MATERNAL NURSING

A nurse is aware that more teaching is necessary when a pregnant woman with gestational diabetes states: a. "I will eat only three meals a day." b. "I will decrease my complex carbohydrates to 40% of my diet." c. "I can increase my fat intake slightly during the pregnancy." d. "I will not eat any sugary snacks until after the baby is born."

a

An 8-month-pregnant woman with gestational diabetes has been admitted to the antepartal unit of the hospital for fetal surveillance. The woman's blood sugar at 2 PM was 70 mg/dL. The nurse should: a. Record this reassuring blood sugar reading. b. Offer the woman 4 ounces of apple juice. c. Administer the appropriate amount of regular insulin needed for this blood sugar level according to the sliding scale ordered. d. Reassess the blood sugar reading in 30 minutes.

b

Methergine or pitocin are prescribed for a client with PP hemorrhage. Before administering the medication(s), the nurse contacts the health provider who prescribed the medication(s) in which of the following conditions is documented in the client's medical history? A) Peripheral vascular disease B) Hypothyroidism C) Hypotension D) Type 1 diabetes

A) Peripheral vascular disease Rationale: These medications are avoided in clients with significant cardiovascular disease, peripheral disease, hypertension, eclampsia, or preeclampsia. These conditions are worsened by the vasoconstriction effects of these medications.

As part of the postpartum assessment, the nurse examines the breasts of a primiparous breastfeeding woman who is one day postpartum. An expected finding would be: A) Soft, non-tender; colostrum is present B) Leakage of milk at let down C) Swollen, warm, and tender upon palpation D) A few blisters and a bruise on each areola

A) Soft, non-tender; colostrum is present Rationale: Breasts are essentially unchanged for the first two to three days after birth. Colostrum is present and may leak from the nipples.

Which of the following factors might result in a decreased supply of breastmilk in a PP mother? A) Supplemental feedings with formula B) Maternal diet high in vitamin C C) An alcoholic drink D) Frequent feedings

A) Supplemental feedings with formula Rationale: Routine formula supplementation may interfere with establishing an adequate milk volume because decreased stimulation to the mother's nipples affects hormonal levels and milk production.

During the 3rd PP day, which of the following observations about the client would the nurse be most likely to make? A) The client appears interested in learning about neonatal care B) The client talks a lot about her birth experience C) The client sleeps whenever the neonate isn't present D) The client requests help in choosing a name for the neonate

A) The client appears interested in learning about neonatal care Rationale: The third to tenth days of PP care are the "taking-hold" phase, in which the new mother strives for independence and is eager for her neonate. The other options describe the phase in which the mother relives her birth experience.

Medications used to manage postpartum hemorrhage include (choose all that apply): A. Pitocin B. Methergine C. Terbutaline D. Hemabate E. Magnesium sulfate

A, B, D

A 34-year-old female is currently 16 weeks pregnant. You're collecting the patient's health history. She has the following health history: gravida 5, para 4, BMI 28, hypertension, depression, and family history of Type 2 diabetes. Select below all the risk factors in this scenario that increases this patient's risk for developing gestational diabetes? A. 34-years-old B. 16 weeks pregnant C. Gravida 5, para 4 D. BMI 28 E. Hypertension F. Depression G. Family history of Type 2 diabetes

A, C, D, and G. Remember from the lecture we talked about the risk factors for gestational diabetes. To help you remember the risk factors think of the word "MOMMA". Maternal age > 25, Obese or overweight (BMI >25), Macrosomia (fetal) previous babies greater than 9 lbs, Multiple pregnancies, A history (previous diagnoses of gestational diabetes or family history of diabetes).

Select all the signs and symptoms associated with Hepatitis? A. Arthralgia B. Bilirubin 1 mg/dL C. Ammonia 15 mcg/dL D. Dark urine E. Vision changes F. Yellowing of the sclera G. Fever H. Loss of appetite

A, D, F, G, and H. The bilirubin and ammonia levels are normal in these options, but they would be abnormal in Hepatitis. A normal bilirubin is 1 or less, and a normal ammonia is 15-45 mcg/dL.

A patient with viral Hepatitis states their flu-like symptoms have subsided. However, they now have yellowing of the skin and sclera along with dark urine. Based on this finding, this is what phase of Hepatitis? A. Icteric B. Posticteric C. Preicteric D. Convalescent

A.

How is Hepatitis E transmitted? A. Fecal-oral B. Percutaneous C. Mucosal D. Body fluids

A.

What PPH conditions are considered medical emergencies that require immediate treatment? A. Inversion of the uterus and hypovolemic shock B. Hypotonic uterus and coagulopathies C. Subinvolution of the uterus and idiopathic thrombocytopenic purpura D. Uterine atony and disseminated intravascular coagulation

A.

Which of the following statements are INCORRECT about exercise management for the diabetic patient? A. "I will check my blood glucose prior to exercise. If it is less than 200 I will eat a complex carb snack prior to exercising." B. "I plan on exercising for an extended period. So I will check my blood glucose prior, during, and after exercising." C. "My blood glucose is 268 and I have ketones in my urine. Therefore, I will avoid exercising today." D. All of the options are correct statements.

A.

A pregnant client is diagnosed with partial placenta previa. In explaining the diagnosis, the nurse tells the client that the usual treatment for partial placenta previa is which of the following? A. Activity limited to bed rest B. Platelet infusion C. Immediate cesarean delivery D. Labor induction with oxytocin

A. Treatment of partial placenta previa includes bed rest, hydration, and careful monitoring of the client's bleeding.

A patient has lab work drawn and it shows a positive HBsAg. What education will you provide to the patient? A. Avoid sexual intercourse or intimacy such as kissing until blood work is negative. B. The patient is now recovered from a previous Hepatitis B infection and is now immune. C. The patient is not a candidate from antiviral or interferon medications. D. The patient is less likely to develop a chronic infection.

A. A positive HBsAg (hepatitis B surface antigen) indicates an active Hepatitis B infection. Therefore, the patient should avoid sexual intercourse and other forms of intimacy until their HBsAg is negative.

A 22-year-old patient has presented to her primary care provider for her scheduled Pap smear. Abnormal results of this diagnostic test may imply infection with: a) human papillomavirus (HPV). b) Chlamydia trachomatis. c) Candida albicans. d) Trichomonas vaginalis.

A

A 36-year-old male is newly diagnosed with Type 2 diabetes. Which of the following treatments do you expect the patient to be started on initially? A. Diet and exercise regime B. Metformin BID by mouth C. Regular insulin subcutaneous D. None, monitoring at this time is sufficient enough

A

A client with a history of HSV-2 infection asks the nurse about future sexual activity. Which of the following responses would be most appropriate? a) "Inform all potential sexual partners about the infection, even if it is inactive.". b) "Use a condom during sexual activity if the infection becomes active again." c) "If the infection has healed, you probably don't have to use a condom." d) "Refrain from all sexual activity until you don't have another outbreak for a year."

A

A nurse performs an assessment on a client who is 4 hours PP. The nurse notes that the client has cool, clammy skin and is restless and excessively thirsty. The nurse prepares immediately to: A) Assess for hypovolemia and notify the health care provider B) Begin hourly pad counts and reassure the client C) Begin fundal massage and start oxygen by mask D) Elevate the head of the bed and assess vital signs

A

A nursing student, who you are precepting during their OB rotation, asks you when the fundus of the uterus is no longer palpable. You answer: A. at about 10 to 14 days B. at about 7 days C. at 6 weeks D. 48 hours after the delivery of the baby

A

A patient is scheduled to take 10 units of Humulin N at 1100. When is the patient most susceptible for hypoglycemia? A. 1900 B. 1300 C. 1130 D. 1500

A

A patient newly diagnosed with diabetes is about to be discharged home. You are watching the patient administer insulin. Which of the following actions causes you to re-educate them? A. They massaged the site after administering the insulin. B. They injected into the fat of their thighs. C. They used an opposite side for injection compared to the last insulin injection. D. They engaged the safety after administering the medication.

A

A pregnant woman at 28 weeks of gestation has been diagnosed with gestational diabetes. The nurse caring for this client should know that: a. Oral hypoglycemic agents are the preferred choice to control an elevated blood sugar level. b. Dietary modifications and insulin are both required for adequate treatment. c. Glucose levels are monitored by testing urine four times a day and at bedtime. d. Dietary management involves distributing nutrient requirements over three meals and two or three snacks.

A

Katrina Sterrett, a 26-year-old preschool teacher, is being seen by a physician who is part of the internist group where you practice nursing. She is undergoing her annual physical and is having many lab tests done as a condition of her employment and upcoming wedding. She is returning for her results and is devastated to learn that she has the sexually-transmitted infection, gonorrhea. What would contribute to her ignorance of her condition? a) Being asymptomatic b) All options are correct c) Being sexually inactive d) Knowing the signs and symptoms of STIs

A

The current incidence of STDs is related in part to: a. increased virulence of organisms causing STDS b. development of resistance of organisms to antibiotics c. increase in homosexuality

A

The perinatal nurse caring for the postpartum woman understands that late postpartum hemorrhage is most likely caused by: A. Subinvolution of the placental site B. Defective vascularity of the decidua C. Cervical lacerations D. Coagulation disorders

A

Type 1 diabetics typically have the following clinical characteristics: A. Thin, young with ketones present in the urine B. Overweight, young with no ketones present in the urine C. Thin, older adult with glycosuria D. Overweight, adult-aged with ketones present in the urine

A

A maternity nurse is caring for a client with abruptio placentae and is monitoring the client for disseminated intravascular coagulopathy. Which assessment finding is least likely to be associated with disseminated intravascular coagulation? A. Swelling of the calf in one leg B. Prolonged clotting times C. Decreased platelet count D. Petechiae, oozing from injection sites, and hematuria

A DIC is a state of diffuse clotting in which clotting factors are consumed, leading to widespread bleeding. Platelets are decreased because they are consumed by the process; coagulation studies show no clot formation (and are thus normal to prolonged); and fibrin plugs may clog the microvasculature diffusely, rather than in an isolated area. The presence of petechiae, oozing from injection sites, and hematuria are signs associated with DIC. Swelling and pain in the calf of one leg are more likely to be associated with thrombophlebitis.

A patient who has diabetes is nothing by mouth as prep for surgery. The patient states they feel like their blood sugar is low. You check the glucose and find it to be 52. The next nursing intervention would be to: A. Administer Dextrose 50% IV per protocol B. Continue to monitor the glucose C. Give the patient 4 oz of fruit juice D. None, this is a normal blood glucose reading

A This question requires critical thinking because the patient is NPO for surgery and can NOT eat but is experiencing hypoglycemia. Normally, you could give the patient 15 grams of a simple carbohydrate like 4 oz of fruit juice or soda, glucose tablets, gel etc. per hypoglycemia protocol However, the patient can NOT eat due to surgery prep. Therefore the nurse would need to administer Dextrose 50% IV per protocol to help increase the blood glucose and recheck the glucose level.

The nurse is caring for a client in labor. The external fetal monitor shows a pattern of variable decelerations in fetal heart rate. What should the nurse do first? A. Change the client's position. B. Prepare for emergency cesarean section. C. Administer oxygen. D. Check for placenta previa.

A Variable decelerations in fetal heart rate are an ominous sign, indicating compression of the umbilical cord. Changing the client's position from supine to side-lying may immediately correct the problem. An emergency cesarean section is necessary only if other measures, such as changing position and amnioinfusion with sterile saline, prove unsuccessful. Administering oxygen may be helpful, but the priority is to change the woman's position and relieve cord compression.

Select all the types of viral Hepatitis that have preventive vaccines available in the United States? A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D E. Hepatitis E

A and B. Currently there is only a vaccine for Hepatitis A and B in the U.S.

A patient is diagnosed with Hepatitis D. What statement is true about this type of viral Hepatitis? Select all that apply: A. The patient will also have the Hepatitis B virus. B. Hepatitis D is most common in Southern and Eastern Europe, Mediterranean, and Middle East. C. Prevention of Hepatitis D includes handwashing and the Hepatitis D vaccine. D. Hepatitis D is most commonly transmitted via the fecal-oral route.

A and B. These are true statements about Hepatitis D. Prevention for Hepatitis D includes handwashing and the Hepatitis B vaccine (since it occurs only with the Hepatitis B virus). It is transmitted via blood.

Select all of the physiological maternal changes that occur during the PP period. (Select all that apply) A) Cervical involution occurs B) Vaginal distention decreases slowly C) Fundus begins to descend into the pelvis after 24 hours D) Cardiac output decreases with resultant tachycardia in the first 24 hours E) Digestive processes slow immediately

A and C

Which statements are INCORRECT regarding the anatomy and physiology of the liver? Select all that apply: A. The liver has 3 lobes and 8 segments. B. The liver produces bile which is released into the small intestine to help digest fats. C. The liver turns urea, a by-product of protein breakdown, into ammonia. D. The liver plays an important role in the coagulation process.

A and C. The liver has 2 lobes (not 3), and the liver turns ammonia (NOT urea), which is a by-product of protein breakdown, into ammonia. All the other statements are true about liver's anatomy and physiology.

You're providing an in-service on viral hepatitis to a group of healthcare workers. You are teaching them about the types of viral hepatitis that can turn into chronic infections. Which types are known to cause ACUTE infections ONLY? Select all that apply: A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D E. Hepatitis E

A and E. Only Hepatitis A and E cause ACUTE infections, not chronic. Hepatitis B, C, and D can cause both acute and chronic infections.

A patient is 35 weeks pregnant. She has gestational diabetes and uncontrolled hyperglycemia. Her current blood glucose is 290 mg/dL. You administer insulin per physician's order and recheck the blood glucose level per protocol. It is now 135 mg/dL. Which statement by the patient requires you to notify the physician? A. "It burns when I urinate." B. "My back is hurting." C. "I feel tired." D. "I feel the baby kick about 10 times an hour."

A. Gestational diabetes places a patient at risk for urinary tract infections because the glucose can leak into the urine leading to infection (remember bacteria thrive on glucose). This scenario tells us the patient has uncontrolled hyperglycemia, which definitely puts her at risk for glycosuria (glucose in the urine). The physician should be notified if the patient reports burning on urination so a urine analysis can be performed. All the other options are normal findings in a pregnancy at this stage.

You administered 5 units of Humalog at 0800. What is the ONSET and DURATION of this medication? A. Onset: 15 minutes, Duration: 3 hours B. Onset: 2 hours, Duration: 16 hours C. Onset: 30 minutes, Duration: 1 hour D. Onset: 2 hours, Duration: 24 hours

A. Humalog is a rapid-acting insulin. It has an onset: 15 minutes and duration: 3 hours Watch the YouTube video to learn the mnemonics on how to remember these times...very helpful.

You're performing a head-to-toe assessment on a patient admitted with abruptio placentae. Which of the following assessment findings would you immediately report to the physician? A. Oozing around the IV site B. Tender uterus C. Hard abdomen D. Vaginal bleeding

A. Oozing around the IV site can indicate the patient is entering into DIC (disseminated intravascular coagulation) because clotting levels have been depleted. Therefore, the MD should be notified. Option B, C, and D are findings found in this condition, but Option A is a SEVERE complication that can develop from it.

Which patients below are at risk for developing complications related to a chronic hepatitis infection, such as cirrhosis, liver cancer, and liver failure? Select all that apply: A. A 55-year-old male with Hepatitis A. B. An infant who contracted Hepatitis B at birth. C. A 32-year-old female with Hepatitis C who reports using IV drugs. D. A 50-year-old male with alcoholism and Hepatitis D. E. A 30-year-old who contracted Hepatitis E.

B, C, and D. Infants or young children who contract Hepatitis B are at a very high risk of developing chronic Hepatitis B (which is why option B is correct). Option C is correct because most cases of Hepatitis C turn into chronic cases and IV drug use increases this risk even more. Option D is correct because Hepatitis D occurs when Hepatitis B is present and constant usage of alcohol damages the liver. Therefore, the patient is at high risk of developing chronic hepatitis. Hepatitis A and E tend to only cause acute infections, not chronic.

A patient with Hepatitis has a bilirubin of 6 mg/dL. What findings would correlate with this lab result? Select all that apply: A. None because this bilirubin level is normal B. Yellowing of the skin and sclera C. Clay-colored stools D. Bluish discoloration on the flanks of the abdomen E. Dark urine F. Mental status changes

B, C, and E. This is associated with a high bilirubin level. A normal bilirubin level is 1 or less.

nurse is preparing a list of self-care instructions for a PP client who was diagnosed with mastitis. (Select all that apply) A) Take the prescribed antibiotics until the soreness subsides. B) Wear supportive bra C) Avoid decompression of the breasts by breastfeeding or breast pump D) Rest during the acute phase E) Continue to breastfeed if the breasts are not too sore.

B, D, E Rationale: Mastitis are an infection of the lactating breast. Client instructions include resting during the acute phase, maintaining a fluid intake of at least 3 L a day, and taking analgesics to relieve discomfort. Antibiotics may be prescribed and are taken until the complete prescribed course is finished. They are not stopped when the soreness subsides. Additional supportive measures include the use of moist heat or ice packs and wearing a supportive bra. Continued decompression of the breast by breastfeeding or pumping is important to empty the breast and prevent formation of an abscess.

The perinatal nurse is caring for a woman in the immediate postbirth period. Assessment reveals that the woman is experiencing profuse bleeding. The most likely etiology for the bleeding is: A. Uterine atony B. Uterine inversion C. Vaginal hematoma D. Vaginal laceration

A. Uterine atony is marked hypotonia of the uterus. It is the leading cause of postpartum hemorrhage. Uterine inversion may lead to hemorrhage, but it is not the most likely source of this client's bleeding. Furthermore, if the woman was experiencing a uterine inversion, it would be evidenced by the presence of a large, red, rounded mass protruding from the introitus. A vaginal hematoma may be associated with hemorrhage. However, the most likely clinical finding would be pain, not the presence of profuse bleeding. A vaginal laceration may cause hemorrhage, but it is more likely that profuse bleeding would result from uterine atony. A vaginal laceration should be suspected if vaginal bleeding continues in the presence of a firm, contracted uterine fundus.

A patient with Hepatitis is extremely confused. The patient is diagnosed with Hepatic Encephalopathy. What lab result would correlate with this mental status change? A. Ammonia 100 mcg/dL B. Bilirubin 7 mg/dL C. ALT 56 U/L D. AST 10 U/L

A. When ammonia levels become high (normal 15-45 mcg/dL) it affects brain function. Therefore, the nurse would see mental status changes in a patient with this ammonia level.

A patient who is 25 weeks pregnant has partial placenta previa. As the nurse you're educating the patient about the condition and self-care. Which statement by the patient requires you to re-educate the patient? A. "I will avoid sexual intercourse and douching throughout the rest of the pregnancy." B. "I may start to experience dark red bleeding with pain." C. "I will have another ultrasound at 32 weeks to re-assess the placenta's location." D. "My uterus should be soft and non-tender."

B. All the other options are CORRECT about partial placenta previa. Option B is WRONG because this condition will present with PAINLESS, bright red bleeding NOT with pain and dark red bleeding, which happens in abruptio placentae.

Your patient is 36 weeks pregnant and has gestational diabetes. Which lab result below is euglycemic? A. Blood glucose 55 mg/dL B. Blood glucose 82 mg/dL C. Blood glucose 148 mg/dL D. Blood glucose 325 mg/dL

B. Euglycemic means "normal" blood glucose level. Typically a normal blood glucose level is about 70-140 mg/dL. The only option that reflects a normal blood glucose level is option B: 82 mg/dL...Option A is HYPOglycemic, Option C is slightly HYPERglycemic, Option D is HYPERglycemic.

A patient with Type 2 Diabetes is started on the medication Glyburide. Which of the following statements by the patient causes concern? A. "I will monitor my blood glucose regularly because I know this medication can cause a low blood sugar." B. "I will consume no more than 8 oz. of alcohol per week." C. "I will continue monitoring my diet and participating in exercise while taking this medication." D. "This medication works by stimulating the beta cells in the pancreas to make insulin."

B. Glyburide is a sulfonylureas diabetic medication and a patient should NEVER consume alcohol while taking this medication because it can cause severe hypoglycemia.

A patient was exposed to Hepatitis B recently. Postexposure precautions include vaccination and administration of HBIg (Hepatitis B Immune globulin). HBIg needs to be given as soon as possible, preferably ___________ after exposure to be effective. A. 2 weeks B. 24 hours C. 1 month D. 7 days

B. HBIg should be given 24 hours after exposure to maximum effectiveness of temporary immunity against Hepatitis B. It would be given within 12 hours after birth to an infant born to a mother who has Hepatitis B.

What woman is at greatest risk for early postpartum hemorrhage? A. A primiparous woman (G 2 P 1 0 0 1) being prepared for an emergency cesarean birth for fetal distress B. A woman with severe preeclampsia on magnesium sulfate whose labor is being induced C. A multiparous woman (G 3 P 2 0 0 2) with an 8-hour labor D. A primigravida in spontaneous labor with preterm twins

B. Magnesium sulfate administration during labor poses a risk for PPH. Magnesium acts as a smooth muscle relaxant, thereby contributing to uterine relaxation and atony

A patient is scheduled to take a morning dose of Metformin. The patient is scheduled for surgery tomorrow. Which of the following nursing interventions are correct? A. Administer the medication as ordered. B. Hold the dose and notify the doctor for further orders. C. Administer the medication as ordered but hold the next day's dose. D. Check the patient's blood glucose prior to administering the medication.

B. Metformin (Glucophage) is held 48 hours prior to surgery (however a doctor's order is needed for this). Therefore, you should hold the dose and call the doctor for further orders.

Which patient below is at MOST risk for developing a complication related to a Hepatitis E infection? A. A 45-year-old male with diabetes. B. A 26-year-old female in the 3rd trimester of pregnancy. C. A 12-year-old female with a ventricle septal defect. D. A 63-year-old male with cardiovascular disease.

B. Patients who are in the 3rd trimester of pregnancy are at a HIGH risk of developing a complication related to a Hepatitis E infection.

You're discharging a patient who just gave birth to a baby at 39 weeks gestation. The patient had gestational diabetes throughout her pregnancy. Her blood glucose levels have now returned to normal. When should the patient first follow-up with her physician for blood glucose testing? A. 1-3 years B. 6-12 weeks postpartum C. 1 year postpartum D. Not applicable since this condition has resolved and only occurs during pregnancy

B. Patients who've had gestational diabetes are at high risk for developing Type 2 diabetes. She should first follow-up with her physician at 6-12 weeks postpartum for initial blood glucose testing. After this, she should follow-up 1-3 years for blood glucose testing since there is a high risk of her developing Type 2 diabetes.

A 28 year old female, who is 33 weeks pregnant with her second child, has uncontrolled hypertension. What risk factor below found in the patient's health history places her at risk for abruptio placentae? A. childhood polio B. preeclampisa C. c-section D. her age

B. Preeclampisa is a risk factor for experiencing abruptio placentae. The patient is at risk for developing this condition again since she is currently experiencing uncontrolled hypertension with this pregnancy.

Which of the following patients is at most risk for Type 2 diabetes? A. A 6 year old girl recovering from a viral infection with a family history of diabetes. B. A 28 year old male with a BMI of 49. C. A 76 year old female with a history of cardiac disease. D. None of the options provided.

B. Remember Type 2 diabetes risk factors are related to lifestyle. Being obese is a risk factor (BMI >30 in males is considered obese). So, the 28 year old male with a BMI of 49 is most at risk for Type 2.

A patient is scheduled to take 5 units of Humulin R and 10 units of NPH. What is the proper way of mixing these insulins? A. These insulins cannot be mixed, therefore, should be drawn up in different syringes. B. Draw-up the Humulin R insulin first and then the NPH insulin. C. Draw-up 2.5 units of NPH, then 10 units of Humulin R, and then finish drawing up 2.5 units of NPH. D. Draw-up the NPH insulin first and then the Humulin R insulin.

B. Remember when drawing up regular and intermediate insulins, you draw-up clear (regular insulins) to cloudy (NPH intermediate). Remember the mnemonic R.N.

Nurses should first look for the most common cause of PPH, _____, by _____. A. Lacerations of the genital tract; checking for the source of blood B. Uterine atony; evaluating the contractility of the uterus C. Inversion of the uterus; feeling for a smooth mass through the dilated cervix D. Retained placenta; noting the type of bleeding

B. The leading cause of PPH is uterine atony, which complicates one in 20 births. The uterus is overstretched and contracts poorly after the birth.

The liver receives blood from two sources. The _____________ is responsible for pumping blood rich in nutrients to the liver. A. hepatic artery B. hepatic portal vein C. mesenteric artery D. hepatic iliac vein

B. The liver receives blood from two sources. The hepatic portal vein is responsible for pumping blood rich in nutrients to the liver.

A patient with diabetes is experiencing a blood glucose of 275 when waking. What is a typical treatment for this phenomenon? A. None, this is a normal blood glucose reading. B. The patient may need a night time dose of an intermediate-acting insulin to counteract the morning hyperglycemia. C. A bedtime snack may prevent this phenomenon. D. This is known as the Somogyi effect and requires decreasing the bedtime dose of insulin.

B. This is known as the DAWN PHENOMENON and is best treated with a night time dose of an intermediate-acting insulin to counteract the morning hyperglycemia.

In caring for an immediate postpartum client, you note petechiae and oozing from her IV site. You would monitor her closely for the clotting disorder: A. Disseminated intravascular coagulation B. Amniotic fluid embolism C. Hemorrhage D. HELLP syndrome

A. The diagnosis of DIC is made according to clinical findings and laboratory markers. Physical examination reveals unusual bleeding. Petechiae may appear around a blood pressure cuff on the woman's arm. Excessive bleeding may occur from the site of a slight trauma, such as venipuncture sites. B. Incorrect: These symptoms are not associated with AFE, nor is AFE a bleeding disorder. C. Incorrect: Hemorrhage occurs for a variety of reasons in the PP client. These symptoms are associated with DIC. Hemorrhage would be a finding associated with DIC and is not a clotting disorder in and of itself. D. Incorrect: HELLP is not a clotting disorder, but it may contribute to the clotting disorder DIC.

A PP nurse is assessing a mother who delivered a healthy newborn infant by C-section. The nurse is assessing for signs and symptoms of superficial venous thrombosis. Which of the following signs or symptoms would the nurse note if superficial venous thrombosis were present? A) Paleness of the calf area B) Enlarged, hardened veins C) Coolness of the calf area D) Palpable dorsalis pedis pulses

B

A PP nurse is providing instructions to a woman after delivery of a healthy newborn infant. The nurse instructs the mother that she should expect normal bowel elimination to return: A) One the day of the delivery B) 3 days PP C) 7 days PP D) within 2 weeks PP

B

A Type 2 diabetic may have all the following signs or symptoms EXCEPT: A. Blurry vision B. Ketones present in the urine C. Glycosuria D. PoA 34-year-old female is currently 16 weeks pregnant. You're collecting the patient's health history. She has the following health history: gravida 5, para 4, BMI 28, hypertension, depression, and family history of Type 2 diabetes. Select below all the risk factors in this scenario that increases this patient's risk for developing gestational diabetes? A. 34-years-old B. 16 weeks pregnant C. Gravida 5, para 4 D. BMI 28 E. Hypertension F. Depression G. Family history of Type 2 diabetesor wound healing

B

A client is being treated for gonorrhea. Which agent would the nurse expect the physician to prescribe? a) Tetracycline b) Ceftriaxone c) Penicillin d) Levofloxacin

B

A client with primary syphilis is allergic to penicillin. The nurse would expect the physician to order which agent? a) Podophyllum resin b) Tetracycline c) Ceftriaxone d) Acyclovir

B

A male patient comes to the clinic and is diagnosed with gonorrhea. Which symptom most likely prompted him to seek medical attention?a) Painful red papules on the shaft of the penis b) Foul-smelling discharge from the penis c) Rashes on the palms of the hands and soles of the feet d) Cauliflower-like warts on the penis

B

A newly diagnosed pregnant woman has diabetes mellitus, type 2. When planning the prenatal care for this woman, the nurse identifies actions based on the knowledge that: a. Insulin needs increase during the first trimester and decrease thereafter. b. The danger of diabetic ketoacidosis is highest during the second and third trimesters. c. Oligohydramnios can occur, leading to fetal distress during labor. d. Maternal blood glucose levels need to be maintained between 125 and 135 mg/dL.

B

A nurse is caring for a client diagnosed with a chlamydia infection. The nurse teaches the client about disease transmission and advises the client to inform his sexual partners of the infection. The client refuses, stating, "This is my business and I'm not telling anyone. Beside, chlamydia doesn't cause any harm like the other STDs." How should the nurse proceed? a) Do nothing because the client's sexual habits place him at risk for contracting other STDs. b) Educate the client about why it's important to inform sexual contacts so they can receive treatment. c) Inform the health department that this client contracted an STD. d) Inform the client's sexual contacts of their possible exposure to chlamydia.

B

A nurse is monitoring a new mother in the PP period for signs of hemorrhage. Which of the following signs, if noted in the mother, would be an early sign of excessive blood loss? A) A temperature of 100.4*F B) An increase in the pulse from 88 to 102 BPM C) An increase in the respiratory rate from 18 to 22 breaths per minute D) A blood pressure change from 130/88 to 124/80 mm Hg

B

A nurse is teaching a health class to a group of clients likely to be at highest risk for gonorrhea. What is the age range of the clients? a) 60 to 70 years b) 15 to 24 years c) 25 to 29 years d) 30 to 45 years

B

A patient has herpes simplex 2 viral infection (HSV-2). The nurse recognizes that which of the following should be included in teaching the patient? a) The virus causes "cold sores" of the lips. b) Treatment is focused on relieving symptoms .c) The virus may be cured with antibiotics. d) The virus when active may not be contracted during intercourse.

B

A patient is 40 weeks pregnant, and you find the fundal height to be 4 cm below the xiphoid process. Your next nursing action is to: A. Notify the MD immediately B. Chart this as a normal finding C. Place the patient on continuous fetal monitoring D. Assess the baby's heart rate with a Doppler

B

A patient with diabetes has a morning glucose of 50. The patient is sweaty, cold, and clammy. Which of the following nursing interventions is the MOST important? A. Recheck the glucose level B. Give the patient ½ cup (4 oz) of fruit juice C. Call the doctor D. Keep the patient nothing by mouth

B

A student nurse is caring for a male patient diagnosed with gonorrhea. The patient is receiving ceftriaxone and doxycycline. The nursing instructor asks the student why the patient is receiving two antibiotics. What is the student nurse's best response? a) "This combination of medications will eradicate the infection faster than a single antibiotic." b) "Many people infected with gonorrhea are infected with chlamydia as well." c) "The combination of these two antibiotics reduces the risk of reinfection." d) "There are many resistant strains of gonorrhea, so more than one antibiotic may be required for successful treatment."

B

A woman with gestational diabetes is at 36 weeks' gestation. On the regular antepartal visit, the woman tells the nurse, "I am so excited. My blood sugars have gone down and I have been able to decrease the amount of insulin I need by about half." The nurse should be aware that this is an indication of a: a. Diabetic in good glycemic control. b. Fetal problem that needs further investigation. c. Placental problem that needs further investigation. d. Maternal pancreas that is increasing its insulin production.

B

During a prenatal visit, you are assessing the fundal height. You find the fundus of the uterus to be right above the symphysis pubis. Based on this finding the patient is about how far along in her pregnancy? A. 20 weeks B. 12 weeks C. 16 weeks D. 24 weeks

B

When is a patient most susceptible to hypoglycemic symptoms after the administration of insulin? A. Onset B. Peak C. Duration D. Duration & Peak

B

When performing a PP assessment on a client, the nurse notes the presence of clots in the lochia. The nurse examines the clots and notes that they are larger than 1 cm. Which of the following nursing actions is most appropriate? A) Document the findings B) Notify the physician C) Reassess the client in 2 hours D) Encourage increased intake of fluids

B

Which finding while measuring the fundal height of a patient who is 36 weeks pregnant would require immediate action? A. The fundal height measures at 38 cm. B. The patient complains of feeling lightheaded and dizzy. C. The fundus of the uterus is at the xiphoid process. D. The patient states she cannot sleep at night.

B

Which of the following patient statements about the diabetic diet regime is correct? A. "I'll try to consume about 20% carbs and 40% fats on a daily basis." B. "Foods that are high in mono and poly fats are avocados, olives, and nuts." C. "Meats increase the glycemic index; therefore, I should only consume 5% of them on a daily basis." D. "I should completely avoid starchy vegetables like potatoes and corn."

B

Which of the following statements are true regarding Type 2 diabetes treatment? A. Insulin and oral diabetic medications are administered routinely in the treatment of Type 2 diabetes. B. Insulin may be needed during times of surgery or illness. C. Insulin is never taken by the Type 2 diabetic. D. Oral medications are the first line of treatment for newly diagnosed Type 2 diabetics.

B

Which pregnancy hormones are responsible for creating insulin resistance in maternal cells? Select all that apply. a. FSH (follicle- stimulating hormone) b. Estrogen c. Progesterone d. HPL (human placental lactogen) e. LH (luteinizing hormone) f. Testosterone

B

Within the free clinic where you practice nursing, you hold weekly sexual education classes open to the public. Within the classroom, you communicate the CDC's numbers for the incidence of STIs and their impact upon public health. Which is the fastest-spreading bacterial STI in the United States? a) Gonorrhea b) Chlamydia c) Herpes simplex 1 d) HPV

B

The nurse examines a woman one hour after birth. The woman's fundus is boggy, midline, and 1 cm below the umbilicus. Her lochial flow is profuse, with two plum-sized clots. The nurse's initial action would be to: A) Place her on a bedpan to empty her bladder B) Massage her fundus C) Call the physician D) Administer Methergine 0.2 mg IM which has been ordered prn

B A boggy or soft fundus indicates that uterine atony is present. This is confirmed by the profuse lochia and passage of clots. The first action would be to massage the fundus until firm, followed by 3 and 4, especially if the fundus does not become or remain firm with massage. There is no indication of a distended bladder since the fundus is midline and below the umbilicus.

Which of the following would the nurse assess in a client experiencing abruptio placenta? A. Bright red, painless vaginal bleeding B. Concealed or external dark red bleeding C. Palpable fetal outline D. Soft and nontender abdomen

B A client with abruptio placentae may exhibit concealed or dark red bleeding, possibly reporting sudden intense localized uterine pain. The uterus is typically firm to boardlike, and the fetal presenting part may be engaged. Bright red, painless vaginal bleeding, a palpable fetal outline and a soft nontender abdomen are manifestations of placenta previa.

A patient has a 3 hour glucose tolerance test performed. The results are the following: Fasting 94 mg/dL, 1 hour 210 mg/dL, 2 hour 180 mg/dL, 3 hour 130 mg/dL. Identify which results are abnormal: Select all that apply: A. Fasting result B. 1 hour result C. 2 hour result D. 3 hour result

B and C. Abnormal results for a 3 hour glucose tolerance test are: Fasting >95 mg/dL, 1 hour >180 mg/dL, 2 hour >155 mg/dL, 3 hour >140 mg/dL

You're providing an educational class for pregnant women about gestational diabetes. You discuss the role of insulin in the body. Select all the CORRECT statements about the role and function of insulin: A. "Insulin is a type of cell that provides glucose to the body from the blood." B. "Insulin is a hormone secreted by the beta cells of the pancreas." C. "Insulin influences cells by causing them to uptake glucose from the blood." D. "Insulin is a protein that helps carry glucose into the cell for energy."

B and C. Insulin is a HORMONE secreted by the beta cells found in the pancreas. It influences or causes cells to take in glucose from the blood. Option A and D are incorrect statements about insulin.

A patient has gestational diabetes and is currently 34 weeks pregnant. Which assessment findings below should you immediately report to the physician? Select all that apply: A. Blood glucose 129 mg/dL B. Blood pressure 190/102 C. Proteinuria D. Linea nigra E. Negative glycosuria

B and C. Preeclampsia is a potential complication of gestational diabetes. It can cause hypertension (option B) and protein in the urine (option C). Option A is a normal blood glucose reading, option D is a normal finding during pregnancy, and option E is a normal finding (an abnormal finding would be positive glycosuria...meaning there is glucose leaking in the urine).

A baby is born at 37 weeks gestation to a mother with gestational diabetes. As the nurse you know at birth that the newborn is at risk for? Select all that apply: A. Hyperglycemia B. Hypoglycemia C. Respiratory distress D. Jaundice E. Hyperthermia

B and C. The newborn is at risk for hypoglycemia and respiratory distress. When a baby of a mom, who has gestational diabetes, is still in utero there is a constant high supply of glucose. This causes the baby to increase its fat stores (producing a large baby) and create a lot of insulin to deal with the high glucose it is receiving from mom. BUT once the baby leaves utero, the glucose supply decreases but the baby still has a lot of insulin on board. This can lead to a drop in blood glucose (hypoglycemia) at birth. In addition, uncontrolled gestational diabetes can affect lung maturity in babies and this increases the newborn's risk of respiratory distress at birth.

During the posticteric phase of Hepatitis the nurse would expect to find? Select all that apply: A. Increased ALT and AST levels along with an increased bilirubin level B. Decreased liver enzymes and bilirubin level C. Flu-like symptoms D. Resolved jaundice and dark urine

B and D.

Methergine or pitocin is prescribed for a woman to treat PP hemorrhage. Before administration of these medications, the priority nursing assessment is to check the: A) Amount of lochia B) Blood pressure C) Deep tendon reflexes D) Uterine tone

B) Blood pressure Rationale: Methergine and pitocin are agents that are used to prevent or control postpartum hemorrhage by contracting the uterus. They cause continuous uterine contractions and may elevate blood pressure. A priority nursing intervention is to check blood pressure. The physician should be notified if hypertension is present.

On which of the postpartum days can the client expect lochia serosa? A) Days 3 and 4 PP B) Days 3 to 10 PP C) Days 10-14 PP D) Days 14 to 42 PP

B) Days 3 to 10 PP Rationale: On the third and fourth PP days, the lochia becomes a pale pink or brown and contains old blood, serum, leukocytes, and tissue debris. This type of lochia usually lasts until PP day 10. Lochia rubra usually last for the first 3 to 4 days PP. Lochia alba, which contain leukocytes, decidua, epithelial cells, mucus, and bacteria, may continue for 2 to 6 weeks PP

Which of the following changes best described the insulin needs of a client with type 1 diabetes who has just delivered an infant vaginally without complications? A) Increase B) Decrease C) Remain the same as before pregnancy D) Remain the same as during pregnancy

B) Decrease Rationale: The placenta produces the hormone human placental lactogen, an insulin antagonist. After birth, the placenta, the major source of insulin resistance, is gone. Insulin needs decrease and women with type 1 diabetes may only need one-half to two-thirds of the prenatal insulin during the first few PP days.

Which of the following physiological responses is considered normal in the early postpartum period? A) Urinary urgency and dysuria B) Rapid diuresis C) Decrease in blood pressure D) Increase motility of the GI system

B) Rapid diuresis Rationale: In the early PP period, there's an increase in the glomerular filtration rate and a drop in the progesterone levels, which result in rapid diuresis. There should be no urinary urgency, though a woman may feel anxious about voiding. There's a minimal change in blood pressure following childbirth, and a residual decrease in GI motility.

Select all the ways a person can become infected with Hepatitis B: A. Contaminated food/water B. During the birth process C. IV drug use D. Undercooked pork or wild game E. Hemodialysis F. Sexual intercourse

B, C, E, and F. Hepatitis B is spread via blood and body fluids. It could be transmitted via the birthing process, IV drug use, hemodialysis, or sexual intercourse etc.

A female college student is distressed at the recent appearance of genital warts, an assessment finding that her care provider has confirmed as attributable to human papillomavirus (HPV) infection. Which of the following information should the nurse give the patient? a) "It's important to start treatment soon, so you will be prescribed pills today." b) "I'd like to give you an HPV vaccination if that's okay with you." c) "There is a chance that these will clear up on their own without any treatment." d) "Unfortunately, this is going to greatly increase your chance of developing pelvic inflammatory disease."

C

A nurse is caring for a PP woman who has received epidural anesthesia and is monitoring the woman for the presence of a vulva hematoma. Which of the following assessment findings would best indicate the presence of a hematoma? A) Complaints of a tearing sensation B) Complaints of intense pain C) Changes in vital signs D) Signs of heavy bruising

C

One hour after delivery where do you expect to find the fundus of the uterus? A. 4 cm below the xiphoid process B. right above the symphysis pubis C. At the umbilicus D. 2 cm below the umbilicus

C

The most effective and least expensive treatment of puerperal infection is prevention. What is important in this strategy? A. Large doses of vitamin C during pregnancy B. Prophylactic antibiotics C. Strict aseptic technique, including handwashing, by all health care personnel D. Limited protein and fat intake

C

Which of the following insulins can be administered intravenously? A. NPH B. Lantus C. Humulin R D. Novolog

C

Which of the following is associated with preexisting diabetes in a pregnant woman, but not in a woman with gestational diabetes? a. Neonatal hypocalcemia b. Neonatal hypoglycemia c. Congenital malformations d. Macrosomia

C

Which of the following symptoms do NOT present in hyperglycemia? A. Extreme thirst B. Hunger C. Blood glucose <60 mg/dL D. Glycosuria

C

You're assessing a patient's chart and find that the patient is 36 weeks pregnant. Where should you find the fundus of the uterus during your assessment of fundal height? A. midway between the umbilicus and xiphoid process B. about 4 cm below the xiphoid process C. at the xiphoid process D. 5 cm above the umbilicus

C

You're providing discharge teaching to a new mother who is going home after a vaginal delivery. The woman asks when the uterus will return to its pre-pregnancy size. Your response is? A. At about 14 days B. At about 6 months C. At about 6 weeks D. At about 7 days

C

Your patient is 24 weeks pregnant, and you're measuring the fundal height. Which finding below is a normal measurement for this patient? A. 16 cm B. 28 cm C. 26 cm D. 12 cm

C

new mother received epidural anesthesia during labor and had a forceps delivery after pushing 2 hours. At 6 hours PP, her systolic blood pressure has dropped 20 points, her diastolic BP has dropped 10 points, and her pulse is 120 beats per minute. The client is anxious and restless. On further assessment, a vulvar hematoma is verified. After notifying the health care provider, the nurse immediately plans to: A) Monitor fundal height B) Apply perineal pressure C) Prepare the client for surgery. D) Reassure the client

C

A pregnant woman arrives at the emergency department (ED) with abruptio placentae at 34 weeks' gestation. She's at risk for which of the following blood dyscrasias? A. Thrombocytopenia. B. Idiopathic thrombocytopenic purpura (ITP). C. Disseminated intravascular coagulation (DIC). D. Heparin-associated thrombosis and thrombocytopenia (HATT).

C Abruptio placentae is a cause of DIC because it activates the clotting cascade after hemorrhage. Option A: Thrombocytopenia results from decreased production of platelets. Option B: ITP doesn't have a definitive cause. Option D: A patient with abruptio placentae wouldn't get heparin and, as a result, wouldn't be at risk for HATT.

A patient is scheduled to take 7 units of Humulin R at 0830. You administer Humulin R at 0900 in the right thigh. When do you expect this medication to peak? A. 1300 B. 0930 C. 1100 D. 1700

C Humulin-R is a SHORT-ACTING insulin which has a PEAK time of 2 hours. If you gave the medication at 0900, it would peak at 1100.

A nurse is assessing a pregnant client in the 2nd trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which of the following assessment findings would the nurse expect to note if this condition is present? A. Absence of abdominal pain B. A soft abdomen C. Uterine tenderness/pain D. Painless, bright red vaginal bleeding

C In abruptio placentae, acute abdominal pain is present. Uterine tenderness and pain accompany placental abruption, especially with a central abruption and trapped blood behind the placenta. The abdomen will feel hard and board-like on palpation as the blood penetrates the myometrium and causes uterine irritability. Observation of the fetal monitoring often reveals increased uterine resting tone, caused by the failure of the uterus to relax in an attempt to constrict blood vessels and control bleeding.

Which of the following insulins has no peak but a duration of 24 hours? A. NPH B. Novolog C. Lantus D. Humulin N

C Lantus is the only option here that is a LONG-ACTING insulin which has NO peak and a 24 hour duration.

A maternity nurse is preparing for the admission of a client in the 3rd trimester of pregnancy that is experiencing vaginal bleeding and has a suspected diagnosis of placenta previa. The nurse reviews the physician's orders and would question which order? A. Prepare the client for an ultrasound B. Obtain equipment for external electronic fetal heart monitoring C. Obtain equipment for a manual pelvic examination D. Prepare to draw a Hgb and Hct blood sample

C Manual pelvic examinations are contraindicated when vaginal bleeding is apparent in the 3rd trimester until a diagnosis is made and placental previa is ruled out. Digital examination of the cervix can lead to maternal and fetal hemorrhage. A diagnosis of placenta previa is made by ultrasound. The H/H levels are monitored, and external electronic fetal heart rate monitoring is initiated. External fetal monitoring is crucial in evaluating the fetus that is at risk for severe hypoxia.

Which of the following increases the risk of placental abruption? A. Age < 35 years B. Gestational diabetes C. Previous placental abruption D. Strenuous exercise

C Previous placental abruption. The risk of placental abruption is increased 15- to 20-fold if an earlier pregnancy had been complicated by placental abruption.6 Other risk factors include chronic hypertension, cocaine use, preeclampsia, age over 35 years, trauma, thrombophilia, cigarette smoking, preterm premature rupture of membranes, chorioamnionitis, and multiparity

An ultrasound is performed on a client at term gestation that is experiencing moderate vaginal bleeding. The results of the ultrasound indicate that an abruptio placentae is present. Based on these findings, the nurse would prepare the client for: A. Complete bed rest for the remainder of the pregnancy B. Delivery of the fetus C. Strict monitoring of intake and output D. The need for weekly monitoring of coagulation studies until the time of delivery

C The goal of management in abruptio placentae is to control the hemorrhage and deliver the fetus as soon as possible. Delivery is the treatment of choice if the fetus is at term gestation or if the bleeding is moderate to severe and the mother or fetus is in jeopardy.

Which of the following is NOT a common source of transmission for Hepatitis A? Select all that apply: A. Water B. Food C. Semen D. Blood

C and D. The most common source for transmission of Hepatitis A is water and food.

You're providing education to a patient with an active Hepatitis B infection. What will you include in their discharge instructions? Select all that apply: A. "Take acetaminophen as needed for pain." B. "Eat large meals that are spread out through the day." C. "Follow a diet low in fat and high in carbs." D. "Do not share toothbrushes, razors, utensils, drinking cups, or any other type of personal hygiene product." E. "Perform aerobic exercises daily to maintain strength."

C and D. The patient should NOT take acetaminophen (Tylenol) due to its effective on the liver. The patient should eat small (NOT large), but frequent meals...this may help with the nausea. The patient should rest (not perform aerobic exercises daily) because this will help with liver regeneration.

Which measure would be least effective in preventing postpartum hemorrhage? A) Administer Methergine 0.2 mg every 6 hours for 4 doses as ordered B) Encourage the woman to void every 2 hours C) Massage the fundus every hour for the first 24 hours following birth D) Teach the woman the importance of rest and nutrition to enhance healing

C) Rationale: The fundus should be massaged only when boggy or soft. Massaging a firm fundus could cause it to relax. Responses 1, 2, and 4 are all effective measures to enhance and maintain contraction of the uterus and to facilitate healing.

When making a visit to the home of a postpartum woman one week after birth, the nurse should recognize that the woman would characteristically: A) Express a strong need to review events and her behavior during the process of labor and birth B) Exhibit a reduced attention span, limiting readiness to learn C) Vacillate between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn D) Have reestablished her role as a spouse/partner

C) Rationale: One week after birth the woman should exhibit behaviors characteristic of the taking-hold stage as described in response 3. This stage lasts for as long as 4 to 5 weeks after birth. Responses 1 and 2 are characteristic of the taking-in stage, which lasts for the first few days after birth. Response 4 reflects the letting-go stage, which indicates that psychosocial recovery is complete.

Which of the following complications may be indicated by continuous seepage of blood from the vagina of a PP client, when palpation of the uterus reveals a firm uterus 1 cm below the umbilicus? A) Retained placental fragments B) Urinary tract infection C) Cervical laceration D) Uterine atony

C) Cervical laceration Rationale: Continuous seepage of blood may be due to cervical or vaginal lacerations if the uterus is firm and contracting. Retained placental fragments and uterine atony may cause subinvolution of the uterus, making it soft, boggy, and larger than expected. UTI won't cause vaginal bleeding, although hematuria may be present.

A PP client is being treated for DVT. The nurse understands that the client's response to treatment will be evaluated by regularly assessing the client for: A) Dysuria, ecchymosis, and vertigo B) Epistaxis, hematuria, and dysuria C) Hematuria, ecchymosis, and epistaxis D) Hematuria, ecchymosis, and vertigo

C) Hematuria, ecchymosis, and epistaxis Rationale: The treatment for DVT is anticoagulant therapy. The nurse assesses for bleeding, which is an adverse effect of anticoagulants. This includes hematuria, ecchymosis, and epistaxis. Dysuria and vertigo are not associated specifically with bleeding.

The nurse is about to give a Type 2 diabetic her insulin before breakfast on her first day postpartum. Which of the following answers best describes insulin requirements immediately postpartum? A) Lower than during her pregnancy B) Higher than during her pregnancy C) Lower than before she became pregnant D) Higher than before she became pregnant

C) Lower than before she became pregnant Rationale: PP insulin requirements are usually significantly lower than pre pregnancy requirements. Occasionally, clients may require little to no insulin during the first 24 to 48 hours postpartum.

A client is complaining of painful contractions, or afterpains, on postpartum day 2. Which of the following conditions could increase the severity of afterpains? A) Bottle-feeding B) Diabetes C) Multiple gestation D) Primiparity

C) Multiple gestation Rationale: Multiple gestation, breastfeeding, multiparity, and conditions that cause overdistention of the uterus will increase the intensity of after-pains. Bottle-feeding and diabetes aren't directly associated with increasing severity of afterpains unless the client has delivered a macrosomic infant.

A nurse is assessing a client in the 4th stage if labor and notes that the fundus is firm but that bleeding is excessive. The initial nursing action would be which of the following? A) Massage the fundus B) Place the mother in the Trendelenburg's position C) Notify the physician D) Record the findings

C) Notify the physician Rationale: If the bleeding is excessive, the cause may be laceration of the cervix or birth canal. Massaging the fundus if it is firm will not assist in controlling the bleeding. Trendelenburg's position is to be avoided because it may interfere with cardiac function.

Which of the following interventions would be helpful to a breastfeeding mother who is experiencing engorged breasts? A) Applying ice B) Applying a breast binder C) Teaching how to express her breasts in a warm shower D) Administering bromocriptine (Parlodel)

C) Teaching how to express her breasts in a warm shower Rationale: Teaching the client how to express her breasts in a warm shower aids with let-down and will give temporary relief. Ice can promote comfort by vasoconstriction, numbing, and discouraging further letdown of milk.

Following the birth of her baby, a woman expresses concern about the weight she gained during pregnancy and how quickly she can lose it now that the baby is born. The nurse, in describing the expected pattern of weight loss, should begin by telling this woman that: A) Return to pre pregnant weight is usually achieved by the end of the postpartum period B) Fluid loss from diuresis, diaphoresis, and bleeding accounts for about a 3 pound weight loss C) The expected weight loss immediately after birth averages about 11 to 13 pounds D) Lactation will inhibit weight loss since caloric intake must increase to support milk production

C) The expected weight loss immediately after birth averages about 11 to 13 pounds Rationale: Prepregnant weight is usually achieved by 2 to 3 months after birth, not within the 6-week postpartum period. Weight loss from diuresis, diaphoresis, and bleeding is about 9 pounds. Weight loss continues during breast

Which of the following circumstances is most likely to cause uterine atony and lead to PP hemorrhage? A) Hypertension B) Cervical and vaginal tears C) Urine retention D) Endometritis

C) Urine retention Rationale: Urine retention causes a distended bladder to displace the uterus above the umbilicus and to the side, which prevents the uterus from contracting. The uterus needs to remain contracted if bleeding is to stay within normal limits. Cervical and vaginal tears can cause PP hemorrhage but are less common occurrences in the PP period

You're teaching a pregnant mother with gestational diabetes about the signs and symptoms of hyperglycemia. What are the signs and symptoms you will include in your education to the patient? Select all that apply: A. Sweating B. Confusion C. Frequent hunger D. Polydipsia E. Anxiety F. Frequent urination

C, D, and F. Remember the 3 Ps for hyperglycemia: Polyphagia (frequent hunger), polydipsia (frequent thirst), polyuria (frequent urination). Sweating, confusion, and anxiety are signs and symptoms of Hypoglycemia (low blood glucose).

A patient is prescribed Peginterferon alfa-2a. The nurse will prepare to administer this medication what route? A. Oral B. Intramuscular C. Subcutaneous D. Intravenous

C.

A patient completes a one hour glucose tolerance test. The patient's result is 190 mg/dL. As the nurse you know that the next step in the patient's care is to? A. Continue monitoring pregnancy, the test is normal B. Reassess blood glucose in 2 weeks C. Notify the physician who will order the patient to take a 3 hour glucose tolerance test D. Provide education to the patient about how to manage gestational diabetes during pregnancy

C. A test result >140 mg/dL for 1 hour glucose tolerance test requires that the patient take a 3 hour glucose tolerance test. This test will be used to diagnose if the patient has gestational diabetes.

A patient with diabetes asks you about what type of exercise they should perform throughout the week. The best response is: A. Lifting weights B. Sprinting C. Swimming D. Jumping

C. Aerobic exercise is the best and swimming is the only option that is an aerobic exercise.

1. A woman, who is 22 weeks pregnant, has a routine ultrasound performed. The ultrasound shows that the placenta is located at the edge of the cervical opening. As the nurse you know that which statement is FALSE about this finding: A. This is known as marginal placenta previa. B. The placenta may move upward as the pregnancy progresses and needs to be re-evaluated with another ultrasound at about 32 weeks gestation. C. The patient will need to have a c-section and cannot deliver vaginally. D. The woman should report any bleeding immediately to the doctor.

C. All the other options are CORRECT. Option C is FALSE. This is a type of placenta previa called marginal (or low-lying). There is a chance the woman can delivery vaginally, but if the placenta was completely over the cervix or partially covering it a c-section would be required. At the 20 week ultrasound the location of the placenta is detected. The location will be re-evaluated at about 32 weeks. If a placenta is found to be low lying there is a chance the placenta will move upward (away from the cervix) as the uterus grows to accommodate the baby.

What is the BEST preventive measure to take to help prevent ALL types of viral Hepatitis? A. Vaccination B. Proper disposal of needles C. Hand hygiene D. Blood and organ donation screening

C. Hand hygiene can help prevent all types of viral hepatitis. However, not all types of viral Hepatitis have a vaccine available or are spread through needle sticks or blood/organs donations. Remember Hepatitis A and E are spread only via fecal-oral routes.

The physician writes an order for the administration of Lactulose. What lab result indicates this medication was successful? A. Bilirubin <1 mg/dL B. ALT 8 U/L C. Ammonia 16 mcg/dL D. AST 10 U/L

C. Lactulose is ordered to decrease a high ammonia level. It will cause excretion of ammonia via the stool. A normal ammonia level would indicate the medication was successful (normal ammonia level 15-45 mcg/dL).

A patient taking the medication Precose asks when it is the best time to take this medication. Your response is: A. 1 hour prior to eating B. 1 hour after eating C. With the first bite of food D. At bedtime

C. Precose is an alpha-glucoside inhibitor that works by lowering the blood sugar by slowly breaking down starchy foods in the GI system which helps slowly rise the blood sugar. Therefore, it should be taken with the first bite of food.

The first and most important nursing intervention when a nurse observes profuse postpartum bleeding is to: A. Call the woman's primary health care provider B. Administer the standing order for an oxytocic C. Palpate the uterus and massage it if it is boggy D. Assess maternal blood pressure and pulse for signs of hypovolemic shock

C. The initial management of excessive postpartum bleeding is firm massage of the uterine fundus.

A patient with Hepatitis A asks you about the treatment options for this condition. Your response is? A. Antiviral medications B. Interferon C. Supportive care D. Hepatitis A vaccine

C. There is no current treatment for Hepatitis A but supportive care and rest. Treatments for the other types of Hepatitis such as B, C, and D include antiviral or interferon (mainly the chronic cases) along with rest.

Which statement is TRUE regarding abruptio placenta? A. This condition occurs due to an abnormal attachment of the placenta in the uterus near or over the cervical opening. B. A marginal abruptio placenta occurs when the placenta is located near the edge of the cervical opening. C. Nursing interventions for this condition includes measuring the fundal height. D. Fetal distress is not common in this condition as it is in placenta previa.

C. All the other options are INCORRECT.

. Which of the following new pregnant clients should the nurse monitor more closely for signs of gestational diabetes mellitus? a. Gravida 2 with a body mass index of 2 b. Gravida 1 who is 24 years old c. Gravida 3 whose previous children weighed 6 lb, 4 oz and 7 lb, 5 oz at birth d. Gravida 2 who is pregnant with triplets

D

A 16-year-old patient comes to the free clinic and is diagnosed with primary syphilis. The patient states that she contracted this disease by holding hands with someone who has syphilis. What is the most appropriate nursing diagnosis for this patient? a) Alteration in comfort related to impaired skin integrity b) Fear related to complications c) Noncompliance with treatment regimen related to age d) Knowledge deficit related to modes of transmission

D

A client is diagnosed as being in the primary stage of syphilis? Which of the following would the nurse expect as a finding? a) Palmar rash b) Development of gummas c) Development of central nervous system lesions d) Genital chancres

D

A nurse is teaching a client with genital herpes. Education for this client should include an explanation of: a) why the disease is transmittable only when visible lesions are present. b) the need for the use of petroleum products. c) the option of disregarding safer-sex practices now that he's already infected. d) the importance of informing his partners of the disease.

D

A patient has a blood glucose of 400. Which of the following medications could be the cause of this? A. Glyburide B. Atenolol C. Bactrim D. Prednisone

D

After teaching a group of students about sexually transmitted infections (STIs), the instructor determines that additional teaching is necessary when the students identify which STI as curable with treatment? a) Syphillis b) Gonorrhea c) Chlamydia d) Genital herpes

D

One of the first symptoms of puerperal infection to assess for in the postpartum woman is: A. Fatigue continuing for longer than 1 week B. Pain with voiding C. Profuse vaginal bleeding with ambulation D. Temperature of 38° C (100.4° F) or higher on 2 successive days starting 24 hours after birth

D

The _____ ______ secrete insulin which are located in the _______. A. Alpha cells, liver B. Alpha cells, pancreas C. Beta cells, liver D. Beta cells, pancreas

D

When teaching a diabetic pregnant woman to give herself insulin injections, the nurse should emphasize that: a. A meal should be eaten before insulin injections. b. The angle of the subcutaneous injection should be 45 degrees. c. Once the needle is injected, the woman should aspirate before injecting the medication. d. The medication should be injected slowly.

D

Your patient is 48 hours post-delivery. While assessing fundal height, you would expect the fundal height to be? A. 1 cm above the umbilicus B. 2 cm above the umbilicus C. 1 cm below the umbilicus D. 2 cm below the umbilicus

D

Which of the following is described as premature separation of a normally implanted placenta during the second half of pregnancy, usually with severe hemorrhage? A. Placenta previa B. Ectopic pregnancy C. Incompetent cervix D. Abruptio placentae

D Abruptio placentae is described as premature separation of a normally implanted placenta during the second half of pregnancy, usually with severe hemorrhage. Placenta previa refers to implantation of the placenta in the lower uterine segment, causing painless bleeding in the third trimester of pregnancy. Ectopic pregnancy refers to the implantation of the products of conception in a site other than the endometrium. Incompetent cervix is a conduction characterized by painful dilation of the cervical os without uterine contractions.

A nurse assists in the vaginal delivery of a newborn infant. After the delivery, the nurse observes the umbilical cord lengthen and a spurt of blood from the vagina. The nurse documents these observations as signs of: A. Hematoma B. Placenta previa C. Uterine atony D. Placental separation

D As the placenta separates, it settles downward into the lower uterine segment. The umbilical cord lengthens, and a sudden trickle or spurt of blood appears.

A nurse in the postpartum unit is caring for a client who has just delivered a newborn infant following a pregnancy with placenta previa. The nurse reviews the plan of care and prepares to monitor the client for which of the following risks associated with placenta previa? A. Disseminated intravascular coagulation B. Chronic hypertension C. Infection D. Hemorrhage

D Because the placenta is implanted in the lower uterine segment, which does not contain the same intertwining musculature as the fundus of the uterus, this site is more prone to bleeding.

A patient has a blood glucose of 58 and is sweating, cold, and clammy. The patient is conscious. What is your next nursing intervention? A. Recheck the blood glucose in 5 minutes. B. Give the patient 15 grams of a complex carbohydrate. C. No intervention is needed because this is a normal blood glucose. D. Give the patient 15 grams of a simple carbohydrate.

D Simple carbohydrates work faster than complex. Example of a simple carbohydrate would be 4 oz of fruit juice or soda, glucose tablet or gel, etc.

Four hours after a difficult labor and birth, a primiparous woman refuses to feed her baby, stating that she is too tired and just wants to sleep. The nurse should: A) Tell the woman she can rest after she feeds her baby B) Recognize this as a behavior of the taking-hold stage C) Record the behavior as ineffective maternal-newborn attachment D) Take the baby back to the nursery, reassuring the woman that her rest is a priority at this time

D) Rationale: Response 1 does not take into consideration the need for the new mother to be nurtured and have her needs met during the taking-in stage. The behavior described is typical of this stage and not a reflection of ineffective attachment unless the behavior persists. Mothers need to reestablish their own well-being in order to effectively care for their baby.

Perineal care is an important infection control measure. When evaluating a postpartum woman's perineal care technique, the nurse would recognize the need for further instruction if the woman: A) Uses soap and warm water to wash the vulva and perineum B) Washes from symphysis pubis back to episiotomy C) Changes her perineal pad every 2 - 3 hours D) Uses the peribottle to rinse upward into her vagina

D) Responses 1, 2, and 3 are all appropriate measures. The peribottle should be used in a backward direction over the perineum. The flow should never be directed upward into the vagina since debris would be forced upward into the uterus through the still-open cervix.

A nurse is providing instructions to a mother who has been diagnosed with mastitis. Which of the following statements if made by the mother indicates a need for further teaching? A) "I need to take antibiotics, and I should begin to feel better in 24-48 hours." B) "I can use analgesics to assist in alleviating some of the discomfort." C) "I need to wear a supportive bra to relieve the discomfort." D) "I need to stop breastfeeding until this condition resolves."

D) "I need to stop breastfeeding until this condition resolves." Rationale: In most cases, the mother can continue to breastfeed with both breasts. If the affected breast is too sore, the mother can pump the breast gently. Regular emptying of the breast is important to prevent abscess formation. Antibiotic therapy assists in resolving the mastitis within 24-48 hours. Additional supportive measures include ice packs, breast supports, and analgesics.

Which type of lochia should the nurse expect to find in a client 2 days PP? A) Foul-smelling B) Lochia serosa C) Lochia alba D) Lochia rubra

D) Lochia rubra

Which of the following responses is most appropriate for a mother with diabetes who wants to breastfeed her infant but is concerned about the effects of breastfeeding on her health? A) Mothers with diabetes who breastfeed have a hard time controlling their insulin needs B) Mothers with diabetes shouldn't breastfeed because of potential complications C) Mothers with diabetes shouldn't breastfeed; insulin requirements are doubled D) Mothers with diabetes may breastfeed; insulin requirements may decrease from breastfeeding

D) Mothers with diabetes may breastfeed; insulin requirements may decrease from breastfeeding Rationale: Breastfeeding has an antidiabetogenic effect. Insulin needs are decreased because carbohydrates are used in milk production. Breastfeeding mothers are at a higher risk of hypoglycemia in the first PP days after birth because the glucose levels are lower. Mothers with diabetes should be encouraged to breastfeed.

After expulsion of the placenta in a client who has six living children, an infusion of lactated ringer's solution with 10 units of pitocin is ordered. The nurse understands that this is indicated for this client because: A) She had a precipitate birth B) This was an extramural birth C) Retained placental fragments must be expelled D) Multigravidas are at increased risk for uterine atony

D) Multigravidas are at increased risk for uterine atony Rationale: Multiple full-term pregnancies and deliveries result in overstretched uterine muscles that do not contract efficiently and bleeding may ensue.

Which of the following findings would be a source of concern if noted during the assessment of a woman who is 12 hours postpartum? A) Postural hypotension B) Temperature of 100.4°F C) Bradycardia — pulse rate of 55 BPM D) Pain in left calf with dorsiflexion of left foot

D) Pain in left calf with dorsiflexion of left foot Rationale: Responses 1 and 3 are expected related to circulatory changes after birth. A temperature of 100.4°F in the first 24 hours is most likely indicative of dehydration which is easily corrected by increasing oral fluid intake. The findings in response 4 indicate a positive Homan sign and are suggestive of thrombophlebitis and should be investigated further.

A nurse is developing a plan of care for a PP woman with a small vulvar hematoma. The nurse includes which specific intervention in the plan during the first 12 hours following the delivery of this client?A) Assess vital signs every 4 hours B) Inform health care provider of assessment findings C) Measure fundal height every 4 hours D) Prepare an ice pack for application to the area.

D) Prepare an ice pack for application to the area. Rationale: Application of ice will reduce swelling caused by hematoma formation in the vulvar area. The other options are not interventions that are specific to the plan of care for a client with a small vulvar hematoma.

On the first PP night, a client requests that her baby be sent back to the nursery so she can get some sleep. The client is most likely in which of the following phases? A) Depression phase B) Letting-go phase C) Taking-hold phase D) Taking-in phase

D) Taking-in phase Rationale: The taking-in phase occurs in the first 24 hours after birth. The mother is concerned with her own needs and requires support from staff and relatives. The taking-hold phase occurs when the mother is ready to take responsibility for her care as well as the infants care. The letting-go phase begins several weeks later, when the mother incorporates the new infant into the family unit.

Before giving a PP client the rubella vaccine, which of the following facts should the nurse include in client teaching? A) The vaccine is safe in clients with egg allergies B) Breast-feeding isn't compatible with the vaccine C) Transient arthralgia and rash are common adverse effects D) The client should avoid getting pregnant for 3 months after the vaccine because the vaccine has teratogenic effects

D) The client should avoid getting pregnant for 3 months after the vaccine because the vaccine has teratogenic effects Rationale: The client must understand that she must not become pregnant for 3 months after the vaccination because of its potential teratogenic effects. The rubella vaccine is made from duck eggs so an allergic reaction may occur in clients with egg allergies. The virus is not transmitted into the breast milk, so clients may continue to breastfeed after the vaccination. Transient arthralgia and rash are common adverse effects of the vaccine.

What type of milk is present in the breasts 7 to 10 days PP? A) Colostrum B) Hind milk C) Mature milk D) Transitional milk

D) Transitional milk Rationale: Transitional milk comes after colostrum and usually lasts until 2 weeks PP.

Which of the following complications is most likely responsible for a delayed postpartum hemorrhage? A) Cervical laceration B) Clotting deficiency C) Perineal laceration D) Uterine subinvolution

D) Uterine subinvolution Rationale: Late postpartum bleeding is often the result of subinvolution of the uterus. Retained products of conception or infection often cause subinvolution. Cervical or perineal lacerations can cause an immediate postpartum hemorrhage. A client with a clotting deficiency may also have an immediate PP hemorrhage if the deficiency isn't corrected at the time of delivery.

Disseminated intravascular coagulation (DIC) can occur in __________________. This happens because when the placenta becomes damaged and detaches from the uterine wall, large amounts of _____________ are released into mom's circulation, leading to clot formation and then clotting factor depletion. A. Placenta previa, fibrinogen B. Placenta previa, platelets C. Abruptio placentae, fibrinogen D. Abruptio placentae, thromboplastin

D.

Tyra experienced painless vaginal bleeding has just been diagnosed as having a placenta previa. Which of the following procedures is usually performed to diagnose placenta previa? A. Amniocentesis B. Digital or speculum examination C. External fetal monitoring D. Ultrasound

D. Once the mother and the fetus are stabilized, ultrasound evaluation of the placenta should be done to determine the cause of the bleeding. Amniocentesis is contraindicated in placenta previa. A digital or speculum examination shouldn't be done as this may lead to severe bleeding or hemorrhage. External fetal monitoring won't detect a placenta previa, although it will detect fetal distress, which may result from blood loss or placenta separation.

A patient has completed the Hepatitis B vaccine series. What blood result below would demonstrate the vaccine series was successful at providing immunity to Hepatitis B? A. Positive IgG B. Positive HBsAg C. Positive IgM D. Positive anti-HBs

D. A positive anti-HBs (Hepatitis B surface antibody) indicates either a past infection of Hepatitis B that is now cleared and the patient is immune, OR that the vaccine has been successful at providing immunity. A positive HBsAg (Hepatitis B surface antigen) indicates an active infection.

When do most patients tend to develop gestational diabetes during pregnancy? A. usually during the 1-3 month of pregnancy B. usually during the 2-3 month of pregnancy C. usually during the 1-2 trimester of pregnancy D. usually during the 2-3 trimester of pregnancy

D. Gestational diabetes is a form of diabetes that develops during pregnancy, usually during 2nd or 3rd trimester.

When caring for a postpartum woman experiencing hemorrhagic shock, the nurse recognizes that the most objective and least invasive assessment of adequate organ perfusion and oxygenation is: A. Absence of cyanosis in the buccal mucosa B. Cool, dry skin C. Diminished restlessness D. Urinary output of at least 30 ml/hr

D. Hemorrhage may result in hemorrhagic shock. Shock is an emergency situation in which the perfusion of body organs may become severely compromised, and death may occur. The presence of adequate urinary output indicates adequate tissue perfusion.

A patient is diagnosed with Hepatitis A. The patient asks how a person can become infected with this condition. You know the most common route of transmission is? A. Blood B. Percutaneous C. Mucosal D. Fecal-oral

D. Hepatitis A is most commonly transmitted via the fecal-oral route.

What is the MOST common transmission route of Hepatitis C? A. Blood transfusion B. Sharps injury C. Long-term dialysis D. IV drug use

D. IV drug use is the MOST common transmission route of Hepatitis C.

A 32-year-old female is diagnosed with gestational diabetes. As the nurse you know that what test below is used to diagnose a patient with this condition? A. 1 hour glucose tolerance test B. 24 hour urine collection C. Hemoglobin A1C D. 3 hour glucose tolerance test

D. If a patient has a positive 1 hour glucose tolerance test (which is administered at about 24-28 weeks), a 3 hour glucose tolerance test is ordered. If this test is abnormal, it is used to diagnose gestational diabetes.

A 25-year-old patient was exposed to the Hepatitis A virus at a local restaurant one week ago. What education is important to provide to this patient? A. Inform the patient to notify the physician when signs and symptoms of viral Hepatitis start to appear. B. Reassure the patient the chance of acquiring the virus is very low. C. Inform the patient it is very important to obtain the Hepatitis A vaccine immediately to prevent infection. D. Inform the patient to promptly go to the local health department to receive immune globulin.

D. Since the patient was exposed to Hepatitis A, the patient would need to take preventive measures to prevent infection because infection is possible. The patient should not wait until signs and symptoms appear because the patient can be contagious 2 weeks BEFORE signs and symptoms appear. The vaccine would not prevent Hepatitis A from this exposure, but from possible future exposures because it takes the vaccine 30 days to start working. The best answer is option D. The patient would need to receive immune globulin to provide temporary immunity within 2 weeks of exposure.

Fill-in the blank: When a woman develops gestational diabetes it is during a time in the pregnancy when insulin sensitivity is _____________. This is majorly influenced by hormones such as estrogen, progesterone, _______________ and _______________. A. high; prolactin and human chorionic gonadotropin (hCG) B. low; estriol and human placental lactogen (hPL) C. high; human chorionic gonadotropin (hCG) and cortisol D. low; human placental lactogen (hPL) and cortisol

D. The statement should read: When a woman develops gestational diabetes it is during a time in the pregnancy when insulin sensitivity is LOW. This is majorly influenced by hormones such as estrogen, progesterone, HUMAN PLACENTAL LACTOGEN (hPL) and CORTISOL.

You educate a pregnant patient with gestational diabetes that she should try to have a blood glucose level of ______________ 1 hour after a meal. A. <70 mg/dL B. <250 mg/dL C. >160 mg/dL D. <140 mg/dL

D: <140 mg/dL

What statement or statements are INCORRECT regarding Diabetic Ketoacidosis? A. DKA occurs mainly in Type 1 diabetics. B. Ketones are present in the urine in DKA. C. Cheyne-stokes breathing will always present in DKA. D. Severe hypoglycemia is a hallmark sign in DKA. E. Options C & D

E

True or False: The Somogyi effect causes the patient to experience an increase in their blood glucose during the hours of 2-3 am. A. True B. False

FALSE. The Somogyi effect causes the patient to experience a DECREASE in their blood glucose during the hours of 2-3 am.

Select all the patients below who are at risk for developing placenta previa: A. A 37 year old woman who is pregnant with her 7th child. B. A 28 year old pregnant female with chronic hypertension. C. A 25 year old female who is 36 weeks pregnant that has experienced trauma to abdomen. D. A 20 year old pregnant female who is a cocaine user.

The answer is A and D. Risk factors for developing placenta previa include: Maternal age >35 years old, multiples (twins etc.), already had a baby, drug use: cocaine or smoking, surgery to the uterus that will leave scarring: fibroid removal, c-section etc.

Select all the signs and symptoms associated with placenta previa: A. Painless bright red bleeding B. Concealed bleeding C. Hard, tender uterus D. Normal fetal heart rate E. Abnormal fetal position F. Rigid abdomen

The answer is A, D, and E. These are all sign and symptoms of placenta previa. The other options are associated abruptio placentae.

When are most pregnant patients tested for gestational diabetes? A. 6-12 weeks gestation B. 12-20 weeks gestation C. 24-28 weeks gestation D. 34-36 week gestation

The answer is C: 24-28 weeks gestation

TRUE or FALSE: A patient with Hepatitis A is contagious about 2 weeks before signs and symptoms appear and 1-3 weeks after the symptoms appear. True False

The answer is TRUE.

A 36 year old woman, who is 38 weeks pregnant, reports having dark red bleeding. The patient experienced abruptio placentae with her last pregnancy at 29 weeks. What other signs and symptoms can present with abruptio placentae? Select all that apply: A. Decrease in fundal height B. Hard abdomen C. Fetal distress D. Abnormal fetal position E. Tender uterus

The answers are: B, C, and E. Option A is wrong because there may be an INCREASE in fundal height (not decrease) due to concealed bleeding. Option D is wrong because this tends to occur in placenta previa because the placenta attaches too low in the uterus at the cervical opening.

Your patient who is 34 weeks pregnant is diagnosed with total placenta previa. The patient is A positive. What nursing interventions below will you include in the patient's care? Select all that apply: A. Routine vaginal examinations B. Monitoring vital signs C. Administer RhoGAM per MD order D. Assess internal fetal monitoring E. Placing patient on side-lying position F. Monitoring pad count G. Monitoring CBC and clotting levels

The answers are: B, E, F, and G. Option A is WRONG because vaginal exams are avoided to prevent causing damage to the placenta presenting at the cervical opening. Option C is WRONG because the patient is A positive and does NOT need RhoGAM, which is for patients who are RH negative. Option D is WRONG because external monitoring should be used NOT internal, which can damage the placenta at the cervical opening.

Which of the following behaviors characterizes the PP mother in the taking in phase? A) Passive and dependant B) Striving for independence and autonomy C) Curious and interested in care of the baby D) Exhibiting maximum readiness for new learning

A) Passive and dependant Rationale: During the taking in phase, which usually lasts 1-3 days, the mother is passive and dependent and expresses her own needs rather than the neonate's needs. The taking hold phase usually lasts from days 3-10 PP. During this stage, the mother strives for independence and autonomy; she also becomes curious and interested in the care of the baby and is most ready to learn.

Parents can facilitate the adjustment of their other children to a new baby by: A) Having the children choose or make a gift to give to the new baby upon its arrival home B) Emphasizing activities that keep the new baby and other children together C) Having the mother carry the new baby into the home so she can show the other children the new baby D) Reducing stress on other children by limiting their involvement in the care of the new baby

A) Rationale: Special time should be set aside just for the other children without interruption from the newborn. Someone other than the mother should carry the baby into the home so she can give full attention to greeting her other children. Children should be actively involved in the care of the baby according to their ability without overwhelming them.

When performing a postpartum check, the nurse should: A) Assist the woman into a lateral position with upper leg flexed forward to facilitate the examination of her perineum B) Assist the woman into a supine position with her arms above her head and her legs extended for the examination of her abdomen C) Instruct the woman to avoid urinating just before the examination since a full bladder will facilitate fundal palpation D) Wash hands and put on sterile gloves before beginning the check

A) Rationale: While the supine position is best for examining the abdomen, the woman should keep her arms at her sides and slightly flex her knees in order to relax abdominal muscles and facilitate palpation of the fundus. The bladder should be emptied before the check. A full bladder alters the position of the fundus and makes the findings inaccurate. Although hands are washed before starting the check, clean (not sterile) gloves are put on just before the perineum and pad are assessed

On completing a fundal assessment, the nurse notes the fundus is situated on the client's left abdomen. Which of the following actions is appropriate? A) Ask the client to empty her bladder B) Straight catheterize the client immediately C) Call the client's health provider for direction D) Straight catheterize the client for half of her uterine volume

A) Ask the client to empty her bladder Rationale: A full bladder may displace the uterine fundus to the left or right side of the abdomen. Catheterization is unnecessary invasive if the woman can void on her own.

Which of the following findings would be expected when assessing the postpartum client? A) Fundus 1 cm above the umbilicus 1 hour postpartum B) Fundus 1 cm above the umbilicus on postpartum day 3 C) Fundus palpable in the abdomen at 2 weeks postpartum D) Fundus slightly to the right; 2 cm above umbilicus on postpartum day 2

A) Fundus 1 cm above the umbilicus 1 hour postpartum Rationale: Within the first 12 hours postpartum, the fundus usually is approximately 1 cm above the umbilicus. The fundus should be below the umbilicus by PP day 3. The fundus shouldn't be palpated in the abdomen after day 10.

A nurse is preparing to assess the uterine fundus of a client in the immediate postpartum period. When the nurse locates the fundus, she notes that the uterus feels soft and boggy. Which of the following nursing interventions would be most appropriate initially? A) Massage the fundus until it is firm B) Elevate the mothers legs C) Push on the uterus to assist in expressing clots D) Encourage the mother to void

A) Massage the fundus until it is firm Rationale: If the uterus is not contracted firmly, the first intervention is to massage the fundus until it is firm and to express clots that may have accumulated in the uterus. Pushing on an uncontracted uterus can invert the uterus and cause massive hemorrhage. Elevating the client's legs and encouraging the client to void will not assist in managing uterine atony. If the uterus does not remain contracted as a result of the uterine massage, the problem may be distended bladder and the nurse should assist the mother to urinate, but this would not be the initial action.

What laboratory marker is indicative of disseminated intravascular coagulation (DIC)? A. Bleeding time of 10 minutes B. Presence of fibrin split products C. Thrombocytopenia D. Hyperfibrinogenemia

A. Bleeding time in DIC is normal. B. Correct: Degradation of fibrin leads to the accumulation of fibrin split products in the blood. C. Incorrect: Low platelets may occur with but are not indicative of DIC, because they may result from other coagulopathies. D. Incorrect: Hypofibrinogenemia would occur with DIC.

A primary nursing responsibility when caring for a woman experiencing an obstetric hemorrhage associated with uterine atony is to: A. Establish venous access B. Perform fundal massage C. Prepare the woman for surgical intervention D. Catheterize the bladder

A. Incorrect: Although this may be a necessary intervention, the initial intervention would be fundal massage. B. Correct: The initial management of excessive postpartum bleeding is firm massage of the uterine fundus. C. Incorrect: The woman may need surgical intervention to treat her postpartum hemorrhage, but the initial nursing intervention would be to assess the uterus. D. Incorrect: After uterine massage, the nurse may want to catheterize the client to eliminate any bladder distension that may be preventing the uterus from contracting properly.

A woman who has recently given birth complains of pain and tenderness in her leg. Upon physical examination, the nurse notices warmth and redness over an enlarged, hardened area. The nurse should suspect _____ and should confirm the diagnosis by _____. A. Disseminated intravascular coagulation; asking for laboratory tests B. von Willebrand disease; noting whether bleeding times have been extended C. Thrombophlebitis; using real time and color Doppler ultrasound D. Coagulopathies; drawing blood for laboratory analysis

A. Incorrect: Pain and tenderness in the extremities, which show warmth, redness, and hardness, is likely thrombophlebitis. A Doppler ultrasound is a common, noninvasive way to confirm the diagnosis. B. Incorrect: Pain and tenderness in the extremities, which show warmth, redness, and hardness, is likely thrombophlebitis. A Doppler ultrasound is a common, noninvasive way to confirm the diagnosis. C. Correct: Pain and tenderness in the extremities, which show warmth, redness, and hardness, is likely thrombophlebitis. A Doppler ultrasound is a common noninvasive way to confirm diagnosis. D. Incorrect: Pain and tenderness in the extremities, which show warmth, redness, and hardness, is likely thrombophlebitis. A Doppler ultrasound is a common, noninvasive way to confirm the diagnosis.

It is important for the perinatal nurse to be knowledgeable regarding conditions of abnormal adherence of the placenta. This occurs when the zygote implants in an area of defective endometrium and results in little to no zone separation between the placenta and decidua. Which classification of separation is not recognized as an abnormal adherence pattern? A. Placenta accreta B. Placenta increta C. Placenta percreta D. Placenta abruptio

A. Incorrect: This is a recognized degree of attachment. With placenta accreta there is slight penetration of the trophoblast into the myometrium. B. Incorrect: This is a recognized degree of attachment that results in deep penetration of the myometrium. C. Incorrect: This is the most severe degree of placental penetration that results in deep penetration of the myometrium. Bleeding with complete placental attachment will occur only when separation of the placenta is attempted after delivery. Treatment includes blood component therapy and in extreme cases, hysterectomy may be necessary. D. Correct: Placenta abruptio is premature separation of the placenta as opposed to partial or complete adherence. This occurs between the 20th week of gestation and delivery in the area of the decidua basilis. Symptoms include localized pain and bleeding.

Nurses need to know the basic definitions and incidence data about postpartum hemorrhage. For instance: A. PPH is easy to recognize early; after all, the woman is bleeding. B. Traditionally, it takes more than 1000 ml of blood after vaginal birth and 2500 ml after cesarean birth to define the condition as PPH. C. If anything, nurses and doctors tend to overestimate the amount of blood loss. D. Traditionally, PPH has been classified as early or late with respect to birth.

A. Incorrect: Unfortunately, PPH can occur with little warning and often is recognized only after the mother has profound symptoms . B. Incorrect: Traditionally, a 500 ml blood loss after a vaginal birth and a 1000 ml blood loss after a cesarean birth constitute PPH. C. Incorrect: Medical personnel tend to underestimate blood loss by as much as 50% in their subjective observations. D. Correct: Early PPH is also known as primary, or acute, PPH; late PPH is known as secondary PPH.

The perinatal nurse assisting with establishing lactation is aware that acute mastitis can be minimized by: A. Washing the nipples and breasts with mild soap and water once a day B. Using proper breastfeeding techniques C. Wearing a nipple shield for the first few days of breastfeeding D. Wearing a supportive bra 24 hours a day

A. Incorrect: Washing the nipples and breasts daily is no longer indicated. In fact, this can cause tissue dryness and irritation, which can lead to tissue breakdown and infection. B. Correct: Almost all instances of acute mastitis can be avoided by proper breastfeeding technique to prevent cracked nipples. C. Incorrect: Wearing a nipple shield does not prevent mastitis. D. Incorrect: Wearing a supportive bra 24 hours a day may contribute to mastitis, especially if an underwire bra is worn, because it may put pressure on the upper, outer area of the breast, contributing to blocked ducts and mastitis.

In caring for the woman with disseminated intravascular coagulation (DIC), what order should the nurse anticipate? A. Administration of blood B. Preparation of the client for invasive hemodynamic monitoring C. Restriction of intravascular fluids D. Administration of steroids

A. Primary medical management in all cases of DIC involves correction of the underlying cause, volume replacement, blood component therapy, optimization of oxygenation and perfusion status, and continued reassessment of laboratory parameters. B. Incorrect: Central monitoring would not be ordered initially in a client with DIC, because this can contribute to more areas of bleeding. C. Incorrect: Management of DIC would include volume replacement, not volume restriction. D. Incorrect: Steroids are not indicated for the management of DIC.

A 36-year-old pregnant female is diagnosed with gestational diabetes at 28 weeks gestation. You're educating the patient about this condition. Which statement by the patient demonstrates they understood your teaching about gestational diabetes? A. "Once I deliver the baby, it will go away, and I will not need any further testing." B. "It is important I try to get my fasting blood glucose around 70-95 mg/dL and <140 mg/dL 1 hour after meals." C. "There are no risks or complications related to gestational diabetes other than hyperglycemia." D. "I'm at risk for delivering a baby that is too small for its gestational age due to this condition."

B. This is the only correct statement in the scenario. It is important the mother monitors her blood glucose level regularly and tries to maintain an euglycemic level (normal blood glucose level): 70-95 mg/dL fasting and <140 mg/dL 1 hour after meals. In most cases, once the baby is delivered, the gestational diabetes will disappear, BUT at 6-12 weeks postpartum the mother will need to be reassessed for diabetes. Remember in the lecture, according to the CDC.gov 50% of women who are diagnosed with gestational diabetes will develop Type 2 diabetes later on. There are risks and complications associated with gestational diabetes such as pre-term labor, preeclampsia, hyper/hypoglycemia, macrosomia (large baby), hypoglycemia in baby at birth etc.

A 36-year-old patient's lab work show anti-HAV and IgG present in the blood. As the nurse you would interpret this blood work as? A. The patient has an active infection of Hepatitis A. B. The patient has recovered from a previous Hepatitis A infection and is now immune to it. C. The patient is in the preicetric phase of viral Hepatitis. D. The patient is in the icteric phase of viral Hepatitis.

B. When a patient has anti-HAV (antibodies of the Hepatitis A virus) and IgG, this means the patient HAD a past infection of Hepatitis A but it is now gone, and the patient is immune to Hepatitis A now. If the patient had anti-HAV and IgM, this means the patient has an active infection of Hepatitis A.