Maternity Exam 2

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

.c. bacterial endocarditis.

1. The standard of care for women who are dependent on heroin or other narcotics is ___________ maintenance treatment (MMT).

ANS: methadone Methadone maintenance treatment should be offered as part of a comprehensive care program that includes behavior therapy and support services. MMT has been shown to decrease opioid and other drug abuse, decrease criminal activity, improve individual functioning, and decrease the HIV rate.

1. A woman who is 36 weeks pregnant reports to the labor and delivery triage area expressing concerns that her baby "is not moving." Along with a nonstress test (NST) the nurse might also use ______________ to determine fetal well-being.

ANS: vibroacoustic stimulation Also referred to as VAS or acoustic stimulation, the vibroacoustic stimulator (similar to an electronic larynx) is applied to the maternal abdomen over the area of the fetal head. Vibration and sound are emitted for up to 3 seconds and may be repeated. A fetus near term responds by increasing the number of gross body movements, which can be easily seen and felt. The procedure can confirm reassuring NST findings and shorten the length of time necessary to obtain NST data.

Inquiring about past pregnancies is an important part of the nursing assessment. Women who have had a previous cesarean birth may request a trial of labor and a ______ delivery.

ANS: VBAC Although vaginal birth after cesarean is less common, it may be chosen for a variety of reasons. The nurse should be aware of the need for increased support of the woman in labor, and for complications that may occur.

3. The antidote administered to reverse magnesium toxicity is ______________.

ANS: calcium gluconate Calcium gluconate is the antidote necessary to reverse magnesium toxicity. The nurse caring for this patient should keep calcium gluconate in the room along with secured, syringes and needles. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 595 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

7. What is most likely to be a concern for the older mother? a. The importance of having enough rest and sleep b. Information about effective contraceptive methods c. Nutrition and diet planning d. Information about exercise and fitness

ANS: A Feedback A The woman who delays childbearing may have unique concerns, one of which is having less energy than younger mothers. B The older mother usually has more financial means to search out effective contraceptive methods. C The older mother is better off financially and can afford better nutrition. D Information about exercise and fitness is readily available.

Recurrent spontaneous abortion refers to a condition in which a woman experiences three or more consecutive abortions or miscarriages. This is also known as ________ abortion.

ANS: habitual Primary causes are believed to be genetic or chromosomal abnormalities of the fetus. For the mother who repeatedly aborts, the cause is often an anomaly of the reproductive tract such as bicornate uterus or incompetent cervix. Systemic illnesses such as lupus erythematosus and diabetes mellitus have been implicated in this condition as well. Treatment depends entirely on the cause and therefore varies between medical and surgical approaches. PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 578 OBJ: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity

2. The condition in which the placenta is implanted in the lower uterine segment near or over the internal cervical os is _____________.

ANS: placenta previa In placenta previa, the placenta is implanted in the lower uterine segment such that it completely or partially covers the cervix or is close enough to the cervix to cause bleeding when the cervix dilates or the lower uterine segment effaces. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 583 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

A woman at 40 weeks of gestation should be instructed to go to a hospital or birth center for evaluation when she experiences a. A trickle of fluid from the vagina b. Thick pink or dark red vaginal mucus c. Irregular contractions for 1 hour d. Fetal movement

ANS: A Feedback A A trickle of fluid from the vagina may indicate rupture of the membranes requiring evaluation for infection or cord compression. B Bloody show may occur before the onset of true labor. It does not require professional assessment unless the bleeding is pronounced. C This is a sign of false labor and does not require further assessment. D The lack of fetal movement needs further assessment.

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

ANS: A Feedback A An abortion is the termination of pregnancy before the age of viability (20 weeks). B The weight of the fetus is not considered because some fetuses of an older age may have a low birth weight. C A spontaneous abortion may be complete or incomplete. D A spontaneous abortion may be caused by many problems, one being intrauterine infection. PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 576 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

What occurrence is associated with cervical dilation and effacement? a. Bloody show b. False labor c. Lightening d. Bladder distention

ANS: A Feedback A As the cervix begins to soften, dilate, and efface, expulsion of the mucous plug that sealed the cervix during pregnancy occurs. This causes rupture of small cervical capillaries. B Cervical dilation and effacement do not occur with false labor. C Lightening is the descent of the fetus toward the pelvic inlet before labor. D Bladder distention occurs when the bladder is not empted frequently. It may slow down the decent of the fetus during labor.

7. The priority nursing intervention when admitting a pregnant woman who has experienced a bleeding episode in late pregnancy is to a. Assess fetal heart rate (FHR) and maternal vital signs. b. Perform a venipuncture for hemoglobin and hematocrit levels. c. Place clean disposable pads to collect any drainage. d. Monitor uterine contractions.

ANS: A Feedback A Assessment of the FHR and maternal vital signs will assist the nurse in determining the degree of the blood loss and its effect on the mother and fetus. B The most important assessment is to check mother/fetal well-being. The blood levels can be obtained later. C It is important to assess future bleeding, but the top priority is mother/fetal well-being. D Monitoring uterine contractions is important, but not the top priority. PTS: 1 DIF: Cognitive Level: Application REF: p. 587 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

27. Approximately 12% to 26% of all clinically recognized pregnancies end in miscarriage. Which is the most common cause of spontaneous abortion? a. Chromosomal abnormalities b. Infections c. Endocrine imbalance d. Immunologic factors

ANS: A Feedback A At least 60% of pregnancy losses result from chromosomal abnormalities that are incompatible with life. B Maternal infection may be a cause of early miscarriage. C Endocrine imbalances such as hypothyroidism or diabetes are possible causes for early pregnancy loss. D Women who have repeated early pregnancy losses appear to have immunologic factors the play a role in spontaneous abortion incidents. PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 576 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

12. Which assessment finding should convince the nurse to "hold" the next dose of magnesium sulfate? a. Absence of deep tendon reflexes b. Urinary output of 100 mL total for the previous 2 hours c. Respiratory rate of 14 breaths/min d. Decrease in blood pressure from 160/100 to 140/85

ANS: A Feedback A Because absence of deep tendon reflexes is a sign of magnesium toxicity, the next scheduled dose should not be administered. Calcium gluconate is the antidote that should be administered. B An hourly output of less than 30 mL could indicate toxicity. C A respiratory rate of less than 12 breaths/min could indicate toxicity. D Decrease in blood pressure is an expected side effect of magnesium sulfate. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 600 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

19. What order should the nurse expect for a patient admitted with a threatened abortion? a. Bed rest b. Ritodrine IV c. NPO d. Narcotic analgesia every 3 hours, prn

ANS: A Feedback A Decreasing the woman's activity level may alleviate the bleeding and allow the pregnancy to continue. B Ritodrine is not the first drug of choice for tocolytic medications. C There is no reason for having the woman NPO. At times dehydration may produce contractions, so hydration is important. D Narcotic analgesia will not decrease the contractions. It may mask the severity of the contractions. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 577 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

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

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

17. Rh incompatibility can occur if the woman is Rh negative and her a. Fetus is Rh positive b. Husband is Rh positive c. Fetus is Rh negative d. Husband and fetus are both Rh negative

ANS: A Feedback A For Rh incompatibility to occur, the mother must be Rh negative and her fetus Rh positive. B The husband's Rh factor is a concern only as it relates to the possible Rh factor of the fetus. C If the fetus is Rh negative, the blood types are compatible and no problems should occur. D If the fetus is Rh negative, the blood type with the mother is compatible. The husband's blood type does not enter into the problem. PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 601 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

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

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

Leopold's maneuvers are used by practitioners to determine a. The best location to assess the fetal heart rate (FHR) b. Cervical dilation and effacement c. Whether the fetus is in the posterior position d. The status of the membranes

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

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

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

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

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

To adequately care for a laboring woman, the nurse should know that the _____ stage of labor varies the most in length. a. First b. Second c. Third d. Fourth

ANS: A Feedback A The first stage of labor is considered to last from the onset of regular uterine contractions to full dilation of the cervix. The first stage is much longer than the second and third stages combined. In a first pregnancy, the first stage of labor can take up to 20 hours. B The second stage of labor lasts from the time the cervix is fully dilated to the birth of the fetus. The average length is 20 minutes for a multiparous woman and 50 minutes for a nulliparous woman. C The third stage of labor lasts from the birth of the fetus until the placenta is delivered. This stage may be as short as 3 minutes or as long as 1 hour. D The fourth stage of labor, recovery, lasts about 2 hours after delivery of the placenta.

To be aware of potential risks to the laboring woman, the nurse understands that a breech presentation is associated with a. Umbilical cord compression b. More rapid labor c. A high risk of infection d. Maternal perineal trauma

ANS: A Feedback A The umbilical cord can be compressed between the fetal body and the maternal pelvis when the body has been born but the head remains within the pelvis. B Breech presentation is not associated with a more rapid labor. C There is no higher risk of infection with a breech birth. D There is no higher risk for perineal trauma with a breech birth.

A laboring woman is lying in the supine position. The most appropriate nursing action is to a. Ask her to turn to one side. b. Elevate her feet and legs. c. Take her blood pressure. d. Determine if fetal tachycardia is present.

ANS: A Feedback A The woman's supine position may cause the heavy uterus to compress her inferior vena cava, reducing blood return to her heart and reducing placental blood flow. This problem is relieved by having her turn onto her side. B Elevating her legs will not relieve the pressure from the inferior vena cava. C This position may produce hypotension in the woman, but the action should be to prevent this from happening, not to assess for the problem. D If the woman is allowed to stay in the supine position and blood flow to the placental is reduced significantly, fetal tachycardia may occur. The most appropriate nursing action is to prevent this from occurring by turning the woman to her side.

5. In counseling a patient who has decided to relinquish her baby for adoption, the nurse should a. Affirm her decision while acknowledging her maturity in making it. b. Question her about her feelings regarding adoption. c. Tell her she can always change her mind about adoption. d. Ask her if anyone is coercing her into the decision to relinquish her baby.

ANS: A Feedback A A supportive, affirming approach by the nurse will strengthen the patient's resolve and help her to appreciate the significance of the event. The teen needs help in coping with her feelings about this decision. B It is important for the nurse to support and affirm the decision the patient has made. This will strengthen the patient's resolve to follow through. Later the patient should be given an opportunity to express her feelings. C This should not be an option after the baby is born and placed with the adoptive parents. D It is important that the teenager is treated as an adult, with the assumption that she is capable of making an important decision on her own.

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

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

3. The nurse providing care for the pregnant woman understands that a factor indicating the need for fetal diagnostic procedures is a. Maternal diabetes b. Maternal age older than 30 years c. Previous infant more than 3000 g at birth d. Weight gain of 25 pounds

ANS: A Feedback A Diabetes is a risk factor in pregnancy because of possible impairment of placental perfusion. B A maternal age greater than 35 years is an indication for testing. C Having had another infant weighing greater than 4000 g at birth is an indication for testing. D Excessive weight gain is an indication for testing. Normal weight gain is 15 to 35 pounds.

17. In helping bereaved parents cope and move on, nurses should keep in mind that a. A perinatal or parental grief support group is more likely to be helpful if the needs of the parents are matched with the focus of the group. b. When pictures of the infant are taken for keepsakes, no close-ups should be taken of any congenital anomalies. c. No significant differences exist in grieving individuals from various cultures, ethnic groups, and religions. d. In emergency situations, nurses who are so disposed must resist the temptation to baptize the infant in the absence of a priest or minister.

ANS: A Feedback A For example, a religious-based group may not work for nonreligious parents. B Close-up pictures of the baby must be taken as the infant was, congenital anomalies and all. C Although death and grieving are events shared by all people, mourning rituals, traditions, and taboos vary by culture, ethnicity, and religion. Differences must be respected. D Baptism for some religious groups can be performed by a layperson, such as a nurse, in an emergency situation when a priest is not available.

2. Which analysis of maternal serum may predict chromosomal abnormalities in the fetus? a. Multiple-marker screening b. Lecithin/sphingomyelin (L/S) ratio c. Biophysical profile d. Type and crossmatch of maternal and fetal serum

ANS: A Feedback A Maternal serum can be analyzed for abnormal levels of alpha-fetoprotein, human chorionic gonadotropin, and estriol. The multiple-marker screening may predict chromosomal defects in the fetus. B The L/S ratio is used to determine fetal lung maturity. C A biophysical profile is used for evaluating fetal status during the antepartum period. Five variables are used, but none is concerned with chromosomal problems. D The blood type and crossmatch will not predict chromosomal defects in the fetus.

15. Despite warnings, prenatal exposure to alcohol continues to far exceed exposure to illicit drugs. A diagnosis of Fetal Alcohol Syndrome is made when there are visible markers in each of three categories. Which is not a recognized category for diagnosis of FAS? a. Respiratory conditions b. Impaired growth c. CNS abnormality d. Craniofacial dysmorphologies

ANS: A Feedback A Respiratory difficulties are not a category of conditions that are related to FAS. Other abnormalities related to FAS include: organ deformities, genital malformations and kidney and urinary defects. B Impaired growth is a visible marker for FAS. C A CNS abnormality with neurologic and intellectual impairments is a category used to assist in the diagnosis of FAS. D An infant with FAS manifests at least two craniofacial abnormalities such as microcephaly, short palpebral fissures, poorly developed philtrum, thin upper lip or flattening of the maxillary.

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

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

16. When the nurse is alone with a battered patient, the patient seems extremely anxious and says, "It was all my fault. The house was so messy when he got home and I know he hates that." The best response by the nurse is a. "No one deserves to be hurt. It's not your fault. How can I help you?" b. "What else do you do that makes him angry enough to hurt you?" c. "He will never find out what we talk about. Don't worry. We're here to help you." d. "You have to remember that he is frustrated and angry so he takes it out on you."

ANS: A Feedback A The nurse should stress that the patient is not at fault. B This is placing the blame on the woman. C This is false reassurance. In order to assist the woman, many times the batterer will find out about the conversation. D This is placing the blame on the woman and finding excuses for the batterer.

3. The nursing student is planning to assess a fetal heart rate. The registered nurse reminds the student to get gel. Which method of assessing the fetal heart rate is the student planning on conducting? a. Fetoscope b. Tocodynamometer c. Doppler d. Scalp electrode

ANS: C Doppler is the only listed method involving ultrasonic transmission of fetal heart rates; it requires use of a gel. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 338 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

4. A nurse manager plans staffing for the Labor and Delivery unit. How does the available staff influence the selection of either continuous electronic or intermittent auscultation as the fetal monitoring method? a. There must be a 1:1 nurse-to-patient ratio regardless of the method used. b. Staffing patterns do not influence fetal monitoring choices. c. Use of intermittent auscultation requires a lower nurse-to-patient ratio. d. More nurses are needed when electronic fetal monitoring is used.

ANS: A A one-to-one ratio is needed during the second stage of labor or if a high-risk condition exists, regardless of the monitoring method used. Intermittent auscultation is more staff-intensive. Less nursing time is needed with electronic monitoring, giving the nurse more time for teaching and supporting the laboring woman. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 336 OBJ: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment

22. In the low-risk patient assessments for variability and periodic changes if using the fetal monitor should be done how often? a. Every 15 to 30 minutes b. Every 5 to 15 minutes c. Every 30 to 60 minutes d. Only before and after ambulation

ANS: A During the active first stage of labor, FHR should be assessed every 15 to 30 minutes just after a contraction. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 385 | Box 17.1 OBJ: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment

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

ANS: A Teaching is an essential part of the nurse's role. Corrective actions should be initiated first in order to correct abnormal findings as quickly as possible. The support person should be encouraged to assist with the comfort measures. Electronic monitoring will record the contractions and FHR response. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 347 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

13. The fetal heart rate baseline increases 15 beats per minute after vibroacoustic stimulation. What action by the nurse is most appropriate? a. Reassure the family the finding is normal. b. Prepare to assist with obtaining cord blood gases. c. Position the woman on her left side. d. Administer oxygen at 4 L via nasal cannula.

ANS: A The fetus with adequate reserve for the stress of labor will usually respond to vibroacoustic stimulation with a temporary increase in the fetal heart rate (FHR) over baseline of 15 bpm for 15 seconds or more. The nurse reassures the family that this finding is normal. The other actions are not warranted. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 346 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

10. In which situation is a baseline fetal heart rate of 160 to 170 beats per minute considered a normal finding? a. The fetus is at 28 weeks of gestation. b. The mother has been given an epidural block. c. The mother has a history of fast labors. d. The mother has mild preeclampsia but is not in labor.

ANS: A The normal preterm fetus may have a baseline rate slightly higher than the term fetus because of an immature parasympathetic nervous system that does not yet exert a slowing effect on the fetal heart rate (FHR). Any change in the FHR with an epidural is not considered an expected outcome. Fast labors should not alter the FHR normally. Preeclampsia should not cause a normal elevation of the FHR. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 340 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

5. A student nurse is placing a tocotransducer on a woman for electronic fetal monitoring. What action by the student indicates to the registered nurse that the student understands the procedure? a. Places the tocotransducer over the uterine fundus b. Prepares sterile field for fetal scalp electrode placement c. Positions the tocotransducer on the woman's upper arm d. Attaches the tocotransducer to the woman's lower abdomen

ANS: A The tocotransducer monitors uterine activity and should be placed over the fundus, where the most intensive uterine contractions occur. No sterile field is needed. The tocotransducer is not placed on the upper arm or lower abdomen. PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating REF: p. 338 OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance

1. The nurse sees this pattern on the fetal monitor. What action by the nurse is most appropriate? a. Apply oxygen via face mask, and position the woman on her left side. b. Document the findings in the chart along with maternal vital signs. c. Prepare to start an infusion of oxytocin per unit protocol. d. Decrease the rate of the woman's IV maintenance fluids.

ANS: A This tracing shows a late deceleration. The mother should be given oxygen and positioned on her left side. The findings should be documented, but only after interventions have occurred. Oxytocin would increase uterine activity (and increase stress on the fetus) so should not be started, or if already running, discontinued. IV fluids should be increased. PTS: 1 DIF: Cognitive Level: Analysis REF: Figure 17.10 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

2. Which maternal condition is considered a contraindication for the application of internal monitoring devices? a. Unruptured membranes b. Cervix is dilated to 4 cm c. External monitors are currently being used d. Fetus has a known heart defect

ANS: A To apply internal monitoring devices, the membranes must be ruptured. Cervical dilation of 4 cm permits the insertion of fetal scalp electrodes and intrauterine catheter. The external monitor can be discontinued after the internal ones are applied. A compromised fetus should be monitored with the most accurate monitoring devices. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 338 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

20. The new nurse learns that which condition related to decreased variability is considered benign? a. A periodic fetal sleep state b. Extreme prematurity c. Fetal hypoxemia d. Preexisting neurologic injury

ANS: A When the fetus is temporarily in a sleep state there is minimal variability present. Periodic fetal sleep states usually last no longer than 30 minutes. The other conditions would be considered conducive to abnormal variability. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 340 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance

4. Which of the following factors place the intrapartum woman at risk for complications during labor and delivery? (Select all that apply.) a. Prolonged rupture of membranes b. Chorioamnionitis c. Fever d. History of stillbirth e. Drug use

ANS: A, B, C Prolonged rupture of membranes, Chorioamnionitis, and fever are specific to the intrapartum period. Stillbirths and drug use are problems found in the antepartum period. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: Box 17.1 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

1. Transvaginal ultrasonography is often performed during the first trimester. While preparing your 6-week-gestation patient for this procedure, she expresses concerns over the necessity for this test. The nurse should explain that this diagnostic test may be necessary to determine which of the following? Select all that apply. a. Multifetal gestation b. Bicornate uterus c. Presence and location of pregnancy (intrauterine or elsewhere) d. Amniotic fluid volume e. Presence of ovarian cysts

ANS: A, B, C, E Feedback Correct All of these conditions can be determined by transvaginal ultrasound in the first trimester of pregnancy. This procedure is also used for estimating gestational age, confirming fetal viability, identifying fetal abnormalities or chromosomal defects, and identifying the maternal abnormalities mentioned, as well as fibroids. Incorrect Amniotic fluid volume is assessed during the second and third trimester. Conventional ultrasound would be used.

1. Many teens wait until the second or even third trimester to seek prenatal care. The nurse should understand that the reasons behind this delay include (select all that apply) a. Lack of realization that they are pregnant b. Uncertainty as to where to go for care c. Continuing to deny the pregnancy d. A desire to gain control over their situation e. Wanting to hide the pregnancy as long as possible

ANS: A, B, C, E Feedback Correct These are all valid reasons for the teen to delay seeking prenatal care. An adolescent often has little to no understanding of the increased physiologic needs that a pregnancy places on her body. Once care is sought, it is often sporadic and many appointments are missed. The nurse should formulate a diagnosis that assists the pregnant teen to receive adequate prenatal care. Incorrect The opposite is true. Planning for her pregnancy and impending birth actually provides some sense of control for the teen and increases feelings of competency. Receiving praise from the nurse when she attends her prenatal appointments will reinforce the young woman's positive self-image.

Throughout the world the rate of ectopic pregnancy has increased dramatically over the past 20 years. This is believed to be due primarily to scarring of the fallopian tubes as a result of pelvic infection, inflammation, or surgery. The nurse who suspects that a patient has early signs of ectopic pregnancy should be observing her for symptoms such as (select all that apply) a. Pelvic pain b. Abdominal pain c. Unanticipated heavy bleeding d. Vaginal spotting or light bleeding e. Missed period

ANS: A, B, D, E Feedback Correct A missed period or spotting can easily be mistaken by the patient as early signs of pregnancy. More subtle signs depend on exactly where the implantation occurs. The nurse must be thorough in her assessment because pain is not a normal symptom of early pregnancy. Incorrect As the fallopian tube tears open and the embryo is expelled, the patient often exhibits severe pain accompanied by intraabdominal hemorrhage. This may progress to hypovolemic shock with minimal or even no external bleeding. In about half of women, shoulder and neck pain occurs due to irritation of the diaphragm from the hemorrhage. PTS: 1 DIF: Cognitive Level: Application REF: p. 580 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

MULTIPLE RESPONSE The nurse who elects to practice in the area of obstetrics often hears discussion regarding the "four Ps." These are the four major factors that interact during normal childbirth. What are the "four Ps"? a. Powers b. Passage c. Position d. Passenger e. Psyche

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

A patient who has undergone a D&C for early pregnancy loss is likely to be discharged the same day. The nurse must ensure that vital signs are stable, that bleeding has been controlled, and that the woman has adequately recovered from the administration of anesthesia. In order to promote an optimal recovery, discharge teaching should include (select all that apply) a. Iron supplementation b. Resumption of intercourse at 6 weeks post-procedure c. Referral to a support group if necessary d. Expectation of heavy bleeding for at least 2 weeks e. Emphasizing the need for rest

ANS: A, C, E Feedback Correct The woman should be advised to consume a diet high in iron and protein. For many women, iron supplementation also is necessary. Acknowledge that the patient has experienced a loss, albeit early. She can be taught to expect mood swings and possibly depression. Referral to a support group, clergy, or professional counseling may be necessary. Discharge teaching should emphasize the need for rest. Incorrect Nothing should be placed in the vagina for 2 weeks postprocedure. This includes tampons and vaginal intercourse. The purpose of this recommendation is to prevent infection. Should infection occur, antibiotics may be prescribed. The patient should expect a scant, dark discharge for 1 to 2 weeks. Should heavy, profuse, or bright bleeding occur she should be instructed to contact her provider. PTS: 1 DIF: Cognitive Level: Application REF: p. 579, 583 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

2. Percutaneous umbilical cord sampling (PUBS), also called cordocentesis, involves the aspiration of fetal blood from the umbilical cord for prenatal diagnosis or therapy. Major indications include (select all that apply) a. Rh disease b. Fetal well-being c. Infection d. Lung maturity e. Karyotyping

ANS: A, C, E Feedback Correct These are all indications for PUBS. Another indication is for diagnosis or disorders that require fetal blood for testing. Although used to develop a karyotype (chromosome evaluation) other DNA analysis techniques might also be utilized. Incorrect NST or BPP are used to determination fetal well-being. An amniocentesis is done in order to determine lung maturity.

During the active phase of labor, the FHR of a low-risk patient should be assessed every a. 15 minutes b. 30 minutes c. 45 minutes d. 1 hour

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

9. A woman with severe preeclampsia is being treated with bed rest and intravenous magnesium sulfate. The drug classification of this medication is a. Tocolytic b. Anticonvulsant c. Antihypertensive d. Diuretic

ANS: B Feedback A A tocolytic drug does slow the frequency and intensity of uterine contractions but is not used for that purpose in this scenario. B Anticonvulsant drugs act by blocking neuromuscular transmission and depress the central nervous system to control seizure activity. C Decreased peripheral blood pressure is a therapeutic response (side effect) of the anticonvulsant magnesium sulfate. D Diuresis is a therapeutic response to magnesium sulfate. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 594 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

4. An abortion in which the fetus dies but is retained in the uterus is called _____ abortion. a. Inevitable b. Missed c. Incomplete d. Threatened

ANS: B Feedback A An inevitable abortion means that the cervix is dilating with the contractions. B Missed abortion refers to a dead fetus being retained in the uterus. C An incomplete abortion means that not all of the products of conception were expelled. D With a threatened abortion the woman has cramping and bleeding but not cervical dilation. PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 578 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

24. Which 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

ANS: B Feedback A Bleeding time in DIC is normal. B Degradation of fibrin leads to the accumulation of multiple fibrin clots throughout the body's vasculature. C Low platelets may occur with but are not indicative of DIC because they may result from other coagulopathies. D Hypofibrinogenemia occurs with DIC. PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 578 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

To adequately teach patients about the process of labor, the nurse knows that which event is the best indicator of true labor? a. Bloody show b. Cervical dilation and effacement c. Fetal descent into the pelvic inlet d. Uterine contractions every 7 minutes

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

The primary difference between the labor of a nullipara and that of a multipara is the a. Amount of cervical dilation b. Total duration of labor c. Level of pain experienced d. Sequence of labor mechanisms

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

29. The nurse caring for a woman hospitalized for hyperemesis gravidarum should expect that initial treatment involves a. Corticosteroids to reduce inflammation b. IV therapy to correct fluid and electrolyte imbalances c. An antiemetic, such as pyridoxine, to control nausea and vomiting d. Enteral nutrition to correct nutritional deficits

ANS: B Feedback A Corticosteroids have been used successfully to treat refractory hyperemesis gravidarum, but they are not the expected initial treatment for this disorder. B Initially, the woman who is unable to down clear liquids by mouth requires IV therapy for correction of fluid and electrolyte imbalances. C Pyridoxine is vitamin B6, not an antiemetic. Promethazine, a common antiemetic, may be prescribed. D In severe cases of hyperemesis gravidarum, enteral nutrition via a feeding tube may be necessary to correct maternal nutritional deprivation. This is not an initial treatment for this patient. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 590 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

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

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

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

ANS: B Feedback A If the mother has stable vital signs and the fetus is alive, a vaginal delivery can be attempted. If the fetus has died, a vaginal delivery is preferred. B In total placenta previa, the placenta completely covers the cervical os. The fetus would die if a vaginal delivery occurred. C The most common ectopic pregnancy is a tubal pregnancy, which is usually detected and treated in the first trimester. D Labor can be safely induced if the eclampsia is under control. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 583, 585 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

Which statement is the best rationale for assessing maternal vital signs between contractions? a. During a contraction, assessing fetal heart rates is the priority. b. Maternal circulating blood volume increases temporarily during contractions. c. Maternal blood flow to the heart is reduced during contractions. d. Vital signs taken during contractions are not accurate.

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

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

ANS: B Feedback A Oral contraceptives do not increase the risk for ectopic pregnancies. B Infection and subsequent scarring of the fallopian tubes prevents normal movement of the fertilized ovum into the uterus for implantation. C Ovarian cysts do not cause scarring of the fallopian tubes. D This will not cause scarring of the fallopian tubes, which is the main risk factor for ectopic pregnancies. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 580 | Box 25-1 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

Which maternal factor may inhibit fetal descent and require further nursing interventions? a. Decreased peristalsis b. A full bladder c. Reduction in internal uterine size d. Rupture of membranes

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

If a woman's fundus is soft 30 minutes after birth, the nurse's first response should be to a. Take the blood pressure. b. Massage the fundus. c. Notify the physician or nurse-midwife. d. Place the woman in Trendelenburg position.

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

It is important for the nurse providing care during labor to be aware that pregnant women can usually tolerate the normal blood loss associated with childbirth because they have a. A higher hematocrit b. Increased blood volume c. A lower fibrinogen level d. Increased leukocytes

ANS: B Feedback A The hematocrit decreases with pregnancy due to the high fluid volume. B Women have a significant increase in blood volume during pregnancy. After delivery, the additional circulating volume is no longer necessary. C Fibrinogen levels increase with pregnancy. D Leukocyte levels increase during labor, but that is not the reason for the toleration of blood loss.

To teach and support the woman in labor, the nurse explains that the strongest part of a labor contraction is the a. Increment b. Acme c. Decrement d. Interval

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

A patient whose cervix is dilated to 5 cm is considered to be in which phase of labor? a. Latent phase b. Active phase c. Second stage d. Third stage

ANS: B Feedback A The latent phase is from the beginning of true labor until 3 cm of cervical dilation. B The active phase of labor is characterized by cervical dilation of 4 to 7 cm. C The second stage of labor begins when the cervix is completely dilated until the birth of the baby. D The third stage of labor is from the birth of the baby until the expulsion of the placenta.

16. A patient with pregnancy-induced hypertension is admitted complaining of pounding headache, visual changes, and epigastric pain. Nursing care is based on the knowledge that these signs indicate a. Anxiety due to hospitalization b. Worsening disease and impending convulsion c. Effects of magnesium sulfate d. Gastrointestinal upset

ANS: B Feedback A These are danger signs and should be treated. B Headache and visual disturbances are due to increased cerebral edema. Epigastric pain indicates distention of the hepatic capsules and often warns that a convulsion is imminent. C She has not been started on magnesium sulfate as a treatment yet. Also, these are not expected effects of the medication. D These are danger signs showing increased cerebral edema and impending convulsion. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 599-600 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

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

ANS: B Feedback A This is an important nursing assessment, but does not take priority if the birth is imminent. B All options describe relevant intrapartum nursing assessments, but the focus assessment has priority. If the maternal and fetal conditions are normal and birth is not imminent, other assessments can be performed in an unhurried manner. C This is an assessment that can occur later in the admission process if time permits. D This part of the assessment can occur later in the admission process if time permits.

To assess the duration of labor contractions, the nurse determines the time a. From the beginning of one contraction to the beginning of the next b. From the beginning to the end of each contraction c. Of the strongest intensity of each contraction d. Of uterine relaxation between two contractions

ANS: B Feedback A This is the frequency of the contractions. B Duration of labor contractions is the average length of contractions from beginning to end. C This is the strength or intensity of the contractions. D This is the interval of the contraction phase.

8. A pregnant woman is being discharged from the hospital after placement of a cerclage because of a history of recurrent pregnancy loss secondary to an incompetent cervix. Discharge teaching should emphasize that a. Any vaginal discharge should be reported immediately to her care provider. b. The presence of any contractions, rupture of membranes, or severe perineal pressure should be reported. c. She will need to make arrangements for care at home, because her activity level will be restricted. d. She will be scheduled for a cesarean birth.

ANS: B Feedback A Vaginal bleeding needs to be reported to her primary care provider. B Nursing care should stress the importance of monitoring signs and symptoms of preterm labor. C Bed rest is an element of care. However, the woman may stand for periods of up to 90 minutes, which allows her the freedom to see her physician. Home uterine activity monitoring may be used to limit the woman's need for visits and to safely monitor her status at home. D The cerclage can be removed at 37 weeks of gestation (to prepare for a vaginal birth), or a cesarean birth can be planned. PTS: 1 DIF: Cognitive Level: Application REF: p. 579 OBJ: Nursing Process: Planning and Implementation MSC: Client Needs: Health Promotion and Maintenance

2. During which phase of the cycle of violence does the batterer become contrite and remorseful? a. Battering phase b. Honeymoon phase c. Tension-building phase d. Increased drug-taking phase

ANS: B Feedback A During the battering phase violence actually occurs, and the victim feels powerless. B During the honeymoon phase, the battered person wants to believe that the battering will never happen again, and the batterer will promise anything to get back into the home. C During the tension-building phase, the batterer becomes increasingly hostile, swears, threatens, throws things, and pushes the battered. D Often the batterer increases the use of drugs during the tension-building phase.

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

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

13. The purpose of initiating contractions in a CST is to a. Determine the degree of fetal activity. b. Apply a stressful stimulus to the fetus. c. Identifying fetal acceleration patterns. d. Increase placental blood flow.

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

9. Which nursing intervention is necessary before a second-trimester transabdominal ultrasound? a. Place the woman NPO for 12 hours. b. Instruct the woman to drink 1 to 2 quarts of water. c. Administer a soapsuds enema. d. Perform an abdominal prep.

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

15. In many settings, nurses may perform nonstress tests (NST), conduct an initial assessment of the woman and begin necessary interventions for nonreassuring results. These nursing procedures are accomplished after additional education and training under established protocols. Which nursing action is necessary when preparing the patient for the NST? a. Position the woman on her left side. b. Be certain that the woman is seated comfortably in a reclining chair. c. Encourage the woman to drink one liter of water prior to the test. d. Place conduction gel on the woman's abdomen with one belt.

ANS: B Feedback A The woman should be seating in a reclining chair or in semi-Fowler position if on a bed or stretcher. B To correctly position the pregnant patient for an NST, the nurse should place the woman in a reclining chair or in semi-Fowler position with a lateral tilt. will optimize uterine perfusion and prevent supine hypotension. C This is the appropriate preparation for abdominal ultrasonography. Caregivers sometimes suggest that the women drink juice in order to increase her glucose level and stimulate fetal movement. Although this practice is common, research has not proven it effective. D Conduction gel should be applied along with two belts. One belt has a Doppler transducer to detect the fetal heart rate. The other belt has a tocodynamometer to detect fetal movement or uterine contractions.

14. A woman who is 6 months pregnant has sought medical attention, saying she fell down the stairs. What scenario would cause an emergency department nurse to suspect that the woman has been battered? a. The woman and her partner are having an argument that is loud and hostile. b. The woman has injuries on various parts of her body that are in different stages of healing. c. Examination reveals a fractured arm and fresh bruises. Her husband asks her about her pain. d. She avoids making eye contact and is hesitant to answer questions.

ANS: B Feedback A This is not always an indication of battering. Many times the batterer will be attentive and refuse to leave the woman's bedside. B The battered woman often has multiple injuries in various stages of healing. C With battering there are injuries in various stages of healing. D It is more normal for the woman to have a flat affect.

23. A new nurse notes a fetal heart rate pattern of late deceleration with minimal variability in a laboring woman with vaginal bleeding. Which action by the new nurse warrants intervention by the charge nurse? a. Assesses maternal blood pressure b. Assesses for a prolapsed cord c. Prepares to administer terbutaline d. Discontinues oxytocin

ANS: B Assessing for a prolapsed cord requires a vaginal examination, which is contraindicated when the woman has active vaginal bleeding. The other actions are appropriate. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 344 | Safety Alert Box OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

6. A student nurse is preparing to administer misoprostol (Cytotec). What action by the student seen by the registered nurse demonstrates adequate knowledge about this medication? a. Assesses maternal blood pressure 30 minutes after administration b. Assesses fetal heart tones prior to administering the medication c. Documents the drug administration in the woman's chart d. Takes and records an apical pulse for 1 minute prior to administration

ANS: B Fetal heart tones should be assessed prior to giving cervical ripening agents such as misoprostol. It is not necessary to assess maternal blood pressure afterward or an apical pulse prior to administering the medication. Documentation of all medications is a legal requirement but is not related specifically to this drug. PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating REF: Box 17.2 OBJ: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity

7. A woman has a history of hypertension during pregnancy. What method of intrapartum fetal monitoring does the nurse initiate? a. Continuous auscultation with a fetoscope b. Continuous electronic fetal monitoring c. Intermittent assessment with a Doppler transducer d. Intermittent electronic fetal monitoring for 15 minutes each hour

ANS: B Maternal hypertension may reduce placental blood flow through vasospasm of the spiral arteries. Reduced placental perfusion is best assessed with continuous electronic fetal monitoring to identify patterns associated with this condition. It is not practical to provide continuous auscultation with a fetoscope. This fetus needs continuous monitoring because it is at high risk for complications. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 333 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

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

ANS: B The uterus may contract more firmly, and the resting tone may be increased with oxytocin use. This response reduces entrance of freshly oxygenated maternal blood into the intervillous spaces, depleting fetal oxygen reserves. Hypotension is not a common side effect of oxytocin. All laboring women are at risk for fluid volume deficit; oxytocin administration does not increase the risk. Oxytocin affects the uterine muscles. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 333 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

1. A Labor and Delivery nurse knows that four of the five fetal factors that interact to regulate the heart rate are which of the following? (Select all that apply.) a. Uterine activity b. Autonomic nervous system c. Baroreceptors d. Chemoreceptors e. Adrenal glands

ANS: B, C, D, E The sympathetic and parasympathetic branches of the autonomic nervous system are balanced forces that regulate FHR. Sympathetic stimulation increases the heart rate, while parasympathetic responses, through stimulation of the vagus nerve, reduce the FHR and maintain variability. The baroreceptors stimulate the vagus nerve to slow the FHR and decrease the blood pressure. These are located in the carotid arch and major arteries. The chemoreceptors are cells that respond to changes in oxygen, carbon dioxide, and pH. They are found in the medulla oblongata and the aortic and carotid bodies. The adrenal medulla secretes epinephrine and norepinephrine in response to stress, causing an acceleration in FHR. Uterine activity is a maternal factor. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 333 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

2. Approximately 82% of teen pregnancies are unintended. Seventy percent of teens have had sex by their 19th birthday. Factors that contribute to an increased risk for teen pregnancy include (select all that apply) a. High self-esteem b. Peer pressure c. Limited access to contraception d. Planning sexual activity e. Lack of role models

ANS: B, C, E Feedback Correct Peer pressure to begin sexual activity is a contributing factor towards teenage pregnancy. Limited access to contraceptive devices and lack of accurate information about how to use these devices are also factors. Lack of appropriate role models, desire to alleviate or escape the present situation at home, along with feelings of invincibility, also contribute to teenage pregnancy. Incorrect Low self-esteem and the consequent inability to set limits on sexual activity places the adolescent at risk for teen pregnancy. Ambivalence towards sexuality, and not planning intercourse, are more likely to result in teen pregnancy.

3. A new nurse to Labor and Delivery learns about the three categories of fetal heart rate patterns. Which characteristics of the fetal heart belong in Category III? (Select all that apply.) a. Baseline rate of 110 to 160 bpm b. Tachycardia c. Absent baseline variability NOT accompanied by recurrent decelerations d. Variable decelerations with other characteristics such as shoulders or overshoots e. Absent baseline variability with recurrent variable decelerations f. Bradycardia

ANS: B, D, E, F These characteristics are all considered non-reassuring or abnormal and belong in Category III. A fetal heart rate of 110 to 160 bpm is considered normal and belongs in Category I. Absent baseline variability not accompanied by recurrent decelerations is a Category II characteristic. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 344 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance

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

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

6. What condition indicates concealed hemorrhage in an abruptio placentae? a. Decrease in abdominal pain b. Bradycardia c. Hard, boardlike abdomen d. Decrease in fundal height

ANS: C Feedback A Abdominal pain may increase. B The patient will have shock symptoms that include tachycardia. C Concealed hemorrhage occurs when the edges of the placenta do not separate. The formation of a hematoma behind the placenta and subsequent infiltration of the blood into the uterine muscle results in a very firm, boardlike abdomen. D The fundal height will increase as bleeding occurs. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 586 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

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

ANS: C Feedback A Birth of the head occurs when the station is +4. A 0 station indicates engagement. B Bloody show occurs throughout the labor process and is not an indication of an imminent birth. C A bulging vulva that encircles the fetal head describes crowning, which occurs shortly before birth. D Rupture of membranes can occur at any time during the labor process and does not indicate an imminent birth.

23. The primary symptom present in abruptio placentae that distinguishes it from placenta previa is a. Vaginal bleeding b. Rupture of membranes c. Presence of abdominal pain d. Changes in maternal vital signs

ANS: C Feedback A Both may have vaginal bleeding. B Rupture of membranes may occur with both conditions. C Pain in abruptio placentae occurs in response to increased pressure behind the placenta and within the uterus. Placenta previa manifests with painless vaginal bleeding. D Maternal vital signs may change with both if bleeding is pronounced. PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 585 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

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

ANS: C Feedback A Descent is the moving of the fetus through the birth canal. B Engagement occurs when the largest diameter of the fetal presenting part has passed the pelvic inlet. C Flexion of the fetal head allows the smallest head diameters pass through the pelvis. D The station is the relationship of the fetal presenting part to the level of the ischial spines.

13. The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the Pitocin infusion, the nurse reviews the woman's latest laboratory test findings, which reveal a low platelet count, an elevated aspartate transaminase (AST) level, and a falling hematocrit. The nurse notifies the physician, because the lab results are indicative of a. Eclampsia b. Disseminated intravascular coagulation c. HELLP syndrome d. Rh incompatibility

ANS: C Feedback A Eclampsia is determined by the presence of seizures. B DIC is a potential complication associated with HELLP syndrome. C HELLP syndrome is a laboratory diagnosis for a variant of severe preeclampsia that involves hepatic dysfunction characterized by hemolysis (H), elevated liver enzymes (EL), and low platelets (LP). D These are not clinical indications of Rh incompatibility. PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 600-601 OBJ: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity

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

ANS: C Feedback A Edema classified as +1 indicates minimal edema of the lower extremities. B Marked edema of the lower extremities is termed +2 edema. C Edema of the extremities, face, and sacral area is classified as +3 edema. D Generalized massive edema (+4) includes accumulation of fluid in the peritoneal cavity. PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 593 | Table 25-2 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

When assessing the fetus using Leopold maneuvers, the nurse feels a round, firm, movable fetal part in the fundal portion of the uterus and a long, smooth surface in the mother's right side close to midline. What is the likely position of the fetus? a. ROA b. LSP c. RSA d. LOA

ANS: C Feedback A Fetal position is denoted with a three-letter abbreviation. The first letter indicates the presenting part in either the right or left side of the maternal pelvis. The second letter indicates the anatomic presenting part of the fetus. The third letter stands for the location of the presenting part in relation to the anterior, posterior, or transverse portion of the maternal pelvis. Palpation of a round, firm fetal part in the fundal portion of the uterus would be the fetal head, indicating that the fetus is in a breech position with the sacrum as the presenting part in the maternal pelvis. Palpation of the fetal spine along the mother's right side denotes the location of the presenting part in the mother's pelvis. The ability to palpate the fetal spine indicates that the fetus is anteriorly positioned in the maternal pelvis. RO/A/ denotes a fetus that is positioned anteriorly in the right side of the maternal pelvis with the occiput as the presenting part. B Fetal position is denoted with a three-letter abbreviation. The first letter indicates the presenting part in either the right or left side of the maternal pelvis. The second letter indicates the anatomic presenting part of the fetus. The third letter stands for the location of the presenting part in relation to the anterior, posterior, or transverse portion of the maternal pelvis. Palpation of a round, firm fetal part in the fundal portion of the uterus would be the fetal head, indicating that the fetus is in a breech position with the sacrum as the presenting part in the maternal pelvis. Palpation of the fetal spine along the mother's right side denotes the location of the presenting part in the mother's pelvis. The ability to palpate the fetal spine indicates that the fetus is anteriorly positioned in the maternal pelvis. LSP describes a fetus that is positioned posteriorly in the left side of the pelvis with the sacrum as the presenting part. C Fetal position is denoted with a three-letter abbreviation. The first letter indicates the presenting part in either the right or left side of the maternal pelvis. The second letter indicates the anatomic presenting part of the fetus. The third letter stands for the location of the presenting part in relation to the anterior, posterior, or transverse portion of the maternal pelvis. Palpation of a round, firm fetal part in the fundal portion of the uterus would be the fetal head, indicating that the fetus is in a breech position with the sacrum as the presenting part in the maternal pelvis. Palpation of the fetal spine along the mother's right side denotes the location of the presenting part in the mother's pelvis. The ability to palpate the fetal spine indicates that the fetus is anteriorly positioned in the maternal pelvis. This fetus is positioned anteriorly in the right side of the maternal pelvis with the sacrum as the presenting part. RS/A/ is the correct three-letter abbreviation to indicate this fetal position. D Fetal position is denoted with a three-letter abbreviation. The first letter indicates the presenting part in either the right or left side of the maternal pelvis. The second letter indicates the anatomic presenting part of the fetus. The third letter stands for the location of the presenting part in relation to the anterior, posterior, or transverse portion of the maternal pelvis. Palpation of a round, firm fetal part in the fundal portion of the uterus would be the fetal head, indicating that the fetus is in a breech position with the sacrum as the presenting part in the maternal pelvis. Palpation of the fetal spine along the mother's right side denotes the location of the presenting part in the mother's pelvis. The ability to palpate the fetal spine indicates that the fetus is anteriorly positioned in the maternal pelvis. /A/ fetus that is LOA, would be positioned anteriorly in the left side of the pelvis with the occiput as the presenting part.

What results from the adaptation of the fetus to the size and shape of the pelvis? a. Lightening b. Lie c. Molding d. Presentation

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

10. What is the only known cure for preeclampsia? a. Magnesium sulfate b. Antihypertensive medications c. Delivery of the fetus d. Administration of acetylsalicylic acid (ASA) every day of the pregnancy

ANS: C Feedback A Magnesium sulfate is one of the medications used to treat but not to cure preeclampsia. B Antihypertensive medications are used to lower the dangerously elevated blood pressures in preeclampsia and eclampsia. C If the fetus is viable and near term, delivery is the only known "cure" for preeclampsia. D Low doses of ASA (60 to 80 mg) have been administered to women at high risk for developing preeclampsia. PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 593 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

28. Methotrexate is recommended as part of the treatment plan for which obstetric complication? a. Complete hydatidiform mole b. Missed abortion c. Unruptured ectopic pregnancy d. Abruptio placentae

ANS: C Feedback A Methotrexate is not indicated or recommended as a treatment option for a complete hydatidiform mole. B Methotrexate is not indicated or recommended as a treatment option for missed abortions. C Methotrexate is an effective, nonsurgical treatment option for a hemodynamically stable woman whose ectopic pregnancy is unruptured and less than 4 cm in diameter. D Methotrexate is not indicated or recommended as a treatment option for abruptio placentae. PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 580 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

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

ANS: C Feedback A Nausea increases in a molar pregnancy because of the increased production of hCG. B A woman with a molar pregnancy may have early-onset pregnancy-induced hypertension. C The uterus in a hydatidiform molar pregnancy is often larger than would be expected on the basis of the duration of the pregnancy. D The history of bleeding is normally described as being brownish. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 582 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

During labor, a vaginal examination should be performed only when necessary because of the risk of a. Fetal injury b. Discomfort c. Infection d. Perineal trauma

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

The nurse thoroughly dries the infant immediately after birth primarily to a. Stimulate crying and lung expansion. b. Remove maternal blood from the skin surface. c. Reduce heat loss from evaporation. d. Increase blood supply to the hands and feet.

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

25. A woman taking magnesium sulfate has respiratory rate of 10 breaths/min. In addition to discontinuing the medication, the nurse should a. Vigorously stimulate the woman. b. Instruct her to take deep breaths. c. Administer calcium gluconate. d. Increase her IV fluids.

ANS: C Feedback A Stimulation will not increase the respirations. B This will not be successful in reversing the effects of the magnesium sulfate. C Calcium gluconate reverses the effects of magnesium sulfate. D Increasing her IV fluids will not reverse the effects of the medication. PTS: 1 DIF: Cognitive Level: Application REF: p. 595 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

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

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

The maternity nurse understands that as the uterus contracts during labor, maternal-fetal exchange of oxygen and waste products a. Continues except when placental functions are reduced b. Increases as blood pressure decreases c. Diminishes as the spiral arteries are compressed d. Is not significantly affected

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

15. A primigravida is being monitored in her prenatal clinic for preeclampsia. What finding should concern her nurse? a. Blood pressure increase to 138/86 mm Hg b. Weight gain of 0.5 kg during the past 2 weeks c. A dipstick value of 3+ for protein in her urine d. Pitting pedal edema at the end of the day

ANS: C Feedback A Generally, hypertension is defined as a BP of 140/90 or an increase in systolic pressure of 30 mm Hg or 15 mm Hg diastolic pressure. B Preeclampsia may be manifested as a rapid weight gain of more than 2 kg in 1 week. C Proteinuria is defined as a concentration of 1+ or greater via dipstick measurement. A dipstick value of 3+ should alert the nurse that additional testing or assessment should be made. D Edema occurs in many normal pregnancies as well as in women with preeclampsia. Therefore, the presence of edema is no longer considered diagnostic of preeclampsia. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 592 OBJ: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity

1. A pregnant woman who abuses cocaine admits to exchanging sex for her drug habit. This behavior puts her at a greater risk for a. Depression of the central nervous system b. Hypotension and vasodilation c. Sexually transmitted diseases d. Postmature birth

ANS: C Feedback A Cocaine is a central nervous system stimulant. B Cocaine causes hypertension and vasoconstriction. C Sex acts exchanged for drugs place the woman at increased risk for sexually transmitted diseases because of multiple partners and lack of protection. D Premature delivery of the infant is one of the most common problems associated with cocaine use during pregnancy.

11. What is the purpose of amniocentesis for the patient hospitalized at 34 weeks with pregnancy-induced hypertension? a. Identification of abnormal fetal cells b. Detection of metabolic disorders c. Determination of fetal lung maturity d. Identification of sex of the fetus

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

3. What is a major barrier to health care for teen mothers? a. The hospital/clinic is within walking distance of the girl's home. b. The institution is open days, evenings, and Saturday by special arrangement. c. The teen must be prepared to see a different nurse or doctor or both at every visit. d. The health care workers have a positive attitude.

ANS: C Feedback A If the hospital/clinic were within walking distance of the girl's home, it would prevent the teen from missing appointments because of transportation problems. B If the institution were open days, evenings, and Saturday by special arrangement, this availability would be helpful for teens who work, go to school, or have other time-of-day restrictions. Scheduling conflicts are a major barrier to health care. C Whenever possible, the teen should be scheduled to see the same nurses and practitioners for continuity of care. D A negative attitude is unfortunate, because it discourages families that would benefit most from consistent prenatal care.

6. While working with the pregnant woman in her first trimester, the nurse is aware that chorionic villus sampling can be performed during pregnancy as early as _____ weeks. a. 4 b. 8 c. 10 d. 12

ANS: C Feedback A It is too early to perform this test at 4 weeks. B It is too early to perform this test at 8 weeks. C Fetal villus tissue can be obtained as early as 10 weeks of gestation and analyzed directly for chromosomal or genetic abnormalities. D The test should be performed at 13 weeks, but it can be done as early as 10 weeks.

11. When helping the mother, father, and other family members actualize the loss of the infant, nurses should a. Use the words lost or gone rather than dead or died. b. Make sure the family understands that it is important to name the baby. c. If the parents choose to visit with the baby, apply lotion to the baby and wrap the infant in a pretty blanket. d. Set a firm time for ending the visit with the baby so that the parents know when to let go.

ANS: C Feedback A Nurses must use dead and died to assist the bereaved in accepting reality. B Although naming the baby can be helpful, it is important not to create the sense that parents have to name the baby. In fact, some cultural taboos and religious rules prohibit the naming of an infant who has died. C Presenting the baby in a nice way stimulates the parents' senses and provides pleasant memories of their baby. D Parents need different time periods with their baby to say goodbye. Nurses need to be careful not to rush the process.

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

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

6. A woman who is older than 35 years may have difficulty achieving pregnancy, because a. Personal risk behaviors influence fertility. b. She has used contraceptives for an extended time. c. Her ovaries may be affected by the aging process. d. Prepregnancy medical attention is lacking.

ANS: C Feedback A The older adult participates in fewer risk behaviors than the younger adult. B The problem is the age of the ovaries, not the past use of contraceptives. C Once the mature woman decides to conceive, a delay in becoming pregnant may occur because of the normal aging of the ovaries. D Prepregnancy medical care is available and encouraged.

14. Which response by the nurse is most appropriate to this statement: "This test isn't my idea, but my husband insists"? a. "Don't worry. Everything will be fine." b. "Why don't you want to have this test?" c. "You're concerned about having this test?" d. "It's your decision."

ANS: C Feedback A This is false reassurance and does not deal with the concerns expressed by the woman. B The woman may not be able to answer "why" questions. It may also make her defensive. C The nurse should clarify the statement and assist the patient in exploring her feelings about the test. D This is a closed statement and does not encourage the woman to express her feelings.

9. A patient at 24 weeks of gestation says she has a glass of wine with dinner every evening. The nurse will counsel her to eliminate all alcohol intake, because a. A daily consumption of alcohol indicates a risk for alcoholism. b. She will be at risk for abusing other substances as well. c. The fetus is placed at risk for altered brain growth. d. The fetus is at risk for multiple organ anomalies.

ANS: C Feedback A This is not the major risk for the infant. B This has not been proven. C The brain grows most rapidly in the third trimester and is most vulnerable to alcohol exposure during this time. D The major concerns are mental retardation, learning disabilities, high activity level, and short attention span.

4. Of adolescents who become pregnant, what percentage have had a previous birth? a. 10% b. 15% c. 19% d. 35%

ANS: C Feedback A This percentage rate is too low; it is actually 19%. B The percentage of teens who have had a previous birth is 19%. C 19% of pregnant adolescents have had one or more previous births. D This percentage rate is too high when measuring previous adolescent births.

17. Ultrasonography is an important and safe technique used in antepartum surveillance. It provides critical information related to fetal activity, gestational age and fetal well-being. Which statement regarding ultrasonography during pregnancy is most accurate? a. Ultrasonography uses infrared technology to create an image. b. Ultrasonography is only utilized as an adjunct to more invasive tests. c. Ultrasonography is not harmful to the fetus. d. Ultrasonography is not a component of biophysical profile testing.

ANS: C Feedback A Ultrasonography uses sound waves to create an image. B As an adjunct to more invasive tests, ultrasonography can provide visual guidance for increased safety. It can be done as a standalone test. C Most women look forward to the results of this test, which causes no harm to the fetus. D Ultrasonography is a component of biophysical profile testing.

9. The nurse-midwife is concerned that a woman's uterine activity is too intense and that her obesity is preventing accurate assessment of the actual intrauterine pressure. On the basis of this information, the nurse should obtain a(n) a. tocotransducer. b. scalp electrode. c. intrauterine pressure catheter. d. Doppler transducer.

ANS: C An intrauterine pressure catheter can measure actual intrauterine pressure. The tocotransducer measures the uterine pressure externally; this not be accurate with obesity. A scalp electrode measures the fetal heart rate (FHR). A Doppler auscultates the FHR. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 339 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

15. The nurse notes a pattern of late decelerations on the fetal monitor. The most appropriate action is to a. continue observation of this reassuring pattern. b. notify the physician or nurse-midwife. c. give the woman oxygen by face mask. d. place the woman in a Trendelenburg position.

ANS: C Late decelerations are associated with reduced placental perfusion. Giving the laboring woman oxygen increases the oxygen saturation in her blood, making more oxygen available to the fetus. This is not a reassuring pattern; interventions are needed. Nursing interventions should be initiated before notifying the health care provider. The Trendelenburg position will not increase the placental perfusion. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 342 | p. 344 | Safety Alert Box OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

14. The nurse notes a nonreassuring pattern of the fetal heart rate. The mother is already lying on her left side. What nursing action is indicated? a. Lower the head of the bed. b. Place the mother in a Trendelenburg position. c. Change her position to the right side. d. Place a wedge under the left hip.

ANS: C Repositioning on the opposite side may relieve compression on the umbilical cord and improve blood flow to the placenta. The other actions are not warranted. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 347 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

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

ANS: C The tocotransducer should fit snugly on the abdomen to monitor uterine activity accurately. The tocotransducer does not need gel to operate appropriately. The patient should be encouraged to move around during labor. The tocotransducer should be placed at the fundal area of the uterus. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 338 | Procedure Box OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

To adequately care for patients, the nurse understands that labor contractions facilitate cervical dilation by a. Contracting the lower uterine segment b. Enlarging the internal size of the uterus c. Promoting blood flow to the cervix d. Pulling the cervix over the fetus and amniotic sac

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

2. The labor nurse is evaluating the patient's most recent 10-minute segment on the monitor strip and notes a late deceleration. This is likely to be caused by which physiologic alterations? (Select all that apply.) a. Spontaneous fetal movement b. Compression of the fetal head c. Placental abruption d. Cord around the baby's neck e. Maternal supine hypotension

ANS: C, E Late decelerations are almost always caused by uteroplacental insufficiency. Insufficiency is caused by uterine tachysystole, maternal hypotension, epidural or spinal anesthesia, IUGR, intraamniotic infection, or placental abruption. Spontaneous fetal movement, vaginal examination, fetal scalp stimulation, fetal reaction to external sounds, uterine contractions, fundal pressure, and abdominal palpation are all likely to cause accelerations of the FHR. Early decelerations are most often the result of fetal head compression and may be caused by uterine contractions, fundal pressure, vaginal examination and placement of an internal electrode. A variable deceleration is likely caused by umbilical cord compression. This may happen when the cord is around the baby's neck, arm, leg or other body part, a short cord, a knot in the cord, or a prolapsed cord. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: Table 17.1 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

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

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

What finding should the nurse recognize as being associated with fetal compromise? a. Active fetal movements b. Contractions lasting 90 seconds c. FHR in the 140s d. Meconium-stained amniotic fluid

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

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

ANS: D Feedback A If all the products of conception have been passed (complete abortion), a D&C is not used. B D&C is used to remove the products of conception from the uterus and can be done safely until week 14 of gestation. C If the pregnancy is still viable (threatened abortion), a D&C is not used. D D&C is used to remove the products of conception from the uterus and can be used safely until week 14 of gestation. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 578 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

30. A woman with preeclampsia has a seizure. The nurse's primary duty during the seizure is to a. Insert an oral airway. b. Suction the mouth to prevent aspiration. c. Administer oxygen by mask. d. Stay with the patient and call for help.

ANS: D Feedback A Insertion of an oral airway during seizure activity is no longer the standard of care. The nurse should attempt to keep the airway patent by turning the patient's head to the side to prevent aspiration. B Once the seizure has ended, it may be necessary to suction the patient's mouth. C Oxygen would be administered after the convulsion has ended. D If a patient becomes eclamptic, the nurse should stay with her and call for help. Nursing actions during a convulsion are directed towards ensuring a patent airway and patient safety. PTS: 1 DIF: Cognitive Level: Application REF: p. 597 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

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

ANS: D Feedback A Monitoring FHR and maternal vital signs is a necessary part of the assessment for this woman. B Monitoring for bleeding and rupture of membranes is not contraindicated with this woman. C Monitoring contractions is not contraindicated with this woman. D Vaginal examination of the cervix may result in perforation of the placenta and subsequent hemorrhage. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 584 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

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

ANS: D Feedback A Soft, indirect lighting is more soothing than irritating bright lights. B Women in labor become hot and perspire. Cool cloths are much better C A full bladder intensifies labor pain. The bladder should be emptied every 2 hours. D Frequent maternal position changes reduce the discomfort from constant pressure and promote fetal descent.

11. Which clinical sign is not included in the classic symptoms of preeclampsia? a. Hypertension b. Edema c. Proteinuria d. Glycosuria

ANS: D Feedback A The first indication of preeclampsia is usually an increase in the maternal blood pressure. B The first sign noted by the pregnant woman is a rapid weight gain and edema of the hands and face. C Proteinuria usually develops later than the edema and hypertension. D Spilling glucose into the urine is not one of the three classic symptoms of preeclampsia. PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 592 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

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

ANS: D Feedback A The recommended treatment is to remove the pregnancy before hemorrhaging. B If the tube must be removed, her fertility will decrease but she will not be infertile. C A D&C is done on the inside of the uterine cavity. The ectopic is located within the tubes. D Severe bleeding occurs if the fallopian tube ruptures. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 580 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

A pregnant woman is at 38 weeks of gestation. She wants to know if any signs indicate "labor is getting closer to starting." The nurse informs the woman that which of the following is a sign that labor may begin soon? a. Weight gain of 1.5 to 2 kg (3 to 4 lb) b. Increase in fundal height c. Urinary retention d. Surge of energy

ANS: D Feedback A The woman may lose 0.5 to 1.5 kg, the result of water loss caused by electrolyte shifts, which in turn are caused by changes in the estrogen and progesterone levels. B When the fetus descends into the true pelvis (called lightening), the fundal height may decrease. C Urinary frequency may return before labor. D Women speak of having a burst of energy before labor.

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

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

5. A placenta previa in which the placental edge just reaches the internal os is called a. Total b. Partial c. Complete d. Marginal

ANS: D Feedback A With a total placenta previa the placenta completely covers the os. B With a partial previa the lower border of the placenta is within 3 cm of the internal cervical os, but does not completely cover the os. C A complete previa is termed total. The placenta completely covers the internal cervical os. D A placenta previa that does not cover any part of the cervix is termed marginal. PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 583 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

12. An NST in which two or more fetal heart rate (FHR) accelerations of 15 beats per minute (bpm) or more occur with fetal movement in a 20-minute period is termed a. Nonreactive b. Positive c. Negative d. Reactive

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

8. Which diagnostic test evaluates the effect of fetal movement on fetal heart activity? a. Contraction stress test (CST) b. Sonography c. Biophysical profile d. Nonstress test (NST)

ANS: D Feedback A CST evaluates the fetal reaction to contractions. B Sonographic examinations visualize the fetus and are done for various reasons. C The biophysical profile evaluates fetal status using many variables. D An NST evaluates the ability of the fetal heart to accelerate either spontaneously or in association with fetal movement.

16. Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy, including that a. Chorionic villus sampling (CVS) is becoming more popular because it provides early diagnosis. b. Screening for maternal serum alpha-fetoprotein (MSAFP) levels is recommended between 10 and 12 weeks of gestation in order to give parents time to consider options. c. Percutaneous umbilical blood sampling (PUBS) is one of the multiple marker screen tests for Down syndrome. d. MSAFP is a screening tool only; it identifies candidates for more definitive procedures.

ANS: D Feedback A CVS does provide a rapid result, but it is declining in popularity because of advances in noninvasive screening techniques. B MSAFP screening is recommended for all pregnant women. C Screening is recommended between 15 and 20 weeks of gestation. Abnormal findings give parents time to have additional tests done. D This is correct, MSAFP is a screening tool, not a diagnostic tool. Further diagnostic testing is indicated after an abnormal MSAFP.

8. The most dangerous effect on the fetus of a mother who smokes cigarettes while pregnant is a. Genetic changes and anomalies b. Extensive central nervous system damage c. Fetal addiction to the substance inhaled d. Intrauterine growth restriction

ANS: D Feedback A Cigarettes normally will not cause genetic changes. B Cigarettes normally will not cause extensive central nervous system damage. C Addiction is not a normal concern with the neonate. D The major consequences of smoking tobacco during pregnancy are low-birth-weight infants, prematurity, and increased perinatal loss.

4. When is the best time to determine gestational age based on biparietal diameter through ultrasound? a. 4 to 6 weeks b. 5 to 7 weeks c. 7 to 10 weeks d. 12 to 20 weeks

ANS: D Feedback A During this time frame, the gestational age is determined by measuring the crown-rump length. B During this time frame, the gestational age is determined by measuring the crown-rump length. C During this time frame, the gestational age is determined by measuring the crown-rump length. D The biparietal diameter, a method of assessing gestational age during the last half of pregnancy, is most accurate from 12 to 20 weeks.

10. As a powerful central nervous system stimulant, which of these substances can lead to miscarriage, preterm labor, placental separation (abruption), and stillbirth? a. Heroin b. Alcohol c. PCP d. Cocaine

ANS: D Feedback A Heroin is an opiate. Its use in pregnancy is associated with preeclampsia, intrauterine growth restriction, miscarriage, premature rupture of membranes, infections, breech presentation, and preterm labor. B The most serious effect of alcohol use in pregnancy is FAS. C The major concerns regarding PCP use in pregnant women are its association with polydrug abuse and the neurobehavioral effects on the neonate. D Cocaine is a powerful CNS stimulant. Effects on pregnancy associated with cocaine use include abruptio placentae, preterm labor, precipitous birth, and stillbirth.

10. The major advantage of chorionic villus sampling (CVS) over amniocentesis is that it a. Is not an invasive procedure b. Does not require hospitalization c. Has less risk of spontaneous abortion d. Is performed earlier in pregnancy

ANS: D Feedback A It is an invasive procedure. B The woman does have to be in a hospital setting for the fetus and her to be properly assessed during and after the procedure. C The risk of an abortion is at the same level for both procedures. D CVS is performed between 10 and 13 weeks of gestation, providing earlier results than amniocentesis.

13. An appropriate nursing measure when a baby has an unexpected anomaly is to a. Remove the baby from the delivery area immediately. b. Tell the parents that the baby has to go to the nursery immediately. c. Inform the parents immediately that something is wrong. d. Explain the defect and show the baby to the parents as soon as possible.

ANS: D Feedback A The parents should be able to touch and hold the baby as soon as possible. B This would raise anxiety levels of the parents; they should be told about the defect and allowed to see the baby. C They should be told immediately, but they should be told about the defect and be allowed to see the infant. D Parents experience less anxiety when they are told about the defect as early as possible and are allowed to touch and hold the baby.

12. A woman has delivered twins. The first twin was stillborn, and the second is in the intensive care nursery and is recovering quickly from respiratory distress. The woman is crying softly and says, "I wish my baby could have lived." What is the most therapeutic response? a. "Don't be sad. At least you have one healthy baby." b. "How soon do you plan to have another baby?" c. "I have a friend who lost a twin and she's doing just fine now." d. "I am so sorry about your loss. Would you like to talk about it?"

ANS: D Feedback A This is denying the loss of the other infant. B This is denying the loss of the infant and her grief and belittling her feelings. C This is belittling her feelings. D The nurse should recognize the woman's grief and its significance.

16. The nurse explains to the student that increasing the infusion rate of non-additive intravenous fluids can increase fetal oxygenation primarily by a. maintaining normal maternal temperature. b. preventing normal maternal hypoglycemia. c. increasing the oxygen-carrying capacity of the maternal blood. d. expanding maternal blood volume.

ANS: D Filling the mother's vascular system makes more blood available to perfuse the placenta and may correct hypotension. Increasing fluid volume may alter the maternal temperature only if she is dehydrated. Most intravenous fluids for laboring women are isotonic and do not improve hypoglycemia. Oxygen-carrying capacity is increased by adding more red blood cells. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 344 | Safety Alert Box OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic Integrity

19. The precepting nurse explains to the newly hired nurse that when using IA for FHR which situation is unit protocol? a. The nurses can be expected to cover only two or three patients when IA is the primary method of fetal assessment. b. The best course is to use the descriptive terms associated with EFM when documenting results. c. If the heartbeat cannot be found immediately, a shift must be made to electronic monitoring. d. Ultrasound can be used to find the fetal heartbeat and reassure the mother if initial difficulty was a factor.

ANS: D Locating fetal heartbeats often takes time. Mothers can be reassured verbally and by the ultrasound pictures if that device is used to help locate the heartbeat. When used as the primary method of fetal assessment, auscultation requires a nurse-to-patient ratio of one to one. Documentation should use only terms that can be numerically defined; the usual visual descriptions of EFM are inappropriate. Electronic monitoring is not needed at this point. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 335 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance

21. A nurse might be called on to stimulate the fetal scalp a. as part of fetal scalp blood sampling. b. in response to tocolysis. c. in preparation for fetal oxygen saturation monitoring. d. to elicit an acceleration in the FHR.

ANS: D The scalp can be stimulated using digital pressure during a vaginal examination, which should cause an increase in FHR. Stimulating the fetal scalp is not part of blood sampling, assessing the response to tocolysis, or in preparation for oxygen saturation monitoring. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 345 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

11. The nurse assesses the fetal monitor and sees the following strip. What action by the nurse is most appropriate? a. Administer oxygen by nasal cannula. b. Reposition the woman. c. Apply a fetal scalp electrode. d. Record this reassuring pattern.

ANS: D This is a reassuring pattern and no intervention is necessary beyond documentation. PTS: 1 DIF: Cognitive Level: Analysis/Analyzing REF: Figure 17.6 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

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

ANS: D When the membranes rupture, amniotic fluid may carry the umbilical cord to a position where it will be compressed between the maternal pelvis and the fetal presenting part, resulting in a variable deceleration pattern. This is not an expected occurrence after the rupture of membranes. Accelerations are considered reassuring; they are not a concern after rupture of membranes. Early declarations are considered reassuring; they are not a concern after rupture of membranes. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 343 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

Occasionally a woman arrives at the intrapartum unit ready to give birth. Bearing down, grunting, or stating something like "the baby's coming" should direct the nurse to advise the client, "Do not push, pant, and blow until the physician arrives." Is this statement true or false?

ANS: F The nurse's priority is to prevent or reduce injury to mother and infant if delivery is imminent. The emergency delivery kit should be obtained and preparation made for immediate delivery. An abbreviated assessment should be completed in order to obtain the mother's name, that of the support partner, and her care provider. Estimated date of delivery, allergies, and prenatal care are also important information. If time allows, maternal vital signs should be done, as well as a fetal assessment. After delivery, the priority is to maintain the infant's airway and temperature.

2. An increasing number of women are now becoming pregnant relatively late in their reproductive lives. The birth rate for women ages 40 to 44 has increased to the highest level in 40 years. Which advances in maternity care these women are at no greater risk for obstetric complications. Is this statement true or false?

ANS: F The older women it is definitely at an increased risk for obstetric complications, including spontaneous abortion, gestational diabetes, cesarean births, stillbirth, preeclampsia, placenta previa, abruption, preterm delivery, and low birth weight infants.

The woman in labor should be encouraged to use the Valsalva maneuver (holding one's breath and tightening abdominal muscles) for pushing during the second stage. Is this statement true or false?

ANS: F The woman should actually be discouraged from using the Valsalva maneuver. This activity increases intrathoracic pressure, reduces venous return, and increases venous pressure. During the Valsalva maneuver, fetal hypoxia may occur. The process is reversed when the woman takes a breath.

1. Society tends to minimize perinatal loss because of the prevailing belief that there are no barriers to getting pregnant and the expectation that once a woman is pregnant, a healthy, live infant will result. Is this statement true or false?

ANS: T Because of these perceptions, grieving parents often do not receive the support they need, and society often allows much too short a time for mothers to grieve (and even less for fathers).

1. The nurse has instructed the pregnant patient to self-assess movement of her fetus by doing "kick counts." The nurse knows that the woman has had effective learning when she states "Two or three times a day I will be sure that my baby moves at least three times in an hour." Is this statement true or false?

ANS: T The other method of self-assessment for fetal well-being is referred to as the "count to 10." The woman is taught to perceive at least 10 fetal movements within a 12 hour period of time. However, maternal reporting of atypical changes in fetal activity has shown to be as valid as counting and documentation.

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

a. Ask the patient when she last had anything to eat or drink.

An infant of a diabetic mom arrives in the nursery unit for observation. The infant is term at 38 weeks' gestation and weighs 10 pounds. The maternal hemoglobin A1c level is noted at 10%. Which findings would the nurse suspect as being present? (Select all that apply.) a. Fetus is jittery, temperature is decreased b. Nasal flaring and retractions c. Slight jaundice noted on blanching of nose d. Calcium level of 10 mg/dL

a. Fetus is jittery, temperature is decreased b. Nasal flaring and retractions c. Slight jaundice noted on blanching of nose

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

a. Hypoglycemia

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

a. Previous birth of large infant

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

a. Rubella

For which of the following infectious diseases can a woman be immunized? a. Rubella b. Toxoplasmosis c. Cytomegalovirus d. Herpesvirus type 2

a. Rubella

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

a. varied depending on the stage of gestation.

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

b. "Even though my test is positive, my baby might not be affected."

A pregnant patient with acquired immunodeficiency syndrome (AIDS) is reviewing infant care instructions with the prenatal nurse. Which patient statement indicates to the nurse that the teaching was effective? a. "I will bathe my baby twice a day." b. "I will use premixed formula to feed my baby." c. "I will use gloves to change my baby's diapers." d. "I will use alcohol wipes six times a day on the baby's cord until it falls off."

b. "I will use premixed formula to feed my baby."

When a pregnant client with diabetes experiences hypoglycemia while hospitalized, which should the nurse have the client do? a. Eat a candy bar. b. Eat six saltine crackers or drink 8 oz of milk. c. Drink 4 oz of orange juice followed by 8 oz of milk. d. Drink 8 oz of orange juice with 2 teaspoons of sugar added.

b. Eat six saltine crackers or drink 8 oz of milk.

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

b. G1 P1 with Class II heart disease who complains of frequent coughing

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

b. Instruct her to avoid strenuous activity.

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

b. Mitral valve prolapse

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

b. Plan for retesting during the third trimester.

The labor nurse is providing care to a patient at 37 weeks' gestation who is an insulin-dependent diabetic. The health care provider prescribes an infusion of insulin throughout her induction to be titrated to keep her blood glucose levels below 110 mg/dL. What type of insulin will the nurse select to prepare the infusion? a. NPH insulin b. Regular insulin c. Lispro (Humalog) d. Aspart (Novolog)

b. Regular insulin

When planning intrapartum care for a client with heart disease, the nurse should include: a. taking vital signs according to standard protocols. b. continuously monitoring cardiac rhythm with telemetry. c. massaging the uterus to hasten birth of the placenta. d. maintaining the infusion of intravenous fluids to avoid dehydration.

b. continuously monitoring cardiac rhythm with telemetry.

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

c. "I will have blood drawn at 1 hour after I drink the glucose solution."

A client who has type 2 diabetes is pregnant with her second child. She was not diagnosed with diabetes until after her first pregnancy. Past obstetric history is unremarkable—spontaneous vaginal birth of a male weighing 7 pounds, 15 ounces. The client is now concerned over what will happen during this subsequent pregnancy as a result of her disease process. What impact could the disease process have on her upcoming birth? a. Client will not be able to receive an epidural for pain management. b. Client will not be able to have a vaginal birth. c. A planned birth will be instituted by her health care provider. d. It is likely that she will deliver a fetus who is small for gestational age (SGA).

c. A planned birth will be instituted by her health care provider.

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

c. Degree of glycemic control before and during the pregnancy

Which disease process improves during pregnancy? a. Epilepsy b. Bell's palsy c. Rheumatoid arthritis d. Systemic lupus erythematosus (SLE)

c. Rheumatoid arthritis

Which client teaching instructions are necessary for a pregnant client who is to undergo a glucose challenge test (GCT) as part of a routine pregnancy treatment plan? a. Consume a low-fat diet for 48 hours prior to testing. b. Fast for 12 hours prior to testing. c. There are no dietary restrictions prior to testing. d. Consume a consistent carbohydrate diet (60 g) prior

c. There are no dietary restrictions prior to testing.

The most important instruction to include in a teaching plan for a client in early pregnancy who has Class I heart disease is she: a. must report any nausea or vomiting. b. may experience mild fatigue in early pregnancy. c. must report any chest discomfort or productive cough. d. should plan to increase her daily exercise gradually throughout pregnancy.

c. must report any chest discomfort or productive cough.

The results of a pregnant patient's glucose tolerance test (GTT) were 158 mg/dL. What is the next test that the nurse will include in the patient's teaching plan? a. Urinalysis b. Amniocentesis c. Nonstress test d. Oral glucose tolerance test (OGTT)

d. Oral glucose tolerance test (OGTT)

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

d. She must make arrangements to stay somewhere other than her home until the children are no longer contagious.