdominal pain

c. Abnormal uterine bleeding Most women are asymptomatic. Abnormal uterine bleeding is the most common symptom of leiomyomas. Diarrhea is not commonly associated with leiomyomas. Weight loss does not usually occur in the woman with leiomyomas, and the client with leiomyomas is unlikely to experience abdominal pain.

Nurses can help their clients by keeping them informed about the distinctive stages of labor. Which description of the phases of the first stage of labor is accurate? Select one: a. Transition: More progress in effacement of cervix b. Latent: More progress in dilation of cervix c. Active: More progress in rate of descent of presenting part d. Lull: No contractions; dilation stable

c. Active: More progress in rate of descent of presenting part Read p 328

Which statement regarding the postpartum uterus is correct? Select one: a. After 2 weeks postpartum, it weighs 100 g. b. At the end of the third stage of labor, the postpartum uterus weighs approximately 500 g. c. After 2 weeks postpartum, it should be abdominally nonpalpable. d. Postpartum uterus returns to its original (prepregnancy) size by 6 weeks postpartum.

c. After 2 weeks postpartum, it should be abdominally nonpalpable. The uterus does not return to its original size. At the end of the third stage of labor, the uterus weighs approximately 1000 g. After 2 weeks postpartum, the uterus weighs approximately 350 g. The normal self-destruction of excess hypertrophied tissue accounts for the slight increase in uterine size after each pregnancy.

A 25-year-old gravida 1 para 1 who had an emergency cesarean birth 3 days ago is scheduled for discharge. As the nurse prepares her for discharge, she begins to cry. The nurse's next action should be what? Select one: a. Assess her for pain. b. Explain that she is experiencing postpartum blues. c. Allow her time to express her feelings d. Point out how lucky she is to have a healthy baby.

c. Allow her time to express her feelings The nurse needs to hear from the patient why she is crying before offering a response.

A 36 y/o pregnant woman has been diagnosed with polyhydraminos. The nurse knows this is based on which of the following? Select one: a. Amniotic fluid index of 20 cm b. Amniotic fluid index of 7 cm c. Amniotic fluid index of 30 cm d. Amniotic fluid index of 10 cm

c. Amniotic fluid index of 30 cm

According to the American Cancer Society, which of the following is true about screening mammogram? Select one: a. Average-risk women should begin screening mammogram at 40 y/o b. Screening mammograms every year for average-risk women after age 65y/o. c. Average-risk women should begin screening mammogram at 45 y/o d. Only high risk women should get screening mammograms.

c. Average-risk women should begin screening mammogram at 45 y/o According to the PowerPoint the screening range has moved up from 40 to 45 y/o.

Susie is 19 y/o and presents to the clinic for her well-woman exam. She denies any problems or family history of cancer. Which of the following are recommended for Susie? (select all that apply). Select one or more: a. HPV test b. Pap smear c. Blood pressure d. Clinical breast exam e. Hearing Screen

c. Blood pressure See Table 4-3 pg. 75 Blood pressure, height, and weight are recommended at every examination. Pap smear is recommended every 3 years between ages 21-65 and every 5 years between ages 30-65 if done with HPV testing. HPV testing recommended if patient is sexually active along with testing for other potential STIs. Clinical breast exam recommended every 3 years ages 20-44, and every year after age 45. Hearing screening recommended at age 18 then once every 10 years until age 49, every 3 years after age 50.

A patient at 28 weeks' gestation was last seen in the prenatal clinic at 24 weeks' gestation. Which of the following changes should the nurse bring to the attention of the Certified Nurse Midwife? Select one: a. Weight change from 128 pounds to 132 pounds b. Pulse change from 88 bpm to 92 bpm c. Blood pressure change from 110/70 to 140/90 d. Respiratory change from 16 rpm to 20 rpm

c. Blood pressure change from 110/70 to 140/90 Read p 291

A breastfeeding woman develops engorged breasts at 3 days postpartum. What action will help this client achieve her goal of reducing the engorgement? Select one: 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. Breastfeed her infant every 2 hours. 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.

Which presentation is accurately described in terms of both the presenting part and the frequency of occurrence? Select one: a. Breech: sacrum, 10% to 15% b. Cephalic: cranial, 80% to 85% c. Cephalic: occiput, at least 96% d. Shoulder: scapula, 10% to 15%

c. Cephalic: occiput, at least 96% Read pg. 368 In cephalic presentations (head first), the presenting part is the occiput; this presentation occurs in 96% of births. In a breech birth, the sacrum emerges first; this presentation occurs in approximately 3% of births. In shoulder presentations, the scapula emerges first; this presentation occurs in only 1% of births. In a cephalic presentation, the part of the head or cranium that emerges first is the occiput; cephalic presentations occur in 96% of births.

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 nurse's first priority? Select one: a. Insert a scalp electrode. b. Assist with amnioinfusion c. Change the woman's position. d. Notify the health care provider.

c. Change the woman's position. Read pp 417- 425 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 nurse's first priority.

A client is experiencing back labor and complains of intense pain in her lower back. Which measure would best support this woman in labor? a. Conscious relaxation or guided imagery b. Effleurage c. Counterpressure against the sacrum d. Pant-blow (breaths and puffs) breathing techniques

c. Counterpressure against the sacrum Read p 339 Counterpressure is steady pressure applied by a support person to the sacral area with the fist or heel of the hand. This technique helps the woman cope with the sensations of internal pressure and pain in the lower back. The pain management techniques of pant-blow, effleurage, and conscious relaxation or guided imagery are usually helpful for contractions per the gate-control theory.

A nurse is reviewing maternal nutritional needs during lactation. Which statement should the nurse identify as being accurate? Select one: a. The mother's intake of vitamin C, zinc, and protein now can be lower than during pregnancy. b. Lactating women can go back to their prepregnant calorie intake. c. Critical iron and folic acid levels must be maintained. d. Caffeine consumed by the mother accumulates in the infant, who therefore may be unusually active and wakeful.

c. Critical iron and folic acid levels must be maintained A lactating woman needs to avoid consuming too much caffeine. Vitamin C, zinc, and protein levels need to be moderately higher during lactation than during pregnancy. The recommendations for iron and folic acid are somewhat lower during lactation. Lactating women should consume about 500 kcal more than their prepregnancy intake, at least 1800 kcal daily overall.

If nonsurgical treatment for late PPH is ineffective, which surgical procedure would be appropriate to correct the cause of this condition? Select one: a. Laparotomy b. Hysterectomy c. Dilation and curettage (D&C) d. Laparoscopy

c. Dilation and curettage (D&C) D&C allows the examination of the uterine contents and the removal of any retained placental fragments or blood clots. Hysterectomy is the removal of the uterus and is not the appropriate treatment for late PPH. A laparoscopy is the insertion of an endoscope through the abdominal wall to examine the peritoneal cavity, but it, too, is not the appropriate treatment for this condition. A laparotomy is the surgical incision into the peritoneal cavity to explore it but is also not the appropriate treatment for late PPH.

When assessing a woman in the first stage of labor, which clinical finding will alert the nurse that uterine contractions are effective? Select one: a. Descent of the fetus to -2 station b. Rupture of the amniotic membranes c. Dilation of the cervix d. Increase in bloody show

c. Dilation of the cervix The vaginal examination reveals whether the woman is in true labor. Cervical change, especially dilation, in the presence of adequate labor, indicates that the woman is in true labor. Engagement and descent of the fetus are not synonymous and may occur before labor. ROM may occur with or without the presence of labor. Bloody show may indicate a slow, progressive cervical change (e.g., effacement) in both true and false labor.

A number of metabolic changes occur throughout pregnancy. Which physiologic adaptation of pregnancy will influence the nurse's plan of care? Select one: 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. During the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus. 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.

The nurse is assessing the neonate's skin and notes the presence of a rash with red macules and papules on the trunk. The name for this common neonatal skin condition is: a. Milia b. Neonatal acne c. Erythema toxicum d. Pustular melanosis

c. Erythema toxicum a benign rash which disappears without treatment.

A labor and delivery nurse is reviewing cultural concepts as they apply to birthing practices. Which culture should the nurse identify is the father is more likely to be expected to participate in the labor and delivery? Select one: a. Hispanic b. African-American c. European-American d. Asian-American

c. European-American Read pg. 22

The schedule for prenatal care includes which of the following? (select all that apply). Select one or more: a. First visit within the first 6 weeks b. Biweekly visits 36 to 40 weeks c. Every 2 weeks from 29 to 36 weeks gestation d. Every 4 weeks from 16 to 28 weeks gestation

c. Every 2 weeks from 29 to 36 weeks gestation d. Every 4 weeks from 16 to 28 weeks gestation First visit should be within the first 12 weeks (first trimester). Visits should be every week from 36-40 weeks. Biweekly visits from week 29-36 is recommended. Monthly visits from week 16 to 28 is the recommendation.

Strategies for culturally responsive care include (select all that apply): Select one or more: a. Practicing ethnocentrism b. Applying stereotyping c. Examining one's own biases d. Learning another language

c. Examining one's own biases d. Learning another language The only actions among the choices that are culturally responsive are examining one's own biases and learning another language or breaking down language barriers. Ethnocentrism and stereotyping are not culturally responsive actions. See pp 26-28 and Box 2-3

In which clinical situation would the nurse most likely anticipate a fetal bradycardia? Select one: a. Fetal anemia b. Tocolytic treatment using terbutaline c. Fetal cardiac problem d. Intraamniotic infection

c. Fetal cardiac problem Read p 366 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.

Which description of the four stages of labor is correct for both the definition and the duration? Select one: a. Second stage: full effacement to 4 to 5 cm; visible presenting part; 1 to 2 hours b. Fourth stage: delivery of the placenta to recovery; 30 minutes to 1 hour c. First stage: onset of regular uterine contractions to full dilation; great variability in duration d. Third stage: active pushing to birth; 20 minutes (multiparous woman), 50 minutes (nulliparous woman)

c. First stage: onset of regular uterine contractions to full dilation; great variability in duration Read p 328 Full dilation may occur in less than 1 hour, but in first-time pregnancies full dilation can take up to 20 hours. The second stage of labor extends from full dilation to birth and takes an average of 20 to 50 minutes, although 2 hours is still considered normal. The third stage of labor extends from birth to the expulsion of the placenta and usually takes a few minutes. The fourth stage begins after the expulsion of the placenta and lasts until homeostasis is reestablished (approximately 2 hours).

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 newborn's 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 nurse's most appropriate action? Select one: a. Leave the parents at the bedside while they are visiting so that they have some privacy. b. Tell the parents only about the newborn's physical condition and caution them to avoid touching their baby. c. 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. d. Wait quietly at the newborn's bedside until the parents come closer.

c. 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 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 infant's condition. Parents need to see and touch their infant as soon as possible to acknowledge the reality of the birth and the infant's appearance and condition. Encouragement from the nurse is instrumental in this process. Telling the parents only about the newborn's physical condition and cautioning them to avoid touching their baby is an inappropriate action.

Nurses with an understanding of cultural differences regarding likely reactions to pain may be better able to help their clients. Which clients may initially appear very stoic but then become quite vocal as labor progresses until late in labor, when they become more vocal and request pain relief? Select one: a. African-American b. Chinese c. Hispanic d. Arab or Middle Eastern

c. Hispanic Read p. 383 Hispanic women may be stoic early in labor but more vocal and ready for medications later. Chinese women may not show reactions to pain. Medical interventions must be offered more than once. Arab or Middle Eastern women may be vocal in response to labor pain from the start; they may prefer pain medications. African-American women may openly express pain; the use of medications for pain is more likely to vary with the individual.

A diagnostic test commonly used to assess problems of the fallopian tubes is: Select one: a. Endometrial biopsy b. Ovarian reserve testing c. Hysterosalpingogram d. Screening for sexually transmitted infections

c. Hysterosalpingogram Hysterosalpingogram provides information on the endocervical canal, uterine cavity, and fallopian tubes.

The nurse is teaching new parents about metabolic screening for the newborn. Which statement is most helpful to these clients? Select one: a. Federal law prohibits newborn genetic testing without parental consent. b. Hearing screening is now mandated by federal law. c. If genetic screening is performed before the infant is 24 hours old, then it should be repeated at age 1 to 2 weeks. d. All states test for phenylketonuria (PKU), hypothyroidism, cystic fibrosis, and sickle cell diseases.

c. If genetic screening is performed before the infant is 24 hours old, then it should be repeated at age 1 to 2 weeks. If testing is performed before the infant is 24 hours old, then genetic screening should be repeated when the infant is 1 to 2 weeks old. All states test for PKU and hypothyroidism but not for other genetic defects. Federal law mandates newborn genetic screening; however, parents can decline the testing. A waiver should be signed, and a notation made in the infants medical record. Federal law does not mandate screening for hearing problems; however, the majority of states have enacted legislation mandating newborn hearing screening. In the United States, the majority (95%) of infants are screened for hearing loss before discharge from the hospital.

Which cardiovascular changes cause the foramen ovale to close at birth? Select one: a. Changes in the hepatic blood flow b. Decreased blood flow to the left ventricle c. Increased pressure in the left atrium d. Increased pressure in the right atrium

c. Increased pressure in the left atrium With the increase in the blood flow to the left atrium from the lungs, the pressure is increased, and the foramen ovale is functionally closed. The hepatic blood flow changes, but that is not the only reason for the closure of the foramen ovale. The pressure in the right atrium decreases at birth as well.

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? Select one: a. If infants are weaned from breast milk before 12 months, then they should receive cow's milk, not formula. b. Infants fed on formula should be started on solid food sooner than breastfed infants. c. Infants should be given only human milk for the first 6 months of life. d. After 6 months, mothers should shift from breast milk to cow's milk.

c. Infants should be given only human milk for the first 6 months of life. 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.

Which condition is considered a medical emergency that requires immediate treatment? Select one: a. ITP b. Uterine atony c. Inversion of the uterus d. Hypotonic uterus

c. Inversion of the uterus likely to lead to hypovolemic shock and therefore is considered a medical emergency. Although hypotonic uterus, ITP, and uterine atony are serious conditions, they are not necessarily medical emergencies that require immediate treatment.

Angela is 12 weeks pregnant in October. She asks the nurse if she should get the flu shot. The nurse's best response would be: a. You should avoid all immunizations during pregnancy b. You should wait until you are at least 20 weeks pregnant. c. It is highly recommended you get the flu shot as it is more dangerous for you and your baby to get the flu during pregnancy than to get the shot d. I cannot tell you. You need to ask you physician.

c. It is highly recommended you get the flu shot as it is more dangerous for you and your baby to get the flu during pregnancy than to get the shot. Read page 283

A neonate born at 36 weeks gestation is classified as which of the following? Select one: a. Very preterm b. Moderately preterm c. Late preterm d. Term

c. Late Preterm Preterm Births are classified as: Very Premature (<32 weeks gestation); Moderately Premature (32-34 weeks gestation); and Late Premature (34-36 weeks gestation).

18 year old Ellen has a positive pregnancy test and cries when she sees the result. Per her LMP, the nurse determines she is approx 7 weeks pregnant. She asks the nurse what should she do. Which of the following is the nurse's best initial response? Select one: a. I think adoption would be your best choice at this time. b. Here is a list of clinics that provide abortions. My sister liked this one best. c. Let's discuss your three options. d. You need to decide what obstetrician you want to see for prenatal care.

c. Let's discuss your three options

A woman gave birth to a healthy infant boy 5 days ago. What type of lochia does the nurse expect to find when evaluating this client? Select one: a. Lochia rubra b. Lochia alba c. Lochia serosa d. Lochia sangra

c. Lochia serosa Lochia serosa, which consists of blood, serum, leukocytes, and tissue debris, generally occurs around day 3 or 4 after childbirth. Lochia rubra consists of blood and decidual and trophoblastic debris. The flow generally lasts 3 to 4 days and pales, becoming pink or brown. Lochia sangra is not a real term. Lochia alba occurs in most women after day 10 and can continue up to 6 weeks after childbirth.

The nurse is providing prenatal teaching to a group of diverse pregnant women. One woman, who indicates she smokes two to three cigarettes a day, asks about its impact on her pregnancy. The nurse explains that the most significant risk to the fetus is: Select one: a. Respiratory distress at birth b. Severe neonatal anemia c. Low neonatal birth weight d. Neonatal hyperbilirubinemia

c. Low neonatal birth weight Read p. 6

A client has been sexually assaulted and presents to the Emergency Department for a sexual assault examination. Which action would be a priority for the nurse assigned to take care of the client? Select one: a. Provide the client with contact information regarding psychological resources that may help her with dealing with this situation b. Ask the client for her insurance card so that you can validate information. c. Maintain chain of custody for collection of evidence. d. Provide the client with a washcloth and allow her to provide needed hygiene measures.

c. Maintain chain of custody for collection of evidence. Read pg. 94-96

During labor induction with oxytocin, the fetal heart rate baseline is in the 140s with moderate variability. Contraction frequency is assessed to be every 2-3 minutes with duration of 60 seconds, of moderate strength to palpation. Based on this assessment, the nurse should take which action? Select one: a. Increase oxytocin infusion rate per providers protocol b. Stop oxytocin infusion immediately c. Maintain present oxytocin infusion rate and continue to assess d. Decrease oxytocin infusion rate by 2 mU/min and report to provider

c. Maintain present oxytocin infusion rate and continue to assess The goal of oxytocin use in labor is to establish uterine contraction patterns that promote cervical dilation of about 1 cm/hr once in active labor. The lowest possible dose should be used to achieve labor progress. Generally, the labor pattern should be 3 UCs in 10 minutes, lasting 40-60 seconds with an intensity of 25-75 mm/HG with IUPC and resting tone <20 mm HG with 1 minute between each UC. The labor pattern described above is appropriate and no increase or decrease in oxytocin infusion rate is indicated

Nursing care measures are commonly offered to women in labor. Which nursing measure reflects the application of the gate-control theory? Select one: a. Give the prescribed medication. b. Encourage the woman to rest between contractions. c. Massage the woman's back. d. Change the woman's position.

c. Massage the woman's back. Read page 383-384 According to the gate-control theory, pain sensations travel along sensory nerve pathways to the brain, but only a limited number of sensations, or messages, can travel through these nerve pathways at one time. Distraction techniques, such as massage or stroking, music, focal points, and imagery, reduce or completely block the capacity of the nerve pathways to transmit pain. These distractions are thought to work by closing down a hypothetic gate in the spinal cord, thus preventing pain signals from reaching the brain. The perception of pain is thereby diminished. Changing the woman's position, administering pain medication, and resting between contractions do not reduce or block the capacity of the nerve pathways to transmit pain using the gate-control theory.

Early decelerations are probably caused by: Select one: a. Decreased maternal-fetal exchange b. Umbilical cord occlusion c. Momentary increase in intracranial pressure due to head compression d. Compression of umbilical cord

c. Momentary increase in intracranial pressure due to head compression Early decelerations are visually apparent, usually symmetrical, with a gradual decrease and return of FHR associated with a uterine contraction (UC). Early decels usually mirror the UC and are generally associated with fetal head compression resulting in a transient increase in intracranial pressure. Early decels are considered benign and require no intervention but should be documented in the nurse's charting.

Rho immune globulin will be ordered postpartum if which situation occurs? Select one: a. Mother Rh-, baby Rh- b. Mother Rh+, baby Rh- c. Mother Rh-, baby Rh+ d. Mother Rh+, baby Rh+

c. Mother Rh-, baby Rh+ An Rh- mother delivering an Rh+ baby may develop antibodies to fetal cells that entered her bloodstream when the placenta separated. The Rho immune globulin works to destroy the fetal cells in the maternal circulation before sensitization occurs. If mother and baby are both Rh+ or Rh the blood types are alike, so no antibody formation would be anticipated. If the Rh+ blood of the mother comes in contact with the Rh blood of the infant, no antibodies would develop because the antigens are in the mothers blood, not in the infants.

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? Select one: a. Increased physical activity b. Bradycardia, followed by an increased heart rate c. Mottled skin with acrocyanosis d. Decreased respiratory rate

c. Mottled skin with acrocyanosis 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 nurse's 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.

A group of nurses are discussing the impact of obesity in the United States. Which statements should the nurses indicate as being accurate? Select all that apply. Select one or more: a. Women who are obese may be more likely to have regular menstrual cycle. b. Obesity is associated with a decreased incidence of diabetes. c. Obesity is associated with hypercholesterolemia d. One third of women in the United States are currently considered to be obese. e. Women in the age group 40 to 59 years have the highest prevalence.

c. Obesity is associated with hypercholesterolemia d. One third of women in the United States are currently considered to be obese. e. Women in the age group 40 to 59 years have the highest prevalence. Read pg. 61 More than 1/3 of women in the US are obese (BMI of 30 or greater), with adults 40-59 years of age having the highest prevalence. Highest rates of obesity are found in Hispanic and non-Hispanic Blacks. Obesity is a risk factor for: premature death, diabetes, heart disease, stroke, hypertension, hypercholesterolemia, menstrual irregularities, hirsutism, stress incontinence, depression, pregnancy complications, and increased surgical risk (such as difficulty intubating).

The nurse is completing the lab order for a pap smear performed on a 22 year old female. Which of the following options will the nurse select? Select one: a. Pap smear- cytology with high risk HPV test b. Pap smear- cytology with reflux to high risk HPV test for ASCUS result c. Pap smear - cytology only d. Pap smear - no cytology, high risk HPV testing only

c. Pap smear - cytology only Read online article on cervical cancer screening

A woman who is 12 weeks postpartum presents with the following behavior: she reports severe mood swings and hearing voices, believes her infant is going to die, she has to be reminded to shower and put on clean clothes, and she feels she is unable to care for her baby. These behaviors are associated with which of the following? Select one: a. Postpartum blues b. Postpartum depression c. Postpartum psychosis d. Maladaptive mother-infant attachment

c. Postpartum psychosis Postpartum psychosis (PPP) is a variant of bipolar disorder and is the most serious form of postpartum mood disorders. Onset of symptoms can be as early as the 3rd postpartum day. Assessment findings include paranoia, delusions associated with the baby, mood swings, extreme agitation, confused thinking, inability to care for self or infant, and strange beliefs.

A multipara, 26 weeks' gestation and accompanied by her husband, has just delivered a fetal demise. Which of the following nursing actions is appropriate at this time? Select one: a. Encourage the parents to pray for the baby's soul. b. Advise the parents that it is better for the baby to have died than to have had to live with a defect. c. Provide opportunities for grieving parents and family members to spend time with the baby d. Advise the parents to refrain from discussing the baby's death with their other children.

c. Provide opportunities for grieving parents and family members to spend time with the baby a. It is inappropriate for the nurse to advise prayer. The parents must decide for themselves how they wish to express their spirituality. b. This is an inappropriate suggestion. c. This is an appropriate suggestion. Encouraging parents to spend time with their baby and hold their baby is an action that supports the parents during the grieving process. d. This is an inappropriate suggestion. It is very important for the parents to clearly communicate the baby's death with their other children.

What is the correct terminology for the nerve block that provides anesthesia to the lower vagina and perineum? Select one: a. Spinal block b. Local c. Pudendal d. Epidural

c. Pudendal Read p. 396 A pudendal block anesthetizes the lower vagina and perineum to provide anesthesia for an episiotomy and the use of low forceps, if needed. An epidural provides anesthesia for the uterus, perineum, and legs. A local provides anesthesia for the perineum at the site of the episiotomy. A spinal block provides anesthesia for the uterus, perineum, and down the legs.

When assessing the fetus using Leopold's maneuvers (See Box 19-5, page 440), the nurse feels a round, firm/hard, and movable fetal part in the fundal portion of the uterus and a long, smooth surface in the mother's right side close to midline. What is the position of the fetus? Select one: a. LSP b. ROA c. RSA d. LOA

c. RSA Fig 16-2 Fetal position is denoted with a three-letter abbreviation. The first letter indicates the presenting part in either the right or the left side of the maternal pelvis. The second letter indicates the anatomic presenting part of the fetus. The third letter stands for the location of the presenting part in relationship to the anterior, posterior, or transverse portion of the maternal pelvis. Palpation of a round, firm fetal part in the fundal portion of the uterus would be the fetal head, indicating that the fetus is in a breech position with the sacrum as the presenting part in the maternal pelvis. Palpation of the fetal spine along the mother's right side denotes the location of the presenting part in the mother's pelvis. The ability to palpate the fetal spine indicates that the fetus is anteriorly positioned in the maternal pelvis. This fetus is anteriorly positioned in the right side of the maternal pelvis with the sacrum as the presenting part. RSA is the correct three-letter abbreviation to indicate this fetal position. ROA denotes a fetus that is anteriorly positioned in the right side of the maternal pelvis with the occiput as the presenting part. LSP describes a fetus that is posteriorly positioned in the left side of the pelvis with the sacrum as the presenting part. A fetus that is LOA would be anteriorly positioned in the left side of the pelvis with the occiput as the presenting part.

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

c. Retinopathy of prematurity (ROP) 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 rupture of the fragile blood vessels in the ventricles of the brain. It is most often associated with hypoxic injury, increased blood pressure, and fluctuating cerebral blood flow.

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

c. Risk for infection 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.

A woman has requested an epidural for her pain. She is 5 cm dilated and 100% effaced. The baby is in a vertex position and is engaged. The nurse increases the woman's IV fluid for a preprocedural bolus. The nurse reviews her laboratory values and notes that the woman's hemoglobin is 12 g/dl, hematocrit is 38%, platelets are 67,000, and white blood cells (WBCs) are 12,000/mm 3 . Which factor would contraindicate an epidural for this woman? a. She is too far dilated. b. She is septic. c. She has thrombocytopenia. d. She is anemic.

c. She has thrombocytopenia. Her platelets are too low indicating a potential bleeding disorder that could increase risk of hematoma at insertion site, causing compression of the spinal cord and lead to serious CNS complications. Read p 402 Other Rationale: The platelet count indicates a coagulopathy, specifically, thrombocytopenia (low platelets), which is a contraindication to epidural analgesia and anesthesia. Typically, epidural analgesia and anesthesia are used in the laboring woman when a regular labor pattern has been achieved, as evidenced by progressive cervical change. The laboratory values show that the woman's hemoglobin and hematocrit levels are in the normal range and show a slight increase in the WBC count that is not uncommon in laboring women.

Which of the following is true about sperm? (select all that apply). Select one or more: a. All of the sperm a male will have are developed during prenatal development b. Sperm are formed in the vas deferens c. Sperm can live up to 72 hours in the female reproductive tract d. Sperm undergo primary mitosis in the testes e. There are approx 200-500 million sperm with each ejaculation.

c. Sperm can live up to 72 hours in the female reproductive tract e. There are approx 200-500 million sperm with each ejaculation. See pp 265-267 and powerpoint

A client is to take Clomiphene Citrate for infertility. Which of the following is the expected action of this medication? Select one: a. Decrease the symptoms of endometriosis b. Increase serum progesterone levels c. Stimulate release of FSH and LH d. Reduce the acidity of vaginal secretions

c. Stimulates release of FSH and LH Clomiphene triggers the brain's pituitary gland to secrete an increased amount of follicle stimulating hormone (FSH) and LH (luteinizing hormone). This action stimulates the growth of the ovarian follicle and thus initiates ovulation.

A woman on the day of discharge from the postpartum unit asks a number of questions regarding breastfeeding and shares that she is nervous about taking her baby home and not being able to remember everything she has been taught. These are behaviors associated with: Select one: a. Bonding b. Taking in c. Taking hold d. Attachment

c. Taking hold The "taking hold" phase indicates the movement between dependent and independent behaviors. During this phase, the mother may have feelings of inadequacy and being overwhelmed.

Which information should nurses provide to expectant mothers when teaching them how to evaluate daily fetal movement counts (DFMCs)? (Select all that apply) Select one or more: a. Alcohol or cigarette smoke can irritate the fetus into greater activity. b. Kick counts should be taken every ½ 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 three fetal movements in 1 hour warrants future evaluation.

c. The fetal alarm signal should go off when fetal movements stop entirely for 12 hours d. A count of less than three fetal movements in 1 hour warrants future evaluation. 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.

While performing Leopold's maneuvers on a woman in early labor, the nurse palpates a flat area in the fundal region, a hard round mass on the left side, a soft round mass on the right side, and small parts just above the symphysis. The nurse concludes which of the following? a. The fetal position is right occiput posterior. b. The fetal attitude is flexed. c. The fetal presentation is scapular. d. The fetal lie is vertical.

c. The fetal presentation is scapular Read powerpoint presentation and Box 19-5 **Note: This is odd because the baby's shoulders are up in the fundus not engaging in the pelvis so if Transverse was an option that would make more sense.

A nurse is preparing to make a family assessment. Which statement would the nurse select to best explain the difference between an echomap and a genogram? Select one: a. The genogram provides a glimpse of the family structure for one generation whereas the echomap provides a more detailed view of multiple generations. b. Software is needed to create an echomap whereas a genogram can be drawn by hand. c. The genogram provides generational aspects whereas the echomap provides social aspects of the family. d. They are equivalent assessments in that they both represent a graphic interpretation.

c. The genogram provides generational aspects whereas the echomap provides social aspects of the family Read pg. 19-21

Which statement regarding hemolytic diseases of the newborn is most accurate? Select one: a. Rh incompatibility matters only when an Rh-negative child is born to an Rh-positive mother. b. Exchange transfusions are frequently required in the treatment of hemolytic disorders. c. The indirect Coombs' test is performed on the mother before birth; the direct Coombs' test is performed on the cord blood after birth. d. ABO incompatibility is more likely than Rh incompatibility to precipitate significant anemia.

c. The indirect Coombs' test is performed on the mother before birth; the direct Coombs' test is performed on the cord blood after birth. An indirect Coombs test may be performed on the mother a few times during pregnancy. Only the Rh-positive child of an Rh-negative mother is at risk. ABO incompatibility is more common than Rh incompatibility but causes less severe problems; significant anemia, for instance, is rare with ABO. Exchange transfers infrequently are needed because of the decrease in the incidence of severe hemolytic disease in newborns from Rh incompatibility.

A woman who is 6 months pregnant has sought medical attention, saying she fell down the stairs. What scenario would cause an emergency department nurse to suspect that the woman has been a victim of IPV? Select one: a. The woman and her partner are having an argument that is loud and hostile. b. She avoids making eye contact and while answering questions. c. The woman has injuries on various parts of her body that are in different stages of healing. d. Examination reveals a fractured arm and fresh bruises.

c. The woman has injuries on various parts of her body that are in different stages of healing. Read pg. 86-90 The client may have multiple injuries in various stages of healing that indicates a pattern of violence. An argument is not always an indication of battering. A fractured arm and fresh bruises could be caused by the reported fall and do not necessarily indicate IPV. It may be normal for the woman to be reticent and have a dull affect.

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 nurse's role at this time? Select one: a. To encourage the grandparents to take over b. To take over as much as possible to relieve the pressure c. To ensure that the parents, themselves, approve the final decisions d. To leave them alone to work things out

c. To ensure that the parents, themselves, approve the final decisions The nurse is always the client's 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 nurse's 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.

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

c. Unless a blood vessel is involved, linear skull fractures heal without special treatment 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.

During a health history interview, a woman tells the nurse that her husband physically abuses her. The nurse's priority response should be to: Select one: a. Give the woman referrals to local agencies and shelters where she can obtain help. b. Formulate an escape plan for the woman that she can use the next time her husband abuses her. c. Reassure the woman that the abuse is not her fault. d. Advise the woman of mandatory state reporting laws pertaining to abuse and confidentiality.

d. Advise the woman of mandatory state reporting laws pertaining to abuse and confidentiality Read Legal Aspects pg. 88

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? Select one: a. "I can continue with the same diet as before pregnancy as long as it is well balanced." b. "I will need to eat 600 more calories per day because I am pregnant." c. "I will plan my diet based on the results of urine glucose testing." d. "Diet and insulin needs change during pregnancy."

d. "Diet and insulin needs change during pregnancy." 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.

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

d. "I burp my daughter during and after the feeding as needed." 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.

47 y/o Sallie is interested in HRT for her hot flushes and vaginal dryness. She has high blood pressure and her LMP was 3 months ago. She asks the nurse what can she use? What is the nurse's best response? Select one: a. "You cannot take HRT since your blood pressure is high." b. "All women should take the bio-identical estrogen and progesterone pills." c. "You need to be on the birth control pill for your symptoms and contraception." d. "It would be best to talk to the health care provider to determine what type of HRT might be best for you."

d. "It would be best to talk to the health care provider to determine what type of HRT might be best for you." It is beyond the nurse's scope of practice to tell the patient what HRT she should use. It is best to refer her to her health care provider.

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 best response by the nurse? Select one: 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. "Oral contraceptives are the only form of birth control that will prevent a recurrence of a molar pregnancy." 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. "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."

d. "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." 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.

An expectant father confides in the nurse that his pregnant wife, at 10 weeks of gestation, is driving him crazy. "One minute she seems happy, and the next minute she is crying over nothing at all. Is there something wrong with her?" What is the nurse's best reponse? Select one: a. "You seem inclement with her. Perhaps this is precipitating her behavior." b. "She may be having difficulty adjusting to pregnancy; I will refer her to a counselor I know." c. "This is normal behavior and should begin to subside by the second trimester." d. "This is called emotional lability and is related to hormone changes and anxiety during pregnancy. The mood swings will eventually subside as she adjusts to being pregnant."

d. "This is called emotional lability and is related to hormone changes and anxiety during pregnancy. The mood swings will eventually subside as she adjusts to being pregnant." This statement is the most appropriate response because it gives an explanation and a time frame for when the mood swings may stop.

Which statement is the most appropriate for the nurse to make when caring for bereaved parents? Select one: 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. "What can I do for you?" 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 clichés. Unless the nurse has lost a child, he or she does not understand how the parents feel.

Which statement concerning the third stage of labor is correct? Select one: a. The placenta eventually detaches itself from a flaccid uterus. b. It is important that the dark, roughened maternal surface of the placenta appears before the shiny fetal surface. c. The major risk for women during the third stage is a rapid heart rate. d. An expectant or active approach to managing this stage of labor reduces the risk of complications.

d. An expectant or active approach to managing this stage of labor reduces the risk of complications. Active management facilitates placental separation and expulsion, reducing the risk of complications. The placenta cannot detach itself from a flaccid (relaxed) uterus. Which surface of the placenta comes out first is not clinically important. The major risk for women during the third stage of labor is postpartum hemorrhaging.

The clinic nurse sees Xiao and her infant in the clinic for their 2-week follow-up visit. Xiao appears to be tired, her clothes and hair appear unwashed, and she does not make eye contact with her infant. She is carrying her son in the infant carrier and when asked to put him on the examining table, she holds him away from her body. The clinic nurse's most appropriate question to ask would be: Select one: a. "What has happened to you?" b. "Do you have help at home?" c. "Is there anything wrong with your son?" d. "Would you tell me about the first few days at home?"

d. "Would you tell me about the first few days at home?" The well-baby checkup that generally takes place 1 to 2 weeks following the hospital discharge may offer the first opportunity to assess the mother-baby dyad. In this setting, the nurse needs to be alert for subtle cues from the new mother, such as making negative comments about the baby or herself, ignoring the baby's or other children's needs, as well as the mother's physical appearance. In a private area, the nurse should take time to explore the new mother's feelings. A nonthreatening way to open the dialogue might be to say: "Tell me how the first few days at home have gone." This statement provides the new mother with an opportunity to share both positive and negative impressions.

Which of the following prenatal tests is done to screen for gestational diabetes? Select one: a. 3 hr GTT test b. GBS testing c. Sequential integrated screening d. 1 hr GTT test

d. 1 hr GTT test Read Table 14-1 Note: 3 hr GTT test is the follow up to diagnose gestational diabetes. For a 1-hour glucose challenge test, a 75-g oral glucose load is given, without regard to the timing or content of the last meal. Blood glucose is measured 1 hour later; a level above 140 mg/dL is abnormal. If the result is abnormal, a 3-hour glucose tolerance test is done.

A woman's obstetric history indicates that she is pregnant for the fourth time, and all of her children from previous pregnancies are living. One was born at 39 weeks of gestation, twins were born at 34 weeks of gestation, and another child was born at 35 weeks of gestation. What is her gravidity and parity using the GTPAL system? Select one: a. 3-0-3-0-3 b. 4-2-1-0-3 c. 3-1-1-1-3 d. 4-1-2-0-4

d. 4-1-2-0-4 Twins count as one G and one delivery with 2 babies.

Mary G10000 is 38 weeks pregnant and has been diagnosed with severe preeclampsia. The physician orders magnesium sulfate infusion for Mary, which includes a maintenance dose of 2 grams/hr. Her IV is a premixed magnesium sulfate solution of 40grams per 1000mL. What will the nurse program the infusion pump to deliver 2 grams/hr? Select one: a. 20mL/hr b. 40mL/hr c. 80mL/hr d. 50 mL/hr

d. 50 mL/hr

Which client is most likely to experience strong and uncomfortable afterpains? Select one: a. A woman who is bottle-feeding her infant b. A woman who experienced oligohydramnios c. A woman whose infant weighed 5 pounds, 3 ounces d. A woman who is a gravida 4-4-0-0-4

d. A woman who is gravida 4-4-0-0-4 Afterpains are more common in multiparous women. In a woman who experienced polyhydramnios, afterpains are more noticeable because the uterus was greatly distended. Breastfeeding may cause the afterpains to intensify. In a woman who delivered a large infant, afterpains are more noticeable because the uterus was greatly distended.

Which nutritional recommendation regarding fluids is accurate? Select one: a. Coffee should be limited to no more than 2 cups, but tea and cocoa can be consumed without worry. b. Water with fluoride is especially encouraged because it reduces the child's risk of tooth decay. c. Of the artificial sweeteners, only aspartame has not been associated with any maternity health concerns. d. A woman's daily intake should be six to eight glasses of water, milk, and/or decaffeinated drinks.

d. A woman's daily intake should be six to eight glasses of water, milk, and/or decaffeinated drinks. Read page 352 Six to eight glasses is still the standard for fluids; however, they should be the right fluids. All beverages containing caffeine, including tea, cocoa, and some soft drinks, should be avoided or should be consumed only in limited amounts. Artificial sweeteners, including aspartame, have no ill effects on the normal mother or fetus. However, mothers with phenylketonuria (PKU) should avoid aspartame. Although no evidence indicates that prenatal fluoride consumption reduces childhood tooth decay, fluoride still helps the mother.

Which description of the phases of the second stage of labor is most accurate? Select one: a. Transitional phase: Woman "laboring down"; fetal station 0; duration of 15 minutes b. Latent phase: Feeling sleepy; fetal station 2+ to 4+; duration of 30 to 45 minutes c. Active phase: Overwhelmingly strong contractions; Ferguson reflux activated; duration of 5 to 15 minutes d. Active pushing phase (AKA Descent Phase): Significant increase in contractions; Ferguson reflux activated; average duration varies

d. Active pushing phase (AKA Descent Phase): Significant increase in contractions; Ferguson reflux activated; average duration varies Read Table 19-4 The descent phase begins with a significant increase in contractions; the Ferguson reflex is activated, and the duration varies, depending on a number of factors. The latent phase is the lull or "laboring down" period at the beginning of the second stage and lasts 10 to 30 minutes on average. The second stage of labor has no active phase. The transition phase is the final phase in the second stage of labor; contractions are strong and painful.

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? Select one: a. Anticipatory grief b. Reorganization c. Intense grief d. Acute distress

d. Acute distress 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 infant's 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.

A woman exhibits symptoms that may lead to a possible diagnosis of polycystic ovary syndrome (PCOS). While completing the initial assessment of the client, which clinical finding would the nurse not anticipate? Select one: a. Hirsutism b. Irregular menses c. Infertility d. Anorexia

d. Anorexia These clients often are obese rather than anorexic with weight loss. Approximately 40% of these women also display glucose intolerance and hyperinsulinemia. Excessive hair growth is often present in women with PCOS. This client is likely to have irregular menses or even amenorrhea. Infertility as a result of decreased levels of follicle-stimulating hormone is common with this syndrome.

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

d. Assess for dyspnea and crackles 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.

A multiparous woman has been in labor for 8 hours. Her membranes have just ruptured. What is the nurse's highest priority in this situation? Select one: a. Document the characteristics of the fluid. b. Notify the woman's primary health care provider. c. Prepare the woman for imminent birth. d. Assess the fetal heart rate (FHR) and pattern.

d. Assess the FHR and pattern The umbilical cord may prolapse when the membranes rupture. The FHR and pattern should be closely monitored for several minutes immediately after the ROM to ascertain fetal well-being, and the findings should be documented. The ROM may increase the intensity and frequency of the uterine contractions, but it does not indicate that birth is imminent. The nurse may notify the primary health care provider after ROM occurs and the fetal well-being and response to ROM have been assessed. The nurse's priority is to assess fetal well-being. The nurse should document the characteristics of the amniotic fluid, but the initial response is to assess fetal well-being and the response to ROM.

Preeclampsia begins at what point during the pregnancy? Select one: a. At conception b. At 12 weeks gestation c. After 20 weeks gestation d. At placental implantation

d. At placental implantation

According to the CDC, which of the following has the highest maternal mortality rate in the United States? Select one: a. Asian Women b. Hispanic Women c. White Women d. Black Women

d. Black women

A pregnant woman's diet may not meet her increased need for folates. Which food is a rich source of this nutrient (50 mcg or more per serving)? Select one: a. Milk b. Eggs c. Nuts d. Broccoli

d. Broccoli Read Table and Box 15-1 Sources of folate include green leafy vegetables, whole grains, fruits, liver, dried peas, and beans. Chicken is a good source of protein, but poor in folate. Cheese is an excellent source of calcium, but poor in folate. Potatoes contain carbohydrates and vitamins but are poor in folate.

A mother refused to allow her son to receive the vitamin K injection at birth. Which of the following signs or symptoms might the nurse observe in the baby as a result? Select one: a. Skin color is dusky. b. Vital signs are labile. c. Glucose levels are subnormal. d. Circumcision site oozes blood.

d. Circumcision site oozes blood. Vitamin K activates coagulation factors which prevent delayed clotting and hemorrhagic disease

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

d. Colostrum is high in antibodies, protein, vitamins, and minerals 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.

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? Select one: a. HIV b. Herpes simplex virus (HSV) infection c. Gonorrhea d. Congenital syphilis

d. Congenital syphilis 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.

When a nurse is unsure about how to perform a client care procedure, the best action would be to: Select one: a. Look up the procedure in a nursing textbook. b. Ask another nurse. c. Discuss the procedure with the client's physician. d. Consult the agency procedure manual and follow the guidelines for the procedure.

d. Consult the agency procedure manual and follow the guidelines for the procedure. Read page 11 - Legal Tip Following the agency's policies and procedures manual is always best when seeking information on correct client procedures. These policies should reflect the current standards of care and the individual state's guidelines. Each nurse is responsible for his or her own practice. Relying on another nurse may not always be a safe practice. Each nurse is obligated to follow the standards of care for safe client care delivery. Physicians are responsible for their own client care activity. Nurses may follow safe orders from physicians, but they are also responsible for the activities that they, as nurses, are to carry out. Information provided in a nursing textbook is basic information for general knowledge. Furthermore, the information in a textbook may not reflect the current standard of care or the individual state or hospital policies.

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

d. Cry face; eyes squeezed; increase in BP 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.

Dysfunctional uterine bleeding (DUB) is defined as excessive uterine bleeding without a demonstrable cause. Which statement regarding this condition is most accurate? Select one: a. DUB most often occurs in middle age. b. Steroids are the most effective medical treatment for DUB. c. The diagnosis of DUB should be the first consideration for abnormal menstrual bleeding. d. DUB is most commonly caused by anovulation.

d. DUB is most commonly caused by anovulation. Anovulation may occur because of hypothalamic dysfunction or polycystic ovary syndrome. DUB most often occurs when the menstrual cycle is being established or when it draws to a close at menopause. A diagnosis of DUB is made only after all other causes of abnormal menstrual bleeding have been ruled out. The most effective medical treatment is oral or intravenous estrogen.

The perinatal nurse listens as Chantal describes her labor and emergency cesarean birth. Providing an opportunity to review this experience may assist Chantal in: Select one: a. Her role development in the "letting go" stage b. Decreasing her ambivalence about her labor and birth c. Understanding her guilt involved in her labor and birth d. Developing more positive feelings about her labor and birth

d. Developing more positive feelings about her labor and birth After a cesarean birth, especially when unplanned, nurses must be aware of the myriad of potential psychological issues that may arise. Research suggests that women may perceive cesarean birth to be a less positive experience than a vaginal birth. Unplanned or emergent cesarean deliveries and the experience of cesarean birth may be associated with more negative perceptions of the birthing experience. Allowing Chantal to talk about the experience can help her develop a more positive attitude about her own experience.

The uterine contractions of a woman early in the active phase of labor are assessed by an internal uterine pressure catheter (IUPC). The uterine contractions occur every 3 to 4 minutes and last an average of 55 to 60 seconds. They are becoming more regular and are moderate to strong. Based on this information, what would a prudent nurse do next? Select one: a. Prepare the woman for the onset of the second stage of labor. b. Immediately notify the woman's primary health care provider. c. Prepare to administer an oxytocic to stimulate uterine activity. d. Document the findings because they reflect the expected contraction pattern for the active phase of labor.

d. Document the findings because they reflect the expected contraction pattern for the active phase of labor. The nurse is responsible for monitoring the uterine contractions to ascertain whether they are powerful and frequent enough to accomplish the work of expelling the fetus and the placenta. In addition, the nurse documents these findings in the client's medical record. This labor pattern indicates that the client is in the active phase of the first stage of labor. Nothing indicates a need to notify the primary health care provider at this time. Oxytocin augmentation is not needed for this labor pattern; this contraction pattern indicates that the woman is in active labor. Her contractions will eventually become stronger, last longer, and come closer together during the transition phase of the first stage of labor. The transition phase precedes the second stage of labor, or delivery of the fetus.

Which intervention can nurses use to prevent evaporative heat loss in the newborn? Select one: a. Keeping the baby out of drafts and away from air conditioners b. Warming the stethoscope and the nurse's hands before touching the baby c. Placing the baby away from the outside walls and windows d. Drying the baby after birth, and wrapping the baby in a dry blanket

d. Drying the baby after birth, and wrapping the baby in a dry blanket Because the infant is wet with amniotic fluid and blood, heat loss by evaporation quickly occurs. Heat loss by convection occurs when drafts come from open doors and air currents created by people moving around. If the heat loss is caused by placing the baby near cold surfaces or equipment, it is referred to as a radiation heat loss. Conduction heat loss occurs when the baby comes in contact with cold surfaces.

When caring for a pregnant woman with cardiac problems, the nurse must be alert for the signs and symptoms of cardiac decompensation. Which critical findings would the nurse find on assessment of the client experiencing this condition? Select one: a. Increased urinary output, tachycardia, and dry cough b. Regular heart rate and hypertension c. Shortness of breath, bradycardia, and hypertension d. Dyspnea, crackles, and an irregular, weak pulse

d. Dyspnea, crackles, and an irregular, weak pulse Signs of cardiac decompensation include dyspnea; crackles; an irregular, weak, and rapid pulse; rapid respirations; a moist and frequent cough; generalized edema; increasing fatigue; and cyanosis of the lips and nailbeds.

Which guidance might the nurse provide for a client with severe morning sickness? Select all that apply. Select one or more: a. Never snacking before bedtime b. Drinking plenty of fluids early in the day c. Immediately brushing her teeth after eating d. Eat toast or crackers e. Eat small, frequent amounts of food

d. Eat toast or crackers e. Eat small, frequent amounts of food Read Teaching for Self Management page 314 Eating dry, starchy foods such as toast or crackers upon waking up is recommended. Avoiding large meals, and eating small/frequent amounts (q 2-3hrs) is recommended. Interestingly, some women can tolerate tart or salty foods when they are nauseated. Lemonade and potato chips are an ideal combination. The woman should avoid drinking too much when nausea is most likely, but she should increase her fluid levels later in the day when she feels better. The woman should avoid brushing her teeth immediately after eating. A small snack of cereal and milk or yogurt before bedtime may help the stomach in the morning.

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

d. Intravenous (IV) therapy to correct fluid and electrolyte imbalances Initially, the woman who is unable to down clear liquids by mouth requires IV therapy to correct fluid and electrolyte imbalances.

When managing the care of a woman in the second stage of labor, the nurse uses various measures to enhance the progress of fetal descent. Which instruction best describes these measures? a. Telling the woman to start pushing as soon as her cervix is fully dilated b. Continuing an epidural anesthetic so pain is reduced and the woman can relax c. Coaching the woman to use sustained, 10- to 15-second, closed-glottis bearing-down efforts with each contraction d. Encouraging the woman to try various upright positions, including squatting and standing

d. Encouraging the woman to try various upright positions, including squatting and standing Both upright and squatting positions may enhance the progress of fetal descent. Many factors dictate when a woman should begin pushing. Complete cervical dilation is necessary, but complete dilation is only one factor. If the fetal head is still in a higher pelvic station, then the physician or midwife may allow the woman to "labor down" if the woman is able (allowing more time for fetal descent and thereby reducing the amount of pushing needed). The epidural may mask the sensations and muscle control needed for the woman to push effectively. Closed glottic breathing may trigger the Valsalva maneuver, which increases intrathoracic and cardiovascular pressures, reducing cardiac output and inhibiting perfusion of the uterus and placenta. In addition, holding her breath for longer than 5 to 7 seconds diminishes the perfusion of oxygen across the placenta and results in fetal hypoxia.

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

d. Ensuring the baby is clothed or wrapped if the parents choose to visit with the baby 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.

The perinatal nurse teaches the postpartum woman about the normal process of diuresis that she can expect to occur approximately 6 to 8 hours after birth. A decrease in which of the following hormones is primarily responsible for the diuresis? Select one: a. Prolactin b. Progesterone c. Lactogen d. Estrogen

d. Estrogen Maternal diuresis occurs almost immediately after birth and urinary output reaches up to 3000 mL each day by the second to fifth postpartum days. After childbirth, a decrease in the level of estrogen naturally occurs and contributes to the diuresis.

A woman who is gravida 3 para 2 arrives on the intrapartum unit. What is the most important nursing assessment at this time? Select one: a. Identification of ruptured membranes, woman's medical history, and her support person b. Last food intake, when labor began, and cultural practices the couple desires c. Contraction pattern, amount of discomfort, and outcomes of other pregnancy d. FHR, maternal vital signs, and the woman's nearness to birth

d. FHR, maternal vital signs, and the woman's nearness to birth All options describe relevant intrapartum nursing assessments; however, this focused assessment has a priority. If the maternal and fetal conditions are normal and birth is not imminent, then other assessments can be performed in an unhurried manner; these include: gravida, para, support person, pregnancy history, pain assessment, last food intake, and cultural practices.

A nurse is reviewing the perinatal continuum of care. Which option should the nurse identify as representing the beginning of the continuum? Select one: a. The interval just before birth b. The diagnosis of pregnancy. c. Identification of a pregnant woman as high risk. d. Family planning and preconception care.

d. Family planning and preconception care Read pg. 27 The perinatal continuum of care begins with family planning and continues until the infant is 1 year old. It takes place both at home and in health care facilities. The perinatal continuum does not end with the birth. The perinatal continuum begins before conception and continues after the birth. Home care is one delivery component; health care facilities are another.

Postoperative care of the pregnant woman who requires abdominal surgery for appendicitis includes which additional assessment? Select one: a. Signs and symptoms of infection b. Vital signs and incision c. Intake and output (I&O) and intravenous (IV) site d. Fetal heart rate (FHR) and uterine activity

d. Fetal heart rate (FHR) and uterine activity Care of a pregnant woman undergoing surgery for appendicitis differs from that for a nonpregnant woman in one significant aspect: the presence of the fetus. Continuous fetal and uterine monitoring should take place.

Certain changes stimulate chemoreceptors in the aorta and carotid bodies to prepare the fetus for initiating respirations immediately after birth. Which change in fetal physiologic activity is not part of this process? Select one: a. Fetal lung fluid is cleared from the air passages during labor and vaginal birth. b. Fetal partial pressure of carbon dioxide in arterial blood (PaCO2) increases. c. Fetal partial pressure of oxygen (PO2) decreases. d. Fetal respiratory movements increase during labor.

d. Fetal respiratory movements increase during labor. Read p 379 Fetal respiratory movements actually decrease during labor. Fetal lung fluid is cleared from the air passages during labor and vaginal birth. Fetal PO2 decreases, and fetal PaCO2 increases.

Which important component of nutritional counseling should the nurse include in health teaching for a pregnant woman who is experiencing cholecystitis? Select one: a. Assess the woman's dietary history for adequate calories and proteins. b. Instruct the woman to eat a low-cholesterol, low-salt diet. c. Teach the woman that the bulk of calories should come from proteins. d. Instruct the woman to eat a low-fat diet and to avoid fried foods.

d. Instruct the woman to eat a low-fat diet and to avoid fried foods. Eating a low-fat diet and avoiding fried foods is appropriate nutritional counseling for this client. Caloric and protein intake do not predispose a woman to the development of cholecystitis. The woman should be instructed to limit protein intake and choose foods that are high in carbohydrates. A low-cholesterol diet may be the result of limiting fats. However, a low-salt diet is not indicated.

Which collection of risk factors will most likely result in damaging lacerations, including episiotomies? Select one: a. Dark-skinned woman who has had more than one pregnancy, who is going through second-stage labor, and who is attended by a midwife b. Reddish-haired mother of two who is going through a vertex birth c. Dark-skinned first-time mother who is going through a long labor d. First-time mother with reddish hair whose rapid labor was overseen by an obstetrician

d. First-time mother with reddish hair whose rapid labor was overseen by an obstetrician A rapid labor, especially on a vagina and perineum that has never undergone birth and light-skinned reddish hair patient, can result in a fast delivery that can increase risk for injury. Other Rationale: Reddish-haired women have tissue that is less distensible than darker-skinned women and therefore may have less efficient healing. First-time mothers are also at greater risk, especially with breech births, long second-stage labors, or rapid labors during which the time for the perineum to stretch is insufficient. The rate of episiotomies is higher when obstetricians rather than midwives attend the births. The woman in the first scenario (a) is at low risk for either damaging lacerations or an episiotomy. She is multiparous, has dark skin, and is being attended by a midwife, who is less likely to perform an episiotomy. Reddish-haired women have tissue that is less distensible than that of darker-skinned women. Consequently, the client in the second scenario (b) is at increased risk for lacerations; however, she has had two previous deliveries, which result in a lower likelihood of an episiotomy. The fact that the woman in the third scenario (c) is experiencing a prolonged labor might increase her risk for lacerations. Fortunately, she is dark skinned, which indicates that her tissue is more distensible than that of fair-skinned women and therefore less susceptible to injury.

Which statement, related to the reconditioning of the urinary system after childbirth, should the nurse understand? Select one: a. Diastasis recti abdominis is a common condition that alters the voiding reflex. b. Kidney function returns to normal a few days after birth. c. With adequate emptying of the bladder, bladder tone is usually restored 2 to 3 weeks after childbirth. d. Fluid loss through perspiration and increased urinary output accounts for a weight loss of more than 2 kg during the puerperium.

d. Fluid loss through perspiration and increased urinary output accounts for a weight loss of more than 2 kg during the puerperium. Excess fluid loss through other means besides perspiration and increased urinary output occurs as well. Kidney function usually returns to normal in approximately 1 month. Diastasis recti abdominis is the separation of muscles in the abdominal wall and has no effect on the voiding reflex. Bladder tone is usually restored 5 to 7 days after childbirth.

Which of the following antepartum tests is (are) used to evaluate a Multiple Marker Screening test that is negative for increased risk? Select one: a. CVS b. Amniocentesis c. Biophysical profile d. Further followup test not necessary

d. Further followup test not necessary

To explain hemolytic disorders in the newborn to new parents, the nurse who cares for the newborn population must be aware of the physiologic characteristics related to these conditions. What is the most common cause of pathologic hyperbilirubinemia? a. Postmaturity b. Hepatic disease c. Congenital heart defect d.Hemolytic disorders

d. Hemolytic disorders Hemolytic disorders in the newborn are the most common cause of pathologic jaundice. Hepatic damage may be a cause of pathologic hyperbilirubinemia, but it is not the most common cause. Prematurity would be a potential cause of pathologic hyperbilirubinemia in neonates, but it is not the most common cause. Congenital heart defect is not a common cause of pathologic hyperbilirubinemia in neonates.

A nurse is reviewing maternal medical risk factors. Which of the following would the nurse identify as being the two most frequently reported maternal medical risk factors? Select one: a. Behaviors and lifestyles. b. Drug use and alcohol abuse. c. Homelessness and lack of insurance. d. Hypertension associated with pregnancy and diabetes.

d. Hypertension associated with pregnancy and diabetes. Read pg. 7 Hypertension and diabetes are the most frequently reported maternal risk factors. Both are associated with obesity. Approximately 20% of U.S. women who give birth are obese. Obesity in pregnancy is associated with the use of more health care services and longer hospital stays. Both drug use and alcohol abuse continue to increase in the maternal population; they are associated with low-birth-weight infants, mental retardation, and birth defects. The number of clients who are homeless or lack health care insurance is increasing; however, these are not the most common risks. Behavior and lifestyle choices do contribute to the health of the mother and fetus.

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? Select one: a. Spinal cord injuries almost always result from vacuum-assisted deliveries. b. Subarachnoid hemorrhage (the most common form of ICH) occurs in term infants as a result of hypoxia. c. Intracranial hemorrhage (ICH) as a result of birth trauma is more likely to occur in the preterm, low-birth-weight infant. d. In many infants, signs of hemorrhage in a full-term infant are absent and diagnosed only through laboratory tests.

d. In many infants, signs of hemorrhage in a full-term infant are absent and diagnosed only through laboratory tests. 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.

Maternal hypotension is a potential side effect of regional anesthesia and analgesia. What nursing interventions could the nurse use to increase the client's blood pressure? (Select all that apply.) Select one or more: a. Perform a vaginal examination. b. Catheterize the patient. c. Place the woman in a supine position. d. Increase IV fluids. e. Administer oxygen f. Place the woman in a lateral position.

d. Increase IV fluids. e. Administer oxygen f. Place the woman in a lateral position. Read emergency box page 399 Nursing interventions for maternal hypotension arising from analgesia or anesthesia include turning the woman to a lateral position, increasing IV fluids, administering oxygen via face mask, elevating the woman's legs, notifying the physician, administering an IV vasopressor, and monitoring the maternal and fetal status at least every 5 minutes until the woman is stable. Placing the client in a supine position causes venous compression, thereby limiting blood flow to and oxygenation of the placenta and fetus. A sterile vaginal examination has no bearing on maternal blood pressure.

Elisa asks the nurse why a bimanual examination is done? Select one: a. It allows for the provider to inspect your cervix and vaginal walls. b. It allows for the provider to inspect your uterus and ovaries. c. It enables the provider to inspect the vulva and vaginal os. d. It allows for the provider to palpate your uterus and ovaries.

d. It allows for the provider to palpate your uterus and ovaries. Bimanual examination of the cervix, uterus, fallopian tubes, and ovaries is performed by the provider.The provider inserts two gloved fingers into the vagina and traps the reproductive structures between the fingers of the one hand and the fingers of the opposite hand that is on the abdomen. Palpation of the structures is done during this time.

According to the CDC, which of the following are true? Select one: a. Maternal mortality rate in the US has increased but infection is no longer a significant cause. b. Maternal mortality rate in the US has decreased from 1987-2013 c. Maternal mortality rate in the US has increased primarily due to anesthesia complications d. Maternal mortality rate in the US has increased from 1987-2013

d. Maternal mortality rate in the US has increased from 1987-2013

A patient, G1 P0, is admitted to the labor and delivery unit for induction of labor. The following assessments were made on admission: Bishop score of 4, fetal heart rate 140s with moderate variability and no decelerations, TPR 98.6°F, 88, 20, BP 120/80, negative obstetrical history. A prostaglandin suppository was inserted at that time. Which of the following findings, 6 hours after insertion, would warrant the removal of the Cervidil (dinoprostone)? Select one: a. Bishop score of 5 b. Fetal heart of 152 bpm c. Respiratory rate of 24 rpm d. More than 5 contractions in 10 minutes

d. More than 5 contractions in 10 minutes Feedback a. A Bishop score of 9 or higher indicates that the primigravida woman's cervix is ripe. b. A fetal heart rate of 152 is within normal limits for this fetus. c. A respiratory rate of 24 is within normal limits. d. Cervidil should be removed for tachysystole.

A nursery nurse observes that a full-term AGA neonate has nasal congestion, hypertonia, and tremors and is extremely irritable. Based on these observations, the nurse suspects which of the following? Select one: a. Hypoglycemia b. Hypercalcemia c. Cold stress d. Neonatal withdrawal

d. Neonatal withdrawal a. Signs and symptoms of hypoglycemia are jitteriness, hypotonia, irritability, apnea, lethargy, and temperature instability, but not nasal congestion. b. Signs and symptoms of hypercalcemia are vomiting, constipation, and cardiac arrhythmias. c. Signs and symptoms of cold stress are decreased temperature, cool skin, lethargy, pallor, tachypnea, hypotonia, jitteriness, weak cry, and grunting. d. These are common signs and symptoms of neonatal withdrawal.

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? Select one: a. Bradycardia b. Tachycardia c. Hypoxia d. Normal baseline heart rate

d. Normal baseline heart rate Normal baseline fetal heart rate is 110-160bpm during labor

A woman who is 16 weeks pregnant has come in for a follow-up visit with her significant other. To reassure the client regarding fetal well-being, which is the highest priority action for the nurse to perform? Select one: a. Complete an ultrasound examination (sonogram). b. Measure the girth of the woman's abdomen. c. Assess the fetal heart tones with a stethoscope. d. Offer the woman and her family the opportunity to listen to the fetal heart tones

d. Offer the woman and her family the opportunity to listen to the fetal heart tones. Best answer for this question

What is the correct placement of the tocotransducer for effective EFM? Select one: a. Inside the uterus b. Over the mother's lower abdomen c. On the fetal scalp d. Over the uterine fundus

d. Over the uterine fundus Read pp 362-363 and powerpoint 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.

The nurse is massaging a boggy uterus. The uterus does not respond to the massage. Which medication would the nurse expect would be given first: Select one: a. Methergine b. Epinephrine c. Carboprost (Hemabate) d. Oxytocin or pitocin

d. Oxytocin or pitocin If the cause of the hemorrhage is uterine atony, continual fundal massage with lower uterine segment support is mandatory. While one member of the team massages the fundus, another nurse establishes intravenous access with a large bore needle and administers oxytocic drugs in the following order: oxytocin (Pitocin), followed by methylergonovine (Methergine), and carboprost (Hemabate).

Having a genetic mutation may create an 85% chance of developing breast cancer in a woman's lifetime. Which condition does not increase a client's risk for breast cancer? Select one: a. Cowden syndrome b. BRCA1 or BRCA2 gene mutation c. Li-Fraumeni syndrome d. Paget disease

d. Paget's disease Paget disease originates in the nipple and causes nipple carcinoma and exhibits bleeding, oozing, and crusting of the nipple. BRCA1 or BRCA2, Li-Fraumeni syndrome, and Cowden syndrome are all genetic mutations that have different family pedigrees and increase the risk of breast cancer.

If the umbilical cord prolapses during labor, the nurse should immediately. Select one: a. Type and cross-match blood for an emergency transfusion b. Await provider order for preparation for an emergency cesarean section. c. Attempt to reposition the cord above the presenting part d. Perform vaginal exam and lifting the presenting part off of the cord to relieve pressure on the cord.

d. Perform vaginal exam and lifting the presenting part off of the cord to relieve pressure on the cord. Type and cross-match is one of the interventions with cord prolapse but not a priority. Awaiting MD intervention is not appropriate as umbilical cord prolapse is an obstetrical emergency requiring immediate intervention. Once the cord has prolapsed, it cannot be repositioned. Performing a vaginal exam and applying manual pressure to the presenting part to relieve pressure on the cord represents the first nursing intervention to attempt to improve circulation to the fetus.

What is the primary nursing responsibility when caring for a client who is experiencing an obstetric hemorrhage associated with uterine atony? Select one: a. Establishing venous access b. Catheterizing the bladder c. Preparing the woman for surgical intervention d. Performing fundal massage

d. Performing fundal massage The initial management of excessive postpartum bleeding is a firm massage of the uterine fundus. Although establishing venous access may be a necessary intervention, fundal massage is the initial intervention. The woman may need surgical intervention to treat her postpartum hemorrhage, but the initial nursing intervention is to assess the uterus. After uterine massage, the nurse may want to catheterize the client to eliminate any bladder distention that may be preventing the uterus from properly contracting.

A woman at 28 weeks of gestation experiences blunt abdominal trauma as the result of a fall. The nurse must closely observe the client for what? Select one: a. Complaints of abdominal pain b. Hemorrhage c. Alteration in maternal vital signs, especially blood pressure d. Placental abruption

d. Placental abruption Electronic fetal monitoring (EFM) tracings can help evaluate maternal status after trauma and can reflect fetal cardiac responses to hypoxia and hypoperfusion. Signs and symptoms of placental absorption include uterine irritability, contractions, vaginal bleeding, and changes in FHR characteristics. Hypoperfusion may be present in the pregnant woman before the onset of clinical signs of shock. EFM tracings show the first signs of maternal compromise.

During a telephone follow-up conversation with a woman who is 4 days postpartum, the woman tells the nurse, "I don't know what's wrong. I love my son, but I feel so let down. I seem to cry for no reason!" Which condition might this new mother be experiencing? Select one: a. Letting-go b. Postpartum depression (PPD) c. Attachment difficulty d. Postpartum blues

d. Postpartum blues During the PP blues women are emotionally labile, often crying easily and for no apparent reason. This lability seems to peak around the fifth PP day.

While providing care to the maternity client, the nurse should be aware that one of these anxiety disorders is likely to be triggered by the process of labor and birth. Which disorder fits this criterion? Select one: a. Panic disorder b. Phobias c. Obsessive-compulsive disorder (OCD) d. Posttraumatic stress disorder (PTSD)

d. Posttraumatic stress disorder (PTSD) PTSD can occur as the result of a past trauma such as rape. Symptoms of PTSD include re- experiencing the event, numbing, irritability, angry outbursts, and exaggerated startle reflex. With the increased bodily touch and vaginal examinations that occur during labor, the client may have memories of the original trauma. The process of giving birth may result in her feeling out of control. The nurse should verbalize an understanding and reassure the client as necessary.

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? Select one: a. Low birth weight is a newborn who weighs below 3.7 pounds b. Preterm birth rate in the United States continues to increase c. Terms preterm birth and low birth weight can be used interchangeably d. Preterm labor is defined as cervical changes and uterine contractions occuring between 20 and 37 weeks of gestation

d. Preterm labor is defined as cervical changes and uterine contractions occuring between 20 and 37 weeks of gestation 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.

Depo provera, or The Shot, contains which of the following hormones? Select one: a. estrogen b. estrogen and progesterone c. neither estrogen or progesterone d. progesterone

d. Progresterone

A nurse is teaching a woman about her menstrual cycle. The nurse states that ____ is the most important change that happens during the secretory phase of the menstrual cycle. Select one: a. Maturation of the graafian follicle b. Multiplication of the fimbriae c. Secretion of human chorionic gonadotropin d. Proliferation of the endometrium

d. Proliferation of the endometrium see pp 52-53 The four phases of the endometrial cycle are 1) the menstrual phase where shedding of the functional 2/3 of the endometrium is initiated, 2) the proliferative phase which is a period of rapid growth lasting from about the 5th day to ovulation, 3) the secretory phase which starts from ovulation to about 3 days before the next menstrual period large amounts of progesterone are produced and an edematous, vascular, functional endometrium is produced creating a suitable environment for fertilization, 4) the ischemic phase the blood supply to the functional endometrium is blocked and necrosis develops, functional layer separates and menstrual bleeding begins.

After giving birth to a healthy infant boy, a primiparous client, 16 years of age, is admitted to the postpartum unit. An appropriate nursing diagnosis for her at this time is "Deficient knowledge of infant care." What should the nurse be certain to include in the plan of care as he or she prepares the client for discharge? Select one: a. Teach the client how to feed and bathe her infant. b. Advise the client that all mothers instinctively know how to care for their infants. c. Give the client written information on bathing her infant. d. Provide time for the client to bathe her infant after she views a demonstration of infant bathing.

d. Provide time for the client to bathe her infant after she views a demonstration of infant bathing. Allows nurse to evaluate parental ease with care and adequacy of techniques and provide further instruction if necessary

A primiparous woman is in the taking-in stage of psychosocial recovery and adjustment after childbirth. Recognizing the needs of women during this stage, how should the nurse respond? Select one: a. Foster an active role in the baby's care. b. Promote maternal independence by encouraging her to meet her own hygiene and comfort needs. c. Recognize the woman's limited attention span by giving her written materials to read when she gets home rather than doing a teaching session while she is in the hospital. d. Provide time for the mother to reflect on the events of her labor and delivery.

d. Provide time for the mother to reflect on the events of her labor and delivery. During this stage, the new mother is excited and talkative. It is important that she be able to fulfill her desire to review her birth experience. During this stage, the new mother still relies upon others to meet her physical needs. Once these are met, she will be more able to take an active role, not only in her own care but also in the care of her newborn, which happens during the taking-hold stage. Short teaching sessions, using written materials to reinforce the content presented, is a more effective approach. The focus of the taking-in or dependency stage is to nurture the new mother by meeting her dependency needs for rest, comfort, hygiene, and nutrition.

What should the nurse's next action be if the client's white blood cell (WBC) count is 25,000/mm 3 on her second postpartum day? Select one: a. Immediately begin antibiotic therapy. b. Immediately inform the physician. c. Have the laboratory draw blood for reanalysis. d. Recognize that this count is an acceptable range at this point postpartum

d. Recognize that this count is an acceptable range at this point postpartum An increase in WBC count to 25,000/mm3 during the postpartum period is considered normal and not a sign of infection. The nurse should document the finding. Because this is a normal finding, there is no reason to alert the health care provider. Antibiotics are not needed because the elevated WBCs are caused by the stress of labor and not an infectious process. There is no need for reassessment as it is expected for the WBCs to be elevated.

After change of shift report, the nurse assumes care of a multiparous client in labor. The woman is complaining of pain that radiates to her abdominal wall, lower back, and buttocks, and down her thighs. Before implementing a plan of care, the nurse should understand that this type of pain is: Select one: a. Visceral b. Somatic c. Afterpain d. Referred

d. Referred As labor progresses the woman often experiences referred pain. It occurs when pain that originates in the uterus radiates to the abdominal wall, the lumbosacral area of the back, the gluteal area, and the thighs. The woman usually has pain only during a contraction and is free from pain between contractions. Visceral pain predominates the first stage of labor. This pain originates from cervical changes, distention of the lower uterine segment, and uterine ischemia. Visceral pain is located over the lower portion of the abdomen. Somatic pain is described as intense, sharp, burning, and well localized. It results from stretching of the perineal tissues and the pelvic floor and occurs during the second stage of labor. Pain experienced during the third stage of labor or afterward during the early postpartum period is uterine. This pain is very similar to that experienced in the first stage of labor.

When caring for clients with neoplasms of the reproductive system, the nurse must begin by assessing the woman's knowledge of the disorder, its management, and prognosis. This assessment should be followed by a nursing diagnosis. Which diagnosis fails to address the psychologic effect of these disorders? Select one: a. Disturbed body image, as a result of changes in anatomy b. Anxiety, related to surgical procedures c. Interrupted family processes d. Risk for injury, related to lack of skill for self-care

d. Risk for injury, related to lack of skill for self-care Although risk for injury, related to lack of skill for self-care, is appropriate to this clients condition, this diagnosis is more suited to the clients learning needs than the psychologic effect. Anxiety, related to surgical procedures, is appropriate for addressing psychosocial concerns; the client may also develop anxiety related to the diagnosis and prognosis and whether or not surgery is required. Disturbed body image is an applicable diagnosis; changes in her anatomy and function may also result in low self-esteem and ineffective coping skills. Interrupted family processes is a possible and acceptable diagnosis; functional and anatomic changes may result in the clients inability to fulfill her familial role. Depending on the severity of her condition, interrupted family processes could also lead to social isolation.

A nurse is providing preconception care to a client. Which statement should be included by the nurse? Select one: a. Includes risk factor assessments for potential medical and psychologic problems but by law cannot consider finances or workplace conditions. b. Is designed for women who have never been pregnant. c. Avoids teaching about safe sex to avoid political controversy. d. Should include interventions to reduce substance use and abuse.

d. Should include interventions to reduce substance use and abuse. Read pg. 58

What is one of the initial signs and symptoms of puerperal infection in the postpartum client? Select one: a. Profuse vaginal lochia with ambulation b. Fatigue continuing for longer than 1 week c. Pain with voiding d. Temperature of 38° C (100.4° F) or higher on 2 successive days

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

Providing treatment and rehabilitation for people who have developed disease is part of: Select one: a. Primordial preventive care. b. Primary preventive care. c. Secondary preventive care. d. Tertiary preventive care.

d. Tertiary preventive care Primary preventive care involves promoting healthy lifestyles. Secondary preventive care involves targeting populations at risk. Tertiary preventive care is the treatment or rehabilitation of those who already have a specific disease. Primordial preventive care refers to prevention of the risk factors themselves at either the social or environmental level.

What important, immediate postoperative care practice should the nurse remember when caring for a woman who has had a mastectomy? Select one: a. The affected arm should be held down close to the woman's side. b. Venipuncture for blood work should be performed on the affected arm. c. The affected arm should be used for intravenous (IV) therapy. d. The blood pressure (BP) cuff should not be applied to the affected arm.

d. The blood pressure (BP) cuff should not be applied to the affected arm. The affected arm should not be used for BP readings, IV therapy, or venipuncture. The affected arm should be elevated with pillows above the level of the right atrium.

What is the most common cause of birth defects in humans? Select one: a. Drugs b. Single gene mutations c. Viral infections d. Unknown causes

d. Unknown causes most common = unknown etiology (50-60%) multifactorial inheritance (20-25%) combination of genetic predisposition and environment- chromosomal abnormalities (6-7%) mutant genes (7-8%)

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

d. Unruptured ectopic pregnancy 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.

While taking a family history, 37 y/o Bernice tells the nurse her paternal grandmother had breast and colon cancer in her 60's, two paternal aunts had breast cancer in their 40's, one of those aunts also had ovarian cancer in her 40's, one paternal uncle had colon cancer in his 40's, her paternal cousin has breast cancer in her 40's, and her father had colon cancer in his 40's. She denies cancer on her mother's side of the family. Bernice states she has 2 younger sisters. Which of the following responses would be best for the nurse to say to Bernice about her reported family history? Select one: a. "Have you had a screening mammogram?" b. "Do you have cancer on your mother's side of the family?" c. "Have you had your pap smear recently?" d. "Since all of these cancers are on your father's side of the family, you have no increased risk for cancer." e. "The types of cancers reported on your father's side of the family may be due to a gene mutation that can be passed onto to each generation. Have any of your relatives or you considered genetic testing?"

e. "The types of cancers reported on your father's side of the family may be due to a gene mutation that can be passed onto each generation. Have any of your relatives or you considered genetic testing?"

Match the definition to the correct term. (HINT: not all terms are used). number of deaths of infants younger than 28 days of age per 1000 live births number of deaths of infants younger than 1 year of age per 1000 live births number of maternal deaths from births and complications of pregnancy, childbirth and puerperium per 100.000 live births number of live births in 1 year per 1000 population Number of stillbirths and neonatal deaths per 1000 deaths

number of deaths of infants younger than 28 days of age per 1000 live births ~ Neonatal Mortality Rate number of deaths of infants younger than 1 year of age per 1000 live births ~Infant Mortality Rate number of maternal deaths from births and complications of pregnancy, childbirth and puerperium per 100.000 live births ~Maternal Mortality Rate number of live births in 1 year per 1000 population ~Birth Rate Number of stillbirths and neonatal deaths per 1000 deaths ~Perinatal Mortality Rate See Box 1-6, pg. 6