Exam 2 OB Study questions

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The nurse is assessing the duration of a client's labor contractions. Which action 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 to a group of nursing students what occurs during active labor as the uterus contracts. Which statement explains the maternal-fetal exchange of oxygen and waste products during a contraction? a. Is not significantly affected 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.

What 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 client 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 client having a cesarean birth.

A pregnant client has lactose intolerance. What recommendation will the nurse provide to best help the client meet dietary needs for calcium? a. Add foods such as nuts, dried fruit, and broccoli to the diet. b. Consume dairy products but take an over-the-counter anti-gas product. c. Increase the intake of dark leafy vegetables, such as spinach and chard. d. Use powdered milk instead of liquid forms of milk.

ANS: A Calcium is present in legumes, nuts, dried fruits, and broccoli, so these foods can be added to increase calcium intake. Although dark leafy vegetables contain calcium, they also contain oxalates that decrease the availability of calcium. Powdered milk contains lactase, just like the nondehydrated varieties. Milk products can be avoided by those with lactose intolerance because adequate calcium may be obtained from food and supplements.

To determine if the client 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 client in labor experiences a spontaneous rupture of membranes. What information related to this event must the nurse include in the client's record? a. Fetal heart rate b. Pain level c. Test results ensuring that the fluid is not urine d. The client'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 client's understanding of the event would only need to be documented if it presents a problem

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/min by face mask. c. increase the IV flow rate from 125 to 150 mL/hr. 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 in early decelerations.

The clinic nurse is obtaining a health history on a newly pregnant client. Which is an indication for fetal diagnostic procedures if present in the health history? a. Maternal diabetes b. Weight gain of 25 lb c. Maternal age older than 30 d. Previous infant weighing more than 3000 g at birth

ANS: A Diabetes is a risk factor in pregnancy because of possible impairment of placental perfusion. Excessive weight gain is an indication for testing. Normal weight gain is 25 to 35 lb. A maternal age older than 35 years is an indication for testing. Having had another infant weighing more than 4000 g is an indication for testing.

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.

Increasing the infusion rate of nonadditive intravenous fluids can increase fetal oxygenation primarily by: a. expanding the maternal blood volume. b. maintaining a normal maternal temperature. c. preventing normal maternal hypoglycemia. d. increasing the oxygen-carrying capacity of the maternal blood.

ANS: A Filling the mother's vascular system makes more blood available to perfuse the placenta and may correct hypotension. Increasing fluid volume may alter the maternal temperature only if she is dehydrated. Most IV fluids for laboring women are isotonic and do not add extra glucose. Oxygen-carrying capacity is increased by adding more red blood cells.

What does a score of 9 on a biophysical profile signify? a. Normal b. Abnormal c. Equivocal d. Nonreactive

ANS: A Five parameters of fetal activity—fetal heart rate, fetal breathing movements, gross fetal movements, fetal tone, and amniotic fluid volume—are used to determine the biophysical profile. The maximum score is 2 points for each parameter. A score falling between 8 and 10 is considered normal. A score of 4 or less is considered abnormal. Equivocal and nonreactive are not terms used to describe the results of a biophysical profile.

When is the most accurate time to determine gestational age through ultrasound? a. First trimester b. Second trimester c. Third trimester d. No difference in accuracy among the trimesters

ANS: A Gestational age determination by ultrasonography is increasingly less accurate after the first trimester. Gestational age determination is best done in the first trimester. There is a difference in trimesters when doing a gestational age ultrasonography.

Which is an essential part of nursing care for a laboring client? 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 client 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, but managing pain is a top priority.

The procedure in which ova are removed by laparoscopy, mixed with sperm, and the embryo(s) returned to the woman's uterus is: a. in vitro fertilization. b. tubal embryo transfer. c. therapeutic insemination. d. gamete intrafallopian transfer.

ANS: A In vitro fertilization is a procedure used to bypass blocked or absent fallopian tubes. Tubal embryo transfer places the conceptus into the fallopian tube. Therapeutic insemination uses the partner's sperm or that of a donor and places it directly into the woman. Gamete intrafallopian transfer is when the sperm and ova are placed in the fallopian tube.

A patient at 8 weeks' gestation complains to the nurse, "I feel sick almost every morning. And I throw up at least two or three times a week." What is the nurse's best advice to the patient? a. "Do you like cheese?" b. "Try eating four meals a day instead of three meals a day." c. "Try eating peanut butter on whole wheat bread right before going to bed." d. "If you can eat enough throughout the day, you don't have to worry about being sick."

ANS: C Eating a bedtime protein snack helps maintain glucose levels throughout the night. Cheese is high in fat and can aggravate nausea. Small and frequent meals is the recommendation; four meals a day is not frequent enough. Consumption is not the patient's stated concern—it is the nausea and vomiting.

The nurse is advising a lactose-intolerant pregnant client about calcium intake. Which calcium sources are approximately equivalent to 1 cup of milk? (Select all that apply.) a. cup yogurt b. 1 cup of sherbet c. oz of hard cheese d. cups of ice cream e. cup of low-fat cottage cheese

ANS: A, C, D Calcium sources approximately equivalent to 1 cup of milk include cup yogurt, oz of hard cheese, and cups of ice cream. It takes 3 cups of sherbet and cups of low-fat cottage cheese to equal the calcium equivalent of 1 cup of milk.

The results of a contraction stress test (CST) are positive. Which intervention is necessary based on this test result? a. Repeat the test in 1 week so that results can be trended based on this baseline result. b. Contact the health care provider to discuss birth options for the client. c. Send the client out for a meal and repeat the test to confirm that the results are valid. d. Ask the client to perform a fetal kick count assessment for the next 30 minutes and then reassess the client.

ANS: B A positive CST test is an abnormal finding, and the physician should be notified so that birth options can be initiated. A positive CST indicates possible fetal compromise. Intervention should not be delayed by 1 week and results do not have to be trended. Because this is an abnormal result, there is no need to repeat the test. Sending the client out for a meal will delay treatment options and may interfere with possible birth interventions if anesthesia is needed. Fetal kick count assessment is not needed at this time and will further delay treatment interventions for this abnormal result, which indicates fetal compromise.

What does nursing care after amniocentesis include? a. Forcing fluids by mouth b. Monitoring uterine activity c. Placing the client in a supine position for 2 hours d. Applying a pressure dressing to the puncture site

ANS: B A risk with amniocentesis is the onset of spontaneous contractions. Hydration is important, but the woman has not been NPO, so this should not be a problem. The supine position may decrease uterine blood flow; the side-lying position is preferred. Pressure dressings are not necessary.

A client is receiving oxytocin (Pitocin) to induce labor. The uterine contractions have become persistently hypertonic and the infusion is stopped. The health care provider has prescribed a tocolytic to stop contractions. Which medication should the nurse be prepared to administer? a. Naloxone (Narcan) b. Terbutaline (Brethine) c. Ephedrine d. Diphenhydramine (Benadryl)

ANS: B A tocolytic drug, such as terbutaline (0.125 to 0.25 mg IV or 0.25 mg subcutaneously), may be given to reduce uterine activity. Narcan is a narcotic antagonist. Benadryl is an antihistamine. Ephedrine is a vasopressor used to increase blood pressure.

When planning a diet for a pregnant client, which nutritional interventions should be implemented? a. Fluids should be restricted to 6 glasses a day to minimize fluid retention and occurrence of edema. b. Protein in the diet should be increased to meet growth and development needs. c. Nutrient density should be used only if there are problems with weight gain during the course of the pregnancy. d. Advise the client that the pattern of weight gain is not as important as the overall weight gained during the pregnancy.

ANS: B An increase in protein consumption is recommended as compared with prepregnancy diet recommendations. Fluid intake should be 8 to 10 glasses per day to maintain hydration. Nutrient density should be used throughout the pregnancy to meet increasing caloric needs. The pattern of weight gain is critical in helping identify potential risks associated with the development of fluid retention and preeclampsia.

The primipara at 39 weeks' gestation states to the nurse, "I can breathe easier now." What is the nurse's best response? a. "You 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.

When instructing a client in the use of spermicidal foam or gel, it is important to include the information that: a. effectiveness is about 85%. b. douching should be avoided for at least 6 hours. c. it should be inserted 1 to 2 hours before intercourse. d. one application is effective for several hours.

ANS: B Douching within 6 hours of intercourse would remove the spermicide and increase the risk of pregnancy. Effectiveness is only 29% when used alone. The spermicidal foam or gel should be inserted 15 minutes before intercourse. One application is effective for about 1 hour.

The nurse is assessing a client in the active phase of labor. What should the nurse expect during this phase? a. The client is sociable and excited. b. The client is requesting pain medication. c. The client begins to experience the urge to push. d. The client 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 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 statement correctly describes the incidence of intimate partner violence (IPV) in the United States? a. Intimate partner violence seldom occurs during pregnancy. b. Each year about 42.4 million women experience intimate partner violence. c. The largest number of intimate partner violence is in the lower socioeconomic classes. d. Intimate partner violence is second only to automobile accidents as the most frequent cause of injury to women.

ANS: B IPV occurs to approximately 42.4 million women each year. IPV occurs frequently during pregnancy. IPV victims come from all different backgrounds and socioeconomic classes. Intimate partner violence is a more common cause of injury than automobile accidents.

The nurse is reviewing the procedure for alpha-fetoprotein (AFP) screening with a patient at 16 weeks' gestation. The nurse determines that the patient understands the teaching when she mentions that which fluid will be collected for the initial screening process? a. Urine b. Blood c. Saliva d. Amniotic

ANS: B Initial screening is completed with blood. AFP can be detected in amniotic fluid; however, that procedure is more costly and invasive. Procedures progress from least invasive to most invasive.

Which is the most appropriate method of intrapartum fetal monitoring 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 symptom in a client using oral contraceptives should be reported to the physician immediately? a. 5-lb weight gain b. Leg pain and edema c. Decrease in menstrual flow d. Increased pigmentation of the face

ANS: B Oral contraceptives increase clotting factors, which place the woman at risk for thrombophlebitis. Leg pain and edema are symptoms of thrombophlebitis. A 5-lb weight gain can be expected. A decrease in menstrual flow is an expected finding. Increased pigmentation of the face is a common finding.

Which of the following medical conditions could possible affect a woman's fertility status? a. Past medical history of asthma during childhood that is presently under control with the use of an inhaler b. Recently diagnosed with PCOS c. Past surgical history of removal of external polyps on labial tissue d. History of frequent sinus headaches that is seasonal in nature treated with over-the-counter medication

ANS: B PCOS (polycystic ovarian syndrome) is associated with infertility issues related to syndrome presentation—hormonal abnormalities, obesity, and dyslipidemia. The use of inhaler therapy for the treatment of asthma should not affect the client's fertility status. Removal of external polyps on the labia should not affect the client's fertility. A history of sinus headaches should not affect the client's fertility.

When reading a new client's birth plan, the nurse notices that the client will be bringing a doula to the hospital during labor. What does the nurse think that this means? a. The client will have her grandmother as a support person. b. The client will bring a paid, trained labor support person with her during labor. c. The client will have a special video she will play during labor to assist with relaxation. d. The client will have a bag that contains all the approved equipment that may help with the labor process.

ANS: B A doula is a trained labor support person who is employed by the mother to provide labor support. She gives physical support such as massage, helps with relaxation, and provides emotional support and advocacy throughout labor. A doula is usually not a relative of the woman. A doula is a trained labor support person.

Which pregnant adolescent is most at risk for a nutritional deficit during pregnancy? a. A 16-year-old who is 10 lb overweight b. A 17-year-old who is 10 lb underweight c. A 15-year-old of normal height and weight d. A 16-year-old of normal height and weight

ANS: B The adolescent who is pregnant and underweight is most at risk because she is already deficient in nutrition and must now supply the nutritional intake for both herself and her fetus. An overweight pregnant teen is at risk for deficiency but is not at the highest risk. Being underweight is the most risky because she is already deficient. A 15-year-old has special nutritional needs during pregnancy, but she is not at the highest risk for deficiency. A 16-year-old has special nutritional needs during pregnancy, but she is not at the highest risk for deficiency.

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.

A pregnant client asks the nurse if she can double her prenatal vitamin dose because she doesn't like to eat vegetables. What is the nurse's response about the danger of taking excessive vitamins? a. Increases caloric intake b. Has toxic effects on the fetus c. Increases absorption of all vitamins d. Promotes development of pregnancy-induced hypertension (PIH)

ANS: B The use of vitamin supplements in addition to food may increase the intake of some nutrients to doses much higher than the recommended amounts. Overdoses of some vitamins have been shown to cause fetal defects. Vitamin supplements do not contain calories. Vitamin supplements do not have better absorption than natural vitamins and minerals. There is no relationship between vitamin supplements and PIH.

A client at 40 weeks' gestation should be instructed to go to a hospital or birth center for evaluation when she experiences: a. 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. The lack of fetal movement needs 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.

Which of the following is the priority intervention for a supine client 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/min.

ANS: C Decelerations that begin at the peak of the contractions and recover after the contractions end are caused by uteroplacental insufficiency. When the client 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 client is in a supine position.

Which food selections would lead to enhanced iron absorption during pregnancy? a. Eating additional fiber and grains in the diet b. Drinking coffee with meals c. Drinking orange juice d. Including spinach in the diet two to three times a week

ANS: C Drinking orange juice, which contains ascorbic acid, acts to enhance iron absorption. Foods that are high in fiber and grains contain phytates, which can decrease iron absorption. Coffee intake can affect iron binding and therefore decrease absorption. Spinach contains oxalates, which can interfere with iron absorption.

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, but 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 contraceptive method should be contraindicated in a client with a history of toxic shock syndrome? a. Condom b. Spermicide c. Cervical cap d. Oral contraceptives

ANS: C The cervical cap may increase the risk of toxic shock syndrome because it may be left in the vagina for a prolonged period. A condom is not contraindicated with a history of toxic shock syndrome. Spermicide is not contraindicated with a history of toxic shock syndrome. Oral contraceptives are not contraindicated with a history of toxic shock syndrome.

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.

. Pregnant clients can usually tolerate the normal blood loss associated with childbirth because they have: 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 because of the high fluid volume. Leukocyte levels increase during labor, but that is not the reason for the toleration of blood loss. Fibrinogen levels increase with pregnancy.

Pregnant clients can usually tolerate the normal blood loss associated with childbirth because they have: a. a higher hematocrit. b. increased leukocytes. c. increased blood volume. d. a lower fibrinogen level.

A client has been diagnosed with an incompetent cervix. What treatment option will be incorporated into the plan of care? a. Bed rest throughout the pregnancy b. Wait and see approach to determine if the client goes into preterm labor c. Preparation for cerclage procedure at 32 weeks' gestation d. More frequent ultrasounds to assess progression of pregnancy

ANS: D An incompetent cervix would place the client in a high-risk category, and more frequent ultrasound monitoring would be included. Although bed rest may be ordered, there is conflicting evidence about the merits of this intervention. However, it is unlikely that it would be ordered for the duration of the pregnancy. An incompetent cervix is a clinical abnormality, so the standard of care requires appropriate surgical intervention. A cerclage procedure is typically done much earlier in the pregnancy period.

The nurse has given the newborn an Apgar score of 5. She should then: a. begin ventilation and compressions. b. do nothing except place the infant under a radiant warmer. c. observe the infant and recheck the score after 10 minutes. d. gently stimulate by rubbing the infant's back while administering O2.

ANS: D An infant who receives a score of 4 to 6 requires only additional oxygen and gentle stimulation. An infant who receive a score of 3 or less requires ventilation and compressions. An infant who scores less than 7 requires more intervention than placement under a radiant warmer. Observing and rechecking the infant will not improve newborn's transition to extrauterine life.

The nurse is concerned that a client'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 client, even with repositioning. A Doppler auscultates the FHR. A scalp electrode (or spiral electrode) measures the fetal heart rate (FHR).

A client asks, "What can I do to help decrease the amount of pain with labor?" What should be the nurse's best response? a. "Nothing. That is the way God intended it to be." b. "We can give you medications to help with the pain." c. "You should not worry about the pain; leave that concern up to the staff." d. "By trying to relax, the contractions will be more efficient and the pain may be less."

ANS: D Anxiety and tension will make the uterine contractions less effective and increase the length of labor. Relaxation will help the contractions to be more effective and the labor will be less painful. Stating nothing is demeaning and does not answer the woman's questions. The woman may not want medications but instead is looking for alternatives. "You should not worry about the pain; leave that concern up to the staff" does not answer the woman's questions and would not alleviate her concern about pain control.

A nurse is teaching a nutrition class to a group of pregnant clients. The nurse should include that the major source of nutrients in the diet of a pregnant woman should be composed of which? a. Fats b. Fiber c. Simple sugars d. Complex carbohydrates

ANS: D Complex carbohydrates supply the pregnant woman with vitamins, minerals, and fiber. Fats provide 9 calories in each gram, in contrast to carbohydrates and proteins, which provide only 4 calories in each gram. Fiber is supplied mainly by the complex carbohydrates. The most common simple carbohydrate is table sugar, which is a source of energy but does not provide any nutrients.

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

What is the purpose of amniocentesis for a client hospitalized at 34 weeks of gestation with pregnancy-induced hypertension? a. Determine if a metabolic disorder is genetic. b. Identify the sex of the fetus. c. Identify abnormal fetal cells. d. Determine fetal lung maturity.

ANS: D During the third trimester, amniocentesis is most often performed to determine fetal lung maturity. In cases of pregnancy-induced hypertension, preterm birth may be necessary because of changes in placental perfusion. The test is done in the early portion of the pregnancy if the metabolic disorder is genetic. Amniocentesis is done early in the pregnancy to do genetic studies and determine the sex. Identification of abnormal cells is done during the early portion of the pregnancy

The nurse is directing an unlicensed assistive personnel (UAP) to take maternal vital signs between contractions. Which statement is the best rationale for assessing maternal vital signs between contractions? a. Vital signs taken during contractions are not accurate. 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 client asks the nurse how the labor contractions work to dilate the cervix. The best response by the nurse is 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

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 volume.

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.

When is the earliest that chorionic villus sampling can be performed during pregnancy? a. 4 weeks b. 8 weeks c. 10 weeks d. 12 weeks

ANS: C Fetal villus tissue can be obtained as early as 10 weeks of gestation and can be analyzed directly for chromosomal or genetic abnormalities. It is too early to be performed at 4 weeks. It is too early to be performed at 8 weeks. The test should be performed at 12 weeks, but it can be done as early as 10 weeks.

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 client's own pain perception.

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

ANS: C 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.

Which client is a safe candidate for the use of oral contraceptives? a. 39-year-old with a history of thrombophlebitis b. 16-year-old with a benign liver tumor c. 20-year-old who suspects she may be pregnant d. 43-year-old who does not smoke cigarettes

ANS: D Heavy cigarette smoking is a contraindication. Oral contraceptives are contraindicated with a history of thrombophlebitis. Liver tumors, benign or malignant, preclude the use of oral contraceptives. Pregnancy is a contraindication.

A nurse is leading a discussion regarding birth control measures. Which method is considered the most reliable method? a. Coitus interruptus b. Breastfeeding c. Natural family planning d. Intrauterine device

ANS: D IUDs are 98% effective. Although coitus interruptus is considered 81% effective, it requires great control by the man and may be unsatisfying for both partners. Only women who breastfeed every 2 hours around the clock may avoid ovulation. Another method should be used when the frequency of breastfeeding decreases. Couples must be highly motivated to use natural family planning because they must abstain from sex for as much as half of their cycle. Errors in the forbidden time carry a very high risk of pregnancy.

24. Which of the following is associated with inadequate maternal weight gain during pregnancy? a. Prolonged labor b. Preeclampsia c. Gestational diabetes d. Low-birth-weight infant

ANS: D Inadequate maternal weight gain during pregnancy can manifest in the birth of a low- birth-weight infant. Prolonged labor and gestational diabetes are associated with excess weight gain during pregnancy. Preeclampsia is based on maternal hypertension, proteinuria, and edema states.

Which of the following is associated with inadequate maternal weight gain during pregnancy? a. Prolonged labor b. Preeclampsia c. Gestational diabetes d. Low-birth-weight infant

Understand the symptoms related to poor nutrition in pregnancy

Bleeding gums may indicate inadequate intake of vitamin C. Iron deficiency anemia: pallor, low hemoglobin levels, fatigue and increase susceptibility to infection evaluation of weight gain each visit pg 161

A client 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.

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 clients 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.

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.

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

ANS: D Variable decelerations are caused by conditions that reduce flow through the umbilical cord. The client 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.

Identify the characteristics of the various stages of labor

First stage: cervical effacement and dilation occur. begins with the onset of true labor contractions and ends with complete dilation 10 cm and 100% effacement. Three phases within first stage: latent active and transition latent phase: 0-3 cm active: 4-7 cm transition: 8-10 cm second stage- delivery of baby, uterine contractions strong every 2-3 mins. and voluntary bearing down efforts. urge to push becomes stronger as fetus descends third stage-delivery of placenta, uterine contractions, slight discomfort, slight cramps fourth stage-first 1-4 hrs post delivery uterine contractions to control bleeding from placenta site, discomfort varies pg 211

identify the components to evaluating a pregnant women

Focus assessment Fetal heart rate (FHR) FHR 110 to 160 Regular rhythm: presence of acceleration; absence of deceleration Maternal vital signs Identify signs of hypertension and infection Impending birth Grunting sounds Bearing down Urgency to push

Understand the differences in fetal heart tracings and interventions. Chapter 14 A, D, E, I p265-268

VEAL CHOP [-if decelerations occur: Reposition the mother Give O2-8-10L Stop pitocin in late decel.] Significance of FHR Patterns Category 1 (reassuring) Category 2 indeterminate Category 3 abnormal (nonreassuring) interventions Clarification of data Vibroacoustic stimulation Fetal scalp stimulation Fetal scalp blood sample Fetal oxygen saturation monitor Cord blood gasses and pH Identify cause Improve fetal oxygenation Increase maternal blood oxygen saturation Reduce cord compression The nurse notes a pattern of late decelerations on the fetal monitor. The most appropriate action is to: A. Continue observation of this reassuring pattern. B. Notify the physician or nurse-midwife. C. Give the woman oxygen by face mask. D. Place the woman in a Trendelenburg position. Answer C

The nurse understands how APGAR is assigned

Method for rapid evaluation of infants cardiorespiratory adaptation after birth scored at 1-5 minutes in 5 areas Points are 0-2 Heart rate: absent=0/ below 100 BPM =1 / 100 BPM or higher = 2 respiratory effort: no spontaneous respirations = 0 / slow respirations or weak cry= 1 / spontaneous resp. with strong lusty cry =2 Muscle tone: limp = 0 / minimal flexion= 1/ flexed body posture spontaneous and vigorous movements =2 reflex response: no response to suction or gentle slap =0 / minimal response (grimace)= 1 / response promptly with our cry or active movement =2 Color: pallor or cyanosis=0 / bluish hands and feet only = 1/ pink 2 pg 249

30) Utilize the nursing process in caring for a fetus during labor and birth.

Nursing care of the newborn includes supporting cardiopulmonary and thermoregulatory function and identifying the infant (p. 246). Also assess for approximate gestational age and obvious anomalies and birth injuries (p. 248). See Table 13-2 on p. 249 for Apgar scoring. Also, observe mom for hemorrhage and promote comfort as well as early family attachment (Ppt).

Name at least three nursing interventions that can be done to decrease late decelerations.

Nursing interventions should be done to improve the placental perfusion such as turning the patient to her side, increase in IV fluids and oxygen administration.

Understand the nurses role in managing a laboring woman

Nursing skills needed by the intrapartum nurse are basic: Observation, critical thinking, problem solving, therapeutic communication, comfort promotion, empathy, and common sense (p. 220). The two nursing priorities when the woman arrives at the birth center are to (1) establish a therapeutic relationship and (2) assess the condition of the mother and fetus (p. 221) See intrapartum assessment guide on pages 223-228. Assessment of fetus starts on p. 229 (everything seems important)! Give report, obtain orders. Get consent forms, lab tests, IV access (Ppt). Assess FHR, amniotic fluid, mom's vital signs, contractions, labor progress, I&O, response to labor, and support person's response (Ppt). Monitor mom AND baby (two patients)!

position

Relation of a fixed reference point on the fetus to the quadrants of the maternal pelvis

35. Doppler ultrasound

b. A test to assess blood flow to identify abnormalities

27. Dick-Read childbirth education

c. Classes focus on breathing to prevent the fear-tension-pain cycle

The nurse knows how to interpret prenatal labs

page 110 table 7-4 lab values in pregnancy RBC is 3.8-4.4 million/mm3 it RBC decreases because of hemodilution, hemodilution 11 g/dL first/third trimester and 10.5 g/dL during second trimester. hematocrit packed cell volume decreases from norm is not at 33.8%-39% WBC count increases is not at 5,000 to 15,000 mm3 firbrinogen increases from norm to 300-600 mg/dL

Understand the risks related to different forms of birth control

sterilizations: complications are same risks as surgery. Risks of hemorrhage, infection and anesthesia complications. Oral contraceptive : risks of thromboembolisms, may increase cervical cancers,MIs, hypertension ,provides no protections from STDs. some meds interfere with effectiveness. Smokers should not take. morning after pill: may cause nausea. IUD: risk of perforation of uterus at time of insertion, bleeding, infections see pages 686-96 for more detailed info. just did basics of what she went over in video on ch 31

understand the relationship between the passage and the passenger

the birth passage consists of maternal pelvis and soft tissues The true pelvis is most important to childbirth, the passenger is the fetus, membranes, and placenta. the fetus enters the birth canal in the cephalic presentation, variations in passenger include fetal lie, attitude, and presentation 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.

Understand the implications of female infections

infections are associated with general com;actions of pregnancy and may also be related to early pregnancy losses. Often asymptomatic , making diagnosis and link to pregnancy loss difficult to establish. PID (pelvic inflammatory disease) is an infection of the upper genital tract. can cause tubal scarring which can cause ectopic pregnancies or infertility. Gonorrhea and chlamydia is associated with PID pg 706, 750-52

A client is using Depo-Provera as her method of birth control. Which finding warrants immediate intervention? a. Mid-cycle bleeding b. Nausea c. Temperature of 100° F d. Irregular periods

ANS: A When using Depo-Provera, the major side effect is irregular bleeding. The presence of mid-cycle bleeding warrants further investigation at this time so it is the priority assessment.

Which clinical findings would be considered to be normal for a preterm fetus during the labor period? a. Baseline tachycardia b. Baseline bradycardia c. Fetal anemia d. Acidosis

ANS: A Because the nervous system is immature, it is expected that the preterm fetus will have a baseline tachycardia because of stimulation of the sympathetic nervous system. Baseline bradycardia, fetal anemia, and acidosis would indicate abnormal findings and fetal compromise.

Which is the common effect of both smoking and cocaine use on the pregnant client? a. Vasoconstriction b. Increased appetite c. Increased metabolism d. Changes in insulin metabolism

ANS: A Both smoking and cocaine use cause vasoconstriction, which results in impaired placental blood flow to the fetus. Smoking and cocaine use do not increase appetite, change insulin metabolism, or increase metabolism.

Know the differences between true and false labor

True labor has increase in contractions and discomfort. The cervical changes of progressive effacement and dilation is most important. In false labor, contractions are inconsistent, the discomfort is more annoying than truly painful, and the cervix does not change (Ppt). See box on p. 208 titled "How to Know Whether Labor Is Real. If a woman presents in false labor, reassure her and teach her the signs to watch for to come back to the hospital.

Know the unique considerations in counseling adolescents in health care.

- be adept to determining the adolescent's needs and reassure her that her visits are confidential and what is discussed will not be shared with others - during first visit teenager receives info about contraceptive methods taking extra time to explain different methods helps dispel misinformation and allays the common concerns of adolescents about potential adverse health effects of contraceptives. It also helps the teenager to feel comfortable in a clinical setting. -because of youth and possible lack of knowledge the adolescent needs more counseling aobut anatomy and physiology -using understandable terminology is esp. important when teaching adolescents. The nurse must know street terms for body parts and sexual intercourse because they may be the only words that are familiar to the teenager. -most popular contraceptives are OC's and condoms, they'll choose a contraceptive that seems easiest to use and unrelated to coitus - adolescent girls may be inconsistent with taking pills every day - teens are more likely than older women to discontinue any method because of side effects they should understand what to use as back up if necessary - condoms should be used to prevent STDs even when another contraceptive is used

evaluation/risks related to post menopausal women

...Osteoporosis one of the greatest hazards of postmenopausal women. small boned, fair skinned white women ( Uh OH...) are at greatest risks. called the "silent thief" because bone mass loss over many years with no S & S. first sign noticeable is loss of height, back pain. later signs : dowagers hump. the vertebrae can no longer support body in upright position diagnosis requires thorough history, physical exam and bone mineral analysis. DEXA or DXA scan is highly accurate, fast and inexpensive

Recommendations in nutrition and weight for pregnancy

..Recommendation for total weight gain Weight gain recommendations based on the woman's prepregnancy body mass index (BMI) Recommended weight gain is 11.5 to 16 kg (25 to 35 lb) for women who begin pregnancy at normal BMI. Low pre pregnancy weight : should gain 28-40 lbs. overweight women : 15-25 lbs. obese women: 11-20 lbs. Carbohydrates: Simple or complex Fats Provide energy and fat-soluble vitamins Calories: Most pregnant women need 2200 to 2900 calories daily. Nutrient density: The quantity and quality of the various nutrients in each 100 calories of food. Protein: Necessary for metabolism, tissue synthesis, and tissue repair Daily protein RDA is 46 g for nonpregnant females. Daily recommended protein intake of 71 g during pregnancy Expansion of blood volume Growth of maternal and fetal tissues Vitamins: Fat-soluble A, D, E, and K Stored in liver Excessive intake of these vitamins can be toxic. Water-soluble B6, B12, and C; folic acid; thiamin; riboflavin; and niacin Should be included in the daily diet Folic acid (also called folate) 400 mcg daily Can decrease the occurrence of neural tube defectsIron Iron: Important in the formation of hemoglobin During pregnancy approximately 1000 mg of absorbed iron above maternal iron stores are needed. Calcium: Important for mineralization of fetal bones and teeth Calcium absorption and retention increase during pregnancy. Sodium Sodium needs are increased during pregnancy to provide for an expanded blood volume and the needs of the fetus. Food is the best source of nutrients p.143-150

The nurse is able to council a woman on routine examinations

.Opportunity to counsel women about preventive measures that often reduce their physical problems Counseling about self-care measures to improve health such as adequate physical activity, or stop smoking should be reinforces Counseling about diet may identify measures that improve multiple problems Counseling for the woman to deal with complex social problems Screening procedures Prevention is better than a cure. Early diagnosis allows early treatment. Some screening procedures are recommended for all women of reproductive age. breast exams, vulvar self exams, pelvic exams,pap tests, rectal exams Other screening procedures are recommended for older women or those with higher risk. counseling of dangers of malignant melanoma with UVA rays of sun, alcohol and substance abuse, domestic violence week 5 ppt and pg 720-725

Know the impact of Substance abuse and how it relates to nutrition in pregnancy

.Recommended weight gain is 11.5 to 16 kg (25 to 35 lb) for women who begin pregnancy at normal BMI. Smoking: cigarette smoking increases maternal metabolic rate and decreases appetite, which may result in lower weight gain and lower birth weights of infants. Decreases the availability of some vitamins/minerals. Caffeine: evidence is conflicting and more research is needed. Appears caffeine intake less than 200mg/day is not a major contributing factor for miscarriage or preterm births. Alcohol: association between drinking and fetal alcohol spectrum disorders, alcohol should be avoided. Effects the absorption of vitamin B12, folic acid and magnesium and often takes the place of food . Vitamin/mineral supplements may be necessary for women who had large intakes of alcohol before pregnancy. Drugs: drugs are a danger to the fetus an may interfere with nutrition. Even some prescribed drugs have risks during pregnancy. Benefits must be weighed. Marijuanna increases appetite but woman may not satisfy their hunger with foods of good nutrient quality. Herion alters metabolism an may cause a woman to become malnourished . cocaine is an appetite suppressant . vasoconstriction from cocaine use decreases nutrient flow to the fetus. pg 155-156

achievement of three goals or expected outcomes occurs if the following conditions are met-

1. the women indicates satisfaction with her method of pain management or requests nursing assistance to find other, more satisfactory methods/ 2. The woman's support person expresses satisfaction with having provided labor support by the time of discharge 3. The woman describes her birth experience as positive by time of discharge

36. Lecithin-to-sphingomyelin (L/S) ratio

A test for estimating fetal lung maturity

37. Chorionic villus sampling (CVS)

A test to diagnose fetal chromosomal, metabolic, or DNA abnormalities

25) Understand the different monitors used for fetal heart rate and uterine contractions.

A tocotransducer, or "toco", detects changes in the abdominal contour to measure uterine activity. Other movements register as well, such as material respirations, which cause a zig-zag appearance, or fetal hiccups, which appear as spikes on the uterine activity tracing. It does not reliably measure actual contraction intensity and uterine resting tone (p. 260). Accuracy is the main advantage of using internal devices for EFM. However, their use requires ruptured membranes and about 2 cm of cervical dilation. The devices are invasive, and the risk of infection is slightly increased (p. 261). The fetal scalp electrode (internal device) detects electric signals from the fetal heart. IUPCs are discussed on p. 262. See page 231 for palpating contractions.

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. External monitors currently being used

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. The external monitor can be discontinued after the internal ones are applied.

Which client could safely be cared for by a certified nurse-midwife? a. Gravida 3, para 2, with no complications b. Gravida 1, para 0, with mild hypertension c. Gravida 2, para 1, with insulin-dependent diabetes d. Gravida 1, para 0, with borderline pelvic measurements

ANS: A A certified nurse-midwife (CNM) cares for women who are at low risk for complications. The CNM would not care for a woman with hypertension. The CNM would not care for a woman with insulin-dependent diabetes. The CNM would not care for a woman with borderline pelvic measurements.

Which of the following is the priority intervention for the client 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/min. b. Decrease the IV rate to 100 mL/hr. 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 client'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 client is a candidate for internal monitoring with an intrauterine pressure catheter? a. Obese client 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.

What should be the goal of a client with the nursing diagnosis "Imbalanced nutrition: Less than body requirements" (related to diet choices inadequate to meet the nutrient requirements of pregnancy)? a. Gain a total of 30 lb. b. Decrease intake of snack foods. c. Take daily supplements consistently. d. Increase intake of complex carbohydrates.

ANS: A A weight gain of 30 lb is one indication that the client has gained a sufficient amount for the nutritional needs of pregnancy. Decreasing snack food may be the problem and should be assessed. However, assessing the weight gain is the best method of monitoring intake for this pregnancy. A daily supplement is not the best goal for this client. It does not meet the basic need of proper nutrition during pregnancy. Increasing the intake of complex carbohydrates is important for this client, but monitoring the weight gain should be the end goal.

In teaching a pregnant adolescent about nutrition, what should the nurse plan to do? a. Determine the weight gain needed to meet adolescent growth and add 35 lb. b. Suggest that she not eat at fast food restaurants to avoid foods of poor nutritional value. c. Realize that most adolescents are unwilling to make dietary changes during pregnancy. d. Emphasize the need to eliminate common teen snack foods because they are too high in fat and sodium.

ANS: A Adolescents should gain in the upper range of the recommended weight gain. They also need to gain weight that would be expected for their own normal growth. Adolescents are willing to make changes; however, they still need to be like their peers. Eliminating fast foods will make her appear different from her peers. She should be taught to choose foods that add needed nutrients. Changes in the diet should be kept at a minimum and snacks should be included. Snack foods can be included in moderation and other foods added to make up for the lost nutrients.

A client post-delivery is concerned about getting back to her prepregnancy weight. She had only gained 15 pounds during her pregnancy. Which assessment factor would be of concern at her 6-week postpartum checkup? a. Client has lost 35 pounds during the 6-week period prior to her scheduled checkup. b. Client states that she is eating healthy and limiting intake of processed foods. c. Client relates increased consumption of fruits and vegetables in her diet postbirth. d. Client has resumed her usual exercise pattern of walking around the neighborhood for 10 minutes each night.

ANS: A Although a certain amount of weight loss is expected in the postpartum period, the fact that the reported weight loss is double the amount of weight gained during the pregnancy places the client at risk for malnutrition. Further inquiry is needed. Limiting the intake of processed foods is a healthy dietary alternative to decreasing sodium intake. Increases in fruits and vegetables are a healthy dietary alternative to decrease possible occurrence of hypertension. An exercise program is part of a healthy nutrition approach.

On which aspect of fetal diagnostic testing do parents usually place the most importance? a. Safety of the fetus b. Duration of the test c. Cost of the procedure d. Physical discomfort caused by the procedure

ANS: A Although all these are considerations, parents are usually most concerned about the safety of the fetus. Parents are concerned about the duration, but it is not the greatest concern. The cost of the procedure is important to parents, especially those without third-party payers, but is not the greatest concern. Discomfort of the procedure is important, especially for the mother, but is not the greatest concern.

A pregnant client would like to know a good food source of calcium other than dairy products. Which is the best answer that the nurse should give? a. Legumes b. Lean meat c. Whole grains d. Yellow vegetables

ANS: A Although dairy products contain the greatest amount of calcium, it can also be found in legumes, nuts, dried fruits, and some dark green leafy vegetables. Lean meats are rich in protein and phosphorus. Whole grains are rich in zinc and magnesium. Yellow vegetables are rich in vitamin A.

A newly pregnant patient tells the nurse that she has irregular periods and is unsure of when she got pregnant. Scheduling an ultrasound is a standing prescription for the patient's health care provider. When is the best time for the nurse to schedule the patient's ultrasound? a. Immediately b. In 2 weeks c. In 4 weeks d. In 6 weeks

ANS: A An embryo can be seen about 5 to 6 weeks after the last menstrual period. At this time the crown-rump length (CRL) of the embryo is the most reliable measure of gestational age. Fetal viability is confirmed by observation of fetal heartbeat, which is visible when the CRL of the embryo is 5 mm.

Which assessment finding could indicate hemorrhage in the 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 most likely indicates: 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 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.

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 decelerations is not a recognized term.

Which statement is incorrect regarding prepared childbirth education? a. No use of anesthetics or drugs is to be administered to clients so they can have a natural childbirth experience. b. Clients can take refresher courses if they have delivered within the last 2 years. c. Prepared childbirth classes may differ slightly based on the available resources of health care facilities. d. Prepared childbirth classes are aimed at increasing awareness of the childbirth experience for parents and significant others to promote better control of pain and decrease anxiety.

ANS: A Medications and anesthesia information are provided during childbirth education. It is up to the client to decide if she wants to use these treatment options during the course of labor. Refresher courses are available up to 3 years postbirth for clients. Different information may be provided based on the availability of resources in health care facilities that provide obstetric care to clients. Goals of childbirth classes are to increase knowledge of the birth experience, foster control of the situation to decrease anxiety, and minimize the pain experience.

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.

What will the nurse advise when providing nutrition education to the pregnant client? a. "Every day you need to have at least 6 ounces of protein from sources such as meat, fish, eggs, beans, nuts, soybean products, and tofu." b. "High-dose vitamin A supplements will promote optimal vision while preventing a common cause of blindness in neonates." c. "Meals such as sushi with a cold deli salad made with raw sprouts combine high-fiber foods with protein sources to meet multiple nutritional needs." d. "Vitamin and mineral supplements can meet your nutrient needs if you have inadequate intake because of nausea or a sensation of fullness."

ANS: A Protein sources include meat, poultry, fish, eggs, legumes (e.g., beans, peas, lentils), nuts, and soybean products such as tofu. Pregnant women need 6 to 6.5 oz of protein daily. Vitamin A can cause fetal anomalies of the bones, urinary tract, and central nervous system when taken in high doses. Pregnant women should avoid raw fish and foods such as cold deli salads and raw sprouts. Supplements do not generally contain protein and calories and may lack many necessary nutrients; therefore, they cannot serve as food substitutes.

In a prenatal education class, the nurse is reviewing the importance of using relaxation techniques during labor. Which client 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 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 couple who has not achieved a successful pregnancy is scheduled to meet with a fertility specialist. Which simple evaluation is usually the first test to be performed? a. Semen analysis b. Testicular biopsy c. Endometrial biopsy d. Hysterosalpingography

ANS: A Semen analysis is usually the first test to be performed because it is least costly and noninvasive. Endometrial biopsy determines whether the endometrium is responding to ovarian stimulation. A testicular biopsy is an invasive examination using a local anesthetic. Hysterosalpingography uses a contrast medium to evaluate the structure and patency of the uterus and tubes.

A laboring client 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 help a client increase her intake of these foods by which action? a. Suggest that she eat more tofu, bok choy, and broccoli. b. Suggest that she eat more hot foods during pregnancy. c. Emphasize the need for increased milk intake during pregnancy. d. Tell her husband that she must increase her intake of fruits and vegetables for the baby's sake.

ANS: A The diet should be improved by increasing foods acceptable to the woman. These foods are common in the Asian diet and are good sources of calcium and iron. Pregnancy is considered hot; therefore, the woman would eat cold foods. Because milk products are not part of this woman's diet, it should be respected and other alternatives offered. Also, lactose intolerance is common. Fruits and vegetables are cold foods and should be included in the diet. In regard to the family dynamics, however, the husband does not dictate to the wife in this culture.

The nurse observes the following data on an electronic fetal monitor attached to a client in the active phase of the first stage of labor: fetal heart rate baseline, 125 to 140 bpm, three accelerations over the course of 20 minutes, moderate variability. What is the priority action based on these findings? a. Document the findings. b. Contact the health care provider. c. Increase the rate of the existing IV to 200 mL/hr as per the standing prescription. d. Place oxygen via a rebreather mask at 10 L/min as per the standing prescription.

ANS: A The findings are all within normal limits for the laboring client. Accelerations are usually a reassuring sign. Normal fetal heart rate is 110 to 160 bpm and of moderate variability; amplitude range of 6 to 25 bpm is desirable. No intervention is required because the pattern suggests that the fetus has adequate reserves to tolerate intrapartum stressors.

Martha is a gravida 3, para 2, whose last child was born 5 years ago. She attended childbirth preparation classes with her first pregnancy. Which class would be most appropriate for her? a. Refresher course b. Infant care classes c. Postpartum classes d. Early pregnancy classes

ANS: A When 2 or more years elapse between a prepared childbirth class and a subsequent pregnancy, a refresher course is recommended to provide couples with an update on new developments and to review techniques. Infant care classes cover the basics of infant care, with which she is familiar. She has experienced the postpartum period so this class would not be as beneficial as a refresher class. Early pregnancy classes cover information on adapting to pregnancy, dealing with discomforts such as morning sickness and fatigue, and understanding what to expect in the months ahead.

A pregnant client's biophysical profile score is 8. She asks the nurse to explain the results. What is the nurse's best response? a. "The test results are within normal limits." b. "Immediate birth by cesarean birth is being considered." c. "Further testing will be performed to determine the meaning of this score." d. "An obstetric specialist will evaluate the results of this profile and, within the next week, will inform you of your options regarding birth."

ANS: A The normal biophysical score ranges from 8 to 10 points if the amniotic fluid volume is adequate. A normal score allows conservative treatment of high-risk patients. Birth can be delayed if fetal well-being is an issue. Scores less than 4 would be investigated, and birth could be initiated sooner than planned. This score is within normal range, and no further testing is required at this time. The results of the biophysical profile are usually available immediately after the procedure is performed.

A client just delivered a baby by the vaginal route. The client asks the nurse why the baby's head is not round, but oval. Which explanation should the nurse give to the client? 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 client with a BMI of 32 has a positive pregnancy test. What is the maximum number of pounds that the nurse will advise the client to gain during the pregnancy? a. 20 b. 25 c. 28 d. 40

ANS: A The weight gain for obese women is 5 to 9 kg (11 to 20 lb). A BMI of 30 or higher categorizes the client as obese. The other options refer to minimal or maximal weight gain for clients in other BMI categories.

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 section.

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. The presence of two or more nonreassuring fetal heart rate patterns increases the level of concern.

The nurse is reviewing maternal serum alpha-fetoprotein (MSAFP) results. Which conditions are associated with elevated levels of MSAFP? (Select all that apply.) a. Fetal demise b. Neural tube defects c. Abdominal wall defects d. Chromosomal trisomies e. Gestational trophoblastic disease

ANS: A, B, C Elevated levels of AFP may indicate open neural tube defects (e.g., anencephaly, spina bifida), abdominal wall defects (e.g., omphalocele, gastroschisis), or fetal demise. Low levels of AFP may indicate chromosomal trisomies (e.g., Down syndrome, trisomy 21) or gestational trophoblastic disease.

While interviewing a 48-year-old client during her annual physical examination, the nurse learns that she has never had a mammogram. The American Cancer Society recommends annual mammography screening starting at age 40. Before the nurse encourages this client to begin annual screening, it is important for her to understand the reasons why women avoid testing. These reasons include which of the following? (Select all that apply.) a. Fear of x-ray exposure b. Expense of the procedure c. Reluctance to hear bad news d. Having heard that the test is painful e. Belief that lack of family history makes this test unnecessary

ANS: A, B, C, D Fear of x-ray exposure, expense, reluctance to hear bad news, and fear of pain are reasons women avoid having a mammogram done. Although the test is expensive, it is usually covered by health insurance, and many communities offer low-cost or free screening to women without insurance. It is important to acknowledge that some discomfort occurs with screening. Scheduling the test immediately at the end of a period makes it less painful. The risk of radiation exposure is minimal to none. Nurses play a vital role in providing information and reassurance to help women overcome these fears. Even clients with no family history should have a regular screening done. The nurse should emphasize that a combination of breast self-examination and mammography needs to be performed at regular intervals. Women with a family history may need to begin screening at a younger age and have additional testing such as ultrasound performed.

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.

Transvaginal ultrasonography is often performed during the first trimester. A 6-week-gestation client expresses concerns over the necessity for this test. The nurse should explain that this diagnostic test may be necessary to determine which of the following? (Select all that apply.) a. Multifetal gestation b. Bicornuate uterus c. Presence and location of pregnancy d. Amniotic fluid volume e. Presence of ovarian cysts

ANS: A, B, C, E A bicornuate uterus, multifetal gestation, presence of ovarian cysts, and presence and location of pregnancy can be determined by transvaginal ultrasound in the first trimester of pregnancy. This procedure is also used for estimating gestational age, confirming fetal viability, identifying fetal abnormalities or chromosomal defects, and identifying the maternal abnormalities mentioned, as well as fibroids. Amniotic fluid volume is assessed during the second and third trimesters. Conventional ultrasound would be used.

The nurse is teaching a breastfeeding client about substances to avoid while she is breastfeeding. Which substances should the nurse include in the teaching session? (Select all that apply.) a. Caffeine b. Alcohol c. Omega-6 fatty acids d. Appetite suppressants e. Polyunsaturated omega-3 fatty acids

ANS: A, B, D Foods high in caffeine should be limited. Infants of mothers who drink more than two or three cups of caffeinated coffee or the equivalent each day may be irritable or have trouble sleeping. Although the relaxing effect of alcohol was once thought to be helpful to the nursing mother, the deleterious effects of alcohol are too important to consider this suggestion appropriate today. An occasional single glass of an alcoholic beverage may not be harmful, but larger amounts may interfere with the milk ejection reflex and may be harmful to the infant. Nursing mothers should avoid appetite suppressants, which may pass into the milk and harm the infant. The long-chain polyunsaturated omega-3 and omega-6 fatty acids are present in human milk. Therefore, they should be included in the mother's diet during lactation.

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.

The nurse is teaching a pregnant client about food safety during pregnancy and lactation. Which statements by the client indicate she understood the teaching? (Select all that apply.) a. "I will limit my intake of shrimp to 12 oz a week." b. "I will avoid the soft cheeses made with unpasteurized milk." c. "I plan to continue to pack my bologna sandwich for lunch." d. "I am glad I can still go to the sushi bar during my pregnancy." e. "I will not eat any swordfish or shark while I am pregnant or nursing."

ANS: A, B, E Statements that indicate the client understood the teaching are limiting shrimp to 12 oz a week, avoiding soft cheeses, and not eating any swordfish. A bologna sandwich should be avoided unless it is reheated until steaming hot. Raw or undercooked fish should be avoided.

A client asks the nurse how she can tell if labor is real? What should the nurse give as an explanation? (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.

Which nursing assessment indicates that a woman 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.

ANS: B 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 0 station indicates engagement

A client has had a prior history of endometriosis and comes to the clinic asking about which method of birth control might be helpful to alleviate her symptoms. Which birth control method should the client use? a. Withdrawal method b. Oral contraceptives c. Depo-Provera d. Intrauterine device (IUD)

ANS: B A client who has a history of endometriosis may gain additional benefit from using an oral contraceptive as her birth control method because hormone levels will be more uniformly regulated with this type of treatment. The withdrawal method and Depo-Provera will not provide any additional benefit relative to a history of endometriosis. An IUD may cause further irritation to the endometrial lining so it would not be a prudent choice.

The physician has ordered an amnioinfusion for the laboring client. What 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 used during labor when cord compression or the detection of gross meconium staining is found in the amniotic fluid. A saline solution is used as an irrigation method through the IUPC (intrauterine pressure catheter).

A client presents to the Women's Health Clinic for continuation of her contraceptive method. She has been using Depo-Provera (medroxyprogesterone acetate) for 24 months. In preparation for instituting a plan of care, the nurse would consider which option as a priority? a. Schedule the client for follow-up baseline diagnostic testing to confirm that the client is not pregnant. b. Obtain information for an alternate contraception method. c. Ask the client for additional information related to her menstrual cycle. d. Inspect the skin for site selection of contraceptive method.

ANS: B According to WHO (World Health Organization) guidelines, women should not be on Depo-Provera for more than 2 years because of bone density loss. Therefore, the nurse should include assessments for other types of contraception methods for the client. Although it may prove to be important to rule out possible pregnancy, based on the provided information, discontinuation of this method is the priority intervention. Depo-Provera can cause menstrual irregularities, but this is not the priority intervention. The nurse can follow up on this issue later. Because the current method of contraception should no longer be used, this option is not necessary.

A pregnant client has received the results of her triple-screen testing and it is positive. She provides you with a copy of the test results that she obtained from the lab. What would the nurse anticipate as being implemented in the client's plan of care? a. No further testing is indicated at this time because results are normal. b. Refer to the physician for additional testing. c. Validate the results with the lab facility. d. Repeat the test in 2 weeks and have the client return for her regularly scheduled prenatal visit.

ANS: B Additional genetic testing is indicated to provide the client with treatment options. A positive result on a triple-screen test is considered to be an abnormal finding so the client should be referred to the physician for additional genetic testing. Validation of the test with a lab facility is not necessary because the client provided you with a copy of the test results. There is no need to repeat the clinical test because the findings have already been determined.

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

ANS: B After the first 12 weeks (first trimester), the pregnant woman should gain 0.35 to 0.5 kg (0.8 to 1 lb) per week for the remainder of the pregnancy.

A woman who is gravida 3, para 2, enters the intrapartum unit. The most important nursing assessments are: 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 her 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.

While performing a self-breast exam, the client notes an area on the right breast that is nodular, with some associated tenderness. This is a new onset finding because the exams were not problematic in the past,. The left breast examination is unremarkable. The client calls to report her findings to the clinical nurse because this is not her typical result. What action should the nurse take next? a. Refer the client to an oncologist because the results sound suspicious. b. Ask the client to come in for an office visit so that the findings can be validated but tell her that this information is within the normal range of presentation. c. Have the client wear a tight-fitting bra and tell her that the tenderness is associated with ovulation and will pass. d. Have the client repeat the self-breast exam in 2 weeks and call back with findings to provide a basis for comparison.

ANS: B Although these findings are within the normal range of presentation for breast tissue, they are not in the normal presentation for this client. The client has called to express concern; therefore, the nurse should have the client schedule an appointment for assessment and evaluation. There is no need for referral to a specialist at this time. Wearing a tight fitting bra may help provide support but does not address the physical findings and concern of the client. Repeating the self-breast exam may be required but it does not address the client's current concerns; therefore, the client should be seen by a health care provider.

A pregnant client asks the nurse if she should take herbal supplements during pregnancy. What is the best response to her query? a. "As long as you have had no reaction to them in the past, they would be safe to use during pregnancy." b. "Prenatal vitamins are the only things that should be taken during pregnancy." c. "Nutritional supplements will be prescribed by the health care provider based on individual needs." d. "During pregnancy, no supplementation is required because this is considered to be a healthy state."

ANS: B Prenatal vitamins are noted as the standard of care in the medical treatment of pregnancy. A nurse should not encourage the use of herbal supplements to a pregnant client (or to any client) without obtaining information relative to constituent ingredients and assessment of potential interactions. This discussion should include the health care provider as a member of the interdisciplinary team. Nutritional supplements are not indicated during pregnancy, other than prenatal vitamins. During pregnancy, the client will not be able to meet their nutritional needs without the use of prenatal vitamins.

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

ANS: B Prenatal vitamins include adequate folic acid supplementation, so clients should not take additional supplementation as long they continue their prenatal vitamins. During pregnancy, the recommendation is to increase the folic acid intake to 600 mcg. 1000 mcg of folic acid would be an excessive dose. The AFP test should be done at 15 to 18 weeks' gestation. This is not clinically indicated because the client is at 8 weeks' gestation.

Which factor serves as a clinical indicator for a third trimester amniocentesis? a. Sex of the fetus b. Rh isoimmunization c. Placenta previa d. Placental abruption

ANS: B Rh isoimmunization is a clinical indicator for a third-trimester amniocentesis. Although an amniocentesis can determine the sex of the fetus, this is not a primary indication for a third-trimester amniocentesis. Ultrasound imaging would be indicated for evaluation of placenta previa. Ultrasound imaging would be indicated for evaluation of placental abruption.

Which client is most likely to have osteoporosis? a. A 50-year-old client on estrogen therapy b. A 55-year-old client with a sedentary lifestyle c. A 65-year-old client who walks 2 miles each day d. A 60-year-old client who takes supplemental calcium

ANS: B Risk factors for the development of osteoporosis include smoking, alcohol consumption, sedentary lifestyle, family history of the disease, and a high-fat diet. Hormone therapy may prevent bone loss. Weight-bearing exercises have been shown to increase bone density. Supplemental calcium will help prevent bone loss, especially when combined with vitamin D.

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.

A 45-year-old client asks how often she should have a mammogram. The most appropriate answer is: a. whenever she feels a lump. b. every year beginning at age 40. c. they are unnecessary until age 50. d. every year if you have risk factors.

ANS: B The American Cancer Society recommends that women have an annual mammogram after 40 years of age. Mammography should be done routinely following the American Cancer Society guidelines. Mammograms are necessary when a woman is in her 40s. Women with high-risk factors may need them more often.

A client whose cervix is dilated to 5 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 4 to 7 cm. The latent phase is from the beginning of true labor until 3 cm of cervical dilation. 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.

The assessment finding which indicates that the client is in the active phase of the first stage of labor is: a. 80% effacement. b. dilation of 5 cm. c. presence of bloody show. d. regular contraction every 3 to 4 minutes.

ANS: B The active phase of labor is defined by cervical dilation between 4 to 7 cm. Effacement, bloody show, and regular contractions are not parameters whereby the phases of labor are defined.

A biophysical profile is performed on a pregnant client. The following assessments are noted: nonreactive stress test (NST), three episodes of fetal breathing movements (FBMs), limited gross movements, opening and closing of hang indicating the presence of fetal tone, and adequate amniotic fluid index (AFI) meeting criteria. What would be the correct interpretation of this test result? a. A score of 10 would indicate that the results are equivocal. b. A score of 8 would indicate normal results. c. A score of 6 would indicate that birth should be considered as a possible treatment option. d. A score of 9 would indicate reassurance.

ANS: B The biophysical profile is used to assess fetal well-being. Five categories of assessment are used in this combination test: fetal monitoring NST, evaluation of FBMs, gross movements, fetal tone, and calculation of the amniotic fluid index (AFI). A maximum of 2 points is used if criteria are met successfully in each category; thus a score in the range of 8 to 10 indicates a normal or reassuring finding. A score of 6 provides equivocal results and further testing or observation is necessary. A score of 4 or less requires immediate intervention, and birth may be warranted. The provided assessments indicate a score of 8 as the only area that has not met the stated criteria in the NST.

Which client is most at risk for a low-birth-weight infant? a. 22-year-old, 60 inches tall, normal prepregnant weight b. 18-year-old, 64 inches tall, body mass index is <18.5 c. 30-year-old, 78 inches tall, prepregnant weight is 15 lb above the norm d. 35-year-old, 75 inches tall, total weight gain in previous pregnancies was 33 lb

ANS: B The client who has a low prepregnancy weight is associated with preterm labor and low- birth-weight infants. Women who are underweight should gain more during pregnancy to meet the needs of pregnancy as well as their own need to gain weight; clients who have a normal prepregnancy weight, who start pregnancy overweight, or who have a history of excessive weight gain in pregnancy are not at risk for low-birth-weight infants.

Which event is the best indicator 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.

The breastfeeding client whose recommended prepregnancy caloric intake was 2000 calories per day would need how many calories per day to meet her current needs? a. 2300 b. 2500 c. 2750 d. 3000

ANS: B The increase for a breastfeeding client is 500 calories above her recommended prepregnancy caloric intake. 2300 calories is not enough to meet her needs. 2750 calories may be too many calories and may lead to weight gain. 3000 calories is too many for this client and will lead to weight gain.

A client in her fifth month of pregnancy asks the nurse, "How many more calories should I be eating daily?" What should the nurse's response be? a. 180 more calories a day b. 340 more calories a day c. 452 more calories a day d. 500 more calories a day

ANS: B The increased nutritional needs of pregnancy can be met with an additional 340 calories per day. 180 calories are not enough to meet the increased nutritional needs of pregnancy. 452 calories are more than the recommended calories for pregnancy. 500 calories are more than the recommended calories for pregnancy.

Which of the following is a potential disadvantage for a client who wishes to use an intrauterine device (IUD) as a method of birth control? a. Insertion of the device prior to coitus resulting in decreased spontaneity b. Ectopic pregnancy c. Protection against STDs d. Decrease in dysmenorrhea

ANS: B The insertion of an IUD is done in a health care provider's office. An ectopic pregnancy can occur as a possible complication of the IUD. An IUD does not offer protection against STDs. A decrease in dysmenorrhea would be an advantage of using an IUD.

At 5 minutes after birth, the nurse assesses that the neonate's heart rate is 96 bpm, respirations are spontaneous, with a strong cry, body posture is flexed with vigorous movement, reflexes are brisk, and there is cyanosis of the hands and feet. What Apgar score will the nurse assign? a. 7 b. 8 c. 9 d. 10

ANS: B The neonate is assigned a score of 1 for heart rate and color and a score of 2 for respiratory effort, muscle tone, and reflex response, for a combined total of 8.

The nurse's role in diagnostic testing is to provide which of the following? a. Advice to the couple b. Information about the tests c. Reassurance about fetal safety d. Assistance with decision making

ANS: B The nurse should provide the couple with all necessary information about a procedure so that the couple can make an informed decision. The nurse's role is to inform, not to advise. Ensuring fetal safety is not possible with all the diagnostic tests. To offer this is to give false reassurance to the parents. The nurse can inform the couple about potential problems so they can make an informed decision. Decision making should always lie with the couple involved. The nurse should provide information so that the couple can make an informed decision.

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 client 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 client should be encouraged to move around during labor. The tocotransducer should be placed at the fundal area of the uterus.

You are teaching a group of adolescents about myths and facts related to contraception. Which statement indicates that additional teaching is needed for this group with regard to contraception? a. Adolescents are more likely to become pregnant even if they use available contraception methods correctly. b. The withdrawal technique provides a higher likelihood that a teen will not get pregnant. c. Pregnancy can occur in the presence or absence of orgasm. d. Pregnancy can occur even if a teen is menstruating at the time of coitus.

ANS: B The withdrawal technique does not decrease the likelihood of becoming pregnant for a teen because it is unreliable in application and, even without penetration, ejaculation can result in pregnancy. It is true that adolescents are more likely to become pregnant even if they correctly use available contraception methods, based on current clinical evidence, because they are more likely to have contraceptive failure in the context of decreased knowledge. It is also true that pregnancy can occur in the presence or absence of orgasm, and even if a teen is menstruating at the time of coitus.

Identify the appropriate weight gain at 28 weeks' gestation for a client with a normal BMI (body mass index) before pregnancy. a. 10 pounds b. 19 pounds c. 25 pounds d. 30 pounds

ANS: B The woman with a normal BMI before pregnancy will gain approximately 4.4 pounds during the first trimester and 1 pound per week during the second and third trimesters. At 28 weeks, normal weight gain would be 4 pounds during the first trimester and 15 pounds in the second trimester. Ten pounds at 29 weeks gestation is adequate weight gain. Twenty-five and 30 pounds at 28 weeks is excessive weight gain.

The husband of a laboring woman asks the nurse how he can help his wife throughout the first stage of labor. The nurse informs him that in addition to all that he's doing now, he could tell her when the contractions are: a. 2 minutes apart. b. at their acme. c. at their increment. d. at their decrement.

ANS: B When the contraction is most intense, the coach can tell the laboring woman that this contraction will be over soon to help her remain focused. Describing the frequency of the contractions is not usually helpful. The increment occurs as the contraction begins in the fundus and spreads through the uterus. Calling attention to this phase may cause the woman to become tense. The woman does not need anyone to tell her that the contraction is decreasing in intensity.

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.

Which factors would contribute to abnormalities of the fallopian tube associated with the development of infertility? (Select all that apply.) a. History of conization of the cervix b. History of pelvic surgical procedures c. Incompetent cervix d. Past treatments of STD with follow-up test of cure e. Endometriosis

ANS: B, D, E Surgical procedures related to the cervix, along with an incompetent cervix, would not affect the fallopian tubes in terms of infertility. It would affect fertility issues related to the cervix as a result of potential scarring (conization) and an inability to maintain the pregnancy in the presence of an incompetent cervix. A history of pelvic surgical procedures could result in the development of pelvic adhesions, which would affect the fallopian tube. Also, the presence of STDs, even with effective treatment, along with the clinical diagnosis, would affect the fallopian tube and possibly result in infertility.

A client is 27 years old and delivered her first baby yesterday. She and her husband do not want to have another baby for at least 3 to 4 years. The best method of birth control to meet their needs is: a. withdrawal. b. fertility awareness method. c. combination of condoms and foam. d. vasectomy with a reversal in 3 years.

ANS: C Of the methods listed, condoms and foam would be the best for this couple. Withdrawal is the least effective form of birth control. Fertility awareness is not that effective and an unwanted pregnancy could result. They want another child so a vasectomy with a reversal would not be an appropriate option.

Which assessment finding would cause a concern for a client 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. Client complains of fingers tingling d. Client complains of thirst

ANS: C A client'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 client slow breathing down and restore normal carbon dioxide levels.

The method of contraception that is considered the safest for women is a(n): a. IUD. b. diaphragm. c. male condom. d. oral contraceptive.

ANS: C A male condom does not have any side effects or risk factors for the woman. Oral contraception, an IUD, and the diaphragm all have significant side effects or risk factors for the woman.

Large amounts of leukocytes in the seminal fluid suggest: a. inadequate fructose. b. inflammation of the testes. c. an infection of the genital tract. d. an obstruction in the vas deferens.

ANS: C The presence of large amounts of leukocytes suggests an infection. Adequate fructose must be present to supply energy for the sperm. An inflammatory process would be diagnosed by abnormal consistency or chemical composition. If an obstruction is present, the total amount of the seminal fluid would be abnormal.

The nurse is seeing a 17-year-old female in the clinic for complaints of acne. The nurse plans on taking advantage of this teachable moment with the teen. What topics will the nurse include in the teen's teaching plan? a. Smoking habits, folic acid intake, and heart disease b. Hyperlipidemia, distracted driving, and menstrual history c. Sexual activity, contraception, and screening for violence d. Optimum weight, hypothyroidism, and sexually transmitted diseases

ANS: C All the topics mentioned are worthy of discussion. However, sexual activity, contraception, and screening for violence have priority related to the age and gender of the patient. Because adolescents are often seen by a health care provider for various reasons before they become pregnant, counseling to improve health for a future pregnancy should be offered to them during any health care visit. Smoking cessation, attaining optimum weight, folic acid intake, and screening for violence are topics that should be discussed with all young women so that any future pregnancy has the most positive outcome.

The primary reason for evaluating alpha-fetoprotein (AFP) levels in maternal serum is to determine whether the fetus has which? a. Hemophilia b. Sickle cell anemia c. A neural tube defect d. A normal lecithin-to-sphingomyelin ratio

ANS: C An open neural tube allows a high level of AFP to seep into the amniotic fluid and enter the maternal serum. Hemophilia is a genetic defect and is best detected with chromosomal studies, such as chorionic villus sampling or amniocentesis. Sickle cell anemia is a genetic defect and is best detected with chromosomal studies such as chorionic villus sampling or amniocentesis. L/S ratios are determined with an amniocentesis and are usually done in the third trimester.

A nurse is developing information to give to a group of pregnant women who are interested in nutritional management of their pregnancy with regard to expected weight gain. The nurse bases the amount of weight gain for pregnant women on calculation of their: a. EDC (expected date of confinement). b. prepregnancy weight. c. BMI (body mass index). d. basal energy expenditure (BEE).

ANS: C BMI takes into account height, weight, and body frame characteristics. Weight gain is not based on the EDC. Although the prepregnancy weight is important, it must be looked at in correlation to a calculated BMI. The calculation of BEE is used for clients who are at nutritional risk and are receiving enteral and/or parenteral nutrition therapies.

Which contraceptive method provides protection against sexually transmitted diseases? a. Oral contraceptives b. Tubal ligation c. Male or female condoms d. Intrauterine device (IUD)

ANS: C Because latex condoms provide the best protection available, they should be used during any potential exposure to a sexually transmitted disease. Only the barrier methods provide some protection from sexually transmitted diseases. A tubal ligation is considered a permanent contraceptive method but does not offer any protection against sexually transmitted diseases. IUDs are inserted in the uterus but do not block or inhibit sexually transmitted diseases.

A pregnant woman is scheduled to undergo chorionic villus sampling (CVS) based on genetic family history. Which medication does the nurse anticipate will be administered? a. Magnesium sulfate b. Prostaglandin suppository c. RhoGAM if the client is Rh-negative d. Betamethasone

ANS: C CVS can increase the likelihood of Rh sensitization if a woman in Rh-negative. There is no indication for magnesium sulfate because it is used to stop preterm labor. There is no indication for administration of a prostaglandin suppository. Betamethasone is given to pregnant women in preterm labor to improve fetal lung maturity.

An assessment finding that would indicate to the nurse that cervical dilation and/or effacement has occurred is: 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 mucous 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.

The client who has had an intrauterine device (IUD) inserted should be instructed to: a. use a vinegar douche weekly for 4 weeks. b. have the IUD replaced every 2 to 4 years. c. check the placement of the string once a week for 4 weeks. d. use another method of contraception for 2 weeks after insertion.

ANS: C Checking the placement of the string is necessary to determine whether the IUD is still correctly positioned. If the string is shorter or longer than when checked previously, she should contact her physician. A vinegar douche weekly for 4 weeks is not required. An IUD can be left in place for up to 10 years. A second method of contraception is not required after insertion of the IUD; it is effective immediately.

For the pregnant client who is a vegan, what combination of foods will the nurse advise to meet the nutritional needs for all essential amino acids? a. Eggs and beans b. Fruits and vegetables c. Grains and legumes d. Vitamin and mineral supplements

ANS: C Combining incomplete plant proteins with other plant foods that have complementary amino acids allows intake of all essential amino acids. Dishes that contain grains (e.g., wheat, rice, corn) and legumes (e.g., garbanzo, navy, kidney, or pinto beans, peas, peanuts) are combinations that provide complete proteins. Eggs are not eaten by vegans. Fruits and vegetables alone will not provide the essential amino acids. Vitamin and mineral supplements do not provide amino acids.

The nurse assess a laboring patient's contraction pattern and notes the frequency at every 3 to 4 minutes, duration 50 to 60 sections, 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 Ferguson reflex. She is actively bearing down during the active phase of the second stage.

Informed consent concerning contraceptive use is important because some of the methods: a. may not be reliable. b. require a surgical procedure to insert. c. have potentially dangerous side effects. d. are invasive procedures that require hospitalization.

ANS: C It is important for couples to be aware of potential side effects so they can make an informed decision about the use of contraceptives. Some contraceptives are not reliable but the side effects are the reason for the informed consent. A written consent is required if it involves a surgical procedure. Some contraceptive procedures are invasive but do not require hospitalization.

A pregnant client comes to the OB clinic and informs you that she is very concerned about the amount of weight gain associated with pregnancy. She then tells you that she wants to switch to a low-fat diet during pregnancy. BMI measurements indicate a BMI of 22.7. What would be the best nursing response to this client's stated plan? a. Tell the client that as long as she maintains a varied diet with regard to the other nutrients, there should be no problems. b. Refer the client to a dietician for assistance in planning the low-fat diet. c. Advise the client that it is important to maintain the intake of essential fatty acids during pregnancy. d. Schedule the client for more frequent visits during the next few months to evaluate her weight pattern.

ANS: C It is important to teach the client that essential fatty acids are needed in the diet to assist fetal development (visual and cognitive). Dieting during pregnancy is not advised. Clients should maintain a regular diet that has a varied intake of nutrient sources. There is no need for referral at this time because dieting is not recommended during pregnancy. The client's BMI indicates that she is within the normal weight range. There is no need to add additional appointments at this time.

If a notation on the client's health record states that the fetal position is LSP, this means 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 nurse is reviewing the option of childbirth classes with a patient in her second trimester. Which statement indicates to the nurse that the patient has understood the teaching? a. "My labor will likely be shorter if I go to classes." b. "I will likely perceive less pain during labor if I go to classes." c. "I will likely be more satisfied with my labor if I go to classes." d. "I will likely use fewer medications during labor if I go to classes."

ANS: C Many studies agree that couples receiving prenatal preparation for childbirth are more satisfied with their birth experiences and have greater feelings of control, even when unexpected complications occur. Studies to determine whether education for childbirth affects patient satisfaction, pain relief, length of labor, and frequency of complications have had conflicting results.

A woman undergoing evaluation of infertility states, "At least when we're through with all of these tests, we will know what is wrong." The nurse's best response is: a. "I know the test will identify what is wrong." b. "I'm sure that once you finish these tests, your problem will be resolved." c. "Even with diagnostic testing, infertility remains unexplained in about 20% of couples." d. "Once you've identified your problem, you may want to look at the option of adoption."

ANS: C Problems with infertility must be approached realistically. Nurses should not make judgments or give false reassurance. Providing accurate information to the couple is the best response. The nurse should not make statements indicating that problems will be resolved, because this gives a false impression. The tests are not always definitive, so the nurse should not give false reassurance. The nurse should not offer her view or opinion but should state the facts.

When explaining the recommended weight gain to your client, the nurse's teaching should include which statement? a. "All pregnant women need to gain a minimum of 25 to 35 pounds." b. "The fetus, amniotic fluid, and placenta require 15 pounds of weight gain." c. "Weigh gain in pregnancy is based on the client's prepregnant body mass index." d. "More weight should be gained in the first and second trimesters and less in the third."

ANS: C Recommendations for weight gain in pregnancy are based on the woman's prepregnancy weight for her height (body mass index). Depending on the prepregnant weight, recommendation for weight gain may be more or less than 25 to 35 pounds. The combination of the fetus, amniotic fluid, and placenta averages about 11 pounds in the client who has a normal BMI. Less weight should be gained in the first trimester, when the fetus needs fewer nutrients for growth, and more in the third trimester, when fetal growth is accelerated.

Chromosome analysis is a diagnostic test that should be offered to which couple? a. Never conceived b. Has long-standing infertility c. Has had repeated pregnancy losses d. Has a normal child but has not conceived again

ANS: C Repeated failures to carry a pregnancy to term may indicate genetic defects in the fetus that are incompatible with life. A couple who has never conceived would not be offered chromosome analysis. Long-standing infertility is not an indicator for chromosome analysis. Secondary infertility with an existing normal child would not be an indicator for chromosome analysis.

When a nonreassuring pattern of the fetal heart rate is noted and the client 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 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 is the major advantage of chorionic villus sampling over amniocentesis? a. It is not an invasive procedure. b. It does not require a hospital setting. c. It requires less time to obtain results. d. It has less risk of spontaneous abortion.

ANS: C Results from chorionic villus sampling can be known within 24 to 48 hours, whereas results from amniocentesis require 2 to 4 weeks. It is an invasive procedure. The woman has to be in a hospital setting for her and the fetus to be properly assessed during and after the procedure. The risk of an abortion is at the same level for both procedures.

Which of the statements is correct regarding use of contraception and the occurrence of sexually transmitted diseases (STDs)? a. As long as the oral contraception method is used correctly, there is no transmission of STDs during sexual activity. b. Oral contraceptives provide the greatest protection against getting STDs. c. Barrier methods, if used correctly, are more likely to protect individuals from STDs as compared with other contraceptive methods. d. It is less likely to see transmission of STDs if clients engage in oral sex as opposed to vaginal penetration.

ANS: C The correct use of barrier methods helps protect against the transmission of STDs compared with other methods of contraception. The use of oral contraceptives has no effect on the transmission of STDs. The effectiveness of oral contraceptives is increased related to the prevention of pregnancy compared with other methods with the exception of abstinence. The method of sexual activity does not affect the transmission of STDs.

The major difference between the diaphragm and the cervical cap is that the diaphragm: a. is more effective. b. requires spermicide. c. applies pressure on the urethra. d. has no contribution to toxic shock syndrome.

ANS: C The diaphragm is made to fit snugly in the vaginal area and contains a hard rim that may put pressure on the urethra. The cervical cap is smaller and fits around the cervix. The cervical cap is not more effective than a diaphragm. The diaphragm does not require spermicide. Both may contribute to toxic shock syndrome.

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. a reassuring 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 reassuring and does not indicate acidosis. An increase in the FHR after stimulation is a reassuring pattern and does not indicate problems with the parasympathetic nervous system.

Which client has correctly increased her caloric intake from her recommended pregnancy intake to the amount necessary to sustain breastfeeding in the first 6 postpartum months? a. From 1800 to 2200 calories per day b. From 2000 to 2500 calories per day c. From 2200 to 2530 calories per day d. From 2500 to 2730 calories per day

ANS: C The increased calories necessary for breastfeeding are 500, with 330 calories coming from increased caloric intake and 170 calories from maternal stores. An increase of 230 calories is insufficient for breastfeeding. An increase of 400 and 500 calories is above the recommended amount.

What is the term for a non-stress test in which there are two or more fetal heart rate accelerations of 15 or more bpm with fetal movement in a 20-minute period? a. Positive b. Negative c. Reactive d. Nonreactive

ANS: C The non-stress test (NST) is reactive (normal) when there are two or more fetal heart rate accelerations of at least 15 bpm (each with a duration of at least 15 seconds) in a 20-minute period. A positive result is not used with an NST. The contraction stress test (CST) uses positive as a result term. A negative result is not used with an NST. The CST uses negative as a result term. A nonreactive result means that the heart rate did not accelerate during fetal movement.

In preparing a pregnant client for a non-stress test (NST), which of the following should be included in the plan of care? a. Have the client void prior to being placed on the fetal monitor because a full bladder will interfere with results. b. Maintain NPO status prior to testing. c. Position the client for comfort, adjusting the tocotransducer belt to locate fetal heart rate. d. Have an infusion pump prepared with oxytocin per protocol for evaluation.

ANS: C The nurse must adjust the tocotransducer to find the best location to pick up and record the fetal heart rate. Positioning the client for comfort during testing is a prime concern. Although a full bladder may affect client comfort, it will not interfere with testing results. NPO status is not required for an NST. Instead, a pregnant client should maintain her normal nutritional intake to provide energy to herself and the fetus. An infusion pump with oxytocin is required for a contraction stress test (CST).

When the deceleration pattern of the fetal heart rate mirrors the uterine contraction, which nursing action is indicated? a. Reposition the client. b. Apply a fetal scalp electrode. c. Record this reassuring 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. It is a reassuring pattern. Repositioning the client, applying a fetal scalp electrode, or administering oxygen would be interventions done for nonreassuring patterns.

A nurse is conducting a prenatal nutritional education class for a group of nursing students. Which should the nurse include as the definition of pica? a. Iron deficiency anemia b. Intolerance to milk products c. Ingestion of nonfood substances d. Episodes of anorexia and vomiting

ANS: C The practice of eating substances not normally thought of as food is called pica. Clay, dirt, and solid laundry starch are the substances most commonly ingested. Pica may produce iron deficiency anemia if proper nutrition is decreased. Intolerance to milk products is termed lactose intolerance. Pica is not related to anorexia and vomiting.

A patient at 36 weeks gestation is undergoing a non-stress (NST) test. The nurse observes the fetal heart rate baseline at 135 beats per minute (bpm) and four nonepisodic patterns of the fetal heart rate reaching 160 bpm for periods of 20 to 25 seconds each. How will the nurse record these findings? a. NST positive, nonreassuring b. NST negative, reassuring c. NST reactive, reassuring d. NST nonreactive, nonreassuring

ANS: C The presence of at least three accelerations of at least 15 beats, over at least 15 seconds, over a duration of at least 20 minutes, is considered reactive and reassuring. Nonreactive testing reveals no or fewer accelerations over the same or longer period. The NST test is not recorded as positive or negative.

Which clinical conditions are associated with increased levels of alpha fetoprotein (AFP)? (Select all that apply.) a. Down syndrome b. Molar pregnancy c. Twin gestation d. Incorrect gestational age assessment of a normal fetus—estimation is earlier in the pregnancy e. Threatened abortion

ANS: C, D, E Elevated APF levels are seen in multiple gestations, underestimation of fetal age, and threatened abortion. Decreased levels are seen in Down syndrome and a molar pregnancy.

The nurse is preparing a client for a non-stress test (NST). Which interventions should the nurse plan to implement? (Select all that apply.) a. Ensure that the client has a full bladder. b. Plan approximately 15 minutes for the test. c. Have the client sit in a recliner with the head elevated 45 degrees. d. Apply electronic monitoring equipment to the client's abdomen. e. Instruct the client to press an event marker every time she feels fetal movement.

ANS: C, D, E The client may be seated in a reclining chair or have her head elevated at least 45 degrees. The nurse applies external electronic monitoring equipment to the client's abdomen to detect the fetal heart rate and any contractions. The woman may be given an event marker to press each time she senses movement. Before the NST, the client should void and her baseline vital signs should be taken. The NST takes about 40 minutes, allowing for most fetal sleep-wake cycles, although the fetus may show a reassuring pattern more quickly or need more time to awaken and become active. Fifteen minutes would not allow enough time to complete the test.

Which client would require additional calories and nutrients? a. A 36-year-old female gravida 2, para 1, in her first trimester of pregnancy b. An 18-year-old female who delivered a 7-lb baby and is bottle feeding c. A 23-year-old female who had a cesarean section birth and is bottle feeding d. A 20-year-old female who had a vaginal birth 5 months ago and is breastfeeding

ANS: D A client who is breastfeeding will require more calories and nutrients than individuals who are pregnant, delivered regardless of the type of birth, and whether they are bottle feeding.

The nurse sees a pattern on the fetal monitor that looks similar to early decelerations, but 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 reassuring fetal heart rate pattern but 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, so the nurse acts 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 client 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 reassuring pattern, so the IV rate should be increased to increase the mother's blood volume. These are late decelerations, not early; therefore, interventions are necessary.

What is the recommended weight gain during pregnancy for a client who begins pregnancy at a normal weight? a. 10 to 15 lb b. 15 to 20 lb c. 20 to 25 lb d. 25 to 35 lb

ANS: D A weight gain of 25 to 35 lb is believed to reduce intrauterine growth restriction that may result from inadequate nutrition, and also allows for variations in individual needs. There is no precise weight gain appropriate for all women. A 10-lb weight gain is not sufficient to meet the needs of the pregnancy. A 15- to 20-lb weight gain is recommended for women who are overweight before the pregnancy. A 20- to 25-lb weight gain is recommended for women who are overweight before the pregnancy.

A client who is in week 28 of gestation is concerned about her weight gain of 17 lb. Which is the nurse's best response? a. "You should not gain any more weight until you reach the third trimester." b. "You should try to decrease your amount of weight gain for the next 12 weeks." c. "You have not gained enough weight for the number of weeks of your pregnancy." d. "You have gained an appropriate amount for the number of weeks of your pregnancy."

ANS: D A woman in her 28th week of gestation should have gained between 17 and 20 lb. The normal pattern of weight gain is about 3.5 lb total in the first trimester (by 13 weeks) and 1 lb per week after that. The client has gained the appropriate amount of weight. It would be inappropriate to have her decrease her weight gain. She has gained an appropriate amount of weight and should not increase the weight gain. Weight gain needs to be consistent during the last part of the pregnancy and should not be suppressed.

The birth educator is discussing the advantages and disadvantages of birthing options. Which disadvantage is common with epidural anesthesia? a. Effective pushing is optimized. b. The risk of catheterization is decreased. c. The length of labor and birth may be decreased. d. The use of forceps and oxytocin administration is increased.

ANS: D Administration of oxytocic drugs and the use of forceps are more likely with epidural anesthesia. Epidural anesthesia can cause less effective pushing because the woman cannot feel the contractions. Catheterizing the patient is common because the woman does not have the urge to empty her bladder. Epidural anesthesia usually removes most pain but may increase the length of labor.

The pregnant client with significant iron deficiency anemia is prescribed iron supplements. The client confides to the nurse that she can't take iron because it makes her nauseous. What is the best response by the nurse? a. "Iron will be absorbed more readily if taken with orange juice." b. "It is important to take this drug regardless of this side effect." c. "Taking the drug with milk may decrease your symptoms." d. "Try taking the iron at bedtime on an empty stomach." AThe pregnant client with significant iron deficiency anemia is prescribed iron supplements. The client confides to the nurse that she can't take iron because it makes her nauseous. What is the best response by the nurse? a. "Iron will be absorbed more readily if taken with orange juice." b. "It is important to take this drug regardless of this side effect." c. "Taking the drug with milk may decrease your symptoms." d. "Try taking the iron at bedtime on an empty stomach."

ANS: D Iron taken at bedtime may be easier to tolerate. All the answers are true statements; however, only the option that states that iron taken at bedtime may be easier to tolerate addresses both optimal absorption of iron and alleviation of nausea, which will not be noticeable during sleep. It is true that taking iron with milk will decrease the symptoms, but it will also decrease absorption.

A male client asks, "Why do I have to use another contraceptive? I had a vasectomy last week." The best response is: a. "A vasectomy is only 85% effective." b. "A vasectomy is not effective in all men." c. "Semen may contain sperm for 6 months following a vasectomy." d. "Complete sterilization doesn't occur until all sperm have left the system."

ANS: D It may take a month or longer for all sperm to be removed from the system. During that time, an additional method of contraception must be used. A vasectomy is more than 85% effective. Vasectomies have a high success rate but it may take 1 month for all the sperm to be removed from the system. After 1 month, all the sperm have usually been removed from the system.

Which should be considered a contraindication for transcervical chorionic villus sampling? a. Rh-negative mother b. Gestation less than 15 weeks c. Maternal age younger than 35 years d. Positive for group B Streptococcus

ANS: D Maternal infection is a risk with this procedure, and it is contraindicated if the client has an active infection in the cervix, vagina, or pelvic area. This procedure is done between 10 and 12 weeks. This procedure is usually done for women older than 35; however, if the woman is at high risk for fetal anomalies, her age is not a contraindication. The procedure can still be performed; however, Rh sensitization may occur if the mother is Rh-negative. Rho(D) immune globulin can be administered following the procedure.

A newly married woman states, "My friend told me I would never have a baby because I had pelvic inflammatory disease when I was younger. I don't understand how that can affect whether or not I get pregnant." The nurse's best response is: a. "Your friend may be right. The disease may affect your ability to conceive." b. "Pelvic inflammatory disease may damage the ovaries and prevent ovulation." c. "Your friend has been misinformed. Fallopian tube damage occurs only following gonorrhea." d. "Infection may cause scarring and obstruction of the fallopian tubes, which can prevent the fertilized egg from reaching the uterus."

ANS: D Providing the client with accurate complete information is the best response. Pelvic inflammatory disease produces scarring and obstruction of the fallopian tube if the infection is not treated. It does not occur following gonorrhea.

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 pregnant client's diet may not meet her need for folate. What is a good source of this nutrient? a. Chicken b. Cheese c. Potatoes d. Green leafy vegetables

ANS: D Sources of folate include green leafy vegetables, whole grains, fruits, liver, dried peas, and beans. Chicken is a good source of protein, but poor in folate. Cheese is an excellent source of calcium, but poor in folate. Potatoes contain carbohydrates and vitamins but are poor in folate

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.

What is the purpose of initiating contractions in a contraction stress test (CST)? a. Increase placental blood flow. b. Identify fetal acceleration patterns. c. Determine the degree of fetal activity. d. Apply a stressful stimulus to the fetus.

ANS: D The CST involves recording the response of the fetal heart rate to stress induced by uterine contractions. The CST records the fetal response to stress. It does not increase placental blood flow. The NST looks at fetal heart accelerations with fetal movements. The NST and biophysical profiles look at fetal movements.

A nullipara client has progressed to the active phase of labor. The nurse understands that this phase of labor, on the average, for a nullipara will last how long? a. 50 minutes b. hours c. 6 to 7 hours d. 8 to 10 hours

ANS: D The active phase of labor for a nullipara lasts 8 to 10 hours. The second phase of labor lasts 50 minutes for a nullipara. The transition phase lasts hours for a nullipara. A multipara's active phase of labor is 6 to 7 hours.

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.

Which response by the nurse is most appropriate when a client asks, "What contraceptive do you think I should use?" a. "Ask your doctor. She will know what is best for you." b. "The male condom is probably the easiest for you to use." c. "Because you are younger than 40, you should use oral contraceptives." d. "I can discuss the various methods with you so you can decide what is best."

ANS: D The nurse should provide the woman with all the necessary information to make an informed decision but should not make the decision for her. The nurse can educate the woman about contraception; she does not have to ask the doctor. The nurse should provide information about contraception, not tell her which one to choose. The nurse should educate the woman about different types of contraception, not make the choice for her.

The role of the nurse in family planning is to: a. refer the couple to a reliable physician. b. decide on the best method for the couple. c. advise couples on which contraceptive to use. d. educate couples on the various methods of contraception.

ANS: D The nurse's role is to provide information to the couple so that they can make an informed decision about family planning. The nurse can help the couple; they do not need to be sent to a physician. The nurse's role is to educate, not decide for the couple which is the best method or advise couples on which contraceptive to use.

In which situation would it be appropriate to obtain a fetal scalp blood sample to establish fetal well-being? a. The fetus has developed tachycardia related to maternal fever. b. The mother has vaginal bleeding, and the baseline fetal heart rate is decreasing. c. The fetal heart tracing on a preterm fetus shows decreased baseline variability. d. The fetal heart tracing shows a persistent pattern of late decelerations, with normal baseline variability.

ANS: D The tracing is nonreassuring, and additional assessment is needed regarding the acid-base status of the fetus. Fetal scalp blood sampling is contraindicated with vaginal bleeding, maternal fever, and a preterm fetus.

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 should the nurse recognize as being associated with fetal compromise? 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.

Which nursing intervention is necessary prior to a second-trimester transabdominal ultrasound? a. Perform an abdominal prep. b. Administer a soap suds enema. c. Ensure the client is NPO for 12 hours. d. Instruct the client to drink 1 to 2 quarts of water.

ANS: D When the uterus is still in the pelvis, visualization may be difficult. It is necessary to perform the test when the woman has a full bladder, which provides a window through which the uterus and its contents can be viewed. An abdominal prep is not necessary for this procedure. A soap suds enema is not necessary for this procedure. The client needs a full bladder to elevate the uterus; therefore, being NPO would not be appropriate.

Understand the rationale behind assessments during labor

assessment priorities are to determine the condition of the mother and fetus and whether birth is imminent page 222

Understands the importance of knowing the status of a woman's bag of waters.

Ask about membrane status: "Has your water broken?" "What time did it break?" "What did the fluid look like?" "About how much fluid did you lose—was it a big gush or a trickle?" (Alerts the nurse of the need to verify whether the membranes have ruptured if it is not obvious. Identifies possible prolonged rupture of membranes or preterm rupture.) If the woman's membranes have ruptured and she is not in labor or if she is not at term, a vaginal examination is often deferred. A speculum examination may be done (Fern Test) by the physician or nurse-midwife to identify the woman's admission status. Labor may be induced if she is at term with ruptured membranes. (p. 224) Status of membranes: During a vaginal examination, a flow of fluid suggests ruptured membranes. A pH test and/or fern test may be done, often using a sterile speculum exam. (Test is not needed if it is obvious that the membranes have ruptured (p. 226). Important to know because if there has been ROM there is increased change of infection in the uterus.

Utilize the nursing process in caring or a fetus during labor and birth.

Assessment- FHR, Amniotic fluid: spontaneous rupture of membranes (SROM) or artificial rupture of membranes (AROM),FHR, Characteristics of amniotic fluid, Maternal vital signs, Pattern of contractions, Initial care and assessment of the newborn, Diagnosis- "potential for complication: fetal compromise" Planning- promote normal placental function and observe for and report problems to the physician or nurse midwife. Implantation-Maintaining cardiopulmonary function (Apgar), Support thermo-regulation, Identify infant, Evaluation- through out labor compare actual data with the norms for mother and fetus

Know the significance of fetal positioning, and presentation.

Cephalic vertex or occiput presentation is the most favorable for normal progress of labor and occurs most often. Breech and shoulder presentations require C-section. Breech is when fetal buttocks enter pelvis first (3-4%). Shoulder presentation is a transverse lie and seldom occurs (0.3%) (pp 202-203). Fetal position describes the location of a fixed reference point on the presenting part in relation to the four quadrants of the maternal pelvis. The four quadrants are the right and left anterior and the right and left posterior. The fetal position is not fixed but changes during labor as the fetus moves downward and adapts to the pelvic contours (pp 203-204).

Know the important topics covered in early prenatal education classes Chapter 11 P

Classes Available: Pain mgmt- what to expect, what is available!!! Conditioning- stimulation based -Preconception -Early pregnancy -Exercise -Childbirth preparation -Refresher courses second/third child... -Cesarean birth preparation -General -Planned -Vaginal birth after cesarean birth (VBAC) -Breastfeeding -Parenting/infant care -Postpartum Classes for other family members -Fathers -Siblings -Grandparent Roles of Labor partner: teach them to respond appropriately to the laboring mom Learn ways to time contractions /distraction/conditioning Alert woman when to begin focused breathing Provide comfort measures - extra pillows, cool cloth around neck, etc. Book p194 Many classes are available for pregnant women and their support persons. Early pregnancy classes emphasize ways to have a healthy pregnancy. Classes conducted in later pregnancy focus on preparation for childbirth, breastfeeding, and early parenting. • Classes for fathers, siblings, and grandparents help all family members prepare for the birth. • Education, relaxation, and conditioning are used to increase coping ability for childbirth. Exercises in relaxation help women recognize and learn methods to reduce tension during labor. • Cutaneous and mental stimulation techniques help to reduce pain perception. Techniques need to be varied to prevent habituation. • Having a labor partner or support person increases a woman's satisfaction with childbirth. • The support person may participate in labor actively, minimally, or only by being present. The nurse should accept all roles taken by support persons. • Specific support techniques include assisting with relaxation and breathing, encouraging the woman, and using sacral pressure, massage, and comfort measures. Prepare a realistic birth plan. Also make concessions for cultural adaptations! Birth plan: allows them to write out expectations

What three nursing interventions that can be done to decrease the variable decelerations?

Continued monitoring, change of positions and hydration either IV or oral are effective nursing interventions.

understand dilation and effacement

Dilation is the opening of the cervix. Effacement is the thinning and shortening of the cervix. Dilation and effacement happen concurrently, but at different rates (p. 197). Cervical effacement and dilation occur in the first stage of labor. The first stage of labor begins with the onset of true labor contractions and ends with complete dilation (10 cm) and effacement (100%) of the cervix (p. 208).

Discuss the various methods of evaluating infertility

Disorders of ovulation: dysfunction in the hypothalamus, failure of the ovaries, age. Abnormalities of the fallopian tubes: Obstruction Abnormalities of the cervix: low estrogen levels, scarring, surgical destruction, infection. Semen analysis evaluates structures and function of sperm. Endocrine test: evaluates function of the hypothalamus, pituitary gland, and response of testicles. Ultrasound: evaluates structure of prostate gland , seminal vesicles and ejaculatory ducts. Females Ovulation prediction identifies the surge of LH ultrasound evaluates structure of organs, cyclic endometrial changes ovarian follicles and release of ova at ovulation. HSG (hysterosalpingogram) visualizes page of dye through uterus and fallopian tubes. pg703

Know the physiological changes that occur with labor

Hyperventilation It may occur with rapid and deep breathing. Respiratory alkalosis occurs as she exhales too much carbon dioxide. She may feel tingling of her hands and feet, numbness, and dizziness. The nurse should help her slow her breathing and breathe into a paper bag or her cupped hands to restore normal blood levels of carbon dioxide and relieve these symptoms. GI Tract slowed, solid food withheld to prevent vomiting/aspiration Hematopoetic 500 mL normal blood loss for vaginal delivery 800 to 1000 mL for c-section Levels of several clotting factors, especially fibrinogen, are elevated during pregnancy and continue to be higher during labor and after delivery. Provides protection from hemorrhage Increases the mother's risk for a venous thrombosis during pregnancy and after birth Factors that appear to have a role in starting labor include: What do Progesterone and Estrogen do during pregnancy Progesterone withdrawal Increase release of prostaglandins Increased secretion of natural oxytocin Increased oxytocin receptors in the uterus Increased stretching and pressure of the uterus and cervix

25. Bradley childbirth education

Includes the father as a support person and a coach

The nurse is aware of the importance of screening women for violence

Intimate partner violence (IPV) is abuse by a current or former partner or spouse. Includes physical, sexual and emotional abuse. pregnancy adds more stress to relationship. partner may feel trapped or under increased pressure to provide emotional and financial support. up to 20% may be abused during pregnancy Nurses should ask about IPV at every visit , on admission to hospital and at postpartum checkup. chp 24 pgs 497-502 nurses must help prevent partner violence and physical abuse, we want to be supportive and recognize s/s

Know the uses of different monitoring devices.

Page 259- Bedside monitor unit- uses info from fetal heart rate and uterine activity sensors to provide a visual output in form of a numeric display and graphic strip, strip can be printed by monitor itself, Paper strip- data about FHR and uterine activity are printed on a horizontal paper strip, lighter lines are 10 seconds a part and darker lines are 1 minute apart. page 260 devices for external fetal monitoring external devices for monitoring can be secured on the moms abdomen by elastic straps, stocking, or adhesive ring, they are slightly less accurate then internal monitors but are non invasive. They do not require ruptured membranes the doppler ultrasound device detects movements other than fetal heart motion. for example fetal or maternal activity or blood flow through the umbilical cord and the woman's aorta. Produces two part muffled sounds that resemble sound of galloping horses, the two closely linked sounds represent closure of heart valves during systole, uterine activity monitoring with TOCO transducer toco transducer has pressure sensitive area to detect changes in abdominal contour to measure uterine activity, the uterus pushes outward against the mother's anterior abodominal wall with each contraction, movement other than uterine activity also registers on the monitor for ex- maternal respirations causes uterine activity line to have a zig zag appearance, fetal hiccups appear as spikes on the strip, it does not reliably measure actual contraction intensity and uterine resting tone, several factors affect intensity such as- fetal size, abdominal fat thickness, maternal position, location of transducer Devices for internal monitoring fetal heart rate monitoring with scalp electrode- fetal scalp electrode detects electric signals from fetal heart, movement does not interfere with accuracy, monitor unit generates a beeping sound with each fetal heartbeat, easily displaced, 2 types of IUPC (intrauterine pressure catheter) can be used to measure uterine activity including contraction intensity and resting tone, this includes solid catheter and hollow fluid filled catheter,

Know the interventions a nurse can perform independently for a laboring woman.

Provide comfort measures with lighting, temperature, cleanliness, mouth care, bladder, positioning, and water (p. 236). Teach positions to use during each phase of labor, method of breathing and breathing pattern, offer encouragement, and "giving of self" (p. 237-240). Offer pharmacologic measures and care for the birth partner as well.

26. Lamaze childbirth education

Psychoprophylaxis class that uses the mind to prevent pain

Discuss the various STDs

STDS CONTINUED Page 750 Syphilis:Different stages, first stage is primary stage: where painless chancre heals in 6 weeks untreated, highly infectious. Secondary stage: enlargement of spleen and liver, headache, anorexia, skin rash. Skin eruptions (resembles warts) may develop on vulva. Last phase if untreated includes CNS, heart, blood vessels and can result in pyschosis and paralysis. Best treatment of all stages of syphilis is with penicillin G. herpes genitalis:2 types hsv-1 oropharyngeal infection hsv-2 usually causes genital lesions. If you have hsv-1 first you can develop antibodies and if you get hsv-2 it will be less severe. A primary hsv-2 infection is one where the person has not had a hsv-1 infection and has no antibodies, within 2-12 days of infection blisters appear in vagina accompanied by flu-like symptoms vesicles burst and heal. When symptoms stop the virus remains dormant and recurrent episodes are seldom but contagious. No cure exists but antiviral drugs may be described, women should be advised to abstain from sexual contact while lesions are present. Human papilloma virus: condylomata acuminata or otherwise known as genital warts are caused by HBV common sites are perneal area, vagina, labia. They are concerning because of association of HPV with cervical cancer. The goal of treatment is to remove warts which can easily transmit the HPV back and forth between partners. Treatments to not eradicated virus, sexual contact should be avoided. Acquired immunodeficiency syndrome: AIDS caused by HIV, primary mode of transmission are infected with bodily secretions, exposure to infected blood and blood products, and perinatal transmission from mother to infant. This testing is routine for all pregnant women, no meds have been shown to cure.

presentation

The fetal part that enters the pelvic inlet first

Know what occurs between uterine contractions and placental function

The interval is the period between the end of one contraction and the beginning of the next. Most fetal exchange of oxygen, nutrients, and waste products occurs in the placenta at this time (p. 197). This happens because the uterine muscle compresses on the spiral arteries, which supply the blood to the intervillous spaces. Fetal protective mechanisms include fetal hemoglobin which more readily takes on oxygen and releases carbon dioxide, high H&H levels that can carry more oxygen then adult hemoglobin, and a high cardiac output. If there is maternal diabetes, hypertension, or fetal anemia, the fetus may not tolerate labor contractions well, as these conditions cause reduced placental function (p. 199). During contractions the fetus depends on the oxygen supply already present in body cells, fetal erythrocytes, and the intervillous spaces. The oxygen supply in these areas is enough for about 1 to 2 minutes. As each contraction relaxes, fresh oxygenated maternal blood reenters the intervillous spaces, and blood containing carbon dioxide and other fetal waste products drains out (p. 254).

fetal lie

The orientation of the long axis of the fetus to the long axis of the woman

early prenatal tests and interpretation of results

Three-dimensional ultrasound images have greater detail. They provide more accurate identification of the extent and size of abnormalities. Real-time scanning Shows movement as it happens Allows the observer to see fetal heart motion, fetal breathing activity, and fetal body movement Can distinguish between moving tissues of the fetus and maternal tissues Ultrasound: First Trimester Purpose Confirm pregnancy Verify the location of the pregnancy Detect multifetal gestations Determine gestational age Identify markers Determine the locations of the uterus, cervix, and placenta for procedures such as chorionic villus sampling (CVS) Procedure:Transvaginal Ultrasound: Second and Third Trimester Purpose Confirm viability Evaluate fetal anatomy Determine gestational age Assess serial fetal growth Compare growth of fetuses in multifetal gestations Evaluate four of five markers in a biophysical profile Locate the placenta when placenta previa is suspected Determine fetal presentation Guide needle for amniocentesis or percutaneous umbilical cord sampling (PUBS) Specialized ultrasound for abnormal findings Hydramnios (excessive amniotic fluid) Oligohydramnios (insufficient amniotic fluid) Abnormal levels of maternal serum alpha-fetoprotein (MSAFP) or other tests in multiple-marker testing Neural tube defects (NTDs) (failure of the bony encasement of spinal cord or skull to close) Procedure Transabdominal Serum Plp Abnormal levels of maternal serum alpha-fetoprotein (MSAFP) or other tests in multiple-marker testing Tests for choromosomal defects p169 Doppler Ultrasound Blood Flow Assessment Purpose Identify abnormalities in the diastolic flow Enhances detail about the degree of resistance to normal blood flow in the growth-restricted fetus Abnormal levels of maternal serum alpha-fetoprotein (MSAFP) or other tests in multiple-marker testing It's a screening not a diagnostic test*** Abnormal concentrations of AFP are associated with serious fetal anomalies. Low levels of MSAFP suggest chromosomal abnormalities such as trisomy 21. Elevated MSAFP levels are associated with open NTDs and body wall defects. Anencephaly Spina bifida Chorionic Villus Sampling: Purpose Diagnose fetal chromosomal, metabolic, or DNA abnormalities Procedure Usually performed between 10 and 12 weeks of gestation Counseling about the procedure Genetic counseling Transcervical or the transabdominal approach 170 There are risks of having a miscarriage Transcervical is most commonly used but it is determined by the position of the baby Amniocentesis:The aspiration of amniotic fluid from the amniotic sac for examination 171 This tests for downs It is done later in pregnancy Done at 16-20 weeks They like to do it before the 20 week period so the mother will have time to make a decision You do not put a pressure dressing on the needle site because you don't want to squeeze out more amniotif fluid monitor the mother for a while after Amniocentesis: Third Trimester Purpose Tests to determine fetal lung maturity Test for fetal hemolytic disease Determine fetal bilirubin concentration (Rh sensitized) Procedure Ultrasonography used to identify the largest pockets of amniotic fluid that can safely be sampled Spinal needle inserted into the pocket of fluid; 1 to 2 mL of fluid discarded Approximately 20 mL of fluid removed for analysis 172 Lung maturity Fetal hemolytic diseases RH factor Don't need to know numbers NST Purpose Identifies whether an increase in the FHR occurs when the fetus moves Procedure Before procedure woman should void, and baseline vital signs should be taken Woman may be seated in a reclining chair or have her head elevated at least 45 degrees Electronic fetal monitor (EFM) applied to abdomen Ultrasound transducer records FHR Tocotransducer records uterine activity Interpretation Reactive (reassuring) Nonreactive (nonreassuring): Tracing does not demonstrate the required characteristics of a reactive tracing within a 40-minute period. BPP Biophysical profile (BPP) assesses five parameters of fetal status: FHR Fetal breathing movements Gross fetal movements Fetal muscle tone Amniotic fluid volume

Know the risks factors and nursing implications of testing done in early pregnancy.

chorionic villus sampling purpose and procedure:purpose- diagnostic fetal chromosomal, metabolic, or DNA abnormalities-procedure: performed at 10-12 weeks, counseling is required, genetic counseling, transcervical or transabdominal approach-Advantages: results are known earlier then amniocentesis, CVS offers prenatal diagnosis to women who find later procedures are unnacceptable risks: rate of pregnancy loss after CVS is similar to that of amniocentesis, more than 2 attempts during week before procedure increases risk for fetal loss, reports of limb reduction defects (limb not developing right) amniocentesis-aspiration of amniotic fluid from amniotic sac for examination, 15-20 weeks before 14 weeks it can result in them not getting enough fluid to examine, deformities are related to procedure, det. if chromosomal abnormalities are present, advantages of having amniocentesis simple/reasonably safe procedure,relatively painless procedure, takes a short time, few reported complications, familiar to most obstetricians disadvantages of amniocentesis, timing- must wait to about 15 to 16 weeks of gestation this limits time for decisions about additional tests or whether to terminate pregnancy before 20 weeks, risks-pregnancy loss rate of less than 1%, higher pregnancy loss rate of 2% to 5% has been noted after early amniocentesis between 11 to 13 weeks, transfer of fetal blood to maternal circulation may occur

Discuss the importance of being involved in preparing for birth

education for childbearing helps couples become knowledgeable consumers and active particpants in pregnancy and childbirth. Many classes are available for pregnant women and their support persons. early pergnancy classes emphasize ways to have a healthy pregnancy. Classes conducted in late pregancy focus on preparation for childbirth, breastfeeding, and early pregnancy. Education, relaxation, and conditioning are used to increase coping ability for childbirth. Exercises in relaxation help women recognize and learn methods to reduce tension during labor, having a labor partner or support person increases a woman's satisfaction with childbirth. page 194

cardinal movements of labor

in order flexion, internal rotation, extension, external rotation, expulsion

Understand the physiologic changes in the birth process- maternal response

page 196 Maternal changes- maternal response- contractions- coordinated, involuntary, intermittent cycle, pattern, duration to them, start out tolerable and get stronger and painful cervical changes- effacement (cervix starts out long and thick and as fetus head is pushed downward against cervix uterus is pulled upward so has thinning effect to cervix as cervix is pulled upward around fetus it is opening as fetal presenting part is pushed down) cardiovascular changes- with every contraction the uterus shunts 300-500 milliliters of blood back into maternal system which causes increase in blood pressure and pulse rate respiratory system- women breathe very rapidly, because of pain/anxiety can hyperventilate and can cause respiratory alkalosis and numbness/tingling in hands and feet, help her slow breathing with exercises- encourage to breathe into paper bag, GI system- gastric motility is reduced during labor, causes nausea/ vomiting throughout labor process urinary system- reduced sensation of full bladder, important to assess while in labor can impede decent of fetus, have empty bladder so fetus can occupy space hematopoetic- tolerate losing blood, women who is already anemic going into labor process and having baby has lower tolerance to excessive bleeding has less hemoglobin to carry oxygen so when blood loss happens it makes baby less able to tolerate

Know the components of the birth process

page 199 Components of birth process 4 P's of labor 1. Powers- Uterine contractions: during first stage of labor (onset to full cervical dilation), uterine contractions are primary force that moves fetus through maternal pelvis. And Maternal Pushing efforts: during second stage of labor (full cervical dilation to birth of baby) uterine contractions continue to propel the fetus through the pelvis. In addition the women feels an urge to push and bear down as the fetus distends her vagina and puts pressure on her rectum. She adds here voluntary pushing efforts to the force of uterine contractions in second stage labor 2. Passage- Birth passage consists of maternal pelvis and soft tissues. The bony pelvis is usually more important to the outcome of labor than the soft tissue because bones and joints do not readily yield to the forces of labor. The true pelvis is most important during birth. 3. Passenger- The passenger is the fetus, membranes, and placenta. Several fetal anatomic and positional variables influence the course of labor. The fetus enters the birth canal in cephalic presentation (fetal part that enters the pelvic inlet first). This includes bones, sutures, fontanels and fetal head diameters. Variations in passenger include fetal lie (orientation of long axis of fetus to long axis of women), attitude (relation of fetal body parts to one another). And presentation (cephalic is most favorable). Fetal position describes the location of a fixed reference point on the presenting part in relation to the four quadrants of maternal pelvis. The four quadrants are right/left anterior and right/left posterior. The first letter of abbreviation describes whether the fetal reference point is to the right or left of the mothers pelvis. The second letter of abbreviation refers to the fixed fetal reference point varies with presentation. The occiput is used in vertex presentation, chin is used for facial presentation, sacrum is used for breech presentation. Anterior, posterior, or transverse. If the fetal reference point is in neither the anterior nor a posterior quadrant of mothers pelvis it is described as transverse. 4. Psyche: A women's pyschological response to labor and birth are influenced by anxiety, culture, expectations, life experiences, and support. Marked anxiety and fear decrease a women's ability to cope with pain in labor. A women's cultural affects her values, expectations for, and responses to birth and practices surrounding it. It is a physical and emotional experience. Support and impact of technology are also included.

The nurse knows how to council a woman on signs of labor

page 207 preliminary signs of labor braxton hicks (uterine contractions that can occur throughout latter pregnancy, can be misinterpreted as true labor- several characteristics are different these type of contractions will go away with rest, oral hydration, IV hydration, painless-esp with oral hydration/rest most of the time they do not cause any progressive effacement or cervical dilation) lightening- descent of fetal head into pelvis, uterus lowers moves more into anterior position, contour shape/ abdomen changes, primaparis women these changes commonly occur 2 weeks before birth, multiparis women lightening does not happen until day of birth or hours before birth) increased vaginal mucous secretions- as cervix softens they will have more secretions when they wipe, even bloody spot of mucus secretions, cervical ripening and bloody show energy spurt/weight loss- women will get an energy spurt before they go into labor, often have had so many months/days of exhaustion this is called nesting which is spontaneous encourages to do last min. activities, page 208 true labor- contractions, bloody show , spontaneous rupture of membranes, strong, regular, consistent contractions dont go away with rest, cervix softens and dilates, consistent pattern of increasing frequency, duration, and intensity. Tend to increase when walking, begin in lower back and sweep around lower abdomen. May persist as back pain in some women, resemble menstrual cramps during early labor, includes progressive effacement and dilation false labor- with rest, hydration contractions will go away, no cervical dilation/effacement over period of time, are inconsistent in frequency, duration, and intensity. Do not change or may decrease with activity (such as walking). Is felt in abdomen and groin, may be more annoying than truly painful. Cervix does not significantly change in effacement or dilation

Discuss the various STDs- continued

page 750 trichomoniasis: symptoms: purulant vaginal discharge, frothy, yellow green or brownish gray, itching,edema, redness may be present. dx is made by identifying the organism in a wet mount. Treatments are metronidazole (Flagyl) or tinidazole (Tindamax) women should be advised against using alcohol during treatment. Sexual partners should refrain from intercourse until a cure is established. Reinfection may result. bacterial vaginosis: causes of bacterial proliferation are not known, although tissue trauma and vaginal intercourse have been identified as contributing factors, multiple partners, douching, and lack of vaginal lactobacilli are associated with bacterial vaginosis. Signs and symptoms are: thin, grayish white vaginal discharge that typically exudes fishy odor, Dx is made as wet mount slide. The women should refrain from sexual intercourse until cured. Treated with Flagyl Chlamydial Infection: Particularly high in sexually active teens and young adults. Asymptomatic in women, it should be suspected when male sexual partner is treated for urethritis and when culture results for gonorrhea are negative, yet the woman exhibits signs similar to gonorrhea, such as a yellowish discharge and painful urination. Undiagnosed chlamydial infection can cause pelvic inflammatory disorder. Treatment options include azithromycin gonorrhea: an infection of genitourinary tract, may be asymptomatic but when symptoms do occur they include: purulent discharge, dysuria, dyspareunia. Associated with PID, duel treatment of chlamydia and gonorrhea is often routine. All sexual partners should be treated and sex should be avoided until the man or women is cured.

Understand the physiologic changes in the birth process- Fetal response

placental circulation- baby responds to blood supply that is occurring with contraction, every time mother has contraction causes blood flow through placenta to the baby to stop temporarily and over time that temporary stop in blood flow to baby reduces oxygen baby is getting, uses up oxygen reserves that are in placenta or baby baby can show compromise of decrease oxygen which will show in fetal monitoring CV system- responds very quickly to events during labor, rate/rhythm of heart results from normal labor effects, fetal intolerance can be seen from labor as well pulmonary system- transition to outside uterus life as baby is pushed through canal the fluid in upper airways/ lung / thorax and rest of fluid is absorbed through interstitial system

Know the nurses role after a delivery

powerpoint care of infant- support cardiopulmonary and respiratory function, thermoregulation (best is skin to skin contact), band the baby and mom and partner, care of mom- observe for hemorrhage through vital signs, fundal checks, full bladder will impede uterus to contract down and maintain contraction state, monitor lochia amount and blood clots, observe perineal and labial areas for hematomas, monitor pain comfort, cleaning perineum, help promote early attachment first 2 hours of birth help new mom and baby start est breastfeeding

Discuss the key points to report for an SBAR for a laboring woman

• Situation Patient, Age, Room, Date/Time of Admission, Physician, Midwife, Multiple birth, Previous C-section, Ruptured membranes, High risk factors, Gestational age, Allergies, Comorbid conditions • Background Gravida/Para, GBS status, Allergies, rH, Labor History, Medications, Pain, Epidural, Lab work, IV, EFM • Assessment Patient is progressing within normal limits; no complications apparent, I am concerned about... • Recommendation I suggest or request that you..., On call/availability resources

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