Maternity Ch 17, 20, 21, 23, 25

1. A pregnant patient in labor is having contractions 2 minutes apart but rarely over 50 mmHg in strength; the resting tone is high, 20 to 25 mmHg. The patient asks what can be done to make contractions more effective. What should the nurse respond to the patient? A) Rest because contractions are hypertonic. B) Receive oxytocin to strengthen contractions. C) Hypotonic contractions of this kind will strengthen by themselves. D) Walking around will make the contractions more regular.

Ans: A Feedback: A danger of hypertonic contractions is that the lack of relaxation between contractions may not allow optimal uterine artery filling; this can lead to fetal anoxia early in the latent phase of labor. The best intervention is to encourage the patient to rest between contractions. Oxytocin will not help strengthen hypertonic contractions. Walking will not help make the contractions more regular. These are hypertonic and not hypotonic contractions.

12. A postpartal patient is receiving heparin as treatment for thrombophlebitis. What should the nurse instruct the patient about breastfeeding during this time? A) Breastfeeding can continue. B) The baby will need weekly blood work. C) The effect of anticoagulants is counteracted by infant gastric juices. D) All anticoagulants pass in breast milk so breastfeeding will have to stop.

Ans: A Feedback: A patient can continue to breastfeed while receiving heparin. The baby is not going to need weekly blood work. Infant gastric juices do not impact the effect of anticoagulants. Medications due affect breast milk; however, breastfeeding can continue while receiving heparin.

8. The nurse is caring for a patient who desires to become pregnant within a few months. Which outcome regarding folic acid intake would be appropriate for this patient? A) The client will begin taking 400 g of folic acid every day. B) The client will begin taking 400 g of folic acid with every meal. C) The client will ingest foods high in folic acid to avoid needing to take folic acid supplements. D) The client will begin taking 400 g of folic acid immediately after confirmation of pregnancy.

Ans: A Feedback: All patients expecting to become pregnant are advised to begin a supplement of 400 g folic acid daily in addition to eating foods rich in folic acid. The folic acid supplement is not needed with each meal. Foods high in folic acid should be consumed in addition to the supplement. The patient should take folic acid supplements before becoming pregnant and not wait until pregnancy is confirmed.

14. A patient is admitted with a diagnosis of ectopic pregnancy. For what should the nurse anticipate preparing the patient? A) Immediate surgery B) Internal uterine monitoring C) Bed rest for the next 4 weeks D) Intravenous administration of a tocolytic

Ans: A Feedback: An ectopic pregnancy is one in which implantation occurred outside the uterine cavity, usually within the fallopian tube. As the embryo grows, the fallopian tube can rupture. The therapy for ruptured ectopic pregnancy is laparoscopy to ligate the bleeding vessels and to remove or repair the damaged fallopian tube. There is no reason to begin uterine monitoring. The patient does not need to be on bed rest for 4 weeks. A tocolytic is not needed because the patient is not in labor.

15. A patient in the second trimester of pregnancy is diagnosed with cervical cancer. For which treatment should the nurse instruct the patient as causing the least harm to the developing fetal? A) Chemotherapy B) Chelation therapy C) Radiation therapy D) Anticoagulant therapy

Ans: A Feedback: As a rule, patients can receive chemotherapy in the second and third trimesters without adverse fetal effects. Radiation therapy puts the fetus at risk throughout pregnancy if the fetus is directly exposed. Chelation and anticoagulants are not therapies associated with cancer treatment.

8. An infant was born after a face presentation. When selecting a nursing diagnosis for the newborn, which body system does the nurse identify as a priority? A) Respiratory B) Genitourinary C) Cardiovascular D) Gastrointestinal

Ans: A Feedback: Babies born after a face presentation have a great deal of facial edema and may be purple from bruising. The infant must be observed closely for a patent airway, which is the priority. A face presentation does not affect the cardiovascular or genitourinary systems. If lip edema is severe, the newborn might need gavage feedings until the edema subsides and sucking can occur.

12. The nurse is caring for a patient in labor whose fetus is in an occiput posterior position. Which intervention should the nurse use to reduce this patient's discomfort? A) Massage the lower back. B) Place in a prone position. C) Apply ice packs to the lower back. D) Place in the Trendelenburg position.

Ans: A Feedback: Because the fetal head rotates against the sacrum in the occiput posterior position, the patient may experience pressure and pain in the lower back because of sacral nerve compression. Applying counter pressure on the sacrum by a back rub may be helpful in relieving a portion of the pain. The patient does not need to be placed in the prone or Trendelenburg positions. Ice packs are not indicated to reduce this pain.

8. The nurse is instructing a postpartum patient on observations to report to the health care provider which signifies retained placental fragments. Which patient statement indicates that teaching has been effective? A) "If the drainage changes from clear to bright red, I am to call the doctor." B) "I will have large amount of vaginal drainage for at least several months." C) "An elevated temperature is normal during the first few weeks after delivery." D) "My drainage will fluctuate between bright red and dark red for several weeks."

Ans: A Feedback: Because the hemorrhage from retained fragments may be delayed until after the patient is home, instruct to observe the color of lochia and to report any tendency for the discharge to change from lochia serosa or alba back to rubra. The patient will not have large amounts of drainage for several months. An elevated temperature indicates an infection. The drainage should not fluctuate between bright and dark red and could indicate retained placental fragments.

6. A pregnant patient receiving intravenous oxytocin for 1 hour has contractions lasting 80 seconds. What should the nurse do first for this patient? A) Discontinue the oxytocin infusion. B) Slow the infusion to below 10 gtt/minute. C) Increase the flow rate of the main line infusion. D) Continue to monitor contraction duration every 2 hours.

Ans: A Feedback: Contractions should last no longer than 70 seconds. If contractions become longer in duration, stop the IV infusion and seek help immediately. The infusion needs to be discontinued and not slowed. Increasing the flow rate could cause fetal distress. The patient needs to be assessed more frequently than every 2 hours.

2. The nurse is preparing an education session on the 2020 National Health Goals to prevent complications of pregnancy. What should the nurse include as the best preventive measure to eliminate complications of pregnancy? A) Encourage all pregnant patients to have prenatal care. B) Suggest all pregnant patients keep weight gain to a minimum. C) Recommend all pregnant patients engage in exercise most days of the week. D) Counsel all pregnant patients to select low-fat dairy products rich in calcium.

Ans: A Feedback: Encouraging all women to come for prenatal care is the best preventive measure for eliminating complications of pregnancy. Weight gain, exercise, and calcium intake are not identified as specific measures to prevent complications of pregnancy.

15. The nurse is evaluating care provided to a patient giving birth to her first child. Which outcome regarding labor indicates that care has been effective? A) Client achieved 4 cm of dilation after 7 hours of labor. B) Client achieved full dilatation after 8 hours of labor. C) Client delivered infant within 2 hours after full dilatation with epidural. D) Client delivered infant within 30 minutes after full dilatation without epidural.

Ans: A Feedback: For a nulliparous patient, achievement of 4 cm of dilation after 7 hours of labor is expected and indicates that care has been effective. Full dilatation after 8 hours is appropriate for a multiparous patient. Delivering the infant within 2 hours after full dilatation with an epidural is appropriate for a multiparous patient. Delivering the infant within 30 minutes after full dilatation without an epidural is appropriate for a multiparous patient without an epidural.

1. A pregnant patient is diagnosed with placenta previa. Which action should the nurse implement immediately for this patient? A) Assess fetal heart sounds with an external monitor. B) Help the patient remain ambulatory to reduce bleeding. C) Assess uterine contractions by an internal pressure gauge. D) Prepare for a vaginal examination to assess the extent of bleeding.

Ans: A Feedback: For placenta previa, the nurse should attach external monitoring equipment to record fetal heart sounds and uterine contractions. Internal pressure gauges to measure uterine contractions are contraindicated. A pelvic or rectal examination should never be done with painless bleeding late in pregnancy because any agitation of the cervix when there is a placenta previa might tear the placenta further and initiate massive hemorrhage, which could be fatal to both mother and child. To ensure an adequate blood supply to the patient and fetus, the patient should be placed immediately on bed rest in a side-lying position.

3. The nurse is concerned that a postpartum patient with a cervical laceration is developing hypovolemic shock. What did the nurse assess in this patient? A) Weak and rapid pulse B) Warm and flushed skin C) Elevated blood pressure D) Decreased respiratory rate

Ans: A Feedback: If the loss of blood is extremely copious, a woman will quickly begin to exhibit symptoms of hypovolemic shock such as a weak and rapid pulse. The skin will be pale and clammy, and the blood pressure will fall. Respiratory rate will be increased and shallow.

7. The nurse is concerned that a new mother is developing a postpartum complication. What did the nurse most likely assess in this patient? A) Absence of lochia B) Red-colored lochia for the first 24 hours C) Lochia that is the color of menstrual blood D) Lochia appearing pinkish-brown on the fourth day

Ans: A Feedback: Lochia should never be absent during the first 1 to 3 weeks because absence of lochia may indicate postpartal infection. Red-colored lochia for the first 24 hours is normal. Lochia that is the color of menstrual blood is normal. Lochia appearing pinkish-brown on the fourth postpartum day is normal.

9. The nurse is evaluating care provided to a patient in the third trimester of pregnancy who has been diagnosed with gestational hypertension. Which finding indicates that treatment has been successful for this patient? A) Urine protein 0 B) Increased perspiration C) Weight gain of 1 lb/week D) Diastolic blood pressure 20 mmHg over normal level

Ans: A Feedback: Manifestations of gestational hypertension include elevated blood pressure, edema, and proteinuria. Absence of protein in the urine indicates that treatment has been successful. Increased perspiration is not a manifestation of gestational hypertension. A weight gain of 1 lb/week in the patient who is in the third trimester of pregnancy is an indication of ongoing edema. A diastolic blood pressure that is 20 mmHg over normal level is an indication of ongoing hypertension.

2. A patient in labor has been prescribed an intravenous infusion of 5% dextrose/water. Following insertion of the intravenous line, what should the nurse instruct the patient to do? A) Try to forget the fluid line is in place. B) Lie on the back to allow optimal flow. C) Not to get out of bed once the needle is in place. D) Lie perfectly still so as not to dislodge the needle.

Ans: A Feedback: Many patients react negatively to the idea of IV fluid therapy during labor to restore body fluid. Assure the patient that being out of bed and walking, turning freely, squatting, sitting, or using whatever position preferred during labor will not disrupt the IV line or the infusion. The nurse should not tell the patient to lie on the back or to lie perfectly still. The patient should also be encouraged to get out of bed if that is permitted and desired by the patient in labor.

15. During a home visit, a postpartum patient is complaining of a painful area on one breast. The nurse notes a local area on one breast to be red and warm to touch. For which health problem should the nurse plan care for this patient? A) Mastitis B) Breast cancer C) Engorgement D) Plugged milk duct

Ans: A Feedback: Mastitis is usually unilateral and the affected breast feels painful, appears swollen, and reddened. The patient is postpartum and is breastfeeding. The nurse has no way of knowing if the patient has breast cancer. Engorgement would affect both breasts equally. Further diagnostic testing would be needed to diagnose a plugged milk duct.

13. A pregnant patient is diagnosed with hyperthyroidism. For which medication should the nurse prepare teaching for this patient? A) Methimazole B) Cephalosporin C) Levothyroxine D) Propylthiouracil

Ans: A Feedback: Methimazole is the preferred drug to treat pregnant patients with hyperthyroidism because it appears to cross the placenta less easily. Propylthiouracil crosses the placenta and can lead to congenital hypothyroidism and an enlarged thyroid gland in the fetus. Cephalosporin is an antibiotic that is not used in the treatment of hyperthyroidism. Levothyroxine is thyroid hormone and is used in the treatment of hypothyroidism.

7. The nurse is assessing a patient in labor. On which complication of labor as identified within the 2020 National Health Goals will the nurse focus? A) Uterine rupture B) Prolapsed fetal cord C) Hypotonic contractions D) Hypertonic contractions

Ans: A Feedback: Nurses can help the nation achieve the 2020 National Health Goals for complications of labor by being alert to the preliminary symptoms of uterine rupture, which accounts for a substantial number of maternal deaths during labor. Hypotonic and hypertonic contractions and prolapsed fetal cord are not identified as specific complications of labor within the 2020 National Health Goals.

6. A pregnant patient with a history of premature cervical dilatation undergoes cervical cerclage. Which outcome indicates that this procedure has been successful? A) The client delivers a full-term fetus at 39 weeks' gestation. B) The client's membranes spontaneously rupture at week 30 of gestation. C) The client experiences minimal vaginal bleeding throughout the pregnancy. D) The client has reduced shortness of breath and abdominal pain during the pregnancy.

Ans: A Feedback: Premature cervical dilatation is when the cervix dilates prematurely and cannot retain a fetus until term. After the loss of one child because of premature cervical dilatation, a surgical operation termed cervical cerclage can be performed to prevent this from happening in a second pregnancy. This procedure is the use of purse-string sutures placed in the cervix to strengthen the cervix and prevent it from dilating until the end of pregnancy. Evidence that this procedure is effective would be the client delivering a full-term fetus at 39 weeks' gestation. Spontaneous rupture of the membranes could indicate that the procedure was not successful. Vaginal bleeding could indicate another health problem or that the procedure was not successful. This procedure does not impact the patient's respirations or amount of abdominal pain while pregnant. These manifestations could indicate another health problem with the pregnancy.

15. The nurse is concerned that a new mother is ambivalent about the newborn and does not participate in newborn care. What action should the nurse take to help both the mother and newborn at this time? A) Contact the Social Services department. B) Schedule home care for the mother and infant. C) Assess who is going to take care of the baby at home. D) Ask the patient if it would be better that the baby is put up for adoption.

Ans: A Feedback: Some patients do not openly voice a wish to give up a child, but their actions demonstrate they feel little attachment to their newborn. A woman who has doubts about wanting the baby is slow to make contact, barely touching the baby even by the time of discharge, and asking few questions about newborn care. When this happens, the hospital social service department can be of assistance in helping the patient plan the child's future. The nurse needs to do more than schedule home care for the mother and infant. The nurse should consult with Social Services that will assess who is going to care for the infant at home and find out if the patient wants to give the baby up for adoption. This is not the nurse's role.

13. While the placenta is being delivered after labor, a patient experiences an amniotic fluid embolism. What should the nurse do first to help this patient? A) Administer oxygen by mask. B) Increase intravenous fluid infusion rate. C) Put firm pressure on the fundus of the uterus. D) Tell the patient to take short, shallow breaths.

Ans: A Feedback: The clinical picture of an amniotic fluid embolism is dramatic. The patient suddenly experiences sharp chest pain and is unable to breathe as pulmonary artery constriction occurs. The immediate management is oxygen administration by face mask or cannula. Intravenous fluids; pressure on the fundus; or taking short, shallow breaths is not going to help the manifestations of an amniotic fluid embolism.

10. The nurse instructs a pregnant patient with sickle-cell anemia on ways to prevent a crisis. Which patient statement indicates that teaching has been effective? A) "I should drink eight glasses of water every day." B) "I should take an iron supplement every day." C) "I should make sure I stand for at least 4 hours every day." D) "I should avoid sitting with my legs elevated during the day."

Ans: A Feedback: The fluid status of a pregnant patient with sickle-cell anemia is important because dehydration can precipitate a crisis. The patient should drink at least eight glasses of fluid each day to prevent dehydration. Patients with sickle-cell anemia should not take an iron supplement because the sickled cells cannot incorporate iron in the same way as nonsickled cells. Standing for long periods of time can cause red cell destruction in the patient with sickle-cell anemia. The patient should sit with the legs elevated to encourage venous return of blood from the lower extremities.

4. While observing care being provided to an infant, the new mother looks at the nurse repeatedly and asks, "Am I doing this the right way?" Which nursing diagnosis should the nurse select to guide the care needs of the mother at this time? A) Health-seeking behaviors related to care of newborn B) Ineffective coping related to expectation to provide newborn care C) Risk for altered family coping related to an additional family member D) Risk for impaired parenting related to disappointment in the sex of the child

Ans: A Feedback: The new mother is asking the nurse to validate actions being performed while providing newborn care. The nursing diagnosis most appropriate for the new mother at this time would be health-seeking behaviors related to care of the newborn. The new mother is not demonstrating signs of ineffective coping. There is no information to support a risk for altered family coping or risk for impaired parenting.

6. The nurse is evaluating the effectiveness of teaching on perineal care provided to a postpartum patient. Which outcome indicates that teaching has been effective? A) Patient performs perineal care independently with every morning shower. B) Patient explains the purpose of performing perineal care at least once a day. C) Patient flushes the commode before standing when performing perineal care. D) Patient washes the perineum from back to front when performing perineal care.

Ans: A Feedback: The nurse should instruct the postpartum patient to include perineal care as part of a daily bath or shower and after every voiding or bowel movement. The patient should stand before flushing the commode when performing perineal care because water from the commode can splash the perineum and cause an infection. The patient should be instructed to wash the perineum from front to back to reduce the potential for contamination from the rectal area.

9. A postpartum patient has a swollen area of purplish discoloration in the perineal area that is 5 cm in diameter. Which nursing diagnosis should the nurse use to plan care for this patient? A) Acute pain B) Risk for injury C) Risk for infection D) Ineffective peripheral tissue perfusion

Ans: A Feedback: The nursing diagnosis of acute pain would be appropriate because of a collection of blood in traumatized tissue secondary to birth trauma. Risk for injury would be appropriate if the patient was demonstrating signs of postpartum depression or psychosis. Risk for infection would be appropriate if the patient had an elevated temperature. Ineffective peripheral tissue perfusion would be appropriate if the patient was demonstrating signs of thrombophlebitis.

7. A patient is receiving treatment for a postpartum complication. Which action should the nurse perform to support the 2020 National Health Goals during the postpartum period? A) Encourage to continue breastfeeding. B) Suggest breastfeeding be discontinued. C) Instruct on supplementing feedings with formula. D) Explain how breastfeeding will weaken the patient's condition.

Ans: A Feedback: The postpartal period is a time when patients are susceptible to complications and may choose not to breastfeed. Nurses can help the nation achieve the 2020 National Health Goals by encouraging women to breastfeed even in the face of a postpartal complication. Suggesting that breastfeeding be discontinued or using supplemental feedings will not support the national goals. Breastfeeding is not known to weaken the patient's condition while being treated for a complication.

2. A patient with type 2 diabetes mellitus is planning to become pregnant within the next several months. What should the nurse instruct the patient to support the 2020 National Health Goals of reducing the complications of pregnancy from diabetes? A) Avoid episodes of hyperglycemia. B) Reduce the current exercise regimen by half. C) Limit the intake of carbohydrates and fats in the diet. D) Reduce the use of insulin for blood glucose coverage.

Ans: A Feedback: To support the 2020 National Health Goals, the nurse should instruct the patient to enter pregnancy without hyperglycemia. This action helps reduce congenital anomalies in newborns. Reducing exercise, limiting carbohydrates and fats, and reducing the use of insulin for blood glucose coverage does not support the 2020 National Health Goals to reduce the complications of pregnancy associated with diabetes.

10. A patient is experiencing dysfunctional labor, which is prolonging the descent of the fetus. Which teaching should the nurse prepare to provide to this patient? A) Oxytocin therapy B) Fluid replacement C) Pain management D) Increasing activity

Ans: A Feedback: With a prolonged descent, intravenous oxytocin may be used to induce the uterus to contract effectively. Fluid replacement, pain management, and activity will not cause the fetus to descend quicker.

8. A pregnant patient is diagnosed with preterm labor. What should the nurse teach the patient to help prevent the reoccurrence of preterm labor? (Select all that apply.) A) Drink 8 to 10 glasses of fluid each day. B) Report any signs of ruptured membranes. C) Remain on bed rest except to use the bathroom. D) Lie flat on the back should uterine contractions occur. E) Engage in mild activities of daily living with frequent rest periods.

Ans: A, B, C Feedback: To reduce the onset of preterm labor, the nurse should instruct the patient to drink 8 to 10 glasses of fluid each day to remain hydrated. The patient should also report any signs of ruptured membranes and remain on bed rest unless using the bathroom. Should uterine contractions begin, the patient should be instructed to lie on either the right or left side to increase blood return to the uterus. The patient should not engage in any activity other than bed rest with bathroom privileges.

5. After delivery, a patient is diagnosed with postpartal gestational hypertension. What care will the nurse provide to this patient? (Select all that apply.) A) Maintain on bed rest. B) Monitor urine output. C) Instruct on the purpose of a fluid restriction D) Administer magnesium sulfate as prescribed. E) Administer antihypertensive medication as prescribed.

Ans: A, B, D, E Feedback: Treatment for postpartal gestational hypertension includes bed rest, monitoring of urine output, and administration of magnesium sulfate or an antihypertensive agent. Fluid restriction is not indicated for postpartal gestational hypertension.

13. A pregnant patient is developing HELLP syndrome. During labor, which order should the nurse question? A) Assess urine output every hour. B) Prepare for epidural anesthesia. C) Position on the left side during labor. D) Assess blood pressure every 15 minutes.

Ans: B Feedback: In the HELLP syndrome, patients develop low platelet counts. With a low platelet count, injections such as epidural anesthesia are contraindicated. This is the order that the nurse should question. The patient's urine output should be assessed every hour because renal failure is a complication of this syndrome. Positioning on the left side during labor will help blood flow to the uterus. Assessing blood pressure every 15 minutes is appropriate for the patient with this syndrome.

9. The nurse manager of a postpartum care area is planning educational sessions for the nursing staff to support the 2020 National Health Goals for postpartum care. Which information should be included in this staff training? (Select all that apply.) A) Encourage postpartum patients to participate in breastfeeding. B) Provide information on reproductive life planning if requested. C) Suggest postpartum patients remain on bed rest for at least 2 postpartum days. D) Recommend new mothers to attend prenatal classes to learn infant care after delivery. E) Explain the importance of close observation to detect postpartum maternal hemorrhage.

Ans: A, B, E Feedback: Nurses can help the nation achieve the 2020 National Health Goals for postpartum care by maintaining close observation in the immediate postpartal period to detect maternal hemorrhage, encouraging and supporting women as they begin breastfeeding, and ensuring women receive reproductive life planning information if desired. Bed rest and attending prenatal classes to learn newborn care are not strategies to support the 2020 National Health Goals for postpartum care.

16. The nurse is concerned that a pregnant patient is developing hydramnios. What did the nurse assess in this patient? (Select all that apply.) A) Tense uterus B) Sudden weight loss C) Extreme shortness of breath D) Difficulty hearing fetal heart rate E) Uterus larger than expected for gestation week

Ans: A, C, D, E Feedback: Hydramnios is an excessive amount of amniotic fluid. The first sign of this disorder may be a rapid enlargement of the uterus. The uterus becomes tense, and the patient experiences shortness of breath because of the uterus pressing on the diaphragm. Auscultating the fetal heart rate can be difficult because of depth of the increased amount of fluid surrounding the fetus. The uterus will be larger than expected for the patient's gestational week.

16. A pregnant patient tells the nurse that she hopes the baby is not in the breech position because she has heard that this causes difficult labor. What should the nurse include when explaining the reasons for this presentation to the patient? (Select all that apply.) A) Multiple fetuses B) Maternal diabetes C) Fetal birth defects D) Lax abdominal muscles E) Fetal age less than 40 weeks

Ans: A, C, D, E Feedback: Reasons for the breech presentation include multiple fetuses, lax abdominal muscles, fetal birth defects such as hydrocephalus, and fetal age less than 40 weeks. Maternal diabetes is not identified as cause for a fetal breech presentation.

15. The nurse is preparing discharge instructions for a pregnant patient experiencing preterm rupture of membranes. What should the nurse include in this teaching? (Select all that apply.) A) Avoid douching. B) Resume regular coitus. C) Take a tub bath at least once per day. D) Expect malodorous vaginal discharge. E) Measure oral temperature twice a day.

Ans: A, E Feedback: The patient with premature rupture of membranes is at risk for developing an infection. The nurse should instruct the patient to avoid douching and measure oral temperature twice a day. Coitus and tub baths should be avoided because these could introduce an infection into the uterus. A malodorous vaginal discharge could indicate infection and should be reported to the health care provider.

2. The nurse is reviewing orders written for a postpartum patient with a fourth-degree perineal laceration. Which order should the nurse question before implementing? A) Providing a sitz bath B) Administering an enema C) Urging to drink all the milk provided during meals D) Administering acetaminophen and codeine for pain

Ans: B Feedback: A fourth-degree perineal laceration involves the entire perineum, rectal sphincter, and some of the mucous membrane of the rectum. Any patient who has a fourth-degree laceration should not have an enema prescribed because the hard tips of equipment could open sutures near to or including those of the rectal sphincter.

7. The nurse is preparing to instruct a pregnant patient with a history of tuberculosis on care needed while pregnant. What should the nurse include when teaching this patient? A) Maintain a high vitamin C intake. B) Maintain a high intake of calcium. C) Be prepared to have the child by cesarean birth. D) Avoid contracting an upper respiratory infection.

Ans: B Feedback: A patient who had tuberculosis earlier in life must be especially careful to maintain an adequate level of calcium during pregnancy to ensure the calcium tuberculosis pockets in the lungs are not broken down and the disease reactivated. A high vitamin C intake is not indicated for this patient's health history. Pushing during labor might cause calcified tuberculosis pockets in the lungs to break, but this does not mean that all patients with a history of tuberculosis have to have cesarean deliveries. All pregnant patients should be instructed to avoid upper respiratory infections.

5. After an hour of oxytocin therapy, a patient in labor experiences headache and vomiting. What should the nurse do? A) Assess the vagina for full dilation. B) Notify the physician and stop the infusion. C) Instruct the patient to breathe in and out rapidly. D) Administer oral orange juice for added potassium.

Ans: B Feedback: A side effect of oxytocin is that it can result in decreased urine flow, possibly leading to water intoxication. This is first manifested by headache and vomiting. If these danger signs are observed in the patient during induction of labor, report them immediately and halt the infusion. Assessing the vagina for dilation, increasing respirations, and administering orange juice for potassium will not help with water intoxication.

14. A postpartum patient is diagnosed with a vaginal laceration. What intervention will the nurse provide to the patient at this time? A) Monitor vital signs every 30 minutes. B) Insert an indwelling urinary catheter. C) Provide stool softeners as prescribed. D) Weigh vaginal packing to estimate blood loss.

Ans: B Feedback: An indwelling urinary catheter may be placed following a vaginal repair because the packing causes such pressure on the urethra it can interfere with voiding. Vital signs do not need to be monitored every 30 minutes. Stool softeners are not indicated for this type of laceration. The packing is not removed for 24 to 48 hours.

11. A postpartum patient is experiencing painful hemorrhoids. Which position should the nurse suggest the patient use when resting? A) Supine B) Sims position C) Knee-chest position D) Trendelenburg position

Ans: B Feedback: Assuming a Sims position several times a day aids in good venous return to the rectal area and reduces the discomfort of hemorrhoids. Supine, knee-chest, and Trendelenburg are not recommended positions to aid in the pain of hemorrhoids.

3. The nurse assesses a postpartum patient's discharge as being moderate in amount and red in color. How should the nurse document the appearance of the lochia? A) Lochia alba B) Lochia rubra C) Lochia serosa D) Lochia normalia

Ans: B Feedback: Lochia that is red in color, or bloody, is termed lochia rubra. Lochia alba is colorless flow that occurs around postpartum day 10. Lochia serosa is pink or brown in color and appears around postpartum day 4. Lochia normalia is not a term used to describe lochia.

5. A postpartum patient is reluctant to begin taking warm sitz baths. What should the nurse emphasize when teaching the patient about this treatment approach? A) Sitz baths may lead to increased postpartal infection. B) Sitz baths increase the blood supply to the perineal area. C) Sitz baths cause perineal vasoconstriction and decreased bleeding. D) The longer a sitz bath is continued, the more therapeutic it becomes.

Ans: B Feedback: Moist heat with a sitz bath is an effective way to increase circulation to the perineum, provide comfort, reduce edema, and promote healing. Sitz baths do not cause postpartal infections. Sitz baths do not cause perineal vasoconstriction and decreased bleeding. Every use of a sitz bath is therapeutic.

5. A patient with diabetes who is in the second trimester of pregnancy notes that the usual dose of insulin to maintain blood glucose levels has been increasing over the last few weeks. What should the nurse explain to the patient about insulin during pregnancy? A) The fetus is using insulin to maintain blood glucose level in utero. B) Insulin resistance develops because of placenta and other hormones. C) An increase in circulating blood volume during pregnancy deactivates insulin. D) The change in diet causes an increased need for insulin to maintain blood glucose levels.

Ans: B Feedback: Patients with diabetes, who become pregnant, develop insulin resistance as the pregnancy progresses, or insulin does not seem as effective during pregnancy. This phenomenon is believed to be caused by the presence of the hormone human placental lactogen and high levels of cortisol, estrogen, progesterone, and catecholamines. The increased need for insulin is not because of the fetus using insulin to maintain blood glucose level in utero. The patient's increased circulating blood volume is not deactivating insulin. The patient's change in diet might necessitate an adjustment in insulin dosage, but this would vary according to blood glucose level.

1. A patient who gave birth 5 hours ago has completely saturated a perineal pad within 15 minutes. Which action by the nurse should be implemented first? A) Assess vital signs. B) Assess the fundus. C) Notify the health care provider. D) Begin an IV infusion of Ringer's lactate solution.

Ans: B Feedback: The best safeguard against uterine atony is to palpate the fundus at frequent intervals to be assured that the uterus is remaining contracted. If bleeding persists, then vital signs assessment and notification to the health care provider may be indicated. An intravenous infusion might be prescribed if bleeding continues.

10. A postpartum patient is concerned about loose tissue around the abdominal area. Which exercise should the nurse recommend that the patient begin on postpartum day 2 to strengthen and tighten these muscles? A) Sit-ups B) Chin-to-chest C) Pelvic rocking D) Kegel exercises

Ans: B Feedback: The chin-to-chest exercise is excellent for the second day to tighten abdominal muscles. The exercise can be done 3 or 4 times a day, and the patient should feel the abdominal muscles pull and tighten if it is being done correctly. Sit-ups, pelvic rocking, and Kegel exercises are not identified to assist with tightening the muscles of the abdominal region.

14. A new mother asks if it is possible to have rooming-in with the newborn. What should the nurse respond to this patient's request? A) It depends on whether the patient plans to breastfeed. B) Rooming-in allows increased maternal-newborn contact. C) This puts too much responsibility on a first-time mother. D) Resting for the first 3 days postpartum will be better for the patient.

Ans: B Feedback: The more time a woman has to spend with her baby, the sooner she can become better acquainted with her child, feel more confident in her ability to care for her baby, and more likely form a sound mother-child relationship. Rooming-in is when the mother and child are together 24 hours a day. Rooming-in does not depend on whether the patient is planning to breastfeed the infant. Rooming-in helps the new mother become confident in abilities to care for the baby. Resting for 3 postpartum days is not recommended.

13. A postpartal patient is being treated for a separated symphysis pubis. Which outcome should the nurse identify when planning care for this patient? A) Patient plans to return to work in 2 weeks. B) Patient has coordinated child care assistance. C) Patient picks up the infant from the bassinette. D) Patient has a urine output of 30 ml per hour or greater.

Ans: B Feedback: With a separated symphysis pubis, bed rest and the application of a snug pelvic binder to immobilize the joint may be necessary to relieve pain and allow healing. A 4- to 6-week period is necessary for healing to be complete. During this time, the patient should avoid heavy lifting and may need to arrange for a person to help with child care at home. The patient should not be lifting the baby. The patient needs at least 4 to 6 weeks to heal before returning to work. Urine output is not a measurement for a separated symphysis pubis.

14. A patient in labor has a spinal cord injury and is unable to effectively push with contractions. Forceps will be used. What should the nurse do to prepare the patient for this type of delivery? (Select all that apply.) A) Provide oxygen 2 L via face mask. B) Validate that the cervix is fully dilated. C) Determine that the patient's bladder is empty. D) Begin an intravenous infusion of replacement fluid E) Ensure that the patient's membranes have ruptured.

Ans: B, C, E Feedback: Prior to using forceps for a delivery, the cervix must be fully dilated, the patient's bladder must be empty, and the patient's membranes must have ruptured. The patient does not need oxygen for a forceps delivery. The patient does not need an intravenous infusion prior to a forceps delivery.

12. The nurse provides discharge instructions to a postpartum patient. Which patient statement indicates that teaching has been effective? A) "I should limit stair climbing to four times a day." B) "I can have coitus at any time after returning home." C) "I should plan to return to my full-time job after 6 weeks." D) "I should notify the physician if my discharge decreases in amount."

Ans: C Feedback: It is usually advised that a woman not return to an outside job for at least 3 to 6 weeks not only for her own health but also for enjoyment of the early weeks with the newborn. Stair climbing should be limited to one flight/day for the first week at home. Coitus is safe as soon as the patient's lochia has turned to alba and, if present, an episiotomy is healed. The patient should notify the primary care provider if there is an increase, not a decrease, in lochial discharge.

16. A postpartum patient is prescribed docusate sodium (Colace) as treatment for constipation. What should the nurse include when teaching the patient about this medication? (Select all that apply.) A) This medication has no adverse effects. B) Be sure to engage in activity to aid in intestinal motility. C) One pill should be taken after every meal for the first week. D) This medication works the best when a high-fiber diet is consumed. E) Take each dose of the medication with a full glass of water or juice.

Ans: B, D, E Feedback: Docusate sodium (Colace) is used in the postpartal period to prevent constipation. It works by lowering the surface tension of feces, allowing water and lipids to penetrate the stool and soften it. The nurse should instruct the patient to engage in activity to promote intestinal motility, consume a diet high in fiber, and take each dose of the medication with a full glass of water or juice. This medication has abdominal pain and diarrhea as potential adverse effects. This medication is not taken after every meal but rather one dose per day.

14. The nurse is designing a plan of care for a pregnant patient with inflammatory bowel disease. What should be included in this patient's plan? (Select all that apply.) A) Instruct on the need for early cesarean birth. B) Carefully measure the patient's weight with each prenatal visit. C) Suggest fluids and oral food intake be restricted to rest the bowel. D) Explain the need for gamma globulin injections during the last trimester. E) Ensure that the patient is taking anti-inflammatory medication as prescribed.

Ans: B, E Feedback: Because of the potential difficulty with absorbing nutrients, the pregnant patient with inflammatory bowel disease needs careful monitoring for weight gain during pregnancy. Anti-inflammatory medication may be continued during pregnancy without fetal injury. The patient does not need a cesarean birth for this health problem. Foods and fluids should not be restricted because the patient has difficulty absorbing nutrients anyway. Gamma globulin injections are not indicated for this disorder

11. After delivery, a patient is diagnosed with placenta succenturiata. For what procedure should the nurse prepare this patient? A) Lavage of the uterus B) Repair of an episiotomy C) Manual removal of accessory lobes D) Emergency resuscitation of the newborn

Ans: C Feedback: A placenta succenturiata is a placenta that has one or more accessory lobes connected to the main placenta by blood vessels. This disorder needs to be recognized because the small lobes may be retained in the uterus after birth, leading to severe maternal hemorrhage. Once the remaining lobes are recognized and removed from the uterus manually, the uterus will contract with no adverse maternal effects. Uterine lavage is not a treatment for this disorder. This disorder is not specifically associated with an episiotomy. No fetal abnormality is associated with this disorder.

11. The nurse is reviewing medication orders for a pregnant patient diagnosed with a urinary tract infection. Which medication order should the nurse question for this patient? A) Ampicillin B) Amoxicillin C) Tetracycline D) Cephalosporin

Ans: C Feedback: Amoxicillin, ampicillin, and cephalosporins are effective against most organisms causing UTIs and are safe antibiotics during pregnancy. Tetracyclines are contraindicated during pregnancy because they cause retardation of bone growth and staining of the fetal teeth.

13. A postpartum patient has a history of thrombophlebitis. What should the nurse do to determine if the patient is developing this after delivery? A) Assess for warmth in the legs. B) Assess temperature every 4 hours. C) Assess for calf redness and edema. D) Palpate the feet for tingling or numbness.

Ans: C Feedback: Assess for thrombophlebitis by dorsiflexing the ankle and asking if pain occurs in the calf region. Assess also for redness in the calf area and edema of the ankle. Warmth is not an indication of a thrombophlebitis. Body temperature is not used to assess for thrombophlebitis. Feet numbness and tingling are not indications of thrombophlebitis.

8. The nurse is assessing the fundus of a patient on postpartum day 2. What should the nurse expect when palpating the fundus? A) Fundus 4 cm above symphysis pubis and firm B) Fundus height 4 cm below umbilicus and midline C) Fundus two fingerbreadths below umbilicus and firm D) Fundus two fingerbreadths above symphysis pubis and hard

Ans: C Feedback: Because uterine contraction begins immediately after placental delivery, the fundus of the uterus is palpable through the abdominal wall, halfway between the umbilicus and the symphysis pubis, within a few minutes after birth. One hour later, it will rise to the level of the umbilicus, where it remains for approximately the next 24 hours. From then on, it decreases one fingerbreadth or centimeter per day and will be palpable 1 cm below the umbilicus. For the second postpartal day, the uterus will be two fingerbreadths or centimeters below the umbilicus. The fundus should not be palpated 4 cm above the symphysis pubis, 4 cm below the umbilicus, or two fingerbreadths above the symphysis pubis on the second postpartum day. The fundus should not be hard.

11. The nurse instructs a patient on actions to prevent postpartum depression. During a home visit, which observation indicates that instruction has been effective? A) Patient complains of fatigue. B) Patient appears disheveled and listless. C) Patient is chatting on the telephone with a friend. D) Patient is cleaning the kitchen while the baby naps.

Ans: C Feedback: Chatting on the phone with friends indicates that the patient is not becoming isolated with baby care. This will help prevent the onset of postpartum depression. Fatigue, listlessness, and trying to be perfect with cleaning are observations that could indicate postpartum depression.

5. The nurse is reviewing the plan of care for a pregnant patient experiencing a threatened miscarriage. Which outcome would be appropriate for this patient? A) Bed rest is maintained until all bleeding stops. B) Less than one perineal pad is saturated per hour. C) Bleeding spontaneously stops within 24 to 48 hours. D) Normal coitus is resumed 1 week after the episode.

Ans: C Feedback: For a threatened miscarriage, an outcome for care would be that all bleeding would spontaneously stop within 24 to 48 hours. Bed rest is not recommended for a threatened miscarriage because blood will pool in the vagina. Vaginal bleeding that saturates a perineal pad in 1 hour is an emergency and could indicate an incomplete or complete miscarriage. Normal coitus should be withheld for 2 weeks after a threatened miscarriage.

2. While documenting patient care, the nurse notes that a postpartum patient is accepting the birth of the child well. What did the nurse most likely observe to come to this conclusion? A) Names the child after a well-loved friend B) Asks the nurse to take a photo of the child C) Turns the face to meet the infant's eyes when holding the baby D) Comments that the baby has the most hair of any in the nursery

Ans: C Feedback: Looking directly at the newborn's face, with direct eye contact or the en face position, is a sign a woman is beginning effective attachment. Naming the child after a well-loved friend, taking a photo of the child, or commenting on the child's hair are not indications that the postpartum patient is accepting the birth of the child well.

6. A postpartum patient is prescribed methylergonovine (Methergine) 0.2 mg for uterine subinvolution. Which action should the nurse take before administering the medication to the patient? A) Assess ambulation. B) Measure urine output. C) Measure blood pressure. D) Evaluate current hematocrit level.

Ans: C Feedback: Methylergonovine (Methergine) can increase blood pressure and must be used with caution in patients with hypertension. The nurse should assess the blood pressure prior to administrating and about 15 minutes afterward to detect this side effect. Methylergonovine (Methergine) does not affect ambulation, urine output, or hematocrit level.

1. The nurse notices that a new mother who is beginning postpartum day 2 handles the newborn tentatively and does not kiss the child when holding him. What should the nurse suspect as the probable reason for this behavior? A) Disappointment with the child's sex B) Difficulty accepting the role changes C) Reacting normally to accepting a new child D) Cultural customs do not include kissing children

Ans: C Feedback: More often, a woman enters into a relationship with her newborn tentatively and with qualms and conflicts that must be addressed before the relationship can be meaningful. This is because parental love is only partly instinctive. The tentative behavior does not indicate disappointment with the child's sex, difficulty accepting role changes, or cultural customs that do not include kissing children.

3. A patient in labor has reached 8 cm dilation, but the fetal heart rate suddenly slows. Perineal inspection reveals a prolapsed fetal cord. What should the nurse do first? A) Turn the patient onto the left side. B) Replace the cord with gentle pressure. C) Place the patient in a knee-chest position. D) Cover the exposed cord with a dry, sterile wrap.

Ans: C Feedback: Prolapsed cord is always an emergency situation because the pressure of the fetal head against the cord at the pelvic brim leads to cord compression and decreased oxygenation to the fetus. Pressure on the cord must be relieved, which is done by placing the patient in a knee-chest or Trendelenburg position to cause the fetal head to fall back from the cord. Turning the patient onto the left side will not relieve pressure on the fetal cord. Any amount of prolapsed cord should not be reinserted into the patient. Exposed cord should be covered with sterile saline compresses to prevent drying.

7. A patient recovering from an uneventful vaginal delivery is prescribed Rh (D) immune globulin (RhIG). What should the nurse explain to the patient regarding the purpose of this medication? A) It prevents fetal Rh blood formation. B) It stimulates maternal D immune antigens. C) It prevents maternal D antibody formation. D) It promotes maternal D antibody formation.

Ans: C Feedback: Rh (D) immune globulin (RhIG) is given to Rh-negative pregnant patients to prevent the formation of maternal antibodies to the Rh-positive blood type of the developing fetus. This medication does not prevent fetal Rh blood formation, stimulate maternal immune antigens, or promote maternal antibody formation.

1. A patient with asthma who is 32 weeks pregnant is concerned that the health care provider has reduced the doses of asthma maintenance medications. What should the nurse respond to this patient's concern? A) Asthma medication is teratogenic and should not be taken. B) Asthma improves during pregnancy so higher doses are not needed. C) Asthma medication may reduce labor contractions and should be reduced. D) Asthma medication is ineffective during pregnancy and should be stopped.

Ans: C Feedback: Some asthma maintenance medication such as beta-adrenergic agonists may be taken safely during pregnancy, but they have the potential to reduce labor contractions. The doses of these medications may be reduced as the patient approaches the time of delivery. Not all asthma medication is teratogenic. Asthma can improve during pregnancy because of circulating corticosteroids; however, the doses of the medications should have already been adjusted according to the patient's symptoms. There is no evidence to support that asthma medication is ineffective during pregnancy.

6. A patient with heart disease who is 28 weeks pregnant asks the nurse why office appointments have been scheduled every week for the next 4 weeks. What should the nurse respond to the patient? A) This is the routine schedule for all pregnant patients. B) This is when most patients have a risk of going into early labor. C) During weeks 28 and 32, blood volume peaks, and heart function can be affected. D) Extra care is needed to make sure the fetus is developing normally during this time period.

Ans: C Feedback: The danger of pregnancy in a patient with heart disease occurs primarily because of this increase in circulatory volume. The most dangerous time for the patient is in weeks 28 to 32, just after the blood volume peaks. Weekly appointments are not routine for all pregnant patients at this part of the pregnancy. This is not the time when most patients have a risk of going into early labor. The extra appointments are not needed to make sure the fetus is developing normally during this time period.

4. A pregnant patient is prescribed to have labor induced with oxytocin. How should the nurse prepare to administer this medication? A) In a 20-cc bolus of saline B) In two divided intramuscular sites C) Diluted as a "piggyback" infusion D) Diluted in the main intravenous fluid

Ans: C Feedback: When administering oxytocin, the infusion should be "piggybacked" to a maintenance IV solution and add the piggyback to the main infusion at the port closest to the patient. If the oxytocin needs to be discontinued quickly during the induction, little solution remains in the tubing to still infuse, and the main IV line can still be maintained. Oxytocin is not administered as an intravenous bolus, as intramuscular injections, nor is it diluted in the main intravenous fluid.

11. The nurse is monitoring a pregnant patient who is receiving intravenous magnesium sulfate for eclampsia. During the last assessment, the nurse was unable to elicit a patellar reflex. What should the nurse do? A) Check fetal heart rate. B) Measure blood pressure. C) Stop the current infusion. D) Increase the infusion rate.

Ans: C Feedback: When infusing magnesium sulfate, the nurse should stop the infusion if deep tendon reflexes are absent. Checking the fetal heart rate and measuring blood pressure could waste time and provide the patient with more magnesium sulfate. The infusion rate should not be increased because this could lead to cardiac dysrhythmias and respiratory depression.

9. The fetus of a pregnant patient is in a breech presentation. Where will the nurse auscultate fetal heart sounds? A) Low in the abdomen B) Left lateral abdomen C) High in the abdomen D) Right lateral abdomen

Ans: C Feedback: With a breech presentation, fetal heart sounds usually are heard high in the abdomen. In a breech presentation, fetal heart sounds will not be heard low in the abdomen or over the left or right lateral abdominal regions.

10. A pregnant patient is being admitted for severe preeclampsia. In which room location should the nurse place this patient? A) Near the nursery B) Next to the elevator C) In the back private room D) Across from the nurse's station

Ans: C Feedback: With severe preeclampsia, hospitalization is required so that bed rest can be enforced and the patient can be observed more closely. A patient with severe preeclampsia is admitted to a private room so that rest is undisturbed. Noises such as a baby crying, elevator doors opening and closing, and conversation from the nurse's station is sufficient to trigger a seizure. A private room will help reduce the likelihood of seizure development.

4. The nurse determines that a pregnant patient is at risk for developing a deep vein thrombosis. What should the nurse instruct the patient to reduce the risk of this potential complication? (Select all that apply.) A) Avoid foods high in calcium. B) Take a baby aspirin every day. C) Avoid standing in one position. D) Do not cross the legs at the knee. E) Do not wear knee-high stockings.

Ans: C, D, E Feedback: The risk of thrombus formation can be reduced through measures such as avoiding the use of constrictive knee-high stockings, not sitting with legs crossed at the knee, and avoiding standing in one position for a long period. Calcium restriction does not reduce the risk of thrombus formation and could potentially harm the developing fetus. The nurse cannot prescribe medication, and the patient should not take any medication without direction from the health care provider.

3. The nurse is concerned that a pregnant patient is experiencing abruptio placentae. What did the nurse assess in this patient? A) Increased blood pressure and oliguria B) Pain in a lower quadrant and increased pulse rate C) Painless vaginal bleeding and a fall in blood pressure D) Sharp fundal pain and discomfort between contractions

Ans: D Feedback: Abruptio placentae is characterized by a sharp, stabbing pain high in the uterine fundus as the initial separation occurs. Manifestations of abruptio placentae do not include increased blood pressure, oliguria, pain in the lower quadrant, increased pule rate, painless vaginal bleeding, or a fall in blood pressure.

12. A postpartum patient with systemic lupus erythematosus asks why symptoms of the disease are worse now that the baby has been born. What should the nurse explain to the patient? A) The fetus was keeping the symptoms in check. B) The stress of delivery causes the symptoms to increase. C) A spike in maternal hormone levels causes an increase in symptoms. D) Symptoms may be worse because corticosteroid levels are returning to normal.

Ans: D Feedback: During the postpartum period, there may be an acute exacerbation of systemic lupus erythematosus symptoms because corticosteroid levels are returning to normal. Symptoms are not increased because the fetus was keeping the symptoms in check. The stress of delivery is not causing the symptoms to increase. The symptoms are not because of a spike in maternal hormone levels.

4. A patient who is 16 weeks pregnant is passing pieces of body tissue along with blood clots and dark red blood from the vagina. What should the nurse direct the patient to do at this time? A) Begin immediate bed rest. B) Count the number of perineal pads that are saturated with blood. C) Continue with normal daily activity and monitor pulse rate every hour. D) Seek immediate medical attention and bring the expressed vaginal material.

Ans: D Feedback: Gestational trophoblastic disease is abnormal proliferation and then degeneration of the trophoblastic villi. The embryo fails to develop beyond a primitive start. At approximately week 16 of pregnancy, vaginal bleeding will begin as spotting of dark-brown blood accompanied by discharge of the clear fluid-filled vesicles. The pregnant patient who begins to miscarry at home needs to bring any clots or tissue passed to the hospital because the presence of clear fluid-filled cysts identifies gestational trophoblastic disease. The patient needs to seek immediate medical attention and not stay at home on bed rest, count perineal pads, or continue with normal activity and count pulse rates every hour.

12. The nurse is identifying nursing diagnoses for a patient with gestational hypertension. Which diagnosis would be the most appropriate for this patient? A) Risk for injury related to fetal distress B) Imbalanced nutrition related to decreased sodium levels C) Ineffective tissue perfusion related to poor heart contraction D) Ineffective tissue perfusion related to vasoconstriction of blood vessels

Ans: D Feedback: In gestational hypertension, vasospasm occurs in both small and large arteries during pregnancy. This can lead to ineffective tissue perfusion. There is no evidence to suggest that the fetus is in distress. There is no enough information to support imbalanced nutrition. Gestational hypertension does not affect heart contractions.

9. A patient who is 36 weeks pregnant has been taking phenytoin (Dilantin) for a seizure disorder. Which supplement should the nurse anticipate being prescribed for this patient? A) Vitamin C B) Vitamin D C) Vitamin E D) Vitamin K

Ans: D Feedback: Phenytoin (Dilantin) is believed to cause a fetal syndrome that includes vitamin K deficiency. To counteract the vitamin K deficiency and prevent hemorrhage in the newborn, the patient may be prescribed vitamin K during the last 4 weeks of gestation. Vitamins C, D, or E have no impact on the pregnant patient who is taking phenytoin (Dilantin) for a seizure disorder.

3. A patient with diabetes is in the first trimester of pregnancy and is currently having difficulty keeping blood glucose levels within normal limits. The patient explains that she has been "eating for two" so the baby is healthy. What should the nurse respond to the patient? A) "Elevated blood glucose levels cause low birth weights in infants." B) "Elevated blood glucose levels ensure the baby has mature lungs at birth." C) "Elevated blood glucose levels hasten the development of the fetus in utero." D) "Elevated blood glucose levels in the first trimester have been linked to congenital anomalies."

Ans: D Feedback: The first trimester of pregnancy is the most important time for fetal development. If the patient can control hyperglycemia during this time, the chances of a congenital anomaly are greatly reduced. Infants of patients with poorly controlled diabetes tend to be large. At birth, babies born to patients with uncontrolled diabetes are prone to respiratory distress syndrome. Elevated blood glucose levels do not hasten the development of the fetus in utero and can lead to hydramnios.

10. A postpartum patient is receiving antibiotics for endometritis. What should the nurse instruct the patient to observe in the infant with breastfeeding? A) Jaundice B) Irritability C) Decreased sleep levels D) White plaques in the mouth

Ans: D Feedback: The patient who is breastfeeding should not be prescribed antibiotics that are incompatible with breastfeeding. The patient should be instructed to observe for problems in their infant, such as white plaques or thrush in their infant's mouth that can occur when a portion of the maternal antibiotic passes into breast milk and causes an overgrowth of fungal organisms in the infant. Antibiotics will not typically cause jaundice. Irritability may or may not be because of the mother taking antibiotics. Decreased sleep levels are not typically associated with maternal antibiotic use.

4. The nurse is planning interventions to prevent the onset of urinary retention in a postpartum patient. Why are these interventions needed? A) Frequent partial voiding never relieves the bladder pressure. B) Catheterization at the time of delivery reduces bladder tonicity. C) Mild dehydration causes a concentrated urine volume in the bladder. D) Decreased bladder sensation results from edema because of pressure of birth.

Ans: D Feedback: Urinary retention occurs when there is inadequate bladder emptying. After childbirth, bladder sensation for voiding is decreased because of bladder edema caused by the pressure of birth. Frequent partial voiding can lead to bladder overdistention. Catheterization at the time of delivery will not reduce bladder tone. Dehydration will not cause urinary retention but an overall reduction in urine volume.