OB Final Exam - All quizzes

The perinatal nurse is providing care to Carol, a 28-year-old multiparous woman in labor. Upon arrival to the birthing suite, Carol was 7 cm dilated and experiencing contractions every 1 to 2 minutes which she describes as "strong." Carol states she labored for 1 hour at home. As the nurse assists Carol from the assessment area to her labor and birth room, Carol states that she is feeling some rectal pressure. Carol is most likely experiencing: Select one: a. Hypertonic contractions b. Hypotonic contractions c. Precipitous labor d. Uterine hyperstimulation

The correct answer is: Precipitous labor. Precipitous labor that lasts fewer than 3 hours from onset to birth. Precipitous labor is more likely to be seen in woman who have previously given birth or have a previous history of rapid labors. As the fetal head descends, the woman may feel rectal pressure indicating delivery is imminent.

Which resource best describes a health care service representing the tertiary level of prevention? Select one: a. Stress prevention seminars b. Self breast exam pamphlet and teaching c. Premenstrual syndrome (PMS) support group d. Childbirth education classes for single parents

The correct answer is: Premenstrual syndrome (PMS) support group

According to research, which risk factor for PPD is likely to have the greatest effect on the client postpartum? Select one: a. Prenatal depression b. Single-mother status c. Unplanned or unwanted pregnancy d. Low socioeconomic status

The correct answer is: Prenatal depression

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

The correct answer is: Previous birth of large infant

A pregnant woman who has a history of cesarean births is requesting to have a vaginal birth after cesarean (VBAC). In which of the following situations should the nurse advise the patient that her request may be declined? Select one: a. Previous uterine surgery b. Flexed fetal attitude c. Previous low flap uterine incision d. Positive vaginal candidiasis

The correct answer is: Previous uterine surgery. Contraindications for trial of labor after cesarean (TOLAC) leading to VBAC include vertical uterine incision, previous uterine surgery, previous uterine rupture, pelvic abnormalities, complications preventing vaginal delivery, lack of personnel required for operative delivery.

The perinatal nurse notes a rapid decrease in the fetal heart rate that does not recover immediately following an amniotomy. The most likely cause of this obstetrical emergency is: Select one: a. Prolapsed umbilical cord. b. Vasa previa c. Oligohydramnios d. Placental abruption

The correct answer is: Prolapsed umbilical cord. Amniotomy is the artificial rupture of membranes (AROM) to induce or augment labor. This is a common procedure seen in obstetrics. Risks associated with amniotomy include umbilical cord prolapse when the presenting part is not engaged. Vasa previa or rupture of fetal vessels unsupported by the placenta is a very rare situation and usually results in rapid fetal exsanguination in the presence of bloody fluid seen following AROM.

A multipara, 26 weeks' gestation and accompanied by her husband, has just delivered a fetal demise. Which of the following nursing actions is appropriate at this time? Select one: a. Encourage the parents to pray for the baby's soul. b. Advise the parents that it is better for the baby to have died than to have had to live with a defect. c. Provide opportunities for grieving parents and family members to spend time with the baby d. Advise the parents to refrain from discussing the baby's death with their other children.

The correct answer is: Provide opportunities for grieving parents and family members to spend time with the baby

113. A primiparous woman is in the taking-in stage of psychosocial recovery and adjustment after childbirth. Recognizing the needs of women during this stage, how should the nurse respond? Select one: a. Foster an active role in the baby's care. b. Promote maternal independence by encouraging her to meet her own hygiene and comfort needs. c. Recognize the woman's limited attention span by giving her written materials to read when she gets home rather than doing a teaching session while she is in the hospital. d. Provide time for the mother to reflect on the events of her labor and delivery.

The correct answer is: Provide time for the mother to reflect on the events of her labor and delivery.

In caring for the preterm infant, what complication is thought to be a result of high arterial blood oxygen level? Select one: a. IVH b. BPD c. ROP d. NEC

The correct answer is: ROP

A family is visiting two surviving triplets. The third triplet died 2 days ago. What action indicates that the family has begun to grieve for the dead infant? Select one: a. Asks about the dead triplet's current status b. Refers to the dead infant in the past tense c. Brings in play clothes for all three infants d. Refers to the two live infants as twins

The correct answer is: Refers to the dead infant in the past tense

A primigravida woman at 42 weeks' gestation received Prepidil (dinoprostone) for induction 12 hours ago. The Bishop score is now 3. Which of the following actions by the nurse is appropriate? Select one: a. Perform Nitrazine analysis of the amniotic fluid. b. Report the lack of progress to the obstetrician. c. Place the woman on her left side. d. Ask the provider for an order for oxytocin.

The correct answer is: Report the lack of progress to the obstetrician. Prepidil is indicated for cervical ripening, the process of physical softening and opening of the cervix. Cervical status is the most important predictor of successful induction of labor. Cervical status is assessed before induction of labor using the Bishop score. A score of 6 or more is considered favorable for successful induction of labor.

Evidence-based practice (EBP) is the integration of the best: Select one: a. Randomized clinical trials, clinical expertise, and patients' requests b. Research evidence, clinical expertise, and patients' values c. Quantitative research, clinical expertise, and patients' preferences d. Research findings, clinical experience, and patients' preferences

The correct answer is: Research evidence, clinical expertise, and patients' values. To practice EBP, a nurse is expected to combine the best research evidence with clinical expertise while taking into account the patients' preferences and their situation in the context of the available resources.

Select one: a. Intellectual impairment b. Respiratory conditions c. Neural development disorder d. Alcohol-related birth defects (ARBDs)

The correct answer is: Respiratory conditions

Which conditions are infants of diabetic mothers (IDMs) at a higher risk for developing? Select one: a. Sepsis b. Respiratory distress syndrome c. Hyponatremia d. Iron deficiency anemia

The correct answer is: Respiratory distress syndrome

30. When caring for clients with neoplasms of the reproductive system, the nurse must begin by assessing the woman's knowledge of the disorder, its management, and prognosis. This assessment should be followed by a nursing diagnosis. Which diagnosis fails to address the psychologic effect of these disorders? Select one: a. Interrupted family processes b. Risk for injury, related to lack of skill for self-care c. Anxiety, related to surgical procedures d. Disturbed body image, as a result of changes in anatomy

The correct answer is: Risk for injury, related to lack of skill for self-care

A pregnant woman at 37 weeks of gestation has had ruptured membranes for 26 hours. A cesarean section is performed for failure to progress. The fetal heart rate (FHR) before birth is 180 beats per minute with limited variability. At birth the newborn has Apgar scores of 6 and 7 at 1 and 5 minutes and is noted to be pale and tachypneic. Based on the maternal history, what is the most likely cause of this newborn's distress? Select one: a. Respiratory distress syndrome b. Phrenic nerve injury c. Hypoglycemia d. Sepsis

The correct answer is: Sepsis

In evaluating the effectiveness of magnesium sulfate for the treatment of preterm labor, which finding alerts the nurse to possible side effects? Select one: a. Serum magnesium level of 10 mg/dl b. DTRs 2+ and no clonus c. Urine output of 160 ml in 4 hours d. Respiratory rate (RR) of 16 breaths per minute

The correct answer is: Serum magnesium level of 10 mg/dl

What family form tends to be the most socially vulnerable? Select one: a. Extended family b. Single-parent family c. Married-blended family d. Nuclear family

The correct answer is: Single-parent family

For an infant experiencing symptoms of drug withdrawal, which intervention should be included in the plan of care? Select one: a. Administering chloral hydrate for sedation b. Snugly swaddling the infant and tightly holding the baby c. Feeding every 4 to 6 hours to allow extra rest between feedings d. Playing soft music during feeding

The correct answer is: Snugly swaddling the infant and tightly holding the baby

Parents are often asked if they would like to have an autopsy performed on their infant. Nurses who are assisting parents with this decision should be aware of which information? Select one: a. Autopsies are usually covered by insurance. b. In the current litigious society, more autopsies are performed than in the past. c. Autopsies must be performed within a few hours after the infant's death. d. Some religions prohibit autopsy.

The correct answer is: Some religions prohibit autopsy.

30. A woman who is 30 weeks of gestation arrives at the hospital with bleeding. Which differential diagnosis would not be applicable for this client? Select one: a. Abruptio placentae b. Placenta previa c. Spontaneous abortion d. Cord insertion

The correct answer is: Spontaneous abortion (occurs prior to 20th week of pregnancy)

A pregnant woman at term is transported to the emergency department (ED) after a severe vehicular accident. The obstetric nurse responds and rushes to the ED with a fetal monitor. Cardiopulmonary arrest occurs as the obstetric nurse arrives. What is the highest priority for the trauma team? Select one: a. Starting cardiopulmonary resuscitation (CPR) b. Transferring the woman to the surgical unit for an emergency cesarean delivery in case the fetus is still alive c. Obtaining IV access, and starting aggressive fluid resuscitation d. Quickly applying the fetal monitor to determine whether the fetus viability

The correct answer is: Starting cardiopulmonary resuscitation (CPR)

12. A client is to take Clomiphene Citrate for infertility. Which of the following is the expected action of this medication? Select one: a. Decrease the symptoms of endometriosis b. Increase serum progesterone levels c. Stimulate release of FSH and LH d. Reduce the acidity of vaginal secretions

The correct answer is: Stimulate release of FSH and LH

Documentation of abuse can be useful to women later in court, should they elect to press charges. It is of key importance for the nurse to document accurately at the time that the client is seen. Which entry into the medical record would be the least helpful to the court? Select one: a. Photographs of injuries b. Accurate description of the client's demeanor c. Clear and legible written documentation d. Summary of information (e.g., "The client is a battered woman.")

The correct answer is: Summary of information (e.g., "The client is a battered woman.")

5. A woman on the day of discharge from the postpartum unit asks a number of questions regarding breastfeeding and shares that she is nervous about taking her baby home and not being able to remember everything she has been taught. These are behaviors associated with: Select one: a. Bonding b. Taking in c. Taking hold d. Attachment

The correct answer is: Taking hold. Correct! The "taking hold" phase indicates the movement between dependent and independent behaviors. During this phase, the mother may have feelings of inadequacy and being overwhelmed.

What is one of the initial signs and symptoms of puerperal infection in the postpartum client? Select one: a. Pain with voiding b. Fatigue continuing for longer than 1 week c. Temperature of 38° C (100.4° F) or higher on 2 successive days Correct! d. Profuse vaginal lochia with ambulation

The correct answer is: Temperature of 38° C (100.4° F) or higher on 2 successive days

20. What important, immediate postoperative care practice should the nurse remember when caring for a woman who has had a mastectomy? Select one: a. The affected arm should be used for intravenous (IV) therapy. b. The affected arm should be held down close to the woman's side. c. Venipuncture for blood work should be performed on the affected arm. d. The blood pressure (BP) cuff should not be applied to the affected arm.

The correct answer is: The blood pressure (BP) cuff should not be applied to the affected arm.

A woman at 24 weeks of gestation states that she has a glass of wine with dinner every evening. Why would the nurse counsel the client to eliminate all alcohol? Select one: a. She will be at risk for abusing other substances as well. b. The fetus is placed at risk for altered brain growth. c. The fetus is at risk for multiple organ anomalies. d. Daily consumption of alcohol indicates a risk for alcoholism.

The correct answer is: The fetus is placed at risk for altered brain growth.

38. A client with maternal phenylketonuria (PKU) has come to the obstetrical clinic to begin prenatal care. Why would this preexisting condition result in the need for closer monitoring during pregnancy? Select one: a. PKU is a recognized cause of preterm labor. b. A pregnant woman is more likely to die without strict dietary control. c. The fetus may develop neurologic problems. d. Women with PKU are usually mentally handicapped and should not reproduce.

The correct answer is: The fetus may develop neurologic problems. see pp 707-708

Another common pregnancy-specific condition is pruritic urticarial papules and plaques of pregnancy (PUPPP). A client asks the nurse why she has developed this condition and what can be done. What is the nurse's best response? Select one: a. PUPPP is associated with decreased maternal weight gain. b. The goal of therapy is to relieve discomfort. c. The rate of hypertension decreases with PUPPP. d. This common pregnancy-specific condition is associated with a poor fetal outcome.

The correct answer is: The goal of therapy is to relieve discomfort.

Which statement regarding hemolytic diseases of the newborn is most accurate? Select one: a. The indirect Coombs' test is performed on the mother before birth; the direct Coombs' test is performed on the cord blood after birth. b. Rh incompatibility matters only when an Rh-negative child is born to an Rh-positive mother. c. Exchange transfusions are frequently required in the treatment of hemolytic disorders. d. ABO incompatibility is more likely than Rh incompatibility to precipitate significant anemia.

The correct answer is: The indirect Coombs' test is performed on the mother before birth; the direct Coombs' test is performed on the cord blood after birth.

114. A nursing student is helping the nursery nurses with morning vital signs. A baby born 10 hours ago by cesarean section is found to have moist lung sounds. What is the best interpretation of these data? Select one: a. The lungs of a baby delivered by cesarean section may sound moist during the first 24 hours after childbirth. b. The nurse should immediately notify the pediatrician for this emergency situation. c. If this baby was born vaginally, then a pneumothorax could be indicated. d. The neonate must have aspirated surfactant.

The correct answer is: The lungs of a baby delivered by cesarean section may sound moist during the first 24 hours after childbirth. Baby did not experience the chest pressure during a vaginal delivery, therefore, negative intrathoracic pressure did not help to draw air into the lungs and clear fluid. Read p524

39. The client is being induced in response to worsening preeclampsia. She is also receiving magnesium sulfate. It appears that her labor has not become active, despite several hours of oxytocin administration. She asks the nurse, "Why is this taking so long?" What is the nurse's most appropriate response? Select one: a. "I don't know why it is taking so long." b. "The length of labor varies for different women." c. "The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor." d. "Your baby is just being stubborn."

The correct answer is: The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor

What is the primary purpose for the use of tocolytic therapy to suppress uterine activity? Select one: a. Tocolytic therapy has no important maternal (as opposed to fetal) contraindications. b. Drugs can be efficaciously administered up to the designated beginning of term at 37 weeks gestation. c. The most important function of tocolytic therapy is to provide the opportunity to administer antenatal glucocorticoids. d. If the client develops pulmonary edema while receiving tocolytic therapy, then intravenous (IV) fluids should be given.

The correct answer is: The most important function of tocolytic therapy is to provide the opportunity to administer antenatal glucocorticoids.

Which finding would indicate to the nurse that the grieving parents have progressed to the reorganization phase of grieving? Select one: a. The parents say that they "feel no pain." b. The parents are discussing sex and a future pregnancy, even if they have not yet sorted out their feelings. c. The parents' questions have progressed from "Why?" to "Why us?" d. The parents have abandoned those moments of "bittersweet grief."

The correct answer is: The parents are discussing sex and a future pregnancy, even if they have not yet sorted out their feelings.

10. A couple who has sought infertility counseling has been told that the man's sperm count is very low. The nurse advises the couple that spermatogenesis is impaired when which of the following occur? Select one: a. The testes are overheated. b. The vas deferens is ligated. c. The prostate gland is enlarged. d. alcohol use

The correct answer is: The testes are overheated.

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 a victim of IPV? Select one: a. The woman has injuries on various parts of her body that are in different stages of healing. b. She avoids making eye contact and while answering questions. c. Examination reveals a fractured arm and fresh bruises. d. The woman and her partner are having an argument that is loud and hostile.

The correct answer is: The woman has injuries on various parts of her body that are in different stages of healing.

Which statement regarding the laboratory test for glycosylated hemoglobin Alc is correct? Select one: a. This laboratory test is a snapshot of glucose control at the moment. b. The laboratory test for glycosylated hemoglobin Alc is performed for all pregnant women, not only those with or likely to have diabetes. c. This laboratory test is performed on the woman's urine, not her blood. d. This laboratory test measures the levels of hemoglobin Alc, which should remain at less than 7%

The correct answer is: This laboratory test measures the levels of hemoglobin Alc, which should remain at less than 7%

36. A woman arrives at the emergency department with complaints of bleeding and cramping. The initial nursing history is significant for a last menstrual period 6 weeks ago. On sterile speculum examination, the primary care provider finds that the cervix is closed. The anticipated plan of care for this woman would be based on a probable diagnosis of which type of spontaneous abortion? Select one: a. Threatened b. Septic c. Incomplete d. Inevitable

The correct answer is: Threatened. Cervix is not dilated

Human immunodeficiency virus (HIV) may be transmitted perinatally or during the postpartum period. Which statement regarding the method of transmission is most accurate? Select one: a. Only in the third trimester from the maternal circulation b. Through the ingestion of breast milk from an infected mother c. Only through the ingestion of amniotic fluid d. From the use of unsterile instruments

The correct answer is: Through the ingestion of breast milk from an infected mother

During the initial acute distress phase of grieving, parents still must make unexpected and unwanted decisions about funeral arrangements and even naming the baby. What is the nurse's role at this time? Select one: a. To leave them alone to work things out b. To ensure that the parents, themselves, approve the final decisions c. To take over as much as possible to relieve the pressure d. To encourage the grandparents to take over

The correct answer is: To ensure that the parents, themselves, approve the final decisions

Prostaglandin gel has been ordered for a pregnant woman at 43 weeks of gestation. What is the primary purpose of prostaglandin administration? Select one: a. To stimulate the amniotic membranes to rupture b. To ripen the cervix in preparation for labor induction c. To enhance uteroplacental perfusion in an aging placenta d. To increase amniotic fluid volume

The correct answer is: To ripen the cervix in preparation for labor induction

A woman in preterm labor at 30 weeks of gestation receives two 12-mg intramuscular (IM) doses of betamethasone. What is the purpose of this pharmacologic intervention? Select one: a. To maintain adequate maternal respiratory effort and ventilation during magnesium sulfate therapy b. To reduce maternal and fetal tachycardia associated with ritodrine administration c. To stimulate fetal surfactant production d. To suppress uterine contractions

The correct answer is: To stimulate fetal surfactant production

Which substance used during pregnancy causes vasoconstriction and decreased placental perfusion, resulting in maternal and neonatal complications? Select one: a. Tobacco b. Caffeine c. Alcohol d. Chocolate

The correct answer is: Tobacco

32. A client at 39 weeks of gestation has been admitted for an external version. Which intervention would the nurse anticipate the provider to order? Select one: a. Contraction stress test (CST) b. Tocolytic drug c. Foley catheter d. Local anesthetic

The correct answer is: Tocolytic drug

Nurses need to understand the basic definitions and incidence data regarding PPH. Which statement regarding this condition is most accurate? Select one: a. PPH is easy to recognize early; after all, the woman is bleeding. b. Traditionally, it takes more than 1000 ml of blood after vaginal birth and 2500 ml after cesarean birth to define the condition as PPH. c. Traditionally, PPH has been classified as early PPH or late PPH with respect to birth. d. If anything, nurses and physicians tend to overestimate the amount of blood loss.

The correct answer is: Traditionally, PPH has been classified as early PPH or late PPH with respect to birth.

The nurse should be cognizant of which condition related to skeletal injuries sustained by a neonate during labor or childbirth? Select one: a. Newborn's skull is still forming and fractures fairly easily. b. Unless a blood vessel is involved, linear skull fractures heal without special treatment. c. Clavicle fractures often need to be set with an inserted pin for stability. d. Other than the skull, the most common skeletal injuries are to leg bones.

The correct answer is: Unless a blood vessel is involved, linear skull fractures heal without special treatment.

20. The nurse is preparing to administer methotrexate to the client. This drug is most often used for which obstetric complication? Select one: a. Complete hydatidiform mole b. Missed abortion c. Unruptured ectopic pregnancy d. Abruptio placentae

The correct answer is: Unruptured ectopic pregnancy

The nurse suspects that her postpartum client is experiencing hemorrhagic shock. Which observation indicates or would confirm this diagnosis? Select one: a. Calm mental status b. Urinary output of at least 30 ml/hr Correct!- this answer should read urinary output of less than 30ml/hr c. Cool, dry skin d. Absence of cyanosis in the buccal mucosa

The correct answer is: Urinary output of at least 30 ml/hr

A pregnant woman at 33 weeks of gestation is brought to the birthing unit after a minor automobile accident. The client is experiencing no pain and no vaginal bleeding, her vital signs are stable, and the FHR is 132 beats per minute with variability. What is the nurse's highest priority? Select one: a. Using continuous EFM for a minimum of 4 hours b. Monitoring the woman for a ruptured spleen c. Monitoring her for 24 hours d. Obtaining a physician's order to discharge her home

The correct answer is: Using continuous EFM for a minimum of 4 hours

2. The perinatal nurse teaches the postpartum woman about warning signs regarding development of postpartum infection. Signs and symptoms that merit assessment by the health-care provider include the development of a fever and: Select one: a. Breast engorgement b. Uterine tenderness c. Diarrhea d. Emotional lability

The correct answer is: Uterine tenderness. During the immediate postpartum period, the most common site of infection is the uterine endometrium. This infection presents with a temperature elevation over 101°F, often within the first 24 to 48 hours after childbirth, followed by uterine tenderness and foul-smelling lochia.

During the postpartum assessment, the perinatal nurse notes that a patient who has just experienced a forceps-assisted birth now has a large quantity of bright red bleeding. Her uterine fundus is firm and midline. The nurse's most appropriate action is to notify the physician/certified nurse midwife and anticipate the need for: Select one: a. Vaginal assessment and possible repair of vaginal and/or cervical lacerations b. An oxytocin infusion c. Further information for the woman/family about forceps d. Bladder assessment and catheterization

The correct answer is: Vaginal assessment and possible repair of vaginal and/or cervical lacerations

Which condition would require prophylaxis to prevent subacute bacterial endocarditis (SBE) both antepartum and intrapartum? Select one: a. Postmyocardial infarction b. Arrhythmias c. Valvular heart disease d. Congestive heart disease

The correct answer is: Valvular heart disease

The perinatal nurse understands that the purpose of the surgical "time-out" is to: Select one: a. Confirm that the surgeon is ready to begin b. Verify that it is the correct patient and planned procedure c. Verify that anesthesia is adequate d. Confirm that the neonatal team is in attendance

The correct answer is: Verify that it is the correct patient and planned procedure. Surgical "time-out" is performed by the entire surgical team and the patient prior to the administration of anesthesia. The purpose is to validate correct patient and planned procedure.

54. Which component of the sensory system is the least mature at birth? Select one: a. Smell b. Taste c. Hearing d. Vision

The correct answer is: Vision

112. A nurse notes that an Eskimo woman does not cuddle or interact with her newborn other than to feed him, change his diapers or soiled clothes, and put him to bed. While evaluating this client's behavior with her infant, what realization does the nurse make? Select one: a. The woman needs a referral to a social worker for further evaluation of her parenting behaviors once she goes home with the newborn. b. What appears to be a lack of interest in the newborn is, in fact, the cultural way of demonstrating intense love by attempting to ward off evil spirits. c. The woman is inexperienced in caring for a newborn. d. Extra time needs to be planned for assisting the woman in bonding with her newborn.

The correct answer is: What appears to be a lack of interest in the newborn is, in fact, the cultural way of demonstrating intense love by attempting to ward off evil spirits.

A nurse notes that an Eskimo woman does not cuddle or interact with her newborn other than to feed him, change his diapers or soiled clothes, and put him to bed. While evaluating this client's behavior with her infant, what realization does the nurse make? Select one: a. The woman needs a referral to a social worker for further evaluation of her parenting behaviors once she goes home with the newborn. b. What appears to be a lack of interest in the newborn is, in fact, the cultural way of demonstrating intense love by attempting to ward off evil spirits. c. The woman is inexperienced in caring for a newborn. d. Extra time needs to be planned for assisting the woman in bonding with her newborn.

The correct answer is: What appears to be a lack of interest in the newborn is, in fact, the cultural way of demonstrating intense love by attempting to ward off evil spirits.

74. The nurse is about to elicit the rooting reflex on a newborn baby. Which of the following responses should the nurse expect to see? Select one: a. When the cheek of the baby is touched, the newborn turns toward the side that is touched. b. When the lateral aspect of the sole of the baby's foot is stroked, the toes extend and fan outward. c. When the baby is suddenly lowered or startled, the neonate's arms straighten outward and the knees flex. d. When the newborn is supine and the head is turned to one side, the arm on that same side extends.

The correct answer is: When the cheek of the baby is touched, the newborn turns toward the side that is touched. An infant exhibits Rooting reflex when the neonate turns his head toward the direction of the stimulus and opens his mouth. Choice 2 is the Babinski reflex; Choice 3 is the Startle or Moro reflex; Choice 4 is the Tonic Neck reflex

68. Early this morning, an infant boy was circumcised using the PlastiBell method. Based on the nurse's evaluation, when will the infant be ready for discharge? Select one: a. When the bleeding completely stops b. When the PlastiBell plastic rim (bell) falls off c. When the infant voids d. When yellow exudate forms over the glans

The correct answer is: When the infant voids

Which client is at greatest risk for early PPH? Select one: a. Woman with severe preeclampsia on magnesium sulfate whose labor is being induced b. Primigravida in spontaneous labor with preterm twins c. Multiparous woman (G 3, P 2-0-0-2) with an 8-hour labor d. Primiparous woman (G 2, P 1-0-0-1) being prepared for an emergency cesarean birth for fetal distress

The correct answer is: Woman with severe preeclampsia on magnesium sulfate whose labor is being induced. The effects of magnesium sulfate puts this patient at greater risk for PPH than the other scenarios.

New screening mammogram recommendations by ACOG include which of the following? Select one: a. All women begin screening mammogram at 40 years old b. All women after 55 y/o should have annual screening mammograms c. Women should talk to their health care provider to decide the best age to begin screening mammograms d. Only women with increased risk for breast begin screening mammogram at age 40

The correct answer is: Women should talk to their health care provider to decide the best age to begin screening mammograms

A postmenopausal woman has been diagnosed with two leiomyomas (fibroids). Which clinical finding is most commonly associated with the presence of leiomyomas? Select one: a. Weight loss b. Diarrhea c. Abnormal uterine bleeding d. Acute abdominal pain

The correct answer is: abnormal uterine bleeding

A woman exhibits symptoms that may lead to a possible diagnosis of polycystic ovary syndrome (PCOS). While completing the initial assessment of the client, which clinical finding would the nurse not anticipate? Select one: a. Anorexia b. Infertility c. Irregular menses d. Hirsutism

The correct answer is: anorexia

A woman has preinvasive cancer of the cervix. Which modality would the nurse discuss as an available option for a client with this condition? Select one: a. internal radiation b. colposcopy c. cryosurgery d. hysterectomy

The correct answer is: cryosurgery

4. Amy is a 20 year old sexually active woman (G0000) who wants an effective birth control method. She denies any medical problems. Which of the following would the nurse not recommend to Amy? Select one: a. essure b. intrauterine device c. oral contraceptive pills d. the implant

The correct answer is: essure

Which of the following cancers has no accurate screening test for secondary prevention? Select one: a. Ovarian cancer b. Breast cancer c. Cervical cancer d. Uterine cancer

The correct answer is: ovarian cancer

1. Combination oral contraceptives, the vaginal ring and the patch contain two hormones. Which of the following is the primary hormone that stops ovulation? Select one: a. estrogen b. progesterone c. testosterone d. hCG

The correct answer is: progesterone

16. Depo provera, or The Shot, contains which of the following hormones? Select one: a. neither estrogen or progesterone b. progesterone c. estrogen d. estrogen and progesterone

The correct answer is: progesterone

31. Which hormone remains elevated in the immediate postpartum period of the breastfeeding woman? a. Progesterone b. Prolactin c. Estrogen d. Human placental lactogen

The correct answer is: prolactin

3. Which of the following is the most effective contraception? Select one: a. the vaginal ring b. condoms c. oral contraceptive pills d. the implant e. natural family planning

The correct answer is: the implant

A nurse is providing education to a support group of women newly diagnosed with breast cancer. It is important for the nurse to discuss which factor related to breast cancer with the group? Select one: a. Genetic mutations account for 50% of women who will develop breast cancer. b. The exact cause of breast cancer remains unknown. c. In the United States, 1 in 10 women will develop breast cancer in her lifetime. d. Breast cancer is the leading cause of cancer death in women.

The correct answer: The exact cause of breast cancer remains unknown.

7. 25 year old Susan (G0000) is thinking about getting pregnant this next year, but wants an effective method right now. She currently uses condoms. She denies medical problems. Which of the following birth control methods are most appropriate for the nurse to discuss with Susan? (Select all that apply). Select one or more: a. The birth control patch b. Condoms (continue). c. Oral contraceptive pills d. The implant e. Vaginal ring

The correct answers are: A, B, C, E. Oral contraceptive pills, Condoms (continue), The birth control patch, Vaginal ring. Long-acting contraception is not the best choice for a woman who desires pregnancy within one year. More appropriate methods include birth control pills and the patch, and the vaginal ring as they are not long acting and are reversible once the woman stops using them. Condoms are short acting with no hormones.

Documentation related to vacuum delivery includes which of the following: Select one or more: a. Fetal heart rate b. Timing and number of applications c. Position and station of fetal head d. Maternal position

The correct answers are: A, B, C. Fetal heart rate, Timing and number of applications, Position and station of fetal head. Assessment of fetal heart rate is part of second-stage management, timing and number of applications are part of standard of care related to safe vacuum deliveries, and position and station of fetal head are noted for safe vacuum extraction. Maternal position is not critical to the documentation related to vacuum deliveries

11. A couple who has been attempting to become pregnant for 5 years is seeking assistance from an infertility clinic. The nurse assesses the clients' emotional responses to their infertility. Which of the following responses would the nurse expect to find? (Select all that apply.) Select one or more: a. Anger at others who have babies. b. Feelings of failure because they cannot make a baby. c. Sexual excitement because they want to conceive a baby. d. Guilt on the part of one partner because he or she is unable to give the other a baby.

The correct answers are: A, B, D. Anger at others who have babies., Feelings of failure because they cannot make a baby., Guilt on the part of one partner because he or she is unable to give the other a baby. Infertility can be seen as a crisis in the couple's lives and relationship. The diagnosis and treatment of infertility can cause anger with others who have babies, feelings of failure, and feelings of guile. Sexual dysfunction can occur based on the type of infertility testing required and the method of treatment.

17. Which of the following is true regarding physiologic jaundice? (Select all that apply). Select one or more: a. Jaundice is more common in preterm infants b. Jaundice is noted 24 hours after birth c. Jaundice persists longer than 14 days of life in a term infant d. It is recommended the mother stop breastfeeding until jaundice resolves e. Jaundice is noted within 24 hours after birth

The correct answers are: A, B. Jaundice is noted 24 hours after birth, Jaundice is more common in preterm infants

Contraindications for induction of labor include: Select one or more: a. Abnormal fetal position b. Post-term pregnancy c. Pre-eclampsia d. Placental abnormalities

The correct answers are: Abnormal fetal position, Placental abnormalities. Contraindications for induction of labor include abnormal fetal position because of the risk of fetal injury and placental abnormalities because of the risk of hemorrhage. Pre-eclampsia and post-term pregnancy are two of the common indications for induction of labor.

Postoperative nursing care and education for a woman who had an abdominal hysterectomy includes (select all that apply): Select one or more: a. Administering hormone therapy as per provider orders. b. Assessing vaginal bleeding c. Instructing the woman vaginal intercourse until she has follow up visit with surgeon. d. Instructing the woman to resume activities as comfort level permits.

The correct answers are: Administering hormone therapy as per provider orders., Assessing vaginal bleeding, Instructing the woman vaginal intercourse until she has follow up visit with surgeon., Instructing the woman to resume activities as comfort level permits.

A thorough abuse assessment screen should be completed on all female clients. This screen should include which components? (select all that apply) Select one or more: a. Asking the client if she has been forced to perform sexual acts b. Asking the client if she is afraid of her partner c. Asking the client what she did wrong to elicit the abuse d. Asking the client if she has ever been slapped, kicked, punched, or physically hurt by her partner

The correct answers are: Asking the client if she has ever been slapped, kicked, punched, or physically hurt by her partner, Asking the client if she is afraid of her partner, Asking the client if she has been forced to perform sexual acts

16. Indications for a primary cesarean birth are often nonrecurring. Therefore, a woman who has had a cesarean birth with a low transverse scar may be a candidate for vaginal birth after cesarean (VBAC). Which clients would be less likely to have a successful VBAC? (Select all that apply.) Select one or more: a. Estimated fetal weight <4000 g b. Delivery at a rural hospital c. Lengthy interpregnancy interval d. African-American race e. Maternal obesity (BMI >30)

The correct answers are: B, D, E. African-American race, Delivery at a rural hospital, Maternal obesity (BMI >30)

37. Approximately 10% to 15% of all clinically recognized pregnancies end in miscarriage. What are possible causes of early miscarriage? (Select all that apply.) Select one or more: a. Systemic disorders b. Varicella c. Nausea and vomiting in early pregnancy d. Chromosomal abnormalities e. Endocrine imbalance

The correct answers are: Chromosomal abnormalities, Endocrine imbalance, Systemic disorders, Varicella, Nausea and vomiting in early pregnancy. Although most N/V in early pregnancy is not likely to relate to miscarriage, severe dehydration can reduce uterine circulation severely enough to impact a pregnancy

Which congenital anomalies can occur as a result of the use of antiepileptic drugs (AEDs) in pregnancy? (Select all that apply.) Select one or more: a. Neural tube defects b. Diaphragmatic hernia c. Gastroschisis d. Congenital heart disease e. Cleft lip

The correct answers are: Cleft lip, Congenital heart disease , Neural tube defects

33. Which finding on a prenatal visit at 10 weeks of gestation might suggest a hydatidiform mole? (Select all that apply). Select one or more: a. Blood pressure of 120/80 mm Hg b. Fundal height measurement of 18 cm c. History of bright red spotting for 1 day, weeks ago d. Complaint of severe nausea

The correct answers are: Complaint of severe nausea, Fundal height measurement of 18 cm

Tachysystole, previously referred to as hyperstimulation, is defined as: Select one or more: a. Contractions lasting 2 minutes or longer b. Five or more contractions in 10 minutes over a 30-minute window c. Contractions occurring within 1 minute of each other d. Uterine resting tone below 20 mm/Hg

The correct answers are: Contractions lasting 2 minutes or longer, Five or more contractions in 10 minutes over a 30-minute window, Contractions occurring within 1 minute of each other. Contractions lasting more than 2 minutes, five or more contractions in 10 minutes, and contractions occurring within 1 minute of each other describe the criteria for tachysystole. Uterine resting tone below 20 mm/Hg reflects normal uterine resting tone.

Which of the following are true regarding interpreter services? Select all that apply. Select one or more: a. It is not necessary to worry about different dialects of a patient's native language when using interpreters. b. Direct questions to the patient, not the interpreter. c. Create environment of respect and privacy. d. Never have a patient's child serve as an interpreter.

The correct answers are: Direct questions to the patient, not the interpreter., Create environment of respect and privacy.

Which of the following nursing interventions are important in the prenatal care of the woman with prenatal depression? (Select all of the following). Select one or more: a. Counsel her on the importance of medication if the woman refuses it. b. Recommend she see a psychiatrist for management c. Maintain a caring relationship d. Educate the woman about depression and plan of care

The correct answers are: Educate the woman about depression and plan of care, Maintain a caring relationship

A serious but uncommon complication of undiagnosed or partially treated hyperthyroidism is a thyroid storm, which may occur in response to stress such as infection, birth, or surgery. What are the signs and symptoms of this emergency disorder? (Select all that apply). Select one or more: a. Bradycardia b. Hypothermia c. Fever d. Restlessness e. Hypertension

The correct answers are: Fever, Restlessness,

Which of the following are primary risk factors for subinvolution of the uterus? (Select all that apply.) Select one or more: a. Fibroids b. Retained placental tissue c. Metritis d. Urinary tract infection

The correct answers are: Fibroids, Retained placental tissue, Metritis. Retained placental tissue does not allow the uterus to remain contracted. Infection in the uterus is a risk factor for subinvolution. UTI does not interfere with involution of the uterus.

8. 16 y/o Susie presents to the clinic, wanting a pregnancy test. What questions would be appropriate for the professional nurse to ask Susie prior to completing the pregnancy test? Select one or more: a. Does your mother know you are wanting a pregnancy test? b. Have you been using birth control? c. Have you done a home pregnancy test? d. What is the first day of your last menstrual period? e. Are you excited that you might be pregnant?

The correct answers are: Have you done a home pregnancy test?, What is the first day of your last menstrual period?, Have you been using birth control?

Primary prevention of preterm labor and birth include which of the following? (Select all that apply). Select one or more: a. Induce pregnant woman at 37 weeks b. Identify risk factors of preterm birth for individual pregnant woman c. Treat pregnant woman with magnesium sulfate this is secondary prevention- see powerpoint d. Manage risk factors for preterm birth in individual pregnant woman correct!

The correct answers are: Identify risk factors of preterm birth for individual pregnant woman, Manage risk factors for preterm birth in individual pregnant woman

39. Hypothyroidism occurs in 2 to 3 pregnancies per 1000. Because severe hypothyroidism is associated with infertility and miscarriage, it is not often seen in pregnancy. Regardless of this fact, the nurse should be aware of the characteristic symptoms of hypothyroidism. Which do they include? (Select all that apply.) Select one or more: a. Lethargy b. Weight loss c. Cold intolerance d. Decrease in exercise capacity e. Hot flashes

The correct answers are: Lethargy, Decrease in exercise capacity, Cold intolerance

Jennifer is 3 hours postpartum following the vaginal delivery of a 9lb 15oz baby girl. Estimated blood loss at delivery was 800 ml. The RN is aware that Jennifer experienced an early-postpartum hemorrhage. Select the appropriate nursing actions for the care of this patient. (Select all that apply.) Select one or more: a. Maintain IV site in case fluids/medication for PPH are indicated b. Frequent fundal assessment to prevent uterine atony and further blood loss c. Assess for displaced uterus secondary to overdistended bladder. d. Assess lochia for amount and for clots

The correct answers are: Maintain IV site in case fluids/medication for PPH are indicated, Frequent fundal assessment to prevent uterine atony and further blood loss, Assess for displaced uterus secondary to overdistended bladder., Assess lochia for amount and for clots. PPH is blood loss greater than 500 ml for vaginal deliveries and 1000 ml for cesarean with a 10% drop in hemoglobin and/or hematocrit. Unfortunately, postpartum women may not show signs/symptoms of PPH until about 1/3 of entire blood volume is lost. RNs must frequently assess uterine tone, location, and position as well as blood loss amount and characteristics (slow, steady, sudden, massive, presence of clots, possible distended bladder). Keeping the IV site intact will allow immediate access to fluids and/or medications should PPH worsen.

20. Which of the following are management options for couples faced with infertility challenges, depending of the cause? (Select all that apply). Select one or more: a. assisted reproductive technology procedures b. adoption c. Medication d. remain child-free

The correct answers are: Medication, assisted reproductive technology procedures, adoption, remain child-free. see p 204 for child-free option

Which medications are used to manage PPH? (Select all that apply.) Select one or more: a. Hemabate b. Methergine c. Oxytocin d. Terbutaline e. Magnesium sulfate

The correct answers are: Oxytocin, Methergine, Hemabate

29. Which of the following screens for cervical cancer? (Select all that apply). Select one or more: a. chlamydia b. high risk HPV test c. herpes simplex 1 and 2 d. Pap smear test

The correct answers are: Pap smear test, high risk HPV test. Pap smear test and high risk HPV tests are used to screen cervical cancer. Other STD testing is not done for cervical cancer screening.

6. The perinatal nurse observed the pediatrician completing the Ballard Maturational Score (BMS). The maturity components used with this assessment are (select all that apply): Select one or more: a. Physical b. Behavioral c. Reflexive d. Neuromuscular

The correct answers are: Physical, Neuromuscular. With the BMS, the infant examination yields a score of neuromuscular and physical maturity that can be extrapolated onto a corresponding age scale to reveal the infant's gestational age in weeks.

Which of the following perinatal complications have been associated with untreated asymptomatic bacteriuria? (Select all that apply). Select one or more: a. chorioamniotis b. Preterm birth c. Low birth weight d. congenital birth defects

The correct answers are: Preterm birth, Low birth weight

Which of the following are indications for cesarean birth? (Select all that apply.) Select one or more: a. Previous cesarean birth b. Placental abnormalities c. Previous uterine surgery d. Failure to progress in labor

The correct answers are: Previous cesarean birth, Placental abnormalities, Previous uterine surgery, Failure to progress in labor

The induction of labor is considered an acceptable obstetric procedure if it is in the best interest to deliver the fetus. The charge nurse on the labor and delivery unit is often asked to schedule clients for this procedure and therefore must be cognizant of the specific conditions appropriate for labor induction. What are appropriate indications for induction? (Select all that apply) Select one or more: a. Fetal death b. Convenience of the woman or her physician c. Rupture of membranes at or near term d. Postterm pregnancy e. Maternal fatigue and frustration at 38 weeks gestation

The correct answers are: Rupture of membranes at or near term, Postterm pregnancy, Fetal death

Reports have linked third trimester use of selective serotonin uptake inhibitors (SSRIs) with a constellation of neonatal signs. The nurse is about to perform an assessment on the infant of a mother with a history of a mood disorder. Which signs and symptoms in the neonate may be the result of maternal SSRI use? (Select all that apply.) Select one or more: a. Hyperglycemia b. Irritability c. Hypotonia d. Shivering e. Fever

The correct answers are: Shivering, Fever, Irritability

21. A health care provider performs a clinical breast examination on a woman diagnosed with fibroadenoma. How would the nurse explain the defining characteristics of a fibroadenoma? (Select all that apply). Select one or more: a. Single lump in one breast that can increase in size. b. Lumpiness in both breasts that develops 1 week before menstruation c. Does not increase risk for breast cancer d. Inflammation of the milk ducts and glands behind the nipples e. Thick, sticky discharge from the nipple of the affected breast

The correct answers are: Single lump in one breast that can increase in size., Does not increase risk for breast cancer

Which client(s) should the nurse report to the health care provider? (Select all that apply). Select one or more: a. Small dimple located in the upper outer quadrant of the right breast b. One 2-3mm sized mobile, nontender mass in lower outer quadrant of left breast c. Left breast slightly smaller than right breast d. Eversion (elevation) of both nipples

The correct answers are: Small dimple located in the upper outer quadrant of the right breast, One 2-3mm sized mobile, nontender mass in lower outer quadrant of left breast

The client is undergoing treatment for ovarian cancer. Which common nutritional problems are related to gynecologic cancers and the treatment thereof? (Select all that apply.) Select one or more: a. Increased Appetite b. Stomatitis c. Diarrhea d. Constipation e. Nausea and vomiting

The correct answers are: Stomatitis, Constipation, Diarrhea, Nausea and vomiting

What are some common characteristics of a potential male batterer? (select all that apply) Select one or more: a. Substance abuse problems b. Personality disorders c. High level of self-esteem d. Ability to empathize with others e. High frustration tolerance

The correct answers are: Substance abuse problems, Personality disorders

115. Pain should be regularly assessed in all newborns. If the infant is displaying physiologic or behavioral cues that indicate pain, then measures should be taken to manage the pain. Which interventions are examples of nonpharmacologic pain management techniques? (Select all that apply.) Select one or more: a. Skin-to-skin contact with the mother b. Acetaminophen c. Sucrose d. Nonnutritive sucking e. Swaddling

The correct answers are: Sucrose, Skin-to-skin contact with the mother , Swaddling, Nonnutritive sucking

32. One of the most important components of the physical assessment of the pregnant client is the determination of BP. Consistency in measurement techniques must be maintained to ensure that the nuances in the variations of the BP readings are not the result of provider error. Which techniques are important in obtaining accurate BP readings? (Select all that apply.) Select one or more: a. The client's arm should be placed at the level of the heart. b. The same arm should be used for every reading c. The cuff should cover a minimum of 60% of the upper arm. d. An electronic BP device should be used. e. The client should be seated

The correct answers are: The client should be seated, The client's arm should be placed at the level of the heart., The same arm should be used for every reading

14. A couple is undergoing an infertility workup. The semen analysis indicates a decreased number of sperm and immature sperm. Which of the following factors can have a potential effect on sperm maturity? (Select all that apply.) Select one or more: a. The man rides a bike to and from work each day. b. The man takes a calcium channel blocker for the treatment of hypertension. c. The man drinks 6 cups of coffee a day. d. The man was treated for prostatitis 12 months ago and has been symptom free since treatment.

The correct answers are: The man rides a bike to and from work each day., The man takes a calcium channel blocker for the treatment of hypertension. The daily riding of a bike can be the cause of prolonged heat exposure to the testicles. Prolonged heat exposure is a gonadotoxin. A number of medications, such as calcium channel blockers, can have an effect on sperm production. Coffee has not been associated with low sperm counts. Prostatitis or other infections within the last 3 months may have an effect on the sperm analysis. This man's episode of prostatitis was 12 months prior.

Women who are obese are at risk for several complications during pregnancy and birth. Which of these would the nurse anticipate with an obese client? (Select all that apply.) Select one or more: a. Thromboembolism b. Breech presentation c. Cesarean birth d. Hypertension e. Wound infection

The correct answers are: Thromboembolism, Cesarean birth, Wound infection, Hypertension

Nursing actions focused at reducing a postpartum woman's risk for cystitis include which of the following? (Select all that apply.) Select one or more: a. Voiding within a few hours post-birth b. Oral intake of a minimum of 3000 mL per day c. Changing peri-pads every 3 to 4 hours or more frequently as indicated d. Reminding the woman to void every 3 to 4 hours while awake

The correct answers are: Voiding within a few hours post-birth, Oral intake of a minimum of 3000 mL per day, Changing peri-pads every 3 to 4 hours or more frequently as indicated, Reminding the woman to void every 3 to 4 hours while awake Early voiding helps flush bacteria from the urethra. Voiding every 3 to 4 hours will decrease the risk of bacterial growth in the bladder. Soiled peri-pads are a media for bacterial growth. It is recommend that a postpartum woman drink a minimum of 3000 mL/day to help dilute urine and promote frequent voiding.

For which of the following reproductive cancers is high risk HPV infection thought to be primarily responsible? (Select all that apply). Select one or more: a. Vulvar cancer b. Endometrial cancer c. Vaginal cancer d. Cervical cancer e. Ovarian cancer

The correct answers are: Vulvar cancer, Cervical cancer, Vaginal cancer

23. Which of the following are milestones in the care of mothers and babies? (Select all that apply). Select one or more: a. abortion is legalized b. folic acid is recommended to prevent neural tube defects c. HIV vaccine is available d. FDA approves birth control pill for men See Box 1-1, page 2

The correct answers are: abortion is legalized, folic acid is recommended to prevent neural tube defects

Which of the following are milestones in the care of mothers and babies? (Select all that apply). Select one or more: a. abortion is legalized b. folic acid is recommended to prevent neural tube defects c. HIV vaccine is available d. FDA approves birth control pill for men

The correct answers are: abortion is legalized, folic acid is recommended to prevent neural tube defects

4. Which societal factors have a strong influence on parental response to their infant? (Select all that apply.) Select one or more: a. Adolescent mothers have a higher documented incidence of child abuse. b. Mothers older than 35 years of age often deal with more stress related to work and career issues, as well as decreasing libido. c. An adolescent mother is likely to use less verbal instruction, be less responsive, and interact less positively than other mothers. d. Relationships between adolescent mothers and fathers are more stable than older adults. e. An adolescent mother's egocentricity and unmet developmental needs interfere with her ability to parent effectively.

The correct answers are: b, c, e. An adolescent mother's egocentricity and unmet developmental needs interfere with her ability to parent effectively., An adolescent mother is likely to use less verbal instruction, be less responsive, and interact less positively than other mothers., Mothers older than 35 years of age often deal with more stress related to work and career issues, as well as decreasing libido.

According to the CDC,which of the following are significant causes of maternal death in the United States? (Select all that apply). Select one or more: a. cardio-vascular disease b. non-cardiovascular conditions c. hemorrhage d. street drug use e. ski accidents f. hypertensive disorders

The correct answers are: cardio-vascular disease, hemorrhage, non-cardiovascular conditions, hypertensive disorders

17. Which of the following can provide contraception and protection against sexually transmitted infections? (Select all that apply). Select one or more: a) diaphragm b) abstinence c) natural family planning d) condoms e) birth control pills f) intrauterine devices

The correct answers are: condoms, abstinence

38. Ultrasound can be used in antepartum care for which of the following assessments? (Select all that apply). Select one or more: a. placental position and function b. fetal growth c. gestational age d. adjunct use in chorionic villi sampling (CVS)

The correct answers are: fetal growth, placental position and function, adjunct use in chorionic villi sampling (CVS), gestational age

9. 16 year old Emily lives in Blackfoot, ID. She has a boyfriend but does not want to have a baby for at least 10 years. She wants an effective, easy birth control method and denies medical problems. She has periods every 4-6 weeks. The nurse would recommend which of the following methods to Emily? (Select all that apply). Select one or more: a. hormonal IUD b. natural family planning c. the implant d. bilateral tubal ligation

The correct answers are: hormonal IUD, the implant

15. Which of the following is true regarding infertility? (Select all that apply). Select one or more: a. infertility effects approx 5% of reproductive-age couples b. infertility is defined as the inability to achieve pregnancy after a year of unprotected intercourse c. approx 60% of infertility problems are related to the female factors d. anovulation can cause primary and/or secondary infertility

The correct answers are: infertility is defined as the inability to achieve pregnancy after a year of unprotected intercourse, anovulation can cause primary and/or secondary infertility

A pregnant woman was admitted for induction of labor at 43 weeks of gestation with sure dates. A nonstress test (NST) in the obstetrician's office revealed a nonreactive tracing. On artificial rupture of membranes, thick meconium-stained fluid was noted. What should the nurse caring for the infant after birth anticipate? (Select all that apply). Select one or more: a. excessive vernix caseosa covering the skin b. meconium aspiration c. increased amount of subcutaneous fat d. hypoglycemia e. dry, cracked skin f. absence of scalp hair,

The correct answers are: meconium aspiration, hypoglycemia, dry, cracked skin

5. Yolanda is 6 weeks pregnant by dates and is considering abortion. What options might be appropriate for her at this point? (Select all that apply). Select one or more: a. surgical abortion with aspiration b. emergency contraception c. it is too late for her to have an abortion d. medical abortion with mifepristone and misopristol

The correct answers are: surgical abortion with aspiration, medical abortion with mifepristone and misopristol

27. Pre-surgical nursing care for the woman who is going to have a hysterectomy for ovarian cancer includes which of the following? (Select all that apply). Select one or more: a. teach post-op routine care such as need for early ambulation b. ensure lab results are available to the surgeon prior to surgery c. administer enema if ordered d. Sips of water for hydration e. identification band is in place

The correct answers are: teach post-op routine care such as need for early ambulation, administer enema if ordered, ensure lab results are available to the surgeon prior to surgery, identification band is in place

31. For which of the following conditions is colposcopy used to further evaluate need for intervention? (Select all that apply). Select one or more: a. cervical cancer b. bacterial vaginosis c. vaginal cancer d. uterine fibroids e. uterine cancer

The correct answers are: vaginal cancer, cervical cancer

The perinatal nurse explains to the student nurse that ____ is the leading cause of neonatal death in the United States. Select one: a. Sudden Infant Death Syndrome b. Respiratory distress of newborns c. Effects of maternal complications d. Congenital malformations

The leading causes of neonatal deaths (in order) are: 1) congenital malformations; 2) disorders related to short gestation and low birth weight; and 3) sudden infant death syndrome. The correct answer is: Congenital malformations

40. Preeclampsia begins at what point during the pregnancy? Select one: a. After 20 weeks gestation This is when symptoms begin to occur; the disease process starts at placental implantation b. At 12 weeks gestation c. At conception d. At placental implantation

correct answer: D

1. Which of the following lab tests are routinely performed on pregnant women? (Select all that apply). Select one or more: a. Syphilis test b. Genetic testing for cystic fibrosis c. 3 hr GTT d. Blood type e. Rubella titer

A, D, E. Blood type, Syphilis test, Rubella titer

11. Which adverse prenatal outcomes are associated with the HELLP syndrome? (Select all that apply.) Select one or more: a. Renal failure b. Cirrhosis c. Placenta previa d. Maternal and fetal death e. Placental abruption

A, D, E. Placental abruption, Renal failure, Maternal and fetal death

23. Researchers have found a number of common risk factors that increase a woman's chance of developing a breast malignancy. It is essential for the nurse who provides care to women of any age to be aware of which risk factors? (Select all that apply.) Select one or more: a. Age b. Early menopause c. Late menarche d. Family history e. Nulliparity or first pregnancy after age 40 years

A. Age D. Family history, E. Nulliparity or first pregnancy after age 40 years

6. A 36 y/o pregnant woman has been diagnosed with polyhydraminos. The nurse knows this is based on which of the following? Select one: a. Amniotic fluid index of 30 cm b. Amniotic fluid index of 7 cm c. Amniotic fluid index of 20 cm d. Amniotic fluid index of 10 cm

A. Amniotic fluid index of 30 cm

2. For which of the following conditions is Daily Fetal Movement Count indicated? (Select all that apply). Select one or more: a. Mother with low amniotic fluid volume or oligohydraminos b. Mother with diabetes during pregnancy c. Pregnant woman who is older than 35 years with no complications d. Mother who complains of headaches during pregnancy that are relieved with Tylenol

A. Mother with low amniotic fluid volume or oligohydraminos B. Mother with diabetes during pregnancy,

9. A pregnant woman has been receiving a magnesium sulfate infusion for treatment of severe preeclampsia for 24 hours. On assessment, the nurse finds the following vital signs: temperature 37.3° C, pulse rate 88 beats per minute, respiratory rate 10 breaths per minute, BP 148/90 mm Hg, absent deep tendon reflexes (DTRs), and no ankle clonus. The client complains, "I'm so thirsty and warm." What is the nurse's immediate action? Select one: a. To discontinue the magnesium sulfate infusion b. Call the physician c. To call for an immediate magnesium sulfate level d. To administer oxygen

A. To discontinue the magnesium sulfate infusion. this is the first nursing action.

The perinatal nurse listens as Chantal describes her labor and emergency cesarean birth. Providing an opportunity to review this experience may assist Chantal in: a. her role development in the "letting go" stage b. decreasing her ambivalence about her labor and birth c. understanding her guilt involved in labor and birth d. developing more positive feelings about her labor and birth

Answer: D. After a cesarean birth, especially when unplanned, nurses must be aware of the myriad of potential psychological issues that may arise. Research suggests that women may perceive cesarean birth to be a less positive experience than a vaginal birth. Unplanned or emergent cesarean deliveries and the experience of cesarean birth may be associated with more negative perceptions of the birthing experience. Allowing Chantal to talk about the experience can help her develop a more positive attitude about her own experience.

5. Which information should nurses provide to expectant mothers when teaching them how to evaluate daily fetal movement counts (DFMCs)? (Select all that apply) Select one or more: a. Alcohol or cigarette smoke can irritate the fetus into greater activity. b. The fetal alarm signal should go off when fetal movements stop entirely for 12 hours c. Kick counts should be taken every ½ hour and averaged every 6 hours, with every other 6-hour stretch off. d. A count of less than three fetal movements in 1 hour warrants future evaluation.

B, D. The fetal alarm signal should go off when fetal movements stop entirely for 12 hours, A count of less than three fetal movements in 1 hour warrants future evaluation. Read p 635

3. Which of the following antepartum tests is (are) used to evaluate a Maternal Serum Screening test that is negative for increased risk? Select one: a. Amniocentesis b. Further followup test not necessary c. Biophysical profile d. CVS

B. Further followup test not necessary

7. The nurse has evaluated a client with preeclampsia by assessing DTRs. The result is a grade of 3+. Which DTR response most accurately describes this score? Select one: a. Brisk, hyperactive, with intermittent or transient clonus b. More brisk than expected, slightly hyperactive c. Sluggish or diminished d. Active or expected response

B. More brisk than expected, slightly hyperactive

22. Cellulitis with or without abscess formation is a fairly common condition. The nurse is providing education for a client whose presentation to the emergency department includes an infection of the breast. Which information should the nurse share with this client? (Select all that apply.) Select one or more: a. Breast is pale in color and cool to the touch. b. Nipple piercing may be the cause of a recent infection c. Treatment for cellulitis or breast infection will include antibiotics. d. Obesity, smoking, and diabetes are risk factors. e. Methicillin- resistant Streptococcus aureus is the most common pathogen.

B. Nipple piercing may be the cause of a recent infection, C. Treatment for cellulitis or breast infection will include antibiotics. D. Obesity, smoking, and diabetes are risk factors.

22. Cellulitis with or without abscess formation is a fairly common condition. The nurse is providing education for a client whose presentation to the emergency department includes an infection of the breast. Which information should the nurse share with this client? (Select all that apply.) Select one or more: a. Breast is pale in color and cool to the touch. b. Nipple piercing may be the cause of a recent infection c. Treatment for cellulitis or breast infection will include antibiotics. d. Obesity, smoking, and diabetes are risk factors. e. Methicillin- resistant Streptococcus aureus is the most common pathogen.

B. Nipple piercing may be the cause of a recent infection, C. Treatment for cellulitis or breast infection will include antibiotics., Obesity, smoking, and diabetes are risk factors.

12. What is the primary purpose for magnesium sulfate administration for clients with preeclampsia and eclampsia? Select one: a. To prevent a boggy uterus and lessen lochial flow b. To prevent convulsions c. To shorten the duration of labor d. To improve patellar reflexes and increase respiratory efficiency

B. To prevent convulsions

13. A woman with preeclampsia has a seizure. What is the nurse's highest priority during a seizure? Select one: a. To administer oxygen by mask b. To stay with the client and call for help c. To suction the mouth to prevent aspiration d. To insert an oral airway

B. To stay with the client and call for help

21. The CHOICE Project removed 3 key barriers to contraception for many women. These included which of the following? Select one or more: a. state laws that restrict methods b. lack of access to preferred method c. knowledge deficit d. parental permission e. cost

B. lack of access to preferred method C. knowledge deficit E. cost

15. A 26-year-old pregnant woman, gravida 2, para 1-0-0-1, is 28 weeks pregnant when she experiences bright red, painless vaginal bleeding. On her arrival at the hospital, which diagnostic procedure will the client most likely have performed? Select one: a. Internal fetal monitoring b. Amniocentesis for fetal lung maturity c. Transvaginal ultrasound for placental location d. Contraction stress test (CST)

C. Transvaginal ultrasound for placental location. The symptoms, bright red and painless vaginal bleeding, indicate placental previa. An ultrasound can confirm this diagnosis.

18. A woman seeks care at an infertility clinic. Which of the following tests may this woman undergo to determine what, if any, infertility problem she may have? (Select all that apply.) Select one or more: a) Chorionic villus sampling b) Endometrial biopsy c) Hysterosalpingogram d) Serum FSH analysis

Common diagnostic tests to determine infertility include: screening for STIs, assessment of hormonal levels (TSH, FSH, LH), assessment for ovulatory dysfunction, detection of LH surge, endometrial biopsy, hysterosalpingogram, and laparoscopy to visualize pelvic structures.. Chorionic Villus Sampling is aspiration of a small amount of placental tissue for genetic testing. The correct answers are: Endometrial biopsy, Hysterosalpingogram, Serum FSH analysis

107. What is the primary rationale for nurses wearing gloves when handling the newborn? Select one: a. To protect the nurse from contamination by the newborn b. To protect the baby from infection c. Because the nurse has the primary responsibility for the baby during the first 2 hours d. As part of the Apgar protocol

Correct Answer: A

109. Which information should the nurse provide to a breastfeeding mother regarding optimal self-care? Select one: a. She should avoid trying to lose large amounts of weight. b. She will need an extra 1000 calories a day to maintain energy and produce milk. c. She can return to prepregnancy consumption patterns of any drinks as long as she gets enough calcium. d. She must avoid exercising because it is too fatiguing.

Correct Answer: A

The exact cause of preterm labor is unknown but believed to be multifactorial. Infection is thought to be a major factor in many preterm labors. Which type of infection has not been linked to preterm birth? Select one: a. Viral b. Periodontal c. Urinary tract d. Cervical

Correct Answer: A

A woman who has recently given birth complains of pain and tenderness in her leg. On physical examination, the nurse notices warmth and redness over an enlarged, hardened area. Which condition should the nurse suspect, and how will it be confirmed? Select one: a. Idiopathic or immune thrombocytopenic purpura (ITP); drawing blood for laboratory analysis b. Thrombophlebitis; using real-time and color Doppler ultrasound c. von Willebrand disease (vWD); noting whether bleeding times have been extended d. Disseminated intravascular coagulation (DIC); asking for laboratory tests

Correct Answer: B

Which is true regarding breast cyst? Select one: a. It requires surgery for diagnosis b. It can be tender or not c. It is usually fixed and hard d. Removal is the best treatment

Correct Answer: B

A client in late middle age who is certain she is not pregnant tells the nurse during an office visit that she has urinary problems, as well as sensations of bearing down and of something in her vagina. What condition would the nurse suspect based upon this report? Select one: a. Genital fistulas b. Pelvic relaxation c. Cystocele and/or rectocele d. Uterine prolapse

Correct Answer: C

108. A mother is changing the diaper of her newborn son and notices that his scrotum appears large and swollen. The client is concerned. What is the best response from the nurse? Select one: a. "I don't know, but I'm sure it is nothing." b. "Your baby might have testicular cancer." c. "Your baby's urine is backing up into his scrotum." d. "A large scrotum and swelling indicate a hydrocele, which is a common finding in male newborns."

Correct Answer: D

A primigravida at 40 weeks of gestation is having uterine contractions every 1½ to 2 minutes and states that they are very painful. Her cervix is dilated 2 cm and has not changed in 3 hours. The woman is crying and wants an epidural. What is the likely status of this woman's labor? Select one: a. She is experiencing precipitous labor. b. She is experiencing a normal latent stage. c. She is exhibiting hypotonic uterine dysfunction. d. She is exhibiting hypertonic uterine dysfunction

Correct Answer: D

A client is diagnosed with having a stillborn infant. At first, she appears stunned by the news, cries a little, and then asks the nurse to call her mother. What is the proper term for the phase of bereavement that this client is experiencing? a. anticipatory grief b. acute distress c. reorganization d. intense grief

Correct answer: acute distress

105. The perinatal nurse is caring for Christy following the birth of her first child. Based on Christy's history, the RN recognizes that risk factors for postpartum depression include: Select one or more: a. Loss of friends based on upcoming divorce; family is unable to assist. b. Separated from spouse pending divorce. c. Unplanned cesarean delivery secondary to Category III fetal tracing. d. Good prenatal care with uneventful pregnancy

Correct answers: A, B, & C Rationale: Recognized risk factors for postpartum depression include a history of depression before pregnancy, depression or anxiety during pregnancy, poor quality relationship with partner, life/child care stresses, and complications of pregnancy/childbirth.

8. A primigravida is being monitored at the prenatal clinic for preeclampsia. Which finding is of greatest concern to the nurse? Select one: a. Pitting pedal edema at the end of the day b. Blood pressure (BP) increase to 138/86 mm Hg c. Weight gain of 0.5 kg during the past 2 weeks d. Dipstick value of 3+ for protein in her urine

D. Dipstick value of 3+ for protein in her urine

4. Anna wants to know if her baby has Trisomy 18 as early in the pregnancy as possible. She is 8 weeks pregnant. Her physician will suggest which of the following diagnostic test? Select one: a. Noninvasive prenatal screening test b. sequential integrated test c. amniocentesis d. chorionic villi sampling (CVS)

D. chorionic villi sampling (CVS)

116. Felicity Chan, a new mother, is accompanied by her mother during her hospital stay on the postpartum unit. Felicity's mother makes specific, various requests of the nurses including bringing warm tea, a cot to sleep on, and that the baby not be bathed at this time. Felicity's mother is also concerned about the amount of work that Felicity may be doing in the provision of infant care. Felicity asks for help with breastfeeding. After Felicity has finished breastfeeding, her mother asks for a bottle so they can warm it and "feed" the baby. How would the perinatal nurse best respond to Felicity's mother in a culturally sensitive way? Select one: a. Ask Felicity's mother to leave for 30 minutes to allow for some private time with Felicity to explore her learning needs privately. b. Ask both Felicity and her mother about the preferred infant feeding method, and assess what they already know. c. Convey to Felicity and her mother an understanding of the concepts of "hot" and "cold" within their belief system. d. Ask Felicity what she knows about breastfeeding, and provide information to both women to support Felicity's decision.

In certain multicultural populations such as India, Thailand, and China, the woman's postpartum confinement lasts for 40 days. During this time, prolonged rest with restricted activity is believed to be essential. The postpartum period is an important time for ensuring future good health, and great emphasis is placed on allowing the mother's body to regain balance after the birth of a child. To provide sensitive, appropriate care, nurses need to adopt a flexible approach when caring for women who embrace non-Western health beliefs and practices. The nurse should advocate for the patient by inquiring about her feeding preferences and by providing information to the mother and her family to support her in her decision. Felicity has obviously chosen to breastfeed; therefore, the best answer is to ask her what she knows about breastfeeding and to provide her and her mother information that supports her feeding choice. The correct answer is: Ask Felicity what she knows about breastfeeding, and provide information to both women to support Felicity's decision.

111. Heat loss through radiation can be reduced by: (Select all that apply). Select one or more: a. Removing wet blankets used to dry the infant after birth from the crib b. Placing a stocking cap on the neonate's head and placing in a crib c. Providing skin-to-skin contact with the mother and covering both with a warm blanket when the room temperature is cool d. Placing crib near a warm wall

Loss of body heat through radiation results from transfer of heat from the neonate to cooler objects not in direct contact with the neonate, such as cold walls of the crib, cold equipment, wet blankets, cold room temperature, etc.

Supportive care of the infant with neonatal abstinence syndrome (NAS) include both pharmacologic and nonpharmacologic therapy. Nonpharmacologic therapy would include which of the following (select all that apply): Select one or more: a. Quiet environment with low lighting and use of soft voices b. Clonidine for infants who do not respond to a single agent c. Swaddling, clustering care, use of pacifiers to promote "self-soothing" d. Use of oral morphine and methadone

Nonpharmacologic therapy includes quiet environment, low lighting, soft voices, clustering care, swaddling, pacifier use, frequent small feedings, and vertical rocking.

PPH may be sudden and result in rapid blood loss. The nurse must be alert to the symptoms of hemorrhage and hypovolemic shock and be prepared to act quickly to minimize blood loss. Astute assessment of the client's circulatory status can be performed with noninvasive monitoring. Match the type of noninvasive assessment that the nurse would perform with the appropriate clinical manifestation or body system.

Observation → presence or absence of anxiety, Measurement → pulse oximetry, Palpation → arterial pulses, Auscultation → heart pulses, Inspection → skin color, temperature, and turgor

19. A nurse working with an infertile couple has made the following nursing diagnosis: Sexual dysfunction related to decreased libido. Which of the following assessments is the likely reason for this diagnosis? Select one: a. The couple has established a set schedule for their sexual encounters. b. The couple has been married for more than 8 years. c. The couple lives with one set of parents. d. The couple has close friends who gave birth within the last year.

Pregnancy occurs with ovulation; sexual intercourse outside the time of ovulation will not result in conception. The correct answer is: The couple has established a set schedule for their sexual encounters.

81. A woman gave birth to a healthy infant boy 5 days ago. What type of lochia does the nurse expect to find when evaluating this client? Select one: a. lochia rubra b. lochia serosa c. lochia alba d. lochia sangra

The correct answer is "lochia serosa"

11. The clinic nurse recognizes that the longer an infant is formula fed, the greater is the immunity and resistance the infant will develop against bacterial and viral infections. Select one: True False

The correct answer is 'False'. One of the primary benefits of breastfeeding, not formula feeding, is the decreased incidence of bacterial and viral infections as a result of passive immunity, including the transfer of maternal antibodies.

Endometritis is an infection that usually starts at the placental site. Select one: True False

The correct answer is 'True'. Endometritis is an infection of the endometrium that usually starts at the placental site and spreads to encompass the entire endometrium.

14. Abruptio placenta is a risk factor for amniotic fluid embolism. Select one: True False

The correct answer is 'True'. Risk factors for amniotic fluid embolism include induction of labor, maternal age over 35, operative delivery, placenta previa, abruptio placenta, polyhydramnios, eclampsia, and cervical or uterine lacerations.

A NICU nurse is caring for a full-term neonate being treated for group B streptococcus (GBS). The mother of the neonate is crying and shares that she cannot understand how her baby became infected. The best response by the nurse is: Select one: a. "Newborns are more susceptible to infections due to an immature immune system. Would you like additional information on the newborn immune system?" b. "The infection was transmitted to your baby during the birthing process. Do you have a history of sexual transmitted infections?" c. "Approximately 15% to 40% of women have no symptoms but are carriers of group B streptococcus which is found in the vaginal and lower intestinal areas. What other questions do you have regarding your baby's health?" d. "I see that this is very upsetting for you. I will come back later and answer your questions."

The correct answer is: "Approximately 15% to 40% of women have no symptoms but are carriers of group B streptococcus which is found in the vaginal and lower intestinal areas. What other questions do you have regarding your baby's health?"

After the Nurse Practitioner treats a 25 y/o's Bartholin cyst with incision and drainage procedure (I&D), the nurse is providing take-home instructions. The patient asks, "Will this happen again?" The nurse's best response is: Select one: a. "No, since it is drained it won't come back." b. "I cannot answer that question for you. Let me have the NP come and talk to you." c. "If you take your antibiotics and not get an infection, recurrence is rare. Let's talk about how to prevent infection." d. "Bartholin cysts can recur. There is another procedure that can be done to reduce risk for recurrence.Would you like to talk to the NP about it?"

The correct answer is: "Bartholin cysts can recur. There is another procedure that can be done to reduce risk for recurrence.Would you like to talk to the NP about it?"

23 y/o Amy delivered a baby 2 months ago and presents to the clinic with complaint of stool coming out of her vagina for the past week. The nurse suspects recto-vaginal fistula. What is the next most appropriate question the nurse should ask Amy? Select one: a. "Did you deliver your baby vaginally?" b. "How long has this been going on?" c. "How big was your baby?" d. "Are you sure it is stool?"

The correct answer is: "Did you deliver your baby vaginally?"

During a prenatal visit, the nurse is explaining dietary management to a woman with pregestational diabetes. Which statement by the client reassures the nurse that teaching has been effective? Select one: a. "I will plan my diet based on the results of urine glucose testing." b. "I will need to eat 600 more calories per day because I am pregnant." c. "I can continue with the same diet as before pregnancy as long as it is well balanced." d. "Diet and insulin needs change during pregnancy."

The correct answer is: "Diet and insulin needs change during pregnancy."

To provide culturally competent care to an Asian-American family, which question should the nurse include during the assessment interview? Select one: a. "Do you want music playing while you are in labor?" b. "Do you have a name selected for the baby?" c. "Do you prefer hot or cold beverages?" d. "Do you want some milk to drink?"

The correct answer is: "Do you prefer hot or cold beverages?" See Table 2-2, pp 26-27

A primigravida has just delivered a healthy infant girl. The nurse is about to administer erythromycin ointment in the infant's eyes when the mother asks, "What is that medicine for?" How should the nurse respond? Select one: a. "This medicine will protect your baby's eyes from drying out over the next few days." b. "It is to protect your baby from contracting herpes from your vaginal tract." c. "Erythromycin is prophylactically given to prevent a gonorrheal infection." d. "It is an eye ointment to help your baby see you better."

The correct answer is: "Erythromycin is prophylactically given to prevent a gonorrheal infection."

60. Pelvic floor exercises, also known as Kegel exercises, will help to strengthen the perineal muscles and encourage healing after childbirth. The nurse requests the client to repeat back instructions for this exercise. Which response by the client indicates successful learning? Select one: a. "I stand while practicing this new exercise routine." b. "I perform 10 of these exercises every day." c. "I contract my thighs, buttocks, and abdomen." d. "I pretend that I am trying to stop the flow of urine in midstream."

The correct answer is: "I pretend that I am trying to stop the flow of urine in midstream."

When the nurse is alone with a battered client, the client 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." What is the most suitable response by the nurse? Select one: a. "What else do you do that makes him angry enough to hurt you?" b. "You have to remember that he is frustrated and angry so he takes it out on you." c. "He will never find out what we talk about. Don't worry. We're here to help you." d. "No one deserves to be hurt. It's not your fault. How can I help you?"

The correct answer is: "No one deserves to be hurt. It's not your fault. How can I help you?" Violence against women is not acceptable in any situation; no deserves to be hurt or mistreated. Telling her this may be the first step to empower her. see p107 of book.

31. A woman with worsening preeclampsia is admitted to the hospital's labor and birth unit. The physician explains the plan of care for severe preeclampsia, including the induction of labor, to the woman and her husband. Which statement by the husband leads the nurse to believe that the couple needs further information? Select one: a. "I will help my wife use the breathing techniques that we learned in our childbirth classes." b. "I will give my wife ice chips to eat during labor." c. "Since we will be here for a while, I will call my mother so she can bring the two boys—2 years and 4 years of age—to visit their mother." d. "I will stay with my wife during her labor, just as we planned."

The correct answer is: "Since we will be here for a while, I will call my mother so she can bring the two boys—2 years and 4 years of age—to visit their mother."

16. A perinatal nurse is giving discharge instructions to a woman, status postsuction, and curettage secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next 12 months. What is the best response by the nurse? Select one: a. "If you get pregnant within 1 year, the chance of a successful pregnancy is very small. Therefore, if you desire a future pregnancy, it would be better for you to use the most reliable method of contraception available." b. "If you can avoid a pregnancy for the next year, the chance of developing a second molar pregnancy is rare. Therefore, to improve your chance of a successful pregnancy, not getting pregnant at this time is best." c. "The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produces during pregnancy. If you were to get pregnant, then it would make the diagnosis of this cancer more difficult." d. "Oral contraceptives are the only form of birth control that will prevent a recurrence of a molar pregnancy."

The correct answer is: "The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produces during pregnancy. If you were to get pregnant, then it would make the diagnosis of this cancer more difficult."

24. Your pregnant patient is in her first trimester and is scheduled for an ultrasound. When explaining the rationale for early pregnancy ultrasound, the best response is: Select one: a. "The test will help to determine the baby's position." b. "The test will help to determine how many weeks you are pregnant." c. "The test will help to determine if your baby is growing appropriately." d. "The test will help to determine if you have a boy or girl."

The correct answer is: "The test will help to determine how many weeks you are pregnant."

28. While taking a family history, 37 y/o Bernice tells the nurse her paternal grandmother had breast and colon cancer in her 60's, two paternal aunts had breast cancer in their 40's, one of those aunts also had ovarian cancer in her 40's, one paternal uncle had colon cancer in his 40's, her paternal cousin has breast cancer in her 40's, and her father had colon cancer in his 40's. She denies cancer on her mother's side of the family. Bernice states she has 2 younger sisters. Which of the following responses would be best for the nurse to say to Bernice about her reported family history? Select one: a. "Do you have cancer on your mother's side of the family?" b. "The types of cancers reported on your father's side of the family may be due to a gene mutation that can be passed onto to each generation. Have any of your relatives or you considered genetic testing?" c. "Have you had your pap smear recently?" d. "Have you had a screening mammogram?" e. "Since all of these cancers are on your father's side of the family, you have no increased risk for cancer."

The correct answer is: "The types of cancers reported on your father's side of the family may be due to a gene mutation that can be passed onto to each generation. Have any of your relatives or you considered genetic testing?"

A newborn in the neonatal intensive care unit (NICU) is dying as a result of a massive infection. The parents speak to the neonatologist, who informs them of their son's prognosis. When the father sees his son, he says, "He looks just fine to me. I can't understand what all this is about." What is the most appropriate response or reaction by the nurse at this time? Select one: a. "This must be a difficult time for you. Tell me how you're doing." b. Quietly stand beside the infant's father. c. "You'll have to face up to the fact that he is going to die sooner or later." d. "Didn't the physician tell you about your son's problems?"

The correct answer is: "This must be a difficult time for you. Tell me how you're doing."

Which statement is the most appropriate for the nurse to make when caring for bereaved parents? Select one: a. "This happened for the best." b. "You have an angel in heaven." c. "What can I do for you?" d. "I know how you feel."

The correct answer is: "What can I do for you?"

Which options for saying "good-bye" would the nurse want to discuss with a woman who is diagnosed with having a stillborn girl? Select one: a. "What funeral home do you want notified after the baby is born?" b. "Would you like a picture taken of your baby after birth?" c. The nurse should not discuss any options at this time; plenty of time will be available after the baby is born. d. "When your baby is born, would you like to see and hold her?

The correct answer is: "When your baby is born, would you like to see and hold her?"

A healthy 60-year-old African-American woman regularly receives health care at her neighborhood clinic. She is due for a mammogram. At her first visit, her health care provider is concerned about the 3-week wait at the neighborhood clinic and made an appointment for her to have a mammogram at a teaching hospital across town. She did not keep her appointment and returned to the clinic today to have the nurse check her blood pressure. What is the most appropriate statement for the nurse to make to this client? Select one: a. "Would you like me to make an appointment for you to have your mammogram here?" b. "I'm concerned that you missed your appointment; let me make another one for you." c. "Do you have transportation to the teaching hospital so that you can get your mammogram?" d. "It's very dangerous to skip your mammograms; your breasts need to be checked." a. is the BEST answer to meet this pt's needs. It is evident the pt can make it to the neighborhood clinic, not the hospital across town.

The correct answer is: "Would you like me to make an appointment for you to have your mammogram here?"

On day 3 of life, a newborn continues to require 100% oxygen by nasal cannula. The parents ask if they may hold their infant during his next gavage feeding. Considering that this newborn is physiologically stable, what response should the nurse provide? Select one: a. "Feedings cause more physiologic stress; therefore, the baby must be closely monitored. I don't think you should hold the baby." b. "You may only hold your baby's hand during the feeding." c. "Parents are not allowed to hold their infants who are dependent on oxygen." d. "You may hold your baby during the feeding."

The correct answer is: "You may hold your baby during the feeding."

21. Sally is 34 weeks pregnant and has a biophysical profile score of 8. She asks the nurse what does that mean? The nurse's best response is: Select one: a. "Your baby has low risk for having a problem having enough oxygen in her body and your doctor will probably want to do the test again soon. I will call your doctor. " b. "Your baby is in danger of dying and you will probably need to deliver ASAP. I will call your doctor." c. "Since you are more than 36 weeks, it is best to deliver your baby as she may have asphyxia. I will call your doctor." d. " Your baby may be having some problems and your doctor may want to check to see if it is safe to deliver her soon. I will call your doctor."

The correct answer is: "Your baby has low risk for having a problem having enough oxygen in her body and your doctor will probably want to do the test again soon. I will call your doctor. "

Sandy G21001 is 41 weeks pregnant and presents to L&D for induction. The physician orders Pitocin to be infused at 2mU/min. The IV bag is LR 1000mL with 10 units of Pitocin. The infusion pump delivers ___mL/hour. How will the nurse program the infusion pump to deliver the medication as ordered? Select one: a. 6mL/hour b. 18mL/hour c. 12 mL/hour d. 30mL/hour

The correct answer is: 12 mL/hour 10 units:1000mL:: X:1mL 1000X=10 X=0.01unit or 10 mU 2mU/min divided by 10mU/mL = 0.2mL/min x 60 min = 12 mL/hour

18. When is a prophylactic cerclage for an incompetent cervix usually placed (in weeks of gestation)? Select one: a. After 24 b. 6 to 8 c. 23 to 24 d. 12 to 14

The correct answer is: 12 to 14

26. Which woman is at the greatest risk for psychologic complications after hysterectomy? Select one: a. 46-year-old woman who has had three children and has just been promoted at work b. 62-year-old widow who has three friends who have had uncomplicated hysterectomies c. 19-year-old woman who had a ruptured uterus after giving birth to her first child d. 55-year-old woman who has been having abnormal bleeding and pain for 3 years

The correct answer is: 19-year-old woman who had a ruptured uterus after giving birth to her first child

An infant at 36 weeks of gestation has increasing respirations (80 to 100 breaths per minute with significant substernal retractions). The infant is given oxygen by continuous nasal positive airway pressure (CPAP). What level of partial pressure of arterial oxygen (PaO2) indicates hypoxia? Select one: a. 67 mmHg b. 89 mmHg c. 73 mmHg d. 45 mmHg

The correct answer is: 45 mmHg

A woman with gestational diabetes has had little or no experience reading and interpreting glucose levels. The client shows the nurse her readings for the past few days. Which reading signals the nurse that the client may require an adjustment of insulin or carbohydrates? Select one: a. 75 mg/dl before lunch. This is low; better eat now. b. 115 mg/dl 2 hours after lunch. This is too high; it is time for insulin. c. 50 mg/dl just after waking up from a nap. This is too low; maybe eat a snack before going to sleep. d. 115 mg/dl 1 hour after lunch. This is a little high; maybe eat a little less next time.

The correct answer is: 50 mg/dl just after waking up from a nap. This is too low; maybe eat a snack before going to sleep.

15. The nurse who elects to work in the specialty of obstetric care must have the ability to distinguish between preterm birth, preterm labor, and low birth weight. Which statement regarding this terminology is correct? Select one: a. Preterm labor is defined as cervical changes and uterine contractions occurring between 20 and 37 weeks of gestation. b. Low birth weight is a newborn who weighs below 3.7 pounds. c. Terms preterm birth and low birth weight can be used interchangeably. d. Preterm birth rate in the United States continues to increase.

The correct answer is: A. Preterm labor is defined as cervical changes and uterine contractions occurring between 20 and 37 weeks of gestation.

9. An infant admitted to the newborn nursery has a blood glucose level of 55 mg/dL. Which of the following actions should the nurse perform at this time? Select one: a. Provide the baby with routine feedings. b. Assess the baby's blood pressure. c. Place the baby under the infant warmer. d. Monitor the baby's urinary output.

The correct answer is: A. Provide the baby with routine feedings. Neonatal hypoglycemia is defined as <40mg/dL; 55mg/dL is a normal glucose value requiring no treatment

12. In assisting the breastfeeding mother to position the baby, which information regarding positioning is important for the nurse to keep in mind? Select one: a. Whatever the position used, the infant is "belly to belly" with the mother. b. Women with perineal pain and swelling prefer the modified cradle position. c. The cradle position is usually preferred by mothers who had a cesarean birth. d. While supporting the head, the mother should push gently on the occiput.

The correct answer is: A. Whatever the position used, the infant is "belly to belly" with the mother.

Necrotizing enterocolitis (NEC) is an inflammatory disease of the gastrointestinal mucosa. The signs of NEC are nonspecific. What are generalized signs and symptoms of this condition? Select one: a. Scaphoid abdomen, no residual with feedings, and increased urinary output b. Hypertension, absence of apnea, and ruddy skin color c. Abdominal distention, temperature instability, and grossly bloody stools d. Hypertonia, tachycardia, and metabolic alkalosis

The correct answer is: Abdominal distention, temperature instability, and grossly bloody stools

Which term is an accurate description of the process by which people retain some of their own culture while adopting the practices of the dominant society? Select one: a. Cultural relativism b. Ethnocentrism c. Assimilation d. Acculturation

The correct answer is: Acculturation

24. Which statement regarding the postpartum uterus is correct? Select one: a. After 2 weeks postpartum, it weighs 100 g. b. At the end of the third stage of labor, the postpartum uterus weighs approximately 500 g. c. After 2 weeks postpartum, it should be abdominally nonpalpable. d. Postpartum uterus returns to its original (pre pregnancy) size by 6 weeks postpartum.

The correct answer is: After 2 weeks postpartum, it should be abdominally nonpalpable.

A pregnant woman arrives at the birth unit in labor at term, having had no prenatal care. After birth, her infant is noted to be small for gestational age with small eyes and a thin upper lip. The infant also is microcephalic. Based on her infant's physical findings, this woman should be questioned about her use of which substance during pregnancy? Select one: a. Alcohol b. Marijuana c. Cocaine d. Heroin

The correct answer is: Alcohol

Which substance, when abused during pregnancy, is the most significant cause of cognitive impairment and dysfunction in the infant? Select one: a. Heroin b. Tobacco c. Alcohol d. Marijuana

The correct answer is: Alcohol

8. The nurse is teaching the parents of a female baby how to change a baby's diapers. Which of the following should be included in the teaching? Select one: a. Always wipe the perineum from front to back. b. Use an antibiotic ointment at the first sign of diaper rash c. Put powder on the buttocks every time the baby stools. d. Weigh every diaper in order to assess for hydration.

The correct answer is: Always wipe the perineum from front to back. Clean female genitals by washing from front to back to decrease the risk of cystitis

Tobacco use during pregnancy is associated with adverse effects on the unborn infant such as intrauterine growth restriction, preterm births, and respiratory problems. By race, which has the highest percentages of smokers? Select one: a. American Indian and Alaskan Natives b. Asian or Pacific Islanders c. Non-Hispanic blacks d. Non-Hispanic whites

The correct answer is: American Indian and Alaskan Natives

Approximately 8 hours ago, Juanita, a 32-year-old G1 P0, gave birth after 2 hours of pushing. She required an episiotomy and an assisted birth (forceps) due to the weight and size of her baby (9 lb. 9 oz.). The perinatal nurse is performing an assessment of Juanita's perineal area. A slight bulge is palpated and the presence of ecchymoses to the right of the episiotomy is noted. The area feels "full" and is approximately 4 cm in diameter. Juanita describes this area as "very tender." The perinatal nurse notifies the physician of the findings related to Juanita's assessment. The first step in care will most likely be to: Select one: a. Prepare Juanita for surgery b. Administer intravenous fluids c. Apply ice to the perineum d. Insert a urinary catheter

The correct answer is: Apply ice to the perineum. If the hematoma is less than 3 to 5 centimeters in diameter, the physician usually orders palliative treatments such as ice to the area for the first 12 hours along with pain medication. After 12 hours, sitz baths are prescribed to replace the application of ice. However, a hematoma larger than 5 centimeters may require incision and drainage with the possible placement of a drain.

A 3.8-kg infant was vaginally delivered at 39 weeks after a 30-minute second stage. A nuchal cord was found at delivery. After birth, the infant is noted to have petechiae over the face and upper back. Which information regarding petechiae is most accurate and should be provided to the parents? Select one: a. Result from increased blood volume b. Usually occur with a forceps-assisted delivery c. Should always be further investigated d. Are benign if they disappear within 48 hours of birth

The correct answer is: Are benign if they disappear within 48 hours of birth

Which nursing intervention is paramount when providing care to a client with preterm labor who has received terbutaline? Select one: a. Assess deep tendon reflexes (DTRs). b. Assess for dyspnea and crackles. c. Assess for bradycardia. d. Assess for hypoglycemia.

The correct answer is: Assess for dyspnea and crackles.

Breast pain occurs in many women during their perimenopausal years. Which information is (are) a priority for the nurse to share with the client? (Select all that apply). Select one or more: a. Assess for prior trauma or possible infection b. Distinguishing between cyclical and noncyclical pain is important. c. Pain is almost always an indication of a solid mass. d. Breast pain is an early indication of cancer.

The correct answer is: Assess for prior trauma or possible infection AND Distinguishing between cyclical and noncyclical pain is important.

33. A 25-year-old woman gave birth to her second child 6 hours ago. She informs the nurse that she is bleeding more than with her previous birth experience. The initial nursing action is to: a. Explain that this is normal for second-time moms. b. Assess the location and firmness of the fundus. c. Change her pad and return in 1 hour to reassess. d. Give her 10 units of oxytocin as per standing order.

The correct answer is: Assess the location and firmness of the fundus.

19. What is the highest priority nursing intervention when admitting a pregnant woman who has experienced a bleeding episode in late pregnancy? Select one: a. Performing a venipuncture for hemoglobin and hematocrit levels b. Placing clean disposable pads to collect any drainage c. Monitoring uterine contractions d. Assessing FHR and maternal vital signs

The correct answer is: Assessing FHR and maternal vital signs

The obstetric provider has informed the nurse that she will be performing an amniotomy on the client to induce labor. What is the nurse's highest priority intervention after the amniotomy is performed? Select one: a. Taking the client's vital signs b. Applying clean linens under the woman c. Assessing the fetal heart rate (FHR) d. Performing a vaginal examination

The correct answer is: Assessing the fetal heart rate (FHR)

Which nursing intervention should be immediately performed after the forceps-assisted birth of an infant? Select one: a. Administering prophylactic antibiotic agents to the infant b. Assessing the infant for signs of trauma c. Applying a cold pack to the infant's scalp d. Measuring the circumference of the infant's head

The correct answer is: Assessing the infant for signs of trauma

3. Which nursing action is most appropriate to correct a boggy uterus that is displaced above and to the right of the umbilicus? Select one: a. Assist the client in emptying her bladder. b. Assess the blood pressure and pulse. c. Administer pitocin d. Notify the physician of an impending hemorrhage.

The correct answer is: Assist the client in emptying her bladder.

24. According to the American Cancer Society, which of the following is true about screening mammogram? Select one: a. Average-risk women should begin screening mammogram at 40 y/o b. Average-risk women should begin screening mammogram at 45 y/o c. Only high risk women should get screening mammograms. d. Screening mammograms every year for average-risk women after age 65y/o.

The correct answer is: Average-risk women should begin screening mammogram at 45 y/o. ***Read the posted article- the book is not up-to-date

The nurse is developing a plan of care for a African American client who just delivered a newborn. Which cultural variation is most important to include in the care plan? Select one: a. Male infants are typically circumcised. b. Avoid offering tub baths and shampooing after delivery. c. Paternal grandmother participates in the care of the mother and her infant after birth. d. Breastfeeding is encouraged immediately after birth.

The correct answer is: Avoid offering tub baths and shampooing after delivery.

14. What is the most dangerous effect on the fetus of a mother who smokes cigarettes while pregnant? Select one: a. Fetal addiction to the substance inhaled b. Intrauterine growth restriction c. Extensive CNS damage d. Genetic changes and anomalies

The correct answer is: B. Intrauterine growth restriction

According to the CDC, which of the following has the highest maternal mortality rate in the United States? Select one: a. Black Women b. Hispanic Women c. White Women d. Asian Women

The correct answer is: Black Women: 41. 1 deaths per 100,000 live births

25. The symptoms of mild to moderate urinary incontinence can be successfully decreased by a number of strategies. Which of these should the nurse instruct the client to use first? Select one: a. Bladder training and pelvic muscle exercises or Kegels b. Surgery c. Medications d. Pelvic floor support devices

The correct answer is: Bladder training and pelvic muscle exercises or Kegels

Which of the following is an indication for the administration of methylergonovine (Methergine)? Select one: a. Boggy uterus that does not respond to massage and oxytocin therapy b. Woman with a large hematoma c. Woman with a deep vein thrombosis d. Woman with severe postpartum depression

The correct answer is: Boggy uterus that does not respond to massage and oxytocin therapy. Methergine is administered IM or IV in the presence of postpartum hemorrhage due to uterine atony or subinvolution when fundal massage and oxytocin therapy are ineffective. Always check BP before administration and notify provider before injection if elevated as Methergine can increase BP.

10. A postpartum woman, who gave birth 12 hours ago, is breastfeeding her baby. She tells her nurse that she is concerned that her baby is not getting enough food since her milk has not come in. The best response for this patient is: Select one: a. "I understand your concern, but your baby will be okay until your milk comes in." b. "Your baby seems content, so you should not worry about him getting enough to eat." c. "Milk normally comes in around the third day. Prior to that, he is getting colostrum which is high in protein and immunoglobulins which are important for your baby's health." d. "You can bottle feed until your milk comes in."

The correct answer is: C. "Milk normally comes in around the third day. Prior to that, he is getting colostrum which is high in protein and immunoglobulins which are important for your baby's health."

Which statement related to cephalopelvic disproportion (CPD) is the least accurate? Select one: a. CPD can be accurately predicted b. The fetus cannot be born vaginally. c. Causes of CPD may have maternal or fetal origins. d. CPD can be related to either fetal size or fetal position.

The correct answer is: CPD can be accurately predicted

27. Which statement best describes chronic hypertension? Select one: a. Chronic hypertension is general hypertension plus proteinuria. b. Chronic hypertension can occur independently of or simultaneously with preeclampsia. c. Chronic hypertension is considered severe when the systolic BP is higher than 140 mm Hg or the diastolic BP is higher than 90 mm Hg. d. Chronic hypertension is defined as hypertension that begins during pregnancy and lasts for the duration of the pregnancy.

The correct answer is: Chronic hypertension can occur independently of or simultaneously with preeclampsia.

A postpartum woman has been diagnosed with postpartum psychosis and will shortly be admitted to the psychiatric unit. Which of the following actions should the nurse perform to ensure safety for both mother and infant? Select one: a. Closely monitor all mother-infant interactions b. Maintain client on strict bed rest. c. Restrict visitation to her partner. d. Carefully monitor toileting.

The correct answer is: Closely monitor all mother-infant interactions Postpartum psychosis (PPP) is a variant of bipolar disorder and is the most serious form of postpartum mood disorders. Onset of symptoms can be as early as the 3rd postpartum day. Assessment findings include paranoia, delusions associated with the baby, mood swings, extreme agitation, confused thinking, and strange beliefs.

As a powerful central nervous system (CNS) stimulant, which of these substances can lead to miscarriage, preterm labor, placental separation (abruption), and stillbirth? Select one: a. Cocaine b. Heroin c. Alcohol d. Phencyclidine (1-phenylcyclohexylpiperidine; PCP)

The correct answer is: Cocaine

30. A new mother asks whether she should feed her newborn colostrum, because it is not "real milk." What is the nurse's most appropriate answer? Select one: a. Giving colostrum is important in helping the mother learn how to breastfeed before she goes home. b. Colostrum is high in antibodies, protein, vitamins, and minerals. c. Colostrum is unnecessary for newborns. d. Colostrum is lower in calories than milk and should be supplemented by formula.

The correct answer is: Colostrum is high in antibodies, protein, vitamins, and minerals.

Select one: a. Hyperemesis gravidarum b. Hydramnios c. Frequent episodes of maternal hypoglycemia d. Congenital anomalies in the fetus

The correct answer is: Congenital anomalies in the fetus

Near the end of the first week of life, an infant who has not been treated for any infection develops a copper-colored maculopapular rash on the palms and around the mouth and anus. The newborn is displaying signs and symptoms of which condition? Select one: a. Gonorrhea b. Congenital syphilis c. Herpes simplex virus (HSV) infection d. HIV

The correct answer is: Congenital syphilis

23. Which of the following tests should never be performed during the first trimester? Select one: a. Noninvasive Prenatal Screening test b. Ultrasound c. Maternal screening test for cystic fibrosis d. Contraction Stress test

The correct answer is: Contraction Stress test

Which clinical findings would alert the nurse that the neonate is expressing pain? Select one: a. Cry face; eyes squeezed; increase in blood pressure b. High-pitched, shrill cry; withdrawal; change in heart rate c. Cry face; flaccid limbs; closed mouth d. Low-pitched crying; tachycardia; eyelids open wide

The correct answer is: Cry face; eyes squeezed; increase in blood pressure

Which clinical findings would alert the nurse that the neonate is expressing pain? Select one: a. High-pitched, shrill cry; withdrawal; change in heart rate b. Cry face; flaccid limbs; closed mouth c. Low-pitched crying; tachycardia; eyelids open wide d. Cry face; eyes squeezed; increase in blood pressure

The correct answer is: Cry face; eyes squeezed; increase in blood pressure

10. Mary G10000 is 38 weeks pregnant and has been diagnosed with severe preeclampsia. The physician orders magnesium sulfate infusion for Mary, which includes a maintenance dose of 2 grams/hr. Her IV is a premixed magnesium sulfate solution of 40grams per 1000mL. What will the nurse program the infusion pump to deliver 2 grams/hr? Select one: a. 20mL/hr b. 80mL/hr c. 40mL/hr d. 50 mL/hr

The correct answer is: D. 50mL/hr 50 mL/hr 40 gm = 40,000mg 40,000mg:1000mL:: X: 1mL 1000X = 40000 X= 40mg 2 grams = 2000 mg 2000mg: X:: 40mg: 1 mL X=50mL/hr

13. The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the oxytocin (Pitocin) infusion, the nurse reviews the woman's latest laboratory test findings, which reveal a platelet count of 90,000 mm3, an elevated aspartate aminotransaminase (AST) level, and a falling hematocrit. The laboratory results are indicative of which condition? Select one: a. Idiopathic thrombocytopenia b. Eclampsia c. Disseminated intravascular coagulation (DIC) syndrome d. Hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome

The correct answer is: D. Hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome

An 18-year-old client who has reached 16 weeks of gestation was recently diagnosed with pregestational diabetes. She attends her centering appointment accompanied by one of her girlfriends. This young woman appears more concerned about how her pregnancy will affect her social life than her recent diagnosis of diabetes. A number of nursing diagnoses are applicable to assist in planning adequate care. What is the most appropriate diagnosis at this time? Select one: a. Deficient knowledge, related to diabetic pregnancy management b. Deficient knowledge, related to insulin administration c. Risk for injury, to the mother related to hypoglycemia or hyperglycemia d. Risk for injury, to the fetus related to birth trauma

The correct answer is: Deficient knowledge, related to diabetic pregnancy management

Which statement concerning the complication of maternal diabetes is the most accurate? Select one: a. Even mild-to-moderate hypoglycemic episodes can have significant effects on fetal well-being. b. Infections occur about as often and are considered about as serious in both diabetic and nondiabetic pregnancies. c. Hydramnios occurs approximately twice as often in diabetic pregnancies than in nondiabetic pregnancies. d. Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy.

The correct answer is: Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy.

The nurse is performing an assessment on a client who thinks she may be experiencing preterm labor. Which information is the most important for the nurse to understand and share with the client? Select one: a. Because all women must be considered at risk for preterm labor and prediction is so variable, teaching pregnant women the symptoms of preterm labor probably causes more harm through false alarms. b. Because preterm labor is likely to be the start of an extended labor, a woman with symptoms can wait several hours before contacting the primary caregiver. c. Braxton Hicks contractions often signal the onset of preterm labor. d. Diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical change.

The correct answer is: Diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical change.

If nonsurgical treatment for late PPH is ineffective, which surgical procedure would be appropriate to correct the cause of this condition? Select one: a. Dilation and curettage (D&C) b. Laparoscopy c. Hysterectomy d. Laparotomy

The correct answer is: Dilation and curettage (D&C)

29. In caring for an immediate postpartum client, the nurse notes petechiae and oozing from her intravenous (IV) site. The client would be closely monitored for which clotting disorder? Select one: a. Disseminated Intravascular Coagulation (DIC) b. HELLP syndrome c. Hemorrhage d. Amniotic fluid embolism (AFE)

The correct answer is: Disseminated Intravascular Coagulation (DIC)

Which is the most accurate description of PPD without psychotic features? Select one: a. Condition that disappears without outside help b. Postpartum baby blues requiring the woman to visit with a counselor or psychologist c. Condition that is more common among older Caucasian women because they have higher expectations d. Distinguishable by irritability

The correct answer is: Distinguishable by irritability

The nurse is teaching a client with preterm premature rupture of membranes (PPROM) regarding self-care activities. Which activities should the nurse include in her teaching? Select one: a. Tampons are safe to use to absorb the leaking amniotic fluid. b. Do not engage in sexual activity. c. Report a temperature higher than 40° C. d. Taking frequent tub baths is safe.

The correct answer is: Do not engage in sexual activity.

A number of metabolic changes occur throughout pregnancy. Which physiologic adaptation of pregnancy will influence the nurse's plan of care? Select one: a. Women with insulin-dependent diabetes are prone to hyperglycemia during the first trimester because they are consuming more sugar. b. Insulin crosses the placenta to the fetus only in the first trimester, after which the fetus secretes its own. 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.

The correct answer is: During the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus.

To manage her diabetes appropriately and to ensure a good fetal outcome, how would the pregnant woman with diabetes alter her diet? Select one: a. Increase her consumption of protein. b. Reduce the carbohydrates in her diet. c. Eat six small equal meals per day. d. Eat her meals and snacks on a fixed schedule.

The correct answer is: Eat her meals and snacks on a fixed schedule.

An ethical dilemma unique to perinatal nursing is the: Select one: a. Embryo/fetal rights b. Intensive use of technology to maintain life c. Limited access to care d. Ethnicity disparities in health care

The correct answer is: Embryo/fetal rights

Which of the following would be a priority for the nurse when caring for a pregnant woman who has recently emigrated from another country? Select one: a. Help her develop a realistic, detailed birth plan. b. Encourage her to include her family for support. c. Teach her about expected emotional changes of pregnancy. d. Refer her to a doula for labor support.

The correct answer is: Encourage her to include her family for support.

When assisting the mother, father, and other family members to actualize the loss of an infant, which action is most helpful? Select one: a. Setting a firm time for ending the visit with the baby so that the parents know when to let go b. Using the words lost or gone rather than dead or died c. Making sure the family understands that naming the baby is important d. Ensuring the baby is clothed or wrapped if the parents choose to visit with the baby

The correct answer is: Ensuring the baby is clothed or wrapped if the parents choose to visit with the baby

A premature infant never seems to sleep longer than an hour at a time. Each time a light is turned on, an incubator closes, or people talk near her crib, she wakes up and inconsolably cries until held. What is the correct nursing diagnosis beginning with "ineffective coping, related to"? Select one: a. Severe immaturity b. Behavioral responses c. Environmental stress d. Physiologic distress

The correct answer is: Environmental stress

Which neurologic condition would require preconception counseling, if at all possible? Select one: a. Multiple sclerosis b. Bell palsy c. Eclampsia d. Epilepsy

The correct answer is: Epilepsy. Discuss risks of condition and medication

What information is important for the nurse to include in planning for the care of a woman who has had a vaginal hysterectomy (no oopherectomy) for fibroids? Select one: a. Expect surgical menopause. b. Next pap smear is due in one year. c. Expect to be fully recovered in 4 to 6 weeks. d. Expect no changes in her hormone levels.

The correct answer is: Expect no changes in her hormone levels.

Postoperative care of the pregnant woman who requires abdominal surgery for appendicitis includes which additional assessment? Select one: a. Signs and symptoms of infection b. Fetal heart rate (FHR) and uterine activity c. Intake and output (I&O) and intravenous (IV) site d. Vital signs and incision

The correct answer is: Fetal heart rate (FHR) and uterine activity

A macrosomic infant is born after a difficult forceps-assisted delivery. After stabilization, the infant is weighed, and the birth weight is 4550 g (9 lb, 6 oz). What is the nurse's first priority? Select one: a. Leave the infant in the room with the mother. b. Frequently monitor blood glucose levels, and closely observe the infant for signs of hypoglycemia. c. Immediately take the infant to the nursery. d. Perform a gestational age assessment to determine whether the infant is large for gestational age.

The correct answer is: Frequently monitor blood glucose levels, and closely observe the infant for signs of hypoglycemia.

What is the most important nursing action in preventing neonatal infection? Select one: a. Separate gown technique b. Isolation of infected infants c. Good handwashing or hand hygiene d. Standard Precautions

The correct answer is: Good handwashing or hand hygiene

A nurse caring for a family during a loss might notice that a family member is experiencing survivor guilt. Which family member is most likely to exhibit this guilt? Select one: a. Grandparents b. Father c. Siblings d. Mother

The correct answer is: Grandparents- I think this is supposed to be siblings... It is grandparents: Survivor guilt is sometimes felt by grandparents because they feel that the death is out of order; they are still alive, while their grandchild has died. They may express anger that they are alive and their grandchild is not. The siblings of the expired infant may also experience a profound loss. A young child will respond to the reactions of the parents and may act out. Older children have a more complete understanding of the loss. School-age children are likely to be frightened, whereas teenagers are at a loss on how to react. The mother of the infant is experiencing intense grief at this time. She may be dealing with questions such as, "Why me?" or "Why my baby?" and is unlikely to be experiencing survival guilt. Realizing that fathers can be experiencing deep pain beneath their calm and quiet appearance and may need help acknowledging these feelings is important. This need, however, is not the same as survivor guilt.

What bacterial infection is definitely decreasing in neonates because of effective drug treatment? Select one: a. Escherichia coli infection b. Group B streptococci (GBS) infection c. Tuberculosis d. Candidiasis

The correct answer is: Group B streptococci (GBS) infection

When a woman is diagnosed with postpartum depression (PPD) with psychotic features, what is the nurse's primary concern in planning the client's care? Select one: a. Neglecting her hygiene b. Harming her infant c. Displaying outbursts of anger d. Losing interest in her husband

The correct answer is: Harming her infant Despite warnings, prenatal exposure to alcohol continues to far exceed exposure to illicit drugs. Which condition is rarely associated with fetal alcohol syndrome (FAS)?

69. At a 2-month well-baby examination, it was discovered that an exclusively breastfed infant had only gained 10 ounces in the past 4 weeks. The mother and the nurse develop a feeding plan for the infant to increase his weight gain. Which change in dietary management will assist the client in meeting this goal? Select one: a. Start iron supplements. b. Have a bottle of formula after every feeding. c. Begin solid foods. d. Have one extra breastfeeding session every 24 hours.

The correct answer is: Have one extra breastfeeding session every 24 hours.

A nurse is providing breast care education to a client after mammography. Which information regarding fibrocystic changes in the breast is important for the nurse to share? Select one: a. It is a premalignant disorder characterized by lumps found in the breast tissue. b. Fibrocystic breast disease is a disease of the milk ducts and glands in the breasts c. Healthy women with fibrocystic breast disease find lumpiness with pain and tenderness in varying degrees in the breast tissue during menstrual cycles. d. Lumpiness is accompanied by tenderness after menses.

The correct answer is: Healthy women with fibrocystic breast disease find lumpiness with pain and tenderness in varying degrees in the breast tissue during menstrual cycles.

To explain hemolytic disorders in the newborn to new parents, the nurse who cares for the newborn population must be aware of the physiologic characteristics related to these conditions. What is the most common cause of pathologic hyperbilirubinemia? Select one: a. Postmaturity b. Congenital heart defect c. Hepatic disease d. Hemolytic disorders

The correct answer is: Hemolytic disorders

28. A woman with severe preeclampsia has been receiving magnesium sulfate by intravenous infusion for 8 hours. The nurse assesses the client and documents the following findings: temperature of 37.1° C, pulse rate of 96 beats per minute, respiratory rate of 24 breaths per minute, BP of 155/112 mm Hg, 3+ DTRs, and no ankle clonus. The nurse calls the provider with an update. The nurse should anticipate an order for which medication? Select one: a. Calcium gluconate b. Magnesium sulfate bolus c. Diazepam d. Hydralazine

The correct answer is: Hydralazine (vasodilator)

An infant was born 2 hours ago at 37 weeks of gestation and weighs 4.1 kg. The infant appears chubby with a flushed complexion and is very tremulous. The tremors are most likely the result of what condition? Select one: a. Hypoglycemia b. Hypocalcemia c. Birth injury d. Seizures

The correct answer is: Hypoglycemia

13. A diagnostic test commonly used to assess problems of the fallopian tubes is: Select one: a. Endometrial biopsy b. Ovarian reserve testing c. Hysterosalpingogram d. Screening for sexually transmitted infections

The correct answer is: Hysterosalpingogram

43. The nurse is teaching new parents about metabolic screening for the newborn. Which statement is most helpful to these clients? a. If genetic screening is performed before the infant is 24 hours old, then it should be repeated at age 1 to 2 weeks. b. All states test for phenylketonuria (PKU), hypothyroidism, cystic fibrosis, and sickle cell diseases. c. Federal law prohibits newborn genetic testing without parental consent. d. Hearing screening is now mandated by federal law.

The correct answer is: If genetic screening is performed before the infant is 24 hours old, then it should be repeated at age 1 to 2 weeks.

Which information regarding to injuries to the infant's plexus during labor and birth is most accurate? Select one: a. If the nerves are stretched with no avulsion, then they should completely recover in 3 to 6 months. b. Parents of children with brachial palsy are taught to pick up the child from under the axillae. c. Breastfeeding is not recommended for infants with facial nerve paralysis until the condition resolves. d. Erb palsy is damage to the lower plexus.

The correct answer is: If the nerves are stretched with no avulsion, then they should completely recover in 3 to 6 months.

A 26-year-old primigravida has come to the clinic for her regular prenatal visit at 12 weeks. She appears thin and somewhat nervous. She reports that she eats a well-balanced diet, although her weight is 5 pounds less than it was at her last visit. The results of laboratory studies confirm that she has a hyperthyroid condition. Based on the available data, the nurse formulates a plan of care. Which nursing diagnosis is most appropriate for the client at this time? Select one: a. Imbalanced nutrition: less than body requirements b. Imbalanced nutrition: more than body requirements c. Deficient fluid volume d. Disturbed sleep pattern

The correct answer is: Imbalanced nutrition: less than body requirements

The perinatal nurse explains to the student nurse that a goal of the Healthy People 2020 is to: Select one: a. Increase proportion of infants who are bottle-feed. b. Increase number of unintended pregnancies. c. Increase the number of babies who are born preterm. d. Increase proportion of infants who are breastfed.

The correct answer is: Increase proportion of infants who are breastfed.

Which infant is most likely to express Rh incompatibility? Select one: a. Infant of an Rh-negative mother and a father who is Rh positive and heterozygous for the Rh factor b. Infant of an Rh-negative mother and a father who is Rh positive and homozygous for the Rh factor c. Infant who is Rh negative and a mother who is Rh negative d. Infant who is Rh positive and a mother who is Rh positive

The correct answer is: Infant of an Rh-negative mother and a father who is Rh positive and homozygous for the Rh factor

43. A woman gave birth to a 3200 g baby girl with an estimated gestational age of 40 weeks. The baby is 1 hour of age. In preparation for administration of Vitamin K to the infant, the nurse will explain to the parents that an injection of this medication: a. Influences the activation of coagulation factors to prevent delayed clotting and hemorrhagic disease. b. Prevents high levels of unconjugated bilirubin the newborn's blood. c. Prevents the excessive loss of RBCs. d. Aids the liver in regulation of blood glucose.

The correct answer is: Influences the activation of coagulation factors to prevent delayed clotting and hemorrhagic disease.

18. What is the most critical physiologic change required of the newborn after birth? Select one: a. Full function of the immune defense system b. Initiation and maintenance of respirations c. Closure of fetal shunts in the circulatory system d. Maintenance of a stable temperature

The correct answer is: Initiation and maintenance of respirations

8. Because a full bladder prevents the uterus from contracting normally, nurses intervene to help the woman spontaneously empty her bladder as soon as possible. If all else fails, what tactic might the nurse use? Select one: a. Placing oil of peppermint in a bedpan under the woman b. Inserting a sterile catheter c. Asking the physician to prescribe analgesic agents d. Pouring water from a squeeze bottle over the woman's perineum

The correct answer is: Inserting a sterile catheter, Pouring water from a squeeze bottle over the woman's perineum is a first intervention

Which important component of nutritional counseling should the nurse include in health teaching for a pregnant woman who is experiencing cholecystitis? Select one: a. Instruct the woman to eat a low-fat diet and to avoid fried foods. b. Instruct the woman to eat a low-cholesterol, low-salt diet. c. Assess the woman's dietary history for adequate calories and proteins. d. Teach the woman that the bulk of calories should come from proteins.

The correct answer is: Instruct the woman to eat a low-fat diet and to avoid fried foods.

17. In contrast to placenta previa, what is the most prevalent clinical manifestation of Grade 3 abruptio placentae? Select one: a. Intermittent uterine contractions b. Cramping c. Bleeding d. Intense abdominal pain

The correct answer is: Intense abdominal pain

6. The nurse is working with a 36-year-old, married client, with 6 children who smokes. The woman states, "I don't expect to have any more kids, but I hate the thought of being sterile." Which of the following contraceptive methods would be best for the nurse to recommend to this client? Select one: a. Intrauterine contraceptive device (IUD) b. Contraceptive patch c. Bilateral tubal ligation d. Birth control pills with estrogen and progestin

The correct answer is: Intrauterine contraceptive device (IUD) Intrauterine contraception device (IUD) is the recommended method for this patient. IUD has a low failure rate and provides long-term contraception for 3-10 years. Bilateral tubal ligation (BTL) is a surgical procedure which results in sterilization. Due to her history of smoking, neither birth control pills with estrogen nor contraceptive patch is recommended due to the increased risks for blood clots, heart disease, and strokes, also associated with smoking.

26. Which neonatal complications are associated with hypertension in the mother? Select one: a. Intrauterine growth restriction (IUGR) and prematurity b. Seizures and cerebral hemorrhage c. Hepatic or renal dysfunction d. Placental abruption and DIC

The correct answer is: Intrauterine growth restriction (IUGR) and prematurity

The nurse who is caring for a woman hospitalized for hyperemesis gravidarum would expect the initial treatment to involve what? Select one: a. Antiemetic medication, such as pyridoxine, to control nausea and vomiting b. Intravenous (IV) therapy to correct fluid and electrolyte imbalances c. Corticosteroids to reduce inflammation d. Enteral nutrition to correct nutritional deficits

The correct answer is: Intravenous (IV) therapy to correct fluid and electrolyte imbalances Preconception counseling is critical in the safe management of diabetic pregnancies. Which complication is commonly associated with poor glycemic control before and during early pregnancy?

Which condition is considered a medical emergency that requires immediate treatment? Select one: a. Uterine atony b. Inversion of the uterus c. Hypotonic uterus d. ITP

The correct answer is: Inversion of the uterus

Which statement most accurately describes complicated grief? Select one: a. Occurs when, in multiple births, one child dies and the other or others live b. Is an extremely intense grief reaction that persists for a long time c. Is felt by the family of adolescent mothers who lose their babies d. Is a state during which the parents are ambivalent, as with an abortion

The correct answer is: Is an extremely intense grief reaction that persists for a long time

Augmentation of labor: Select one: a. Is part of the active management of labor instituted when the labor process is unsatisfactory and uterine contractions are ineffective b. Relies on more invasive methods when oxytocin and amniotomy have failed c. Is elective induction of labor d. Is an operative vaginal delivery that uses vacuum cups

The correct answer is: Is part of the active management of labor instituted when the labor process is unsatisfactory and uterine contractions are ineffective. Labor augmentation is the stimulation of ineffective UCs after the onset of spontaneous labor to manage labor dystocia. Lower doses of oxytocin are required but all of the principles pertaining to the use of oxytocin apply to augmentation.

2. 18 year old Ellen has a positive pregnancy test and cries when she sees the result. Per her LMP, the nurse determines she is approx 7 weeks pregnant. She asks the nurse what should she do. Which of the following is the nurse's best initial response? Select one: a. You need to decide what obstetrician you want to see for prenatal care. b. Here is a list of clinics that provide abortions. My sister liked this one best. c. Let's discuss your three options. d. I think adoption would be your best choice at this time.

The correct answer is: Let's discuss your three options.

Intervention for the sexual abuse survivor is often not attempted by maternity and women's health nurses because of the concern about increasing the distress of the woman and the lack of expertise in counseling. What initial intervention is appropriate and most important in facilitating the woman's care? Select one: a. Initiating a referral to an expert counselor b. Acknowledging the nurse's discomfort to the client as an expression of empathy c. Listening and encouraging therapeutic communication skills d. Setting limits on what the client discloses

The correct answer is: Listening and encouraging therapeutic communication skills

Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the client mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. This fetus is at the greatest risk for which condition? Select one: a. Macrosomia b. Congenital anomalies of the central nervous system c. Preterm birth d. Low birth weight

The correct answer is: Macrosomia

During labor induction with oxytocin, the fetal heart rate baseline is in the 140s with moderate variability. Contraction frequency is assessed to be every 2-3 minutes with duration of 60 seconds, of moderate strength to palpation. Based on this assessment, the nurse should take which action? Select one: a. Increase oxytocin infusion rate per provider's protocol. b. Stop oxytocin infusion immediately. c. Maintain present oxytocin infusion rate and continue to assess. d. Decrease oxytocin infusion rate by 2 mU/min and report to provider.

The correct answer is: Maintain present oxytocin infusion rate and continue to assess. The goal of oxytocin use in labor is to establish uterine contraction patterns that promote cervical dilation of about 1 cm/hr once in active labor. The lowest possible dose should be used to achieve labor progress. Generally, the labor pattern should be 3 UCs in 10 minutes, lasting 40-60 seconds with an intensity of 25-75 mm/HG with IUPC and resting tone <20 mm HG with 1 minute between each UC. The labor pattern described above is appropriate and no increase or decrease in oxytocin infusion rate is indicated.

A married couple lives in a single-family house with their newborn son and the husband's daughter from a previous marriage. Based on this information, what family form best describes this family? Select one: a. Same-sex family b. Married-blended family c. Nuclear family d. Extended family

The correct answer is: Married-blended family

35. Karen, a G2 P2, experienced a precipitous birth 90 minutes ago. Her infant is 4200 grams and a repair of a second-degree laceration was needed following the birth. As part of the nursing assessment, the nurse discovers that Karen's uterus is boggy. Furthermore, it is noted that Karen's vaginal bleeding has increased. What is the nurse's most appropriate actions? Select all that apply. a. Assess vital signs including blood pressure and pulse. b. Massage the uterine fundus with continual lower segment support. c. Measure and document each perineal pad changed in order to assess blood loss. d. Assess for bladder distention and encourage patient to void.

The correct answer is: Massage the uterine fundus with continual lower segment support; Assess for bladder distention and encourage patient to void.

According to the CDC, which of the following are true? Select one: a. Maternal mortality rate in the US has increased primarily due to anesthesia complications b. Maternal mortality rate in the US has increased but infection is no longer a significant cause. c. Maternal mortality rate in the US has increased from 1987-2013 d. Maternal mortality rate in the US has decreased from 1987-2013

The correct answer is: Maternal mortality rate in the US has increased from 1987-2013

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

The correct answer is: Mitral valve prolapse

A patient, G1 P0, is admitted to the labor and delivery unit for induction of labor. The following assessments were made on admission: Bishop score of 4, fetal heart rate 140s with moderate variability and no decelerations, TPR 98.6°F, 88, 20, BP 120/80, negative obstetrical history. A prostaglandin suppository was inserted at that time. Which of the following findings, 6 hours after insertion, would warrant the removal of the Cervidil (dinoprostone)? Select one: a. Bishop score of 5 b. Fetal heart of 152 bpm c. Respiratory rate of 24 rpm d. More than 5 contractions in 10 minutes Correct! This is hyperstimulation.

The correct answer is: More than 5 contractions in 10 minutes

By understanding the four mechanisms of heat transfer (convection, conduction, radiation, and evaporation), the nurse can create an environment for the infant that prevents temperature instability. Which significant symptoms will the infant display when experiencing cold stress? Select one: a. Decreased respiratory rate b. Mottled skin with acrocyanosis c. Bradycardia, followed by an increased heart rate d. Increased physical activity

The correct answer is: Mottled skin with acrocyanosis

19. Which diagnostic test is used to confirm a suspected diagnosis of breast cancer? Select one: a. Mammogram b. Ultrasound c. Magnetic resonance imaging (MRI) d. Needle-localization biopsy

The correct answer is: Needle-localization biopsy

Providing care for the neonate born to a mother who abuses substances can present a challenge for the health care team. Nursing care for this infant requires a multisystem approach. What is the first step in the provision of care for the infant? Select one: a. Pharmacologic treatment b. Reduction of environmental stimuli c. Neonatal abstinence syndrome (NAS) scoring d. Adequate nutrition and maintenance of fluid and electrolyte balance

The correct answer is: Neonatal abstinence syndrome (NAS) scoring

A nursery nurse observes that a full-term AGA neonate has nasal congestion, hypertonia, and tremors and is extremely irritable. Based on these observations, the nurse suspects which of the following? Select one: a. Hypoglycemia b. Hypercalcemia c. Cold stress d. Neonatal withdrawal This infant is most likely going through withdrawal

The correct answer is: Neonatal withdrawal

What information regarding a fractured clavicle is most important for the nurse to take into consideration when planning the infant's care? Select one: a. No special treatment is necessary. b. Prone positioning facilitates bone alignment. c. The shoulder should be immobilized with a splint. d. Parents should be taught range-of-motion exercises.

The correct answer is: No special treatment is necessary.

22. Allison is 32 weeks pregnant presents to L&D and tells the nurse she has not felt her baby move in 48 hours. The nurse begins electronic fetal monitoring and notes the baby's heart rate is in the 130's. The nurse contacts Allison's physician to obtain an order for which of the following tests? Select one: a. Maternal Serum Screening Test b. Leopolds Maneuvers c. Biophysical profile d. Non stress Test e. Fetal fibronectin

The correct answer is: Non stress Test

Which of these medications is commonly used to control postpartum bleeding related to uterine atony? Select one: a. Magnesium sulfate b. Phytonadione c. Oxytocin d. Warfarin

The correct answer is: Oxytocin. Oxytocin promotes contraction of the uterus by stimulating the smooth muscle of the uterus.

18. Having a genetic mutation may create an 85% chance of developing breast cancer in a woman's lifetime. Which condition does not increase a client's risk for breast cancer? Select one: a. Paget disease b. Li-Fraumeni syndrome c. Cowden syndrome d. BRCA1 or BRCA2 gene mutation

The correct answer is: Paget disease

29. The nurse is completing the lab order for a pap smear performed on a 22 year old female. Which of the following options will the nurse select? Select one: a. Pap smear- cytology with reflux to high risk HPV test for ASCUS result b. Pap smear - no cytology, high risk HPV testing only c. Pap smear - cytology only d. Pap smear- cytology with high risk HPV test

The correct answer is: Pap smear - cytology only. Read online article on cervical cancer screening

If the umbilical cord prolapses during labor, the nurse should immediately: Select one: a. Type and cross-match blood for an emergency transfusion. b. Await provider order for preparation for an emergency cesarean section. c. Attempt to reposition the cord above the presenting part. d. Perform vaginal exam and lifting the presenting part off of the cord to relieve pressure on the cord.

The correct answer is: Perform vaginal exam and lifting the presenting part off of the cord to relieve pressure on the cord. Prolapse of the umbilical cord is when the cord lies below the presenting part of the fetus. The cord becomes trapped against the presenting part and circulation is occluded; FHR will usually show bradycardia or prolonged decel. An emergency cesarean birth is typically performed. Occlusion of the cord may be partially relieved by lifting the presenting part off the cord with a vaginal exam. The examiner's hand remains in the vagina, lifting the presenting part off the cord until delivery by cesarean. There is no attempt to push the cord above the presenting part. Type and screen of blood is generally done on admission for all laboring women; type and cross-match can readily be accomplished using the blood sample already in the lab.

What is the primary nursing responsibility when caring for a client who is experiencing an obstetric hemorrhage associated with uterine atony? Select one: a. Catheterizing the bladder b. Establishing venous access c. Performing fundal massage d. Preparing the woman for surgical intervention

The correct answer is: Performing fundal massage

Tanya, a 30-year-old woman, is being prepared for a planned cesarean birth. The perinatal nurse assists the anesthesiologist with the spinal block and then positions Tanya in a supine position. Tanya's blood pressure drops to 90/52, and there is a decrease in the fetal heart rate to 110 bpm. The perinatal nurse's best response is to: Select one: a. Place Tanya in a left lateral tilt b. Discontinue Tanya's intravenous administration. c. Have naloxone (Narcan) ready for administration. d. Have epinephrine ready for administration.

The correct answer is: Place Tanya in a left lateral tilt. Reposition the woman after epidural or spinal anesthesia in a supine position with a left lateral tilt to decrease the pressure from the uterus on the inferior vena cava and to maintain placental perfusion.

Which classification of placental separation is not recognized as an abnormal adherence pattern? Select one: a. Placenta accreta b. Placenta increta c. Placenta percreta d. Placenta abruptio

The correct answer is: Placenta abruptio

A woman at 28 weeks of gestation experiences blunt abdominal trauma as the result of a fall. The nurse must closely observe the client for what? Select one: a. Complaints of abdominal pain b. Placental abruption c. Alteration in maternal vital signs, especially blood pressure d. Hemorrhage

The correct answer is: Placental abruption

Which woman has the highest risk for endometrial cancer? Select one: a. Perimenopausal woman who has a cystocele b. Postmenopausal woman with hypertension c. Woman who has an intrauterine device (IUD) d. Woman who has been on birth control pills for 15 years

The correct answer is: Postmenopausal woman with hypertension

A woman who is 12 weeks postpartum presents with the following behavior: she reports severe mood swings and hearing voices, believes her infant is going to die, she has to be reminded to shower and put on clean clothes, and she feels she is unable to care for her baby. These behaviors are associated with which of the following? Select one: a. Postpartum blues b. Postpartum depression c. Postpartum psychosis d. Maladaptive mother-infant attachment

The correct answer is: Postpartum psychosis. Postpartum psychosis (PPP) is a variant of bipolar disorder and is the most serious form of postpartum mood disorders. Onset of symptoms can be as early as the 3rd postpartum day. Assessment findings include paranoia, delusions associated with the baby, mood swings, extreme agitation, confused thinking, inability to care for self or infant, and strange beliefs.

While providing care to the maternity client, the nurse should be aware that one of these anxiety disorders is likely to be triggered by the process of labor and birth. Which disorder fits this criterion? Select one: a. Posttraumatic stress disorder (PTSD) b. Obsessive-compulsive disorder (OCD) c. Panic disorder d. Phobias

The correct answer is: Posttraumatic stress disorder (PTSD)

106. The nurse is teaching the parents of a healthy newborn about infant safety. Which of the following should be included in the teaching plan? (Select all that apply). Select one or more: a. Water temperature for the infant's bath should be 100.4 degrees F. b. Do not cook while holding an infant c. Cover electrical outlets d. Remove strings from infant sleepwear, bedding, and pacifiers to prevent strangulation.

Correct Answers: A, B, C & D

104. Which of the following actions can decrease the risk for a postpartum infection? (Select all that apply.) Select one or more: a. Diet high in protein and vitamin C. b. Increased fluid intake. c. Ambulating within a few hours after delivery d. Good hand washing techniques by staff and patients.

Correct answers: A, B, & D Rationale: Protein and vitamin C assist with tissue healing. Rehydrating a woman after delivery can assist with decreasing risk for infections. Early ambulation decreases risk for infection by promoting uterine drainage. Hand washing by staff and patients has been shown to be the number one measure in the transmission of infection.

67. Instructions to a mother of an uncircumcised male infant should include which of the following? Select one: a. Instruct her to use a cotton swab to clean under the foreskin. b. Instruct her to clean the penis by retracting the foreskin. c. Instruct her to clean the penis with alcohol. d. Instruct her not to retract the foreskin.

Do not force the foreskin over the penis or use cotton swabs to clean under the foreskin as this may damage the inner layer of the foreskin which can lead to adhesion formation. Gently cleanse the penis when bathing the infant and when changing the diaper. The correct answer is: Instruct her not to retract the foreskin.

100. A perinatal nurse assesses a term newborn for respiratory functioning. The nurse knows that which of the following conditions is normal for newborns? Select one: a. A respiratory rate of 60 to 80 breaths per minute b. A breathing pattern that is often shallow, diaphragmatic, and irregular c. Periodic episodes of apnea d. Retractions of the chest wall

Expected findings when assessing the neonate's respiratory system include 30-60 breaths per minute; slightly irregular, diaphragmatic/abdominal breathing; increase in rate when crying; decrease in rate when sleeping. Abnormal findings include periods of apnea >15 seconds; tachypnea; respirations <30 per minute The correct answer is: A breathing pattern that is often shallow, diaphragmatic, and irregular

5. The nurse is massaging a boggy uterus. The uterus does not respond to the massage. Which medication would the nurse expect would be given first: Select one: a. Methergine b. Epinephrine c. Carboprost (Hemabate) d. Oxytocin or pitocin

If the cause of the hemorrhage is uterine atony, continual fundal massage with lower uterine segment support is mandatory. While one member of the team massages the fundus, another nurse establishes intravenous access with a large bore needle and administers oxytocic drugs in the following order: oxytocin (Pitocin), followed by methylergonovine (Methergine), and carboprost (Hemabate).

101. A healthy, full-term baby boy is scheduled for a circumcision. Nursing actions prior to the procedure include which of the following? (Select all that apply.) Select one or more: a. Obtain written consent from the parents b. Administer acetaminophen PO 1 hour before procedure per provider order. c. Feed the neonate glucose water 30 minutes before the procedure. d. Verify that the neonate has voided

Nursing actions include obtaining written consent, administering acetaminophen as per provider order, and ensuring the neonate has voided; neonate should not eat 2-3 hours prior to the procedure to avoid risk of vomiting and aspiration The correct answers are: Obtain written consent from the parents, Administer acetaminophen PO 1 hour before procedure per provider order., Verify that the neonate has voided

The nurse assessing a newborn for heat loss is aware that nonshivering thermogenesis utilizes the newborn's stores of brown adipose tissue (BAT) to provide heat in the cold-stressed newborn. Select one: True False

The correct answer is 'True'. Brown adipose tissue, also known as "brown fat," is a unique highly vascular fat found only in newborns. BAT promotes an increase in metabolism, heat production, heat transfer to the peripheral system. Heat is produced by intense lipid metabolic metabolism but reserves are rapidly depleted during periods of cold stress.

88. A pregnant woman wants to breastfeed her infant; however, her husband is not convinced that there are any scientific reasons to do so. The nurse can give the couple printed information comparing breastfeeding and bottle feeding. Which statement regarding bottle feeding using commercially prepared infant formulas might influence their choice? a. Bottle feeding using a commercially prepared formula increase the risk that the infant will develop allergies. b. Bottle feeding requires that multivitamin supplements be given to the infant. c. Commercially prepared formula ensures that the infant is getting iron in a form that is easily absorbed. d. Bottle feeding helps the infant sleep through the night.

The correct answer is: "Bottle feeding using a commercially prepared formula increase the risk that the infant will develop allergies."

37. Many first-time parents do not plan on having their parents' help immediately after the newborn arrives. Which statement by the nurse is the most appropriate when counseling new parents regarding the involvement of grandparents? a. "Grandparent involvement can be very disruptive to the family." b. "They are getting old. You should let them be involved while they can." c. "Grandparents can help you with parenting skills." d. "You should tell your parents to leave you alone."

The correct answer is: "Grandparents can help you with parenting skills."

47. A new mother wants to be sure that she is meeting her daughter's needs while feeding the baby commercially prepared infant formula. The nurse should evaluate the mother's knowledge about appropriate infant feeding techniques. Which statement by the client reassures the nurse that correct learning had taken place? a. "Since reaching 2 weeks of age, I add rice cereal to my daughter's formula to ensure adequate nutrition." b. "I refrigerate any leftover formula for the next feeding." c. "I burp my daughter during and after the feeding as needed." d. "I warm the bottle in my microwave oven."

The correct answer is: "I burp my daughter during and after the feeding as needed."

79. Nurses should be able to teach breastfeeding mothers the signs that the infant has correctly latched on. Which client statement indicates a poor latch? Select one: a. "My baby's jaw glides smoothly with sucking." b. "My baby sucks with cheeks rounded, not dimpled." c. "I feel a firm tugging sensation on my nipples but not pinching or pain." d. "I hear a clicking or smacking sound."

The correct answer is: "I hear a clicking or smacking sound."

90. A 25-year-old multiparous woman gave birth to an infant boy 1 day ago. Today her husband brings a large container of brown seaweed soup to the hospital. When the nurse enters the room, the husband asks for help with warming the soup so that his wife can eat it. What is the nurse's most appropriate response? a. "Does your physician know that you are planning to eat that?" b. "Didn't you like your lunch?" c. "I'll warm the soup in the microwave for you." d. "What is that anyway?"

The correct answer is: "I'll warm the soup in the microwave for you."

49. Which statement by a newly delivered woman indicates that she knows what to expect regarding her menstrual activity after childbirth? Select one: a. "My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles." b. "My first menstrual cycle will be heavier than normal and then will be light for several months after." c. "My first menstrual cycle will be lighter than normal and then will get heavier every month thereafter." d. "I will not have a menstrual cycle for 6 months after childbirth."

The correct answer is: "My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles."

82. The nurse is caring for a recently immigrated Chinese woman in the postpartum unit. Based on cultural beliefs and practices of the woman, the nurse would anticipate which of the following? Select all that apply. a. The woman prefers cold water for drinking. b. The woman prefers not to shower. c. The woman prefers to have her female relatives care for her baby. d. The woman prefers a wide variety of foods to eat.

The correct answer is: "The woman prefers to have her female relatives care for her baby."

46. A nurse is making a home visit on the twelfth postpartum day to assess a 23-year-old primipara woman and her full-term, healthy baby. Breastfeeding is the method of infant nutrition. The woman tells the nurse that she does not think her milk is good because it looks very watery when she expresses a little before each feeding. The nurse's best response is: a. "This is normal. You only have to be concerned when your baby does not gain weight." b. "What types of foods are you eating? A lack of protein in the diet can cause watery looking breast milk." c. "How much fluid are you drinking while you are nursing your baby? Too much fluid during the feeding session can dilute the breast milk." d. "This is normal and is referred to as foremilk which is higher in water content. Later in the feeding the fat content increases and the milk becomes richer in appearance."

The correct answer is: "This is normal and is referred to as foremilk which is higher in water content. Later in the feeding the fat content increases and the milk becomes richer in appearance."

87. The nurse is assessing the neonate's skin and notes the presence of a rash with red macules and papules on the trunk. The name for this common neonatal skin condition is: a. milia b. neonatal acne c. erythema toxicum d. pustular melanosis

The correct answer is: "erythema toxicum"

48. A woman gave birth to an infant boy 10 hours ago. Where does the nurse expect to locate this woman's fundus? Select one: a. Nonpalpable abdominally b. 2 centimeters below the umbilicus c. 1 centimeter above the umbilicus d. Midway between the umbilicus and the symphysis pubis

The correct answer is: 1 centimeter above the umbilicus

66. The nurse is assessing a full term, quiet, and alert newborn. What is the average expected apical pulse range (in beats per minute)? Select one: a. 100 to 120 b. 120 to 160 c. 80 to 100 d. 150 to 180

The correct answer is: 120 to 160

23. At 1 minute after birth a nurse assesses an infant and notes a heart rate of 80 beats per minute, some flexion of extremities, a weak cry, grimacing, and a pink body but blue extremities. Which Apgar score does the nurse calculate based upon these observations and signs? Select one: a. 4 b. 5 c. 6 d. 7

The correct answer is: 5

102. Screening for critical congenital heart disease (CCHD) was added to the uniform screening panel in 2011. The nurse has explained this testing to the new mother. Which action by the nurse related to this test is correct? Select one: a. Testing is performed with an electrocardiogram. b. Screening is performed when the infant is 12 hours of age. c. A passing result is an O2 saturation of ≥95%. d. Oxygen (O2) is measured in both hands and in the right foot.

The correct answer is: A passing result is an O2 saturation of ≥95%.

71. Which client is most likely to experience strong and uncomfortable afterpains? Select one: a. A woman who is a gravida 4, para 4-0-0-4 b. A woman who experienced oligohydramnios c. A woman whose infant weighed 5 pounds, 3 ounces d. A woman who is bottle-feeding her infant

The correct answer is: A woman who is a gravida 4, para 4-0-0-4

75. The nurse completes an initial newborn examination on a baby boy at 90 minutes of age. The baby was born at 40 weeks' gestation with no birth trauma. The nurse's findings include the following parameters: heart rate 136 beats per minute; respiratory rate 64 breaths per minute; temperature 98.2°F (36.8°C); length 49.5 cm; and weight 3500 g. The nurse documents the presence of a heart murmur, absence of bowel sounds, symmetry of ears and eyes, no grunting or nasal flaring, and full range of movement of all extremities. Which assessment would warrant further investigation and require immediate consultation with the baby's health-care provider? Select one: a. Respiratory rate b. Presence of a heart murmur c. Absent bowel sounds d. Weight

The correct answer is: Absent bowel sounds - Bowel sounds are present but may be hypoactive for the first few days

7. Maddy, a G3 P1 woman, gave birth 12 hours ago to a 9 lb. 13 oz. daughter. She experiences severe cramps with breastfeeding. The perinatal nurse best describes this condition as: Select one: a. Afterpains b. Uterine hypertonia c. Bladder hypertonia d. Rectus abdominis diastasis

The correct answer is: Afterpains. Afterpains (afterbirth pains) are intermittent uterine contractions that occur during the process of involution. Afterpains are more pronounced in patients with decreased uterine tone due to overdistension, which is associated with multiparity and macrosomia. Patients often describe the sensation as a discomfort similar to menstrual cramps. Afterpains are also related to the increase of oxytocin released in response to infant suckling.)

13. A 25-year-old gravida 1 para 1 who had an emergency cesarean birth 3 days ago is scheduled for discharge. As the nurse prepares her for discharge, she begins to cry. The nurse's next action should be what? Select one: a. Explain that she is experiencing postpartum blues. b. Point out how lucky she is to have a healthy baby. c. Allow her time to express her feelings. d. Assess her for pain.

The correct answer is: Allow her time to express her feelings. The nurse needs to hear from the patient why she is crying before offering a response.

52. The nurse is developing a plan of care for a client who is in the "taking-in" phase after delivering a healthy baby boy. Which of the following should the nurse include in the plan? Select one: a. Assist the woman in selecting a nutritious meal plan. b. Teach baby care skills like diapering. c. Discuss the pros and cons of circumcision. d. Counsel her regarding future sexual encounters.

The correct answer is: Assist the woman in selecting a nutritious meal plan. The "taking-in" phase is a period of dependent behaviors and occurs during the first 24-48 hours. Assisting her in ordering her meals allows her to focus on her comfort while acknowledging her decreased ability to make decisions. Teaching infant skills is probably more appropriate during the "taking-hold" phase. "Letting go" phase would include resumption of sexual intimacy. See Table 22-4

26. An infant boy was delivered minutes ago. The nurse is conducting the initial assessment. Part of the assessment includes the Apgar score. When should the Apgar assessment be performed? Select one: a. At least twice, 1 minute and 5 minutes after birth b. Every 15 minutes during the newborn's first hour after birth c. Only if the newborn is in obvious distress d. Once by the obstetrician, just after the birth

The correct answer is: At least twice, 1 minute and 5 minutes after birth

14. The nursery nurse notes the presence of diffuse edema on a baby girl's head. Review of the birth record indicates that her mother experienced a prolonged labor and difficult childbirth. By the second day of life, the edema has disappeared. The nurse documents the following condition in the infant's chart. Select one: a. Caput succedaneum b. Cephalhematoma c. Subperiosteal hemorrhage d. Epstein pearls

The correct answer is: Caput succedaneum Caput succedaneum is localized soft tissue edema of the scalp; feels spongy; may cross suture lines; results from prolonged pressure of the head against the maternal cervix during labor; resolves within the first week of life.

22. Match the definition or description to the appropriate term. HINT: not all terms are used. a) Conditions occurring in late pregnancy, usually as a result of maternal or placental factors. typically have a weight less than the 10th percentile and length and head circumference will be greater than the 10th percentile. b) Less than the 10th percentile c) Conditions occurring in the first trimester that affect all aspects of fetal growth. d) Rate of growth does not meet expected growth pattern 1) IUGR 2) Asymmetric IGR 3) SGA 4) Symmetric SGA

The correct answer is: Conditions occurring in late pregnancy, usually as a result of maternal or placental factors. typically have a weight less than the 10th percentile and length and head circumference will be greater than the 10th percentile. → Asymmetric IUGR, Less than the 10th percentile → SGA, Conditions occurring in the first trimester that affect all aspects of fetal growth. → Symmetric SGA, Rate of growth does not meet expected growth pattern. → IUGR 1→d 2→a 3→b 4→c

2. A postpartum client is concerned that her breasts are engorged and uncomfortable. What is the nurse's explanation for this physiologic change? Select one: a. Congestion of veins and lymphatic vessels b. Hyperplasia of mammary tissue c. Accumulation of milk in the lactiferous ducts and glands d. Overproduction of colostrum

The correct answer is: Congestion of veins and lymphatic vessels

98. The perinatal nurse teaches the postpartum woman about the normal process of diuresis that she can expect to occur approximately 6 to 8 hours after birth. A decrease in which of the following hormones is primarily responsible for the diuresis? Select one: a. Prolactin b. Progesterone c. Lactogen d. Estrogen

The correct answer is: Estrogen

36. The postpartum nurse is caring for a couple who experienced an unplanned emergency cesarean birth. The nurse observes the following behaviors: Parents are gently touching their newborn. Mother is softly singing to her baby. Father is gazing into his baby's eyes. Based on this data, the correct nursing diagnosis is altered parent-infant bonding related to emergency cesarean birth. a. True b. False

The correct answer is: False.

24. The nurse is using the New Ballard Scale to determine the gestational age of a newborn. Which assessment finding is consistent with a gestational age of 40 weeks? Select one: a. Faint red marks on the soles of the feet b. Abundant lanugo c. Flexed posture d. Smooth, pink skin with visible veins

The correct answer is: Flexed posture

50. Which statement, related to the reconditioning of the urinary system after childbirth, should the nurse understand? Select one: a. Fluid loss through perspiration and increased urinary output accounts for a weight loss of more than 2 kg during the puerperium. b. With adequate emptying of the bladder, bladder tone is usually restored 2 to 3 weeks after childbirth. c. Kidney function returns to normal a few days after birth. d. Diastasis recti abdominis is a common condition that alters the voiding reflex.

The correct answer is: Fluid loss through perspiration and increased urinary output accounts for a weight loss of more than 2 kg during the puerperium.

20. The nurse is teaching the parents of a 1-day-old baby how to give their baby a bath. Which of the following actions should be included? Select one: a. Clean the eye from the outer aspect to the inner aspect. b. Keep the door of the room open to allow for ventilation. c. Gather all supplies before beginning the bath. d. Bathe daily with warm soapy water.

The correct answer is: Gather all supplies before beginning the bath. Bathing is done in a warm room free from drafts. Gather all items required prior to beginning the bath. Cleanse eyes from the inner to outer aspects using a clean corner of the washcloth per eye. Daily bathing with soap is not necessary and can cause skin irritation.

95. A nurse is performing a newborn assessment on a new admission to the nursery. Which of the following actions should the nurse make when evaluating the baby for congenital dislocation of the hip? Select one: a. Grasp the inner aspects of the baby's calves with thumbs and forefingers. b. Gently abduct the baby's thighs listening for clicks at the joints. c. Palpate the baby's patellae to assess for subluxation of the bones. d. Dorsiflex the baby's feet.

The correct answer is: Gently abduct the baby's thighs listening for clicks at the joints. The Barlow-Ortolani maneuver evaluates for congenital hip dislocation. The infants knees are flexed toward the trunk and thighs are then gently abducted. The examiner observes for symmetrical leg length, full range of motion, no clicks at joints and equal gluteal folds.

78. A postpartum woman telephones the provider regarding her 5-day-old infant. The client is not scheduled for another weight check until the infant is 14 days old. The new mother is worried about whether breastfeeding is going well. Which statement indicates that breastfeeding is effective for meeting the infant's nutritional needs? Select one: a. Has at least one breast milk stool every 24 hours b. Sleeps for 6 hours at a time between feedings c. Gains 1 to 2 ounces per week d. Has at least six to eight wet diapers per day

The correct answer is: Has at least six to eight wet diapers per day

42. To accurately measure the neonate's head, the nurse places the measuring tape around the head: a. Just above the ears and eyebrows. b. Middle of the ear and over the eyes. c. Middle of the ear and over the bridge of the nose. d. Just below the ears and over the upper lip.

The correct answer is: Just above the ears and eyebrows.

73. During which phase of maternal adjustment will the mother relinquish the baby of her fantasies and accept the real baby, moving forward as a family? Select one: a. Taking in b. Taking on c. Letting go d. Taking hold

The correct answer is: Letting go

72. On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. What is the nurse's highest priority at this time? Select one: a. Calling the woman's primary health care provider b. Beginning an intravenous (IV) infusion of Ringer's lactate solution c. Massaging the woman's fundus d. Assessing the woman's vital signs

The correct answer is: Massaging the woman's fundus - making uterus firm will slow down bleeding

39. While evaluating the reflexes of a newborn, the nurse notes that with a loud noise the newborn symmetrically abducts and extends his arms, his fingers fan out and form a C with the thumb and forefinger, and he has a slight tremor. The nurse would document this finding as a positive _____ reflex. a. glabellar b. tonic neck c. Moro d. Babinski

The correct answer is: Moro.

9. Rho immune globulin will be ordered postpartum if which situation occurs? Select one: a. Mother Rh+, baby Rh- b. Mother Rh-, baby Rh+ c. Mother Rh-, baby Rh- d. Mother Rh+, baby Rh+

The correct answer is: Mother Rh-, baby Rh+

45. Which statement is the best rationale for recommending formula over breastfeeding? a. Mother has a medical condition or is taking drugs that could be passed along to the infant via breast milk. b. Other family members or care providers also need to feed the baby. c. Mother sees bottle feeding as more convenient. d. Mother lacks confidence in her ability to breastfeed.

The correct answer is: Mother has a medical condition or is taking drugs that could be passed along to the infant via breast milk.

64. The early postpartum period is a time of emotional and physical vulnerability. Many mothers can easily become psychologically overwhelmed by the reality of their new parental responsibilities. Fatigue compounds these issues. Although the baby blues are a common occurrence in the postpartum period, approximately 500,000 women in America experience a more severe syndrome known as PPD. Which statement regarding PPD is essential for the nurse to be aware of when attempting to formulate a nursing diagnosis? Select one: a. This syndrome affects only new mothers. b. PPD symptoms are consistently severe. c. PPD can easily go undetected. d. Only mental health professionals should teach new parents about this condition.

The correct answer is: PPD can easily go undetected.

17. A first-time dad is concerned that his 3-day-old daughter's skin looks "yellow." In the nurse's explanation of physiologic jaundice, what fact should be included? Select one: a. Physiologic jaundice is caused by blood incompatibilities between the mother and the infant blood types. b. Physiologic jaundice is also known as breast milk jaundice. c. Physiologic jaundice occurs during the first 24 hours of life. d. Physiologic jaundice becomes visible when serum bilirubin levels peak between the second and fourth days of life

The correct answer is: Physiologic jaundice becomes visible when serum bilirubin levels peak between the second and fourth days of life

55. As part of their teaching function at discharge, nurses should educate parents regarding safe sleep. Based on the most recent evidence, which information is incorrect and should be discussed with parents? Select one: a. Prevent exposure to people with upper respiratory tract infections. b. Avoid loose bedding, water beds, and beanbag chairs. c. Keep the infant away from secondhand smoke. d. Place the infant on his or her abdomen to sleep.

The correct answer is: Place the infant on his or her abdomen to sleep. (Infants should always be placed on their backs to sleep.

40. The nurse assesses that a full-term neonate's temperature is 97.1°F (36.2°C). The first nursing action is to: a. Turn up the heat in the room. b. Place the neonate on the mother's chest with a warm blanket over the mother and baby. c. Take the neonate to the nursery and place in a radiant warmer. d. Notify the neonate's primary provider.

The correct answer is: Place the neonate on the mother's chest with a warm blanket over the mother and baby.

21. A newborn is jaundiced and is receiving phototherapy via ultraviolet bank lights. What is the most appropriate nursing intervention when caring for an infant with hyperbilirubinemia and receiving phototherapy? Select one: a. Placing eye shields over the newborn's closed eyes b. Limiting the newborn's intake of milk to prevent nausea, vomiting, and diarrhea c. Applying an oil-based lotion to the newborn's skin to prevent dying and cracking d. Changing the newborn's position every 4 hours

The correct answer is: Placing eye shields over the newborn's closed eyes

41. Typical signs of abusive head trauma (AHT, also known as Shaken Baby Syndrome) include which of the following? (Select all that apply.) a. Broken clavicle b. Poor feeding c. Vomiting d. Breathing problems

The correct answer is: Poor feeding; Vomiting; Breathing problems.

15. During a telephone follow-up conversation with a woman who is 4 days postpartum, the woman tells the nurse, "I don't know what's wrong. I love my son, but I feel so let down. I seem to cry for no reason!" Which condition might this new mother be experiencing? Select one: a. Postpartum blues b. Attachment difficulty c. Postpartum depression (PPD) d. Letting-go

The correct answer is: Postpartum blues

29. Parents have been asked by the neonatologist to provide breast milk for their newborn son, who was born prematurely at 32 weeks of gestation. The nurse who instructs them regarding pumping, storing, and transporting the milk needs to assess their knowledge of lactation. Which statement is valid? Select one: a. A glass of wine just before pumping will help reduce stress and anxiety. b. Premature infants more easily digest breast milk than formula. c. The mother should pump every 2 to 3 hours, including during the night. d. The mother should only pump as much milk as the infant can drink.

The correct answer is: Premature infants more easily digest breast milk than formula. The question asks- The nurse who instructs them regarding pumping, storing, and transporting the milk needs to assess their knowledge of lactation. Which statement is valid? This answer (the mother should pump every 2-3 hours, including during the night) does not address knowledge of lactation, as indicated in this statement. The answer "Premature infants more easily digest breast milk than formula" does.

65. After giving birth to a healthy infant boy, a primiparous client, 16 years of age, is admitted to the postpartum unit. An appropriate nursing diagnosis for her at this time is "Deficient knowledge of infant care." What should the nurse be certain to include in the plan of care as he or she prepares the client for discharge? Select one: a. Give the client written information on bathing her infant. b. Teach the client how to feed and bathe her infant. c. Provide time for the client to bathe her infant after she views a demonstration of infant bathing. d. Advise the client that all mothers instinctively know how to care for their infants.

The correct answer is: Provide time for the client to bathe her infant after she views a demonstration of infant bathing.

103. Which type of formula is not diluted with water, before being administered to an infant? Select one: a. Concentrated b. Powdered c. Modified cow's milk d. Ready-to-use

The correct answer is: Ready-to-use

3. What should the nurse's next action be if the client's white blood cell (WBC) count is 25,000/mm3 on her second postpartum day? Select one: a. Immediately begin antibiotic therapy. b. Immediately inform the physician. c. Recognize that this count is an acceptable range at this point postpartum d. Have the laboratory draw blood for reanalysis.

The correct answer is: Recognize that this count is an acceptable range at this point postpartum

1. The nurse should be cognizant of which postpartum physiologic alteration? Select one: a. Hypercoagulable state protects the new mother from thromboembolism, especially after a cesarean birth. b. Lowered white blood cell count after pregnancy can lead to false-positive results on tests for infections. c. Respiratory function returns to nonpregnant levels by 6 to 8 weeks after childbirth d. Cardiac output, pulse rate, and stroke volume all return to prepregnancy normal values within a few hours of childbirth.

The correct answer is: Respiratory function returns to nonpregnant levels by 6 to 8 weeks after childbirth

32. What are the most common causes for subinvolution of the uterus? a. Postpartum hemorrhage and infection b. Uterine tetany and overproduction of oxytocin c. Multiple gestation and postpartum hemorrhage d. Retained placenta fragments and infection

The correct answer is: Retained placenta fragments and infection.

61. The laboratory results for a postpartum woman are as follows: blood type, A; Rh status, positive; rubella non-immune (titer 1:8 or enzyme immunoassay [EIA] 0.8); hematocrit, 30%. How should the nurse best interpret these data? Select one: a. Rh immune globulin is necessary within 72 hours of childbirth. b. Rubella vaccine should be administered. c. Blood transfusion is necessary. d. Kleihauer-Betke test should be performed.

The correct answer is: Rubella vaccine should be administered.

44. One of the following neonates is at highest risk for cold stress: a. LGA neonate at 38 weeks gestation. b. AGA neonate at 37 weeks gestation. c. SGA neonate at 33 weeks gestation. d. SGA neonate at 40 weeks gestation.

The correct answer is: SGA neonate at 33 weeks gestation.

93. The nurse observes that a first-time mother appears to ignore her newborn. Which strategy should the nurse use to facilitate mother-infant attachment? Select one: a. Tell the mother she must pay attention to her infant. b. Arrange for the mother to watch a video on parent-infant interaction. c. Show the mother how the infant initiates interaction and attends to her. d. Demonstrate for the mother different positions for holding her infant while feeding.

The correct answer is: Show the mother how the infant initiates interaction and attends to her.

77. Painful nipples are a major reason why women stop breastfeeding. A primary intervention to decrease nipple irritation is: Select one: a. Teaching proper techniques for latching-on and releasing of suction b. Applying hot compresses to breast prior to feeding c. Instructing woman to express colostrum or milk at the end of the feeding session and rub it on her nipples d. Air drying nipples for 10 minutes at the end of the feeding session

The correct answer is: Teaching proper techniques for latching-on and releasing of suction While all these interventions are correct, the primary intervention is to ensure correct latching-on and suction release as problems with these lead to early cessation of breastfeeding.

4. A woman gave birth to a 7-pound, 6-ounce infant girl 1 hour ago. The birth was vaginal and the estimated blood loss (EBL) was 1500 ml. When evaluating the woman's vital signs, which finding would be of greatest concern to the nurse? Select one: a. Temperature 36.8° C, heart rate 60 bpm, respirations 18 breaths per minute, and blood pressure 140/90 mm Hg b. Temperature 37.4° C, heart rate 88 bpm, respirations 36 breaths per minute, and blood pressure 126/68 mm Hg c. Temperature 37.9° C, heart rate 120 bpm, respirations 20 breaths per minute, and blood pressure 90/50 mm Hg d. Temperature 38° C, heart rate 80 bpm, respirations 16 breaths per minute, and blood pressure 110/80 mm Hg

The correct answer is: Temperature 37.9° C, heart rate 120 beats per minute (bpm), respirations 20 breaths per minute, and blood pressure 90/50 mm Hg. These vital signs best demonstrate the body's attempt to compensate for significant blood loss

96. Four babies have just been admitted into the neonatal nursery. Which of the babies should the nurse assess first? Select one: a. The baby with respirations 52, oxygen saturation 98% b. The baby with Apgar 9/9, weight 2960 grams c. The baby with temperature 96.3°F, length 17 inches d. The baby with glucose 60 mg/dL, heart rate 132

The correct answer is: The baby with temperature 96.3°F, length 17 inches

38. In follow-up appointments or visits with parents and their new baby, it is useful if the nurse can identify infant behaviors that can either facilitate or inhibit attachment. What is an inhibiting behavior? a. The infant clings to the parents. b. The infant seeks attention from any adult in the room. c. The infant cries only when hungry or wet. d. The infant's activity is somewhat predictable.

The correct answer is: The infant seeks attention from any adult in the room.

28. A newly delivered mother who intends to breastfeed tells her nurse, "I am so relieved that this pregnancy is over so that I can start smoking again." The nurse encourages the client to refrain from smoking. However, this new mother is insistent that she will resume smoking. How will the nurse adapt her health teaching with this new information? Select one: a. The mother should not smoke in the same room her baby is in. b. Smoking has little-to-no effect on milk production c. The effects of secondhand smoke on infants are less significant than for adults. d. No relationship exists between smoking and the time of feedings.

The correct answer is: The mother should not smoke in the same room her baby is in.

16. The nurse caring for a newborn checks the record to note clinical findings that occurred before her shift. Which finding related to the renal system would be of increased significance and require further action? Select one: a. Weight loss from fluid loss and other normal factors should be made up in 4 to 7 days. b. Breastfed infants will likely void more often during the first days after birth. c. The pediatrician should be notified if the newborn has not voided in 24 hours d. Brick dust or blood on a diaper is always cause to notify the physician.

The correct answer is: The pediatrician should be notified if the newborn has not voided in 24 hours

34. A recently delivered mother and her baby are at the clinic for a 6-week postpartum checkup. Which response by the client alerts the nurse that psychosocial outcomes have not been met? a. The woman feels that her baby is more attractive and clever than any others. b. The woman has a partner or family members who react very positively about the baby. c. The woman excessively discusses her labor and birth experience. d. The woman has not given the baby a name.

The correct answer is: The woman has not given the baby a name.

25. A new father wants to know what medication was put into his infant's eyes and why it is needed. How does the nurse explain the purpose of the erythromycin (Ilotycin) ophthalmic ointment? Select one: a. This ointment prevents the infant's eyelids from sticking together and helps the infant see. b. Erythromycin (Ilotycin) ophthalmic ointment destroys an infectious exudate caused by Staphylococcus that could make the infant blind. c. Erythromycin (Ilotycin) prevents potentially harmful exudate from invading the tear ducts of the infant's eyes, leading to dry eyes. d. This ophthalmic ointment prevents gonorrheal infection of the infant's eyes, potentially acquired from the birth canal.

The correct answer is: This ophthalmic ointment prevents gonorrheal infection of the infant's eyes, potentially acquired from the birth canal.

6. What information should the nurse understand fully regarding rubella and Rh status? Select one: a. Women should be warned that the rubella vaccination is teratogenic and that they must avoid pregnancy for at least 1 month after vaccination b. Breastfeeding mothers cannot be vaccinated with the live attenuated rubella virus. c. Rh immunoglobulin boosts the immune system and thereby enhances the effectiveness of vaccinations. d. Rh immunoglobulin is safely administered intravenously because it cannot harm a nursing infant.

The correct answer is: Women should be warned that the rubella vaccination is teratogenic and that they must avoid pregnancy for at least 1 month after vaccination

85. Which concerns regarding parenthood are often expressed by visually impaired mothers? Select one or more. a. needing extra time for parenting activities to accommodate the visual limitations. b. infant safety c. ability to care for the infant d. transportation.

The correct answers are: "needing extra time for parenting activities to accommodate the visual limitations" "infant safety" "transportation"

84. Nurses play a critical role in educating parents regarding measures to prevent infant abduction. Which instructions contribute to infant safety and security. SATA. a. The baby should be carried in the parent's arms from the room to the nursery. b. The mom should request that a second staff member verify the identity of any questionable person. c. Because of infant security systems, the baby can be left unattended in the client's room. d. The mother should check the photo identification of any person who comes to her room. e. Parents should use caution when posting photographs of their infant on the internet.

The correct answers are: "The mom should request that a second staff member verify the identity of any questionable person." "The mother should check the photo identification of any person who comes to her room." "Parents should use caution when posting photographs of their infant on the internet."

97. Which of the following statements indicates that a new mother needs additional teaching? Select all that apply: a. "I need to supervise my cat when she is in the same room as my baby." b. "I will place my baby on her back when she is sleeping." c. "I will not leave my baby on an elevated flat surface after she is able to turn over on her own." d. "I have asked my husband to install safety latches on the lower cabinets."

The correct answers are: "I need to supervise my cat when she is in the same room as my baby.", "I will not leave my baby on an elevated flat surface after she is able to turn over on her own."

56. General skin care for full-term infants includes which of the following? (Select all that apply.) Select one or more: a. Avoid daily bathing with soap. It is not necessary to bathe an infant daily. Daily bathing with soap can cause dry skin in the infant. The cleanser should be of neutral pH and free of additives such as fragrances that could be irritants. b. Use a cleanser with a neutral pH. c. Avoid fragrant soaps. It is not necessary to bathe an infant daily. Daily bathing with soap can cause dry skin in the infant. The cleanser should be of neutral pH and free of additives such as fragrances that could be irritants. d. Apply petrolatum-based ointments sparingly to dry skin, but avoid head and face.

The correct answers are: Avoid daily bathing with soap., Use a cleanser with a neutral pH., Avoid fragrant soaps., Apply petrolatum-based ointments sparingly to dry skin, but avoid head and face.

70. The perinatal nurse describes infant feeding cues to a new mother. These feeding cues include (select all that apply): Select one or more: a. Awake and alert b. Mouth movements c. Moving the hand to the mouth d. Yawning

The correct answers are: Awake and alert, Mouth movements, Moving the hand to the mouth The infant demonstrates readiness for feeding when he or she is awake and alert, makes hand-to-mouth or hand-to-hand movements, exhibits sucking or licking, exhibits rooting, and demonstrates increased activity with the arms and legs flexed and the hands in a fist.

27. Which statements concerning the benefits or limitations of breastfeeding are accurate? (Select all that apply.) Select one or more: a. Long-term studies have shown that the benefits of breast milk are only good while baby is breastfeeding. b. Breastfeeding increases the risk of childhood obesity. c. Breast milk changes over time to meet the changing needs as infants grow. d. Breast milk and breastfeeding may enhance cognitive development. e. Benefits to the infant include a reduced incidence of SIDS.

The correct answers are: Breast milk changes over time to meet the changing needs as infants grow., Breast milk and breastfeeding may enhance cognitive development., Benefits to the infant include a reduced incidence of SIDS.

59. A nurse is discussing the signs and symptoms of mastitis with a mother who is breastfeeding. Which findings should the nurse include in the discussion? (Select all that apply.) Select one or more: a. Breast tenderness b. Fever and flulike symptoms c. Warmth in the breast d. Small white blister on the tip of the nipple

The correct answers are: Breast tenderness , Warmth in the breast, Fever and flulike symptoms

57. A first-time mother informs her nurse that she is concerned about infant abduction. The nurse should explain to the parents which of the following? (Select all that apply.) Select one or more:p a. Do not allow a person without proper unit specific hospital ID to take their baby. b. Encourage parents to accompany any person who removes their infant from the hospital room c. Instruct parents not to leave their newborn unattended at any time d. Inform parents that ID bands with matching identification numbers are placed on the parents and infant at birth to ensure identification of the correct infant with the correct parents

The correct answers are: Do not allow a person without proper unit specific hospital ID to take their baby., Encourage parents to accompany any person who removes their infant from the hospital room, Instruct parents not to leave their newborn unattended at any time, Inform parents that ID bands with matching identification numbers are placed on the parents and infant at birth to ensure identification of the correct infant with the correct parents

58. The let-down reflex occurs in response to the release of oxytocin. Which of the following can stimulate the release of oxytocin? (Select all that apply.) Select one or more: a. Emotional response to thinking about her baby b. Infant suckling c. Emotional response to hearing an infant crying d. Sexual activity

The correct answers are: Emotional response to thinking about her baby, Infant suckling, Emotional response to hearing an infant crying, Sexual activity The let-down reflex or milk ejection reflex results in milk being ejected into and through the lactiferous duct system. Oxytocin causes the alveoli to contract and forces milk into the duct system. Oxytocin is released in response to suckling and/or maternal emotional response to hearing a baby cry or thinking of her own baby. Let-down reflex also occurs during sexual arousal.

12. The nurse is caring for a postpartum woman who gave birth to a healthy, full-term baby girl. She has a 2-year-old son. She voices concern about her older child's adjustment to the new baby. Nursing actions that will facilitate the older son's adjustment to having a new baby in the house would include which of the following? (Select all that apply.) Select one or more: a. Explain to the mother that she can have her son visit her in the hospital. b. Teach her son how to change the baby's diapers. c. Assist her son in holding his new baby sister. d. Recommend that she spend time reading to her older son while he sits in her lap.

The correct answers are: Explain to the mother that she can have her son visit her in the hospital., Assist her son in holding his new baby sister. Younger children experience a sense of loss over no longer being the baby of the family while older children may have a sense of increased responsibility. Siblings should be introduced to the newest family member as soon as possible and spend time with his/her mother and new sibling during the postpartum hospitalization.

19. The postpartum mother asks the nurse why is it so important to prevent cold stress in her baby- can't she shiver to stay warm? What should the nurse include in their response? (Select all that apply) Select one or more: a. Yes, your baby can shiver; but it important that we prevent her from needing to so. b. If your baby gets too cold and we don't help her, her body will use a lot of oxygen to try and get warm, which can ultimately lead to decrease oxygen to her lungs and body causing respiratory problems. c. Your baby will eventually warm up on her own, but it is best if we keep the hat on her head. d. No, your baby cannot shiver; therefore, it is important to prevent her from losing body heat.

The correct answers are: If your baby gets too cold and we don't help her, her body will use a lot of oxygen to try and get warm, which can ultimately lead to decrease oxygen to her lungs and body causing respiratory problems., No, your baby cannot shiver; therefore, it is important to prevent her from losing body heat.

51. A G2 P2 woman who experienced a prolonged labor and prolonged rupture of membranes is at risk for metritis. Which of the following nursing actions are directed at decreasing this risk? (Select all that apply.) Select one or more: a. Instruct woman to increase her fluid intake b. Instruct woman to change her peri-pads after each voiding c. Instruct woman to ambulate in the halls four times a day d. Instruct woman to apply ice packs to the perineum

The correct answers are: Instruct woman to increase her fluid intake, Instruct woman to change her peri-pads after each voiding, Instruct woman to ambulate in the halls four times a day. Metritis is an infection of the endometrium, myometrium, and/or parametrial tissue. Risk factors include cesarean birth, prolonged rupture of membranes, prolonged labor, etc. Symptoms include elevated temp, lower abdominal pain, uterine tenderness, tachycardia, subinvolution. Metritis is generally treated with antibiotics based on culture results. Nursing actions include proper hand washing techniques, proper pericare/wipe front to back after urination, change peripad after each urination, early ambulation, rehydration, diet high in protein/vitamin C, and monitoring for symptoms.

76. The "Period of Purple Crying" is a program developed to educate new parents about infant crying and the dangers of shaking a baby. Each letter in the acronym "PURPLE" represents a key concept of this program. Which concepts are accurate? (Select all that apply.) Select one or more: a. U: unexpected b. L: extremely loud c. P: peak of crying and painful expression d. E: evening e. R: baby is resting at last

The correct answers are: P: peak of crying and painful expression, U: unexpected, E: evening

89. Which of the following nursing actions are directed at promoting bonding? (Select all that apply.) Select one or more: a. Providing opportunity for parents to hold their newborn as soon as possible following the birth. b. Providing opportunities for the couple to talk about their birth experience and about becoming parents. c. Promoting rest and comfort by keeping the newborn in the nursery at night. d. Providing positive comments to parents regarding their interactions with their newborn.

The correct answers are: Providing opportunity for parents to hold their newborn as soon as possible following the birth., Providing opportunities for the couple to talk about their birth experience and about becoming parents., Providing positive comments to parents regarding their interactions with their newborn.

10. If a woman is at risk for thrombus and is not ready to ambulate, which nursing intervention would the nurse use? (Select all that apply.) Select one or more: a. Having her flex, extend, and rotate her feet, ankles, and legs b. Putting her in antiembolic stockings (thromboembolic deterrent [TED] hose) and/or sequential compression device (SCD) boots c. Having her sit in a chair d. Immediately notifying the physician if a positive Homans sign occurs e. Promoting bed rest

The correct answers are: Putting her in antiembolic stockings (thromboembolic deterrent [TED] hose) and/or sequential compression device (SCD) boots, Having her flex, extend, and rotate her feet, ankles, and legs , Immediately notifying the physician if a positive Homans sign occurs

53. Which of the following nursing actions are directed at assisting men in their transition to fatherhood? (Select all that apply.) Select one or more: a. Encourage the woman to take on the major responsibility for infant care. b. Talk to the couple about their expectations of the parenting role. c. Praise the father for his interactions with his infant. d. Provide information on infant care and behavior to both parents.

The correct answers are: Talk to the couple about their expectations of the parenting role., Praise the father for his interactions with his infant., Provide information on infant care and behavior to both parents. It is important to first have the couple discuss with each other their expectations of the fathering role. Once this has occurred, then the woman and nurse need to support the man in his role of infant care. Both parents need to receive information about infant care and infant behaviors, and both parents need to be praised for their interactions with their baby.

11. A parent who has a hearing impairment is presented with a number of challenges in parenting. Which nursing approaches are appropriate for working with hearing-impaired new parents? (Select all that apply.) Select one or more: a. Ascertaining whether the client can read lips before teaching b. Using devices that transform sound into light c. Assuming that the client knows sign language d. Speaking quickly and loudly e. Writing messages that aid in communication

The correct answers are: Using devices that transform sound into light, Ascertaining whether the client can read lips before teaching, Writing messages that aid in communication

62. The clinic nurse sees Xiao and her infant in the clinic for their 2-week follow-up visit. Xiao appears to be tired, her clothes and hair appear unwashed, and she does not make eye contact with her infant. She is carrying her son in the infant carrier and when asked to put him on the examining table, she holds him away from her body. The clinic nurse's most appropriate question to ask would be: Select one: a. "What has happened to you?" b. "Do you have help at home?" c. "Is there anything wrong with your son?" d. "Would you tell me about the first few days at home?"

The well-baby checkup that generally takes place 1 to 2 weeks following the hospital discharge may offer the first opportunity to assess the mother-baby dyad. In this setting, the nurse needs to be alert for subtle cues from the new mother, such as making negative comments about the baby or herself, ignoring the baby's or other children's needs, as well as the mother's physical appearance. In a private area, the nurse should take time to explore the new mother's feelings. A nonthreatening way to open the dialogue might be to say: "Tell me how the first few days at home have gone." This statement provides the new mother with an opportunity to share both positive and negative impressions. The correct answer is: "Would you tell me about the first few days at home?"