Module 2 Pediatrics

Often parents are confused by the terms growth and development and use the terms interchangeably. Based on the nurse's knowledge of growth and development, the most appropriate explanation of development is: 1 a child grows taller all through early childhood. 2 a child learns to throw a ball overhand. 3 a child's weight triples during the first year. 4 a child's brain increases in size until school age.

2 Development is the mental and cognitive attainment of skills. Growth is the increase in physical size—both height and weight.

The nurse notices that a child's spleen is quite large. To which age group does the child belong? 1 0-12 months 2 1-6 years 3 6-12 years 4 12-18 years

3 The spleen is easily palpated between the ages of 6 and 12 years. If it is palpated at any other age, such as 0-12 months, 1-6 years, or 12-18 years, this finding must be reported to the primary health care provider.

Prophylaxis of subacute bacterial endocarditis (SBE) is given before and after birth when a pregnant woman has a. valvular disease. b. congestive heart disease. c. dysrhythmias. d. postmyocardial infarction.

A

What type of breath sound is normally heard over the entire surface of the lungs, except for the upper intrascapular area and the area beneath the manubrium? a. Vesicular c. Adventitious b. Bronchial d. Bronchovesicular

ANS: A Test Bank - Maternal Child Nursing Care by Perry (6th Edition, 2017) 467 Vesicular breath sounds are heard over the entire surface of lungs, with the exception of the upper intrascapular area and the area beneath the manubrium. Bronchial breath sounds are heard only over the trachea near the suprasternal notch. Adventitious breath sounds are not usually heard over the chest. These sounds occur in addition to normal or abnormal breath sounds. Bronchovesicular breath sounds are heard over the manubrium and in the upper intrascapular regions where trachea and bronchi bifurcate.

The earliest age at which a satisfactory radial pulse can be taken in children is: a. 1 year c. 3 years b. 2 years d. 6 years

ANS: B Satisfactory radial pulses can be used in children older than 2 years. In infants and young children the apical pulse is more reliable. The radial pulse can be used for assessment at ages 3 and 6 years.

The nurse is testing an infants visual acuity. By what age should the infant be able to fix on and follow a target? a. 1 month c. 3 to 4 months b. 1 to 2 months d. 6 months

ANS: C Visual fixation and following a target should be present by ages 3 to 4 months. Ages 1 to 2 months are too young for this developmental milestone. If the infant is not able to fix and follow by 6 months of age, further ophthalmologic evaluation is needed.

A woman has a history of drug use and is screened for hepatitis B during the first trimester. What is an appropriate action? a. Provide a low-protein diet. b. Offer the vaccine. c. Discuss the recommendation to bottle-feed her baby. d. Practice respiratory isolation.

B

Which statement helps explain the growth and development of children? 1 Development proceeds at a predictable rate. 2 The sequence of developmental milestones is predictable. 3 Rates of growth are consistent among children. 4 At times of rapid growth, there is also acceleration of development

2 There is a fixed, precise order to development. There are periods of both accelerated and decelerated growth and development. Each child develops at his or her own rate. Physical growth and development proceed at differing rates. Test-Taking Tip: Do not worry if you select the same numbered answer repeatedly, because there usually is no pattern to the answers.

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

A

During a funduscopic examination of a school-age child, the nurse notes a brilliant, uniform red reflex in both eyes. The nurse should recognize that this is: a. A normal finding. b. An abnormal finding; the child needs referral to an ophthalmologist. c. A sign of a possible visual defect; the child needs vision screening. d. A sign of small hemorrhages, which usually resolve spontaneously.

ANS: A A brilliant, uniform red reflex is an important normal and expected finding. It rules out many serious defects of the cornea, aqueous chamber, lens, and vitreous chamber.

The nurse must assess 10-month-old infant. The infant is sitting on the fathers lap and appears to be afraid of the nurse and of what may happen next. Which initial action by the nurse would be most appropriate? a. Initiate a game of peek-a-boo. Test Bank - Maternal Child Nursing Care by Perry (6th Edition, 2017) 470 b. Ask the father to place the infant on the examination table. c. Undress the infant while he is still sitting on his fathers lap. d. Talk softly to the infant while taking him from his father.

ANS: A Peek-a-boo is an excellent means of initiating communication with infants while maintaining a safe, nonthreatening distance. The child will most likely become upset if separated from his father. As much of the assessment as possible should be done while the child is on the fathers lap. The nurse should have the father undress the child as needed for the examination.

Binocularity, the ability to fixate on one visual field with both eyes simultaneously, is normally present by what age? a. 1 month c. 6 to 8 months b. 3 to 4 months d. 12 months

ANS: B Binocularity is usually achieved by ages 3 to 4 months. Age 1 month is too young for binocularity. If binocularity is not achieved by 6 months, the child must be observed for strabismus.

The appropriate placement of a tongue blade for assessment of the mouth and throat is the: a. The center back area of the tongue. c. Against the soft palate. b. The side of the tongue. d. On the lower jaw

ANS: B The side of the tongue is the correct position. It avoids the gag reflex yet allows visualization. Placement on the center back area of the tongue elicits the gag reflex. Against the soft palate and on the lower jaw are not appropriate places for the tongue blade.

By what age do the head and chest circumferences generally become equal? a. 1 month c. 1 to 2 years b. 6 to 9 months d. 2.5 to 3 years

ANS: C Head circumference begins larger than chest circumference. Between ages 1 and 2 years, they become approximately equal. Head circumference is larger than chest circumference at ages 1 month and 6 to 9 months. Chest circumference is larger than head circumference at age 2.5 to 3 years.

Where is the best place to observe for the presence of petechiae in dark-skinned individuals? a. Face c. Oral mucosa b. Buttocks d. Palms and soles

ANS: C Petechiae, small distinct pinpoint hemorrhages, are difficult to see in dark skin unless they are in the mouth or Test Bank - Maternal Child Nursing Care by Perry (6th Edition, 2017) 464 conjunctiva.

The nurse should expect the anterior fontanel to close at age: a. 2 months c. 6 to 8 months Test Bank - Maternal Child Nursing Care by Perry (6th Edition, 2017) 465 b. 2 to 4 months d. 12 to 18 months

ANS: D Ages 2 through 8 months are too early. The expected closure of the anterior fontanel occurs between ages 12 and 18 months; if it closes at these earlier ages, the child should be referred for further evaluation.

In caring for a pregnant woman with sickle cell anemia the nurse is aware that signs and symptoms of sickle cell crisis include a. anemia. b. endometritis. c. fever and pain. d. urinary tract infection.

C

Which age group is most concerned with body integrity? a. Toddler c. School-age child b. Preschooler d. Adolescent

ANS: C School-age children have a heightened concern about body integrity. They place importance and value on their bodies and are overly sensitive to anything that constitutes a threat or suggestion of injury. Body integrity is not as important a concern to children in the toddler, preschooler, and adolescent age groups.

A preschool child watches a nurse pour medication from a tall, thin glass to a short, wide glass. Which statement is appropriate developmentally for this age group? 1 The amount of medicine is less. 2 The amount of medicine did not change, only its appearance. 3 Pouring medicine makes the medicine hot. 4 The glass changed shape to accommodate the medicine

1 A preschool child does not have the ability to understand the concept of conservation . This concept is not developed until school age. Understanding conservation occurs between 7 to 10 years of age, when a child begins to realize that physical factors, such as volume, weight, and number, remain the same even though outward appearances are changed. Children are able to deal with a number of different aspects of a situation simultaneously. This is not an expected response by a child. A preschool child will not typically believe the glass changed shape to accommodate the medicine but rather that the amount of medicine is less in the short, wide glass.

During their school-age years, children best understand concepts that can be seen or illustrated. The nurse knows this type of thinking is termed as: 1 concrete operations. 2 preoperational. 3 school-age rhetoric. 4 formal operations.

1 Black-and-white reasoning involves a situation in which only two alternatives are considered, when in fact there are additional options. Preoperational thinking is concrete and tangible. During the school-age years, children deal with thoughts and learn through observation. They do not have the ability to do abstract reasoning and learn best with illustration. Thought at this time is dominated by what the school-age child can see, hear, or otherwise experience. School-age rhetoric simply refers to the type of ideas that arise out of the years children attend school. Formal operations are characterized by the adaptability and flexibility that occurs during the adolescent years. Test-Taking Tip: Answer every question because, on the NCLEX exam, you must answer a question before you can move on to the next question.

Which pattern of growth and development would be seen when a parent is working with a toddler to read the alphabet? 1 Sensitive 2 Sequential 3 Directional 4 Developmental

1 When the child is learning or training and going through psychologic changes, the child is going through the sensitive phase of development and growth pattern. Sequential growth patterns are definite growth patterns where the child crawls before standing and stands before walking. Directional development refers to early development and symmetrical growth along with central and peripheral nervous system development. Developmental pace focuses on growth patterns of the child as toddler, preschooler, and adolescent.

The nurse is assessing a toddler's psychosocial development using Erikson's theory. What should the nurse include in the evaluation? Select all that apply. 1 Gross and fine motor skills 2 Mental acuity and capability 3 Level of doubt and shame 4 Competition with others 5 Inadequacy or inferior feelings

1, 2, 3 The stage in Erikson theory of psychosocial development that is used for toddlers (1-3 years) is autonomy versus shame and doubt. In this stage the toddler's motor skills, such as walking and climbing, are evaluated. The toddler's mental acuity and thought processes are also evaluated. The toddler develops negative feelings of doubt and shame when feeling low at this stage of growth. In the middle childhood growth pattern, the child tends to compete with others, aiming to accomplish tasks. This stage is referred to as industry versus inferiority in child. Inadequacy or inferiority complexes arise in this stage when parents impose huge expectations on the child. They tend to feel inferior in this stage of development.

The nurse is teaching a group of student nurses about developmental patterns of neonates. Which information should the nurse include in the teaching plan? Select all that apply. Infants: 1 use their eyes before they use their hands. 2 gain control of their feet before their hands. 3 use their hands to observe things around them. 4 stand erect first to get control of their back. 5 have structural control of the head before the trunk

1, 5 Postnatal development happens in a cephalocaudal pattern, from the head to the feet. Infants use or develop their eyes before gaining control of their hands. Infants are able to first hold their head up, and then they can stabilize their trunk. In this development pattern, infants have control of their hands first and then gain control of their feet. Infants observe objects first using their eyes and then with their hands. Infants must be able to control their back before they can stand erect.

The nurse finds that a newborn infant weighs approximately 3 kg (7 lb). Approximately how much would the child weigh when he reaches 2.5 years of age? 1. 9 kg (20 lb) 2. 12 kg (27 lb) 3. 15 kg (33 lb) 4. 17 kg (38 lb)

2 A baby typically quadruples in weight by the time the child reaches 2 to 2.5 years of age. A child who weighed 3 kg (7 lb) at birth should weigh four times as much as that by 2.5 years, or 12 kg (27 lb). Birth weight triples by the age of 6-12 months, so the child's weight would be 9 kg (20 lb) at 6-12 months. The child would attain a body weight of 15 kg (33 lb) and 17 kg (38 lb) after 2.5 years of age.

The nurse is assessing a newborn who weighs 3 kg (7 lb). At what growth stage would the child weigh 12 kg (26 lb)? 1 Infancy 2 Toddlerhood 3 Preschool age 4 School age

2 A child's weight should quadruple by the toddler stage. The child's weight would be 12 kg if it was 3 kg at birth. Birth weight triples by the end of infancy, so it would be 9 kg if it is 3 kg at birth. After the toddler weight is achieved, an annual weight increase of 2-3 kg is seen in both preschool- and school-age children. STUDY TIP: You have a great resource in your classmates. We all have different learning styles, strengths, and perspectives on the material. Participating in a study group can be a valuable addition to your nursing school experience.

A nurse is examining a toddler and is discussing with the mother psychosocial development according to Erikson's theories. Based on the nurse's knowledge of Erikson, the most age-appropriate activity to suggest to the mother at this stage is to: 1 feed lunch. 2 allow the toddler to start making choices about what to wear. 3 allow the toddler to pull a talking-duck toy. 4 turn on a TV show with bright colors and loud songs

2 A toddler is developing autonomy and is able to start making some choices about what he or she can wear. A toddler is developing autonomy and focusing on doing things for himself or herself and therefore would not want the mother to feed him or her. The child is at the stage of autonomy versus shame and doubt, as defined by Erikson. At this age, the mother should provide opportunities for the child to be active and learn by experience and imitation. Providing toys the child can control will help achieve this stage. A toddler might easily become overstimulated by images from TV and loud sounds. Toddlers are more interested in manipulating and learning from objects in the environment.

In what age group should the nurse expect a child to develop gross motor skills? 1 Birth through infancy 2 Early childhood 3 Later childhood 4 Middle childhood

2 Children between 1 and 6 years of age are considered to be in early childhood. This is when motor skills such as walking, talking, and climbing develop. The nurse should assess the child to determine whether the child is progressing appropriately. The period from birth to 12 months is called infancy. This is when the relationship between parent and child develops. This increases trust in the baby, and gross motor activity is not prominent at this growth stage. Later childhood is from 11 to 19 years of age. It is a period of rapid maturation and a point of entry into adulthood. Middle childhood encompasses the age group from 6 to 10 years old. This is when steady physical, mental, and social development is seen in children.

The nurse observes a child having difficulty getting a mobile phone to work and looking puzzled. What type of play is the child demonstrating? 1 Skill play 2 Dramatic or pretend play 3 Social-effective play 4 Sense-pleasure play

2 Children's play activities are categorized during each stage of development. Pretend play, which is also called dramatic play, is seen in 11- to 13-month-old children when they perform activities that might be puzzling or frustrating to them. Skill play is seen after infants have developed the ability to grasp objects with their hands and manipulate them. This is when they use their skills to do things they observe such as putting paper in and out of a toy. Social-effective play is seen in infancy, when infants take pleasure in relationships with people. Sense-pleasure play happens when infants become attracted to natural colors or things and focus intently on them. An example is playing with sand.

A patient who is undergoing stem cell therapy asks the nurse about undifferentiated cells. Which response given by the nurse is most appropriate? "These cells:" 1 are able to divide at a very rapid rate." 2 multiply to form any part of the body." 3 can perform specialized functions." 4 are similar to all other cells in the body."

2 Differentiation is the process by which immature cells transform into mature cells to form tissues. Thus undifferentiated cells are immature and not developed. These cells would be able to reproduce to form any part of the body. These cells are not similar to cancer cells and do not multiply rapidly. These cells are immature and are not able to perform specialized functions. These cells are not well developed and thus do not resemble other mature cells of the body.

The nurse is caring for a 2-day-old neonate who is healthy but has a low body temperature. The nurse instructs the infant's mother to place the unclothed infant on her bare chest. Which finding in the infant indicates ineffective management of the infant's condition? 1 Hyperglycemia 2 Metabolic acidosis 3 Body weight of 21 lbs 4 Body weight of 7.5 lbs

2 The neonate has hypothermia, and therefore the nurse instructs the mother to perform kangaroo care, in which the unclothed infant is placed on the mother's bare chest. This ensures improved thermoregulation and improves the complications of hypothermia. The presence of metabolic acidosis is a symptom of hypothermia. Hypoglycemia is caused by hypothermia in the infant. The normal weight of a healthy neonate at birth is approximately 7.5 lbs. By one year of age, the infant's weight normally triples to 21 lbs. Test-Taking Tip: Be alert for details. Details provided in the stem of the item such as behavioral changes or clinical changes (or both) within a certain time period can provide a clue to the most appropriate response or, in some cases, responses.

Which statement made by a child's parent supports the nurse's conclusion that the child has a difficult temperament? 1 "My child has predictable habits." 2 "My child often cries and throws tantrums." 3 "My child responds with passive resistance to new routines." 4 "My child becomes inactive and moody with change in routine."

2 The temperament of a child is said to be difficult when the child exhibits frequent episodes of crying, frustration, and tantrums. Such children are irritable and show irregularity in habits. Almost 10 percent of children fall under the category of difficult temperament. A child with an easygoing temperament has predictable habits and a positive attitude towards new stimuli. A slow-to-warm-up child responds with passive resistance to new routines and becomes inactive and moody.

The nurse is teaching a student nurse about a child who only has one X chromosome. What abnormality does the child have? 1 Down syndrome 2 Turner syndrome 3 Fragile X syndrome 4 Contiguous gene syndrome

2 Turner syndrome is the only viable condition that happens as a result of the child missing one X chromosome. Down syndrome occurs when the child has an extra autosome, chromosome 21. Fragile X syndrome is a condition in which the chromosomes are fragile or weak, and it is associated with other changes in the autosomes. Microdeletion or microduplication of chromosome segments is called contiguous gene syndrome.

A child is 50 cm (20 inches) long in the second month of infancy. The nurse checks the baby 2 months later and finds healthy growth in the child. Approximately how long would the baby be at 4 months? 1. 52 cm 2. 55 cm 3. 57 cm 4. 60 cm

2 Until 6 months after birth, infants should grow 2.5 cm every month, so this 50-cm baby would to grow by 5 cm in 2 months. Therefore, the baby should be 55 cm in length by 4 months of age. If the child is only 52 cm, then the nurse should assess the child's nutritional status to determine whether caloric needs are being met. If the child is 57 cm or 60 cm, the nurse should assess the parents' height first. The baby may be longer because of greater than average parental height. If this is not the case, then the nurse should assess the child's endocrine system for growth problems.

The nurse is reviewing Erikson's theory about the autonomy versus shame and doubt stage. The nurse is trying to correlate it to Freud's psychosexual theory. Which stage would the nurse review in Freud's theory? 1 Oral 2 Anal 3 Phallic 4 Latency

2 When the nurse is reviewing the autonomy versus shame and doubt stage in Erikson theory, it refers to a toddler. The corresponding level in Freud's theory for the toddler's psychosexual developmental stage is the anal stage, when the toddler is toilet trained. The oral stage in Freud's theory represents infancy, from birth to 1 year, and is the trust versus mistrust stage in Erikson's theory. The phallic stage in Freud's theory represents early childhood, 3-6 years of age, or initiative versus guilt in Erikson's theory. Latency in Freud's theory represents middle childhood, 6-12 years, or industry versus inferiority in Erikson's theory.

The nurse is developing a teaching plan about preventing fetal exposure to teratogens. Which teratogenic agents or conditions should the nurse include? Select all that apply. 1 acetaminophen (Tylenol) 2 isotretinoin (Accutane) 3 cocaine 4 hyperthermia 5 ethyl alcohol 6 phenytoin (Dilantin)

2, 3, 4, 5, 6 Teratogens, agents that cause birth defects when present in the prenatal environment, account for the majority of adverse intrauterine effects not attributable to genetic factors. Types of teratogens include drugs (phenytoin [Dilantin], warfarin [Coumadin], isotretinoin [Accutane]); chemicals (ethyl alcohol, cocaine, lead); infectious agents (rubella, cytomegalovirus); physical agents (maternal ionizing radiation, hyperthermia); and metabolic agents (maternal PKU). Many of these teratogenic exposures and the resulting effects are completely preventable, such as ingestion of alcohol resulting in fetal alcohol syndrome or fetal alcohol effects, which causes severe birth defects, including cognitive impairment. The incidence of fetal alcohol syndrome is estimated at 5.2 per 10,000 live births (American Academy of Pediatrics, 2000).

The Kohlberg moral development theory states that children are concerned with conformity and loyalty at a stage of their growth. When this stage is correlated with the cognitive development of children, what would the age group be? 1 0-2 years 2 2-7 years 3 7-11 years 4 11-15 years

3 According to Kohlberg's moral development theory, when children are concerned with conformity and loyalty, they are at the conventional level. Children at this level are considered to be working on concrete operations of cognitive development, where children 7-11 years old are included. Infants between 0 and 2 years of age are included in the sensory motor level of cognitive development. Children between 2 and 7 years old are in the preoperational stage of cognitive development. Children between 11 and 15 years are considered to be in the formal operation stage of cognitive development.

The nurse is speaking to a group in the community about psychosocial development according to Erikson's life-span approach. The nurse instructs the group not to impose too many expectations on a child because the child may develop an inferiority complex. What age group of children is nurse referring to here? 1 1-3 years 2 3-6 years 3 6-12 years 4 12-18 years

3 Erikson's life-span approach categorized childhood into five stages. Industry versus Inferiority is the fourth stage of development the crucial stage attained by children 6-12 years of age. Children at this stage are workers and producers, and they initiate and complete work aiming at real achievement. The child may feel inferior if parents impose many expectations on the child. The second stage is autonomy versus shame and doubt (1-3 years), when children increase their ability to control their bodies and their environment and use their mental powers in decision making. Negative feelings develop when children are made to feel low and when others shame them. Initiative versus guilt (3-6 years) is when children explore the physical world with all their senses and powers and may feel guilt when parents make their child feel their behaviors are bad. Identity versus role confusion (12-18 years) is the stage when rapid and marked physical changes occur. Adolescents struggle to fit the roles they have played and those they expect to play. When the ability to resolve these conflicts fails, it leads to role confusion.

A child is assessed and categorized in the industry versus inferiority stage according to Erikson's theory. The nurse compares the child with Freud's psychosexual development theory. At what stage would the child be categorized in Freud's theory? 1 Anal 2 Phallic 3 Latency 4 Genital

3 In Erikson's theory, the industry versus inferiority stage includes children 6-12 years old. The stage in Freud's theory that matches this age group is the latency stage. The anal stage of Freud's theory corresponds to the autonomy versus shame and doubt stage of Erikson's theory. The phallic stage of Freud's theory corresponds to initiative versus guilt, and the genital stage of Freud's theory corresponds to the identity versus role confusion stage of Erikson's theory.

The nurse is assessing a child. The nurse asks the parents, "Has your child started sleeping less lately?" Which attribute of temperament is the nurse assessing? 1 Adaptability 2 Distractibility 3 Rhythmicity 4 Activity

3 Rhythmicity is an attribute of temperament that refers to regularity in the timing of physiologic functions such as sleep and hunger. Because the nurse is asking about changes in the child's duration of sleep, the nurse is assessing rhythmicity. Adaptability is an attribute of temperament that refers to the child's ability to adapt to new situations. Distractibility is an attribute of temperament that refers to the ease with which a child's attention is diverted. Activity is an attribute of temperament that refers to the levels of physical activity such as sleeping and eating.

During assessment of a 7-month-old child, the nurse checks the child's height and weight and compares them with previous assessment records. The nurse finds that the child's height has increased by 1.25 cm, and the weight is 140 g more than in the previous month. What does the nurse infer from this observation? 1 The child is displaying symptoms of Down syndrome. 2 The child's weight is not ideal in relation to height. 3 The child's height and weight are ideal. 4 The child has a calcium deficiency due to malnutrition.

3 The nurse should regularly check the height and weight of the child and compare them with previous assessment records. These comparisons help the nurse identify genetic defects that can affect the child's growth and development. A child gains 140 g in weight, and height increases by 1.25 cm every month from ages 6 to 12 months. Therefore, this child has an ideal height and weight. Down syndrome is characterized by a slower growth rate. The child is having age-appropriate increases in height and weight and thus does not have Down syndrome. Calcium deficiency decreases bone density and causes fractures in children. The nurse cannot determine whether the child has calcium deficiency by assessing height and weight. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation.

The nurse is caring for two children. The younger child creates complex imaginary stories using dolls and toys. The older child is engaged in building a model airplane. Which stages of development are the children likely in, according to Erikson? 1 The younger child is in the trust versus mistrust stage; the older child is in the initiative versus guilt stage. 2 The younger child is in the industry versus inferiority stage; the older child is in the identity versus role confusion stage. 3 The younger child is in the initiative versus guilt stage; the older child is in the industry versus inferiority stage. 4 The younger child is in the identity versus role confusion stage; the older child is in the trust versus mistrust stage.

3 The younger child exhibits a strong imagination and an urge to explore through her doll play, which indicates that she is in the initiative versus guilt stage of Erikson's psychosocial development theory. The older child is building a model, indicating a desire to produce something and complete a task, which is a primary characteristic of the industry versus inferiority stage according to Erikson. The trust versus mistrust stage of Erikson's theory consists of establishing trust and taking in the world using all the senses; neither child is exhibiting characteristics of the trust versus mistrust stage. The identity versus role confusion stage is characterized by rapid physical change in children and concern over how they are viewed by others; neither child is exhibiting behavior associated with this stage.

An infant's blood glucose levels are low, and the nurse instructs the mother to perform kangaroo care. Which condition would the nurse have assessed in the child? 1 Irregular sleep patterns 2 Reduced metabolism 3 Improper thermoregulation 4 Impaired maturation

3 Thermoregulation is one of the most important adaptations for an infant to develop. A hypothermic infant tends to develop conditions such as hypoglycemia and metabolic acidosis. Skin-to-skin contact, or kangaroo care, is beneficial in maintaining the infant's temperature. Sleep irregularities may develop when an infant is suffering from pain internally or externally, which would also affect the growth and development at early postnatal development. Metabolic rates are usually high in children. Neurological maturation, or a dramatic increase in the number of neurons, occurs when the infant is in the embryonic stage and the neonatal state.

What is the characteristic of the type of play that is organized by children playing with other children with the purpose of accomplishing a goal? 1 The group members play independently. 2 The group members act according to their own wishes. 3 The group members do have assigned leadership roles. 4 The group members plan activities even if the group is formed loosely.

4 Cooperative play features one child supplementing another child's function with a common aim of goal completion. In cooperative play, the group may be loosely formed but the members plan activities with the aim of accomplishing a task. The group members play independently among others in parallel play. The members act according to individual wishes in associative play. There is no leadership assignment in associative play.

Which intervention should the nurse incorporate to prevent hypothermia in an infant? 1 Give hot milk or hot water to the infant at regular intervals. 2 Place the unclothed, diapered infant in the sun for few hours. 3 Feed the infant formula, which is higher in calories. 4 Put the unclothed, diapered infant on the mother's bare chest

4 Thermoregulation is not well developed in infants. As a result, babies are at risk for hypothermia. Kangaroo care is an effective way to prevent hypothermia in the infant. In this method, an unclothed, diapered infant is placed on the mother's bare chest. This provides physiological warmth to the infant. It is not advisable to give hot milk or hot water to the infant because it can damage their tissues. An unclothed infant must not be kept in the sun for a long time because the sun's ultraviolet rays can cause skin damage. There is no difference in calories between breast milk and formula. Test-Taking Tip: Avoid selecting answers that state hospital rules or regulations as a reason or rationale for action.

The nurse recognizes a delay in the child's developmental pattern and refers the child for further testing. Which characteristics of this child might the nurse have identified? Select all that apply: 1 Dermatological disorders 2 Impaired hearing ability 3 Immunocompromise 4 Improper communication 5 Impaired social interaction

4, 5 Inability to communicate properly or delays in speech may signify developmental delays. When a child is found to have difficulty making friends or has impaired social interactions, the child should be referred for testing. In this condition, the nurse should provide further interventions for the child to support his or her development. Dermatological disorders are assessed in a child to check for genetic abnormalities. Impaired hearing is assessed through testing of the child's auditory function. Impaired hearing does not directly affect a child's behavior. A child who is immunocompromised has a weakened immune system and is at higher risk for infections.

A nurse has taught a pregnant woman about toxoplasmosis. What statement by the patients indicates a need for further instruction? a. "I will be certain to empty the litter boxes regularly." b. "I won't eat raw eggs." c. "I had better wash all of my fruits and vegetables." d. "I need to be cautious when cooking meat."

A

A pregnant diabetic woman is in the hospital and her blood glucose reading is 42 mg/dL. What action by the nurse is best? a. Provide her with 15 grams of oral carbohydrate if she can swallow. b. Administer a bolus of rapid-acting insulin. c. Order the woman a meal tray from the cafeteria. d. Notify the provider immediately.

A

A woman has been admitted to the labor and delivery unit who is HIV positive. She is in active labor. What action by the nurse is most appropriate? a. Prepare to administer IV zidovudine. b. Place the mother on contact precautions. c. Administer oxygen by face mask. d. Notify social services.

A

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

A

A woman who delivered her third child yesterday has just learned that her two school-age children have contracted chickenpox. What action by the nurse is best? a. Assess if the woman has had chickenpox or been vaccinated. b. Tell her that the baby has immunity from her and is not susceptible. c. Advise her if she is non-immune, she will get vaccinated at her 2-week postpartum checkup. d. The infant will receive prophylactic acyclovir before discharge.

A

In assessing the knowledge of a pregestational woman with type 1 diabetes concerning changing insulin needs during pregnancy, the nurse recognizes that further teaching is warranted when the patient states a. "I will need to increase my insulin dosage during the first 3 months of pregnancy." b. "Insulin dosage will likely need to be increased during the second and third trimesters." c. "Episodes of hypoglycemia are more likely to occur during the first 3 months." d. "Insulin needs should return to normal within 7 to 10 days after birth if I am bottle feeding."

A

Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the woman mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. The nurse identifies that the fetus is at greatest risk for a. macrosomia. b. congenital anomalies of the central nervous system. c. preterm birth. d. low birth weight.

A

With regard to anemia, nurses should be aware that a. it is the most common medical disorder of pregnancy. b. it can trigger reflex brachycardia. c. the most common form of anemia is caused by folate deficiency. d. thalassemia is a European version of sickle cell anemia.

A

With regard to the association of maternal diabetes and other risk situations affecting mother and fetus, nurses should be aware that a. Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy. b. Hydramnios rarely occurs in diabetic pregnancies. c. Infections occur about as often and are considered about as serious in diabetic and nondiabetic pregnancies. d. Women should not use insulin pumps during pregnancy.

A

Congenital anomalies can occur with the use of antiepileptic drugs, including (Select all that apply.) a. Craniofacial abnormalities b. Congenital heart disease c. Neural tube defects d. Gastroschisis e. Diaphragmatic hernia

A,B,C

The student nurse learns that maternal complications of diabetes include which of the following? (Select all that apply.) a. Atherosclerosis b. Retinopathy c. IUFD d. Nephropathy e. Caudal regression syndrome

A,B,D

The student nurse learns that maternal risks of systemic lupus erythematosus include (Select all that apply.) a. Premature rupture of membranes (PROM) b. Fetal death resulting in stillbirth c. Hypertension d. Preeclampsia e. Renal complications

A,C,D,E

The nurse is interviewing the mother of an infant. She reports, I had a difficult delivery, and my baby was born prematurely. This information should be recorded under which heading? a. Birth history c. Chief complaint b. Present illness d. Review of systems

ANS: A The birth history refers to information that relates to previous aspects of the childs health, not to the current problem. The mothers difficult delivery and prematurity are important parts of the past history of an infant. The history of the present illness is a narrative of the chief complaint from its earliest onset through its progression to the present. Unless the chief complaint is directly related to the prematurity, this information is not included in the history of present illness. The chief complaint is the specific reason for the childs visit to the clinic, office, or hospital. It would not include the birth information. The review of systems is a specific review of each body system. It does not include the premature birth. Sequelae such as pulmonary dysfunction would be included.

The nurse is seeing an adolescent boy and his parents in the clinic for the first time. What should the nurse do first? a. Introduce himself or herself. c. Explain the purpose of the interview. b. Make the family comfortable. d. Give an assurance of privacy.

ANS: A The first thing that nurses must do is to introduce themselves to the patient and family. Parents and other adults should be addressed with appropriate titles unless they specify a preferred name. During the initial part of the interview the nurse should include general conversation to help make the family feel at ease. Next, the purpose of the interview and the nurses role should be clarified. The interview should take place in an environment as free of distraction as possible. In addition, the nurse should clarify which

The nurse has a 2-year-old boy sit in tailor position during palpation for the testes. The rationale for this position is that: a. It prevents cremasteric reflex. b. Undescended testes can be palpated. c. This tests the child for an inguinal hernia. d. The child does not yet have a need for privacy.

ANS: A The tailor position stretches the muscle responsible for the cremasteric reflex. This prevents its contraction, which pulls the testes into the pelvic cavity. Undescended testes cannot be predictably palpated. Inguinal hernias are not detected by this method. This position is used for inhibiting the cremasteric reflex. Privacy should always be provided for children.

The nurse has just started assessing a young child who is febrile and appears very ill. There is hyperextension of the childs head (opisthotonos) with pain on flexion. The most appropriate action is to: a. Refer for immediate medical evaluation. b. Continue the assessment to determine the cause of neck pain. c. Ask the parent when the childs neck was injured. d. Record head lag on the assessment record and continue the assessment of the child.

ANS: A These symptoms indicate meningeal irritation and need immediate evaluation. Continuing the assessment is not necessary. No indication of injury is present. This is not descriptive of head lag.

When introducing hospital equipment to a preschooler who seems afraid, the nurses approach should be based on which principle? a. The child may think the equipment is alive. b. The child is too young to understand what the equipment does. c. Explaining the equipment will only increase the childs fear. d. One brief explanation is enough to reduce the childs fear.

ANS: A Young children attribute human characteristics to inanimate objects. They often fear that the objects may jump, Test Bank - Maternal Child Nursing Care by Perry (6th Edition, 2017) 457 bite, cut, or pinch all by themselves without human direction. Equipment should be kept out of sight until needed. The child should be given simple concrete explanations about what the equipment does and how it will feel to the child. Simple, concrete explanations help alleviate the childs fear. The preschooler will need repeated explanations as reassurance.

The nurse is meeting a 5-year-old child for the first time and would like the child to cooperate during a dressing change. The nurse decides to do a simple magic trick using gauze. This should be interpreted as: a. Inappropriate, because of childs age. b. A way to establish rapport. c. Too distracting, when cooperation is important. d. Acceptable, if there is adequate time.

ANS: B A magic trick or other simple game may help alleviate anxiety for a 5-year-old. It is an excellent method to build rapport and facilitate cooperation during a procedure. Magic tricks appeal to the natural curiosity of young children. The nurse should establish rapport with the child. Failure to do so may cause the procedure to take longer and be more traumatic.

When the nurse interviews an adolescent, it is especially important to: a. Focus the discussion on the peer group. Test Bank - Maternal Child Nursing Care by Perry (6th Edition, 2017) 458 b. Allow an opportunity to express feelings. c. Emphasize that confidentiality will always be maintained. d. Use the same type of language as the adolescent.

ANS: B Adolescents, like all children, need an opportunity to express their feelings. Often they will interject feelings into their words. The nurse must be alert to the words and feelings expressed. Although the peer group is important to this age group, the focus of the interview should be on the adolescent. The nurse should clarify which information will be shared with other members of the health care team and any limits to confidentiality. The nurse should maintain a professional relationship with adolescents. To avoid misinterpretation of words and phrases that the adolescent may use, the nurse should clarify terms frequently.

The nurse is taking a sexual history on an adolescent girl. The best way to determine whether she is sexually active is to: a. Ask her, Are you sexually active? b. Ask her, Are you having sex with anyone? c. Ask her, Are you having sex with a boyfriend? d. Ask both the girl and her parent if she is sexually active.

ANS: B Asking the adolescent girl if she is having sex with anyone is a direct question that is well understood. The phrase sexually active is broadly defined and may not provide specific information to the nurse to provide necessary care. The word anyone is preferred to using gender-specific terms such as boyfriend or girlfriend. Because homosexual experimentation may occur, it is preferable to use gender-neutral terms. Questioning about sexual activity should occur when the adolescent is alone.

Which tool measures body fat most accurately? a. Stadiometer c. Cloth tape measure Test Bank - Maternal Child Nursing Care by Perry (6th Edition, 2017) 463 b. Calipers d. Paper or metal tape measure

ANS: B Calipers are used to measure skin-fold thickness, which is an indicator of body fat content. Stadiometers are used to measure height. Cloth tape measures should not be used because they can stretch. Paper or metal tape measures can be used for recumbent lengths and other body measurements that must be made.

The nurse is taking a health history on an adolescent. What best describes how the chief complaint should be determined? a. Ask for a detailed listing of symptoms. b. Ask the adolescent, Why did you come here today? c. Use what the adolescent says to determine, in correct medical terminology, what the problem is. Test Bank - Maternal Child Nursing Care by Perry (6th Edition, 2017) 459 d. Interview the parent away from the adolescent to determine the chief complaint.

ANS: B The chief complaint is the specific reason for the childs visit to the clinic, office, or hospital. Because the adolescent is the focus of the history, this is an appropriate way to determine the chief complaint. A listing of symptoms will make it difficult to determine the chief complaint. The adolescent should be prompted to tell which symptom caused him or her to seek help at this time. The chief complaint is usually written in the words that the parent or adolescent uses to describe the reason for seeking help. The parent and adolescent may be interviewed separately, but the nurse should determine the reason the adolescent is seeking attention at this time.

Kimberly is having a checkup before starting kindergarten. The nurse asks her to do the finger-to-nose test. The nurse is testing for: a. Deep tendon reflexes. c. Sensory discrimination. b. Cerebellar function. d. Ability to follow directions.

ANS: B The finger-to-nose-test is an indication of cerebellar function. This test checks balance and coordination. Each deep tendon reflex is tested separately. Each sense is tested separately. Although this test enables the nurse to evaluate the childs ability to follow directions, it is used primarily for cerebellar function.

What is an important consideration for the nurse who is communicating with a very young child? a. Speak loudly, clearly, and directly. b. Use transition objects such as a doll. c. Disguise own feelings, attitudes, and anxiety. d. Initiate contact with the child when the parent is not present.

ANS: B Using a transition object allows the young child an opportunity to evaluate an unfamiliar person (the nurse). This facilitates communication with this age child. Speaking loudly, clearly, and directly tends to increase anxiety in very young children. The nurse must be honest with the child. Attempts at deception lead to a lack of trust. Whenever possible, the parent should be present for interactions with young children.

With the National Center for Health Statistics (NCHS) criteria, which body mass index (BMI)for-age percentile indicates a risk for being overweight? a. 10th percentile c. 85th percentile b. 9th percentile d. 95th percentile

ANS: C Children who have BMI-for-age greater than or equal to the 85th percentile and less than the 95th percentile are at risk for being overweight. Children in the 9th and 10th percentiles are within normal limits. Children who are greater than or equal to the 95th percentile are considered overweight.

Which action is most likely to encourage parents to talk about their feelings related to their childs illness? a. Be sympathetic. c. Use open-ended questions. b. Use direct questions. d. Avoid periods of silence.

ANS: C Closed-ended questions should be avoided when attempting to elicit parents feelings. Open-ended questions require the parent to respond with more than a brief answer. Sympathy is having feelings or emotions in common with another person rather than understanding those feelings (empathy). Sympathy is not therapeutic in the helping relationship. Direct questions may obtain limited information. In addition, the parent may consider them threatening. Silence can be an effective interviewing tool. It allows sharing of feelings in which two or more people absorb the emotion in depth.

When interviewing the mother of a 3-year-old child, the nurse asks about developmental milestones such as the age of walking without assistance. This should be considered because these milestones are: a. Unnecessary information because the child is age 3 years. b. An important part of the family history. c. An important part of the childs past growth and development. d. An important part of the childs review of systems.

ANS: C Information about the attainment of developmental milestones is important to obtain. It provides data about the childs growth and development that should be included in the history. Developmental milestones provide important information about the childs physical, social, and neurologic health. The developmental milestones are specific to this child. If pertinent, attainment of milestones by siblings would be included in the family history. The review of systems does not include the developmental milestones.

What heart sound is produced by vibrations within the heart chambers or in the major arteries from the back-and-forth flow of blood? a. S1, S2 c. Murmur Test Bank - Maternal Child Nursing Care by Perry (6th Edition, 2017) 468 b. S3, S4 d. Physiologic splitting

ANS: C Murmurs are the sounds that are produced in the heart chambers or major arteries from the back-and-forth flow of blood. S1 is the closure of the tricuspid and mitral valves, and S2 is the closure of the pulmonic and aortic valves, and both are considered normal heart sounds. S3 is a normal heart sound sometimes heard in children. S4 is rarely heard as a normal heart sound. If heard, medical evaluation is required. Physiologic splitting is the distinction of the two sounds in S2, which widens on inspiration. It is a significant normal finding.

An appropriate approach to performing a physical assessment on a toddler is to: a. Always proceed in a head-to-toe direction. b. Perform traumatic procedures first. c. Use minimal physical contact initially. d. Demonstrate use of equipment.

ANS: C Parents can remove the childs clothing, and the child can remain on the parents lap. The nurse should use minimal physical contact initially to gain the childs cooperation. The head-to-toe assessment can be done in Test Bank - Maternal Child Nursing Care by Perry (6th Edition, 2017) 462 older children but usually must be adapted in younger children. Traumatic procedures should always be performed last. These will most likely upset the child and inhibit cooperation. The nurse should introduce the equipment slowly. The child can inspect the equipment, but demonstrations are usually too complex for this age group.

An 8-year-old girl asks the nurse how the blood pressure apparatus works. The most appropriate nursing action is to: a. Ask her why she wants to know. b. Determine why she is so anxious. c. Explain in simple terms how it works. d. Tell her she will see how it works as it is used.

ANS: C School-age children require explanations and reasons for everything. They are interested in the functional aspect of all procedures, objects, and activities. It is appropriate for the nurse to explain how equipment works and what will happen to the child. A nurse should respond positively to requests for information about procedures and health information. By not responding, the nurse may be limiting communication with the child. The child is not exhibiting anxiety, just requesting clarification of what will be occurring. The nurse must explain how the blood pressure cuff works so the child can then observe during the procedure.

When doing a nutritional assessment on an Hispanic family, the nurse learns that their diet consists mainly of vegetables, legumes, and starches. The nurse should recognize that this diet: Test Bank - Maternal Child Nursing Care by Perry (6th Edition, 2017) 461 a. Indicates that they live in poverty. b. Is lacking in protein. c. May provide sufficient amino acids. d. Should be enriched with meat and milk.

ANS: C The diet that contains vegetable, legumes, and starches may provide sufficient essential amino acids, even though the actual amount of meat or dairy protein is low. Many cultures use diets that contain this combination of foods. It does not indicate poverty. Combinations of foods contain the essential amino acids necessary for growth. A dietary assessment should be done, but many vegetarian diets are sufficient for growth.

Where in the health history should the nurse describe all details related to the chief complaint? a. Past history c. Present illness b. Chief complaint d. Review of systems

ANS: C The history of the present illness is a narrative of the chief complaint from its earliest onset through its progression to the present. The focus of the present illness is on all factors relevant to the main problem, even if they have disappeared or changed during the onset, interval, and present. Past history refers to information that relates to previous aspects of the childs health, not to the current problem. The chief complaint is the specific reason for the childs visit to the clinic, office, or hospital. It does not contain the narrative portion describing the onset and progression. The review of systems is a specific review of each body system.

What is the single most important factor to consider when communicating with children? a. The childs physical condition b. The presence or absence of the childs parent c. The childs developmental level Test Bank - Maternal Child Nursing Care by Perry (6th Edition, 2017) 456 d. The childs nonverbal behaviors

ANS: C The nurse must be aware of the childs developmental stage to engage in effective communication. The use of both verbal and nonverbal communication should be appropriate to the developmental level. Although the childs physical condition is a consideration, developmental level is much more important. The parents presence is important when communicating with young children, but it may be detrimental when speaking with adolescents. Nonverbal behaviors vary in importance based on the childs developmental level.

What term is used to describe breath sounds that are produced as air passes through narrowed passageways? a. Rubs c. Wheezes b. Rattles d. Crackles

ANS: C Wheezes are produced as air passes through narrowed passageways. The sound is similar when the narrowing is caused by exudates, inflammation, spasm, or tumor. Rubs are the sound created by the friction of one surface rubbing over another. Pleural friction rub is caused by inflammation of the pleural space. Rattles is the term formerly used for crackles. Crackles are the sounds made when air passes through fluid or moisture.

The nurse must assess a childs capillary filling time. This can be accomplished by: a. Inspecting the chest. b. Auscultating the heart. c. Palpating the apical pulse. d. Palpating the skin to produce a slight blanching.

ANS: D Capillary filling time is assessed by pressing lightly on the skin to produce blanching and then noting the amount of time it takes for the blanched area to refill. Inspecting the chest, auscultating the heart, and palpating the apical pulse will not provide an assessment of capillary filling time.

The nurse is having difficulty communicating with a hospitalized 6-year-old child. What technique may be most helpful? a. Suggest that the child keep a diary. b. Suggest that the parent read fairy tales to the child. c. Ask the parent whether the child is always uncommunicative. d. Ask the child to draw a picture.

ANS: D Drawing is one of the most valuable forms of communication. Childrens drawings tell a great deal about them because they are projections of the childs inner self. It would be difficult for a 6-year-old child to keep a diary because the child is most likely learning to read. Reading fairy tales to the child is a passive activity involving the parent and child. It would not facilitate communication with the nurse. The child is in a stressful situation and is probably uncomfortable with strangers, not necessarily uncommunicative.

During examination of a toddlers extremities, the nurse notes that the child is bowlegged. The nurse should recognize that this finding is: a. Abnormal and requires further investigation. b. Abnormal unless it occurs in conjunction with knock-knee. c. Normal if the condition is unilateral or asymmetric. d. Normal because the lower back and leg muscles are not yet well developed.

ANS: D Lateral bowing of the tibia (bowlegged) is common in toddlers when they begin to walk, not an abnormal Test Bank - Maternal Child Nursing Care by Perry (6th Edition, 2017) 469 finding. It usually persists until all of their lower back and leg muscles are well developed. Further evaluation is needed if it persists beyond ages 2 to 3 years, especially in African-American children.

When palpating the childs cervical lymph nodes, the nurse notes that they are tender, enlarged, and warm. The best explanation for this is: a. Some form of cancer. b. Local scalp infection common in children. c. Infection or inflammation distal to the site. d. Infection or inflammation close to the site.

ANS: D Small nontender nodes are normal. Tender, enlarged, and warm lymph nodes may indicate infection or inflammation close to their location. Tender lymph nodes do not usually indicate cancer. A scalp infection usually does not cause inflamed lymph nodes. The lymph nodes close to the site of inflammation or infection would be inflamed.

The nurse is using the NCHS growth chart for an African-American child. The nurse should consider that: a. This growth chart should not be used. b. Growth patterns of African-American children are the same as for all other ethnic groups. c. A correction factor is necessary when the NCHS growth chart is used for non-Caucasian ethnic groups. d. The NCHS charts are accurate for U.S. African-American children.

ANS: D The NCHS growth charts can serve as reference guides for all racial or ethnic groups. U.S. African Americanchildren were included in the sample population. The growth chart can be used with the perspective that different groups of children have varying normal distributions on the growth curves. No correction factor exists.

The most frequently used test for measuring visual acuity is the: a. Denver Eye Screening test. c. Ishihara vision test. b. Allen picture card test. d. Snellen letter chart.

ANS: D The Snellen letter chart, which consists of lines of letters of decreasing size, is the most frequently used test for visual acuity. Single cards (Denverletter E; Allenpictures) are used for children age 2 years and older who are unable to use the Snellen letter chart. The Ishihara vision test is used for color vision.

Which parameter correlates best with measurements of the bodys total protein stores? a. Height c. Skin-fold thickness b. Weight d. Upper arm circumference

ANS: D Upper arm circumference is correlated with measurements of total muscle mass. Muscle serves as the bodys major protein reserve and is considered an index of the bodys protein stores. Height is reflective of past nutritional status. Weight is indicative of current nutritional status. Skin-fold thickness is a measurement of the bodys fat content.

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

B

In terms of the incidence and classification of diabetes, maternity nurses should know that a. type 1 diabetes is most common. b. type 2 diabetes often goes undiagnosed. c. there is only one type of gestational diabetes. d. type 1 diabetes may become type 2 during pregnancy.

B

Preconception counseling is critical to the outcome of diabetic pregnancies because poor glycemic control before and during early pregnancy is associated with a. frequent episodes of maternal hypoglycemia. b. congenital anomalies in the fetus. c. polyhydramnios. d. hyperemesis gravidarum.

B

The nurse understands that postpartum care of the woman with cardiac disease a. is the same as that for any pregnant woman. b. includes rest and monitoring of the effect of activity. c. includes ambulating frequently, alternating with active range of motion. d. includes limiting visits with the infant to once per day.

B

A nurse in labor and delivery learns about metabolic changes that occur throughout pregnancy in diabetes. What information does the nurse know? a. Insulin crosses the placenta to the fetus only in the first trimester, after which the fetus secretes its own. b. Women with insulin-dependent diabetes are prone to hyperglycemia during the first trimester, because they are consuming more sugar. c. During the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus. d. Maternal insulin requirements steadily decline during pregnancy.

C

A woman in the perinatal clinic asks the nurse how her asthma will affect her pregnancy and fetus. What response by the nurse is best? a. Asthma medications cannot be used during pregnancy. b. The only problem is that you will not be able to breastfeed. c. Medications for asthma do not appear to harm the fetus. d. Pregnancy tends to make asthma worse.

C

A woman who had no prenatal care has just delivered after a brief labor. The baby has rough, dry skin; is large for gestational age; and has an umbilical hernia. What action by the nurse is most appropriate? a. Question the mother about substance abuse. b. Reassess the baby's gestational age. c. Inform the mother her thyroid levels will be checked. d. Perform a bedside blood glucose test on the mother.

C

Nursing intervention for the pregnant diabetic is based on the knowledge that the need for insulin a. increases throughout pregnancy and the postpartum period. b. decreases throughout pregnancy and the postpartum period. c. varies depending on the stage of gestation. d. should not change because the fetus produces its own insulin.

C

To manage her diabetes appropriately and ensure a good fetal outcome, the pregnant woman with diabetes will need to alter her diet by doing which of the following? a. Eating six small equal meals per day b. Reducing carbohydrates in her diet c. Eating her meals and snacks on a fixed schedule d. Increasing her consumption of protein

C

When teaching the pregnant woman with class II heart disease, what information should the nurse provide? a. Advise her to gain at least 30 lb. b. Explain the importance of a diet high in calcium. c. Instruct her to avoid strenuous activity. d. Inform her of the need to limit fluid intake.

C

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

C

When caring for a pregnant woman with suspected cardiomyopathy, the nurse must be alert for signs and symptoms of cardiac decompensation, which include (Select all that apply.) a. A regular heart rate b. Hypertension c. Shortness of breath d. Weakness e. Crackles in the lung bases

C,D,E

Glucose metabolism is profoundly affected during pregnancy because a. pancreatic function in the islets of Langerhans is affected by pregnancy. b. the pregnant woman uses glucose at a more rapid rate than the nonpregnant woman. c. the pregnant woman increases her dietary intake significantly. d. placental hormones are antagonistic to insulin, resulting in insulin resistance.

D

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

D