Evolve questions
A woman is 8 months pregnant. She tells the nurse that she knows her baby listens to her, but her husband thinks she is imagining things. Which response by the nurse is most appropriate? • "Many women imagine what their baby is like." • "A baby in utero does respond to the mother's voice." •"You'll need to ask the doctor if the baby can hear yet." • "Thinking that your baby hears will help you bond with the baby."
"A baby in utero does respond to the mother's voice."
A woman who is 14 weeks pregnant tells the nurse that she always had a glass of wine with dinner before she became pregnant. She has abstained during her first trimester and would like to know whether it is safe for her to have a drink with dinner now. The nurse tells her: • "Because you're in your second trimester, there's no problem with having one drink with dinner." • "One drink every night is too much. One drink three times a week should be fine." • "Because you're in your second trimester, you can drink as much as you like." • "Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy."
"Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy."
In planning for an expected cesarean birth for a woman who has given birth by cesarean section previously and who has a fetus in the transverse presentation, the nurse includes which information? • "Because this is a repeat procedure, you are at the lowest risk for complications." • "Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures." • "Because this is your second cesarean birth, you will recover faster." • "You will not need preoperative teaching because this is your second cesarean birth."
"Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures."
A woman who is 39 weeks pregnant expresses fear about her impending labor and how she will manage. The nurse's best response is: • "Don't worry about it. You'll do fine." • "It's normal to be anxious about labor. Let's discuss what makes you afraid." • "Labor is scary to think about, but the actual experience isn't." • "You may have an epidural. You won't feel anything."
"It's normal to be anxious about labor. Let's discuss what makes you afraid."
An expectant father confides in the nurse that his pregnant wife, at 10 weeks of gestation, is driving him crazy. "One minute she seems happy, and the next minute she is crying over nothing at all. Is there something wrong with her?" The nurse's best response is: • "This is normal behavior and should begin to subside by the second trimester." • "She may be having difficulty adjusting to pregnancy; I will refer her to a counselor I know." • "This is called emotional lability and is related to hormone changes and anxiety during pregnancy. The mood swings will eventually subside as she adjusts to being pregnant." • "You seem impatient with her. Perhaps this is precipitating her behavior.
"This is called emotional lability and is related to hormone changes and anxiety during pregnancy. The mood swings will eventually subside as she adjusts to being pregnant."
A woman who is at 36 weeks of gestation is having a nonstress test. Which statement indicates her correct understanding of the test? • "I will need to have a full bladder for the test to be done accurately." • "I should have my husband drive me home after the test because I may be nauseated." • "This test will help to determine whether the baby has Down syndrome or a neural tube defect." • "This test observes for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby."
"This test observes for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby."
A nurse teaches a pregnant woman about the characteristics of true labor contractions. The nurse evaluates her understanding of the instructions when the woman states: • "True labor contractions will subside when I walk around." • "True labor contractions will cause discomfort over the top of my uterus." • "True labor contractions will continue and get stronger even if I relax and take a shower." • "True labor contractions will remain irregular but become stronger."
"True labor contractions will continue and get stronger even if I relax and take a shower."
A pregnant woman at 10 weeks of gestation jogs three or four times per week. She is concerned about the effect of exercise on the fetus. The nurse should tell her: • "You don't need to modify your exercising any time during your pregnancy." • "Stop exercising, because it will harm the fetus." • "You may find that you need to modify your exercise to walking later in your pregnancy, around the seventh month." • "Jogging is too hard on your joints; switch to walking now."
"You may find that you need to modify your exercise to walking later in your pregnancy, around the seventh month."
Which time span delineates the appropriate length for a normal pregnancy? • 9 lunar months, 8.5 calendar months, 39 weeks, 272 days • 10 lunar months, 9 calendar months, 40 weeks, 280 days • 9 calendar months, 10 lunar months, 42 weeks, 294 days • 9 calendar months, 38 weeks, 266 days
10 lunar months, 9 calendar months, 40 weeks, 280 days
A woman is 6 weeks pregnant. She has had a previous spontaneous abortion at 14 weeks of gestation and a pregnancy that ended at 38 weeks with the birth of a stillborn girl. What is her gravidity and parity according to the GTPAL system? • 2-0-0-1-1 • 2-1-0-1-0 • 3-1-0-1-0 • 3-0-1-1-0
3-1-0-1-0
Which hematocrit (HCT) and hemoglobin (HGB) results represent the lowest acceptable values for a woman in the third trimester of pregnancy? • 38% HCT; 14 g/dL HGB • 35% HCT; 13 g/dL HGB • 33% HCT; 11 g/dL HGB • 32% HCT; 10.5 g/dL HGB
33% HCT; 11 g/dL HGB
Which sign does not precede the onset of labor? • A return of urinary frequency as a result of increased bladder pressure • Persistent low backache from relaxed pelvic joints • Stronger and more frequent uterine (Braxton Hicks) contractions • A decline in energy, as the body stores up for labor
A decline in energy, as the body stores up for labor
A nurse is caring for a client whose labor is being augmented with oxytocin. The nurse recognizes that the oxytocin should be discontinued immediately if there is evidence of: • Uterine contractions occurring every 8 to 10 minutes. • A fetal heart rate (FHR) of 180 with absence of variability. • The client needing to void. • Rupture of the client's amniotic membranes.
A fetal heart rate (FHR) of 180 with absence of variability.
With regard to spinal and epidural (block) anesthesia, nurses should know that: • This type of anesthesia is commonly used for cesarean births but is not suitable for vaginal births. • A high incidence of postbirth headache is seen with spinal blocks. • Epidural blocks allow the woman to move freely. • Spinal and epidural blocks are never used together.
A high incidence of postbirth headache is seen with spinal blocks.
Nurses can help their clients by keeping them informed about the distinctive stages of labor. What description of the phases of the first stage of labor is accurate? • Latent: mild, regular contractions; no dilation; bloody show; duration of 2 to 4 hours • Active: moderate, regular contractions; 4 to 7 cm dilation; duration of 3 to 6 hours • Lull: no contractions; dilation stable; duration of 20 to 60 minutes • Transition: very strong but irregular contractions; 8 to 10 cm dilation; duration of 1 to 2 hours
Active: moderate, regular contractions; 4 to 7 cm dilation; duration of 3 to 6 hours
In the 1970s rape-trauma syndrome (RTS) was identified as a cluster of characteristics, symptoms, and related behaviors seen in the weeks and months after a rape. Which pattern of responses would not apply to a victim of rape? • Acute phase: disorganization • Acute phase: rearranging • Outward adjustment phase • Long-term process: reorganization phase
Acute phase: rearranging
During a health history interview, a woman tells the nurse that her husband physically abuses her. The nurse's first response should be to: • Advise the woman of mandatory state reporting laws pertaining to abuse and confidentiality. •Reassure the woman that the abuse is not her fault. • Give the woman referrals to local agencies and shelters where she can obtain help. •Formulate an escape plan for the woman that she can use the next time her husband abuses her.
Advise the woman of mandatory state reporting laws pertaining to abuse and confidentiality
A woman who is 32 weeks pregnant is informed by the nurse that a danger sign of pregnancy could be: •Constipation • Alteration in the pattern of fetal movement • Heart palpitations • Edema in the ankles and feet at the end of the day
Alteration in the pattern of fetal movement
Sexual assault is: • Limited to rape. •An act of force in which an unwanted and uncomfortable sexual act occurs. • A legal term for sexual violence. • An act of violence in which the partner is unknown.
An act of force in which an unwanted and uncomfortable sexual act occurs.
In reviewing the history of a woman who wants to become pregnant, which medication profile would indicate a potential concern relative to toxic exposure? (Select all that apply.) • Tylenol OTC occasionally for a headache; twice last week • Anticonvulsant for seizure disorder • Lithium for bipolar disorder • Coumadin for atrial fibrillation • Multivitamins once a day
Anticonvulsant for seizure disorder Lithium for bipolar disorder Coumadin for atrial fibrillation
Which of the following statements is not used to describe a characteristic of a uterine contraction? • Frequency (how often contractions occur) • Intensity (the strength of the contraction at its peak) • Resting tone (the tension in the uterine muscle) • Appearance (shape and height)
Appearance (shape and height)
The nurse providing care for the laboring woman understands that accelerations with fetal movement: • Are reassuring. • Are caused by umbilical cord compression. • Warrant close observation. • Are caused by uteroplacental insufficiency.
Are reassuring.
When would the best timeframe be to establish gestational age based on ultrasound? • At term • 8 weeks • Between 14 and 22 weeks • 36 weeks
Between 14 and 22 weeks
Which of the following findings would be a cause for concern for a nurse who is monitoring an obstetric patient who is in early labor? (Select all that apply.) • Biparietal diameter of less than 9.25 cm • Vertex presenting part • Transverse lie • General flexion attitude • Android pelvis
Biparietal diameter of less than 9.25 cm Transverse lie Android pelvis
Women with severe and persistent mental illness are likely to be more vulnerable to being involved in controlling and/or violent relationships. However, many women experience mental health problems as a result of long-term abuse. The psychologic consequences of continued abuse do not include: • Substance abuse. • Posttraumatic stress disorder (PTSD). • Eating disorders. • Bipolar disorder.
Bipolar disorder
With regard to breathing techniques during labor, maternity nurses should be aware that: • Breathing techniques in the first stage of labor are designed to increase the size of the abdominal cavity to reduce friction. • By the time labor has begun, it is too late for instruction in breathing and relaxation. •Controlled breathing techniques are most difficult near the end of the second stage of labor. • The patterned-paced breathing technique can help prevent hyperventilation.
Breathing techniques in the first stage of labor are designed to increase the size of the abdominal cavity to reduce friction
With regard to nutritional needs during lactation, a maternity nurse should be aware that: • The mother's intake of vitamin C, zinc, and protein now can be lower than during pregnancy. • Caffeine consumed by the mother accumulates in the infant, who therefore may be unusually active and wakeful. • Critical iron and folic acid levels must be maintained. • Lactating women can go back to their prepregnant calorie intake
Caffeine consumed by the mother accumulates in the infant, who therefore may be unusually active and wakeful.
The nurse caring for a laboring woman is aware that maternal cardiac output can be increased by: • Change in position. •Oxytocin administration. • Regional anesthesia. • Intravenous analgesic
Change in position.
When performing vaginal examinations on a laboring woman, the nurse should be guided by what principle? • Cleanse the vulva and perineum before and after the examination as needed. • Wear a clean glove lubricated with tap water to reduce discomfort. • Perform the examination every hour during the active phase of the first stage of labor. • Perform an examination immediately if active bleeding is present.
Cleanse the vulva and perineum before and after the examination as needed.
In order to reassure and educate pregnant clients about changes in their blood pressure, maternity nurses should be aware that: • A blood pressure cuff that is too small produces a reading that is too low; a cuff that is too large produces a reading that is too high. • Shifting the client's position and changing from arm to arm for different measurements produces the most accurate composite blood pressure reading at each visit. • The systolic blood pressure increases slightly as pregnancy advances; the diastolic pressure remains constant. • Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of term pregnancy.
Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of term pregnancy.
When counseling a client about getting enough iron in her diet, the maternity nurse should tell her that: • Milk, coffee, and tea aid iron absorption if consumed at the same time as iron. • Iron absorption is inhibited by a diet rich in vitamin C. • Iron supplements are permissible for children in small doses. • Constipation is common with iron supplements.
Constipation is common with iron supplements.
A woman is experiencing back labor and complains of intense pain in her lower back. An effective relief measure is to use: • Counterpressure against the sacrum. • Pant-blow (breaths and puffs) breathing techniques. • Effleurage. • Biofeedback
Counterpressure against the sacrum.
Which description of the phases of the second stage of labor is accurate? • Latent phase: feels sleepy, fetal station is 2+ to 4+, duration is 30 to 45 minutes • Active phase: overwhelmingly strong contractions, Ferguson reflux activated, duration is 5 to 15 minutes • Descent phase: significant increase in contractions, Ferguson reflux activated, average duration varies • Transitional phase: woman "laboring down," fetal station is 0, duration is 15 minutes
Descent phase: significant increase in contractions, Ferguson reflux activated, average duration varies
A patient has been sexually assaulted and is receiving an initial evaluation in the Emergency Department. She is concerned that she may become pregnant. Which priority action should the nurse implement so as to address the patient's concern? • Ask the patient to provide information about the date of her LMP. •Perform a pregnancy test, and as long as the results are negative, the patient does not have to worry about pregnancy. • Have the patient sign a consent form for a dilatation and curettage to be performed. • Determine the length of time after assault, and if it is less than 120 hours, emergency contraception may be provided.
Determine the length of time after assault, and if it is less than 120 hours, emergency contraception may be provided
The nurse sees a woman for the first time when she is 30 weeks pregnant. The woman has smoked throughout the pregnancy, and fundal height measurements now are suggestive of growth restriction in the fetus. In addition to ultrasound to measure fetal size, what would be another tool useful in confirming the diagnosis? • Doppler blood flow analysis • contraction stress test (CST) • Amniocentesis • Daily fetal movement counts
Doppler blood flow analysis
A group of fetal monitoring experts (National Institute of Child Health and Human Development, 2008) recommends that fetal heart rate (FHR) tracings demonstrate certain characteristics to be described as reassuring or normal (category I). These characteristics include: • Bradycardia not accompanied by baseline variability. • Early decelerations, either present or absent. • Sinusoidal pattern. • Tachycardia.
Early decelerations, either present or absent.
A pregnant woman experiencing nausea and vomiting should: • Drink a glass of water with a fat-free carbohydrate before getting out of bed in the morning. • Eat small, frequent meals (every 2 to 3 hours). • Increase her intake of high-fat foods to keep the stomach full and coated. • Limit fluid intake throughout the day.
Eat small, frequent meals (every 2 to 3 hours).
Which findings could be considered to be a barrier to a pregnant woman seeking prenatal care? (Select all that apply.) • Patient would prefer to be cared for by a midwife instead of a physician. • Economic cost of health care. • Patient's cultural beliefs do not include prenatal care as being valued. •Patient speaks several languages. • Patient had a bad experience the last time she went to a doctor for care.
Economic cost of health care. Patient's cultural beliefs do not include prenatal care as being valued. Patient had a bad experience the last time she went to a doctor for care.
With regard to systemic analgesics administered during labor, nurses should be aware that: • Systemic analgesics cross the maternal blood-brain barrier as easily as they do the fetal blood-brain barrier. • Effects on the fetus and newborn can include decreased alertness and delayed sucking. • IM administration is preferred over IV administration. • IV patient-controlled analgesia (PCA) results in increased use of an analgesic.
Effects on the fetus and newborn can include decreased alertness and delayed sucking
In the current practice of childbirth preparation, emphasis is placed on: • The Dick-Read (natural) childbirth method. • The Lamaze (psychoprophylactic) method. • The Bradley (husband-coached) method. • Encouraging expectant parents to attend childbirth preparation in any or no specific method.
Encouraging expectant parents to attend childbirth preparation in any or no specific method
When managing the care of a woman in the second stage of labor, the nurse uses various measures to enhance the progress of fetal descent. These measures include: • Encouraging the woman to try various upright positions, including squatting and standing. • Telling the woman to start pushing as soon as her cervix is fully dilated. • Continuing an epidural anesthetic so that pain is reduced and the woman can relax. • Coaching the woman to use sustained, 10- to 15-second, closed-glottis bearing-down efforts with each contraction.
Encouraging the woman to try various upright positions, including squatting and standing
Over-the-counter (OTC) pregnancy tests usually rely on which technology to test for human chorionic gonadotropin (hCG)? • Radioimmunoassay • Radioreceptor assay • Latex agglutination test • Enzyme-linked immunosorbent assay (ELISA)
Enzyme-linked immunosorbent assay (ELISA)
A pregnant woman demonstrates understanding of the nurse's instructions regarding relief of leg cramps if she: • Wiggles and points her toes during the cramp. • Applies cold compresses to the affected leg. • Extends her leg and dorsiflexes her foot during the cramp. • Avoids weight bearing on the affected leg during the cramp.
Extends her leg and dorsiflexes her foot during the cramp.
Which test is performed to determine whether membranes are ruptured? • Urine analysis • Fern test • Leopold maneuvers • AROM
Fern test
A nurse teaches a pregnant woman about the presumptive, probable, and positive signs of pregnancy. The woman demonstrates understanding of the nurse's instructions if she states that a positive sign of pregnancy is: • A positive pregnancy test result • Fetal movement palpated by the nurse-midwife. • Braxton Hicks contractions. • Quickening
Fetal movement palpated by the nurse-midwife.
Fetal circulation can be affected by many factors during labor. Accurate assessment of the laboring woman and fetus requires knowledge of these expected adaptations. Which factor will not affect fetal circulation during labor? • Fetal position • Uterine contractions • Blood pressure •Umbilical cord blood flow
Fetal position
The most common cause of decreased variability in the FHR that lasts 30 minutes or less is: • Altered cerebral blood flow. • Fetal hypoxemia. • Umbilical cord compression. • Fetal sleep cycles.
Fetal sleep cycles.
A pregnant woman has been diagnosed with oligohydramnios. Which presentation would the nurse suspect to find on physical examination? • Fetus is in a breech position • FHR baseline is within normal range • Fetus with possible renal problems • Increased fundal height
Fetus with possible renal problems
Which of the following would not be included in a labor nurse's plan of care for an expectant mother? • The onset of progressive, regular contractions • The bloody, or pink, show • The spontaneous rupture of membranes • Formulation of the woman's plan of care for labor
Formulation of the woman's plan of care for labor
In the past, factors to determine whether a woman was likely to have a high risk pregnancy were evaluated primarily from a medical point of view. A broader, more comprehensive approach to high risk pregnancy has been adopted. There are now four categories based on threats to the health of the woman and the outcome of pregnancy. Which of the options listed here is not included as a category? • Biophysical • Psychosocial • Geographic • Environmental
Geographic
Which presumptive sign (felt by woman) or probable sign (observed by the examiner) of pregnancy is not matched with another possible cause(s)? • Amenorrhea—stress, endocrine problems • Quickening—gas, peristalsis • Goodell sign—cervical polyps • Chadwick sign—pelvic congestion
Goodell sign—cervical polyps
With regard to what might be called the tactile approaches to comfort management, nurses should be aware that: • Either hot or cold applications may provide relief, but they should never be used together in the same treatment. • Acupuncture can be performed by a skilled nurse with just a little training. • Hand and foot massage may be especially relaxing in advanced labor, when a woman's tolerance for touch is limited. • Therapeutic touch (TT) uses handheld electronic stimulators that produce sympathetic vibrations.
Hand and foot massage may be especially relaxing in advanced labor, when a woman's tolerance for touch is limited
During a client's physical examination, the nurse notes that the lower uterine segment is soft on palpation. The nurse would document this finding as: • Hegar sign. • McDonald sign. • Chadwick sign. • Goodell sign.
Hegar sign
A woman in the active phase of the first stage of labor is using a shallow pattern of breathing, which is about twice the normal adult breathing rate. She starts to complain about feeling lightheaded and dizzy and states that her fingers are tingling. The nurse should: • Notify the woman's physician. • Tell the woman to slow the pace of her breathing. • Administer oxygen via a mask or nasal cannula. • Help her breathe into a paper bag.
Help her breathe into a paper bag.
Which statement is most likely to be associated with a breech presentation? • Least common malpresentation • Descent rapid • Diagnosis by ultrasound only • High rate of neuromuscular disorders
High rate of neuromuscular disorders
The nurse caring for a pregnant woman knows that her health teaching regarding fetal circulation has been effective when the woman reports that she has been sleeping: • In a side-lying position. • On her back with a pillow under her knees. • With the head of the bed elevated. • On her abdomen.
In a side-lying position.
Which suggestion about weight gain is not an accurate recommendation? • Underweight women should gain 12.5 to 18 kg. • Obese women should gain at least 7 kg. • Adolescents are encouraged to strive for weight gains at the upper end of the recommended scale. • In twin gestations, the weight gain recommended for a single fetus pregnancy should simply be doubled.
In twin gestations, the weight gain recommended for a single fetus pregnancy should simply be doubled.
Cardiovascular system changes occur during pregnancy. Which finding would be considered normal for a woman in her second trimester? • Less audible heart sounds (S1, S2) • Increased pulse rate • Increased blood pressure • Decreased red blood cell (RBC) production
Increased pulse rate
An expectant couple asks the nurse about intercourse during pregnancy and whether it is safe for the baby. The nurse should tell the couple that: • Intercourse should be avoided if any spotting from the vagina occurs afterward. • Intercourse is safe until the third trimester. • Safer-sex practices should be used once the membranes rupture. • Intercourse and orgasm are often contraindicated if a history or signs of preterm labor are present.
Intercourse and orgasm are often contraindicated if a history or signs of preterm labor are present
Women with inadequate weight gain during pregnancy are at higher risk of giving birth to an infant with: • Spina bifida. • Intrauterine growth restriction. • Diabetes mellitus. •Down syndrome
Intrauterine growth restriction.
Which minerals and vitamins are usually recommended to supplement a pregnant woman's diet? • Fat-soluble vitamins A and D • Water-soluble vitamins C and B6 • Iron and folate • Calcium and zinc
Iron and folate
A nurse providing care for the antepartum woman should understand that the contraction stress test (CST): • Is considered to have a negative result if no late decelerations are observed with the contractions. Sometimes uses vibroacoustic stimulation. • Is an invasive test; however, contractions are stimulated. • Is considered to have a negative result if no late decelerations are observed with the contractions.
Is considered to have a negative result if no late decelerations are observed with the contractions.
A nurse providing care to a woman in labor should be aware that cesarean birth: • Is declining in frequency in the United States. • Is more likely to be performed in the poor in public hospitals who do not receive the nurse counseling that wealthier clients do. • Is performed primarily for the benefit of the fetus. • Can be either elected or refused by women as their absolute legal right.
Is performed primarily for the benefit of the fetus
Which statement is inaccurate with regard to normal labor? • A single fetus presents by vertex. • It is completed within 8 hours. • A regular progression of contractions, effacement, dilation, and descent occurs. • No complications are involved.
It is completed within 8 hours.
A maternity nurse should be aware of which fact about the amniotic fluid? • It serves as a source of oral fluid and as a repository for waste from the fetus. • The volume remains about the same throughout the term of a healthy pregnancy. • A volume of less than 300 ml is associated with gastrointestinal malformations. • A volume of more than 2 L is associated with fetal renal abnormalities
It serves as a source of oral fluid and as a repository for waste from the fetus.
With regard to the use of tocolytic therapy to suppress uterine activity, nurses should be aware that: • The drugs can be given efficaciously up to the designated beginning of term at 37 weeks. • There are no important maternal (as opposed to fetal) contraindications. • Its most important function is to afford the opportunity to administer antenatal glucocorticoids. • If pulmonary edema develops while the client is receiving tocolytics, IV fluids should be given.
Its most important function is to afford the opportunity to administer antenatal glucocorticoids
If a woman complains of back labor pain, the nurse might best suggest that she: • Lie on her back for a while with her knees bent. • Do less walking around. • Take some deep, cleansing breaths. • Lean over a birth ball with her knees on the floor
Lean over a birth ball with her knees on the floor.
Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy, including that: • Chorionic villus sampling (CVS) is becoming more popular because it provides early diagnosis. • Screening for maternal serum alpha-fetoprotein (MSAFP) levels is recommended only for women at risk for neural tube defects. • Percutaneous umbilical blood sampling (PUBS) is one of the quad-screen tests for Down syndrome. • MSAFP is a screening tool only; it identifies candidates for more definitive procedures.
MSAFP is a screening tool only; it identifies candidates for more definitive procedures
Which developmental finding is accurate with regard to fetal growth? • Heart starts beating at 12 weeks. • Lungs take shape by 8 weeks. • Brain configuration is complete by 8 weeks. • Main blood vessels form by 8 weeks.
Main blood vessels form by 8 weeks.
A patient has been sexually assaulted and presents to the Emergency Department for a sexual assault examination. Which action would be a priority for the nurse assigned to take care of the patient? • Provide the patient with a washcloth and allow her to provide needed hygiene measures. • Ask the patient for her insurance card so that you can validate information. • Maintain chain of custody for collection of evidence. • Provide the patient with contact information regarding psychological resources that may help her with dealing with this situation
Maintain chain of custody for collection of evidence.
With regard to protein in the diet of pregnant women, nurses should be aware that: • Many protein-rich foods are also good sources of calcium, iron, and B vitamins. • Many women need to increase their protein intake during pregnancy. • As with carbohydrates and fat, no specific recommendations exist for the amount of protein in the diet. • High-protein supplements can be used without risk by women on macrobiotic diets.
Many protein-rich foods are also good sources of calcium, iron, and B vitamins.
What is an appropriate indicator for performing a contraction stress test? • Increased fetal movement and small for gestational age • Maternal diabetes mellitus and postmaturity • Adolescent pregnancy and poor prenatal care • History of preterm labor and intrauterine growth restriction
Maternal diabetes mellitus and postmaturity
A pregnant patient is experiencing some integumentary changes and is concerned that they may represent abnormal findings. The nurse provides information to the patient that the following findings would be considered "normal abnormal" findings during pregnancy so that she should not be alarmed. (Select all that apply.) • Facial edema • Melasma • Linea nigra • Superficial thrombophlebitis • Vascular spiders • Allodynia
Melasma Linea nigra Vascular spiders
• A woman in active labor receives an opioid agonist analgesic. Which medication relieves severe, persistent, or recurrent pain, creates a sense of well-being, overcomes inhibitory factors, and may even relax the cervix but should be used cautiously in women with cardiac disease? • Meperidine (Demerol) • Promethazine (Phenergan) • Butorphanol tartrate (Stadol) • Nalbuphine (Nubain)
Meperidine (Demerol)
A nurse caring for a woman in labor understands that increased variability of the fetal heart rate might be caused by: • Narcotics. • Barbiturates. • Methamphetamines. • Tranquilizers.
Methamphetamines.
Another name for human sex trafficking is: • Sex games. • Licensed sexual act. • Modern-day slavery.
Modern-day slavery
What type of cultural concern is the most likely deterrent to many women seeking prenatal care? • Religion • Modesty • Ignorance • Belief that physicians are evil
Modesty
In understanding and guiding a woman through her acceptance of pregnancy, a maternity nurse should be aware that: • Nonacceptance of the pregnancy very often equates to rejection of the child. • Mood swings are most likely the result of worries about finances and a changed lifestyle, as well as profound hormonal changes. • Ambivalent feelings during pregnancy are usually seen only in emotionally immature or very young mothers. • Conflicts such as not wanting to be pregnant or childrearing and career-related decisions need not be addressed during pregnancy because they will resolve themselves naturally after birth.
Mood swings are most likely the result of worries about finances and a changed lifestyle, as well as profound hormonal changes.
You are evaluating the fetal monitor tracing of your client, who is in active labor. Suddenly you see the fetal heart rate (FHR) drop from its baseline of 125 down to 80. You reposition the mother, provide oxygen, increase IV fluid, and perform a vaginal exam. The cervix has not changed. Five minutes have passed, and the FHR remains in the 80s. What additional nursing measures should you take? • Call for help. • Insert a Foley catheter. • Start oxytocin (Pitocin). • Notify the primary health care provider immediately.
Notify the primary health care provider immediately
A patient has undergone an amniocentesis for evaluation of fetal well-being. Which intervention would be included in the nurse's plan of care after the procedure? (Select all that apply.) • Perform ultrasound to determine fetal positioning. • Observe the patient for possible uterine contractions. • Administer RhoGAM to the patient if she is Rh negative. • Perform a minicatheterization to obtain a urine specimen to assess for bleeding.
Observe the patient for possible uterine contractions. Administer RhoGAM to the patient if she is Rh negative
For a woman at 42 weeks of gestation, which finding requires more assessment by the nurse? • Fetal heart rate of 116 beats/min • Cervix dilated 2 cm and 50% effaced • Score of 8 on the biophysical profile • One fetal movement noted in 1 hour of assessment by the mother
One fetal movement noted in 1 hour of assessment by the mother
A pregnant woman's amniotic membranes rupture. Prolapsed cord is suspected. Which intervention is the nurse's top priority? • Place the woman in the knee-chest position. • Cover the cord in a sterile towel saturated with warm normal saline. • Prepare the woman for a cesarean birth. • Start oxygen by face mask
Place the woman in the knee-chest position
With regard to medications, herbs, shots, and other substances normally encountered, the maternity nurse should be aware that during pregnancy: • Prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus. • The greatest danger of drug-caused developmental deficits in the fetus is seen in the final trimester. • Killed-virus vaccines (e.g., tetanus) should not be given, but live-virus vaccines (e.g., measles) are permissible. • No convincing evidence exists that secondhand smoke is potentially dangerous to the fetus.
Prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus.
With regard to primary and secondary powers, the maternity nurse should understand that: • Primary powers are responsible for effacement and dilation of the cervix. • Effacement generally is well ahead of dilation in women giving birth for the first time; they are more together in subsequent pregnancies. • Scarring of the cervix caused by a previous infection or surgery may make the delivery a bit more painful, but it should not slow or inhibit dilation. • Pushing in the second stage of labor is more effective if the woman can breathe deeply and control some of her involuntary needs to push, as the nurse directs
Primary powers are responsible for effacement and dilation of the cervix.
A woman who has completed one pregnancy with a fetus (or fetuses) reaching the stage of fetal viability is called a: • Primipara • Primigravida • Multipara • Nulligravida
Primipara
Many parents-to-be have questions about multiple births. Maternity nurses should be able to tell them that: • Rates of twinning and other multiple births are increasing because of the use of fertility drugs and delayed childbearing. • Dizygotic twins (two fertilized ova) have the potential to be conjoined twins. • Identical twins are more common in Caucasian families. • Fraternal twins are same gender, usually male.
Rates of twinning and other multiple births are increasing because of the use of fertility drugs and delayed childbearing
After change of shift report, the nurse assumes care of a multiparous client in labor. The woman is complaining of pain that radiates to her abdominal wall, lower back, and buttocks, and down her thighs. Before implementing a plan of care, the nurse should understand that this type of pain is: • Visceral • Referred • Somatic • Afterpain
Referred
A sexual assault victim is brought into the Emergency Department for triage. Which health care provider should be contacted to perform the assessment? • Emergency Room physician • RN • LPN • SANE
SANE
Which of the following lab tests would be indicated for a victim of sexual assault? (Select all that apply.) • Chemistry profile and complete blood count • Screening test for hepatitis B •Fecal occult blood testing • Oral swab DNA testing • Serum blood pregnancy test • Gonorrhea culture
Screening test for hepatitis B Oral swab DNA testing Serum blood pregnancy test
Nurses should be aware of the difference that experience can make in labor pain, such as: • Sensory pain for nulliparous women often is greater than for multiparous women during early labor. • Affective pain for nulliparous women usually is less than for multiparous women throughout the first stage of labor. •Women with a history of substance abuse experience more pain during labor. • Multiparous women have more fatigue from labor and therefore experience more pain
Sensory pain for nulliparous women often is greater than for multiparous women during early labor.
A pregnant woman reports that she is still playing tennis at 32 weeks of gestation. The nurse would be most concerned regarding what this woman consumes during and after tennis matches. Which is the most important? • Several glasses of fluid • Extra protein sources, such as peanut butter • Salty foods to replace lost sodium • Easily digested sources of carbohydrate
Several glasses of fluid
Which behavior indicates that a woman is "seeking safe passage" for herself and her infant? • She keeps all prenatal appointments. • She "eats for two." • She drives her car slowly. • She wears only low-heeled shoes.
She keeps all prenatal appointments
The nurse advises the woman who wants to have a nurse-midwife provide obstetric care that: • She will have to give birth at home. • She must see an obstetrician as well as the midwife during pregnancy. • She will not be able to have epidural analgesia for labor pain. • She must be having a low-risk pregnancy.
She must be having a low-risk pregnancy.
Which factors would lead to an increased likelihood of uterine rupture? (Select all that apply.) • Preterm singleton pregnancy • G3P3 with all vaginal deliveries • Short interval between pregnancies • Patient receiving a trial of labor (TOL) following a VBAC delivery • Patient who had a primary caesarean section with a classic incision
Short interval between pregnancies Patient receiving a trial of labor (TOL) following a VBAC delivery Patient who had a primary caesarean section with a classic incision
Evidence-based care practices designed to support normal labor and birth recommend which practice during the immediate newborn period? • The healthy newborn should be taken to the nursery for a complete assessment. • After drying, the infant should be given to the mother wrapped in a receiving blanket. • Skin-to-skin contact of mother and baby should be encouraged. • The father or support person should be encouraged to hold the infant while awaiting delivery of the placenta.
Skin-to-skin contact of mother and baby should be encouraged
Which position would the nurse suggest for second-stage labor if the pelvic outlet needs to be increased? • Semirecumbent • Sitting • Squatting • Side-lying
Squatting
The nurse knows that the second stage of labor, the descent phase, has begun when: • The amniotic membranes rupture. • The cervix cannot be felt during a vaginal examination. • The woman experiences a strong urge to bear down. • The presenting part is below the ischial spines.
The cervix cannot be felt during a vaginal examination.
A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. What finding indicates that preterm labor is occurring? • Estriol is not found in maternal saliva. • Irregular, mild uterine contractions are occurring every 12 to 15 minutes. • Fetal fibronectin is present in vaginal secretions. • The cervix is effacing and dilated to 2 cm.
The cervix is effacing and dilated to 2 cm
Concerning the third stage of labor, nurses should be aware that: • The placenta eventually detaches itself from a flaccid uterus. • The duration of the third stage may be as short as 3 to 5 minutes. • It is important that the dark, roughened maternal surface of the placenta appear before the shiny fetal surface. • The major risk for women during the third stage is a rapid heart rate.
The duration of the third stage may be as short as 3 to 5 minutes.
In order to accurately assess the health of the mother accurately during labor, the nurse should be aware that: • The woman's blood pressure increases during contractions and falls back to prelabor normal between contractions. • Use of the Valsalva maneuver is encouraged during the second stage of labor to relieve fetal hypoxia. • Having the woman point her toes reduces leg cramps. • The endogenous endorphins released during labor raise the woman's pain threshold and produce sedation.
The endogenous endorphins released during labor raise the woman's pain threshold and produce sedation.
When using intermittent auscultation (IA) to assess uterine activity, nurses should be aware that: • The examiner's hand should be placed over the fundus before, during, and after contractions. • The frequency and duration of contractions are measured in seconds for consistency. • Contraction intensity is given a judgment number of 1 to 7 by the nurse and client together. • The resting tone between contractions is described as either placid or turbulent.
The examiner's hand should be placed over the fundus before, during, and after contractions
With regard to the father's acceptance of the pregnancy and preparation for childbirth, the maternity nurse should know that: • The father goes through three phases of acceptance of his own. • The father's attachment to the fetus cannot be as strong as that of the mother because it does not start until after birth. • In the last 2 months of pregnancy, most expectant fathers suddenly get very protective of their established lifestyle and resist making changes to the home. • Typically men remain ambivalent about fatherhood right up to the birth of their child.
The father goes through three phases of acceptance of his own.
A woman at 35 weeks of gestation has had an amniocentesis. The results reveal that surface-active phospholipids are present in the amniotic fluid. The nurse is aware that this finding indicates that: • The fetus is at risk for Down syndrome. • The woman is at high risk for developing preterm labor. • The lungs are mature. • Meconium is present in the amniotic fluid.
The lungs are mature.
In a variation of rooming-in called couplet care, the mother and infant share a room and the mother shares the care of the infant with: • The father of the infant. • Her mother (the infant's grandmother). • Her eldest daughter (the infant's sister). • The nurse.
The nurse
A nurse is providing instruction for an obstetrical patient to perform a daily fetal movement count (DFMC). Which instructions could be included in the plan of care? (Select all that apply.) • The fetal alarm signal is reached when there are no fetal movements noted for 5 hours. • The patient can monitor fetal activity once daily for a 60-minute period and note activity. • Monitor fetal activity two times a day either after meals or before bed for a period of 2 hours or until 10 fetal movements are noted. • Count all fetal movements in a 12-hour period daily until 10 fetal movements are noted.
The patient can monitor fetal activity once daily for a 60-minute period and note activity. Monitor fetal activity two times a day either after meals or before bed for a period of 2 hours or until 10 fetal movements are noted Count all fetal movements in a 12-hour period daily until 10 fetal movements are noted
When assessing a multiparous woman who has just given birth to an 8-pound boy, the nurse notes that the woman's fundus is firm and has become globular. A gush of dark red blood comes from her vagina. The nurse concludes that: • The placenta has separated. • A cervical tear occurred during the birth. • The woman is beginning to hemorrhage. • Clots have formed in the upper uterine segment.
The placenta has separated.
Fetal well-being during labor is assessed by: • The response of the fetal heart rate (FHR) to uterine contractions (UCs). • Maternal pain control. • Accelerations in the FHR. • An FHR greater than 110 beats/min.
The response of the fetal heart rate (FHR) to uterine contractions (UCs)
A 22-year-old woman pregnant with a single fetus had a preconception body mass index (BMI) of 24. When she was seen in the clinic at 14 weeks of gestation, she had gained 1.8 kg (4 lbs) since conception. How would the nurse interpret this finding? • This weight gain indicates possible gestational hypertension. • This weight gain indicates that the woman's infant is at risk for intrauterine growth restriction (IUGR). • This weight gain cannot be evaluated until the woman has been observed for several more weeks. • The woman's weight gain is appropriate for this stage of pregnancy.
The woman's weight gain is appropriate for this stage of pregnancy.
A 40-year-old woman with a high body mass index (BMI) is 10 weeks pregnant. Which diagnostic tool is appropriate to suggest to her at this time? • Biophysical profile • Amniocentesis • Maternal serum alpha-fetoprotein (MSAFP) • Transvaginal ultrasound
Transvaginal ultrasound
Which statement about multifetal pregnancy is not accurate? • The expectant mother often experiences anemia because the fetuses have a greater demand for iron. • Twin pregnancies come to term with the same frequency as single pregnancies. • The mother should be counseled to increase her nutritional intake and gain more weight. • Backache and varicose veins are often more pronounced.
Twin pregnancies come to term with the same frequency as single pregnancies.
Fetal bradycardia is most common during: • Maternal hyperthyroidism. • Fetal anemia. • Viral infection. • Tocolytic treatment using ritodrine.
Viral infection
Under which circumstance would a nurse not perform a vaginal examination on a patient in labor? • An admission to the hospital at the start of labor • When accelerations of the fetal heart rate (FHR) are noted • On maternal perception of perineal pressure or the urge to bear down • When membranes rupture
When accelerations of the fetal heart rate (FHR) are noted
The nurse's best measure when evaluating the care of a woman in an abusive situation is based on the: • Woman's decision to leave her partner. •Woman's declaration of a safety plan. • Couple's follow-through on a referral for counseling. • Woman's gratitude to the nurse for the helpful information.
Woman's declaration of a safety plan.
With regard to dysfunctional labor, nurses should be aware that: • Women who are underweight are more at risk. • Women experiencing precipitous labor are about the only women experiencing dysfunctional labor who are not exhausted. • Hypertonic uterine dysfunction is more common than hypotonic dysfunction. • Abnormal labor patterns are most common in older women
Women experiencing precipitous labor are about the only women experiencing dysfunctional labor who are not exhausted
A woman's cousin gave birth to an infant with a congenital heart anomaly. The woman asks the nurse when such anomalies occur during development. Which response by the nurse is most accurate? • "We don't really know when such defects occur." • "It depends on what caused the defect." • "They occur between the third and fifth weeks of development." • "They usually occur in the first 2 weeks of development."
• "They occur between the third and fifth weeks of development."
