Ch. 9 Nutrition for childbearing, M: Ch 8, Mother baby ch 7, OBExam1Ch7
Match each term with the correct definition. a. Important in cell growth and neuromuscular function b. Important in thyroid function c. Important in DNA and RNA synthesis 1. Iodine 2. Magnesium 3. Zinc
1.b 2.a 3.c
Match each term with the correct definition. a. Necessary for metabolism of calcium b. Necessary for mineralization of fetal bones and teeth c. Deficiency in first weeks of pregnancy may cause spontaneous abortion and neural tube defects 1. Folic acid 2. Vitamin D 3. Calcium
1.c 2.a 3.b
20. A pregnant woman is the mother of two children. Her first pregnancy ended in a stillbirth at 32 weeks of gestation, her second pregnancy with the birth of her daughter at 36 weeks, and her third pregnancy with the birth of her son at 41 weeks. Using the five-digit system to describe this woman's current obstetric history, what should the nurse record? a. 4-1-2-0-2 b. 3-1-2-0-2 c. 4-2-1-0-1 d. 3-1-1-1-3
A
24. When a pregnant woman develops ptyalism, what should the nurse advise? a. Chew gum or suck on lozenges between meals. b. Eat nutritious meals that provide adequate amounts of essential vitamins and minerals. c. Take short walks to stimulate circulation in the legs and elevate the legs periodically. d. Use pillows to support the abdomen and back during sleep.
A
25. A pregnant immigrant has an unknown immunization history. When she presents for routine vaccinations, which will the nurse administer? a. Hepatitis B b. Measles c. Rubella d. Varicella
A
14. A client notices that the doctor writes "positive Chadwick's sign" on her chart. She asks the nurse what this means. The nurse's best response is: a. "It refers to the bluish color of the cervix in pregnancy." b. "It means the cervix is softening." c. "The doctor was able to flex the uterus against the cervix." d. "That refers to a positive sign of pregnancy."
ANS: A Increased vascularity of the pelvic organs during pregnancy results in the bluish color of the cervix, vagina, and labia, called Chadwick's sign. Softening of the cervix is Goodell's sign. The softening of the lower segment of the uterus is (Hegar's sign) and can allow the uterus to be flexed against the cervix. Chadwick's sign is a probable sign of pregnancy.
12. A client in her first trimester complains of nausea and vomiting. She asks, "Why does this happen?" The nurse's best response is: a. "It is due to an increase in gastric motility." b. "It may be due to changes in hormones." c. "It is related to an increase in glucose levels." d. "It is caused by a decrease in gastric secretions."
ANS: B Nausea and vomiting are believed to be caused by increased levels of hormones, decreased gastric motility, and hypoglycemia. Gastric motility decreases during pregnancy. Glucose levels decrease in the first trimester. Gastric secretions do decrease, but this is not the main cause of nausea and vomiting.
6. Vascular volume increases by 40% to 60% during pregnancy to: a. Compensate for decreased renal plasma flow. b. Provide adequate perfusion of the placenta. c. Eliminate metabolic wastes of the mother. d. Prevent maternal and fetal dehydration.
ANS: B The primary function of increased vascular volume is to transport oxygen and nutrients to the fetus via the placenta. Renal plasma flow increases during pregnancy. Assisting with pulling metabolic wastes from the fetus for maternal excretion is one purpose of the increased vascular volume. This is not the primary reason for the increase in volume.
4. What is the term for the step in maternal role attainment that relates to the woman giving up certain aspects of her previous life? a. Fantasy b. Grief work c. Role-playing d. Looking for a fit
ANS: B The woman experiences sadness as she realizes that she must give up certain aspects of her previous self and that she can never go back. This is called grief work. Fantasies allow the woman to try on a variety of possibilities or behaviors. This usually deals with how the child will look and the characteristics of the child. Role-playing involves searching for opportunities to provide care for infants in the presence of another person. Looking for a fit is when the woman observes the behaviors of mothers and compares them with her own expectations. PTS: 1 DIF: Cognitive Level: Understanding REF: 128, 129 OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance
10. A client's last menstrual period was June 10. Her estimated date of delivery (EDD) is: a. April 7. b. March 17. c. March 27. d. April 17.
ANS: B To determine the EDD, the nurse uses the first day of the last menstrual period (June 10), subtracts 3 months (March 10), and adds 7 days (March 17). April 7 would be subtracting 2 months instead of 3 months then subtracting 3 days instead of adding 7 days. March is the correct month, but instead of adding 7 days, 17 days were added. April 17 is subtracting 2 months instead of 3.
7. Physiologic anemia often occurs during pregnancy as a result of: a. Inadequate intake of iron. b. Dilution of hemoglobin concentration. c. The fetus establishing iron stores. d. Decreased production of erythrocytes.
ANS: B When blood volume expansion is more pronounced and occurs earlier than the increase in red blood cells, the woman will have physiologic anemia, which is the result of dilution of hemoglobin concentration rather than inadequate hemoglobin. Inadequate intake of iron may lead to true anemia. If the woman does not take an adequate amount of iron, true anemia may occur when the fetus pulls stored iron from the maternal system. There is an increases production of erythrocytes during pregnancy.
12. Which is the most important reason for evaluating the pattern of weight gain in pregnancy? a. Prevents excessive adipose tissue deposits b. Determines cultural influences on the woman's diet c. Assesses the need to limit caloric intake in obese women d. Identifies potential nutritional problems or complications of pregnancy
ANS: D Deviations from the recommended pattern of weight gain may indicate nutritional problems or developing complications. Excessive adipose tissue may occur with excess weight gain but is not the reason for monitoring the weight gain pattern. The pattern of weight gain is not affected by cultural influences. It is important to monitor the pattern of weight gain for the developing complications. PTS: 1 DIF: Cognitive Level: Understanding REF: 160
24. Which of the following is associated with inadequate maternal weight gain during pregnancy? a. Prolonged labor b. Preeclampsia c. Gestational diabetes d. Low-birth-weight infant
ANS: D Inadequate maternal weight gain during pregnancy can manifest in the birth of a low- birth-weight infant. Prolonged labor and gestational diabetes are associated with excess weight gain during pregnancy. Preeclampsia is based on maternal hypertension, proteinuria, and edema states. PTS: 1 DIF: Cognitive Level: Application REF: 161
11. Why should a woman in her first trimester of pregnancy expect to visit her health care provider every 4 weeks? a. Problems can be eliminated. b. She develops trust in the health care team. c. Her questions about labor can be answered. d. The conditions of the expectant mother and fetus can be monitored.
D
22. A client in her third trimester of pregnancy is asking about safe travel. Which statement should the nurse give about safe travel during pregnancy? a. "Only travel by car during pregnancy." b. "Avoid use of the seat belt during the third trimester." c. "You can travel by plane until your 38th week of gestation." d. "If you are traveling by car stop to walk every 1 to 2 hours."
D
23. The client has just learned she is pregnant and overhears the gynecologist saying that she has a positive Chadwick's sign. When the client asks the nurse what this means, how should the nurse respond? a. "Chadwick's sign signifies an increased risk of blood clots in pregnant women because of a congestion of blood." b. "That sign means the cervix has softened as the result of tissue changes that naturally occur with pregnancy." c. "This means that a mucous plug has formed in the cervical canal to help protect you from uterine infection." d. "This sign occurs normally in pregnancy, when estrogen causes increased blood flow in the area of the cervix."
D
27. When documenting a client encounter, what term will the nurse use to describe the woman who is in the 28th week of her first pregnancy? a. Multigravida b. Multipara c. Nullipara d. Primigravida
D
3. A pregnant client has come to the emergency department with complaints of nasal congestion and epistaxis. Which is the correct interpretation of these symptoms by the health care provider? a. Nasal stuffiness and nosebleeds are caused by a decrease in progesterone. b. These conditions are abnormal. Refer the client to an ear, nose, and throat specialist. c. Estrogen relaxes the smooth muscles in the respiratory tract, so congestion and epistaxis are within normal limits. d. Estrogen causes increased blood supply to the mucous membranes and can result in congestion and nosebleeds.
D
33. Which physiologic event may lead to increased constipation during pregnancy? a. Increased emptying time in the intestines b. Abdominal distention and bloating c. Decreased absorption of water d. Decreased motility in the intestines
D
34. Which physiologic findings are seen with respect to gallbladder function that might lead to the development of gallstones during pregnancy? a. Decrease in alkaline phosphatase levels compared with nonpregnant women b. Increase in albumin and total protein as a result of hemodilution c. Hypertonicity of gallbladder tissue d. Prolonged emptying time
D
36. A pregnant client notices that she is beginning to develop dark skin patches on her face. She denies using any different type of facial products as a cleansing solution or makeup. What would the priority nursing intervention be in response to this situation? a. Refer the client to a dermatologist for further examination. b. Ask the client if she has been eating different types of foods. c. Take a culture swab and send to the lab for culture and sensitivity (C&S). d. Let the client know that this is a common finding that occurs during pregnancy.
D
39. Which of the client health behaviors in the first trimester would the nurse identify as a risk factor in pregnancy? a. Sexual intercourse two or three times weekly b. Moderate exercise for 30 minutes daily c. Working 40 hours a week as a secretary in a travel agency d. Relaxing in a hot tub for 30 minutes a day, several days a week
D
45. A patient reports to the clinic nurse that she has not had a period in over 12 weeks, she is tired, and her breasts are sore all of the time. The patient's urine test is positive for hCG. What is the best nursing action related to this information? a. Ask the patient if she has had any nausea or vomiting in the morning. b. Schedule the patient to be seen by a health care provider within the next 4 weeks. c. Send the patient to the maternity screening area of the clinic for a routine ultrasound. d. Determine if there are any factors that might prohibit her from seeking med
D
46. A nurse is conducting a prenatal history with a patient who is new to the clinic. The woman reports that she had one healthy baby at term, and a miscarriage at 8 weeks. What will the nurse document as the patient's GTPAL? a. 21011 b. 20111 c. 30111 d. 31011
D
5. While providing education to a primiparous client regarding the normal changes of pregnancy, what is important for the nurse to explain about Braxton Hicks contractions? a. These contractions may indicate preterm labor. b. These are contractions that never cause any discomfort. c. Braxton Hicks contractions only start during the third trimester. d. These occur throughout pregnancy, but you may not feel them until the third
D
38. Use Nägele's rule to determine the EDD (estimated day of birth) for a client whose last menstrual period started on April 12. a. February 19 b. January 19 c. January 21 d. February 7
18
16. To relieve a leg cramp, what should the client be instructed to perform? a. Dorsiflex the foot. b. Apply a warm pack. c. Stretch and point the toe. d. Massage the affected muscle.
A
18. Which complaint made by a client at 35 weeks of gestation requires additional assessment? a. Abdominal pain b. Ankle edema in the afternoon c. Backache with prolonged standing d. Shortness of breath when climbing stairs
A
21. Which laboratory result would be a cause for concern if exhibited by a client at her first prenatal visit during the second month of her pregnancy? a. Rubella titer, 1:6 b. Platelets, 300,000/mm3 c. White blood cell count, 6000/mm3 d. Hematocrit 38%, hemoglobin 13 g/dL
A
53. Which are presumptive signs of pregnancy? (Select all that apply.) a. Quickening b. Amenorrhea c. Ballottement d. Goodell's sign e. Chadwick's sign
ABE
13. A pregnant client would like to know a good food source of calcium other than dairy products. Which is the best answer that the nurse should give? a. Legumes b. Lean meat c. Whole grains d. Yellow vegetables
ANS: A Although dairy products contain the greatest amount of calcium, it can also be found in legumes, nuts, dried fruits, and some dark green leafy vegetables. Lean meats are rich in protein and phosphorus. Whole grains are rich in zinc and magnesium. Yellow vegetables are rich in vitamin A. PTS: 1 DIF: Cognitive Level: Application REF: 154
1. A pregnant client's mother is worried that her daughter is not "big enough" at 20 weeks of gestation. The nurse palpates and measures the fundal height at 20 cm, which is even with the woman's umbilicus. What should the nurse report to the client and her mother? a. "The body of the uterus is at the belly button level, just where it should be at this time." b. "You're right. We'll inform the practitioner immediately." c. "When you come for next month's appointment, we'll check you again to make sure that the baby is growing." d. "Lightening has occurred, so the fundal height is lower than expected."
ANS: A At 20 weeks the fundus is usually located at the umbilical level. Because the uterus grows in a predictable pattern, obstetric nurses should know that the uterus of 20 weeks' gestation is located at the level of the umbilicus. This is incorrect information. At 20 weeks the uterus should be at the umbilical level. By avoiding the question, this might increase the anxiety of both the mother and grandmother by avoiding the direct question. The descent of the fetal head (lightening) occurs in late pregnancy.
MULTIPLE RESPONSE 1. A pregnant client reports that she works in a long-term care setting and is concerned about the impending flu season. She asks about receiving the flu vaccine. As the nurse, you are aware that some immunizations are safe to administer during pregnancy, whereas others are not. Which vaccines could this client receive? Select all that apply. a. Tetanus b. Hepatitis A and B c. Measles, mumps, rubella (MMR) d. Influenza e. Varicella
ANS: A, B, D Correct: A, B, D. Inactivated vaccines such as those for tetanus, hepatitis A, hepatitis B, and influenza are safe to administer for women who have a risk for contracting or developing the disease. Incorrect: C, E. Immunizations with live virus vaccines such as MMR, varicella (chickenpox), or smallpox are contraindicated during pregnancy because of the possible teratogenic effects on the fetus.
46. The nurse is advising a lactose-intolerant pregnant client about calcium intake. Which calcium sources are approximately equivalent to 1 cup of milk? (Select all that apply.) a. cup yogurt b. 1 cup of sherbet c. oz of hard cheese d. cups of ice cream e. cup of low-fat cottage cheese
ANS: A, C, D Calcium sources approximately equivalent to 1 cup of milk include cup yogurt, oz of hard cheese, and cups of ice cream. It takes 3 cups of sherbet and cups of low-fat cottage cheese to equal the calcium equivalent of 1 cup of milk. PTS: 1 DIF: Cognitive Level: Application REF: 149
10. A client's last menstrual period was June 10. What is her estimated date of birth (EDD)? a. April 7 b. March 17 c. March 27 d. April 17
B
12. A client in her first trimester complains of nausea and vomiting. She asks, "Why does this happen?" What is the nurse's best response? a. "It is due to an increase in gastric motility." b. "It may be due to changes in hormones." c. "It is related to an increase in glucose levels." d. "It is caused by a decrease in gastric secretions."
B
28. You are performing assessments for an obstetric client who is 5 months pregnant with her third child. Which finding would cause you to suspect that the client was at risk? a. Client states that she doesn't feel any Braxton Hicks contractions like she had in her prior pregnancies. b. Fundal height is below the umbilicus. c. Cervical changes, such as Goodell's sign and Chadwick's sign, are present. d. She has increased vaginal secretions.
B
30. Which physiologic finding is consistent with normal pregnancy? a. Systemic vascular resistance increases as blood pressure decreases. b. Cardiac output increases during pregnancy. c. Blood pressure remains consistent independent of position changes. d. Maternal vasoconstriction occurs in response to increased metabolism.
B
31. A pregnant client complains that since she has been pregnant, her nose is always stuffed and she feels like she has a cold. Past medical history is negative for respiratory problems such as hay fever, sinusitis, or other allergies. What is the most likely cause for the client's presentation? a. Increased effects of progesterone to maintain the pregnancy b. Effects of estrogen on the respiratory tract c. Development of allergies as a result of pregnancy because of altered immunity d. Increase in fluid consumption during pregnancy leading to overhydration
B
35. Which of these findings would indicate a potential complication related to renal function during pregnancy? a. Increase in glomerular filtration rate (GFR) b. Increase in serum creatinine level c. Decrease in blood urea nitrogen (BUN) d. Mild proteinuria
B
1. A pregnant client's mother is worried that her daughter is not "big enough" at 20 weeks of gestation. The nurse palpates and measures the fundal height at 20 cm, which is even with the woman's umbilicus. Which should the nurse report to the client and her mother? a. "You're right. We'll inform the practitioner immediately." b. "Lightening has occurred, so the fundal height is lower than expected." c. "The body of the uterus is at the belly button level, just where it should be at this time." d. "When you come for next month's appointment, we'll check you again to make sure that the baby is growing."
C
15. Which is the gravida and para for a client who delivered triplets 2 years ago and is now pregnant again? a. 2, 3 b. 1, 2 c. 2, 1 d. 1, 3
C
17. A client, gravida 2, para 1, comes for a prenatal visit at 20 weeks of gestation. Her fundus is palpated 3 cm below the umbilicus. This finding is: a. appropriate for gestational age. b. a sign of impending complications. c. lower than normal for gestational age. d. higher than normal for gestational age.
C
19. A gravida client at 32 weeks of gestation reports that she has severe lower back pain. What should the nurse's assessment include? a. Palpation of the lumbar spine b. Exercise pattern and duration c. Observation of posture and body mechanics d. Ability to sleep for at least 6 hours uninterrupted
C
2. While the vital signs of a pregnant client in her third trimester are being assessed, the client complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate? a. Have the client stand up and retake her blood pressure. b. Have the client sit down and hold her arm in a dependent position. c. Have the client turn to her left side and recheck her blood pressure in 5 minutes. d. Have the client lie supine for 5 minutes and recheck her blood pressure on both arms.
C
32. A pregnant client complains of frequent heartburn. The client states that she has never had these symptoms before and wonders why this is occurring now. The best response that the nurse can provide is: a. examine her dietary intake pattern and tell her to avoid certain foods. b. tell her that this is a normal finding during early pregnancy and will resolve as she gets closer to term. c. explain to the client that physiologic changes caused by the pregnancy make her more likely to experience these types of symptoms. d. refer her to her health care provider for additional testing because this is an abnormal finding.
C
42. The client with an IUD has a positive pregnancy test. When planning care, the nurse will base decisions on which anticipated action? a. A therapeutic abortion will need to be scheduled because fetal damage is inevitable. b. Hormonal analyses will be done to determine the underlying cause of the false-positive test result. c. The IUD will need to be removed to avoid complications such as miscarriage or infection. d. The IUD will need to remain in place to avoid injuring the fetus.
C
A client is currently pregnant; she has a 5-year-old son and a 3-year-old daughter. She had one other pregnancy that terminated at 8 weeks. Which are her gravida and para? a. 3, 2 b. 4, 3 c. 4, 2 d. 3, 3
C
37. Determine the obstetric history of a client in her fifth pregnancy who had two spontaneous abortions in the first trimester, one infant at 32 weeks' gestation, and one infant at 38 weeks' gestation. a. G5 T1 P2 A2 L 2 b. G5 T1 P1 A1 L2 c. G5 T0 P2 A2 L2 d. G5 T1 P1 A2 L2
D
41. The patient reports that the first day of her last normal menstrual period was December 8. Using Nägele's rule, what date will the nurse identify as the estimated date of birth? a. March 1 b. March 15 c. September 1 d. September 15
D
47. The clinic nurse confirms that a patient is pregnant. She reports to the nurse that she has regular periods, and the first day of her last period was on January 20. Using Nägele's rule, what due date will the nurse relay to the patient? a. September 23 b. September 27 c. October 23 d. October 27s
D
48. The nurse is scheduling the next appointment for a healthy primigravida currently at 28 weeks gestation. When will the nurse schedule the next prenatal visit? a. 1 week b. 2 weeks c. 3 weeks d. 4 weeks
Dn
10. Which is the common effect of both smoking and cocaine use on the pregnant client? a. Vasoconstriction b. Increased appetite c. Increased metabolism d. Changes in insulin metabolism
ANS: A Both smoking and cocaine use cause vasoconstriction, which results in impaired placental blood flow to the fetus. Smoking and cocaine use do not increase appetite, change insulin metabolism, or increase metabolism. PTS: 1 DIF: Cognitive Level: Understanding REF: 156
50. A pregnant client reports that she works in a long-term care setting and is concerned about the impending flu season. She asks about receiving the flu vaccine. As the nurse, you are aware that some immunizations are safe to administer during pregnancy, whereas others are not. Which vaccines could this client receive? (Select all that apply.) a. Tetanus b. Varicella c. Influenza d. Hepatitis A and B e. Measles, mumps, rubella (MMR)
ACD
52. The nurse is planning care for a client in her first trimester of pregnancy who is experiencing nausea and vomiting. Which interventions should the nurse plan to teach this client? (Select all that apply.) a. Suck on hard candy. b. Take prenatal vitamins in the morning. c. Try some herbal tea to relieve the nausea. d. Drink fluids frequently but separate from meals. e. Eat crackers or dry cereal before arising in the morning.
ADE
54. Which factors contribute to the presence of edema in the pregnant client? (Select all that apply.) a. Diet consisting of processed foods b. Hemoconcentration c. Increase in colloid osmotic pressure d. Last trimester of pregnancy e. Decreased venous return
ADE
16. What should be the goal of a client with the nursing diagnosis "Imbalanced nutrition: Less than body requirements" (related to diet choices inadequate to meet the nutrient requirements of pregnancy)? a. Gain a total of 30 lb. b. Decrease intake of snack foods. c. Take daily supplements consistently. d. Increase intake of complex carbohydrates.
ANS: A A weight gain of 30 lb is one indication that the client has gained a sufficient amount for the nutritional needs of pregnancy. Decreasing snack food may be the problem and should be assessed. However, assessing the weight gain is the best method of monitoring intake for this pregnancy. A daily supplement is not the best goal for this client. It does not meet the basic need of proper nutrition during pregnancy. Increasing the intake of complex carbohydrates is important for this client, but monitoring the weight gain should be the end goal. PTS: 1 DIF: Cognitive Level: Application REF: 157
18. In teaching a pregnant adolescent about nutrition, what should the nurse plan to do? a. Determine the weight gain needed to meet adolescent growth and add 35 lb. b. Suggest that she not eat at fast food restaurants to avoid foods of poor nutritional value. c. Realize that most adolescents are unwilling to make dietary changes during pregnancy. d. Emphasize the need to eliminate common teen snack foods because they are too high in fat and sodium.
ANS: A Adolescents should gain in the upper range of the recommended weight gain. They also need to gain weight that would be expected for their own normal growth. Adolescents are willing to make changes; however, they still need to be like their peers. Eliminating fast foods will make her appear different from her peers. She should be taught to choose foods that add needed nutrients. Changes in the diet should be kept at a minimum and snacks should be included. Snack foods can be included in moderation and other foods added to make up for the lost nutrients. PTS: 1 DIF: Cognitive Level: Application REF: 162
23. A client post-delivery is concerned about getting back to her prepregnancy weight. She had only gained 15 pounds during her pregnancy. Which assessment factor would be of concern at her 6-week postpartum checkup? a. Client has lost 35 pounds during the 6-week period prior to her scheduled checkup. b. Client states that she is eating healthy and limiting intake of processed foods. c. Client relates increased consumption of fruits and vegetables in her diet postbirth. d. Client has resumed her usual exercise pattern of walking around the neighborhood for 10 minutes each night.
ANS: A Although a certain amount of weight loss is expected in the postpartum period, the fact that the reported weight loss is double the amount of weight gained during the pregnancy places the client at risk for malnutrition. Further inquiry is needed. Limiting the intake of processed foods is a healthy dietary alternative to decreasing sodium intake. Increases in fruits and vegetables are a healthy dietary alternative to decrease possible occurrence of hypertension. An exercise program is part of a healthy nutrition approach. PTS: 1 DIF: Cognitive Level: Application REF: 143 OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance
39. A pregnant client has lactose intolerance. What recommendation will the nurse provide to best help the client meet dietary needs for calcium? a. Add foods such as nuts, dried fruit, and broccoli to the diet. b. Consume dairy products but take an over-the-counter anti-gas product. c. Increase the intake of dark leafy vegetables, such as spinach and chard. d. Use powdered milk instead of liquid forms of milk.
ANS: A Calcium is present in legumes, nuts, dried fruits, and broccoli, so these foods can be added to increase calcium intake. Although dark leafy vegetables contain calcium, they also contain oxalates that decrease the availability of calcium. Powdered milk contains lactase, just like the nondehydrated varieties. Milk products can be avoided by those with lactose intolerance because adequate calcium may be obtained from food and supplements. PTS: 1 DIF: Cognitive Level: Understanding REF: 149
37. What will the nurse advise when providing nutrition education to the pregnant client? a. "Every day you need to have at least 6 ounces of protein from sources such as meat, fish, eggs, beans, nuts, soybean products, and tofu." b. "High-dose vitamin A supplements will promote optimal vision while preventing a common cause of blindness in neonates." c. "Meals such as sushi with a cold deli salad made with raw sprouts combine high-fiber foods with protein sources to meet multiple nutritional needs." d. "Vitamin and mineral supplements can meet your nutrient needs if you have inadequate intake because of nausea or a sensation of fullness."
ANS: A Protein sources include meat, poultry, fish, eggs, legumes (e.g., beans, peas, lentils), nuts, and soybean products such as tofu. Pregnant women need 6 to 6.5 oz of protein daily. Vitamin A can cause fetal anomalies of the bones, urinary tract, and central nervous system when taken in high doses. Pregnant women should avoid raw fish and foods such as cold deli salads and raw sprouts. Supplements do not generally contain protein and calories and may lack many necessary nutrients; therefore, they cannot serve as food substitutes. PTS: 1 DIF: Cognitive Level: Application REF: 151
19. The traditional diet of Asian women includes little meat and few dairy products and may be low in calcium and iron. The nurse can help a client increase her intake of these foods by which action? a. Suggest that she eat more tofu, bok choy, and broccoli. b. Suggest that she eat more hot foods during pregnancy. c. Emphasize the need for increased milk intake during pregnancy. d. Tell her husband that she must increase her intake of fruits and vegetables for the baby's sake.
ANS: A The diet should be improved by increasing foods acceptable to the woman. These foods are common in the Asian diet and are good sources of calcium and iron. Pregnancy is considered hot; therefore, the woman would eat cold foods. Because milk products are not part of this woman's diet, it should be respected and other alternatives offered. Also, lactose intolerance is common. Fruits and vegetables are cold foods and should be included in the diet. In regard to the family dynamics, however, the husband does not dictate to the wife in this culture. PTS: 1 DIF: Cognitive Level: Application REF: 152 OBJ: Nursing Process Step: Implementation
35. A client with a BMI of 32 has a positive pregnancy test. What is the maximum number of pounds that the nurse will advise the client to gain during the pregnancy? a. 20 b. 25 c. 28 d. 40
ANS: A The weight gain for obese women is 5 to 9 kg (11 to 20 lb). A BMI of 30 or higher categorizes the client as obese. The other options refer to minimal or maximal weight gain for clients in other BMI categories. PTS: 1 DIF: Cognitive Level: Application REF: 143
7. Margaret, a 36-year-old divorcee with a successful modeling career, finds out that her 18-year-old married daughter is expecting her first child. Which is a major factor in determining how Margaret will respond to becoming a grandmother? a. Her age b. Her career c. Being divorced d. Age of the daughter
ANS: A Age is a major factor in determining the emotional response of prospective grandparents. Young grandparents may not be happy with the stereotype of grandparents as being old. Career responsibilities may have demands that make the grandparents not as accessible but are not a major factor in determining the woman's response to becoming a grandmother. Being divorced is not a major factor that determines the adaptation of grandparents. The age of the daughter is not a major factor that determines the adaptation of grandparents. The age of the grandparent is a major factor. PTS: 1 DIF: Cognitive Level: Understanding REF: 131 OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance
19. A gravida client at 32 weeks of gestation reports that she has severe lower back pain. The nurse's assessment should include: a. Observation of posture and body mechanics. b. Palpation of the lumbar spine. c. Exercise pattern and duration. d. Ability to sleep for at least 6 hours uninterrupted.
ANS: A Correct posture and body mechanics can reduce lower back pain caused by increasing lordosis. Pregnancy should not cause alterations in the spine. Any assessment for malformation should be done early in pregnancy. Certain exercises can help relieve back pain. Rest is important for well-being, but the main concern with back pain is to assess posture and body mechanics.
14. An Asian-American expectant father tells the nurse that he seems to be gaining weight, just like his wife. The nurse recognizes that this behavior is most likely a reflection of which? a. Couvade b. Embarrassment c. Ambivalence regarding the pregnancy d. Limited interest in the well-being of his wife
ANS: A Couvade is when expectant fathers sometimes experience physical symptoms similar to those of pregnant women, such as loss of appetite, nausea, headache, fatigue, and weight gain. The father did not express anything that would indicate embarrassment. There is no indication in the father's statement that he is ambivalent to the pregnancy. There is no data in the question that indicates that the father is not interested in his wife. PTS: 1 DIF: Cognitive Level: Understanding REF: 131 OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance
20. A pregnant woman is the mother of two children. Her first pregnancy ended in a stillbirth at 32 weeks of gestation, her second pregnancy with the birth of her daughter at 36 weeks, and her third pregnancy with the birth of her son at 41 weeks. Using the 5-digit system to describe this woman's current obstetric history, the nurse would record: a. 4-1-2-0-2. b. 3-1-2-0-2. c. 4-2-1-0-1. d. 3-1-1-1-3.
ANS: A Gravida (the first number) is 4 because this woman is now pregnant and was pregnant three times before. Para (the next 4 numbers) represents the outcomes of the pregnancies and would be described as follows: • T: 1 = Term birth at 41 weeks of gestation (son) • P: 2 = Preterm birth at 32 weeks of gestation (stillbirth) and 36 weeks of gestation (daughter) • A: 0 = Abortion: none occurred • L: 2 = Living children: her son and her daughter She is currently pregnant so she is a gravida 4. She had one term infant, 2 preterm infants, no abortion, and 3 living children. She is currently pregnant so she is a gravida 4.
22. In some Middle Eastern and African cultures, female genital mutilation is a prerequisite for marriage. Women who now live in North America need care from nurses who are knowledgeable about the procedure and comfortable with the abnormal appearance of their genitalia. When caring for this client, the nurse can formulate a diagnosis with the understanding that the client may be at risk for which of the following? (Select all that apply.) a. Infection b. Laceration c. Hemorrhage d. Obstructed labor e. Increased signs of pain response
ANS: A, B, C, D The client is at risk for infection, laceration, hemorrhage, and obstructed labor. Female genital mutilation, cutting, or circumcision involves removal of some or all of the external female genitalia. The labia majora are often stitched together over the vaginal and urethral openings as part of this practice. Enlargement of the vaginal opening may be performed before or during the birth. The woman is unlikely to give any verbal or nonverbal signs of pain. This lack of response does not indicate lack of pain. In fact, pelvic examinations are likely to be very painful because the introitus is so small, and inelastic scar tissue makes the area especially sensitive. A pediatric speculum may be necessary, and the client should be made as comfortable as possible. PTS: 1 DIF: Cognitive Level: Analysis REF: 136 OBJ: Nursing Process Step: Diagnosis MSC: Client Needs: Psychosocial Integrity
45. The nurse is teaching a breastfeeding client about substances to avoid while she is breastfeeding. Which substances should the nurse include in the teaching session? (Select all that apply.) a. Caffeine b. Alcohol c. Omega-6 fatty acids d. Appetite suppressants e. Polyunsaturated omega-3 fatty acids
ANS: A, B, D Foods high in caffeine should be limited. Infants of mothers who drink more than two or three cups of caffeinated coffee or the equivalent each day may be irritable or have trouble sleeping. Although the relaxing effect of alcohol was once thought to be helpful to the nursing mother, the deleterious effects of alcohol are too important to consider this suggestion appropriate today. An occasional single glass of an alcoholic beverage may not be harmful, but larger amounts may interfere with the milk ejection reflex and may be harmful to the infant. Nursing mothers should avoid appetite suppressants, which may pass into the milk and harm the infant. The long-chain polyunsaturated omega-3 and omega-6 fatty acids are present in human milk. Therefore, they should be included in the mother's diet during lactation. PTS: 1 DIF: Cognitive Level: Application REF: 158
47. The nurse is teaching a pregnant client about food safety during pregnancy and lactation. Which statements by the client indicate she understood the teaching? (Select all that apply.) a. "I will limit my intake of shrimp to 12 oz a week." b. "I will avoid the soft cheeses made with unpasteurized milk." c. "I plan to continue to pack my bologna sandwich for lunch." d. "I am glad I can still go to the sushi bar during my pregnancy." e. "I will not eat any swordfish or shark while I am pregnant or nursing."
ANS: A, B, E Statements that indicate the client understood the teaching are limiting shrimp to 12 oz a week, avoiding soft cheeses, and not eating any swordfish. A bologna sandwich should be avoided unless it is reheated until steaming hot. Raw or undercooked fish should be avoided. PTS: 1 DIF: Cognitive Level: Analysis REF: 151
23. The nurse is assessing a client in her 37th week of pregnancy for the psychological responses commonly experienced as birth nears. Which psychological responses should the nurse expect to asses? (Select all that apply.) a. The client is excited to see her baby. b. The client has not started to prepare the nursery for the new baby. c. The client expresses concern about how to know if labor has started. d. The client and her spouse are concerned about getting to the birth center in time. e. The client and her spouse have not discussed how they will share household tasks.
ANS: A, C, D As birth nears, the expectant client will express a desire to see the baby. Most pregnant clients are concerned with their ability to determine when they are in labor. Many couples are anxious about getting to the birth facility in time for the birth. As birth nears, a nesting behavior occurs, which means getting the nursery ready. Not preparing the nursery at this stage is not a response that the nurse should expect to assess. Negotiation of tasks is done during this stage. No discussion of division of household chores is not a response that the nurse should expect to assess at this stage. PTS: 1 DIF: Cognitive Level: Analysis REF: 127 OBJ: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity
34. The pregnant woman of normal weight enters her 13th week of pregnancy. If the client eats and exercises as directed, what will the nurse anticipate as the ongoing weight gain for the remaining trimesters? a. 0.3 pound every week b. 1 pound every week c. 1.8 pounds every week d. 2 pounds every week
ANS: B After the first 12 weeks (first trimester), the pregnant woman should gain 0.35 to 0.5 kg (0.8 to 1 lb) per week for the remainder of the pregnancy. PTS: 1 DIF: Cognitive Level: Knowledge REF: 157
20. When planning a diet for a pregnant client, which nutritional interventions should be implemented? a. Fluids should be restricted to 6 glasses a day to minimize fluid retention and occurrence of edema. b. Protein in the diet should be increased to meet growth and development needs. c. Nutrient density should be used only if there are problems with weight gain during the course of the pregnancy. d. Advise the client that the pattern of weight gain is not as important as the overall weight gained during the pregnancy.
ANS: B An increase in protein consumption is recommended as compared with prepregnancy diet recommendations. Fluid intake should be 8 to 10 glasses per day to maintain hydration. Nutrient density should be used throughout the pregnancy to meet increasing caloric needs. The pattern of weight gain is critical in helping identify potential risks associated with the development of fluid retention and preeclampsia. PTS: 1 DIF: Cognitive Level: Application REF: 144
21. A pregnant client asks the nurse if she should take herbal supplements during pregnancy. What is the best response to her query? a. "As long as you have had no reaction to them in the past, they would be safe to use during pregnancy." b. "Prenatal vitamins are the only things that should be taken during pregnancy." c. "Nutritional supplements will be prescribed by the health care provider based on individual needs." d. "During pregnancy, no supplementation is required because this is considered to be a healthy state."
ANS: B Prenatal vitamins are noted as the standard of care in the medical treatment of pregnancy. A nurse should not encourage the use of herbal supplements to a pregnant client (or to any client) without obtaining information relative to constituent ingredients and assessment of potential interactions. This discussion should include the health care provider as a member of the interdisciplinary team. Nutritional supplements are not indicated during pregnancy, other than prenatal vitamins. During pregnancy, the client will not be able to meet their nutritional needs without the use of prenatal vitamins. PTS: 1 DIF: Cognitive Level: Application REF: 150
27. A pregnant client arrives for her first prenatal visit at the clinic. She tells you that she has been taking an additional 400 mcg of folic acid prior to her pregnancy. Based on information obtained, she is at 8 weeks' gestation. What recommendation would you give regarding folic acid supplementation? a. Have the client continue to take 400 mcg folic acid throughout her pregnancy. b. Tell the client that she no longer has to take additional folic acid because it will be included in her prenatal vitamins. c. Have the client increase her folic acid intake to 1000 mcg throughout the rest of her pregnancy. d. Schedule the client to go for an AFP (alpha-fetoprotein) test.
ANS: B Prenatal vitamins include adequate folic acid supplementation, so clients should not take additional supplementation as long they continue their prenatal vitamins. During pregnancy, the recommendation is to increase the folic acid intake to 600 mcg. 1000 mcg of folic acid would be an excessive dose. The AFP test should be done at 15 to 18 weeks' gestation. This is not clinically indicated because the client is at 8 weeks' gestation. PTS: 1 DIF: Cognitive Level: Application REF: 146
15. Which pregnant adolescent is most at risk for a nutritional deficit during pregnancy? a. A 16-year-old who is 10 lb overweight b. A 17-year-old who is 10 lb underweight c. A 15-year-old of normal height and weight d. A 16-year-old of normal height and weight
ANS: B The adolescent who is pregnant and underweight is most at risk because she is already deficient in nutrition and must now supply the nutritional intake for both herself and her fetus. An overweight pregnant teen is at risk for deficiency but is not at the highest risk. Being underweight is the most risky because she is already deficient. A 15-year-old has special nutritional needs during pregnancy, but she is not at the highest risk for deficiency. A 16-year-old has special nutritional needs during pregnancy, but she is not at the highest risk for deficiency. PTS: 1 DIF: Cognitive Level: Application REF: 151
29. Which client is most at risk for a low-birth-weight infant? a. 22-year-old, 60 inches tall, normal prepregnant weight b. 18-year-old, 64 inches tall, body mass index is <18.5 c. 30-year-old, 78 inches tall, prepregnant weight is 15 lb above the norm d. 35-year-old, 75 inches tall, total weight gain in previous pregnancies was 33 lb
ANS: B The client who has a low prepregnancy weight is associated with preterm labor and low- birth-weight infants. Women who are underweight should gain more during pregnancy to meet the needs of pregnancy as well as their own need to gain weight; clients who have a normal prepregnancy weight, who start pregnancy overweight, or who have a history of excessive weight gain in pregnancy are not at risk for low-birth-weight infants. PTS: 1 DIF: Cognitive Level: Analysis REF: 144
1. When planning a diet with a pregnant client, what should the nurse's first action be? a. Teach the client about MyPlate. b. Review the client's current dietary intake. c. Instruct the client to limit the intake of fatty foods. d. Caution the client to avoid large doses of vitamins, especially those that are fat-soluble.
ANS: B The first action should be to assess the client's current dietary pattern and practices because instruction should be geared to what she already knows and does. Teaching the food guide MyPlate is important but not the first action when planning a diet with a pregnant client. Limiting intake of fatty foods is important in a pregnant client's diet but not the first action. Cautioning about excessive fat-soluble vitamins is important but not the first action. PTS: 1 DIF: Cognitive Level: Application REF: 144
11. The breastfeeding client whose recommended prepregnancy caloric intake was 2000 calories per day would need how many calories per day to meet her current needs? a. 2300 b. 2500 c. 2750 d. 3000
ANS: B The increase for a breastfeeding client is 500 calories above her recommended prepregnancy caloric intake. 2300 calories is not enough to meet her needs. 2750 calories may be too many calories and may lead to weight gain. 3000 calories is too many for this client and will lead to weight gain. PTS: 1 DIF: Cognitive Level: Understanding REF: 151
6. A client in her fifth month of pregnancy asks the nurse, "How many more calories should I be eating daily?" What should the nurse's response be? a. 180 more calories a day b. 340 more calories a day c. 452 more calories a day d. 500 more calories a day
ANS: B The increased nutritional needs of pregnancy can be met with an additional 340 calories per day. 180 calories are not enough to meet the increased nutritional needs of pregnancy. 452 calories are more than the recommended calories for pregnancy. 500 calories are more than the recommended calories for pregnancy. PTS: 1 DIF: Cognitive Level: Application REF: 145
8. A pregnant client asks the nurse if she can double her prenatal vitamin dose because she doesn't like to eat vegetables. What is the nurse's response about the danger of taking excessive vitamins? a. Increases caloric intake b. Has toxic effects on the fetus c. Increases absorption of all vitamins d. Promotes development of pregnancy-induced hypertension (PIH)
ANS: B The use of vitamin supplements in addition to food may increase the intake of some nutrients to doses much higher than the recommended amounts. Overdoses of some vitamins have been shown to cause fetal defects. Vitamin supplements do not contain calories. Vitamin supplements do not have better absorption than natural vitamins and minerals. There is no relationship between vitamin supplements and PIH. PTS: 1 DIF: Cognitive Level: Application REF: 154
32. Identify the appropriate weight gain at 28 weeks' gestation for a client with a normal BMI (body mass index) before pregnancy. a. 10 pounds b. 19 pounds c. 25 pounds d. 30 pounds
ANS: B The woman with a normal BMI before pregnancy will gain approximately 4.4 pounds during the first trimester and 1 pound per week during the second and third trimesters. At 28 weeks, normal weight gain would be 4 pounds during the first trimester and 15 pounds in the second trimester. Ten pounds at 29 weeks gestation is adequate weight gain. Twenty-five and 30 pounds at 28 weeks is excessive weight gain. PTS: 1 DIF: Cognitive Level: Application REF: 143
8. Which comment made by a new mother to her own mother is most likely to encourage the grandmother's participation in the infant's care? a. "Could you help me with the housework today?" b. "The baby is spitting up a lot. What should I do?" c. "I know you are busy, so I'll get John's mother to help me." d. "The baby has a stomachache. I'll call the nurse to find out what to do."
ANS: B Looking to the grandmother for advice encourages her to become involved in the care of the infant. Housework does not encourage the grandmother to participate in the infant's care. Getting John's mother to help and calling the nurse about advice excludes the grandmother. PTS: 1 DIF: Cognitive Level: Analysis REF: 131 OBJ: Nursing Process Step: Evaluation MSC: Client Needs: Health Promotion and Maintenance
40. The nurse is reviewing the changes in nutrition related to pregnancy with a 17-year-old who is 12 weeks pregnant. They are specifically focusing on the dairy requirements. What is the nurse's next action? a. Ask, "Do you like milk, yogurt and cheese?" b. Ask, "How many servings from the dairy group do you eat each day?" c. Tell her, "You need to add no less than 3 cups of dairy-based foods each day." d. Inform her, "If you do not like to drink milk, you can eat a spinach salad every day"
ANS: B To individualize the patient's teaching plan, the nurse must first assess the patient's calcium intake. Then the nurse can modify the instructions for adequate calcium intake, based on the patient's actual needs. Milk, yogurt, and cheese are calcium-rich foods but are inappropriate for the lactose-intolerant patient. The adolescent pregnant patient requires more daily calcium than the recommendation of 3 cups per day for the adult woman. Spinach is a source of calcium but it also contains oxalates, which decrease calcium availability. PTS: 1 DIF: Cognitive Level: Analysis REF: 150
30. Changes in the diet of the pregnant client who has phenylketonuria would include: a. adding foods high in vitamin C. b. eliminating drinks containing aspartame. c. restricting protein intake to <20 g a day. d. increasing caloric intake to at least 1800 cal/day.
ANS: B Use of aspartame by women with phenylketonuria can result in fetal brain damage because these women lack the enzyme to metabolize aspartame. Adding vitamin C, restricting protein, and increasing caloric intake are not necessary for the pregnant client with phenylketonuria. PTS: 1 DIF: Cognitive Level: Analysis REF: 145
19. Which of the following would be considered to be a system barrier to the birth of prenatal care? a. Adolescent pregnant client b. Inability to schedule an appointment with the health care provider because of a busy medical practice c. Pregnant client has no health insurance d. Having to sign in for the initial appointment and complete health history records
ANS: B A delay in the ability to schedule an appointment with a health care provider is an example of a system barrier to the birth of prenatal care. An adolescent pregnant client would not be considered to be a system barrier but rather a psychosocial factor that would affect the pregnancy state. Having no health insurance is an example of a financial barrier to the birth of prenatal care. Completing a health history record is part of a comprehensive assessment. PTS: 1 DIF: Cognitive Level: Application REF: 134 OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance
18. Which complaint made by a client at 35 weeks of gestation requires additional assessment? a. Shortness of breath when climbing stairs b. Abdominal pain c. Ankle edema in the afternoon d. Backache with prolonged standing
ANS: B Abdominal pain may indicate preterm labor or serious placental abnormalities. Shortness of breath is an expected finding at 35 weeks. Ankle edema in the afternoon is a normal finding at this stage of the pregnancy. Backaches while standing is a normal finding in the later stage of pregnancy.
9. Which is a major concern among members of lower socioeconomic groups? a. Practicing preventive health care b. Meeting health needs as they occur c. Maintaining an optimistic view of life d. Maintaining group health insurance for their families
ANS: B Because of their economic uncertainty, lower socioeconomic groups place more emphasis on meeting the needs of the present rather than on future goals. Lower socioeconomic groups may value health care but generally cannot afford preventive health care. They may struggle for basic needs and often do not see a way to improve their situation. It is difficult to maintain optimism. Lower socioeconomic groups usually do not have group health insurance. PTS: 1 DIF: Cognitive Level: Understanding REF: 134 OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance
17. Delores, gravida 2, para 1, comes for a prenatal visit at 20 weeks of gestation. Her fundus is palpated 3 cm below the umbilicus. This finding is: a. Appropriate for gestational age. b. Lower than normal for gestational age. c. Higher than normal for gestational age. d. A sign of impending complications.
ANS: B By 20 weeks the fundus should reach the umbilicus. The fundus should be at the umbilicus at 20 weeks, so this is an inappropriate height and needs further assessment. This is lower than expected at this date. It may be a complication, but it may also be due to incorrect dating of the pregnancy.
5. An expectant client in her third trimester reports that she developed a strong tie to her baby from the beginning and now is really in tune to her baby's temperament. The nurse interprets this as the development of which maternal task of pregnancy? a. Learning to give of herself b. Developing attachment with the baby c. Securing acceptance of the baby by others d. Seeking safe passage for herself and her baby
ANS: B Developing a strong tie in the first trimester and progressing to be in tune is the process of commitment, attachment, and interconnection with the infant. This stage begins in the first trimester and continues throughout the neonatal period. Learning to give of herself is the task that occurs during pregnancy as the woman allows her body to give space to the fetus. She continues with giving to others in the form of food and presents. Securing acceptance of the baby is a process that continues throughout pregnancy as the woman reworks relationships. Seeking safe passage is the task that ends with birth. During this task, the woman seeks health care and carries out cultural practices. PTS: 1 DIF: Cognitive Level: Analysis REF: 129 OBJ: Nursing Process Step: Evaluation MSC: Client Needs: Health Promotion and Maintenance
2. A client who is 7 months pregnant states, "I'm worried that something will happen to my baby." Which is the nurse's best response? a. "Your baby is doing fine." b. "Tell me about your concerns." c. "There is nothing to worry about." d. "The doctor is taking good care of you and your baby."
ANS: B Encouraging the client to discuss her feelings is the best approach. The nurse should not disregard or belittle the client's feelings. Responding that your baby is doing fine disregards the client's feelings and treats them as unimportant. Responding that there is nothing to worry about does not answer the client's concerns. Saying that the doctor is taking good care of you and your baby is belittling the client's concerns. PTS: 1 DIF: Cognitive Level: Application REF: 128 OBJ: Nursing Process Step: Implementation MSC: Client Needs: Psychosocial Integrity
44. The nurse is teaching a client taking prenatal vitamins how to avoid constipation. Which should the nurse plan to include in the teaching session? (Select all that apply.) a. Advise taking a daily laxative for constipation. b. Recommend a diet high in fruits and vegetables. c. Encourage an increase in fluid consumption during the day. d. Increase the intake of whole grains and whole grain products. e. Suggest increasing the intake of dairy products, especially cheeses.
ANS: B, C, D Common sources of dietary fiber include fruits and vegetables (with skins when possible—apples, strawberries, pears, carrots, corn, potatoes with skins, and broccoli), whole grains, and whole grain products—whole wheat bread, bran muffins, bran cereals, oatmeal, brown rice, and whole wheat pasta. Increased intake of fluids can help prevent constipation. A pregnant client should not take a daily laxative unless prescribed by her health care provider. Increased intake of dairy products, especially cheese, can increase constipation. PTS: 1 DIF: Cognitive Level: Application REF: 162
24. A Vietnamese client who speaks little English is admitted to the labor and birth unit in early labor. The nurse plans to use an interpreter during an initial assessment. Which should the nurse plan to implement with regard to using an interpreter? (Select all that apply.) a. Face the interpreter when speaking. b. Listen carefully to what the client says. c. Speak slowly and smile when appropriate. d. Plan to use a male interpreter, even if a female interpreter is available. e. Ask the interpreter to explain exactly what is said as much as possible, instead of paraphrasing.
ANS: B, C, E The nurse planning to use an interpreter should listen carefully to what the client says. The nurse should speak slowly and smile when appropriate. Ask the interpreter to explain exactly what is said, as much as possible, instead of paraphrasing. It is preferable to use a trained female interpreter when one is available instead of a male interpreter. The nurse should face the client when speaking, not the interpreter. PTS: 1 DIF: Cognitive Level: Application REF: 137 OBJ: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity
COMPLETION 1. While providing education to a primiparous client regarding the normal changes of pregnancy, it is important for the nurse to explain that the uterus undergoes irregular contractions. These are known as ____________________ contractions.
ANS: Braxton Hicks
38. For the pregnant client who is a vegan, what combination of foods will the nurse advise to meet the nutritional needs for all essential amino acids? a. Eggs and beans b. Fruits and vegetables c. Grains and legumes d. Vitamin and mineral supplements
ANS: C Combining incomplete plant proteins with other plant foods that have complementary amino acids allows intake of all essential amino acids. Dishes that contain grains (e.g., wheat, rice, corn) and legumes (e.g., garbanzo, navy, kidney, or pinto beans, peas, peanuts) are combinations that provide complete proteins. Eggs are not eaten by vegans. Fruits and vegetables alone will not provide the essential amino acids. Vitamin and mineral supplements do not provide amino acids. PTS: 1 DIF: Cognitive Level: Application REF: 153
28. Which food selections would lead to enhanced iron absorption during pregnancy? a. Eating additional fiber and grains in the diet b. Drinking coffee with meals c. Drinking orange juice d. Including spinach in the diet two to three times a week
ANS: C Drinking orange juice, which contains ascorbic acid, acts to enhance iron absorption. Foods that are high in fiber and grains contain phytates, which can decrease iron absorption. Coffee intake can affect iron binding and therefore decrease absorption. Spinach contains oxalates, which can interfere with iron absorption. PTS: 1 DIF: Cognitive Level: Application REF: 150
43. A patient at 8 weeks' gestation complains to the nurse, "I feel sick almost every morning. And I throw up at least two or three times a week." What is the nurse's best advice to the patient? a. "Do you like cheese?" b. "Try eating four meals a day instead of three meals a day." c. "Try eating peanut butter on whole wheat bread right before going to bed." d. "If you can eat enough throughout the day, you don't have to worry about being sick."
ANS: C Eating a bedtime protein snack helps maintain glucose levels throughout the night. Cheese is high in fat and can aggravate nausea. Small and frequent meals is the recommendation; four meals a day is not frequent enough. Consumption is not the patient's stated concern—it is the nausea and vomiting. PTS: 1 DIF: Cognitive Level: Analysis REF: 154
41. The health care provider has recommended an iron supplement for the patient who is 20 weeks pregnant. The nurse is reviewing the recommendation with the patient. What fluid is best for the nurse to recommend when taking an iron supplement? a. 8 ounces of milk b. 8 ounces of water c. 4 ounces of orange juice d. 4 ounces of apple juice
ANS: C Iron absorption is enhanced when taken with a source of vitamin C. Calcium can block the absorption of vitamin C. Water and apple juice to not facilitate or block the absorption of iron. PTS: 1 DIF: Cognitive Level: Application REF: 149
26. A pregnant client comes to the OB clinic and informs you that she is very concerned about the amount of weight gain associated with pregnancy. She then tells you that she wants to switch to a low-fat diet during pregnancy. BMI measurements indicate a BMI of 22.7. What would be the best nursing response to this client's stated plan? a. Tell the client that as long as she maintains a varied diet with regard to the other nutrients, there should be no problems. b. Refer the client to a dietician for assistance in planning the low-fat diet. c. Advise the client that it is important to maintain the intake of essential fatty acids during pregnancy. d. Schedule the client for more frequent visits during the next few months to evaluate her weight pattern.
ANS: C It is important to teach the client that essential fatty acids are needed in the diet to assist fetal development (visual and cognitive). Dieting during pregnancy is not advised. Clients should maintain a regular diet that has a varied intake of nutrient sources. There is no need for referral at this time because dieting is not recommended during pregnancy. The client's BMI indicates that she is within the normal weight range. There is no need to add additional appointments at this time. PTS: 1 DIF: Cognitive Level: Application REF: 145
31. When explaining the recommended weight gain to your client, the nurse's teaching should include which statement? a. "All pregnant women need to gain a minimum of 25 to 35 pounds." b. "The fetus, amniotic fluid, and placenta require 15 pounds of weight gain." c. "Weigh gain in pregnancy is based on the client's prepregnant body mass index." d. "More weight should be gained in the first and second trimesters and less in the third."
ANS: C Recommendations for weight gain in pregnancy are based on the woman's prepregnancy weight for her height (body mass index). Depending on the prepregnant weight, recommendation for weight gain may be more or less than 25 to 35 pounds. The combination of the fetus, amniotic fluid, and placenta averages about 11 pounds in the client who has a normal BMI. Less weight should be gained in the first trimester, when the fetus needs fewer nutrients for growth, and more in the third trimester, when fetal growth is accelerated. PTS: 1 DIF: Cognitive Level: Application REF: 143
33. Which client has correctly increased her caloric intake from her recommended pregnancy intake to the amount necessary to sustain breastfeeding in the first 6 postpartum months? a. From 1800 to 2200 calories per day b. From 2000 to 2500 calories per day c. From 2200 to 2530 calories per day d. From 2500 to 2730 calories per day
ANS: C The increased calories necessary for breastfeeding are 500, with 330 calories coming from increased caloric intake and 170 calories from maternal stores. An increase of 230 calories is insufficient for breastfeeding. An increase of 400 and 500 calories is above the recommended amount. PTS: 1 DIF: Cognitive Level: Analysis REF: 145
9. A nurse is conducting a prenatal nutritional education class for a group of nursing students. Which should the nurse include as the definition of pica? a. Iron deficiency anemia b. Intolerance to milk products c. Ingestion of nonfood substances d. Episodes of anorexia and vomiting
ANS: C The practice of eating substances not normally thought of as food is called pica. Clay, dirt, and solid laundry starch are the substances most commonly ingested. Pica may produce iron deficiency anemia if proper nutrition is decreased. Intolerance to milk products is termed lactose intolerance. Pica is not related to anorexia and vomiting. PTS: 1 DIF: Cognitive Level: Application REF: 155
4. Which suggestion is appropriate for the pregnant woman who is experiencing heartburn? a. Eat only three meals a day so the stomach is empty between meals. b. Drink plenty of fluids at bedtime. c. Use Tums or Alkamints to obtain relief as directed by the physician. d. Drink coffee or orange juice immediately on arising in the morning.
ANS: C Antacids with high sodium content should be avoided to prevent fluid retention. Antacids high in calcium (Tums, Alkamints) can provide temporary relief. Instruct the woman to eat five or six small meals per day rather than three full meals. Fluids overstretch the stomach and may precipitate reflux when lying down. Coffee and orange juice stimulates acid formation in the stomach.
25. A nurse is developing information to give to a group of pregnant women who are interested in nutritional management of their pregnancy with regard to expected weight gain. The nurse bases the amount of weight gain for pregnant women on calculation of their: a. EDC (expected date of confinement). b. prepregnancy weight. c. BMI (body mass index). d. basal energy expenditure (BEE).
ANS: C BMI takes into account height, weight, and body frame characteristics. Weight gain is not based on the EDC. Although the prepregnancy weight is important, it must be looked at in correlation to a calculated BMI. The calculation of BEE is used for clients who are at nutritional risk and are receiving enteral and/or parenteral nutrition therapies. PTS: 1 DIF: Cognitive Level: Application REF: 143
6. Which situation best describes a man trying on fathering behaviors? a. Reading books on newborn care b. Spending more time with his siblings c. Coaching a little league baseball team d. Exhibiting physical symptoms related to pregnancy
ANS: C Coaching a little league baseball team shows interaction with children and assuming the behavior and role of a father. This best describes a man trying on the role of being a father. Men do not normally read information that is provided in advance. The nurse should be prepared to present information after the baby is born, when it is more relevant. The man will normally seek closer ties with his father. Exhibiting physical symptoms related to pregnancy is called couvade. PTS: 1 DIF: Cognitive Level: Understanding REF: 131 OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance
16. To relieve a leg cramp, the client should be instructed to: a. Massage the affected muscle. b. Stretch and point the toe. c. Dorsiflex the foot. d. Apply a warm pack.
ANS: C Dorsiflexion of the foot stretches the leg muscle and relieves the painful muscle contraction. Since she is prone to blood clots, massaging the affected leg muscle is contraindicated. Pointing the toes will contract the muscle and not relieve the pain. Warm packs can be used to relax the muscle, but more immediate relief is necessary, such as dorsiflexion of the foot.
17. During the course of the pregnancy, the client states that she feels a deep connection with her unborn child. This behavior illustrates the maternal task acquisition of: a. safe passage. b. gaining acceptance. c. fostering an interconnection. d. developing empathy through physical actions.
ANS: C During pregnancy, it is important for the mother to relate to and connect with the unborn child as part of the initial attachment and bonding experience. Safe passage refers to securing safety as a primary concern through the pregnancy and birth process. Gaining acceptance relates to behaviors acknowledging the pregnancy as a part of one's maternal role. Pregnant woman may appear to be more nurturing during pregnancy, but this is not necessarily associated through physical actions. PTS: 1 DIF: Cognitive Level: Application REF: 128 OBJ: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity
13. One of the most effective methods for preventing venous stasis is to: a. Wear elastic stockings in the afternoon. b. Sleep with the foot of the bed elevated. c. Rest often with the feet elevated. d. Sit with the legs crossed.
ANS: C Elevating the feet and legs improves venous return and prevents venous stasis. Elastic stockings should be applied before lowering the legs in the morning. Elevating the legs at night may cause pressure on the diaphragm and increase breathing problems. Sitting with the legs crossed will decrease circulation in the legs and increase venous stasis.
44. A patient at 24 week' gestation reports to the clinic nurse that she is tired all the time. What is the nurse's best response? a. "Everyone has chronic anemia at this time in pregnancy." b. "I'll make sure your health care provider is informed of your concern." c. "Your urine is clean of protein and sugar. You are doing well at this time." d. "Make sure you are drinking enough fluid to keep up with the demands of your body."
B
18. A pregnant client relates a story of how her boyfriend is feeling her aches and pains associated with her pregnancy. She is concerned that her boyfriend is making fun of her concerns. How would you respond to this client statement? a. Tell her not to worry because it is natural for her boyfriend to make her feel better by identifying with her pregnancy. b. Refer the client to a psychologist for counseling to deal with this problem because it is clearly upsetting her. c. Explain that her boyfriend may be experiencing couvade syndrome and that this is a normal finding seen with male partners. d. Ask the client specifically to define her concerns related to her relationship with her boyfriend and suggest methods to stop this type of behavior by her significant other.
ANS: C Provide factual information that will help reduce stress and modify acceptance. Telling her not to worry does not address the possibility that her boyfriend may be experiencing couvade syndrome. The client is expressing concern but does not have all the facts related to couvade syndrome and requires education, rather than referral. Couvade syndrome is not an abnormal condition and should be treated with acceptance and understanding. PTS: 1 DIF: Cognitive Level: Application REF: 131 OBJ: Nursing Process Step: Implementation MSC: Client Needs: Psychosocial Integrity
9. Diane is currently pregnant; she has a 5-year-old son and a 3-year-old daughter. She had one other pregnancy that terminated at 8 weeks. Her gravida and para are gravida _____, para _____. a. 3, 2 b. 4, 3 c. 4, 2 d. 3, 3
ANS: C She has had four pregnancies, including the current one (gravida 4). She had two pregnancies that terminated after 20 weeks (para 2). The pregnancy that terminated at 8 weeks is classified as an abortion. Because she is currently pregnant, she is classified as a gravida 4. Gravida 4 is correct, but she is para 2; the pregnancy that was terminated at 8 weeks is classified as an abortion. Since she is currently pregnant, she would be classified as a gravida 4, not 3; the para is correct.
15. The gravida and para for Janice, who delivered triplets 2 years ago and is now pregnant again, is gravida _____, para _____. a. 2, 3 b. 1, 2 c. 2, 1 d. 1, 3
ANS: C She has had two pregnancies (gravida 2); para refers to the outcome of the pregnancy rather than the number of infants from that pregnancy. Para refers to the outcome of the pregnancy, not the number of infants from the pregnancy. She is pregnant now, so that would make her a gravida 2. She is para 1 because she had one pregnancy that progressed to the age of viability. She is pregnant now and had one other pregnancy, making her gravida 2. Para refers to the outcome of the pregnancy, not the number of infants.
11. A woman in her first trimester of pregnancy would expect to visit her physician every 4 weeks so that: a. She develops trust in the health care team. b. Her questions about labor can be answered. c. The condition of both the expectant mother and the fetus can be monitored. d. Problems can be eliminated.
ANS: C This routine allows for monitoring maternal health and fetal growth and ensures that problems will be identified early. Developing a trusting relationship should be established during these visits, but that is not the primary reason. Most women do not have questions concerning labor until the last trimester of the pregnancy. All problems cannot be eliminated because of prenatal visits, but they can be identified.
3. To increase the absorption of iron in a pregnant client, with what should an iron preparation be given? a. Tea b. Milk c. Coffee d. Orange juice
ANS: D A vitamin C source may increase the absorption of iron. Tannin in the tea reduces the absorption of iron. The calcium and phosphorus in milk decrease iron absorption. Decreased intake of caffeine is recommended during pregnancy. PTS: 1 DIF: Cognitive Level: Application REF: 149 OBJ: Nursing Process Step: Implementation
22. Which client would require additional calories and nutrients? a. A 36-year-old female gravida 2, para 1, in her first trimester of pregnancy b. An 18-year-old female who delivered a 7-lb baby and is bottle feeding c. A 23-year-old female who had a cesarean section birth and is bottle feeding d. A 20-year-old female who had a vaginal birth 5 months ago and is breastfeeding
ANS: D A client who is breastfeeding will require more calories and nutrients than individuals who are pregnant, delivered regardless of the type of birth, and whether they are bottle feeding. PTS: 1 DIF: Cognitive Level: Application REF: 145
5. What is the recommended weight gain during pregnancy for a client who begins pregnancy at a normal weight? a. 10 to 15 lb b. 15 to 20 lb c. 20 to 25 lb d. 25 to 35 lb
ANS: D A weight gain of 25 to 35 lb is believed to reduce intrauterine growth restriction that may result from inadequate nutrition, and also allows for variations in individual needs. There is no precise weight gain appropriate for all women. A 10-lb weight gain is not sufficient to meet the needs of the pregnancy. A 15- to 20-lb weight gain is recommended for women who are overweight before the pregnancy. A 20- to 25-lb weight gain is recommended for women who are overweight before the pregnancy. PTS: 1 DIF: Cognitive Level: Understanding REF: 161
17. A client who is in week 28 of gestation is concerned about her weight gain of 17 lb. Which is the nurse's best response? a. "You should not gain any more weight until you reach the third trimester." b. "You should try to decrease your amount of weight gain for the next 12 weeks." c. "You have not gained enough weight for the number of weeks of your pregnancy." d. "You have gained an appropriate amount for the number of weeks of your pregnancy."
ANS: D A woman in her 28th week of gestation should have gained between 17 and 20 lb. The normal pattern of weight gain is about 3.5 lb total in the first trimester (by 13 weeks) and 1 lb per week after that. The client has gained the appropriate amount of weight. It would be inappropriate to have her decrease her weight gain. She has gained an appropriate amount of weight and should not increase the weight gain. Weight gain needs to be consistent during the last part of the pregnancy and should not be suppressed. PTS: 1 DIF: Cognitive Level: Application REF: 162
2. A nurse is teaching a nutrition class to a group of pregnant clients. The nurse should include that the major source of nutrients in the diet of a pregnant woman should be composed of which? a. Fats b. Fiber c. Simple sugars d. Complex carbohydrates
ANS: D Complex carbohydrates supply the pregnant woman with vitamins, minerals, and fiber. Fats provide 9 calories in each gram, in contrast to carbohydrates and proteins, which provide only 4 calories in each gram. Fiber is supplied mainly by the complex carbohydrates. The most common simple carbohydrate is table sugar, which is a source of energy but does not provide any nutrients. PTS: 1 DIF: Cognitive Level: Application REF: 145
36. The pregnant client with significant iron deficiency anemia is prescribed iron supplements. The client confides to the nurse that she can't take iron because it makes her nauseous. What is the best response by the nurse? a. "Iron will be absorbed more readily if taken with orange juice." b. "It is important to take this drug regardless of this side effect." c. "Taking the drug with milk may decrease your symptoms." d. "Try taking the iron at bedtime on an empty stomach."
ANS: D Iron taken at bedtime may be easier to tolerate. All the answers are true statements; however, only the option that states that iron taken at bedtime may be easier to tolerate addresses both optimal absorption of iron and alleviation of nausea, which will not be noticeable during sleep. It is true that taking iron with milk will decrease the symptoms, but it will also decrease absorption. PTS: 1 DIF: Cognitive Level: Application REF: 149
42. The nurse is reviewing a list of foods high in folic acid with a patient who is considering becoming pregnant. The nurse determines that the patient understands the teaching when the patient states she will include which list of foods in her diet? a. Peaches, yogurt, and tofu b. Strawberries, milk, and tuna c. Asparagus, lemonade, and chicken breast d. Spinach, orange juice, and fortified bran flakes
ANS: D Prepregnant, the recommendation for folic acid is 800 mcg. Foods high in folic acid are dark green leafy vegetables, legumes (beans, peanuts), orange juice, asparagus, spinach, and fortified cereal and pasta. In the United States, folic acid is added to orange juice and wheat-based products. PTS: 1 DIF: Cognitive Level: Application REF: 146
7. A pregnant client's diet may not meet her need for folate. What is a good source of this nutrient? a. Chicken b. Cheese c. Potatoes d. Green leafy vegetables
ANS: D 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. PTS: 1 DIF: Cognitive Level: Understanding REF: 147, 148
14. To determine cultural influences on a client's diet, what should the nurse do first? a. Evaluate the client's weight gain during pregnancy. b. Assess the socioeconomic status of the client. c. Discuss the four food groups with the client. d. Identify the food preferences and methods of food preparation common to the client's culture.
ANS: D Understanding the client's food preferences and how she prepares food will assist the nurse in determining whether the client's culture is adversely affecting her nutritional intake. Evaluating a client's weight gain during pregnancy should be included for all clients, not just for those who are culturally different. The socioeconomic status of the clients may alter the nutritional intake, but not the cultural influence. Teaching the food groups to the client should come after assessing food preferences. PTS: 1 DIF: Cognitive Level: Application REF: 160
4. When should iron supplementation during a normal pregnancy begin? a. Before pregnancy b. In the first trimester c. In the third trimester d. In the second trimester
ANS: D Vitamin supplements should be prescribed in the second trimester, when the need for iron is increased. Healthy young women do not usually need iron supplementation for their diets. Morning sickness in the first trimester increases the routine side effects of iron supplements. The iron supplements may continue to be prescribed in the third trimester and during the postpartum period. PTS: 1 DIF: Cognitive Level: Understanding REF: 155
21. Which laboratory result would be a cause for concern if exhibited by a woman at her first prenatal visit during the second month of her pregnancy? a. Hematocrit 38%, hemoglobin 13 g/dl b. White blood cell count 6000/mm3 c. Platelets 300,000/mm3 d. Rubella titer 1:6
ANS: D A rubella titer of less than 1:10 indicates a lack of immunity to rubella, a viral infection that has the potential to cause teratogenic effects on fetal development. Arrangements should be made to administer the rubella vaccine after birth during the postpartum period because administration of rubella, a live vaccine, would be contraindicated during pregnancy. Women receiving the vaccine during the postpartum period should be cautioned to avoid pregnancy for 3 months. The lab values for WBCs, platelets, and rubella titer are within the expected range for pregnant women.
1. Which comment made by a client in her first trimester indicates ambivalent feelings? a. "My body is changing so quickly." b. "I haven't felt well since this pregnancy began." c. "I'm concerned about the amount of weight I've gained." d. "I wanted to become pregnant, but I'm scared about being a mother."
ANS: D Ambivalence refers to conflicting feelings. Expressing a concern about being a mother indicates conflicting or ambivalent feelings. Not feeling well since the pregnancy began does not reflect conflicting feelings. The woman is trying to confirm the pregnancy when she is stating the rapid changes to her body. She is not expressing conflicting feelings. By expressing concerns over gaining weight, which is normal, the woman is trying to confirm the pregnancy. PTS: 1 DIF: Cognitive Level: Analysis REF: 124 OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance
3. A pregnant woman has come to the emergency department with complaints of nasal congestion and epistaxis. What is the correct interpretation of these symptoms by the practitioner? a. These conditions are abnormal. Refer the client to an ear, nose, and throat specialist. b. Nasal stuffiness and nosebleeds are caused by a decrease in progesterone. c. Estrogen relaxes the smooth muscles in the respiratory tract, so congestion and epistaxis are within normal limits. d. Estrogen causes increased blood supply to the mucous membranes and can result in congestion and nosebleeds.
ANS: D As capillaries become engorged, the upper respiratory tract is affected by the subsequent edema and hyperemia, which causes these conditions, seen commonly during pregnancy. The client should be reassured that these symptoms are within normal limits. No referral is needed at this time. Progesterone is responsible for the heightened awareness of the need to breathe in pregnancy. Progesterone levels increase during pregnancy. Relaxation of the smooth muscles in the respiratory tract is affected by progesterone.
2. While the vital signs of a pregnant woman in her third trimester are being assessed, the client complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate? a. Have the patient stand up and retake her blood pressure. b. Have the patient sit down and hold her arm in a dependent position. c. Have the patient lie supine for 5 minutes and recheck her blood pressure on both arms. d. Have the patient turn to her left side and recheck her blood pressure in 5 minutes.
ANS: D Blood pressure is affected by positions during pregnancy. The supine position may cause occlusion of the vena cava and descending aorta. Turning the pregnant woman to a lateral recumbent position alleviates pressure on the blood vessels and quickly corrects supine hypotension. Pressures are significantly higher when the patient is standing. This would cause an increase in systolic and diastolic pressures. The arm should be supported at the same level of the heart. The supine position may cause occlusion of the vena cava and descending aorta, creating hypotension.
20. The nurse reveals to the patient that the over-the-counter test is verified and that she is pregnant. The patient confides to the nurse, "We have wanted to be pregnant for some time. These last few days I have been questioning our decision. I am feeling really bad right now." What is the nurse's best response? a. "You will come around in time and you will grow to love this baby." b. "Don't feel bad. It is the hormones of pregnancy talking right now." c. "Why do you think you are feeling bad when you wanted to be pregnant?" d. "Your feelings are understandable. Ambivalence is not uncommon right now."
ANS: D Early in pregnancy, ambivalence is not uncommon because pregnancy is a life-changing event, even if planned and strongly desired. The client needs reassurance and validation of these natural feelings. Although it is true that the patient will "grow to love the baby," this statement does not acknowledge her ambivalent feelings. "Don't feel bad" dismisses the patient's natural feelings and is a nontherapeutic response. "Why" is nontherapeutic and places the patient on the defensive in her response. PTS: 1 DIF: Cognitive Level: Application REF: 124 OBJ: Nursing Process Step: Implementation MSC: Client Needs: Health Promotion and Maintenance
10. Which comment made by a new mother exhibits understanding of her toddler's response to a new sibling? a. "I can't believe he is sucking his thumb again." b. "He is being difficult and I don't have time to deal with him." c. "When we brought the baby home, we made Michael stop sleeping in the crib." d. "My husband is going to stay with the baby so I can take Michael to the park tomorrow."
ANS: D It is important for a mother to seek time alone with her toddler to reassure him that he is loved. It is normal for a child to regress when a new sibling is introduced into the home. The toddler may have feelings of jealousy and resentment toward the new baby taking attention away from him. Frequent reassurance of parental love and affection are important. Changes in sleeping arrangements should be made several weeks before the birth so the child does not feel displaced by the new baby. PTS: 1 DIF: Cognitive Level: Analysis REF: 132 OBJ: Nursing Process Step: Evaluation MSC: Client Needs: Health Promotion and Maintenance
3. An expectant client asks the nurse about the behavior of "mimicry." Which is an example of mimicry that the nurse should relate to the client? a. Daydreaming about the newborn b. Imagining oneself as a good mother c. Babysitting for a neighbor's children d. Wearing maternity clothes before they are needed
ANS: D Mimicry involves observing and copying the behaviors of other women who are pregnant or are mothers. Wearing maternity clothes before they are needed helps the expectant mother feel what it's like to be obviously pregnant. Daydreaming is a type of fantasy in which the woman tries out a variety of behaviors in preparation for motherhood. Imagining herself as a good mother is the woman's effort to look for a good role fit. She observes behavior of other mothers and compares them with her own expectations. Babysitting other children is a form of role-playing in which the woman practices the expected role of motherhood. PTS: 1 DIF: Cognitive Level: Application REF: 128 OBJ: Nursing Process Step: Implementation MSC: Client Needs: Health Promotion and Maintenance
13. Which client may require more help and understanding when integrating the newborn into the family? a. A primipara from an upper income family b. A primipara who comes from a large family c. A multipara (gravida 2) who has a supportive husband and mother d. A multipara (gravida 6) who has two children younger than 3 years
ANS: D Pregnancy tasks are more complex for the multipara (gravida 6), and she may need special assistance to integrate the infant into the family structure. A primipara from an upper income family has the financial resources to assist her with daily care of the home. This leaves her free to concentrate on the newborn's needs. The primipara with a large support system has help available to her. The multipara (gravida 2) who has a supportive husband and mother has a support system to assist with integrating the infant into the family structure. PTS: 1 DIF: Cognitive Level: Analysis REF: 133 OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance
22. An expectant couple asks the nurse about intercourse during pregnancy and if it is safe for the baby. The nurse should tell the couple that: a. Intercourse should be avoided if any spotting from the vagina occurs afterward. b. Intercourse is safe until the third trimester. c. Safer sex practices should be used once the membranes rupture. d. Intercourse and orgasm are often contraindicated if a history of or signs of preterm labor are present.
ANS: D Rupture of the membranes may require abstaining from intercourse. Uterine contractions that accompany orgasm can stimulate labor and would be problematic if the woman is at risk for or has a history of preterm labor. Some spotting can normally occur as a result of the increased fragility and vascularity of the cervix and vagina during pregnancy. Intercourse can continue as long as the pregnancy is progressing normally. Safer sex practices are always recommended.
16. A pregnant client comes into the medical clinic stating that her family and friends are telling her that she is always talking about the pregnancy and nothing else. She is concerned that something is wrong with her. What psychological behavior is she exhibiting? a. Antepartum obsession b. Ambivalence c. Uncertainty d. Introversion
ANS: D The client is exhibiting behaviors associated with introversion and/or narcissism. These are normal findings during pregnancy as long as they do not become obsessive to the exclusion of everything else. The client is talking about the pregnancy but there is no evidence that it is affecting her perception of reality and/or ability to perform ADLs. It is normal for pregnant women to focus on the self as being of prime importance in their life initially during the pregnancy. Some women may feel ambivalent about their pregnancy, which is a normal reaction. However, this client's behavior does not support this finding. Some women react with uncertainty at the news of being pregnant, which is a normal reaction. However, this client's behavior does not support this finding. PTS: 1 DIF: Cognitive Level: Application REF: 125 OBJ: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity
11. While teaching an Asian client about prenatal care, the nurse notes that the client refuses to make eye contact. Which is the most likely cause? a. A submissive attitude b. Lack of understanding c. Embarrassment about the subject d. Cultural beliefs about eye contact
ANS: D The nurse must understand that making eye contact means different things in different cultures. The nurse should have a basic understanding of normal responses of various cultures within her community. Asians believe that eye contact shows disrespect, not submission. Many Asian women may nod and smile during client teaching, but this does not show understanding. They are responding that they heard you; validation of information is important. Modesty is important in some cultures, but the main response with this questions is the cultural beliefs. PTS: 1 DIF: Cognitive Level: Understanding REF: 138 OBJ: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity
8. A positive sign of pregnancy is: a. Fetal movement felt by the woman. b. Amenorrhea. c. Breast changes. d. Visualization of fetus by ultrasound.
ANS: D The only positive signs of pregnancy are auscultation of fetal heart tones, visualization of the fetus by ultrasound, and fetal movement felt by the examiner. Fetal movement is a presumptive sign of pregnancy. Amenorrhea is a presumptive sign of pregnancy. Breast changes are a presumptive sign of pregnancy.
5. The capacity of the uterus in a term pregnancy is how many times its prepregnant capacity? a. 100 b. 200 c. 300 d. 500
ANS: D The prepregnant capacity of the uterus is about 10 ml, and it reaches 5000 ml (5 L) by the end of the pregnancy, which reflects a 500-fold increase. 100, 200, and 300 are too small for a normal pregnancy.
21. A patient arrives to the clinic 2 hours late for her prenatal appointment. This is the third time she has been late. What is the nurse's best action in response to this patient's tardiness? a. Ask the patient if she has a way to tell the time. b. Ask the patient if she is deliberately being late for her appointments. c. Determine if the patient wants this baby and if this is her way of acting out. d. Determine if the patient arrives after the start time for other types of appointments.
ANS: D Time orientation is viewed differently by other cultures. Native-Americans, Middle Easterners, Hispanics, and American Eskimos tend to emphasize the moment rather than the future. This causes conflicts in the health care setting, in which tests or appointments are scheduled at particular times. If a woman does not place the same importance on keeping appointments, she may encounter anger and frustration in the health care setting. Asking if she has a way to tell time does not get to the potential root of the problem. Asking if she is deliberately late is inconsiderate and nontherapeutic. Although her action may be an acting-out behavior, there are other considerations that must be considered first. PTS: 1 DIF: Cognitive Level: Application REF: 138 OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE
12. The nurse in labor and birth is caring for a Muslim client during the active phase of labor. The nurse notes that the client quickly draws away when touched. Which intervention should the nurse implement? a. Ask the charge nurse to reassign you to another client. b. Assume that she doesn't like you and decrease your time with her. c. Continue to touch her as much as you need to while providing care. d. Limit touching to a minimum because physical contact may not be acceptable in her culture.
ANS: D Touching is an important component of communication in various cultures, but if the client appears to find it offensive, the nurse should respect her cultural beliefs and limit touching her. Asking the charge nurse to reassign you could be offensive to the client. A Muslim's response to touch does not reflect like or dislike. By continuing to touch her, the nurse is showing disrespect for her cultural beliefs. PTS: 1 DIF: Cognitive Level: Application REF: 138 OBJ: Nursing Process Step: Implementation MSC: Client Needs: Psychosocial Integrity
15. An expectant couple asks the nurse about intercourse during pregnancy and whether it is safe for the baby. What should the nurse tell the couple? a. Intercourse is safe until the third trimester. b. Safer sex practices should be used once the membranes rupture. c. Intercourse should be avoided if any spotting from the vagina occurs afterward. d. Intercourse and orgasm are often contraindicated if a history of or signs of preterm labor are present.
ANS: D Uterine contractions that accompany orgasm can stimulate labor and would be problematic if the woman is at risk for or has a history of preterm labor. Intercourse can continue as long as the pregnancy is progressing normally. Rupture of the membranes may require abstaining from intercourse. Safer sex practices are always recommended. Some spotting can normally occur as a result of the increased fragility and vascularity of the cervix and vagina during pregnancy. PTS: 1 DIF: Cognitive Level: Application REF: 126 OBJ: Nursing Process Step: Implementation MSC: Client Needs: Health Promotion and Maintenance
13. Which advice to the client is one of the most effective methods for preventing venous stasis? a. Sit with the legs crossed. b. Rest often with the feet elevated. c. Sleep with the foot of the bed elevated. d. Wear elastic stockings in the afternoon.
B
26. When the pregnant woman develops changes caused by pregnancy, the nurse recognizes that the darkly pigmented vertical midabdominal line is the: a. epulis. b. linea nigra. c. melasma. d. striae gravidarum.
B
40. A client who smokes one pack of cigarettes daily has a positive pregnancy test. The nurse will explain that smoking during pregnancy increases the risk of which condition? a. Congenital anomalies b. Death before or after birth c. Neonatal hypoglycemia d. Neonatal withdrawal syndrome
B
14. A client notices that the health care provider writes "positive Chadwick's sign" on her chart. She asks the nurse what this means. Which is the nurse's best response? a. "It means the cervix is softening." b. "That refers to a positive sign of pregnancy." c. "It refers to the bluish color of the cervix in pregnancy." d. "The doctor was able to flex the uterus against the cervix."
C
29. What is the best explanation that you can provide to a pregnant client who is concerned that she has "pseudoanemia" of pregnancy? a. Have her write down her concerns and tell her that you will ask the physician to respond once the lab results have been evaluated. b. Tell her that this is a benign self-limiting condition that can be easily corrected by switching to a high-iron diet. c. Inform her that because of the pregnancy, her blood volume has increased, leading to a substantial dilution effect on her serum blood levels, and that most women experience this condition. d. Contact the physician and get a prescription for iron pills to correct this condition.
C
6. What is the reason for vascular volume increasing by 40% to 60% during pregnancy? a. Prevents maternal and fetal dehydration b. Eliminates metabolic wastes of the mother c. Provides adequate perfusion of the placenta d. Compensates for decreased renal plasma flow
C
7. Physiologic anemia often occurs during pregnancy because of: a. inadequate intake of iron. b. the fetus establishing iron stores. c. dilution of hemoglobin concentration. d. decreased production of erythrocytes.
C
