exam 1

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Which effect is a common response to both smoking and cocaine use in the pregnant patient? 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.

Which maternal condition should be considered a contraindication for the application of internal monitoring devices? a. Unruptured membranes b. Cervix dilated to 4 cm c. Fetus has known heart defect d. Maternal HIV

ANS: A To apply internal monitoring devices, the membranes must be ruptured. Cervical dilation of 4 cm would permit the insertion of fetal scalp electrodes and an intrauterine catheter. A compromised fetus should be monitored with the most accurate monitoring devices. An internal electrode should not be placed if the patient has hemophilia, maternal HIV, or genital herpes.

1. Which medications could potentially cause hyperstimulation of the uterus during labor? (Select all that apply.) a. Oxytocin (Pitocin) b. Misoprostol (Cytotec) c. Dinoprostone (Cervidil) d. Methylergonovine maleate (Methergine)

ANS: A, B, C, D Oxytocin, misoprostol, and dinoprostone fall under the general category of uterine stimulants. Cytotec and Cervidil are prostaglandins. Methergine is an ergot alkaloid.

The nurse is teaching a pregnant patient about food safety during pregnancy and lactation. Which statements by the patient 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 patient 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.

A maternal indication for the use of vacuum extraction is a. a wide pelvic outlet. b. maternal exhaustion. c. a history of rapid deliveries. d. failure to progress past 0 station.

ANS: B The patient who is exhausted will be unable to assist with the expulsion of the fetus. With a wide pelvic outlet, vacuum extraction would not be necessary. With a rapid birth, vacuum extraction would not be necessary. A station of 0 is too high for a vacuum extraction.

The nurse is explaining genetics to a group of nursing students. Which are autosomal recessive disorders that the nurse should discuss during the teaching session? (Select all that apply.) a. Hemophilia b. Cystic fibrosis c. Sickle cell disease d. Turner's syndrome e. Phenylketonuria (PKU) disease

ANS: B, C, E Cystic fibrosis, sickle cell disease, and PKU disease are autosomal recessive disorders. Hemophilia and Turner's syndrome are X-linked genetic disorders.

A blood-soaked peripad weighs 900 g. The nurse would document a blood loss of _____ mL. a. 1800 b. 450 c. 900 d. 90

ANS: C One g equals 1 mL of blood.

What should the nurse recognize as evidence that the patient is recovering from preeclampsia? a. 1+ protein in urine b. 2+ pitting edema in lower extremities c. Urine output >100 mL/hour d. Deep tendon reflexes +2

ANS: C Rapid reduction of the edema associated with preeclampsia results in urinary output of 4 to 6 L/day as interstitial fluids shift back to the circulatory system. 1+ protein in urine and 2+ pitting edema in lower extremities are signs of continuing preeclampsia. Deep tendon reflexes are not a reliable sign, especially if the patient has been treated with magnesium

Which aspect of newborn assessment may be limited by the application of a vacuum extractor at birth? a. Anterior fontanel b. Coronal suture lines c. Posterior fontanel d. Biparietal diameter

ANS: C The vacuum extractor is applied on the occipital bone and may create scalp edema at the application site. The posterior fontanel connects the occipital bone to the parietal bones. The anterior fontanel, coronal suture lines, and parietal bones are not part of the application area for a vacuum extractor.

The nurse is meeting with a patient with an elevated BMI regarding an optimal diet for pregnancy. Which major source of nutrients should be a significant component of this patient's diet? 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 primarily by complex carbohydrates. The most common simple carbohydrate is table sugar, which is a source of energy but does not provide any nutrients

The nurse notes that a patient who has given birth 1 hour ago is touching her infant with her fingertips and talking to him softly in high-pitched tones. Based on this observation, which action should the nurse take? a. Request a social service consult for psychosocial support. b. Observe for other signs that the mother may not be accepting of the infant. c. Document this evidence of normal early maternal-infant attachment behavior. d. Determine whether the mother is too fatigued to interact normally with her infant

Normal early maternal-infant behaviors are tentative and include fingertip touch, eye contact, and using a high-pitched voice when talking to the infant. There is no indication at this point that a social service consult is necessary. The signs are of normal attachment behavior. These are signs of normal attachment behavior; no other assessment is necessary at this point. The mother may be fatigued but is interacting with the infant in an expected manner.

Which factor is known to increase the risk of gestational diabetes mellitus? a. Previous birth of large infant b. Maternal age younger than 25 years c. Underweight prior to pregnancy d. Previous diagnosis of type 2 diabetes mellitus

The clinic nurse is reviewing charts on prenatal patients. Which patient histories indicate that a referral to a genetic counselor is warranted? (Select all that apply.) a. A father who is aged 35 b. A patient having a first baby at age 30 c. A family history of unexplained stillbirths d. A patient with a family history of birth defects e. A patient who is a carrier of an X-linked disorder

The health care provider reports that the primigravida's fundus can be palpated at the umbilicus. Which priority question will the nurse include in the patient's assessment? a. "Have you noticed that it is easier for you to breathe now?" b. "Would you like to hear the baby's heartbeat for the first time?" c. "Have you felt a fluttering sensation in your lower pelvic area yet?" d. "Have you recently developed any unusual cravings, such as for chalk or dirt?"

The middle school nurse is reviewing the phases of the endometrial cycle with a group of female students. Which statement by a student will the nurse need to correct? a. "The proliferative phase occurs when the ovum is maturing." b. "The expulsion phase occurs when the ovum is discharged from the ovary." c. "The secretory phase occurs during the second half of the menstrual cycle." d. "The menstrual phase occurs after the levels of estrogen and progesterone fall."

The nurse is describing the size and shape of the nonpregnant uterus to a patient. Which is an accurate description? a. The nonpregnant uterus is the size and shape of a pear. b. The nonpregnant uterus is the size and shape of a cantaloupe. c. The nonpregnant uterus is the size and shape of a grapefruit. d. The non-pregnant uterus is the size and shape of a large orange.

Which nursing assessment indicates that a patient who is in the second stage of labor is almost ready to give birth? a. Bloody mucous discharge increases. b. The vulva bulges and encircles the fetal head. c. The membranes rupture during a contraction. d. The fetal head is felt at 0 station during the vaginal examination.

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

A postpartum patient who has had a vaginal birth asks the nurse, "I was wondering if my cervix will return to its previous shape before I had the baby?" Which is the best response by the nurse? a. The cervix will now have a slit-like shape. b. The cervix will be round and smooth after healing occurs. c. The cervix will remain 50% effaced now that you have had a baby. d. The cervix will be slightly dilated to 2 cm for about 6 months.

The labor and birth nurse is reviewing the risk factors for placenta previa with a group of nursing students. The nurse determines that the students understood the discussion when they identify which patient being at the highest risk for developing a placenta previa? a. Female fetus, Mexican-American, primigravida b. Male fetus, Asian-American, previous preterm birth c. Male fetus, African-American, previous cesarean birth d. Female fetus, European-American, previous spontaneous abortion

The rate of placenta previa is increasing. It is more common in older women, multiparous women, women who have had cesarean births, and women who had suction curettage for an induced or spontaneous abortion. It is also more likely to recur if a woman has had a placenta previa. African or Asian ethnicity also increases the risk. Cigarette smoking and cocaine use are personal habits that add to a woman's risk for a previa. Previa is more likely if the fetus is male. The Mexican-American primipara has no risk factors for developing a placenta previa. The Asian-American multipara has two risk factors for developing a previa. The African-American multipara has three risk factors for developing a previa. The European-American multigravida has one risk factor for developing a placenta previa.

Which information should the nurse include when discussing the prenatal diagnosis of genetic disorders with an expectant couple? a. The diagnosis may be slow and could be inconclusive. b. A comprehensive evaluation will result in an accurate diagnosis. c. Common disorders can be quickly diagnosed through blood tests. d. Diagnosis can be obtained promptly through most hospital laboratories.

ANS: A Even the best efforts at diagnosis do not always yield the information needed to counsel the patient. The process may require many visits over several weeks. Some tests must be sent to special laboratories, which take additional time. Despite a comprehensive evaluation, a diagnosis may never be established. At this time there are no rapid result blood tests available to diagnose genetic disorders. Some tests must be sent to a special laboratory, which requires a longer waiting period for results.

A patient at 41 weeks' gestation is undergoing an induction of labor with an IV administration of oxytocin (Pitocin). The fetal heart rate starts to demonstrate a recurrent pattern of late decelerations with moderate variability. What is the nurse's priority action? a. Stop the infusion of Pitocin. b. Reposition the patient from her right to her left side. c. Perform a vaginal exam to assess for a prolapsed cord. d. Prepare the patient for an emergency cesarean birth.

ANS: A There are multiple reasons for late decelerations. Address the probable cause first, such as uterine hyperstimulation with Pitocin, to alleviate the outcome of late decelerations. Repositioning can increase oxygenation to the fetus but does not address the cause of the problem. Variable decelerations are more often seen with a prolapsed cord. In the presence of moderate variability, the fetus continues to have adequate oxygen reserves. If a Category II (indeterminate) or III (abnormal) tracing is interpreted, a prompt approach to assessing oxygenation should be completed.

The labor nurse is admitting a patient in active labor with a history of genital herpes. On assessment, the patient reports a recent outbreak, and the nurse verifies lesions on the perineum. What is the nurse's next action? a. Ask the patient when she last had anything to eat or drink. b. Take a culture of the lesions to verify the involved organism. c. Ask the patient if she has had unprotected sex since her outbreak. d. Use electronic fetal surveillance to determine a baseline fetal heart rate.

ANS: A A cesarean birth is recommended for women with active lesions in the genital area, whether recurrent or primary, at the time of labor. The patient's dietary intake is needed to prepare for surgery. This patient is in active labor and the fetus is at risk for infection if the membranes rupture. The health care provider needs to be notified, and a cesarean birth needs to be performed as soon as possible. There is no need to validate the infection because the patient is well aware of the symptoms of an active infection. Although transmission to sexual partners is valid information, it is not necessary information in an urgent situation such as depicted in this scenario. Electronic fetal surveillance is the standard of care.

Which of the following is the priority intervention for the patient in a left side-lying position whose monitor strip shows a deceleration that extends beyond the end of the contraction? a. Administer O2 at 8 to 10 L/minute. b. Decrease the IV rate to 100 mL/hour. c. Reposition the ultrasound transducer. d. Perform a vaginal exam to assess for cord prolapse

ANS: A A deceleration that returns to baseline after the end of the contraction is a late deceleration caused by placental perfusion problems. Administering oxygen will increase the patient's blood oxygen saturation, making more oxygen available to the fetus. Decreasing the IV rate, repositioning the ultrasound transducer, and performing a vaginal exam to assess for cord prolapse are not effective interventions to improve fetal oxygenation.

Which maternal factor may inhibit fetal descent during labor? a. A full bladder b. Decreased peristalsis c. Rupture of membranes d. Reduction in internal uterine size

ANS: A A full bladder may inhibit fetal descent because it occupies space in the pelvis needed by the fetal presenting part. Peristalsis does not influence fetal descent. Rupture of membranes will assist in the fetal descent. Contractions will reduce the internal uterine size to assist fetal descent

As the triage nurse in the emergency room, you are reviewing results for the high-risk obstetric patient who is in labor because of traumatic injury experienced as a result of a motor vehicle accident (MVA). You note that the Kleihauer-Betke test is positive. Based on this information, you anticipate that a. immediate birth is required. b. the patient should be transferred to the critical care unit for closer observation. c. RhoGAM should be administered. d. a tetanus shot should be administered

ANS: A A positive Kleihauer-Betke test indicates that fetal bleeding is occurring in the maternal circulation. This is a serious complication and, because the patient is a trauma victim, it is highly likely that she is experiencing an abruption. Therefore the patient should be delivered as quickly as possible to improve outcomes. There is no evidence to support that RhoGAM should be administered, because we have no information related to Rh factor and/or blood type. Similarly, a tetanus shot is not indicated at this time because there is no evidence of penetrating trauma. The patient should be transferred to the obstetric area for birth, not the critical care unit setting

Which laboratory result would be a cause for concern if exhibited by a patient 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

ANS: A A rubella titer of less than 1:8 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 hematocrit/hemoglobin are within the expected range for pregnant women

Which patient is a candidate for internal monitoring with an intrauterine pressure catheter? a. Obese patient whose contractions are 3 to 6 minutes apart, lasting 20 to 50 seconds b. Gravida 1, para 0, whose contractions are 2 to 3 minutes apart, lasting 60 seconds c. Multigravida whose contractions are 2 minutes apart, lasting 60 to 70 seconds d. Gravida 2, para 1, in latent phase whose contractions are irregular and mild

ANS: A A thick layer of abdominal fat absorbs energy from uterine contractions, reducing their apparent intensity on the monitor strip. Contraction patterns of 2 to 3 minutes lasting 60 seconds and every 2 minutes lasting 60 to 70 seconds indicate accurate measurement of uterine activity. Irregular and mild contractions are common in the latent phase.

Which complaint made by a patient 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

ANS: A Abdominal pain at 35 weeks gestation may indicate preeclampsia, or abruptio placentae. 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 stages of pregnancy. Shortness of breath is an expected finding at 35 weeks.

In teaching a pregnant adolescent about nutrition, what should the nurse include in the care plan? a. Determine the weight gain needed to meet adolescent growth and add 35 lb. b. Suggest that she does 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.

A 36-year-old divorcee with a successful modeling career finds out that her 18-year-old daughter is expecting her first child. Which is a major factor in determining how this woman 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.

A patient postdelivery is concerned about getting back to her prepregnancy weight as soon as possible. She had only gained 15 lb during her pregnancy. Which assessment factor would be of concern at her 6-week postpartum checkup? a. Patient has lost 30 lb during the 6-week period prior to her scheduled checkup. b. Patient states that she is eating healthy and limiting intake of processed foods. c. Patient relates increased consumption of fruits and vegetables in her diet postbirth. d. Patient 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 patient 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.

A pregnant patient would like to know which foods, other than dairy products, contain the most calcium. Which food group would the nurse recommend? 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.

Spontaneous termination of a pregnancy is considered to be an abortion if a. the pregnancy is less than 20 weeks. b. the fetus weighs less than 1000 g. c. the products of conception are passed intact. d. there is no evidence of intrauterine infection

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

Which assessment finding is an indication of hemorrhage in the recently delivered postpartum patient? a. Elevated pulse rate b. Elevated blood pressure c. Firm fundus at the midline d. Saturation of two perineal pads in 4 hours

ANS: A An increasing pulse rate is an early sign of excessive blood loss. If the blood volume were diminishing, the blood pressure would decrease. A firm fundus indicates that the uterus is contracting and compressing the open blood vessels at the placental site. Saturation of one pad within the first hour is the maximum normal amount of lochial flow. Two pads within 4 hours is within normal limits.

An increase in urinary frequency and leg cramps after the 36th week of pregnancy are an indication of a. lightening. b. breech presentation. c. urinary tract infection. d. onset of Braxton-Hicks contractions.

ANS: A As the fetus descends toward the pelvic inlet near the end of pregnancy, increased pelvic pressure occurs, resulting in greater urinary frequency and more leg cramps. Breech presentation does not cause urinary frequency and leg cramps. A urinary tract infection may cause urinary frequency but with burning and would not cause leg cramps. Braxton-Hicks contractions are irregular and mild and occur throughout the pregnancy.

Which clinical finding can be determined only by electronic fetal monitoring? a. Variability b. Tachycardia c. Bradycardia d. Fetal response to contractions

ANS: A Beat-to-beat variability cannot be determined by auscultation because auscultation provides only an average fetal heart rate (FHR) as it fluctuates. Tachycardia can be determined by any of the FHR monitoring techniques. Bradycardia can be determined by any of the FHR monitoring techniques. The fetal response to the contractions is usually noted by an increase or decrease in fetal heart rate. These can be determined by any of the FHR monitoring techniques.

An expectant mother, diagnosed with oligohydramnios, asks the nurse what this condition means for the baby. Which statement should the nurse provide for the patient? a. Oligohydramnios can cause poor fetal lung development. b. Oligohydramnios means that the fetus is excreting excessive urine. c. Oligohydramnios could mean that the fetus has a gastrointestinal blockage. d. Oligohydramnios is associated with fetal central nervous system abnormalities.

ANS: A Because an abnormally small amount of amniotic fluid restricts normal lung development, the fetus may have poor fetal lung development. Oligohydramnios may be caused by a decrease in urine secretion. Excessive amniotic fluid production may occur when the gastrointestinal tract prevents normal ingestion of amniotic fluid. Excessive amniotic fluid production may occur when the fetus has a central nervous system abnormality.

A pregnant patient has lactose intolerance. Which recommendation will the nurse provide to best help the patient 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, similar to the nondehydrated varieties. Milk products should be avoided by patients with lactose intolerance. Adequate calcium may be obtained from food and supplements. Some patients may be able to tolerate lactose free dairy products.

To determine if the patient is in true labor, the nurse would assess for changes in a. cervical dilation. b. amount of bloody show. c. fetal position and station. d. pattern of uterine contractions.

ANS: A Cervical changes are the only indication of true labor and are used to determine true and false labor. Changes in the amount of bloody show, fetal position and station, and pattern of uterine contractions are unreliable indicators of true labor.

The patient in labor experiences a spontaneous rupture of membranes. Which information related to this event must the nurse include in the patient's record? a. Fetal heart rate b. Pain level c. Test results ensuring that the fluid is not urine d. The patient's understanding of the event

ANS: A Charting related to membrane rupture includes the time, FHR, and character and amount of the fluid. Pain is not associated with this event. When it is obvious that the fluid is amniotic fluid, which is anticipated during labor, it is not necessary to verify this by testing. The patient's understanding of the event would only need to be documented if it presents a problem.

A patient presents with curly hair and blue eyes. These findings are consistent with a. phenotype. b. genotype. c. dominant alleles. d. recessive traits.

ANS: A Curly hair is considered to be a dominant trait, whereas blue eyes are considered to be a recessive trait. Observation of characteristics is noted as phenotype. Genotype identifies the genetic makeup of traits.

A laboratory finding indicative of DIC is one that shows a. decreased fibrinogen. b. increased platelets. c. increased hematocrit. d. decreased thromboplastin time.

ANS: A DIC develops when the blood-clotting factor thromboplastin is released into the maternal bloodstream as a result of placental bleeding. Thromboplastin activates widespread clotting, which uses the available fibrinogen, resulting in a decreased fibrinogen level. The platelet count will decrease. The hematocrit may decrease if bleeding is pronounced. The thromboplastin time is prolonged

Decelerations that mirror the contractions are present with each contraction on the monitor strip of a multipara who received epidural anesthesia 20 minutes ago. The nurse should a. maintain the normal assessment routine. b. administer O2 at 8 to 10 L/minute by face mask. c. increase the IV flow rate from 125 to 150 mL/hour. d. assess the maternal blood pressure for a systolic pressure below 100 mm Hg.

ANS: A Decelerations that mirror the contraction are early decelerations caused by fetal head compression. Early decelerations are not associated with fetal compromise and require no intervention. Administering O2, increasing the IV flow rate, and assessing for hypotension are not necessary within early decelerations.

The nurse is instructing a nursing student on the application of fetal monitoring devices. Which method of assessing the fetal heart rate requires the use of a gel? a. Doppler b. Fetoscope c. Scalp electrode d. Tocodynamometer

ANS: A Doppler is the only listed method involving ultrasonic transmission of fetal heart rates; it requires the use of a gel. The fetoscope does not require gel because ultrasonic transmission is not used. The scalp electrode is attached to the fetal scalp; gel is not necessary. The tocodynamometer does not require gel. This device monitors uterine contractions.

Which statement best describes the changes that occur during the fetal period of development? a. Maturation of organ systems b. Development of basic organ systems c. Resistance of organs to damage from external agents d. Development of placental oxygen-carbon dioxide exchange

ANS: A During the fetal period, the body systems grow in size and mature in function to allow independent existence after birth. Basic organ systems are developed during the embryonic period. The organs are always at risk for damage from external sources; however, the older the fetus, the more resistant will be the organs. The greatest risk is when the organs are developing. The placental system is complete by week 12, but that is not the best description of the fetal period.

A clinic nurse is planning a teaching session for childbearing-age female patients. Which information should the nurse include in the teaching session with regard to avoiding exposing a fetus to teratogens? a. Eliminate use of acne medications. b. Immunizations should be updated during the first trimester of pregnancy. c. Use of saunas and hot tubs during pregnancy should be during the winter months only. d. Alcoholic beverages can be consumed in the first and third trimesters of pregnancy.

ANS: A Elimination of nontherapeutic drugs is the best action to avoid teratogen exposure. Acne medication is not essential during pregnancy. Immunizations for diseases such as rubella are contraindicated during pregnancy. Use of saunas and hot tubs are not recommended because maternal hyperthermia is a significant teratogen. Alcohol is an environmental substance known to be teratogenic and should not be consumed during pregnancy.

What is the purpose of the ovum's zona pellucida? a. Prevents multiple sperm from fertilizing the ovum b. Stimulates the ovum to begin mitotic cell division c. Allows the 46 chromosomes from each gamete to merge d. Makes a pathway for more than one sperm to reach the ovum

ANS: A Fertilization causes the zona pellucida to change its chemical composition so that multiple sperm cannot fertilize the ovum. Mitotic cell division begins when the nuclei of the sperm and ovum unite. Each gamete (sperm and ovum) has only 23 chromosomes; there will be 46 chromosomes when they merge. Once sperm has entered the ovum, the zona pellucida changes to prevent other sperm from entering.

The labor nurse is reviewing breathing techniques with a primiparous patient admitted for induction of labor. When is the best time to encourage the laboring patient to use slow, deep chest breathing with contractions? a. During labor, when she can no longer talk through contractions b. During the first stage of labor, when the contractions are 3 to 4 minutes apart c. Between contractions, during the transitional phase of the first stage of labor d. Between her efforts to push to facilitate relaxation between contractions

ANS: A Focused breathing techniques should not be used in labor until they are actually needed, which is usually when the woman can no longer walk and talk during a contraction. If breathing techniques are used too early, the woman tends to move through the different techniques too quickly, and she may stop using them. In addition, the use of the more complex breathing patterns in latent labor may increase fatigue. Women should be encouraged to adapt the techniques to their own comfort and needs. Breathing deeply between contractions or pushing can increase the possibility of carbon dioxide retention and make the patient dizzy

Immediately following the forceps-assisted birth of an infant, which action should the nurse implement? a. Assess the infant for signs of trauma. b. Apply a cold pack to the infant's scalp. c. Give the infant prophylactic antibiotics. d. Measure the circumference of the infant's head

ANS: A Forceps birth can result in local irritation, bruising, or lacerations of the fetal scalp. This would put the infant at risk for cold stress and would be contraindicated. Prophylactic antibiotics are not necessary with a forceps birth. Measuring the circumference of the head is part of the initial nursing assessment.

Which comfort measure should the nurse utilize in order to enable a laboring woman to relax? a. Recommend frequent position changes. b. Palpate her filling bladder every 15 minutes. c. Offer warm wet cloths to use on the patient's face and neck. d. Keep the room lights lit so the patient and her coach can see everything

ANS: A Frequent maternal position changes reduce the discomfort from constant pressure and promote fetal descent. A full bladder intensifies labor pain. The bladder should be emptied every 2 hours. Women in labor become very hot and perspire. Cool cloths will provide greater relief. Soft indirect lighting is more soothing than irritating bright lights.

Testing for the cause of anomalies in a stillborn infant is underway. The mother angrily asks the nurse how long these tests are going to take. The nurse should understand that this mother is a. exhibiting normal grief behavior. b. trying to place blame on someone. c. being impatient and unreasonable. d. feeling guilty and blaming herself

ANS: A Grief after a fetal loss may initially be expressed as anger. The mother is not placing blame; she is in the anger stage of the grieving process. The mother is not being impatient or unreasonable. The mother is expressing anger as an initial stage of grief, not blaming herself or feeling guilty.

A high-risk labor patient progresses from preeclampsia to eclampsia. Aggressive management is instituted, and the fetus is delivered via cesarean birth. Which finding in the immediate postoperative period indicates that the patient is at risk of developing HELLP syndrome? a. Platelet count of 50,000/mcL b. Liver enzyme levels within normal range c. Negative for edema d. No evidence of nausea or vomiting

ANS: A HELLP syndrome is characterized by Hemolysis, Elevated Liver enzyme levels, and a Low platelet count. A platelet count of 50,000/mcL indicates thrombocytopenia.

Which intervention is an essential part of nursing care for a laboring patient? a. Helping the woman manage the pain b. Eliminating the pain associated with labor c. Feeling comfortable with the predictable nature of intrapartal care d. Sharing personal experiences regarding labor and birth to decrease her anxiety

ANS: A Helping a patient manage the pain is an essential part of nursing care because pain is an expected part of normal labor and cannot be fully relieved. Labor pain cannot be fully relieved. The labor nurse should always be assessing for unpredictable occurrences. Decreasing anxiety is important; however, managing pain is a top priority.

The nurse thoroughly dries the infant immediately after birth primarily to a. reduce heat loss from evaporation. b. stimulate crying and lung expansion. c. increase blood supply to the hands and feet. d. remove maternal blood from the skin surface.

ANS: A Infants are wet with amniotic fluid and blood at birth, which accelerates evaporative heat loss. Rubbing the infant does stimulate crying but is not the main reason for drying the infant. The main purpose of drying the infant is to prevent heat loss. Drying the infant after birth does not remove all of the maternal blood.

Nursing intervention for pregnant patients with diabetes is based on the knowledge that the need for insulin is a. varied depending on the stage of gestation. b. increased throughout pregnancy and the postpartum period. c. decreased throughout pregnancy and the postpartum period. d. should not change because the fetus produces its own insulin.

ANS: A Insulin needs decrease during the first trimester, when nausea, vomiting, and anorexia are a factor. Insulin needs increase during the second and third trimesters, when the hormones of pregnancy create insulin resistance in maternal cells. Insulin needs change during pregnancy

The nurse is reviewing an electronic fetal monitor tracing from a patient in active labor and notes the fetal heart rate gradually drops to 20 beats per minute (bpm) below the baseline and returns to the baseline well after the completion of the patient's contractions. How will the nurse document these findings? a. Late decelerations b. Early decelerations c. Variable decelerations d. Proximal decelerations

ANS: A Late decelerations are similar to early decelerations in the degree of FHR slowing and lowest rate (30 to 40 bpm) but are shifted to the right in relation to the contraction. They often begin after the peak of the contraction. The FHR returns to baseline after the contraction ends. The early decelerations mirror the contraction, beginning near its onset and returning to the baseline by the end of the contraction, with the low point (nadir) of the deceleration occurring near the contraction's peak. The rate at the lowest point of the deceleration is usually no lower than 30 to 40 bpm from the baseline. Conditions that reduce flow through the umbilical cord may result in variable decelerations. These decelerations do not have the uniform appearance of early and late decelerations. Their shape, duration, and degree of fall below baseline rate vary. They fall and rise abruptly (within 30 seconds) with the onset and relief of cord compression, unlike the gradual fall and rise of early and late decelerations. Proximal deceleration is not a recognized term.

Which hormonal effect is noted during the menstrual cycle? a. Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) secretion rise during the ovulatory phase. b. A negative feedback mechanism is exhibited by the anterior pituitary gland and ovaries. c. The posterior pituitary gland secretes LH. d. Estrogen secretion enhances FSH secretion.

ANS: A Levels of LH and FSH rise dramatically during the ovulatory phase and are known as the LH surge prior to ovulation. A positive feedback mechanism occurs with regard to the menstrual cycle. The anterior pituitary gland secretes LH. Estrogen secretion minimizes FSH secretion.

After birth of the placenta the patient states, "All of a sudden I feel very cold." What is the most appropriate nursing action at this time? a. Place a warm blanket over the patient. b. Place the baby on the patient's abdomen. c. Tell the patient that chills are expected after birth. d. "What do you mean by your words 'very cold'?"

ANS: A Many women are chilled after birth. The cause of this reaction is unknown but probably relates to the sudden decrease in effort, loss of the heat produced by the fetus, decrease in intraabdominal pressure, and fetal blood cells entering the maternal circulation. The chill lasts for about 20 minutes and subsides spontaneously. A warm blanket, hot drink, or soup may help relieve the chill and make the woman more comfortable. Placing the baby on her abdomen may result in transfer of heat and make her feel even colder. Reassurance is appropriate after the blanket is provided. Validation of an expected physical response to the birthing process results in a delay of care and is unnecessary.

The nurse is reviewing normal female development with a mother of a 10-year-old daughter. The mother states, "I noticed that my daughter developed breast buds about a year ago. When do you think she will start her menstrual cycle?" What is the nurse's best response? a. "In about a year." b. "Likely any time now." c. "Does your daughter know what to expect?" d. "It is impossible to predict when she will start her cycle.

ANS: A Menarche occurs about 2 to 2.5 years after breast development. Asking the mother if her daughter knows what to expect is a vague response that does not answer the mother's question.

The primary difference between the labor of a nullipara and that of a multipara is a. total duration of labor. b. level of pain experienced. c. amount of cervical dilation. d. sequence of labor mechanisms.

ANS: A Multiparas usually labor more quickly than nulliparas, making the total duration of their labor shorter. The level of pain is individual to the woman, not the number of labors she has experienced. Cervical dilation is the same for all labors. The sequence of labor mechanisms is the same with all labors.

In a prenatal education class, the nurse is reviewing the importance of using relaxation techniques during labor. Which patient statement will the nurse need to correct? a. "We will practice relaxation techniques only in a quiet setting so I can focus." b. "Relaxation is important during labor because it will help me conserve my energy." c. "If I relax in between contractions, my baby will get more oxygen during labor." d. "My partner and I will practice relaxation throughout the remainder of my pregnancy."

ANS: A NURSINGTB.COM Foundations of Maternal-Newborn and Women's Health Nursing 7th Edition Murray Test BankNU RS IN GT B.CO M Relaxation exercises must be practiced frequently to be useful during labor. Couples begin practice sessions in a quiet, comfortable setting. Later, they practice in other places that simulate the noise and unfamiliar setting of the hospital. The ability to relax during labor is an important component of coping effectively with childbirth. Relaxation conserves energy, decreases oxygen use, and enhances other pain relief techniques. Women learn exercises to help them recognize and release tension. The labor partner assists the woman by providing feedback during exercise sessions and labor

A pregnant patient asks the nurse how her baby gets oxygen to breathe. What is the nurse's best response? a. "Oxygen-rich blood is delivered through the umbilical vein to the baby." b. "Take lots of deep breaths because the baby gets all of its oxygen from you." c. "You don't need to be concerned about your baby getting enough oxygen." d. "The baby's lungs are not mature enough to actually breathe, so don't worry."

ANS: A Oxygen-rich blood travels from the mother's circulatory system to the placenta and from the placenta to the umbilical vein (veins carry blood to the heart). From the vein, most of the oxygenated blood travels to the fetal liver or the inferior vena cava. Taking deep breaths can temporarily increase oxygenation but can also lead to increased carbon dioxide retention and dizziness. The patient is asking a normal fetal developmental question often asked by pregnant women. Fetal lungs reach maturity by 37 weeks of gestation, but fetal breathing movements are common. Oxygen transport across lung tissue occurs with the first breath.

Which intrapartal assessment should be avoided when caring for a patient with HELLP syndrome? a. Abdominal palpation b. Venous sample of blood c. Checking deep tendon reflexes d. Auscultation of the heart and lungs

ANS: A Palpation of the abdomen and liver could result in a sudden increase in intraabdominal pressure, leading to rupture of the subcapsular hematoma. Assessment of heart and lungs is performed on every patient. Checking reflexes is not contraindicated. Venous blood is checked frequently to observe for thrombocytopenia.

Which guidance related to a healthy diet during pregnancy will the nurse provide to a patient in her 1st trimester? 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.

A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Nursing care is based on which of the following? a. Hemorrhage is the primary concern. b. She will be unable to conceive in the future. c. Bed rest and analgesics are the recommended treatment. d. A D&C will be performed to remove the products of conception.

ANS: A Severe bleeding occurs if the fallopian tube ruptures. If the tube must be removed, the patient's fertility will decrease; however, she will be able to achieve a future pregnancy. The recommended treatment is to remove the pregnancy before hemorrhage occurs. A D&C is done on the inside of the uterine cavity. The ectopic is located within the tubes.

When a pregnant woman develops ptyalism, which guidance should the nurse provide? 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

ANS: A Some women experience ptyalism, or excessive salivation. The cause of ptyalism may be decreased swallowing associated with nausea or stimulation of the salivary glands by the ingestion of starch. Small frequent meals and use of chewing gum and oral lozenges offer limited relief for some women. All other options include recommendations for pregnant women; however, they do not address ptyalism.

The nurse auscultates the fetal heart rate and determines a rate of 152 bpm. Which nursing intervention is most appropriate at this time? a. Inform the mother that the fetal heart rate is normal. b. Reassess the fetal heart rate in 5 minutes because the rate is too high. c. Report the fetal heart rate to the physician or nurse-midwife immediately. d. Suggest to the mother that she is going to have a boy because the heart rate is fast.

ANS: A The FHR is within the normal range, so no other action is indicated at this time. The FHR is within the expected range; reassessment should occur, but not in 5 minutes. The FHR is within the expected range; no further action is necessary at this point. The gender of the baby cannot be determined by the FHR.

A laboring patient asks the nurse how she will know that the contraction is at its peak. The nurse explains that the contraction peaks during which stage of measurement? a. The acme b. The interval c. The increment d. The decrement

ANS: A The acme is the peak or period of greatest strength during the middle of a contraction cycle. The interval is the period between the end of the contraction and the beginning of the next. The increment is the beginning of the contraction until it reaches the peak. The decrement occurs after the peak until the contraction ends.

The traditional diet of Asian women includes little meat and few dairy products and may be low in calcium and iron. The nurse can assist a patient 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.

Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother? a. Hypoglycemia b. Hypercalcemia c. Hypoinsulinemia d. Hypobilirubinemia

ANS: A The neonate is at highest risk for hypoglycemia because fetal insulin production is accelerated during pregnancy to metabolize excessive glucose from the mother. At birth, the maternal glucose supply stops, and the neonatal insulin exceeds the available glucose, leading to hypoglycemia. Hypocalcemia is associated with preterm birth, birth trauma, and asphyxia, all common problems of the infant of a diabetic mother. Because fetal insulin production is accelerated during pregnancy, the neonate shows hyperinsulinemia. Excess erythrocytes are broken down after birth, releasing large amounts of bilirubin into the neonate's circulation, which results in hyperbilirubinemia.

The nurse is assessing a newborn immediately after birth. After assigning the first Apgar score of 9, the nurse notes two vessels in the umbilical cord. What is the nurse's next action? a. Assess for other abnormalities of the infant. b. Note the assessment finding in the infant's chart. c. Notify the health care provider of the assessment finding. d. Call for the neonatal resuscitation team to attend the infant immediately.

ANS: A The normal finding in the umbilical cord is two arteries and one vein. Two vessels may indicate other fetal anomalies. Notation of the finding is the appropriate next step when the finding is expected. The health care provider will need to be notified; however, the infant is the nurse's primary concern and must be assessed for abnormalities first. The initial Apgar score is 9, indicating no signs of distress or need of resuscitation.

In which situation would a baseline fetal heart rate of 160 to 170 bpm be considered a normal finding? a. The fetus is at 30 weeks of gestation. b. The mother has a history of fast labors. c. The mother has been given an epidural block. d. The mother has mild preeclampsia but is not in labor.

ANS: A The normal preterm fetus may have a baseline rate slightly higher than the term fetus because of an immature parasympathetic nervous system that does not yet exert a slowing effect on the fetal heart rate (FHR). Fast labors should not alter the FHR normally. Any change in the FHR with an epidural is not considered an expected outcome. Preeclampsia should not cause a normal elevation of the FHR

The nurse is preparing to initiate intravenous (IV) access on a patient in the active phase of labor. Which size IV cannula is best for this patient? a. 18-gauge b. 20-gauge c. 22-gauge d. 24-gauge

ANS: A The nurse should select the largest bore cannula possible. An 18-gauge cannula is the largest size available. A 24-gauge cannula would be the smallest. IV access is initiated for hydration prior to epidural placement and for use in an emergency. Both require the rapid administration of fluid, which is most easily accomplished with a large bore cannula.

If a woman's fundus is soft 30 minutes after birth, the nurse's first action should be to a. massage the fundus. b. take the blood pressure. c. notify the physician or nurse-midwife. d. place the woman in Trendelenburg position.

ANS: A The nurse's first response should be to massage the fundus to stimulate contraction of the uterus to compress open blood vessels at the placental site, limiting blood loss. The blood pressure is an important assessment to determine the extent of blood loss but is not the top priority. Notification should occur after all nursing measures have been attempted with no favorable results. The Trendelenburg position is contraindicated for this woman at this point. This position would not allow for appropriate vaginal drainage of lochia. The lochia remaining in the uterus would clot and produce further bleeding.

A patient just delivered her baby via the vaginal route. The patient asks the nurse why the baby's head is not round, but oval. Which explanation should the nurse provide the patient? a. This results from molding. b. This results from lightening. c. This results from the fetal lie. d. This results from the fetal presentation.

ANS: A The sutures and fontanels allow the bones of the fetal head to move slightly, changing the shape of the fetal head so it can adapt to the size and shape of the pelvis. Lightening is the descent of the fetus toward the pelvic inlet before labor. Lie is the relationship of the long axis of the fetus to the long axis of the mother. Presentation is the fetal part that first enters the pelvic outlet.

A patient with a BMI of 32 has a positive pregnancy test. What is the maximum number of pounds that the nurse will advise the patient gain during the pregnancy? a. 20 lb b. 25 lb c. 28 lb d. 40 lb

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 patient as obese. The other options refer to minimal or maximal weight gain for patients in other BMI categories.

For which patient should the oxytocin (Pitocin) infusion be discontinued immediately? a. A patient in transition with contractions every 2 minutes lasting 90 seconds each b. A patient in early labor with contractions every 5 minutes lasting 40 seconds each c. A patient in active labor with contractions every 3 minutes lasting 60 seconds each d. A patient in active labor with contractions every 2 to 3 minutes lasting 70 to 80 seconds each

ANS: A This patient's contraction pattern represents hyperstimulation, and inadequate resting time occurs between contractions to allow placental perfusion. Oxytocin may assist this patient's contractions to become closer and more efficient when the contractions are 5 minutes apart. There is an appropriate resting period between this patient's contractions. There is an appropriate resting period between this patient's contractions for her stage of labor.

Examination of a newborn in the birth room reveals bilateral cataracts. Which disease process in the maternal history would likely cause this abnormality? a. Rubella b. Cytomegalovirus (CMV) c. Syphilis d. HIV

ANS: A Transmission of congenital rubella causes serious complications in the fetus that may manifest as cataracts, cardiac defects, microcephaly, deafness, intrauterine growth restriction (IUGR), and developmental delays.

Which characteristic is related to Down syndrome? a. Up-slanting eyes b. Abnormal genitalia c. Bleeding tendency d. Edema of extremities

ANS: A Up-slanting eyes, wide short fingers, and low-set ears are often seen in infants with Down syndrome. Bleeding tendency, edema of extremities, and abnormal genitalia are not characteristics of Down syndrome.

Which routine nursing assessment is contraindicated for a patient admitted with suspected placenta previa? a. Determining cervical dilation and effacement b. Monitoring FHR and maternal vital signs c. Observing vaginal bleeding or leakage of amniotic fluid d. Determining frequency, duration, and intensity of contractions

ANS: A Vaginal examination of the cervix may result in perforation of the placenta and subsequent hemorrhage. Monitoring FHR and maternal vital signs is a necessary part of the assessment for this patient. Monitoring for bleeding and rupture of membranes is not contraindicated with this patient. Monitoring contractions is not contraindicated with this patient.

During labor a vaginal examination should be performed only when necessary because of the risk of a. infection. b. fetal injury. c. discomfort. d. perineal trauma.

ANS: A Vaginal examinations increase the risk of infection by carrying vaginal microorganisms upward toward the uterus. Properly performed vaginal examinations should not cause fetal injury. Vaginal examinations may be uncomfortable for some women in labor, but that is not the main reason for limiting them. A properly performed vaginal examination should not cause perineal trauma.

Which physical characteristics decrease as the fetus nears term? (Select all that apply.) a. Vernix caseosa b. Lanugo c. Port wine stain d. Brown fat e. Eyebrows or head hair

ANS: A, B Both vernix caseosa and lanugo decrease as the fetus reaches term. Port wine stain is a birthmark and, if present, will be exhibited at or shortly after birth. Brown fat in the fetus will be maintained in order to maintain core temperature. Eyebrows and head hair increase as the fetus nears term.

A laboring patient is 10 cm dilated; however, she does not feel the urge to push. The nurse understands that according to laboring down, the advantages of waiting until an urge to push are which of the following? (Select all that apply.) a. Less maternal fatigue b. Less birth canal injuries c. Decreased pushing time d. Faster descent of the fetus e. An increase in frequency of contractions

ANS: A, B, C Delayed pushing has been shown to result in less maternal fatigue and decreased pushing time. Pushing vigorously sooner than the onset of the reflexive urge may contribute to birth canal injury because her vaginal tissues are stretched more forcefully and rapidly than if she pushed spontaneously and in response to her body's signals. A brief slowing of contractions often occurs at the beginning of the second stage.

A young female patient comes to the health unit at school to discuss her irregular periods. In providing education regarding the female reproductive cycle, the nurse describes the regular and recurrent changes related to the ovaries and the uterine endometrium. Although this is generally referred to as the menstrual cycle, the ovarian cycle includes which phases? (Select all that apply.) a. Follicular b. Ovulatory c. Luteal d. Proliferative e. Secretory

ANS: A, B, C The follicular phase is the period during which the ovum matures. It begins on day 1 and ends around day 14. The ovulatory phase occurs near the middle of the cycle, about 2 days before ovulation. After ovulation and under the influence of the luteinizing hormone, the luteal phase corresponds with the last 12 days of the menstrual cycle. The proliferative and secretory phases are part of the endometrial cycle. The proliferative phase takes place during the first half of the ovarian cycle when the ovum matures. The secretory phase occurs during the second half of the cycle when the uterus is prepared to accept the fertilized ovum. These are followed by the menstrual phase if fertilization does not occur.

The nurse is planning care for a patient during the fourth stage of labor. Which interventions should the nurse plan to implement? (Select all that apply.) a. Offer the patient a warm blanket. b. Place an ice pack on the perineum. c. Massage the uterus if it is boggy. d. Delay breastfeeding until the patient is rested. e. Explain to the patient that the lochia will be light pink in color.

ANS: A, B, C The fourth stage of labor lasts from the birth of the placenta through the first 1 to 4 hours after birth. Many women are chilled after birth. A warm blanket, hot drink, or soup may help relieve the chill and make the woman more comfortable. Localized discomfort from birth trauma such as lacerations, episiotomy, edema, or hematoma is evident as the effects of local and regional anesthetics diminish. Ice packs on the perineum limit this edema and hematoma formation. A soft (boggy) uterus and increasing uterine size are associated with postpartum hemorrhage because large blood vessels at the placenta site are not compressed. The uterus should be massaged if it is not firm. The fourth stage is the best time to initiate breastfeeding if maternal and infant problems are absent. The vaginal drainage after childbirth is called lochia. The three stages are lochia rubra, lochia serosa, and lochia alba. Lochia rubra, consisting mostly of blood, is present in the fourth stage of labor. The color of the lochia will be bright red not pink.

When evaluating the patient's progress, the nurse knows that four of the five fetal factors that interact to regulate the heart rate are (Select all that apply.) a. baroreceptors. b. adrenal glands. c. chemoreceptors. d. uterine activity. e. autonomic nervous system.

ANS: A, B, C, E The sympathetic and parasympathetic branches of the autonomic nervous system are balanced forces that regulate FHR. Sympathetic stimulation increases the heart rate, whereas parasympathetic responses, through stimulation of the vagus nerve, reduce the FHR, and maintain variability. The baroreceptors stimulate the vagus nerve to slow the FHR and decrease the blood pressure. These are located in the carotid arch and major arteries. The chemoreceptors are cells that respond to changes in oxygen, carbon dioxide, and pH. They are found in the medulla oblongata and aortic and carotid bodies. The adrenal medulla secretes epinephrine and norepinephrine in response to stress, causing accelerations in FHR. Hypertonic uterine activity can reduce the time available for the exchange of oxygen and waste products; however, this is a maternal factor. The fifth fetal factor is the central nervous system. The fetal cerebral cortex causes the heart rate to increase during fetal movement and decrease when the fetus sleeps

The nurse is teaching a breastfeeding patient 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.

Which clinical finding should the nurse expect to assess in the third stage of labor that indicates the placenta has separated from the uterine wall? (Select all that apply.) a. A gush of blood appears. b. The uterus rises upward in the abdomen. c. The fundus descends below the umbilicus. d. The cord descends further from the vagina. e. The uterus becomes boggy and soft, with an elongated shape.

ANS: A, B, D Four signs suggest placenta separation. The uterus has a spherical shape. The uterus rises upward in the abdomen as the placenta descends into the vagina and pushes the fundus upward. The cord descends further from the vagina. A gush of blood appears as blood trapped behind the placenta is released. The fundus rises upward above the umbilicus. A boggy uterus with an elongated shape would not be expected.

The nurse is teaching a pregnant patient about signs of possible pregnancy complications. Which should the nurse include in the teaching plan? (Select all that apply.) a. Report watery vaginal discharge. b. Report puffiness of the face or around the eyes. c. Report any bloody show when you go into labor. d. Report visual disturbances, such as spots before the eyes. e. Report any dependent edema that occurs at the end of the day

ANS: A, B, D Watery vaginal discharge could mean that the membranes have ruptured. Puffiness of the face or around the eyes and visual disturbances may indicate preeclampsia or eclampsia. These three signs should be reported. Bloody show as labor starts may mean the mucus plug has been expelled. One of the earliest signs of labor may be bloody show, which consists of the mucus plug and a small amount of blood. This is a normal occurrence. Up to 70% of women have dependent edema during pregnancy. This is not a sign of a pregnancy complication.

The nurse who elects to practice in the area of obstetrics often hears discussion regarding the four Ps. What are the four Ps that interact during childbirth? (Select all that apply.) a. Powers b. Passage c. Position d. Passenger e. Psyche

ANS: A, B, D, E • Powers: The two powers of labor are uterine contractions and pushing efforts. During the first stage of labor, through full cervical dilation, uterine contractions are the primary force moving the fetus through the maternal pelvis. At some point after full dilation, the woman adds her voluntary pushing efforts to propel the fetus through the pelvis. • Passage: The passage for birth of the fetus consists of the maternal pelvis and its soft tissues. The bony pelvis is more important to the successful outcome of labor because bones and joints do not yield as readily to the forces of labor. • Passenger: This is the fetus plus the membranes and placenta. Fetal lie, attitude, presentation, and position are all factors that affect the fetus as passenger. • Psyche: The psyche is a crucial part of childbirth. Marked anxiety, fear, or fatigue decreases the woman's ability to cope. Position is not one of the four Ps.

ANS: A, B, E Quickening, amenorrhea, and Chadwick's sign are presumptive signs of pregnancy. Ballottement and Goodell's sign are probable signs of pregnancy.

The nurse is preparing supplies for an amnioinfusion on a patient with intact membranes. Which supplies should the nurse gather? (Select all that apply.) a. Extra underpads b. Solution of 3% normal saline c. Amniotic hook to perform an amniotomy d. Solid intrauterine pressure catheter with a pressure transducer on its tip

ANS: A, C Amnioinfusion is performed with lactated Ringer's solution or normal saline, not 3%. Normal saline is infused into the uterus through an intrauterine pressure catheter (IUPC). The underpads must be changed regularly because fluid leaks out constantly. The membranes need to be ruptured before an amnioinfusion can be initiated so an amniotic hook will be needed. The IUPC must have a double lumen to run the infusion through.

The nurse is assessing a patient in her 37th week of pregnancy for the psychological responses commonly experienced as birth nears. Which psychological responses should the nurse expect to evaluate? (Select all that apply.) a. The patient is excited to see her baby. b. The patient has not started to prepare the nursery for the new baby. c. The patient expresses concern about how to know if labor has started. d. The patient and her spouse are concerned about getting to the birth center in time. e. The patient and her spouse have not discussed how they will share household tasks.

ANS: A, C, D As birth nears, the expectant patient will express a desire to see the baby. Most pregnant patients 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. Discussion regarding the division of household chores is not a response that the nurse should expect to assess at this stage.

The nurse is advising a lactose-intolerant pregnant patient 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, ounce 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.

A pregnant patient 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 patient receive? (Select all that apply.) a. Tetanus b. Varicella c. Influenza d. Hepatitis A and B e. Measles, mumps, rubella (MMR)

ANS: A, C, D Inactivated vaccines such as those for tetanus, hepatitis A, hepatitis B, and influenza are safe to administer to women who have a risk for contracting or developing the disease. 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.

The nurse is teaching prenatal patients about avoiding substances or conditions that can harm the fetus. Which should the nurse include in the teaching session? (Select all that apply.) a. Elimination of use of alcohol b. Avoidance of supplemental folic acid replacement c. Stabilization of blood glucose levels in a diabetic patient with insulin d. Avoidance of nonurgent radiologic procedures during the pregnancy e. Avoidance of maternal hyperthermia to temperatures of 37.8C (100F) or higher

ANS: A, C, D, E The best action is for the pregnant woman to eliminate use of nontherapeutic drugs and substances such as alcohol. A woman who has diabetes should try to keep her blood glucose levels normal and stable before and during pregnancy for the best possible fetal outcomes. Nonurgent radiologic procedures may be done during the first 2 weeks after the menstrual period begins, before ovulation occurs. Exposure to temperatures of 37.8C (100F) or higher is not advised for the pregnant patient. Folic acid supplements should be taken. All women of childbearing age should take at least 0.4 mg (400 mcg) of folic acid daily before and after conception because this has been found to reduce the incidence of neural tube defects by 50% to 70%.

A patient asks the nurse how she can tell if labor is real. Which information should the nurse provide to this patient? (Select all that apply.) a. In true labor, the cervix begins to dilate. b. In true labor, the contractions are felt in the abdomen and groin. c. In true labor, contractions often resemble menstrual cramps during early labor. d. In true labor, contractions are inconsistent in frequency, duration, and intensity in the early stages. e. In true labor your contractions tend to increase in frequency, duration, and intensity with walking.

ANS: A, C, E In true labor, the cervix begins to dilate, contractions often resemble menstrual cramps in the early stage, and labor contractions increase in frequency, duration, and intensity with walking. False labor contractions are felt in the abdomen and groin and the contractions are inconsistent in frequency, duration, and intensity.

The prenatal nurse educator is teaching couples the technique of applying sacral pressure during labor. Which should be included in the teaching session? (Select all that apply.) a. The technique can be combined with heat to the area. b. A jiggling motion should be used while applying the pressure. c. Tennis balls may be used to apply the pressure to the sacral area. d. The pressure against the sacrum should be intermittent during the contraction. e. The hand may be moved slowly or remain positioned directly over the sacrum.

ANS: A, C, E Sacral pressure can be combined with thermal stimulation to increase effectiveness. The hand may be moved slowly over the area or remain positioned directly over the sacrum, but pressure should be continuous and firm throughout the contraction. Care should be taken not to jiggle the woman, which may be irritating.

The nurse is planning care for a patient in her first trimester of pregnancy. The patient is experiencing nausea and vomiting. Which interventions should the nurse plan to share with this patient? (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

ANS: A, D, E A patient experiencing nausea and vomiting should be taught to suck on hard candy, drink fluids frequently but separately from meals, and eat crackers, dry toast, or dry cereal before arising in the morning. Prenatal vitamins should be taken at bedtime because they may increase nausea if taken in the morning. Before taking herbal tea, the patient should check with her health care provider.

Which factors contribute to the presence of edema in the pregnant patient? (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

ANS: A, D, E Processed foods, which are high in sodium content, can contribute to edema formation. As the pregnancy progresses, because of the weight of the uterus, compression takes place, leading to decreased venous return and an increase in edema formation. A decrease in colloid osmotic pressure would contribute to edema formation and fluid shifting. Hemodilution would also lead to edema formation.

A nurse is conducting prenatal education classes for a group of expectant parents. Which information should the nurse include in her discussion of the purpose of amniotic fluid? (Select all that apply.) a. Cushions the fetus b. Protects the skin of the fetus c. Provides nourishment for the fetus d. Allows for buoyancy for fetal movement e. Maintains a stable temperature for the fetus

ANS: A, D, E The amniotic fluid provides cushioning for the fetus against impacts to the maternal abdomen. It provides a stable temperature and allows room and buoyancy for fetal movement. Vernix caseosa, the cheeselike coating on the fetus, provides skin protection. The placenta provides nourishment for the fetus.

When a pattern of variable decelerations occur, the nurse should immediately a. administer O2 at 8 to 10 L/minute. b. place a wedge under the right hip. c. increase the IV fluids to 150 mL/hour. d. position patient in a knee-chest position

Variable decelerations are caused by conditions that reduce flow through the umbilical cord. The patient should be repositioned when the FHR pattern is associated with cord compression. The knee-chest position uses gravity to shift the fetus out of the pelvis to relieve cord compression. Administering oxygen will not be effective until cord compression is relieved. Increasing the IV fluids and placing a wedge under the right hip are not effective interventions for cord compression.

A 28-year-old gravida 1, para 0 patient who is at term calls the labor and birth unit stating that she thinks she is in labor. She states that she does have some vaginal discharge and feels wet; however, it is not bloody in nature. She relates a contraction pattern that is irregular, ranging from 5 to 7 minutes and lasting 30 seconds. Which questions should the nurse pose to the patient during this telephone triage? (Select all that apply.) a. Does she think that her membranes have ruptured? b. Is there any evidence of bloody show? c. Instruct the patient to keep monitoring her contraction pattern and call you back if they become more regular. d. When is her next scheduled visit with her health care provider? e. Tell her to come into the hospital for evaluation.

ANS: A, E NURSINGTB.COM Foundations of Maternal-Newborn and Women's Health Nursing 7th Edition Murray Test Bank NU RS IN GT B.CO M The cornerstone of obstetric triage is reassurance of maternal-fetal well-being. Thus in view of the assessment data that the patient provided, the nurse should ascertain membrane status and ask the patient to come in for evaluation. The patient has already indicated that the vaginal discharge was not bloody in nature. Having the patient continue to monitor at home would not provide assurance of maternal-fetal well-being. Asking the patient about the next scheduled physician visit does not address current health concerns of impending labor.

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.

ANS: B Cardiac output increases during pregnancy as a result of increased stroke volume and heart rate. Systemic vascular resistance decreases while blood pressure remains the same. Maternal blood pressure changes in response to patient positioning. In response to increased metabolism, maternal vasodilation is seen during pregnancy

A pregnant patient arrives for her first prenatal visit at the clinic. She informs the nurse that she has been taking an additional 400 mcg of folic acid prior to becoming pregnant. Based on the patient's history, she has reached 8 weeks' gestation. Which recommendation would the nurse provide regarding folic acid supplementation? a. Have the patient continue to take 400 mcg folic acid throughout her pregnancy. b. Tell the patient that she no longer has to take additional folic acid because it will be included in her prenatal vitamins. c. Have the patient increase her folic acid intake to 1000 mcg throughout the rest of her pregnancy. d. Schedule the patient to go for an AFP (alpha-fetoprotein) test

ANS: B Prenatal vitamins include adequate folic acid supplementation, so patients should not take additional supplementation as long as 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 patient is at 8 weeks' gestation.

A patient whose cervix is dilated to 6 cm is considered to be in which phase of labor? a. Latent phase b. Active phase c. Second stage d. Third stage

ANS: B The active phase of labor is characterized by cervical dilation of 5 to 6 cm. Historically, the latent phase is from the beginning of true labor until 3 cm of cervical dilation. Recent research has suggested that the latent phase be considered to last up until 5 to 6 cm. dilated. The second stage of labor begins when the cervix is completely dilated until the birth of the baby. The third stage of labor is from the birth of the baby until the expulsion of the placenta.

A 35-year-old patient has an amniocentesis performed to identify whether her baby has a chromosomal defect. Which statement indicates that the patient understands the situation? a. "The doctor will tell me if I should have an abortion when the test results come back." b. "When all the lab results come back, my husband and I will make a decision about the pregnancy." c. "My mother must not find out about all this testing. If she does, she will think I'm having an abortion." d. "I know there are support groups for parents who have a baby with birth defects, but we have plenty of insurance to cover what we need."

ANS: B The final decision about genetic testing and the future of the pregnancy lies with the patient. The patient will involve only those people whom she chooses. An amniocentesis is done to detect chromosomal defects; many women have this done to prepare and educate themselves for the baby's arrival. The woman should also be assured that her care is confidential. Insurance will help cover expenses; however, a child with birth defects also takes a toll on the emotional, physical, and social aspects of the parents' lives. Support groups are extremely important for parents of a baby with birth defects.

Which maternal condition always necessitates delivery by cesarean birth? a. Partial abruptio placentae b. Total placenta previa c. Ectopic pregnancy d. Eclampsia

ANS: B In total placenta previa, the placenta completely covers the cervical os. The fetus would die if a vaginal birth occurred. If the patient has stable vital signs and the fetus is alive, a vaginal birth can be attempted. If the fetus has already expired, a vaginal birth is preferred. The most common ectopic pregnancy is a tubal pregnancy, which is usually detected and treated in the first trimester. Labor can be safely induced if the eclampsia is under control.

When the mother's membranes rupture during active labor, the fetal heart rate should be observed for the occurrence of which periodic pattern? a. Early decelerations b. Variable decelerations c. Nonperiodic accelerations d. Increase in baseline variability

ANS: B When the membranes rupture, amniotic fluid may carry the umbilical cord to a position where it will be compressed between the maternal pelvis and the fetal presenting part, resulting in a variable deceleration pattern. Early declarations are considered reassuring; they are not a concern after rupture of membranes. Accelerations are considered reassuring; they are not a concern after rupture of membranes. Increase in baseline variability is not an expected occurrence after the rupture of membranes.

An abortion when the fetus dies but is retained in the uterus is called a. inevitable. b. missed. c. incomplete. d. threatened.

ANS: B A missed abortion refers to a dead fetus being retained in the uterus. An inevitable abortion means that the cervix is dilating with the contractions. An incomplete abortion means that not all the products of conception were expelled. With a threatened abortion, the patient has cramping and bleeding but not cervical dilation.

Which of the following behaviors would be applicable to a nursing diagnosis of "risk for injury" in a patient who is in labor? a. Length of second-stage labor is 2 hours. b. Patient has received an epidural for pain control during the labor process. c. Patient is using breathing techniques during contractions to maximize pain relief. d. Patient is receiving parenteral fluids during the course of labor to maintain hydration.

ANS: B A patient who has received medication during labor is at risk for injury as a result of altered sensorium, so this presentation is applicable to the diagnosis. A length of 2 hours for the second stage of labor is within the range of normal. Breathing techniques help maintain control over the labor process. Fluids administered during the labor process are used to prevent potential fluid volume deficit.

A patient has a history of drug use and is screened for hepatitis B during the first trimester. Which action is most appropriate? a. Practice respiratory isolation. b. Plan for retesting during the third trimester. c. Discuss the recommendation to bottle feed her baby. d. Anticipate administering the vaccination for hepatitis B as soon as possible

ANS: B A person who has a history of high-risk behaviors should be rescreened during the third trimester. Hepatitis B is transmitted through blood. The first trimester is too early to discuss feeding methods with a woman in the high-risk category. The vaccine may not have time to affect a person with high-risk behaviors.

On admission to the labor and birth unit, a 38-year-old female, gravida 4, para 3, at term in early labor is found to have a transverse lie on vaginal examination. What is the priority intervention at this time? a. Perform a vaginal exam to denote progress. b. Notify the health care provider. c. Initiate parenteral therapy. d. Apply oxygen via nasal cannula at 8 L/minute.

ANS: B A transverse lie is considered to be an abnormal presentation so the physician should be notified and the process of a Caesarean section as the birth method should be initiated. The information provided relative to transverse lie was found on vaginal exam. At this point, the priority is to prepare for a surgical birth because assessment data also indicate that the patient is in early labor; thus a vaginal birth is not imminent. Although initiating parenteral therapy will be required, it is not the priority at this time. Application of oxygen is not required because there is no evidence of fetal or maternal distress.

Which instructions should the nurse include when teaching a pregnant patient with Class II heart disease? a. Advise her to gain at least 30 lb. b. Instruct her to avoid strenuous activity. c. Inform her of the need to limit fluid intake. d. Explain the importance of a diet high in calcium.

ANS: B Activity may need to be limited so that cardiac demand does not exceed cardiac capacity. Weight gain should be kept at a minimum with heart disease. Iron and folic acid are important to prevent anemia. Fluid intake is necessary to prevent fluid deficits. Fluid intake should not be limited during pregnancy. The patient may also be put on a diuretic

A pregnant woman of normal weight enters her 13th week of pregnancy. If the patient eats and exercises as directed, what will the nurse anticipate as the ongoing weight gain for the remaining trimesters? a. 0.3 lb every week b. 1 lb every week c. 1.8 lb every week d. 2 lb 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.

The nurse is reviewing the cardinal maneuvers of labor and birth with a group of nursing students. Which maneuver will immediately follow the birth of the baby's head? a. Expulsion b. Restitution c. Internal rotation d. External rotation

ANS: B After the head emerges, it realigns with the shoulders (restitution). External rotation occurs as the fetal shoulders rotate internally, aligning their transverse diameter with the anteroposterior diameter of the pelvic outlet. Expulsion occurs when the baby is completely delivered. Internal rotation occurs prior to birth of the head.

A woman who is gravida 3, para 2 enters the intrapartum unit. The most important nursing assessments include a. contraction pattern, amount of discomfort, and pregnancy history. b. fetal heart rate, maternal vital signs, and the woman's nearness to birth. c. last food intake, when labor began, and cultural practices the couple desires. d. identification of ruptured membranes, the woman's gravida and para, and access to a support person.

ANS: B All options describe relevant intrapartum nursing assessments, but the focus assessment has priority. If the maternal and fetal conditions are normal and birth is not imminent, other assessments can be performed in an unhurried manner. Contraction pattern, amount of discomfort, and pregnancy history are important nursing assessments but do not take priority if the birth is imminent. Last food intake, when labor began, and cultural practices the couple desires is an assessment that can occur later in the admission process, if time permits. Identification of ruptured membranes, the woman's gravida and para, and her support person are assessments that can occur later in the admission process if time permits.

The physician has ordered an amnioinfusion for the laboring patient. Which data supports the use of this therapeutic procedure? a. Presenting part not engaged b. +4 meconium-stained amniotic fluid on artificial rupture of membranes (AROM) c. Breech position of fetus d. Twin gestation

ANS: B Amnioinfusion is a procedure utilized during labor when cord compression or the detection of gross meconium staining is found in the amniotic fluid. An isotonic (Lactated Ringers or normal saline) solution is used as an irrigation method through the IUPC (intrauterine pressure catheter).

The nurse assesses the amniotic fluid. Which characteristic presents the lowest risk of fetal complications? a. Bloody b. Clear with bits of vernix caseosa c. Green and thick d. Yellow and cloudy with foul odor

ANS: B Amniotic fluid should be clear and may include bits of vernix caseosa, the creamy white fetal skin lubricant. Green fluid indicates that the fetus passed meconium before birth. The newborn may need extra respiratory suctioning at birth if the fluid is heavily stained with meconium. Cloudy, yellowish, strong-smelling, or foul-smelling fluid suggests infection. Bloody fluid may indicate partial placental separation.

A female patient who has gone through puberty and started menstruating without any problems has developed cessation of periods after 2 years of normal cycles. Which finding would indicate a possible cause for this occurrence? a. Lag in development of secondary sexual characteristics b. Overproduction of androgenic hormones c. Negative pregnancy test d. Clinical diagnosis of primary amenorrhea

ANS: B An overproduction of androgenic hormones may cause the development of secondary amenorrhea. This patient has progressed through puberty, which would indicate that there is no problem with the development of secondary sexual characteristics. If the patient had a positive pregnancy test, then menstruation would stop. These signs and symptoms indicate the occurrence of secondary amenorrhea.

The primiparous patient at 39 weeks' gestation states to the nurse, "I can breathe easier now." What is the nurse's most appropriate response? a. "Your labor will start any day now since the baby has dropped." b. "That process is called lightening. Do you have to urinate more frequently?" c. "Contact your health care provider when your contractions are every 5 minutes for 1 hour." d. "You will likely not feel you baby's movements as much now, so do not be concerned."

ANS: B As the fetus descends toward the pelvic inlet (dropping), the woman notices that she breathes more easily because upward pressure on her diaphragm is reduced. However, increased pressure on her bladder causes her to urinate more frequently. Pressure of the fetal head in the pelvis also may cause leg cramps and edema. Lightening (descent of the fetus toward the pelvic inlet before labor) is most noticeable in primiparas and occurs about 2 to 3 weeks before the natural onset of labor. Instructions for labor, although correct, do not address the patient's statement of being able to breathe easier. Fetal movement continues throughout the final weeks of gestation. A decrease in fetal movement is a concerning sign and the health care provider must be notified.

The priority nursing intervention when admitting a pregnant patient who has experienced a bleeding episode in late pregnancy is to a. monitor uterine contractions. b. assess fetal heart rate and maternal vital signs. c. place clean disposable pads to collect any drainage. d. perform a venipuncture for hemoglobin and hematocrit levels.

ANS: B Assessment of the fetal heart rate (FHR) and maternal vital signs will assist the nurse in determining the degree of the blood loss and its effect on the patient and fetus. Monitoring uterine contractions is important; however, not the top priority. It is important to assess future bleeding, but the top priority is patient and fetal well-being. The most important assessment is to check patient and fetal well-being. The blood levels can be obtained later.

You are performing assessments for an obstetric patient who is 5 months pregnant with her third child. Which finding would cause you to suspect that the patient was at risk? a. Patient 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.

ANS: B Based on gestational age (20 weeks), the fundal height should be at the umbilicus. This finding is abnormal and warrants further investigation about potential risk. With subsequent pregnancies, multiparas may not perceive Braxton Hicks contractions as being evident compared with their initial pregnancy. Cervical changes such as Goodell's and Chadwick's signs should be present and are considered a normal finding. Increased vaginal secretions are normal during pregnancy as a result of increased vascularity.

A patient taking magnesium sulfate has a respiratory rate of 10 breaths per minute. In addition to discontinuing the medication, which action should the nurse take? a. Increase the patient's IV fluids. b. Administer calcium gluconate. c. Vigorously stimulate the patient. d. Instruct the patient to take deep breaths.

ANS: B Calcium gluconate reverses the effects of magnesium sulfate. Increasing the patient's IV fluids will not reverse the effects of the medication. Stimulation will not increase the respirations. Deep breaths will not be successful in reversing the effects of the magnesium sulfate

ANS: D A placenta previa that does not cover any part of the cervix is termed marginal. With a total placenta previa, the placenta completely covers the os. With a partial previa, the lower border of the placenta is within 3 cm of the internal cervical os but does not completely cover the os. A complete previa is termed total. The placenta completely covers the internal cervical os.

ANS: B Concealed hemorrhage occurs when the edges of the placenta do not separate. The formation of a hematoma behind the placenta and subsequent infiltration of the blood into the uterine muscle results in a very firm, boardlike abdomen. The patient will have shock symptoms that include tachycardia. The fundal height will increase as bleeding occurs. Abdominal pain may increase significantly.

Which clinical intervention is the only known cure for preeclampsia? a. Magnesium sulfate b. Delivery of the fetus c. Antihypertensive medications d. Administration of aspirin (ASA) every day of the pregnancy

ANS: B Delivery of the infant is the only known intervention to halt the progression of preeclampsia. Magnesium sulfate is one of the medications used to treat but not cure preeclampsia. Antihypertensive medications are used to lower the dangerously elevated blood pressures in preeclampsia and eclampsia. Low doses of aspirin (81 mg/day) have been administered to women at high risk for developing preeclampsia. This intervention appears to have little benefit.

An expectant patient 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.

The clinic nurse is reviewing breastfeeding with a pregnant patient. Which hormone will the nurse explain is responsible for milk production after the birth of the placenta? a. Pitocin b. Prolactin c. Estrogen d. Progesterone

ANS: B During pregnancy, high levels of estrogen and progesterone produced by the placenta stimulate growth of the alveoli and ductal system to prepare them for lactation. Prolactin secretion by the anterior pituitary gland stimulates milk production during pregnancy; however, this effect is inhibited by estrogen and progesterone produced by the placenta. Inhibiting effects of estrogen and progesterone stop when the placenta is expelled after birth, and active milk production occurs in response to the infant's suckling while breastfeeding. Pitocin is the hormone that causes the let-down reflex during breastfeeding.

The nurse is assessing a patient in the active phase of labor. What should the nurse expect during this phase? a. The patient is sociable and excited. b. The patient is requesting pain medication. c. The patient begins to experience the urge to push. d. The patient experiences loss of control and irritability.

ANS: B During the active phase of labor, contraction intensity and discomfort increase to the point where women often request pain medication. Sociability and excitability occur during the latent phase. The urge to push occurs at the end of the transition phase or the second stage of labor. Loss of control and irritability occur during the transition phase of labor.

Which type of cutaneous stimulation involves massage of the abdomen? a. Imagery b. Effleurage c. Mental stimulation d. Thermal stimulation

ANS: B Effleurage is massage usually performed on the abdomen during contractions. Imagery exercises enhance relaxation by teaching the woman to imagine herself in a relaxing setting. Mental stimulation is a group of methods to decrease pain by increasing mental stimulation. Thermal stimulation decreases pain by using applications of heat and cold

Which advice to the patient 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.

ANS: B Elevating the feet and legs improves venous return and prevents venous stasis. Sitting with the legs crossed will decrease circulation in the legs and increase venous stasis. Elevating the legs at night may cause pressure on the diaphragm and increase breathing problems. Elastic stockings should be applied before lowering the legs in the morning.

A patient 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 patient to discuss her feelings is the best approach. The nurse should not disregard or belittle the patient's feelings. Responding that your baby is doing fine disregards the patient's feelings and treats them as unimportant. Responding that there is nothing to worry about does not answer the patient's concerns. Saying that the doctor is taking good care of you and your baby is belittling the patient's concerns.

Which mechanism of labor occurs when the largest diameter of the fetal presenting part passes the pelvic inlet? a. Extension b. Engagement c. Internal rotation d. External rotation

ANS: B Engagement occurs when the presenting part fully enters the pelvic inlet. Extension occurs when the fetal head meets resistance from the tissues of the pelvic floor and the fetal neck stops under the symphysis. This causes the fetal head to extend. Internal rotation occurs when the fetus enters the pelvic inlet. The rotation allows the longest fetal head diameter to conform to the longest diameter of the maternal pelvis. External rotation occurs after the birth of the head. The head then turns to the side so the shoulders can internally rotate and are positioned with their transverse diameter in the anteroposterior diameter of the pelvic outlet.

Which assessment would be important for a 6-hour-old infant who has bruising over the cheeks from a forceps birth? a. Presence of newborn reflexes b. Symmetry of facial movements c. Caput and molding of the head d. Anterior and posterior fontanels

ANS: B Following a forceps birth, the infant may have ecchymoses and facial nerve injury. Facial asymmetry suggests facial nerve damage. Changes in newborn reflexes, presence of caput and molding, and changes in the anterior and posterior fontanels are not risks associated with trauma to the infant's face.

Rh incompatibility can occur if the patient is Rh-negative and the a. fetus is Rh-negative. b. fetus is Rh-positive. c. father is Rh-positive. d. father and fetus are both Rh-negative

ANS: B For Rh incompatibility to occur, the mother must be Rh-negative and her fetus Rh-positive. If the fetus is Rh-negative, the blood types are compatible and no problems should occur. The father's Rh factor is a concern only as it relates to the possible Rh factor of the fetus. If the fetus is Rh-negative, the blood type with the mother is compatible. The father's blood type does not enter into the problem.

The nurse is caring for a low-risk patient in the active phase of labor. At which interval should the nurse assess the fetal heart rate? a. Every 15 minutes b. Every 30 minutes c. Every 45 minutes d. Every 1 hour

ANS: B For the fetus at low risk for complications, guidelines for frequency of assessments are at least every 30 minutes during the active phase of labor. 15-minute assessments would be appropriate for a fetus at high risk. 45-minute assessments during the active phase of labor are not frequent enough to monitor for complications. 1-hour assessments during the active phase of labor are not frequent enough to monitor for complications.

Which postpartum patient requires further assessment? a. G4 P4 who has had four saturated pads during the last 12 hours b. G1 P1 with Class II heart disease who complains of frequent coughing c. G2 P2 with gestational diabetes whose fasting blood sugar level is 100 mg/dL d. G3 P2 postcesarean patient who has active herpes lesions on the labia

ANS: B Frequent coughing may be a sign of congestive heart failure in the postpartum patient with heart disease. Four saturated pads in a 4-hour period is acceptable postpartum blood loss, a fasting blood sugar is a normal value, and the patient with identified active herpes does not require further assessment.

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

ANS: B From 29 to 36 weeks, routine prenatal assessment is every 2 weeks. If the pregnancy is high risk, the patient will see the health care provider more frequently.

Which data found on a patient's health history would place her at risk for an ectopic pregnancy? a. Ovarian cyst 2 years ago b. Recurrent pelvic infections c. Use of oral contraceptives for 5 years d. Heavy menstrual flow of 4 days' duration

ANS: B Infection and subsequent scarring of the fallopian tubes prevent normal movement of the fertilized ovum into the uterus for implantation. Ovarian cysts do not cause scarring of the fallopian tubes. Oral contraceptives do not increase the risk for ectopic pregnancies. Heavy menstrual flow of 4 days' duration will not cause scarring of the fallopian tubes, which is the main risk factor for ectopic pregnancies.

The examiner indicates to the labor nurse that the fetus is in the left occiput anterior (LOA) position. To facilitate the labor process, how will the nurse position the laboring patient? a. On her back b. On her left side c. On her right side d. On her hands and knees

ANS: B LOA is the desired fetal position for the birthing process. Positioning the patient on her left side will accomplish two objectives: (1) by the use of gravity, the fetus will most likely stay in the LOA position; and (2) increase perfusion of the placenta and increase oxygen to the fetus. Positioning the patient on her back decreases placental perfusion. Positioning on her right may facilitate internal rotation and move the fetus out of the LOA position. The hands and knees position is reserved to decrease cord compression, facilitate the fetus out of a posterior position, or increase oxygenation in the presence of hypoxia. Because none of these conditions are present, there is no need to implement this position.

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 o

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

Which method of intrapartum fetal monitoring is the most appropriate when a woman has a history of hypertension during pregnancy? a. Continuous auscultation with a fetoscope b. Continuous electronic fetal monitoring c. Intermittent assessment with a Doppler transducer d. Intermittent electronic fetal monitoring for 15 minutes each hour

ANS: B Maternal hypertension may reduce placental blood flow through vasospasm of the spiral arteries. Reduced placental perfusion is best assessed with continuous electronic fetal monitoring to identify patterns associated with this condition. It is not practical to provide continuous auscultation with a fetoscope. This fetus needs continuous monitoring because it is at high risk for complications.

Which form of heart disease in women of childbearing years usually has a benign effect on pregnancy? a. Cardiomyopathy b. Mitral valve prolapse c. Rheumatic heart disease d. Congenital heart disease

ANS: B Mitral valve prolapse is a benign condition that is usually asymptomatic. Cardiomyopathy produces congestive heart failure during pregnancy. Rheumatic heart disease can lead to heart failure during pregnancy. Some congenital heart diseases will produce pulmonary hypertension or endocarditis during pregnancy.

Which statement regarding multifactorial disorders is correct? a. They may not be evident until later in life. b. They are usually present and detectable at birth. c. The disorders are characterized by multiple defects. d. Secondary defects are rarely associated with them.

ANS: B Multifactorial disorders result from an interaction between a person's genetic susceptibility and environmental conditions that favor development of the defect. They are characteristically present and detectable at birth. They are usually single isolated defects, although the primary defect may cause secondary defects. Secondary defects can occur with multifactorial disorders.

A patient in her first trimester complains of nausea and vomiting. The patient asks, "Why is this happening?" 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."

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 decrease, but this is not the main cause of nausea and vomiting.

Use Nägele's rule to determine the EDD (estimated day of birth) for a patient whose last menstrual period started on April 12. a. February 19 b. January 19 c. January 21 d. February 7

ANS: B Nägele's rule subtracts 3 months from the month of the last menstrual period (month 4 - 3 = January) and adds 7 days to the day that the last menstrual period started (April 12 + 7 days = April 19), so the correct answer is January 19 of the following calendar year.

On vaginal exam, the patient's cervix is anterior, soft, 70% effaced, dilated 2 cm, and the presenting part is at 0 station. The Bishop's score for this patient is a. 6. b. 9. c. 10. d. 12

ANS: B On the Bishop's scoring system, an anterior cervix = 2 points, soft cervix = 2 points, 70% effaced = 2 points, 2 cm dilated = 1 point, and 0 station = 2 points, for a total score of 9.

The nurse is explaining the function of the male's cremaster muscle to a group of nursing students. Which statement accurately describes the function of the cremaster muscle? a. Assists with transporting sperm b. Aids in temperature control of the testicles c. Aids involuntary control of excretion of urine d. Entraps blood in the penis to produce an erection

ANS: B One cremaster muscle is attached to each testicle. Its function is to bring the testicle closer to the body to warm it or allow it to fall away from the body to cool it, thus promoting normal sperm production. Seminal fluid assists with transporting sperm. The urinary meatus aids in controlling the excretion of urine. Entrapment of the blood in the penis is a result of the spongy tissue.

An expectant mother says to the nurse, "When my sister's baby was born, it was covered in a cheese-like coating. What is the purpose of this coating?" The correct response by the nurse is to explain that the purpose of vernix caseosa is to a. regulate fetal temperature. b. protect the fetal skin from amniotic fluid. c. promote normal peripheral nervous system development. d. allow the transport of oxygen and nutrients across the amnion.

ANS: B Prolonged exposure to amniotic fluid during the fetal period could result in breakdown of the skin without the protection of the vernix caseosa. The amniotic fluid aids in maintaining fetal temperature. Normal peripheral nervous system development is dependent on the nutritional intake of the mother. The amnion is the inner membrane that surrounds the fetus. It is not involved in the oxygen and nutrient exchange.

Which statement with regard to reproductive anatomy and physiology is inaccurate? a. Female patients who are past puberty and sexually active can become pregnant even if they have not had a menstrual cycle. b. Puberty symptoms are more prominent in males than females. c. Females enter puberty earlier than their male counterparts. d. Secondary sexual characteristics develop during puberty.

ANS: B Puberty symptoms are less prominent in developing males than females. The other statements are correct.

The pregnant patient expresses a desire to schedule birth during the baby's father's furlough from military service. The nurse explains that prior to induction of labor, it is essential to determine which clinical finding? a. Dilated cervix b. Fetal lung maturity c. Rupture of membranes d. Uterine hypertonia

ANS: B Reassurance of fetal lung maturity is essential before elective procedures such as induction or cesarean. The cervix must be favorable for dilation but need not be dilated prior to induction. Prior rupture of membranes is not necessary for induction. Uterine hypertonia is a risk factor associated with induction of labor.

A patient 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

ANS: B Smoking during pregnancy increases the risk for spontaneous abortion, low birth weight, abruptio placentae, placenta previa, preterm birth, perinatal mortality, and SIDS. Smoking does not appear to cause congenital anomalies, hypoglycemia, or withdrawal syndrome.

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

ANS: B Teaching is an essential part of the nurse's role. Corrective actions should be initiated first to correct abnormal findings as quickly as possible. Electronic monitoring will record the contractions and FHR response. The support person should still be encouraged to assist with the comfort measures

Which factor ensures that the smallest anterior-posterior diameter of the fetal head enters the pelvis? a. Station b. Flexion c. Descent d. Engagement

ANS: B The anterior-posterior diameter of the head varies with how much it is flexed. In the most favorable situation, the head is fully flexed and the anterior-posterior diameter is the suboccipitobregmatic, averaging 9.5 cm. The station is the relationship of the fetal presenting part to the level of the ischial spine. Descent is the moving of the fetus through the birth canal. Engagement occurs when the largest diameter of the fetal presenting part has passed the pelvic outlet.

Which assessment by the nurse would differentiate a placenta previa from an abruptio placentae? a. Saturated perineal pad in 1 hour b. Pain level 0 on a scale of 0 to 10 c. Cervical dilation at 2 cm d. Fetal heart rate at 160 bpm

ANS: B The classic sign of placenta previa is the sudden onset of painless uterine bleeding, whereas abruptio placentae results in abdominal pain and uterine tenderness; heavy bleeding, cervical dilation, and fetal heart rate of 160 bpm could be associated with both conditions.

Which physiologic event is the key indicator of the commencement of true labor? a. Bloody show b. Cervical dilation and effacement c. Fetal descent into the pelvic inlet d. Uterine contractions every 7 minutes

ANS: B The conclusive distinction between true and false labor is that contractions of true labor cause progressive change in the cervix. Bloody show can occur before true labor. Fetal descent can occur before true labor. False labor may have contractions that occur this frequently but is usually inconsistent.

A patient has tested HIV-positive and has now discovered that she is pregnant. Which statement indicates that she understands the risks of this diagnosis? a. "I know I will need to have an abortion as soon as possible." b. "Even though my test is positive, my baby might not be affected." c. "My baby is certain to have AIDS and die within the first year of life." d. "This pregnancy will probably decrease the chance that I will develop AIDS."

ANS: B The fetus is likely to test positive for HIV in the first 6 months, until the inherited immunity from the mother wears off. Many of these babies will convert to HIV-negative status. With the newer drugs, the risk for infection of the fetus has decreased. Also, the life span of an infected newborn has increased. The pregnancy will increase the chance of converting.

When planning a healthy diet with a pregnant patient, what should the nurse's first action be? a. Teach the patient about MyPlate. b. Review the patient's current dietary intake. c. Instruct the patient to limit the intake of fatty foods. d. Caution the patient to avoid large doses of vitamins, especially those that are fat-soluble.

ANS: B The first action should be to assess the patient'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 patient. Limiting intake of fatty foods is important in a pregnant patient's diet; however, not the first action. Caution regarding about excessive fat-soluble vitamins is important; however, not the first action.

Which intervention is the priority for the patient diagnosed with an intact tubal pregnancy? a. Assessment of pain level b. Administration of methotrexate c. Administration of Rh immune globulin d. Explanation of the common side effects of the treatment plan

ANS: B The goal of medical management of an intact tube is to preserve the tube and improve the chance of future fertility. Methotrexate (a folic acid antagonist) is used to inhibit cell division and stop growth of the embryo. Assessment of pain level, administration of Rh immune globulin, and explaining common side effects of the treatment plan should be implemented in conjunction with or soon after treatment with methotrexate has begun.

A patient in her fifth month of pregnancy asks the nurse, "How many more calories should I be eating daily?" What is the correct response by the nurse? 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 at this gestation. A patient in her third trimester would increase her energy intake by 452 calories per day. 500 calories are more than the recommended calories for pregnancy.

Which characteristic best describes the levator ani? a. Division of the fallopian tube b. Collection of three pairs of muscles c. Imaginary line that divides the true pelvis and false pelvis d. Basin-shaped structure at the lower end of the spine

ANS: B The levator ani is a collection of three pairs of muscles that support internal pelvic structures and resist increases in intraabdominal pressure. The fallopian tube divisions are the interstitial portion, isthmus, ampulla, and infundibulum. The linea terminalis is the imaginary line that divides the false from the true pelvis. The basin-shaped structure at the lower end of the spine is the bony pelvis.

An expected change during pregnancy is a darkly pigmented vertical midabdominal line. The nurse recognizes this alteration as a. epulis. b. linea nigra. c. melasma. d. striae gravidarum.

ANS: B The linea nigra is a dark pigmented line from the fundus to the symphysis pubis. Epulis refers to gingival hypertrophy. Melasma is a different kind of dark pigmentation that occurs on the face. Striae gravidarum (stretch marks) are lines caused by lineal tears that occur in connective tissue during periods of rapid growth.

A patient who was pregnant had a spontaneous abortion at approximately 4 weeks' gestation. At the time of the miscarriage, it was thought that all products of conception were expelled. Two weeks later, the patient presents at the clinic office complaining of "crampy" abdominal pain and a scant amount of serosanguineous vaginal drainage with a slight odor. The pregnancy test is negative. Vital signs reveal a temperature of 100F, with blood pressure of 100/60 mm Hg, irregular pulse 88 beats/minute (bpm), and respirations, 20 breaths per minute. Based on this assessment data, what does the nurse anticipate as a clinical diagnosis? a. Ectopic pregnancy b. Uterine infection c. Gestational trophoblastic disease d. Endometriosis

ANS: B The patient is exhibiting signs of uterine infection, with elevated temperature, vaginal discharge with odor, abdominal pain, and blood pressure and pulse manifesting as shock-trended vitals. Because the pregnancy test is negative, an undiagnosed ectopic pregnancy and gestational trophoblastic disease are ruled out. There is no supportive evidence to indicate a clinical diagnosis of endometriosis at this time; however, it is more likely that this is an infectious process that must be aggressively treated.

Which patient 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 patient 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; patients 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.

A labor and birth nurse receives a call from the laboratory regarding a preeclamptic patient receiving an IV infusion of magnesium sulfate. The laboratory technician reports that the patient's magnesium level is 7.6 mg/dL. What is the nurse's priority action? a. Stop the infusion of magnesium. b. Assess the patient's respiratory rate. c. Assess the patient's deep tendon reflexes. d. Notify the health care provider of the magnesium level.

ANS: B The therapeutic serum level for magnesium is 4 to 8 mg/dL although it is elevated in terms of normal lab values. Adverse reactions to magnesium sulfate usually occur if the serum level becomes too high. The most important is CNS depression, including depression of the respiratory center. Magnesium is excreted solely by the kidneys, and the reduced urine output that often occurs in preeclampsia allows magnesium to accumulate to toxic levels in the woman. Frequent assessment of serum magnesium levels, deep tendon reflexes, respiratory rate, and oxygen saturation can identify CNS depression before it progresses to respiratory depression or cardiac dysfunction. Monitoring urine output identifies oliguria that would allow magnesium to accumulate and reach excessive levels. Discontinue magnesium if the respiratory rate is below 12 breaths per minute, a low pulse oximeter level (<95%) persists, or deep tendon reflexes are absent. Additional magnesium will make the condition worse

Which nursing action is correct when initiating electronic fetal monitoring? a. Lubricate the tocotransducer with an ultrasound gel. b. Securely apply the tocotransducer with a strap or belt. c. Inform the patient that she should remain in the semi-Fowler position. d. Determine the position of the fetus before attaching the electrode to the maternal abdomen

ANS: B The tocotransducer should fit snugly on the abdomen to monitor uterine activity accurately. The tocotransducer does not need gel to operate appropriately. The patient should be encouraged to move around during labor. The tocotransducer should be placed at the fundal area of the uterus.

A pregnant patient asks the nurse if she can double her prenatal vitamin dose because she does not like to eat vegetables. What is the nurse's response regarding 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 linked to 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.

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.

The labor nurse is developing a plan of care for a patient admitted in active labor with spontaneous rupture of the membranes 6 hours prior to admission with clear fluid. On admission, vital signs were as follows: maternal heart rate (HR) 92 bpm; fetal rate (FHR) baseline, 150 to 160 bpm; blood pressure, 124/76 mm Hg; temperature 37.2 C (99 F). What is the priority nursing action for this patient? a. Fetal acoustic stimulation b. Assess temperature every 2 hours c. Change absorption pads under her hips every 2 hours d. Review white blood cell count (WBC) drawn at admission

ANS: B The woman's temperature should be assessed at least every 2 to 4 hours after the membranes rupture. Elevations above 38C (100.4F) should be reported. A rising FHR and fetal tachycardia (above 160 bpm) may precede maternal fever. The fetal heart rate is at the high end of the acceptable range and the maternal temperature is slightly above normal. These parameters warrant watching closely with more frequent vital signs. The WBC is often falsely elevated in labor, largely related to the stress of labor. The FHR with a baseline of 150 to 160 bpm demonstrates moderate variability, and fetal acoustic stimulation is not warranted. Amniotic fluid is emitted from the vagina at variable rates and the underpad needs to be changed as needed

The health care provider for a laboring patient makes the following entry into the patient's record: 3/50%/+. What instruction will the nurse implement with the patient? a. "You will need to remain in bed attached to the electronic fetal monitor." b. "Breathe with me slowly, in through your nose and out through your mouth." c. "I will begin the administration of 1000 mL of IV fluid so you can have an epidural." d. "Your partner will need to change into scrub attire to attend the imminent birth."

ANS: B This patient is in the latent phase of the first stage of labor. Use slow, deep chest breathing patterns early in labor to conserve energy for the upcoming process. There is no mention in the stem that the membranes are ruptured, which may prohibit the patient from ambulating. Ambulating during early labor uses gravity to facilitate fetal descent. This is desired because the head is at +1 station. Epidural placement during early labor may slow down the labor process and should be delayed. There is no indication that birth is imminent because the patient is only 3 cm dilated.

The nurse receives report on an infant whose analysis indicates 47 total chromosomes, with the abnormality noted at chromosome 21. Which additional assessments will the nurse include when evaluating the infant? a. Cleft palate b. Protruding tongue c. Extra fingers or toes (polydactyly) d. Intellectual developmental delay

ANS: B Trisomy 21 is associated with a number of notable physical characteristics, including wide-set eyes, flat bridge of the nose, protruding tongue, short neck, small chin, poor muscle tone, and space between the great and second toes. An infant with trisomy 21 tends to be short in stature and developmentally delayed, but two characteristics will become more noticeable as the child gets older. Cleft palate and polydactyly are more common with trisomy 13.

Changes in the diet of the pregnant patient 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 patient with phenylketonuria.

What is the most likely cause for this fetal heart rate pattern? a. Administration of an epidural for pain relief during labor b. Cord compression c. Breech position of fetus d. Administration of meperidine (Demerol) for pain relief during labor

ANS: B Variable deceleration patterns are seen in response to head compression or cord compression. A breech presentation would not be likely to cause this fetal heart rate pattern. Similarly, administration of medication and/or an epidural would not cause this fetal heart rate pattern.

A nursing priority during admission of a laboring patient who has not had prenatal care is a. obtaining admission labs. b. identifying labor risk factors. c. discussing her birth plan choices. d. explaining importance of prenatal care

ANS: B When a patient has not had prenatal care, the nurse must determine through interviewing and examination the presence of any pregnancy or labor risk factors, obtain admission labs, and discuss birth plan choices. Explaining the importance of prenatal care can be accomplished after the patient's history has been completed.

The nurse is working with a patient to obtain information necessary for genetic counseling. Which tool will be used to obtain this information? a. Braden scale b. Genogram c. Chorionic villus sampling (CVS) d. Serum protein electrophoresis

ANS: B When obtaining information with regard to genetic counseling, it is important to obtain a family history using a genogram or pedigree as the clinical tool. The use of this diagram provides information for maternal and paternal histories and allows for the interpretation of significance based on findings of age, death, and medical history. A Braden scale is used to assess problems with skin leading to potential breakdown. CVS is a diagnostic procedure used during pregnancy to obtain genetic information about the fetus. Serum protein electrophoresis is a lab test used to determine immunoglobulin levels.

A laboring patient states to the nurse, "I have to push!" What is the next nursing action? a. Contact the health care provider. b. Examine the patient's cervix for dilation. c. Review with her how to bear down with contractions. d. Ask her partner to support her head with each push.

ANS: B When the cervix is completely dilated, the head can descend through the pelvis and stimulate the pushing, reflex. Cervical dilation must first be confirmed because premature pushing efforts may result in cervical edema and corresponding delay in dilation. Once complete dilation has been confirmed, the nurse can notify the health care provider. Teaching positioning and pushing efforts is accomplished once complete dilation has been confirmed.

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

ANS: B With pregnancy, one would expect the serum creatinine and BUN levels to decrease. An elevation in the serum creatinine level should be investigated. With pregnancy, the GFR increases because of increased renal blood flow and is thus a normal expected finding. A decrease in the blood urea nitrogen level and mild proteinuria is expected findings in pregnancy.

The clinical nurse educator is providing instruction to a group of new nurses during labor orientation. Which information regarding the factors that have a role in the initiation of labor should the educator include in this teaching session? (Select all that apply.) a. Progesterone levels become higher than estrogen levels. b. Natural oxytocin in conjunction with other substances plays a role. c. Stretching, pressure, and irritation of the uterus and cervix increase. d. The secretion of prostaglandins from the fetal membranes decreases

ANS: B, C Factors that appear to have a role in starting labor include the following: (1) natural oxytocin plays a part in labor's initiation in conjunction with other substances; and (2) stretching, pressure, and irritation of the uterus and cervix increase as the fetus reaches term size. The progesterone levels drop and estrogen levels increase. There is an increase in the secretion of prostaglandins from the fetal membranes.

The nurse is explaining fetal circulation to a group of nursing students. Which information should be included in the teaching session? (Select all that apply.) a. After birth the ductus venosus remains open, but the other shunts close. b. The foramen ovale shunts blood from the right atrium to the left atrium. c. The ductus venosus shunts blood from the liver to the inferior vena cava. d. The ductus arteriosus shunts blood from the right ventricle to the left ventricle.

ANS: B, C The foramen ovale shunts oxygenated blood from the right atrium to the left atrium, bypassing the lungs. The ductus venosus shunts oxygenated blood from the liver to the inferior vena cava. All shunts close after birth. The ductus arteriosus shunts blood from the right ventricle to the aorta

The nurse is teaching a patient 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 patient should not take a daily laxative unless prescribed by her health care provider. Increased intake of dairy products, especially cheese, may increase constipation.

When caring for a patient in labor who is considered to be at low risk, which assessments should be included in the plan of care? (Select all that apply.) a. Check the DTR each shift. b. Monitor and record vital signs frequently during the course of labor. c. Document the FHR pattern, noting baseline and response to contraction patterns. d. Indicate on the EFM tracing when maternal position changes are done. e. Provide food, as tolerated, during the course of labor

ANS: B, C, D Nursing care of the normal laboring patient would include monitoring and documentation of vital signs as part of the labor assessment, documentation the FHR, checking patterns to look for assurance of fetal well-being by evaluating baseline and the fetal response to contraction patterns, and noting any position changes on the monitor tracing to evaluate the fetal response. Providing dietary offerings during the course of labor is not part of the nursing care plan because the introduction of food may lead to nausea and vomiting in response to the labor process and might affect the mode of birth

The school nurse is conducting health education classes for a group of adolescent girls. Select the actions of the estrogen hormone that the nurse should include in the lessons. (Select all that apply.) a. Stimulates contractions during birth b. Relaxes pelvic ligaments during pregnancy c. Stimulates the endometrium before ovulation d. Stimulates growth of uterus during pregnancy e. Stimulates the let-down reflex during breastfeeding

ANS: B, C, D The hormone estrogen relaxes pelvic ligaments during pregnancy, stimulates the endometrium before ovulation, and stimulates the growth of the uterus during pregnancy. Oxytocin stimulates contractions during pregnancy and stimulates the let-down reflex during breastfeeding.

The nurse is planning a prenatal class on fetal development. Which characteristics of prenatal development should the nurse include for a fetus of 24 weeks, based on fertilization age? (Select all that apply.) a. Ear cartilage firm b. Skin wrinkled and red c. Testes descending toward the inguinal rings d. Surfactant production nears mature levels e. Fetal movement becoming progressively more noticeable

ANS: B, C, E A fetus of 24 weeks, based on fertilization age, will have wrinkled and red skin, testes descending toward inguinal rings, and the fetal movement becoming progressively more noticeable. Surfactant production nearing the mature levels does not occur until 32 weeks and ear cartilage is not firm until 38 weeks.

The nurse recognizes that fetal scalp stimulation may be prescribed to evaluate the response of the fetus to tactile stimulation. Which conditions contraindicate the use of fetal scalp stimulation? (Select all that apply.) a. Post-term fetus b. Maternal fever c. Placenta previa d. Induction of labor e. Prolonged rupture of membranes

ANS: B, C, E Fetal scalp stimulation is not done when there is maternal fever (possibility of introducing microorganisms into the uterus), placenta previa (placenta overlies the cervix, and hemorrhage is likely), or prolonged rupture of membranes (risk of infection). Fetal scalp stimulation may be used to evaluate a post-term fetus' response to stimulation. It is also used to evaluate a fetus when labor is being induced.

. Which interventions should be performed in the birth room to facilitate thermoregulation of the newborn? (Select all that apply.) a. Place the infant covered with blankets in the radiant warmer. b. Dry the infant off with sterile towels. c. Place stockinette cap on infant's head. d. Bathe the newborn within 30 minutes of birth. e. Remove wet linen as needed.

ANS: B, C, E Following birth, the newborn is at risk for hypothermia. Therefore nursing interventions are aimed at maintaining warmth. Drying the infant off, in addition to maintaining warmth, helps stimulate crying and lung expansion, which helps in the transition period following birth. Placing a cap on the infant's head helps prevent heat loss. Removal of wet linens helps minimize further heat loss caused by exposure. Newborns should not be covered while in a radiant warmer with blankets because this will impede birth of heat transfer. Bathing a newborn should be delayed for at least a few hours so that the newborn temperature can stabilize during the transition period

Along with gas exchange and nutrient transfer, the placenta produces many hormones necessary for normal pregnancy, including which of the following? (Select all that apply.) a. Insulin b. Estrogen c. Progesterone d. Testosterone e. Human chorionic gonadotropin (hCG)

ANS: B, C, E HCG causes the corpus luteum to persist and produce the necessary estrogens and progesterone for the first 6 to 8 weeks. Estrogens cause enlargement of the woman's uterus and breasts and growth of the ductal system in the breasts and, as term approaches, plays a role in the initiation of labor. Progesterone causes the endometrium to change, providing early nourishment. Progesterone also protects against spontaneous abortion by suppressing maternal reactions to fetal antigens and reduces unnecessary uterine contractions. Other hormones produced by the placenta include hCT, hCA, and a number of growth factors. Insulin and testosterone are not secreted by the placenta.

The nurse is monitoring a patient with severe preeclampsia who is on IV magnesium sulfate. Which signs of magnesium toxicity should the nurse monitor for? (Select all that apply.) a. Cool, clammy skin b. Altered sensorium c. Pulse oximeter reading of 95% d. Respiratory rate of less than 12 breaths per minute e. Absence of deep tendon reflexes

ANS: B, D, E Signs of magnesium toxicity include the following: • Respiratory rate of less than 12 breaths per minute (hospitals may specify a rate <14 breaths per minute) • Maternal pulse oximeter reading lower than 95% • Absence of deep tendon reflexes • Sweating, flushing • Altered sensorium (confused, lethargic, slurred speech, drowsy, disoriented) • Hypotension • Serum magnesium value above the therapeutic range of 4 to 8 mg/dL Cold, clammy skin and a pulse oximeter reading of 95% would not be signs of toxicity

The nurse is reviewing the instructions given to a patient at 24 weeks' gestation for a glucose challenge test (GCT). The nurse determines that the patient understands the teaching when she makes which statement? a. "I have to fast the night before the test." b. "I will drink a sugary solution containing 100 g of glucose." c. "I will have blood drawn at 1 hour after I drink the glucose solution." d. "I should keep track of my baby's movements between now and the test."

ANS: C GCT is administered between 24 and 28 weeks of gestation, often to low- and high-risk antepartum patients. Fasting is not necessary for a GCT, and the woman is not required to follow any pretest dietary instructions. The woman should ingest 50 g of oral glucose solution, and 1 hour later a blood sample is taken. Fetal surveillance with kick counts is an ongoing evaluation for pregnant women; they should contact their health care provider if there is a noticeable decrease in fetal movement.

Anti-infective prophylaxis is indicated for a pregnant patient with a history of mitral valve stenosis related to rheumatic heart disease because the patient is at risk of developing a. hypertension. b. postpartum infection. c. bacterial endocarditis. d. upper respiratory infections.

ANS: C Because of vegetations on the leaflets of the mitral valve and the increased demands of pregnancy, the patient is at greater risk of bacterial endocarditis. Pulmonary hypertension may occur with mitral valve stenosis, but anti-infective medications will not prevent it from occurring. Women with cardiac problems must be observed for possible infections during the postpartum period but are not given prophylactic antibiotics to prevent them. Women are not put on prophylactic antibiotics to prevent upper respiratory infections.

For the pregnant patient 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 consumed by vegans. Fruits and vegetables alone will not provide the essential amino acids. Vitamin and mineral supplements do not provide amino acids.

When explaining the recommended weight gain to your patient, the nurse's teaching should include which statement? a. "All pregnant women need to gain a minimum of 25 to 35 lb." b. "The fetus, amniotic fluid, and placenta require 15 lb of weight gain." c. "Weight gain in pregnancy is based on the patient'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 lb. The combination of the fetus, amniotic fluid, and placenta averages about 11 lb in the patient 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.

At 1 minute after birth, the nurse assesses the newborn to assign an Apgar score. The apical heart rate is 110 bpm, and the infant is crying vigorously with the limbs flexed. The infant's trunk is pink and the hands and feet are blue. The Apgar score for this infant is a. 7. b. 8. c. 9. d. 10.

ANS: C The Apgar score is 9 because 1 point is deducted from the total score of 10 for the infant's blue hands and feet. The baby received 2 points for each of the categories except color. Because the infant's hands and feet were blue, this category is given a grade of 1. The baby received 2 points for each of the categories except color. Because the infant's hands and feet were blue, this category is given a grade of 1. The infant had 1 point deducted because of the blue color of the hands and feet.

Which 16-year-old female patient is most likely to experience secondary amenorrhea? a. 5 ft 2 in, 130 lb b. 5 ft 9 in, 180 lb c. 5 ft 7 in, 96 lb d. 5 ft 4 in, 125 lb

ANS: C Due to her height and low body weight, this adolescent is at risk of developing secondary amenorrhea. Secondary amenorrhea occurs in women who are thin and have a low percentage of body fat. Fat is necessary to make the sex hormones that stimulate ovulation and menstruation. The other patients are of sufficient height and weight to promote sex hormone production.

The clinic nurse is performing a prenatal assessment on a pregnant patient at risk for preeclampsia. Which clinical sign would not present as a symptom of preeclampsia? a. Edema b. Proteinuria c. Glucosuria d. Hypertension

ANS: C Glucose into the urine is not one of the three classic symptoms of preeclampsia. The first sign noted by the pregnant patient is rapid weight gain and edema of the hands and face. Proteinuria usually develops later than the edema and hypertension. The first indication of preeclampsia is usually an increase in the maternal blood pressure.

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.

Which assessment in a patient diagnosed with preeclampsia who is taking magnesium sulfate would indicate a therapeutic level of medication? a. Drowsiness b. Urinary output of 20 mL/hour c. Normal deep tendon reflexes d. Respiratory rate of 10 to 12 breaths per minute

ANS: C Magnesium sulfate is administered for preeclampsia to reduce the risk of seizures from cerebral irritability. Hyperreflexia (deep tendon reflexes above normal) is a symptom of cerebral irritability. If the dosage of magnesium sulfate is effective, reflexes should decrease to normal or slightly below normal levels. Drowsiness is another sign of CNS depression from magnesium toxicity. A urinary output of 20 mL/hour is inadequate output. A respiratory rate of 10 to 12 breaths per minute is too slow and could be indicative of magnesium toxicity.

Some of the embryo's intestines remain within the umbilical cord during the embryonic period because the a. intestines need this time to grow until week 15. b. nutrient content of the blood is higher in this location. c. abdomen is too small to contain all the organs while they are developing. d. umbilical cord is much larger at this time than it will be at the end of pregnancy.

ANS: C The abdominal contents grow more rapidly than the abdominal cavity, so part of their development takes place in the umbilical cord. By 10 weeks, the abdomen is large enough to contain them. The intestines remain within the umbilical cord only until about week 10. Blood supply is adequate in all areas; intestines stay in the umbilical cord for about 10 weeks because they are growing faster than the abdomen. Intestines begin their development within the umbilical cord, but only because the liver and kidneys occupy most of the abdominal cavity, not because of the size of the umbilical cord

Pregnant patients can usually tolerate the normal blood loss associated with childbirth because of which physiologic adaptation to pregnancy? a. A higher hematocrit b. Increased leukocytes c. Increased blood volume d. A lower fibrinogen level

ANS: C Women have a significant increase in blood volume during pregnancy. After birth, the additional circulating volume is no longer necessary. The hematocrit decreases with pregnancy due to the higher fluid volume. Leukocyte levels increase during labor; however, that is not the reason for the toleration of blood loss. Fibrinogen levels increase with pregnancy.

When a Category II pattern of the fetal heart rate is noted and the patient is lying on her left side, which nursing action is indicated? a. Lower the head of the bed. b. Place a wedge under the left hip. c. Change her position to the right side. d. Place the mother in Trendelenburg position.

ANS: C A Category II pattern indicates an indeterminate fetal heart rate. Repositioning on the opposite side may relieve compression on the umbilical cord and improve blood flow to the placenta. Lowering the head of the bed would not be the first position change choice. The woman is already on her left side, so a wedge on that side would not be an appropriate choice. Repositioning to the opposite side is the first intervention. If unsuccessful with improving the FHR pattern, further changes in position can be attempted; the Trendelenburg position might be the choice.

Which assessment finding would cause a concern for a patient who had delivered vaginally? a. Estimated blood loss (EBL) of 500 mL during the birth process b. White blood cell count of 28,000 mm3 postbirth c. Patient complains of fingers tingling d. Patient complains of thirst

ANS: C A patient's complaint of fingers tingling may represent respiratory alkalosis due to hyperventilation breathing patterns during labor. As such it requires intervention by the nurse to have the patient slow breathing down and restore normal carbon dioxide levels.

The school nurse is conducting health education classes for a group of adolescents. Which statement best describes a secondary sexual characteristic? a. Maturation of ova b. Production of sperm c. Female breast development d. Secretion of gonadotropin-releasing hormone

ANS: C A secondary sexual characteristic is one not directly related to reproduction, such as development of the characteristic female body form. Maturation of ova is directly related to reproduction and is a primary sexual characteristic. Production of sperm is directly related to reproduction and is a primary sexual characteristic. Secretion of hormones is directly related to reproduction and is a primary sexual characteristic.

Following an external cephalic version, which assessment finding indicates a complication? a. Onset of irregular contractions b. Maternal blood pressure of 110/70 mm Hg c. Deceleration of FHR to 88 bpm d. Maternal pulse rate of 100 bpm

ANS: C A serious risk of external cephalic version is that the fetus may become entangled in the umbilical cord, compressing its vessels and resulting in hypoxia. The onset of irregular contractions, maternal blood pressure of 110/70 mm Hg, and maternal pulse rate of 100 bpm are normal findings.

A patient at 40 weeks' gestation should be instructed to go to a hospital or birth center for evaluation when she experiences a. increased fetal movement. b. irregular contractions for 1 hour. c. a trickle of fluid from the vagina. d. thick pink or dark red vaginal mucus.

ANS: C A trickle of fluid from the vagina may indicate rupture of the membranes, requiring evaluation for infection or cord compression. Decreased or the lack of fetal movement requires further assessment. Irregular contractions are a sign of false labor and do not require further assessment. Bloody show may occur before the onset of true labor. It does not require professional assessment unless the bleeding is pronounced.

Fraternal twins are delivered by your Rh-negative patient. Twin A is Rh-positive and twin B is Rh-negative. Prior to administering Rho(D) immune globulin (RhoGAM), the nurse should determine the results of the a. direct Coombs test of twin A. b. direct Coombs test of twin B. c. indirect Coombs test of the mother. d. transcutaneous bilirubin level for both twins

ANS: C Administration of RhoGAM is based on the results of the indirect Coombs test on the patient. A negative result confirms that the mother has not been sensitized by the positive Rh factor of twin A and that RhoGAM is indicated. A direct Coombs test is a diagnostic test used to determine maternal antibodies in fetal blood and to guide treatment of the newborn when Rh and ABO incompatibilities occur. Transcutaneous bilirubin is a noninvasive measure to determine the level of bilirubin in a newborn.

A patient states, "My breasts are so small. I don't think I will be able to breastfeed my baby." Which is the nurse's best response? a. "It may be difficult but you should try anyway." b. "You can always supplement with formula." c. "All women have about the same amount of glandular tissue necessary to secrete milk." d. "The ability to produce breast milk depends on increased levels of estrogen and progesterone."

ANS: C All women have 15 to 20 lobes arranged around and behind the nipple and areola. These lobes, not the size of the breast, are responsible for milk production. The size of the breasts does not ensure success or failure in breastfeeding. Supplementation decreases the production of breast milk by decreasing stimulation. Stimulation of the breast, not the size of the breast, brings about milk production. Increased levels of estrogen decrease the production of milk by affecting prolactin.

ANS: C Although the reason is unclear, marked improvement is seen with rheumatoid arthritis in pregnancy. Unfortunately relapse occurs within 36 months postpartum. With epilepsy, the effect of pregnancy is variable and unpredictable. Seizures may increase, decrease, or remain the same. Bell's palsy was thought to be the result of infection by a virus three times more common during pregnancy and generally occurring in the third trimester. The patient with SLE can have a normal pregnancy but must be treated as high risk because 50% of all births will be premature. Pregnancy can exacerbate SLE.

Which breech presentation should the nurse recognize as being favorable for an external cephalic version? a. 36-week gestation with low-lying placenta b. 38-week gestation with one previous cesarean c. 37-week gestation with fetal weight of 7 lb d. 40-week gestation with several uterine fibroids

ANS: C An external cephalic version (changing the fetal presentation from breech to cephalic) is more successful when the pregnancy is at least 37 weeks and there is still adequate room and fluid to manipulate the fetus but prior to term or onset of labor. A low-lying placenta, previous cesarean birth, and uterine fibroids are contraindications for version.

A patient with preeclampsia is being treated with bed rest and intravenous magnesium sulfate. The drug classification of this medication is a a. diuretic. b. tocolytic. c. anticonvulsant. d. antihypertensive.

ANS: C Anticonvulsant drugs act by blocking neuromuscular transmission and depress the central nervous system to control seizure activity. Diuresis is a therapeutic response to magnesium sulfate. A tocolytic drug slows the frequency and intensity of uterine contractions but is not used for that purpose in this scenario. Decreased peripheral blood pressure is a therapeutic response (side effect) of the anticonvulsant magnesium sulfate.

While obtaining a genetic history from a female patient, you note that there is a family history of a genetic disease on the maternal side; however, no evidence of symptomatology in the patient or the patient's children, two girls. Which observation can you make related to genetic expression? a. Autosomal dominant expression is observed. b. X-linked dominant trait is observed. c. More information is needed to determine the answer. d. Autosomal recessive expression is observed and both the children will be carriers of the disease process.

ANS: C Because we have no information about the father and/or paternal side, the other stated options do not apply. If an autosomal dominant expression were present in the family history, the patient would be symptomatic. X-linked recessive traits are more common than X-linked dominant traits and, again, the patient and children are not symptomatic. Although an autosomal recessive expression may be present, we cannot predict that the children will be carriers. There is a 25% chance of being affected

During vital sign assessment of a pregnant patient in her third trimester, the patient complains of feeling faint, dizzy, and agitated. Which nursing intervention is most 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 turn to her left side and recheck her blood pressure in 5 minutes. d. Have the patient lie supine for 5 minutes and recheck her blood pressure on both arms.

ANS: C Blood pressure is affected by positioning 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.

A patient, 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

ANS: C By 20 weeks, the fundus should reach the umbilicus. The fundus should be at the umbilicus at 20 weeks, so 3 cm below the umbilicus 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 because of incorrect dating of the pregnancy.

Which assessment finding indicates that cervical dilation and/or effacement has occurred? a. Onset of irregular contractions b. Cephalic presentation at 0 station c. Bloody mucus drainage from vagina d. Fetal heart tones (FHTs) present in the lower right quadrant

ANS: C Cervical dilation and/or effacement results in loss of the mucus plug as well as rupture of small capillaries in the cervix; irregular contractions, cephalic presentation, and FHTs in the lower right quadrant do not indicate the onset of cervical ripening.

Which finding in the exam of a patient with a diagnosis of threatened abortion would change the diagnosis to inevitable abortion? a. Presence of backache b. Rise in hCG level c. Clear fluid from vagina d. Pelvic pressure

ANS: C Clear fluid from the vagina indicates rupture of the membranes. Abortion is usually inevitable (cannot be stopped) when the membranes rupture, the presence of backache and pelvic pressure are common symptoms in threatened abortion, and a rise in the hCG level is consistent with a viable pregnancy.

A gravida 1 patient 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

ANS: C 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 overall well-being; however, the primary concern related to back pain is a thorough evaluation of posture and body mechanics.

Which finding in the assessment of a patient following an abruption placenta could indicate a major complication? a. Urine output of 30 mL in 1 hour b. Blood pressure of 110/60 mm Hg c. Bleeding at IV insertion site d. Respiratory rate of 16 breaths per minute

ANS: C DIC is a life-threatening defect in coagulation that may occur following abruptio placentae. DIC allows excess bleeding from any vulnerable area such as IV sites, incisions, gums, or nose. A urine output of 30 mL in 1 hour, blood pressure of 110/60 mm Hg, and respiratory rate of 16 breaths per minute are normal findings in a postpartum patient.

Which of the following is the priority intervention for a supine patient whose monitor strip shows decelerations that begin after the peak of the contraction and return to the baseline after the contraction ends? a. Increase IV infusion. b. Elevate lower extremities. c. Reposition to left side-lying position. d. Administer oxygen per face mask at 4 to 6 L/minute.

ANS: C Decelerations that begin at the peak of the contractions and recover after the contractions end are caused by uteroplacental insufficiency. When the patient is in the supine position, the weight of the uterus partially occludes the vena cava and descending aorta, resulting in hypotension and decreased placental perfusion. Increasing the IV infusion, elevating the lower extremities, and administering O2 will not be effective as long as the patient is in a supine position.

The nurse is conducting a staff in-service on multifetal pregnancy. Which statement regarding dizygotic twin development should the nurse include in the teaching session? a. Dizygotic twins arise from two fertilized ova and are the same sex. b. Dizygotic twins arise from a single fertilized ovum and are always of the same sex. c. Dizygotic twins arise from two fertilized ova and may be the same sex or different sexes. d. Dizygotic twins arise from a single fertilized ovum and may be the same sex or different sexes.

ANS: C Dizygotic twins arise from two ova that are fertilized by different sperm. They may be the same or different gender, and they may not have similar physical traits. Monozygotic twins are always the same sex. A single fertilized ovum that produces twins is called monozygotic. Dizygotic twins are from two fertilized ova and may or may not be the same sex.

The nurse is assessing the duration of a patient's labor contractions. Which method does the nurse implement to assess the duration of labor contractions? a. Assess the strongest intensity of each contraction. b. Assess uterine relaxation between two contractions. c. Assess from the beginning to the end of each contraction. d. Assess from the beginning of one contraction to the beginning of the next.

ANS: C Duration of labor contractions is the average length of contractions from beginning to end. Assessing the strongest intensity of each contraction assesses the strength or intensity of the contractions. Assessing uterine relaxation between two contractions is the interval of the contraction phase. Assessing from the beginning of one contraction to the beginning of the next is the frequency of the contractions.

The nurse is explaining the physiology of uterine contractions to a group of nursing students. Which statement best explains the maternal-fetal exchange of oxygen and waste products during a contraction? a. Little to no affect b. Increases as blood pressure decreases c. Diminishes as the spiral arteries are compressed d. Continues except when placental functions are reduced

ANS: C During labor contractions, the maternal blood supply to the placenta gradually stops as the spiral arteries supplying the intervillous space are compressed by the contracting uterine muscle. The exchange of oxygen and waste products is affected by contractions. The exchange of oxygen and waste products decreases. The maternal blood supply to the placenta gradually stops with contractions.

Which information is covered by early pregnancy classes offered in the first and second trimesters? a. Methods of pain relief b. The phases and stages of labor c. Coping with common discomforts of pregnancy d. Prebirth and postbirth care of a patient having a cesarean birth

ANS: C Early pregnancy classes focus on the first two trimesters and cover information on adapting to pregnancy, dealing with early discomforts, and understanding what to expect in the months ahead. Methods of pain relief are discussed in a childbirth preparation class. The phases and stages of labor are usually covered in a childbirth preparation class. Cesarean birth preparation classes discuss prebirth and postbirth of a patient having a cesarean birth.

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 guidance for this 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." NURSINGTB.COM Foundations of Maternal-Newborn and Women's Health Nursing 7th Edition Murray Test BankNU RS IN GT B.CO M 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 optimal recommendation. Four meals a day would not be ideal for a patient experiencing nausea, she needs to eat more frequently. Consumption is not the patient's stated concern—it is the nausea and vomiting.

A nurse is explaining to the nursing students working on the antepartum unit how to assess for edema. Which edema assessment score indicates edema of the lower extremities, face, hands, and sacral area? a. +1 b. +2 c. +3 d. +4

ANS: C Edema of the extremities, face, and sacral area is classified as +3 edema. Edema classified as +1 indicates minimal edema of the lower extremities. Marked edema of the lower extremities is +2 edema. Generalized massive edema (+4) includes the accumulation of fluid in the peritoneal cavity.

The nurse admits a laboring patient at term. On review of the prenatal record, the patient's pregnancy has been unremarkable and she is considered low risk. In planning the patient's care, at what interval will the nurse intermittently auscultate (IA) the fetal heart rate during the first stage of labor? a. Every 10 minutes b. Every 15 minutes c. Every 30 minutes d. Every 60 minutes

ANS: C Evaluate the fetal monitoring strip systematically for the elements noted. The following are recommended assessment and documentation intervals for IA and EFM (although facility policies may be different): low-risk women, every 30 minutes during the active phase and every 15 minutes during the second stage.

ANS: C Fetal bradycardia may indicate fetal distress and may require immediate intervention. Maternal pulse rate may increase due to the pushing process. Blood pressure of 120/70 mm Hg is within expected norms for this stage of labor. Decreased intensity of uterine contractions indicates the birth is imminent at this point.

To clarify the fetal condition when baseline variability is absent, the nurse should first a. monitor fetal oxygen saturation using fetal pulse oximetry. b. notify the physician so that a fetal scalp blood sample can be obtained. c. apply pressure to the fetal scalp with a glove finger using a circular motion. d. increase the rate of nonadditive IV fluid to expand the mother's blood volum

ANS: C Fetal scalp stimulation helps identify whether the fetus responds to gentle massage. An acceleration in response to the massage suggests that the fetus is in normal oxygen and acid-base balance. Monitoring fetal oxygen saturation using fetal pulse oximetry is no longer available in the United States. Obtaining a fetal scalp blood sample is invasive and the results are not immediately available. Increasing the rate of nonadditive IV fluid would not clarify the fetal condition.

Which of the following therapeutic applications provides the most accurate information related to uterine contraction strength? a. External fetal monitoring (EFM) b. Internal fetal monitoring c. Intrauterine pressure catheter (IUPC) d. Maternal comments based on perception

ANS: C IUPC is a clinical tool that provides an accurate assessment of uterine contraction strength. EFM provides evidence of contraction pattern and fetal heart rate but only estimates uterine contraction strength. Internal fetal monitoring provides direct evidence of fetal heart rate and contraction pattern. It only estimates uterine contraction strength. Maternal comments related to pain may not be related to uterine contraction strength and thus are influenced by the patient's own pain perception.

The nurse assesses a laboring patient's contraction pattern and notes the frequency at every 3 to 4 minutes, duration 50 to 60 seconds, and the intensity is moderate by palpation. What is the most accurate documentation for this contraction pattern? a. Stage 1, latent phase b. Stage 2, latent phase c. Stage 1, active phase d. Stage 2, active phase

ANS: C In the active phase of stage 1, contractions are about 2 to 5 minutes apart, with a duration of about 40 to 60 seconds and an intensity that ranges from moderate to strong. During the latent phase of stage 1, the interval between contractions shortens until contractions are about 5 minutes apart. Duration increases to 30 to 40 seconds by the end of the latent phase. During stage 2, latent phase, the woman is resting and preparing to push; she likely has not experienced the pushing reflex (sometimes referred to as the Ferguson reflex). She is actively bearing down during the active phase of the second stage.

What is the priority nursing intervention for the patient who has had an incomplete abortion? a. Methylergonovine (Methergine), 0.2 mg IM b. Preoperative teaching for surgery c. Insertion of IV line for fluid replacement d. Positioning of patient in left side-lying position

ANS: C Initial treatment of an incomplete abortion should be focused on stabilizing the patient's cardiovascular state. Methylergonovine would be administered after surgical treatment, preoperative teaching is not a priority until the patient is stabilized, and the left side-lying position provides no benefit to the patient in this situation.

If a notation on the patient's health record states that the fetal position is LSP, this indicates that the a. head is in the right posterior quadrant of the pelvis. b. head is in the left anterior quadrant of the pelvis. c. buttocks are in the left posterior quadrant of the pelvis. d. buttocks are in the right upper quadrant of the abdomen

ANS: C LSP explains the position of the fetus in the maternal pelvis. L = left side of the pelvis, S = sacrum (fetus is in breech presentation), P = posterior quadrants of the pelvis. When the head is in the right posterior quadrant of the pelvis, the position is ROP. When the head is in the left anterior quadrant of the pelvis, the position is ROA. When the buttocks are in the upper quadrant of the abdomen, the position would be ROA, ROP, LOA, LOP, LOT, or ROT

The patient presenting at 38 weeks' gestation, gravida 1, para 0, vaginal exam 4 cm, 100% effaced, +1 station vertex. What is the most likely intervention for this fetal heart rate pattern? a. Continue oxytocin (Pitocin) infusion. b. Contact the anesthesia department for epidural administration. c. Change maternal position. d. Administer Narcan to patient and prepare for immediate vaginal delivery

ANS: C Late decelerations indicate fetal compromise (uteroplacental insufficiency) and are considered to be a significant event requiring immediate assessment and intervention. Of all the options listed, changing maternal position may increase placental perfusion. In the presence of late decelerations, Pitocin infusion should be stopped. Contacting anesthesia for epidural administration will not solve the existing problem of late decelerations. There are no data to support the administration of Narcan and because patient is still in early labor, birth is not imminent.

The nurse is preparing to perform Leopold's maneuvers. Please select the rationale for the consistent use of these maneuvers by obstetric providers? a. To determine the status of the membranes b. To determine cervical dilation and effacement c. To determine the best location to assess the fetal heart rate d. To determine whether the fetus is in the posterior position

ANS: C Leopold's maneuvers are often performed before assessing the fetal heart rate (FHR). These maneuvers help identify the best location to obtain the FHR. A pH test or fern test can be performed to determine the status of the fetal membranes. Dilation and effacement are best determined by vaginal examination. Assessment of fetal position is more accurate with vaginal examination.

An infant is diagnosed with fetal anemia. Which information would support this clinical diagnosis? a. Presence of excess maternal hormones b. Maternal blood type O-negative, Rh-negative, and infant blood type O-negative, Rh-negative c. Passive immunity d. Rh-negative mother and Rh-positive baby

ANS: C Passive immunity provides temporary protection to the baby based on the transfer of maternal antibodies. Maternal hormones would not lead to a clinical diagnosis of fetal anemia. These blood types and Rh factors are the same; therefore, no antibodies will be created. In this situation, an Rh-negative mother and Rh-positive baby will result in stimulation of antibodies that will stimulate a reaction leading to hemolysis.

A patient with an IUD in place 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 since 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

ANS: C Pregnancy with an intrauterine device (IUD) in place is unusual; however, it can occur and cause complications such as spontaneous abortion and infection. A therapeutic abortion is not indicated unless infection occurs

A patient 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 patient 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 patient 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 patient 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 patient 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.

What is the best explanation that the nurse can provide to a patient 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.

ANS: C Providing factual information based on physiologic mechanisms is the best option. Although having the patient write down her concerns is reasonable, the nurse should not refer this conversation to the physician but rather address the patient's specific concerns. Switching to a high-iron diet will not correct this condition. This physiologic pattern occurs during pregnancy as a result of hemodilution from excess blood volume. Iron medication is not indicated for correction of this condition. There is no need to contact the physician for a prescription.

What is the gravida and para for a patient who delivered triplets 2 years ago and is now pregnant again? 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. 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.

The fetal heart rate baseline increases 20 bpm after vibroacoustic stimulation. The best interpretation of this is that the fetus is showing a. a worsening hypoxia. b. progressive acidosis. c. an expected response. d. parasympathetic stimulation.

ANS: C The fetus with adequate reserve for the stress of labor will usually respond to vibroacoustic stimulation with a temporary increase in the fetal heart rate (FHR) baseline. An increase in the FHR with stimulation does not indicate hypoxia. An increase in the FHR after stimulation is an anticipated response and does not indicate acidosis. An increase in the FHR after stimulation is a normal pattern, and does not indicate problems with the parasympathetic nervous system. A Category I pattern is normal and strongly predictive of adequate fetal acid-base status.

An expectant father asks the nurse, "Which part of the mature sperm contains the male chromosome?" What is the correct response by the nurse? a. X-bearing sperm b. The tail of the sperm c. The head of the sperm d. The middle portion of the sperm

ANS: C The head of the sperm contains the male chromosomes that will join the chromosomes of the ovum. If an X-bearing sperm fertilizes the ovum, the baby will be female. The tail of the sperm helps propel the sperm toward the ovum. The middle portion of the sperm supplies energy for the tail's whip-like action.

Which patient 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.

A newly pregnant patient asks the nurse, "What is a false pelvis?" Which statement by the nurse will best explain this anatomy to the patient? a. It is the total anterior portion of the pelvis. b. It is considered to be the lower portion of the pelvis. c. It provides support for the internal organs and the upper part of the body. d. It is the narrowest part of the pelvis through which a fetus will pass during birth.

ANS: C The linea terminalis, also called the pelvic brim or iliopectineal line, is an imaginary line that divides the upper, or false, pelvis from the lower, or true, pelvis. The false pelvis provides support for the internal organs and upper part of the body. The false pelvis is the upper portion, not the total anterior portion. The lower portion of the pelvis is the true pelvis, which is most important during childbirth because it has the narrowest portion through which the fetus will pass during childbirth.

Which factor is most important in diminishing maternal, fetal, and neonatal complications in a pregnant patient with diabetes? a. Evaluation of retinopathy by an ophthalmologist b. The patient's stable emotional and psychological status c. Degree of glycemic control before and during the pregnancy d. Total protein excretion and creatinine clearance within normal limits

ANS: C The occurrence of complications can be greatly diminished by maintaining normal blood glucose levels before and during the pregnancy. Even nonpregnant diabetics should have an annual eye examination. Assessing a patient's emotional status is helpful. Coping with a pregnancy superimposed on preexisting diabetes can be very difficult for the whole family; however, it is not the top priority. Baseline renal function is assessed with a 24-hour urine collection and does not diminish the patient's risk for complications

A patient who is receiving oxytocin (Pitocin) infusion for the augmentation of labor is experiencing a contraction pattern of more than eight contractions in a 10-minute period. Which intervention would be a priority? a. Increase rate of Pitocin infusion to help spread out contraction pattern. b. Place oxygen on patient at 8 to 10 L/minute via face mask and turn patient to left side. c. Stop Pitocin infusion. d. Call physician to obtain an order for initiation of magnesium sulfate.

ANS: C The patient is exhibiting uterine tachysystole (uterine tetany). Priority intervention is to stop the infusion. The next course of action is to place oxygen on the patient and reposition and increase the flow rate of the primary infusion. If the condition does not improve, the physician may be called for additional orders.

When the deceleration pattern of the fetal heart rate mirrors the uterine contraction, which nursing action is indicated? a. Reposition the patient. b. Apply a fetal scalp electrode. c. Record this normal pattern. d. Administer oxygen by nasal cannula.

ANS: C The periodic pattern described is early deceleration that is not associated with fetal compromise and requires no intervention. This is a Category I tracing which is a normal pattern. Repositioning the patient, applying a fetal scalp electrode, or administering oxygen would be interventions performed for Category II or III patterns.

The nurse is conducting a prenatal nutrition education class for a group of nursing students. Which statement best describes the condition known as 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

A pregnant woman complains of frequent heartburn. The patient states that she has never had these symptoms before and wonders why this is happening now. The most appropriate response by the nurse is to 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 patient 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.

ANS: C The presentation of heartburn is a normal abnormal finding that can occur in pregnant woman because of relaxation of the lower esophageal sphincter as a result of the physiologic effects of pregnancy. Although foods may contribute to the heartburn, the patient is asking why this presentation is occurring, so the nurse should address the cause first. It is independent of gestation. There is no need to refer to the physician at this time because this is a normal abnormal finding. There is no evidence of complications ensuing from this presentation.

What is the physiologic 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

ANS: C The primary function of increased vascular volume is to transport oxygen and nutrients to the fetus via the placenta. Preventing maternal and fetal dehydration is not the primary reason for the increase in volume. Assisting with pulling metabolic wastes from the fetus for maternal excretion is one purpose of the increased vascular volume. Renal plasma flow increases during pregnancy.

Proper placement of the tocotransducer for electronic fetal monitoring is a. Inside the uterus. b. On the fetal scalp. c. Over the uterine fundus. d. Over the mother's lower abdomen.

ANS: C The tocotransducer monitors uterine activity and should be placed over the fundus, where the most intensive uterine contractions occur. The tocotransducer is for external use. The tocotransducer monitors uterine contractions. The most intensive uterine contractions occur at the fundus; this is the best placement area.

One of the assessments performed in the birth room is checking the umbilical cord for blood vessels. Which finding is considered to be within normal limits? a. One artery and one vein b. Two veins and one artery c. Two arteries and one vein d. Two arteries and two veins

ANS: C The umbilical cord contains two arteries and one vein to transport blood between the fetus and the placenta. Any option other than two arteries and one vein is considered abnormal and requires further assessment. Two veins and one artery is abnormal and may indicate an anomaly. Two arteries instead is a normal finding; this infant would require further assessment for anomalies due to the finding of two veins.

Which finding on a prenatal visit at 10 weeks might suggest a hydatidiform mole? a. Blood pressure of 120/80 mm Hg b. Complaint of frequent mild nausea c. Fundal height measurement of 18 cm d. History of bright red spotting for 1 day weeks ago

ANS: C The uterus in a hydatidiform molar pregnancy is often larger than would be expected on the basis of the duration of the pregnancy. A patient with a molar pregnancy may have early-onset, pregnancy-induced hypertension. Nausea increases in a molar pregnancy because of the increased production of human chorionic gonadotropin (hCG). The history of bleeding is normally described as being of a brownish color.

On speculum examination of the cervix, it is found to be round and smooth. These findings suggest that the patient a. is a multipara. b. has had previous vaginal deliveries. c. is nulliparous. d. is a gravida 1, para 0.

ANS: C These findings indicate that the patient has never been pregnant and she would be classified as nulliparous. The other findings indicate that the patient is a multipara, has had vaginal deliveries, or is a gravida 1, para 0. These all refer to a patient with a positive history of pregnancy

The parents of a child with a karyotype of 47,XY,+21 ask the nurse what this means. Which is the most accurate response by the nurse? a. This karyotype is for a normal male. b. This karyotype is for a normal female. c. This karyotype is for a male with Down syndrome. d. This karyotype is for a female with Turner's syndrome.

ANS: C This child is male because his sex chromosomes are XY. He has one extra copy of chromosome 21 (for a total of 47, instead of 46), resulting in Down syndrome. A normal female would have 46 chromosomes and XX for the sex chromosomes. A normal male would have 46 chromosomes. A female with Turner's syndrome would have 45 chromosomes; the sex chromosome would have just one X.

Physiologic anemia often occurs during pregnancy due to a. inadequate intake of iron. b. the fetus establishing iron stores. c. dilution of hemoglobin concentration. d. decreased production of erythrocytes.

ANS: C 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 increased production of erythrocytes during pregnancy.

The rate of obesity in the United States has reached epidemic proportions. Morbidity and mortality for both the mother and baby are increased in these circumstances. The nurse caring for the patient with an elevated BMI should be cognizant of these potential complications and plan care accordingly. Significant risks include (Select all that apply.) a. Breech presentation b. Ectopic pregnancy c. Birth defects d. Venous thromboembolism e. Postpartum anemia

ANS: C, D, E Maternal complications associated with pregnancy include: Gestational diabetes, preeclampsia, venous thromboembolism, Caesarean delivery, wound infection, respiratory complications, preterm birth, birth trauma and postpartum anemia. Obese women also have an increased risk of spontaneous abortions and stillbirth. Complications for infants of obese mothers have an increased risk of neural tube defects, hydrocephaly, cardiovascular defects, macrosomia, hypoglycemia, and birth injuries from shoulder dystocia.

People who have two copies of the same abnormal autosomal dominant gene are generally a. mildly affected with the disorder. b. infertile and unable to transmit the gene. c. carriers of the trait but not affected with the disorder. d. more severely affected by the disorder than people with one copy of the gene.

ANS: D People who have two copies of the same abnormal autosomal dominant gene are generally a. mildly affected with the disorder. b. infertile and unable to transmit the gene. c. carriers of the trait but not affected with the disorder. d. more severely affected by the disorder than people with one copy of the gene.

A patient in labor presents with a breech presentation. The nurse understands that a breech presentation is associated with a. more rapid labor. b. a high risk of infection. c. maternal perineal trauma. d. umbilical cord compression.

ANS: D The umbilical cord can compress between the fetal body and maternal pelvis when the body has been born but the head remains within the pelvis. Breech presentation is not associated with a more rapid labor. There is no higher risk of infection with a breech birth. There is no higher risk for perineal trauma with a breech birth. Most breech presentations are now delivered by caesarean birth

Which patient 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 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 patient who is breastfeeding will require more calories and nutrients than women who are pregnant. The type of birth has no impact on nutrient intake. A patient who is bottle-feeding does not require additional calories.

The nurse evaluates a pattern on the fetal monitor that appears similar to early decelerations. The deceleration begins near the acme of the contraction and continues well beyond the end of the contraction. Which nursing action indicates the proper evaluation of this situation? a. This pattern reflects variable decelerations. No interventions are necessary at this time. b. Document this Category I fetal heart rate pattern and decrease the rate of the intravenous (IV) fluid. c. Continue to monitor these early decelerations, which occur as the fetal head is compressed during a contraction. d. This deceleration pattern is associated with uteroplacental insufficiency. The nurse must act quickly to improve placental blood flow and fetal oxygen supply

ANS: D A pattern similar to early decelerations, but the deceleration begins near the acme of the contraction and continues well beyond the end of the contraction, describes a late deceleration. Oxygen should be given via a snug face mask. Position the patient on her left side to increase placental blood flow. Variable decelerations are caused by cord compression. A vaginal examination should be performed to identify this potential emergency. This is not a normal pattern, rather it is a Category III tracing, predictive of abnormal fetal acid status at the time of observation. The IV rate should be increased in order to add to the mother's blood volume. These are late decelerations, not early; therefore interventions are necessary.

A placenta previa when the placental edge just reaches the internal os is called a. total. b. partial. c. low-lying. d. marginal.

When documenting a patient encounter, which 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

ANS: D A primigravida is a woman pregnant for the first time. A multigravida has been pregnant more than once. A nullipara is a woman who has never been pregnant or has not completed a pregnancy of 20 weeks or more. A primipara has delivered one pregnancy of at least 20 weeks. A multipara has delivered two or more pregnancies of at least 20 weeks.

Which nursing diagnosis would take priority in the care of a primipara patient with no visible support person in attendance? The patient has entered the second stage of labor after a first stage of labor lasting 4 hours. a. Fluid volume deficit (FVD) related to fluid loss during labor and birth process b. Fatigue related to length of labor requiring increased energy expenditure c. Acute pain related to increased intensity of contractions d. Anxiety related to imminent birth process

ANS: D A primipara is experiencing the birthing event for the first time and may experience anxiety due to fear of the unknown. It would be important to recognize this because the patient is alone in the labor-birth room and will need additional support and reassurance. Although FVD may occur as a result of fluid loss, prospective management of labor patients includes the use of parenteral fluid therapy; the patient should be monitored for FVD and, if symptoms warrant, receive intervention. Because the patient has been in labor for 4 hours, this is not considered to be a prolonged labor pattern for a primipara patient. Although the patient may be tired, this nursing diagnosis would not be a priority unless there were other symptoms manifested. The patient is entering the second stage of labor; therefore she will be allowed to push with contractions. In terms of pain management, medication will not be administered at this time because of imminent birth.

The nurse is explaining the function of the placenta to a pregnant patient. Which statement indicates to the nurse that further clarification is necessary? a. "My baby gets oxygen from the placenta." b. "The placenta functions to help excrete waste products." c. "The nourishment that I take in passes through the placenta." d. "The placenta helps maintain a stable temperature for my baby."

ANS: D Amniotic fluid and not the placenta helps with thermoregulation. The remaining statements are correct regarding placental function.

The nurse is concerned that a patient's uterine activity is too intense and that her obesity is preventing accurate assessment of the actual intrauterine pressure. Based on this information, which action should the nurse take? a. Reposition the tocotransducer. b. Reposition the Doppler transducer. c. Obtain an order from the health care provider for a spiral electrode. d. Obtain an order from the health care provider for an intrauterine pressure catheter.

ANS: D An intrauterine pressure catheter can measure actual intrauterine pressure. The tocotransducer measures the uterine pressure externally; this would not be accurate with an obese patient, even with repositioning. A Doppler auscultates the FHR. A scalp electrode (or spiral electrode) measures the fetal heart rate (FHR).

Which suggestion is most helpful for the pregnant patient who is experiencing heartburn? a. Drink plenty of fluids at bedtime. b. Eat only three meals a day so the stomach is empty between meals. c. Drink coffee or orange juice immediately on arising in the morning. d. Use Tums or Rolaids to obtain relief, as directed by the health care provider.

ANS: D Antacids high in calcium (e.g., Tums, Rolaids) can provide temporary relief. Fluids overstretch the stomach and may precipitate reflux when lying down. Instruct the patient to eat five or six small meals per day rather than three full meals. Coffee and orange juice stimulate acid formation in the stomach and may need to be eliminated from the diet.

A pregnant woman 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 patient 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.

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. Progesterone is responsible for the heightened awareness of the need to breathe in pregnancy. Progesterone levels increase during pregnancy. The patient should be reassured that these symptoms are within normal limits. No referral is needed at this time. Relaxation of the smooth muscles in the respiratory tract is affected by progesterone.

A patient in her third trimester of pregnancy is asking about safe travel. Which statement should the nurse provide regarding 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."

ANS: D Car travel is safe during normal pregnancies. Suggest that the woman stop to walk every 1 to 2 hours so she can empty her bladder. Walking also helps decrease the risk of thrombosis that is elevated during pregnancy. Seat belts should be worn throughout the pregnancy. Instruct the woman to fasten the seat belt snugly, with the lap belt under her abdomen and across her thighs and the shoulder belt in a diagonal position across her chest and above the bulge of her uterus. Travel by plane is generally safe up to 36 weeks if there are no complications of the pregnancy, so only traveling by car is an inaccurate statement

Which patient presentation is an acceptable indication for serial oxytocin induction of labor? a. Multiple fetuses b. Polyhydramnios c. History of long labors d. Past 42 weeks of gestation

ANS: D Continuing a pregnancy past the normal gestational period is likely to be detrimental to fetal health. Multiple fetuses overdistend the uterus, making induction of labor high risk. Polyhydramnios also overdistends the uterus, creating a high risk for induction. A history of rapid labors is a reason for induction of labor because of the possibility that the baby would otherwise be born in uncontrolled circumstances.

In which situation would a dilation and curettage (D&C) be indicated? a. Complete abortion at 8 weeks b. Incomplete abortion at 16 weeks c. Threatened abortion at 6 weeks d. Incomplete abortion at 10 weeks

ANS: D D&C is carried out to remove the products of conception from the uterus and can be performed safely until week 14 of gestation. If all the products of conception have been passed (complete abortion), a D&C is not necessary. If the pregnancy is still viable (threatened abortion), a D&C is not indicated.

Which physiologic adaptation of pregnancy may lead to increased constipation during the pregnancy? a. Increased emptying time in the intestines b. Abdominal distention and bloating c. Decreased absorption of water d. Decreased motility in the intestines

ANS: D Decreased motility in the intestines leading to increased water absorption would cause constipation. Increased emptying time in the intestines leads to increased nutrient absorption. Abdominal distention and bloating are a result of increased emptying time in the intestines. Decreased absorption of water would not cause constipation.

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.

The nurse is directing an unlicensed assistive personnel (UAP) to obtain maternal vital signs between contractions. Which statement is the appropriate rationale for assessing maternal vital signs between contractions rather than at another interval? a. Vital signs taken during contractions are inaccurate. b. During a contraction, assessing fetal heart rate is the priority. c. Maternal blood flow to the heart is reduced during contractions. d. Maternal circulating blood volume increases temporarily during contractions.

ANS: D During uterine contractions, blood flow to the placenta temporarily stops, causing a relative increase in the mother's blood volume, which in turn temporarily increases blood pressure and slows the pulse. Vital signs are altered by contractions but are considered accurate for a period of time. It is important to monitor the fetal response to contractions, but the question is concerned with the maternal vital signs. Maternal blood flow is increased during a contraction.

The laboring patient asks the nurse how the labor contractions cause the cervix to dilate. The nurse responds that labor contractions facilitate cervical dilation by a. promoting blood flow to the cervix. b. contracting the lower uterine segment. c. enlarging the internal size of the uterus. d. pulling the cervix over the fetus and amniotic sac.

ANS: D Effective uterine contractions pull the cervix upward at the same time the fetus and amniotic sac are pushed downward. Blood flow decreases to the uterus during a contraction. The contractions are stronger at the fundus. The internal size becomes smaller with the contractions; this helps push the fetus down.

A patient with no prenatal care delivers a healthy male infant via the vaginal route, with minimal blood loss. During the labor period, vital signs were normal. At birth, significant maternal hypertension is noted. When the patient is questioned, she relates that there is history of heart disease in her family; but, that she has never been treated for hypertension. Blood pressure is treated in the hospital setting and the patient is discharged. The patient returns at her scheduled 6-week checkup and is found to be hypertensive. Which type of hypertension is the patient is exhibiting? a. Pregnancy-induced hypertension (PIH) b. Gestational hypertension c. Preeclampsia superimposed on chronic hypertension d. Undiagnosed chronic hypertension

ANS: D Even though the patient has no documented prenatal care or medical history, she does relate a family history that is positive for heart disease. Additionally, the patient's blood pressure increased following birth and was treated in the hospital and resolved. Now the patient appears at the 6-week checkup with hypertension. Typically, gestational hypertension resolves by the end of the 6-week postpartum period. The fact that this has not resolved is suspicious for undiagnosed chronic hypertension. There is no evidence to suggest that the patient was preeclamptic prior to the birth.

A patient with preeclampsia is admitted complaining of pounding headache, visual changes, and epigastric pain. Nursing care is based on the knowledge that these signs indicate a. gastrointestinal upset. b. effects of magnesium sulfate. c. anxiety caused by hospitalization. d. worsening disease and impending convulsion.

ANS: D Headache and visual disturbances are caused by increased cerebral edema. Epigastric pain indicates distention of the hepatic capsules and often warns that a convulsion is imminent. Gastrointestinal upset is not an indication as severe as the headache and visual disturbance. She has not yet been started on magnesium sulfate as a treatment. The signs and symptoms do not describe anxiety.

Which clinical finding is associated with inadequate maternal weight gain during pregnancy? a. Prolonged labor b. Preeclampsia c. Gestational diabetes d. Low-birth-weight infan

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.

The patient has just learned that she is pregnant and overhears the gynecologist saying that she has a positive Chadwick's sign. When the patient asks the nurse what this means, how would 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 mucus 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."

ANS: D Increasing levels of estrogen cause hyperemia (congestion with blood) of the cervix, resulting in the characteristic bluish purple color that extends to include the vagina and labia. This discoloration, referred to as Chadwick's sign, is one of the earliest signs of pregnancy. Although Chadwick's sign occurs with hyperemia (congestion with blood), the sign does not signify an increased risk of blood clots. The softening of the cervix is called Goodell's sign, not Chadwick's sign. Although the formation of a mucus plug protects from infection, it is not called Chadwick's sign.

The nurse is explaining the technique of internal version to a nursing orientee. Which statement best describes the technique of internal version? a. Manipulation of the fetus from a breech to a cephalic presentation before labor begins b. Manipulation of the fetus from a transverse lie to a longitudinal lie before cesarean birth c. Manipulation of the second twin from an oblique lie to a transverse lie before labor begins d. Manipulation of the second twin from a transverse lie to a breech presentation during vaginal birth

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

A pregnant patient with significant iron-deficiency anemia is prescribed iron supplements. The patient explains to the nurse that she cannot 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; however, it will also decrease absorption.

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 is important. Changes in sleeping arrangements should be made several weeks before the birth so the child does not feel displaced by the new baby.

A patient who is 16 weeks pregnant with her first baby asks how long it will be before she feels the baby move. Which is the nurse's best answer? a. "You should have felt the baby move by now." b. "The baby is moving, but you can't feel it yet." c. "Some babies are quiet and you don't feel them move." d. "Within the next month you should start to feel fluttering sensations."

ANS: D Maternal perception of fetal movement (quickening) usually begins between 17 and 20 weeks after conception. Because this is her first pregnancy, movement is felt toward the later part of the 17 to 20 weeks. "The baby is moving, but you can't feel it yet" may be alarming to the woman. "Some babies are quiet and you don't feel them move" is a true statement; the fetus' movements are not strong enough to be felt until 17 to 20 weeks; however, this statement does not answer the woman's concern. Fetal movement should be felt between 17 and 20 weeks; if movement is not perceptible by the end of that time, further assessment will be necessary.

Which patient at term should proceed to the hospital or birth center the immediately after labor begins? a. Gravida 2, para 1, who lives 10 minutes away b. Gravida 1, para 0, who lives 40 minutes away c. Gravida 2, para 1, whose first labor lasted 16 hours d. Gravida 3, para 2, whose longest previous labor was 4 hours

ANS: D Multiparous women usually have shorter labors than do nulliparous women. The woman described in option D is multiparous with a history of rapid labors, increasing the likelihood that her infant might be born in uncontrolled circumstances. A gravida 2 would be expected to have a longer labor than the gravida in option C. The fact that she lives close to the hospital allows her to stay home for a longer period of time. A gravida 1 will be expected to have the longest labor. The gravida 2 would be expected to have a longer labor than the gravida 3, especially because her first labor was 16 hours.

In order to increase the absorption of iron by a pregnant patient, which beverage should an iron preparation be given with? a. Tea b. Milk c. Coffee d. Orange juice

ANS: D NURSINGTB.COM Foundations of Maternal-Newborn and Women's Health Nursing 7th Edition Murray Test BankNU RS IN GT B.CO M Vitamin C source may increase the absorption of iron and would be the optimal choice. 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.

A patient tells the nurse at a prenatal interview that she has quit smoking, and only has one glass of wine with dinner. Which response by the nurse will be most helpful in promoting a lifestyle change? a. "Those few things won't cause any trouble. Good for you." b. "You need to do a lot better than that. You are still hurting your baby." c. "Here are some pamphlets for you to study. They will help you to find more ways to improve." d. "You have made some good progress toward having a healthy baby. Let's talk about the changes you have made."

ANS: D Praising her for making positive changes is an effective technique for motivating a patient. She still has risk factors to alter for optimal outcome, and a gentle maneuver to help her see these for herself will be most likely to succeed. Alcohol consumption is still a major risk factor and needs to be addressed in a positive, nonjudgmental manner. The statement, "You need to do a lot better" is belittling to the patient; she will be less likely to confide in the nurse. The nurse is not acknowledging the efforts that the patient has already accomplished by offering pamphlets; those accomplishments need to be praised to motivate the patient to continue.

Which of the patient 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

ANS: D Pregnant women should avoid activities that might cause hyperthermia. Maternal hyperthermia, particularly during the first trimester, may be associated with fetal anomalies. She should not be in a hot tub for more than 10 minutes at less than 100F. Sexual intercourse is generally safe for the healthy pregnant woman; moderate exercise during pregnancy can strengthen muscles, reduce backache and stress, and provide a feeling of well-being; working during pregnancy is acceptable as long as the woman is not continually on her feet or exposed to environmental toxins and industrial hazards.

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.

Which physiologic findings related to gallbladder function may 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

ANS: D Prolonged emptying time is seen during pregnancy and may lead to the development of gallstones. In pregnancy, there is a twofold to fourfold time increase in alkaline phosphatase levels as compared with those in nonpregnant woman. During pregnancy, a decrease in albumin level and total protein is seen as a result of hemodilution. Gallbladder tissue becomes hypotonic during pregnancy.

The nurse is preparing to administer a vaginal prostaglandin preparation to ripen the cervix of her patient. With which patient should the nurse question the use of vaginal prostaglandin as a cervical ripening agent? a. The patient who has a Bishop's score of 5 b. The patient who is at 42 weeks of gestation c. The patient who had a previous low transverse cesarean birth d. The patient who had previous surgery in the upper uterus

ANS: D Prostaglandins are contraindicated in patients who have had a previous surgery in the upper uterus, such as a previous classic cesarean incision or extensive surgery for uterine fibroids. A side effect of prostaglandin administration is hyperstimulation of the uterus. A Bishop's score of 5, 42 weeks of gestation, or a previous low transverse cesarean birth are not contraindications for cervical ripening.

Uncontrolled maternal hyperventilation during labor results in a. metabolic acidosis. b. metabolic alkalosis. c. respiratory acidosis. d. respiratory alkalosis.

ANS: D Rapid deep respirations cause the laboring woman to lose carbon dioxide through exhalation, resulting in respiratory alkalosis. Hyperventilation does not cause respiratory acidosis, metabolic acidosis, or metabolic alkalosis.

A relaxation technique that can be used during the childbirth experience to decrease maternal pain perception is a. using increased environmental stimulation as a method of distraction. b. restricting family and friends from visiting during the labor period to keep the patient focused on breathing techniques. c. medicating the patient frequently to reduce pain perception. d. assisting the patient in breathing methods aimed at taking control of pain perception based on the contraction pattern.

ANS: D Relaxation techniques are aimed at incorporating mind and body activities to maintain control over pain. Additional environmental stimuli may have the opposite effect and increase patient anxiety, which will affect pain perception. Restricting visitors may have the opposite effect, leading to increased anxiety because of isolation. Medicating a patient may not decrease pain perception but may place the patient at risk for adverse reactions and/or complications of pregnancy related to medications.

The patient indicates to the clinic nurse that she is trying to become pregnant. The clinic nurse reviews the patient's chart and notes the following laboratory values: Blood type O−, RPR nonreactive, rubella non-immune, HCT 35%. Which laboratory value is most concerning to the nurse? a. HCT 35% b. Blood type O− c. RPR nonreactive d. Rubella non-immune

ANS: D Rubella non-immune indicates that the patient does not have immunity against rubella and is therefore susceptible to the infection. Exposure to rubella, or German measles, in the first trimester is associated with fetal congenital anomalies. The patient requires a rubella immunization and must not become pregnant within the next 28 days. Although a HCT of 35% is low, women of childbearing age may have mild anemia associated with menstruation. A blood type of O− indicates that the patient will require Rho GAM; however, it is not of concern in the preconception period. A nonreactive RPR indicates that the patient has not been exposed to syphilis

A pregnant patient's diet may not meet her need for folate. Which food choice is an excellent source of this nutrient? a. Chicken b. Cheese c. Potatoes d. Green leafy vegetable

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

Observation of a fetal heart rate pattern indicates an increase in heart rate from the prior baseline rate of 152 bpm. Which physiologic mechanisms would account for this situation? a. Inhibition of epinephrine b. Inhibition of norepinephrine c. Stimulation of the vagus nerve d. Sympathetic stimulation

ANS: D Sympathetic nerve innervation would result in an increase in fetal heart rate. The release of epinephrine as a result of sympathetic innervation would lead to an increase in fetal heart rate. The release of norepinephrine as a result of sympathetic innervation would lead to an increase in fetal heart rate. Stimulation of the vagus nerve would indicate parasympathetic innervation and result in a decreased heart rate

Which is the method of childbirth that helps prevent the fear-tension-pain cycle by using slow abdominal breathing in early labor and rapid chest breathing in advanced labor? a. Bradley b. Lamaze c. Leboyer d. Dick-Read

ANS: D The Dick-Read method helps prevent the fear-tension-pain cycle by using slow abdominal breathing in early labor and rapid chest breathing in advanced labor. The Lamaze method involves concentration and conditioning to help the woman respond to contractions with relaxation to decrease pain. Viewing childbirth as a traumatic experience, the Leboyer method uses decreased light and noise to help the newborn adapt to extrauterine life more easily. The Bradley method teaches women to use abdominal muscles to increase relaxation and breath control; it emphasizes avoidance of all medications and interventions.

What does a birth plan help the parents accomplish? a. Avoidance of an episiotomy b. Determining the outcome of the birth c. Assuming complete control of the situation d. Taking an active part in planning the birth experience

ANS: D The birth plan helps the woman and her partner look at the available options and plan the birth experience to meet their personal needs. A birth plan cannot dictate the need for or avoidance of an episiotomy. The outcome of the birth is not an absolute determinant. A birth plan does not assume complete control of the situation; it allows for expanding communication. Parents who prepare a birth plan should be educated that flexibility is essential as each labor and delivery is unique and may present unexpected complications.

The nurse is explaining the process of cell division during the preembryonic period to a group of nursing students. Which statement best describes the characteristics of the morula? a. Fertilized ovum before mitosis begins b. Double layer of cells that becomes the placenta c. Flattened, disk-shaped layer of cells within a fluid-filled sphere d. Solid ball composed of the first cells formed after fertilization

ANS: D The morula is so named because it resembles a mulberry. It is a solid ball of 12 to 16 cells that develops after fertilization. The fertilized ovum is called the zygote. The placenta is formed from two layers of cells—the trophoblast, which is the other portion of the fertilized ovum, and the decidua, which is the portion of the uterus where implantation occurs. The flattened, disk-shaped layer of cells is the embryonic disk; it will develop into the body.

After a forceps-assisted birth, the patient is observed to have continuous bright red lochia and a firm fundus. Which other data would indicate the presence of a potential vaginal wall hematoma? a. Lack of an episiotomy b. Mild, intermittent perineal pain c. Lack of pain in the perineal area d. Edema and discoloration of the labia and perineum

ANS: D The nurse should monitor for edema and discoloration. Using a cold application to the labia and perineum reduces pain by numbing the area and limiting bruising and edema for the first 12 hours. An episiotomy is performed as the fetal head distends the perineum. The pain with vaginal hematoma is severe and constant. The pain associated with vaginal hematoma is severe.

Which question posed by the nurse will most likely promote the sharing of sensitive information during a genetic counseling interview? a. "What kind of defects or diseases seem to run in the family?" b. "How many people in your family are mentally retarded or handicapped?" c. "Did you know that you can always have an abortion if the fetus is abnormal?" d. "Are there any members of your family who have learning or developmental problems?

ANS: D The nurse should probe gently using layperson-oriented terminology, such as learning problems rather than defects or diseases. Some individuals may not be aware of which diseases are genetically linked and may not answer the question accurately. "How many people in your family are mentally retarded or handicapped?" assumes that there are genetic problems that resulted in retardation in the family. Some individuals may find these terms offensive. "Did you know that you can always have an abortion if the fetus is abnormal?" is taking the decision away from the parents. They are seeking counseling to prevent problems, not to find out what to do if there is a problem.

Which finding is a positive sign of pregnancy? a. Amenorrhea b. Breast changes c. Fetal movement felt by the woman 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. Amenorrhea is a presumptive sign of pregnancy. Breast changes are a presumptive sign of pregnancy. Fetal movement is a presumptive sign of pregnancy

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 correct 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 medical

ANS: D The patient has presumptive and probable indications of pregnancy. However, she has not sought out health care until late in the first or early in the second trimester. The nurse must assess for barriers to seeking health care, physical or emotional, because regular prenatal care is key to a positive pregnancy outcome. Asking if the patient has nausea or vomiting will only add to the list of presumptive signs of pregnancy, and this information will not add to the assessment data to determine whether the patient is pregnant. The patient needs to see a health care provider before the next 4 weeks because she is late in seeking early prenatal care. Ultrasound testing must be prescribed by a health care provider.

A pregnant patient 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 patient 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 patient 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 patient'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 patient's behavior does not support this finding.

A patient who had premature rupture of the membranes (PROM) earlier in the pregnancy at 28 weeks returns to the labor unit 1 week later complaining that she is now in labor. The labor and birth nurse performs the following assessments. The vaginal exam is deferred until the physician is in attendance. The patient is placed on electronic fetal monitoring (EFM) and a baseline FHR of 130 bpm is noted. No contraction pattern is observed. The patient is then transferred to the antepartum unit for continued observation. Several hours later, the patient complains that she does not feel the baby move. Examination of the abdomen reveals a fundal height of 34 cm. Muscle tone is no different from earlier in the hospital admission. The patient is placed on the EFM and no fetal heart tones are observed. What does the nurse suspect is occurring? a. Placental previa b. Active labor has started c. Placental abruption d. Hidden placental abruption

ANS: D The patient's signs and symptoms indicate that a hidden abruption is occurring. Fundal height has increased and there is an absence of fetal heart tones. This is a medical emergency and the physician should be contacted to come directly to the unit for intervention and imminent birth

A primigravida at 39 weeks of gestation is observed for 2 hours in the intrapartum unit. The fetal heart rate has been normal. Contractions are 5 to 9 minutes apart, 20 to 30 seconds in duration, and of mild intensity. Cervical dilation is 1 to 2 cm and uneffaced (unchanged from admission). Membranes are intact. The nurse should expect the patient to be a. discharged home with a sedative. b. admitted for extended observation. c. admitted and prepared for a cesarean birth. d. discharged home to await the onset of true labor.

ANS: D The situation describes a patient with normal assessments who is probably in false labor and will probably not deliver rapidly once true labor begins. The patient will probably be discharged, and there is no indication that a sedative is needed. These are all indications of false labor; there is no indication that further assessment or observations are indicated. These are all indications of false labor without fetal distress. There is no indication that a cesarean birth is indicated.

A 25-year-old primigravida patient is in the first stage of labor. She and her husband have been holding hands and breathing together through each contraction. Suddenly, the patient pushes her husband's hand away and shouts, "Don't touch me!" This behavior is most likely a. a sign of abnormal labor progress. b. an indication that she needs analgesia. c. normal and related to hyperventilation. d. common during the transition phase of labor.

ANS: D The transition phase of labor is often associated with an abrupt change in behavior, including increased anxiety and irritability. This change of behavior is an expected occurrence during the transition phase. If she is in the transitional phase of labor, analgesia may not be appropriate if the birth is near. Hyperventilation will produce signs of respiratory alkalosis.

Which technique would provide the best pain relief for a pregnant woman with an occiput posterior position? a. Neuromuscular disassociation b. Effleurage c. Psychoprophylaxis d. Sacral pressure

ANS: D The use of sacral pressure may provide relief for patients who are experiencing back labor. The presentation of the fetus in a posterior position indicates this. Neuromuscular dissociation is used as a conditioned response to affect pain relief based on the mother tensing one group of muscles and focusing on releasing tension in the rest of her body. Effleurage is the process of using circular massage to effect pain relief. Psychoprophylaxis is another name for the Lamaze method of prepared childbirth

The upper uterus is the best place for the fertilized ovum to implant due to which anatomical adaptation? a. Maternal blood flow is lower. b. Placenta attaches most firmly. c. Uterine endometrium is softer. d. Developing baby is best nourished.

ANS: D The uterine fundus is richly supplied with blood and has the thickest endometrium, both of which promote optimum nourishment of the fetus. The blood supply is rich in the fundus, which allows for optimal nourishment of the fetus. If the placenta attaches too deeply, it does not easily detach. Softness is not a concern with implantation; attachment and nourishment are the major concerns.

Why is continuous electronic fetal monitoring generally used when oxytocin is administered? a. Fetal chemoreceptors are stimulated. b. The mother may become hypotensive. c. Maternal fluid volume deficit may occur. d. Uteroplacental exchange may be compromised.

ANS: D The uterus may contract more firmly and the resting tone may be increased with oxytocin use. This response reduces the entrance of freshly oxygenated maternal blood into the intervillous spaces, depleting fetal oxygen reserves. Oxytocin affects the uterine muscles. Hypotension is not a common side effect of oxytocin. All laboring women are at risk for fluid volume deficit; oxytocin administration does not increase the risk.

A pregnant woman 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 patient to a dermatologist for further examination. b. Ask the patient 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 patient know that this is a common finding that occurs during pregnancy

ANS: D This condition is known as chloasma or melasma (mask of pregnancy) and is a result of pigmentation changes relative to hormones. It can be exacerbated by exposure to the sun. There is no need to refer to a dermatologist. Intake of foods is not associated with exacerbation of this process. There is no need for a C&S to be taken. The patient should be assured that this is a normal finding of pregnancy

Determine the obstetric history of a patient in her fifth pregnancy who has 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

ANS: D This patient is in her fifth pregnancy, which is G5, she had one viable term infant (between 38 and 42 weeks' gestation), which is T1, she had one viable preterm infant (between 20 and 37 weeks' gestation), which is P1, two spontaneous abortions (before 20 weeks' gestation), which is A2, and she has two living children, which is L2.

What is the rationale for a woman in her first trimester of pregnancy to 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.

ANS: D This routine allows for monitoring maternal health and fetal growth and ensures that problems will be identified early. All problems cannot be eliminated because of prenatal visits; however, they can 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

While providing education to a primiparous patient regarding the normal changes of pregnancy, what is an important information for the nurse to share regarding 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 trimester.

ANS: D Throughout pregnancy, the uterus undergoes irregular contractions called Braxton Hicks contractions. During the first two trimesters, the contractions are infrequent and usually not felt by the woman until the third trimester. Braxton Hicks contractions do not indicate preterm labor. Braxton Hicks contractions can cause some discomfort, especially in the third trimester. Braxton Hicks contractions occur throughout the whole pregnancy.

To determine cultural influences on a patient's diet, what is the nurse's primary action? a. Evaluate the patient's weight gain during pregnancy. b. Assess the socioeconomic status of the patient. c. Discuss the four food groups with the patient. d. Identify the food preferences and methods of food preparation common to the patient's culture.

ANS: D Understanding the patient's food preferences and how she prepares food will assist the nurse in determining whether the patient's culture is adversely affecting her nutritional intake. Evaluating a patient's weight gain during pregnancy should be included for all patients, not just for those who are culturally different. The socioeconomic status of the patients may alter the nutritional intake, but not the cultural influence. Teaching the food groups to the patient should come after assessing food preferences.

An expectant couple asks the nurse about intercourse during pregnancy and whether it is safe for the baby. What information should the nurse provide? 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.

A patient, who delivered her third child yesterday, has just learned that her two school-age children have contracted chickenpox. What should the nurse tell her? a. Her two children should be treated with acyclovir before she goes home from the hospital. b. The baby will acquire immunity from her and will not be susceptible to chickenpox. c. The children can visit their mother and baby in the hospital as planned but must wear gowns and masks. d. She must make arrangements to stay somewhere other than her home until the children are no longer contagious.

ANS: D Varicella (chickenpox) is highly contagious. Although the baby inherits immunity from the mother, it would not be safe to expose either the mother or the baby. Acyclovir is used to treat varicella pneumonia. The baby is already born and has received the immunity. If the mother never had chickenpox, she cannot transmit the immunity to the baby. Varicella infection occurring in a newborn may be life-threatening

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.

Which clinical finding would be an indication to the nurse that the fetus may be compromised? a. Active fetal movements b. Fetal heart rate in the 140s c. Contractions lasting 90 seconds d. Meconium-stained amniotic fluid

ANS: D When fetal oxygen is compromised, relaxation of the rectal sphincter allows passage of meconium into the amniotic fluid. Active fetal movement is an expected occurrence. The expected FHR range is 120 to 160 bpm. The fetus should be able to tolerate contractions lasting 90 seconds if the resting phase is sufficient to allow for a return of adequate blood flow.

A couple is undergoing genetic counseling and are very concerned about the possibility of having a child with a birth defect as a result of a strong family history on both sides of the family. Which statement made by the nurse is evidence of therapeutic communication? a. "It is important to ask other members of your family for any information they can provide that will help obtain more insight into the health history." b. "Given what you have told me, there is little that anyone can do to improve outcomes." c. "Although you may feel that you have no options, I can't really discuss these matters as only the physician can provide you with information." d. "Do you have all your forms filled out correctly? This will make the review easier to accomplish. "

ANs: AHaving as much information as possible will help analyze potential health outcomes. It also shows that the nurse is taking the patients' concerns seriously. Telling the patients that there is little anyone can do does not provide any comfort or hope and is therefore self-defeating. Although the patients may have limited options based on their genetic and medical history, it is important to provide support and not defer all communication to the physician. The nurse must be able to provide support and counseling to patients. It is important to have completed forms, but asking patients about them does not address their psychological concerns.

An infant is born with blood type AB. The father is type A and the mother is type B. The father asks why the baby has a blood type different from that of the parents. The nurse's answer should be based on the knowledge that a. both A and B blood types are dominant. b. types A and B are recessive when linked together. c. the baby has a mutation of the parents' blood types. d. type A is recessive and links more easily with type B.

If a woman's menstrual cycle began on June 2, on which date should ovulation mostly likely have occurred? a. June 10 b. June 16 c. June 29 d. July 5

If the position of a fetus in a cephalic presentation is right occiput anterior, the nurse should assess the fetal heart rate in which quadrant of the maternal abdomen? a. Right upper b. Left upper c. Right lower d. Left lower

If the fetus is in a right occiput anterior position, the fetal spine will be on the mother's right side. The best location to hear the fetal heart rate is through the fetal shoulder, which would be in the right lower quadrant. The right upper, left upper, and left lower areas are not the best locations for assessing the fetal heart rate in this case.

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