PrepUtest2

The pregnant client is discussing her dietary needs during pregnancy. Which statements indicate a correct understanding of the intake needed? Select all that apply.

"At least 8 glasses of water daily is needed to maintain hydration." "Taking in at least 1000 mg of calcium daily is important during pregnancy." "Taking my daily iron supplement is key to my pregnancy's health."

A 27-year-old client is in the first trimester of an unplanned pregnancy. She acknowledges that it would be best if she were to quit smoking now that she is pregnant, but states that it would be too difficult given her 13 pack-year history and circle of friends who also smoke. She asks the nurse, "Why exactly is it so important for me to quit? I know lots of smokers who have happy, healthy babies." What can the nurse tell the client about the potential effects of smoking in pregnancy?

"Babies of women who smoke tend to weigh significantly less than other infants."

An older female pregnant with her first child develops some pain in her legs associated with warmth to touch. Suspecting a blood clot, an ultrasound is presribed and a peripheral venous thrombosis is diagnosed. Which intervention was likely prescribed for this woman?

"Buy and wear medical support hose every day."

A pregnant woman notices that sometimes her heart beat is irregular when she is lying down resting on her back. The provider suspects she is experiencing low blood pressure. Which intervention would the health care provider suggest to the woman to prevention this from occurring? Select all that apply.

"Change positions slowly to allow pooled blood to reenter the circulation slowly." "Try sleeping and resting on your side with a small pillow between the knees."

A primigravida who is 40 weeks' pregnant thinks she may be in labor. She calls the nurse and reports that she has had 10 contractions in the last hour. She says that they are mildly painful and last 45 seconds. What is the best response from the nurse?

"Did your water break? Do you feel the baby moving?"

A pregnant client reports frequent urination and tells the health care provider that she has stopped drinking water during the day since she cannot take many breaks during work. Which statement by the nurse is most appropriate at this time?

"Fluids are necessary so your blood volume can double, which is normal in pregnancy."

A pregnant woman at her first prenatal visit asks the nurse if it is safe to have sex during her pregnancy. Which client statement alerts the nurse to the need for further teaching?

"I should substitute intercourse with nonsexual touch to avoid harming the fetus."

A client who is 32 weeks gestation tells the nurse that she has been experiencing shortness of breath when walking up the steps at home. She is concerned that something is wrong. What is the nurse's best response?

"The enlarging uterus pushes against your diaphragm and this makes breathing shallow"

The maternal health nurse is caring for a pregnant client who reports breast tenderness. Which statement(s) will the nurse include when teaching the client about breast self-care? Select all that apply.

"Wash your nipples with clear tap water and no soap." "Colostrum may appear in your second trimester."

Leopold's maneuvers steps

- Maneuver 1: What fetal part (head or buttocks) is located in the fundus (top of the uterus)? - Maneuver 2: On which maternal side is the fetal back located? (Fetal heart tones are best auscultated through the back of the fetus.) - Maneuver 3: What is the presenting part? - Maneuver 4: Is the fetal head flexed and engaged in the pelvis?

- Signs that the placenta is separating include:

- a firmly contracting uterus - a change in uterine shape from discoid to globular ovoid - a sudden gush of dark blood from the vaginal opening - and lengthening of the umbilical cord protruding from the vagina.

The extent of the laceration is defined by depth:

- a first-degree laceration extends through the skin - a second-degree laceration extends through the muscles of the perineal body - a third-degree laceration continues through the anal sphincter muscle - a fourth-degree laceration also involves the anterior rectal wall.

A client in labor is administered lorazepam to help her relax enough so that she can participate effectively during her labor process rather than fighting against it. For which adverse effect of the drug should the nurse monitor? A. Increased sedation B. Newborn respiratory depression C. Nervous system depression D. Decreased alertness

- increase sedation is an adverse effect of lorezapam - diazepam and midazolam cause CNS depression - opiods cause newborn respiration depression

A pregnant woman admitted to the labor and birth suite undergoes rapid HIV testing and is found to be HIV-positive. Which of the following would the nurse expect to include when developing a plan of care for this women? (Select all that apply.) A) Administration of penicillin G at the onset of labor B) Avoidance of scalp electrodes for fetal monitoring C) Refraining from obtaining fetal scalp blood for pH testing D) Administering zidovudine at the onset of labor. E) Electing for the use of forceps-assisted delivery

-Avoidance of scalp electrodes for fetal monitoring -Refraining from obtaining fetal scalp blood for pH testing -Administering zidovudine at the onset of labor

Which position would be most appropriate for the nurse to suggest as a comfort measure to a woman who is in the first stage of labor? (Select all that apply.) A) Walking with partner support B) Straddling with forward leaning over a chair C) Closed knee-chest position D) Rocking back and forth with foot on chair E) Supine with legs raised at a 90-degree angle

-Walking with partner support -Straddling with forward leaning over a chair -Rocking back and forth with foot on chair

Positioning during the first stage of labor includes:

-walking with support from the partner - side-lying with pillows between the knees - leaning forward by straddling a chair, table, or bed or kneeling over a birthing ball -lunging by rocking weight back and forth with a foot up on a chair or birthing ball or an open knee-chest position.

For continuous internal electronic fetal monitoring, four criteria must be met:

1. ruptured membranes 2. cervical dilation of at least 2 cm 3. fetal presenting part low enough to allow placement of the electrode 4. skilled practitioner available to insert the electrode.

A newly pregnant client says that she has heard that her nipples will leak milk during the pregnancy. The nurse should tell the client that she may begin to express colostrum from her nipples by how many weeks' gestation?

16 to 20

The nurse is monitoring a pregnant client admitted to a health care center who is in the latent phase of labor. The nurse demonstrates appropriate nursing care by monitoring the fetal heart rate with the Dopplar at least how often?

30 to 60 min

The woman's temperature is typically assessed every ____ hours during the first stage of labor and every ____ hours after ruptured membranes.

4 2

A 29-week-gestation client is admitted with moderate vaginal discharge. The nurse performs a nitrazine test to determine if the membranes have ruptured. The nitrazine tape remains yellow to olive green, with pH between 5 and 6. What should the nurse do NEXT? A. Prepare the client for birth B. Assess the client's cervical status C. notify the health care provider D. perform leopold's maneuver

5 to 6 pH means acidic environment with presence of vaginal fluid and less blood. notify provider

A 35-year-old client has been told to keep her pulse rate below 140 bpm during workouts because she pregnant. This means that the client will be working roughly what percentage of the suggested pulse rate?

75%

As part of a local college awareness program, a nurse is interviewing several of the participants about their views on rape. Which statement would lead the nurse to determine that teaching about rape is necessary? a. "A woman can avoid being raped. If she doesn't want it to happen, then it won't." b. "Most victims of rape never report the episode to the police or tell anyone about it." c. "What a woman wears has no effect on whether or not she will be raped." d. "Women who are raped may require several years to recover emotionally and physically."

A

There are reasons why formula feeding may be necessary. What is one reason? A. If mother is taking a medication that can harm the newborn. B. If increased immunologic coverage is needed. C. If the infant has multiple episode of otitis media D. If cost is not an issue.

A

When a nurse suspects that a client may have been abused, the first action should be to: a. ask the client about the injuries and if they are related to abuse. b. encourage the client to leave the batterer immediately. c. set up an appointment with a domestic violence counselor. d. ask the suspected abuser about the victim's injuries.

A

When implementing an intervention for a woman in an abusive situation, what is the primary goal? a. The woman will regain a sense of control in her life. b. The woman will be removed from her abusive relationship. c. The woman will be able to care for herself. d. The woman will be able to stand up to her abuser .

A

The nurse notes persistent early decelerations on the fetal monitoring strip. Which of the following would the nurse do next? A) Continue to monitor the FHR because this pattern is benign. B) Perform a vaginal exam to assess cervical dilation and effacement. C) Stay with the client while reporting the finding to the physician. D) Administer oxygen after turning the client on her left side.

A Early decelerations are not indicative of fetal distress and do not require intervention. Therefore, the nurse would continue to monitor the fetal heart rate pattern. They are most often seen during the active stage of any normal labor, during pushing, crowning, or vacuum extraction. They are thought to be a result of fetal head compression that results in a reflex vagal response with a resultant slowing of the FHR during uterine contractions.

A pregnant woman in her second trimester tells the nurse, "I've been passing a lot of gas and feel bloated." Which of the following suggestions would be helpful for the woman? A) "Watch how much beans and onions you eat." B) "Limit the amount of fluid you drink with meals" C) "Try exercising a little more." D) "Some say that eating mints can help." E) "Cut down on your intake of cheeses."

A) "Watch how much beans and onions you eat." C) "Try exercising a little more." D) "Some say that eating mints can help."

A biophysical profile has been completed on a pregnant woman. The nurse interprets which score as normal? A) 9 B) 7 C) 5 D) 3

A) 9

A woman in the 34th week of pregnancy says to the nurse, "I still feel like having intercourse with my husband." The woman's pregnancy has been uneventful. The nurse responds based on the understanding that: A) It is safe to have intercourse at this time. B) Intercourse at this time is likely to cause rupture of membranes. C) There are other ways that the couple can satisfy their needs. D) Intercourse at this time is likely to result in premature labor.

A) It is safe to have intercourse at this time.

A pregnant woman is scheduled to undergo percutaneous umbilical blood sampling. When discussing this test with the woman, the nurse reviews what can be evaluated with the specimens collected. Which of the following would the nurse include? (Select all that apply.) A) Rh incompatibility B) Fetal acid-base status C) Sex-linked disorders D) Enzyme deficiencies E) Coagulation studies

A) Rh incompatibility B) Fetal acid-base status E) Coagulation studies

After teaching a group of students about the discomforts of pregnancy, the students demonstrate understanding of the information when they identify which as common during the first trimester? (Select all that apply.) A) Urinary frequency B) Breast tenderness C) Cravings D) Backache E) Leg cramps

A) Urinary frequency B) Breast tenderness C) Cravings

It is important for a nurse working in pediatrics to understand problems that children face when they have grown up around abuse. Studies indicate that children who witness intimate partner violence are at risk for developing which problems? Select all that apply. a. psychiatric disorders b. developmental problems c. failure to thrive syndrome d. school failures e. violence against others f. low self-esteem c

A, B, D, E, F

A woman in labor received an opioid close to the time of birth. The nurse would assess the newborn for which of the following? A) Respiratory depression B) Urinary retention C) Abdominal distention D) Hyperreflexia

A.

A woman has just entered the second stage of labor. The nurse would focus care on which of the following? A) Encouraging the woman to push when she has a strong desire to do so B) Alleviating perineal discomfort with the application of ice packs C) Palpating the woman's fundus for position and firmness D) Completing the identification process of the newborn with the mother

A. During the second stage of labor, nursing interventions focus on motivating the woman, encouraging her to put all her efforts toward pushing.

The nurse is performing Leopold's maneuvers to determine fetal presentation, position, and lie. Which action would the nurse do first? A) Feel for the fetal buttocks or head while palpating the abdomen. B) Feel for the fetal back and limbs as the hands move laterally on the abdomen. C) Palpate for the presenting part in the area just above the symphysis pubis. D) Determine flexion by pressing downward toward the symphysis pubis.

A. - The first maneuver involves feeling for the buttocks and head. - Next the nurse palpates on which side the fetal back is located. - The third maneuver determines presentation and involves palpating the area just above the symphysis pubis. - The final maneuver determines attitude and involves applying downward pressure in the direction of the symphysis pubis.

Which of the following is a priority when caring for a woman during the fourth stage of labor? A) Assessing the uterine fundus B) Offering fluids as indicated C) Encouraging the woman to void D) Assisting with perineal care

A. During the fourth stage of labor, a priority is to assess the woman's fundus to prevent postpartum hemorrhage.

A nurse palpates a woman's fundus to determine contraction intensity. Which of the following would be most appropriate for the nurse to use for palpation? A) Finger pads B) Palm of the hand C) Finger tips D) Back of the hand

A. To palpate the fundus for contraction intensity, the nurse would place the pads of the fingers on the fundus and describe how it feels.

A nurse is describing the different types of regional analgesia and anesthesia for labor to a group of pregnant women. Which statement by the group indicates that the teaching was successful? A) "We can get up and walk around after receiving combined spinal-epidural analgesia." B) "Higher anesthetic doses are needed for patient-controlled epidural analgesia. C) "A pudendal nerve block is highly effective for pain relief in the first stage of labor." D) "Local infiltration using lidocaine is an appropriate method for controlling contraction pain."

A. When compared with traditional epidural or spinal analgesia, which often keeps the woman lying in bed, combined spinal-epidural analgesia allows the woman to ambulate ("walking epidural").

A client's membranes spontaneously ruptured, as evidenced by a gush of clear fluid with a contraction. Which of the following would the nurse do next? A) Check the fetal heart rate. B) Perform a vaginal exam. C) Notify the physician immediately. D) Change the linen saver pad.

A. When membranes rupture, the PRIORITY focus is on assessing fetal heart rate first to identify a deceleration, which might indicate cord compression secondary to cord prolapse.

One thing a new mother does is to adapt to the new baby psychologically. The woman takes on her new role as mother by going through a series of four developmental stages. What is one of them? A. Achieving a maternal identity B. Finding a way to get the new baby to conform to existing family interrelationships. C. Physical restoration and learning to get help in caring for the infant. D. Preparing for the infant before she conceives.

A. Achieving a maternal identity. The woman adapts to her new role as mother through a series of four developmental stages: 1. Beginning attachment and preparation for the infant during pregnancy. 2. Increasing attachment, learning to care for the infant, and physical restoration during the early postpartum period. 3. Moving toward a new normal in the first four months. 4. Achieving a maternal identity around four months.

The night shift nurse is checking on a woman who had a cesarean delivery with a spinal Duramorph anesthesia early that morning. The nurse counts a respiratory rate of eight per minute. What should the nurse do first? A. Administer naloxone (Narcan), per the preprinted orders B. Awaken the woman and instruct her to breathe more rapidly C. Call the anesthesiologist from the room for orders D. Perform bag-to-mouth rescue breathing at a rate of 12 per minute.

A. Administer naloxone (Narcan), per the preprinted orders. Have naloxone (Narcan) readily available. The anesthesiologist orders naloxone administration if the respiratory rate falls below 10 to 12 per minute.

It is important to assess the breast feeding mother and her infant during a feeding session. What assessment has priority during the feeding session? A. Assess the position, latching on, and sucking of the newborn. B. Assess the woman's visitors and their opinions regarding breastfeeding C. Check the woman's perineal pad for increased lochia flow D. Determine if the woman needs a visit from the lactation consultat.

A. Assess the position, latching on and sucking of the newborn. Correct positioning and latching on of the newborn will help avoid nipple tissue trauma and sore nipples. Once the newborn is nursing, evaluate the effectiveness of the latch and sucking.

You are providing car for a 10 lb 2 oz newborn who is 3 hours old. The infant begins to display signs of hypoglycemia. You do a heel stick to obtain the infant's blood glucose level. At what blood glucose level would you treat the infant for neonatal hypoglycemia. A. Blood glucose of 50 mg/dL B. Blood glucose of 55 mg/dL C. Blood glucose of 60 mg/dL D. Blood glucose of 65 mg/dL

A. Blood glucose of 50 mg/dL If a heel stick specimen reveals a glucose level of less than 50 mg/dL, draw a venous blood sample and send it to the laboratory for confirmation, because it is common for bedside glucose analyzers to underread glucose results. It is critical; however, that you immediately initiate treatment. Follow institutional policy for frequency of testing asymptomatic newborns at risk for hypoglycemia.

Neonatal hypoglycemia is a risk of newborns with diabetic mothers. What laboratory value would be classified as neonatal hypoglycemia? A. Blood glucose of 50 mg/dL B. Blood glucose of 55 mg/dL C. Blood glucose of 60 mg/dL D. Blood glucose of 65 mg/dL

A. Blood glucose of 50 mg/dL Neonatal hypoglycemia occurs when blood glucose levels drop to 50 mg/dL or lower.

While assessing the breastfeeding of a new mother and her infant, you notice that she is dimpling her breast near the newborn's mouth and nose. What would be the most important reason for you to teach the new mother not to do this? A. It can put pressure on the milk ducts and decrease the flow of milk to the infant B. It can lead to sore nipples C. It doesn't make it easier for the infant to breathe. D. It can make it more difficult for the infant to nurse.

A. It can put pressure on the milk ducts and decrease the flow of milk to the infant. When the newborn is latched onto the breast, make sure the woman does not dimple the breast near the newborn's mouth and nose. Many women do this because they thing they are providing breathing space for the newborn. However, this action can interfere with breast-feeding in several ways. It can cause the nipple to be pulled out of the mouth completely. It can cause the nipple to be pulled to the front of the mouth and lead to sore nipples. It can put pressure on the milk ducts, thereby reducing the flow of milk to the newborn and preventing the breast from emptying completely.

Discharge teaching is an important part of the labor and delivery room nurse's position. New parents need to know the basics of baby care, like how to monitor fluid volume and when to call the physician. What are the parameters for calling the physician in regard to infants' temperature? A. Less than 97.7 or greater than 100 B. Less than 97 or greater than 100.5 C. Less than 96.7 or greater than 99.5 D. Less than 96 or greater than 101

A. Less than 97.7 or greater than 100 Temperatures less than 97.7 or greater than 100 should be reported to the physician.

You are assisting with the admission of a newborn boy to the nursery. The mother's history states that she is of Hispanic descent. You note what appears to be bruising on the left upper outer thigh. How would you document this? A. Mongolian spot noted on left upper outer thigh. B. Harlequin sign noted on the left upper outer thigh C. Mottling noted on the left upper outer thigh D. Birth trauma noted on left upper outer thigh.

A. Mongolian spot noted on left upper outer thigh A Mongolian spot is bluish black areas of discoloration on the back and buttocks or extremities of dark-skinned newborns.

Healthy bonding behaviors are important to note when you are assessing the new family. What would you consider a warning sign that the mother and infant may not be bonding as they should? A. Mother states she wanted a boy this time, not another girl. B. Mother cries and says "I have no family nearby and my mother-in-law doesn't like me." C. Mother wants you in the room while she breastfeeds as she is afraid she isn't doing it right. D. Mother states she is concerned about one of her other children not liking the baby.

A. Mother states she wanted a boy this time, not another girl. It is important to differentiate between a new parent who is nervous and anxious about her new role and one who is rejecting her parenting role. Warning signals of poor attachment include turning away from the newborn, refusing or neglecting to provide care, and disengagement from the newborn.

During pregnancy a woman's cardiovascular system expands to care for the growing fetus. After delivery during the early postpartum period, the woman eliminates the additional fluid volume she has been carrying. In what way does the woman get rid of this fluid? A. Urinary elimination B. Elimination of solid wastes C. Being too tired to eat D. Breathing off fluid vapor

A. Urinary elimination In the early postpartum period, the woman eliminates the additional fluid volume that is present during the pregnancy via the skin and urinary tract and through blood loss.

A woman who has just found out that she is pregnant tells the nurse that she takes docusate sodium (colace). The nurse identifies this drug as a category C medication. Which information best reflects the nurse's understanding of this category?

Animal studies have shown an adverse effect on the fetus, but no adequate studies have been done in humans. Pregnancy risk is unknown.

Which of the following would be most appropriate for the nurse to suggest about pushing to a woman in the second stage of labor? A) "Lying flat with your head elevated on two pillows makes pushing easier." B) "Choose whatever method you feel most comfortable with for pushing." C) " Let me help you decide when it is time to start pushing." D) "Bear down like you're having a bowel movement with every contraction."

Ans. B "Choose whatever method you feel most comfortable with for pushing." * The role of the nurse should be to support the woman in her choice of pushing method and to encourage confidence in her maternal instinct of when and how to push.

Amniotic fluid does not grow stagnant because: A) amniotic fluid is constantly formed by the amnion. B) amniotic fluid is constantly absorbed by the chorion. C) the fetal urine increases the bulk of amniotic fluid. D) amniotic fluid circulates through the chorionic villi.

Ans: A Feedback: Amniotic fluid is formed by the amnion; a main portion of it is swallowed by the fetus.

Assessment for surfactant level is a primary estimation of fetal maturity. The purpose of surfactant is to: A) prevent alveoli from collapsing on expiration. B) increase lung resistance on inspiration. C) encourage immunologic competence of lung tissue. D) promote maturation of lung alveoli.

Ans: A Feedback: Surfactant is a phospholipid that reduces surface tension; it prevents alveoli from collapsing on expiration.

A pregnant patient is directed to perform a daily fetal movement count. What should the nurse instruct the patient about this count? Select all that apply. A) Lie down to do the count after eating a meal. B) Count only movements that are strong enough to hurt. C) Report if no movement is felt for any half-hour period. D) Choose a different time frame each day to count movements. E) Count fetal movements until a total of 10 are counted and record the time.

Ans: A, E Feedback: A healthy fetus moves at about 10 times per hour. The nurse should instruct the patient to lie in a left recumbent position after a meal, observe and record the number of fetal movements or kicks the fetus makes until 10 movements are counted, and record the time. If an hour passes without 10 movements, the patient should walk around a little and try a count again. If 10 movements cannot be felt in a second 1-hour period, the patient should telephone the primary health care provider.

On what day during pregnancy does the embryo implant on the uterine surface? A) the 14th day of a "typical" menstrual cycle B) eight days after ovulation C) ten days after the start of the menstrual flow D) four days after ovulation

Ans: B Feedback: After floating free in the uterine cavity for about 4 days, the zygote implants on the uterine surface on about the 22nd day; thereafter it is termed an embryo.

A pregnant patient scheduled for an amniocentesis asks the nurse how the placenta is not punctured during the procedure. What should the nurse respond to the patient? A) "A uterus feels soft over the placenta site." B) "A sonogram to locate it will be done first." C) "It would not be harmful even if it were punctured." D) "Placentas always form on the posterior uterine wall."

Ans: B Feedback: After the patient is placed in the supine position, a sonogram is done to determine the position of the fetus, the location of a pocket of amniotic fluid, and the placenta. The uterus does not feel soft over the placenta site. It would be harmful if the placenta were punctured during the procedure. Placentas do not always form on the posterior uterine wall.

During a physical assessment, the nurse palpates a pregnant patient's fundus at the level of the umbilicus. What statement should the nurse make to the patient about this assessment finding? A) "You are at 12 weeks of your pregnancy." B) "You are at 20 weeks of your pregnancy." C) "You are at 36 weeks of your pregnancy." D) "You can go into labor at any time now."

Ans: B Feedback: As a fetus grows, the uterus expands to accommodate its size. Typical fundal measurements are over the symphysis pubis at 12 weeks, at the umbilicus at 20 weeks, and at the xiphoid process at 36 weeks. The patient will not be going into labor very soon.

A fetus is capable of producing antibodies. The finding of IgM antibodies in an infant at birth implies that: A) antibodies were transferred to the fetus during pregnancy. B) the fetus contracted an infection during intrauterine life. C) the fetus's liver has reached developmental maturity. D) the mother contracted an infection during pregnancy.

Ans: B Feedback: Because IgM antibodies are too large to cross the placenta, the only way they could be present in a fetus is if they were produced by the fetus in response to invading antigens (Toxoplasma gondii, which causes toxoplasmosis).

The nurse teaches the importance of avoiding nonessential substances to a young adult female who is 6 weeks pregnant. Which patient statement indicates that teaching has been effective? A) "I can drink on weekends only." B) "Smoking is bad for me and my baby." C) "Smoking is permitted as long as I do it outdoors." D) "Only one beer or one glass of wine is permitted while pregnant."

Ans: B Feedback: Because almost all drugs are able to cross into the fetal circulation, it is important that a woman take no nonessential drugs, including alcohol and nicotine, during pregnancy. Alcohol perfuses across the placenta and can cause fetal alcohol sequence disorders. Because it is difficult to tell what quantity is "safe," pregnant women are advised to drink no alcohol during pregnancy. The statement that "smoking is bad for me and my baby" indicates that teaching has been effective. The patient should be instructed to avoid all alcohol intakes while pregnant and to not smoke.

Which precaution should the nurse take with a pregnant woman following an amniocentesis? A) Remind her not to raise her head for 4 hours. B) Assess fetal heart rate and possible uterine contractions. C) Perform a vaginal examination for a ferning pattern. D) Assess for increased abdominal distention.

Ans: B Feedback: Because amniocentesis is an invasive procedure, there is a risk that it might initiate uterine contractions. Assessing for contractions postprocedure is important to safeguard the pregnancy.

Implantation generally occurs at which place on the uterus? A) the lower anterior surface B) the upper posterior surface C) directly over the cervical os D) directly over an opening to a fallopian tube

Ans: B Feedback: Implantation occurs most commonly on the upper posterior surface of the uterus. This position allows the fetus to deliver before the placenta.

The nurse is explaining the process of fertilization to a patient who has just learned of being pregnant. On which day during pregnancy should the nurse explain that the embryo implants on the uterine surface? A) Four days after fertilization B) Eight to 10 days after fertilization C) The 14th day of a "typical" menstrual cycle D) Ten days after the start of the menstrual flow

Ans: B Feedback: Implantation, or contact between the growing structure and the uterine endometrium, occurs approximately 8 to 10 days after fertilization. Four days after fertilization the structure is a zygote. Implantation does not occur on the 14th day of a typical menstrual cycle or 10 days after the start of a menstrual flow.

The fetal-assessment technique of a rhythm strip refers to: A) a fetal EKG, because it is effected by glucose stimulation. B) a tracing of fetal heart rate and pattern. C) the rhythm of fetal heart rate compared to maternal pulse. D) the response of fetal heart rate to oxytocin-stimulated contractions.

Ans: B Feedback: Rhythm-strip testing is recording the fetal heart rate and pattern by an external monitor.

The nurse is planning to instruct a patient who is 12 weeks pregnant on interventions to stop smoking. What should the nurse include in these instructions? Select all that apply. A) Purchase nicotine chewing gum. B) Follow a smoking cessation plan. C) Ask a friend to help with smoking cessation actions. D) Apply a nicotine patch when the cravings become severe. E) Ask the physician if a smoking cessation medication can be used.

Ans: B, C, E Feedback: Interventions to help a pregnant patient with smoking cessation include following a smoking cessation plan, asking a friend to help with smoking cessation actions, and asking the physician if a smoking cessation medication can be used. The patient should not be instructed to purchase nicotine chewing gum or a patch because nicotine is a pregnancy category C drug, will cross into the placenta, and adversely affect the developing fetus.

The nurse determines that a fetal nonstress test is nonreactive for over 20 minutes. The nurse interprets this result as suggesting which situation? Select all that apply. A) The patient is sleeping. B) The patient is hypoglycemic. C) The patient is using an illicit drug. D) The patient is exercising too much. E) The patient is smoking while pregnant.

Ans: B, C, E Feedback: Reasons for lessened variability during a fetal nonstress test include maternal smoking, drug use, or hypoglycemia. Lessened variability does not occur because the patient is sleeping or because the patient is exercising too much.

A pregnant woman is asked to observe fetal movements as a fetal assessment technique. The nurse would instruct her to: A) report if she feels no movement for any half-hour period. B) count only movements that are strong enough to hurt. C) count fetal movements for 1 hour at the same time each day. D) choose a different time frame each day to count movements.

Ans: C Feedback: A healthy fetus moves at least 10 times daily. Counting fetal movements at the same time each day can help document fetal health.

An 18-year-old pregnant woman asks the nurse why she has to have a routine alpha-fetoprotein serum level drawn. The nurse explains that this: A) is a screening test for placental function. B) tests the ability of her heart to accommodate the pregnancy. C) may reveal chromosomal abnormalities. D) measures the fetal liver function.

Ans: C Feedback: An alpha-fetoprotein analysis is a cost-effective screening test to detect chromosomal and open-body-cavity disorders

The nurse is teaching a patient in the first trimester of pregnancy about the importance of folic acid in the diet and how folic acid supplements might be beneficial. For which reason is the nurse teaching the patient about this vitamin? A) Maintains energy throughout the pregnancy B) Controls the risk of hypertension while pregnant C) Prevents neural tube disorders in the developing fetus D) Sustains a slow and steady weight gain while pregnant

Ans: C Feedback: Folic acid deficiency in pregnancy can lead to midline closure defects such neural tube disorders. One of the 2020 National Health Goals addresses an adequate folic acid intake while pregnant, and the nurse can help the nation achieve this goal by urging women to have an optimum folic acid level. Folic acid is not encouraged in the pregnant patient to maintain energy, control the risk of hypertension, or sustain a slow and steady weight gain while pregnant.

A pregnant woman tends not to eat for long periods of time because of her busy work schedule. What process safeguards her fetus from becoming hypoglycemic during this time? A) The brain is too undeveloped to use glucose. B) Women naturally ingest complex carbohydrates to last for long periods during pregnancy. C) Somatomammotropin helps to regulate glucose levels. D) Fetal oxygen interferes with the metabolism of glucose and prolongs its action.

Ans: C Feedback: Somatomammotropin makes insulin "less effective" than normal, thus decreasing its ability to produce hypoglycemia.

A patient who is 28 weeks pregnant is demonstrating signs of placental insufficiency. The health care provider prescribes betamethasone. When teaching the patient about this drug's purpose, which information would the nurse include? A) It stops premature labor. B) It improves functioning of the placenta. C) It potentiates the formation of surfactant. D) It improves immunologic function of the fetus.

Ans: C Feedback: Synthetically increasing steroid levels in the fetus through the use of betamethasone can hurry alveolar maturation and surfactant production without interfering with permanent lung function prior to a preterm birth. Surfactant is formed and excreted by the alveolar cells of the lungs at about the 24th week of pregnancy, decreases alveolar surface tension on expiration, prevents alveolar collapse, and improves the infant's ability to maintain respirations in the outside environment at birth. Betamethasone is not being given to this patient to stop premature labor, improve the function of the placenta, or improve immunologic function of the fetus.

The nurse is evaluating the fetal heart rate rhythm strip and determines that the amplitude varies with a rate 15 to 20 beats/min. What does this assessment finding indicate to the nurse about variability? A) Variability is absent. B) Variability is minimal. C) Variability is normal. D) Variability is marked.

Ans: C Feedback: Variability is absent when there is no peak-to-trough range detected. Variability is minimal when an amplitude range is detected but the rate is 5 beat/min or fewer. Variability is moderate or normal when an amplitude range is detected and the rate is 6 to 25 beat/min. Variability is marked when an amplitude range is detected and the rate is greater than 25 beat/min.

The nurse is completing a physical assessment with a patient who has just learned of being pregnant. The patient's last menstrual period was August 15. When should the nurse instruct the patient that the baby will be due? A) July 15 B) June 22 C) May 22 D) April 15

Ans: C Feedback: When using the Naegele rule, the nurse should count backward 3 calendar months from the first day of the patient's last menstrual period and then add 7 days. For August 15, the month would be May and the day would be 15 plus 7 or 22. May 22 is when the patient's baby is due. July 15, June 22, and April 15 are inappropriate applications of the Naegele rule.

A pregnant patient asks why an a-fetoprotein serum level has been ordered. What should the nurse explain to the patient about this test? A) It screens for placenta function. B) It measures the fetal liver function. C) It may reveal chromosomal abnormalities. D) It tests the ability of the patient's heart to accommodate the pregnancy.

Ans: C Feedback: a-Fetoprotein (AFP) is a substance produced by the fetal liver that can be found in both amniotic fluid and maternal serum. The level is abnormally high if the fetus has an open spinal or abdominal wall defect because the open defect allows more AFP to enter the mother's circulation. Although the reason is unclear, the level is low if the fetus has a chromosomal defect such as Down syndrome. Between 85% and 90% of neural tube anomalies, and 80% of Down syndrome babies can be detected by this method. The a-fetoprotein level is not used to screen for placenta functioning, measure fetal liver function, or test the ability of the patient's heart to accommodate the pregnancy.

A nurse is providing care to a woman early in her pregnancy. The woman is scheduled for a sonogram to confirm the presence of the gestational sac. Which instruction would the nurse include when teaching the woman about this test? A) "Do not to drink any fluid 1 hour prior to the study." B) "Be prepared for a catheter to be inserted prior to the study." C) "You'll need to empty your bladder just prior to the study. D) "Make sure to drink a large amount of fluid prior to the study."

Ans: D Feedback: A full bladder before a sonogram helps to stabilize the uterus and best transmit the sound waves to the uterine cavity.

A nurse is reviewing a journal article about fetal development and the formation of various body systems. When reading about the development of the digestive system, the nurse finds information related to the developmental abnormality of omphalocele. The nurse demonstrates understanding of this information by identifying which situation as the reason for an omphalocele? A) Fetus suffered a bowel obstruction at an early point in life. B) Fetal abdomen formed with a smaller internal cavity than normal. C) Intestines formed without sufficient nerve innervation for contraction. D) Intestines failed to return to the abdominal cavity during intrauterine life.

Ans: D Feedback: Because intestines grow more rapidly than the abdominal cavity, they are pushed into the base of the cord for a short span during intrauterine life. If for some reason they do not return to the abdominal cavity, an omphalocele will result.

A pregnant patient is concerned that the baby is going to drown in the uterus because of the fluid. What should the nurse respond about fetal respiration? A) "You are breathing for the baby." B) "The baby's breathing is very minor until delivery." C) "The baby's lungs can accommodate all of the fluid." D) "Oxygen is provided to the baby through the placenta."

Ans: D Feedback: Fetal circulation differs from extrauterine circulation because the fetus derives oxygen and excretes carbon dioxide not from gas exchange in the lung but from exchange in the placenta. The baby's lungs are not functioning in utero so the response that the baby's breathing is very minor until delivery and the baby's lungs being able to accommodate the fluid are incorrect. The patient is not "breathing for the baby."

A nonstress test is an assessment test based on which phenomenon? A) Braxton-Hicks contractions cause fetal heart-rate alterations. B) Fetal heart rate slows in response to a uterine contraction. C) Fetal movement causes an increase in maternal heart rate. D) Fetal heart sounds increase in connection with fetal movement.

Ans: D Feedback: Fetal heart rate increases about 15 beats per minute with fetal movement. Recording fetal movements is noninvasive monitoring, so it is termed a "nonstress" test.

The purpose of a circulatory shunt, such as the ductus arteriosus, is to: A) allow blood to bypass the fetal heart, which does not function as a pump until birth. B) allow fetal blood and maternal blood to mix freely. C) direct blood flow to the lungs to supply nutrients necessary for growth and maturation. D) permit oxygenated blood to supply the most important fetal organs.

Ans: D Feedback: The ductus arteriosus helps propel oxygenated blood quickly to the coronary arteries, brain, and kidneys.

A patient who learns of being 9 weeks pregnant asks the nurse to explain the changes that are occurring with her body. The woman states, "I'm really interested in learning what is happening so I can do the best for my baby." Which nursing diagnosis should the nurse identify as being appropriate for the patient at this time? A) Anxiety B) Impaired coping C) Deficient knowledge D) Readiness for enhanced knowledge

Ans: D Feedback: The patient asks the nurse to explain the changes that are occurring, which indicates that the patient is ready for more information or enhanced knowledge. Deficient knowledge would be appropriate if the patient where participating in some action or activity that would be harmful and would need information to correct that action. The patient's request for more information is not consistent with the diagnoses of anxiety or impaired coping.

A pregnant patient is scheduled for an abdominal ultrasound. What should the nurs atient about this procedure? A) Avoid drinking fluid 1 hour prior to the procedure. B) Expect to have a catheter inserted prior to the procedure. C) Empty the bladder 1 hour and just prior to the start of the procedure. D) Drink a glass of water every 15 minutes starting 90 minutes before the procedure.

Ans: D Feedback: The sound waves reflect best if the uterus can be held stable so it is helpful if the woman has a full bladder at the time of the procedure. To ensure this, ask her to drink a full glass of water every 15 minutes beginning 90 minutes before the procedure and not void until after the procedure. The patient will not have a catheter inserted for this procedure. The patient should not avoid fluids 1 hour prior to the procedure. The bladder should not be emptied until the procedure concludes.

What instruction should a nurse offer to a pregnant client or a client who wishes to become pregnant to help her avoid exposure to teratogenic substances?

Avoid medications.

A nurse is educating a primigravida client about the expected changes during pregnancy. Which measure will provide anticipatory guidance about pregnancy?

Avoid wearing high heels, especially during late pregnancy.

A battered pregnant woman reports to the nurse that her husband has stopped hitting her and promises never to hurt her again. Which response by the nurse would be most appropriate? a. "That's great. I wish you both the best." b. "Remember, the cycle of violence often repeats itself." c. "He probably didn't mean to hurt you." d. "You need to consider leaving him."

B

When a pregnant client is abused during her pregnancy, what complication is likely to occur after birth due to the abuse? a. edema b. postpartum depression c. low birth weight d. schizophrenia

B

Which of the following would the nurse include when teaching a pregnant woman about chorionic villus sampling? A) "The results should be available in about a week." B) "You'll have an ultrasound first and then the test." C) "Afterwards, you can resume your exercise program." D) "This test is very helpful for identifying spinal defects."

B) "You'll have an ultrasound first and then the test."

During a routine prenatal visit, a client, 36 weeks pregnant, states she has difficulty breathing and feels like her pulse rate is really fast. The nurse finds her pulse to be 100 beats per minute (increased from baseline readings of 70 to 74 beats per minute) and irregular, with bilateral crackles in the lower lung bases. Which nursing diagnosis would be the priority for this client? A) Ineffective tissue perfusion related to supine hypotensive syndrome B) Impaired gas exchange related to pulmonary congestion C) Activity intolerance related to increased metabolic requirements D) Anxiety related to fear of pregnancy outcome

B) Impaired gas exchange related to pulmonary congestion

A client's last menstrual period was April 11. Using Nagele's rule, her expected date of birth (EDB) would be: A) January 4 B) January 18 C) January 25 D) February 24

B) January 18

A client's maternal serum alpha-fetoprotein (MSAFP) level was unusually elevated at 17 weeks. The nurse suspects which of the following? A) Fetal hypoxia B) Open spinal defects C) Down syndrome D) Maternal hypertension

B) Open spinal defects

After teaching a group of students about the different perinatal education methods, the instructor determines that the teaching was successful when the students identify which of the following as the Bradley method? A) Psychoprophylactic method B) Partner-coached method C) Natural childbirth method D) Mind prevention method

B) Partner-coached method

A nurse is reviewing the medical record of a pregnant woman and notes that she is gravid II. The nurse interprets this to indicate the number of: A) Deliveries B) Pregnancies C) Spontaneous abortions D) Pre-term births

B) Pregnancies

When describing perinatal education to a pregnant woman and her partner, the nurse emphasizes that the primary goal of these classes is to: A) Equip a couple with the knowledge to experience a pain-free childbirth B) Provide knowledge and skills to actively participate in birth and parenting C) Eliminate anxiety so that they can have an uncomplicated birth D) Empower the couple to totally control the birth process

B) Provide knowledge and skills to actively participate in birth and parenting

After describing continuous internal electronic fetal monitoring to a laboring woman and her partner, which of the following would indicate the need for additional teaching? A) "This type of monitoring is the most accurate method for our baby." B) "Unfortunately, I'm going to have to stay quite still in bed while it is in place." C) "This type of monitoring can only be used after my membranes rupture." D) "You'll be inserting a special electrode into my baby's scalp."

B. With continuous internal electronic monitoring, maternal position changes and movement do not interfere with the quality of the tracing. *Continuous internal monitoring is considered the most accurate method, but it can be used only if certain criteria are met, such as rupture of membranes.

A woman in labor is to receive continuous internal electronic fetal monitoring. The nurse reviews the woman's medical record to ensure which of the following as being required? A) Intact membranes B) Cervical dilation of 2 cm or more C) Floating presenting fetal part D) A neonatologist to insert the electrode

B. For continuous internal electronic fetal monitoring, four criteria must be met: 1. ruptured membranes 2. cervical dilation of at least 2 cm 3. fetal presenting part low enough to allow placement of the electrode 4. skilled practitioner available to insert the electrode.

A nurse is reviewing the fetal heart rate pattern and observes abrupt decreases in FHR below the baseline, appearing as a U-shape. The nurse interprets these changes as reflecting which of the following? A) Early decelerations B) Variable decelerations C) Prolonged decelerations D) Late decelerations

B. Variable decelerations present as visually apparent abrupt decreases in FHR below baseline and have an unpredictable shape on the FHR baseline, possibly demonstrating no consistent relationship to uterine contractions. The shape of variable decelerations may be U, V, or W, or they may not resemble other patterns.

You are the home health nurse making an initial call on a new mother who delivered her third baby five days ago. The woman says to you "I just feel so down this time. Not at all like when I had my other babies. And this one just doesn't sleep. I feel so inadequate." What is the best response to this new mother? A. "Every baby is different with their own temperament. Maybe this one just isn't ready to sleep when you want him to." B. "It sounds like you have the 'baby blues.' They are common after having a baby. They will most likely go away in a day or two but tell your doctor if it lasts more than several days." C. "It sounds like you need to make an appointment with a counselor. You may have postpartum depression." D. "Tell me, are you seeing things that aren't there, or hearing voices?'"

B. "It sounds like you have baby blues..." A combination of factors likely contributes to the baby blues. Psychological adjustment along with a physiologic decrease in estrogen and progesterone appear to be the greatest contributors. Additional contributing factors include too much activity, fatigue, disturbed sleep patterns, and discomfort.

Neonatal screening is done before the infant leaves the hospital. Blood is drawn through a heel stick and tested for several disorders that can cause lifelong disabilities. When is the ideal time to collect this specimen. A. When the infant is 48 hours old. B. 24 hours after the newborn's first protein feeding. C. 36 hours before the infant is discharged home with its parents. D. Just before discharge home.

B. 24 hours after the newborn's first protein feeding. The laws in most states require this initial screening, which is done within 72 hours of birth. The ideal time to collect the specimen is after the newborn is 26 hours old and 24 hours after he has his first protein feeding.

Baby boy Alvarez is 5 minutes old. The nurse performs a quick assessment and determines that the newborn has a heart rate of 110 bpm, a weak cry, and acrocyanosis. His extremities are help in partial flexion, and he grimaces when a catheter is placed in his nose. What Apgar score does the nurse record, and what does this score mean? A. 5-- The newborn is having extreme difficulty transitioning B. 5-- The newborn is having moderate difficulty transitioning C. 6--The newborn is having moderate difficulty transitioning D. 6--The newborn is vigorous and transitioning with minimal effort.

B. 5--The newborn is having moderate difficulty transitioning Scores between 4 and 6 at five minutes mean that the newborn is having moderate difficulty transitioning to extrauterine life.

You are admitting a newborn to the nursery. You know that it is always important to monitor for signs of distress during the transition period. How long is considered to be the most critical transition period? A. 18-24 hours B. 6-12 hours C. 3-5 hours D. 1-2 hours

B. 6-12 hours. The first 6 to 12 hours after birth is considered the most critical time of transition for a newborn.

You are caring for an infant with a birth weight of 8 lb 5 oz. What would be an acceptable discharge weight for this infant. A. 7 lb 3 oz B. 7 lb 5 oz C. 7 lb 12 oz D. 7 lb 15 oz

B. 7 lb 5 oz Monitor the newborn's weight daily during the hospital stay.The breastfeeding newborn should lose no more than 10% of his or her birth weight and should return to birth weight by 7-14 days of age.

You are doing discharge teaching with the parents of baby who is their second child. You explain about sibling regression and you offer ways to deal with regressive behavior. What is this called? A. Reinforcement B. Anticipatory Guidance C. Preparatory Instructions D. Parenting suggestions

B. Anticipatory Guidance Anticipatory guidance is helpful when siblings are involved. Explain to the parents that it is normal for the older sibling to regress in the first few days after the birth of the baby. Tell them it helps if they do not focus undue attention on regressive behaviors, such as a return to bedwetting, sucking the thumb, or clinging to a favorite toy or blanket. It is particularly important for the parents not to criticize or belittle the older child for regressive behaviors.

A woman is bottlefeeding her baby. When the nurse comes into the room the woman says that her breasts are painful and engorged. Which nursing intervention is appropriate? A. Assist the woman into the shower and have her run cold water over her breasts B. Assist the woman in placing ice packs on her breasts C. Explain to the woman that she should breastfeed because she is producing so much milk D. Ask if she wants a breast pump to empty her breasts

B. Assist the woman in placing ice packs on her breasts If the breasts are engorged and the woman in bottlefeeding her newborn, instruct her to keep a support bra on 24 hours per day. Cool compresses or an ice pack wrapped in a towel will usually be soothing and help to suppress milk production.

You are called into the room of one of your clients where the grandparents are visiting with the new parents. The grandmother is visibly upset. She says, "Just look at my grandson! His head is all soft here and it shouldn't be. The doctor injured him when he was born and now he will be retarded." You assess the newborn and find an area of swelling about the size of a half-dollar on the scalp that crosses the suture line. What is this swelling called? A. Cephalohematoma B. Caput succedaneum C. Molding D. Harlequin sign

B. Caput succedaneum Caput succedaneum is swelling of the soft tissue of the scalp caused by pressure of the presenting part on a partially dilated cervix or trauma from a vacuum-assisted delivery.

A new mother calls the clinic and tells you that her breasts are very full and that they hurt. After assessing that there are no overt signs of inflammation present, you suggest that her breasts are engorged. What is the best intervention you could suggest to relieve this woman's discomfort? A. Placing cabbage leaves into your bra. B. Cold packs C. Taking Advil as recommended D. Taking a cold shower several times a day

B. Engorgement of the breasts is a temporary condition that can be uncomfortable for the new mother. Treatments to alleviate discomfort include cold packs to the breast and taking mild analgesic such as ibuprofen (Motrin, Advil) or acetaminophen (Tylenol).

At birth changes from fetal to newborn circulation must occur. What change causes the ductus arteriosus to close? A. Drop in pressure in the neonate's chest B. Higher oxygen content of the circulating blood C. Higher oxygen levels at the respiratory centers of the brain. D. Increase in pressure in the left atrium of the heart.

B. Higher oxygen content of the circulating blood. The first few breaths greatly increase the oxygen content of circulating blood. This chemical change (i.e., higher oxygen content of the blood) contributes to the closing of the ductus arteriosus, which eventually becomes a ligament.

You are doing discharge teaching with the parents of a newborn baby girl. You know that it is important to teach them about diarrhea and dehydration. When should the parents notify the physician about diarrhea in the newborn? A. If the infant has more than one episode of diarrhea in one day. B. If the infant has more than two episodes of diarrhea in one day. C. If the infant has more than three episodes of diarrhea in one day D. If the infant has more than four episodes of diarrhea in one day.

B. If the infant has more than two episodes of diarrhea in one day. Diarrhea is defined as frequent stools with high water content. Because newborns dehydrate quickly, it is important for parents to notify the physician if the newborn has more than two episodes of diarrhea in one day.

A 26-year-old new mother says to her nurse, "I am so disappointed. I gained 25 lb with my baby. Just what the doctor said I should gain. But after I had my baby I only lost 12 lb." What is the best response by the nurse. A. "I see that you are bottle-feeding your baby. You would lose your weight faster if you were breast-feeding." B. It is normal to lose between 12 and 14 lb after the baby delivers. You should be back to your prepregnancy weight by the time the baby is about 6 months old." C. "I know you are anxious to lose all your 'baby fat.' Get yourself on a good diet and you will be down to your original weight in no time." D. "Remember, it took nine months for you to gain all this weight. It won't disappear in just a couple of days."

B. It is normal to lose bewtween 12 and 14 lb... Immediately after delivery, approximately 12 to 14 lb are lost with the expulsion of the fetus, placenta, and amniotic fluid.

You are assessing a newborn girl, 4 hours old, weighing 9 lb 2 oz. While doing the initial assessment the nurse noted that the mothers' history showed her to be morbidly obese. The nurse would know to observe frequently for signs/symptoms of hypoglycemia. What would be early signs of hypoglycemia in this newborn? A. Low temperature and hypertonia B. Jitteriness and irritability C. Hypotonia and fever D. Frequent activity and jitteriness

B. Jitteriness and irritability Early signs of hypoglycemia in the newborn include jitteriness, poor feeding, listlessness, irritability, low temperature, weak or high-pitched cry and hypotonia.

A nurse is assessing a woman after birth and notes a second-degree laceration. The nurse interprets this as indicating that the tear extends through which of the following? A) Skin B) Muscles of perineal body C) Anal sphincter D) Anterior rectal wall

B. Muscle of perineal body

A premature infant often needs a special formula. What formula is specific for a premature infant? A. Alimentum B. Neosure C. Portagen D. Good Start

B. Neosure Neosure is a formula specific to a premature infant. Alimentum is for protein sensitivity, Portagen for impaired fat absorption, and Good Start is for full-term infants.

You are used to working on the postpartum floor taking care of women who have had normal vaginal deliveries. Today; however, you have been assigned to help care for women who are less that 24 hours post scheduled cesarean delivery. You know that in making your assessments you will have to change some things that you would not normally assess. What would you leave out of your patient assessments? A. Breasts B. Perineum C. Lower extremities D. Respiratory Status

B. Perineum Usually a woman who experiences cesarean birth does not have an episiotomy, although rarely this may be the case.

You are doing discharge teaching with a group of new parents before they are discharged home with their infant. One set of parents inquire as to why they need to place their new baby on its back to sleep. What is your best response? A. It really isn't important how you place your baby for it to sleep as long as it is comfortable. B. Research has shown that placing an infant on their back to sleep reduces the risk for SIDS C. Research has found that sleeping on their back reduces the infacts' risk of esophageal reflux D. Sleeping on their stomach is fine, too.

B. Research has shown that placing an infant on their back to sleep reduces the risk for SIDS. Newborns should always be placed on their backs to sleep to reduce the risk for SIDS (AAP Task Force on SIDS 2011).

An antibiotic ointment must be placed in the newborn's eyes to prevent opthalmia neonatroum, a sever eye infection contracted in the birth canal of a woman with gonorrhea or chlamydia. How soon after birth must the antibiotic ointment be applied? A. Within 30 minutes B. Within an hour C. Within an hour and a half D. Within two hours.

B. Within an hour. Within the first hour after birth, an antibiotic ointment must be placed in the newborn's eyes to prevent opthamia neonatorum, a severe eye infection contracted in the birth canal of a woman with gonorrhea or chlamydia.

Feeding rates differ by age, amount of education, and socioeconomic status. Which of the following reflects an accurate statement? A. Women who live in poverty choose to breast-feed B. Women older than 30 years of age choose to breastfeed C. One third of women younger than 20 years of age bottle feed D. Higher education levels correlate with bottlefeeding

B. Women older than 30 years of age choose to breast-feed. Women older than 30 years of age choose to breast-feed.

Place the three phases of intimate partner violence in the order in which they occur. All options must be used. a. acute violence phase b. tension-building phase c. honeymoon phase

BAC

Which teaching strategy would be most appropriate when educating a primapara about the changes that will occur during her pregnancy?

Be selective about the information provided and include those points most relevant to this particular client.

A nurse is teaching a group of primigravida woman who are in their first trimester. One of the women asks the nurse about sexual activity during pregnancy. Which information would the nurse most likely incorporate into the response?

Because of pelvic congestion, women may experience increased clitoral sensitivity.

A client has consumed a large quanity of fish during pregnancy and expressed concern about the unborn child. What can mercury exposure during pregnancy cause?

Brain and neurologic abnormalities in the fetus

A client who is abused fails to report the abuse primarily because of which reason? a. She does not want anyone to know. b. She thinks it will not happen again. c. She feels responsible for causing the incident. d. She feels lucky to be alive.

C

A nurse is preparing a presentation for a local community group about intimate partner violence. Which statement would be most appropriate for the nurse to include in the presentation? a. Abuse primarily affects young, unmarried women. b. Until the 1990s, society tended to legitimize a man's control over a woman. c. Abuse in homosexual relationships may go unreported for fear of harassment. d. Children who witness abuse of a parent are less likely to become batterers.

C

The nurse is conducting a class on rape prevention for a group of young adult women and is describing the various types of date rape drugs. Which drug would the nurse describe as causing a separation in perception and sensation? a. rohypnol b. gamma hydroxybutyrate (GHB) c. ketamine d. diazepam

C

When the nurse is alone with a client, the client says, "It was all my fault. The house was so messy when he got home, and I know he hates that." Which response would be most appropriate? a. "What else did you do to make him so angry with you?" b. "You need to start to clean the house early in the day." c. "It is not your fault. No one deserves to be hurt." d. "Remember, he works hard and you need to meet his needs."

C

A nurse is working with a pregnant woman to schedule follow-up visits for her pregnancy. Which statement by the woman indicates that she understands the scheduling? A) "I need to make visits every 2 months until I'm 36 weeks pregnant." B) "Once I get to 28 weeks, I have to come twice a month." C) "From now until I'm 28 weeks, I'll be coming once a month." D) "I'll make sure to get a day off every 2 weeks to make my visits."

C) "From now until I'm 28 weeks, I'll be coming once a month."

A pregnant woman is flying across the country to visit her family. After teaching the woman about traveling during pregnancy, which statement indicates that the teaching was successful? A) "I'll sit in a window seat so I can focus on the sky to help relax me." B) "I won't drink too much fluid so I don't have to urinate so often." C) "I'll get up and walk around the airplane about every 2 hours." D) "I'll do some upper arm stretches while sitting in my seat."

C) "I'll get up and walk around the airplane about every 2 hours."

A pregnant woman in the 36th week of gestation complains that her feet are quite swollen at the end of the day. After careful assessment, the nurse determines that this is an expected finding at this stage of pregnancy. Which intervention would be most appropriate for the nurse to suggest? A) "Limit your intake of fluids." B) "Eliminate salt from your diet." C) "Try elevating your legs when you sit." D) "Wear Spandex-type full-length pants."

C) "Try elevating your legs when you sit."

A nurse measures a pregnant woman's fundal height and finds it to be 28 cm. The nurse interprets this to indicate which of the following? A) 14 weeks' gestation B) 20 weeks' gestation C) 28 weeks' gestation D) 36 weeks' gestation

C) 28 weeks' gestation

A client who is 4 months pregnant is at the prenatal clinic for her initial visit. Her history reveals she has 7-year-old twins who were born at 34 weeks gestation, a 2-year old son born at 39 weeks gestation, and a spontaneous abortion 1 year ago at 6 weeks gestation. Using the GTPAL method, the nurse would document her obstetric history as: A) 3 2 1 0 3 B) 3 1 2 2 3 C) 4 1 1 1 3 D) 4 2 1 3 1

C) 4 1 1 1 3

On the first prenatal visit, examination of the woman's internal genitalia reveals a bluish coloration of the cervix and vaginal mucosa. The nurse records this finding as: A) Hegar's sign B) Goodell's sign C) Chadwick's sign D) Homans' sign

C) Chadwick's sign

When preparing a woman for an amniocentesis, the nurse would instruct her to do which of the following? A) Shower with an antiseptic scrub. B) Swallow the preprocedure sedative. C) Empty her bladder. D) Lie on her left side.

C) Empty her bladder.

A pregnant woman has a rubella titer drawn on her first prenatal visit. The nurse explains that this test measures which of the following? A) Platelet level B) Rh status C) Immunity to German measles D) Red blood cell count

C) Immunity to German measles

When planning the care of a woman in the active phase of labor, the nurse would anticipate assessing the fetal heart rate at which interval? A) Every 2 to 4 hours B) Every 45 to 60 minutes C) Every 15 to 30 minutes D) Every 10 to 15 minutes

C. During the active phase of labor, FHR is monitored every 15 to 30 minutes.

A woman in labor who received an opioid for pain relief develops respiratory depression. The nurse would expect which agent to be administered? A) Butorphanol B) Fentanyl C) Naloxone D) Promethazine

C. Naloxone is an opioid antagonist used to reverse the effects of opioids such as respiratory depression.

When applying the ultrasound transducers for continuous external electronic fetal monitoring, at which location would the nurse place the transducer to record the FHR? A) Over the uterine fundus where contractions are most intense B) Above the umbilicus toward the right side of the diaphragm C) Between the umbilicus and the symphysis pubis D) Between the xiphoid process and umbilicus

C. - The ultrasound transducer is positioned on the maternal abdomen in the midline between the umbilicus and the symphysis pubis. - The tocotransducer is placed over the uterine fundus in the area of greatest contractility.

When palpating the fundus during a contraction, the nurse notes that it feels like a chin. The nurse interprets this finding as indicating which type of contraction? A) Intense B) Strong C) Moderate D) Mild

C. -A contraction that feels like the chin typically represents a moderate contraction. -A contraction described as feeling like the tip of the nose indicates a mild contraction. - A strong contraction feels like the forehead.

A nurse is assisting with the delivery of a newborn. The fetal head has just emerged. Which of the following would be done next? A) Suctioning of the mouth and nose B) Clamping of the umbilical cord C) Checking for the cord around the neck D) Drying of the newborn

C. Checking for the cord around the neck once the fetal head has emerged, the primary care provider explores the fetal neck to see if the umbilical cord is wrapped around it. If it is, the cord is slipped over the head to facilitate delivery. * Then the health care provider suctions the newborn's mouth first (because the newborn is an obligate nose breather) and then the nares with a bulb syringe to prevent aspiration of mucus, amniotic fluid, or meconium.

When assessing fetal heart rate, the nurse finds a heart rate of 175 bpm, accompanied by a decrease in variability and late decelerations. Which of the following would the nurse do next? A) Have the woman change her position. B) Administer oxygen. C) Notify the health care provider. D) Continue to monitor the pattern every 15 minutes.

C. Fetal tachycardia as evidenced by a fetal heart rate greater than 160 bpm accompanied by a decrease in variability and late decelerations is an ominous sign indicating the need for prompt intervention. The health care provider should be notified immediately and then measures should be instituted such as having the woman lie on her side and administering oxygen.

A nurse is providing care to a woman during the third stage of labor. Which of the following would alert the nurse that the placenta is separating? A) Boggy, soft uterus B) Uterus becoming discoid shaped C) Sudden gush of dark blood from the vagina D) Shortening of the umbilical cord

C. Sudden gush of dark blood from the vagina

A woman is admitted to the labor and birthing suite. Vaginal examination reveals that the presenting part is approximately 2 cm above the ischial spines. The nurse documents this finding as: A) +2 station B) 0 station C) -2 station D) Crowning

C. The ischial spines serve as landmarks and are designated as zero status. If the presenting part is palpated higher than the maternal ischial spines, a negative number is assigned. Therefore, the nurse would document the finding as -2 station.

A nurse is explaining the use of therapeutic touch as a pain relief measure during labor. Which of the following would the nurse include in the explanation? A) "This technique focuses on manipulating body tissues." B) "The technique requires focusing on a specific stimulus." C) "This technique redirects energy fields that lead to pain." D) "The technique involves light stroking of the abdomen with breathing."

C. "This technique redirects energy fields that lead to pain." -Therapeutic touch is an energy therapy and is based on the premise that the body contains energy fields that lead to either good or ill health and that the hands can be used to redirect the energy fields that lead to pain. - Attention focusing and imagery involve focusing on a specific stimulus. - Massage focuses on manipulating body tissues. - Effleurage involves light stroking of the abdomen in rhythm with breathing.

A newborn has unique nutritional needs. The healthy newborn needs how many calories to meet their energy needs? A. 80 to 100 mL/kg/day B. 100 to 115 mL/kg/day C. 100 to 115 kcal/kg/day D. 80 to 100 kcal/kg/day

C. 100 to 115 kcal/kg/day To meet energy requirements, the newborn needs 100 to 115 kcal/kg/day (Colson, Chapman, & Held, 2012).

One assessment parameter that the nurse is responsible for is fluid volume loss. It would be important to assess the umbilical cord for any sign of bleeding. What would be important to assess for if the infant has an unusually large cord? A. Disintegrating vessels B. A large amount of Wharton jelly C. A loose clamp D. A dry cord.

C. A loose clamp. One potential source of hemorrhage is the clamped umbilical cord. An unusually large cord may have large amounts of Wharton jelly, which may disintegrate faster than the cord vessels and cause the clamp to become loose. This situation could lead to blood loss from the cord.

One of the infants you are caring for is scheduled for a circumcision later this afternoon. The physician has ordered EMLA cream to be applied prior to the procedure. When would you apply the EMLA? A. Fifteen minute prior to the procedure B. Thirty minutes prior to the procedure C. An hour prior to the procedure D. An hour and a half prior to the procedure

C. An hour prior to the procedure If an anesthetic cream, such as EMLA, is to be used for the procedure, it must be applied approximately one hour before the procedure to adequately numb the area.

You are the senior LVN/LPN in the newborn nursery and you are orienting a new graduate LVN/LPN. One of the subjects you want to cover today is hepatic adaptation of the normal newborn. What would you know to talk about? A. Ductus arteriosus B. Umbilical veins C. AquaMEPHYTON D. Pathologic jaundice

C. AquaMEPHYTON The newborn cannot produce vitamin K, which in turn causes the liver to be unable to produce some clotting factors. This situation could lead to bleeding problems, so newborns receive vitamin K (AquaMEPHYTON) intramuscularly shortly after birth to prevent hemorrhage.

You are the oncoming nursery nurse in a normal newborn nursery. You receive report on four infants. Baby A is reported as being 16 hours old, vital signs within normal limits (WNL), bilirubin 3.5 mg/dL, rooming in with mother; Baby B is 8 hours old, vital signs WNL, bilirubin 3 mg/dL, returning to nursery for night; Baby C is 19 hours old, vital signs WNL, bilirubin 4 mg/dL, rooming in with mother; Baby D is 4 hours old, vital signs WNL, bilirubin 2 mg/dL, returning to nursery for night. Which baby would you assess first? A. Baby A B. Baby B C. Baby C D. Baby D

C. Baby C. Hyperbilirubinemia, high levels of unconjugated bilirubin in the bloodstream (serum levels of 4 to 6 mg/dL and greater), can lead to jaundice, a yellow staining of the skin.

A woman comes to the nursery and states "Mrs. Smith is ready for her baby. I will be glad to take the baby to her." The woman is dressed in hospital scrub attire but has no name badge showing. What is the best response by the nurse caring for the baby? A. "I don't know you. Are you trying to take a baby?" B. "Leave immediately! I'm calling security." C. Do you have an ID band? I will walk with you to the parent's room." D. "You must be Mrs. Smith's sister. She said her sister is a nurse."

C. Do you have an ID band? I will walk with you to the parent's room." Each member of the hospital staff should have an identification badge clearly displayed. The nurse in the nursery is appropriate in asking to see the identification of the woman who is offering to take Mrs. Smith's baby to her. Educatio and watchful vigilance are keys to preventing infant abductions. Each facility that cares for newborns should have specific policies and procedures in place that address this problem. Review these policies and know the protocols for the facility in which you will be working.

You are the oncoming nursery nurse caring for a 3-hour-old newborn boy. You make your initial assessment and find the following: Respiratory rate 30 bpm, B/P 60/40 mm/Hg, heart rate 155, temperature (axillary) 36.8 C. You assess that the newborn is in a state of quiet alert. What would you do? A. Inform the charge nurse B. Call the physician C. Document the data D. Stimulate the newborn

C. Document the data. The normal respiratory rate is 30-60 breaths per minute and should be counted for a full minute when the infant is quiet. A newborn starts with a low blood pressure (60/40 mm/Hg) and a high pulse (120 to 160 bpm). Normal temperature range is between 97.7 F (36.5 C) and 99.5 F (37.5 C).

The newborn has been placed in skin-to-skin contact with his mother. A blanket covers all of his body except his head. His hair is skill wet with amniotic fluid, and so on. What is the most likely type of heat loss this baby may experience. A. Conductive B. Convective C. Evaporative D. Radiating

C. Evaporative Evaporative heat loss occurs with the evaporation of fluid from the infant.

As the nurse caring for postpartum patients, what laboratory study would you expect to have ordered by the birth attendant the morning after delivery of the baby? A. Blood type B. CBC C. H&H D. Iron level

C. H&H Monitor the hemoglobin and hematocrit (H&H). Note the H&H before delivery. Most practicioners order a postpartum H&H on the morning after delivery. If the values drop significantly, the woman may have experienced postpartum hemorrhage. Note the blood type and Rh. If the woman is Rh-negative, she will a RhoGAM workup. Determine the woman's rubella status. If she is nonimmune, she will need a rubella immunization before she is discharged home.

You have just received a newborn male into the nursery with the report that he has a hypospadias. What does this mean? A. He has normal male genitalia B. His testicles have not descended into the scrotal sac C. His urinary meatus is located on the under surface of the glans D. He has fluid in the scrotal sac

C. His urinary meatus is located on the under surface of the glans. The term hypospadias refers to the urinary meatus being abnormally located on the ventral (under) surface of the glans.

The nurse assessing a 1-day-old newborn and notices a small amount of white drainage and redness at the base of the umbilical cord. What is the best response by the nurse. A. Call the doctor immediately to ask for IV antibiotics B. Carefully clean the area with a damp washcloth and cover it with an absorbent dressing C. Notify the charge nurse, because this finding represents a possible complication D. Show the mother how to clean the area with soap and water

C. Notify the charge nurse, because this finding represents a possible complication, and document the finding. A normal umbilical cord is well formed and has three vessels. The base of the cord should be dried without redness or drainage, and the umbilical clamp should be fastened securely.

You are assisting with the circumcision of a 16-hour-old male infant. If ordered, what kind of dressing would you apply to the surgical area immediately after the procedure. A. Steri strips B. Small pressure dressing C. Petrolatum gauze dressing D. Sterile 2 x 2s and paper tape

C. Petrolatum gauze dressing Immediately after the procedure, place a petrolatum gauze dressing, as ordered by the physician.

A 20-year-old primipara is getting ready to go home. She had a second-degree episiotomy with repair. She confides in the nurse that she is afraid to go to her postpartum checkup because she is afraid to have the stitches removed. Which reply by the nurse is best? A. "It doesn't hurt when the midwife takes out the stitches. You will only feel a little tugging and pulling sensation." B. "It is very important for you to go to your checkup visit. Besides, the stitches do not have to be removed." C. "The stitches do not need to be removed because the suture will be gradually absorbed." D. "Oh, you mustn't miss your follow-up appointment. Don't worry. Your midwife will be very gently."

C. The stitches do not need to be removed. The episiotomy is approximated and repaired using suture that is gradually absorbed by the body.

When positioning the newborn for breastfeeding the mother tells you that she prefers the cradle hold position. How does this mean the infant is lying? A. On its back with its head turned toward its mother B. Lying on its side facing its mother C. Tummy-to-tummy with its mother D. On a pillow slightly on its side.

C. Tummy to tummy with its mother In the cradle hold, the newborn's abdomen is facing and touching the woman's abdomen. Make sure the newborn is not lying on his back and turning his head toward his shoulder to reach the breast. The newborn should be on his side and tummy-to-tummy with the woman.

All of the following are premonitory signs of labor EXCEPT

Chadwick's sign

A client wants to know if she can engage in intercourse during pregnancy. Which information should the nurse confirm to ensure that sexual intercourse or orgasm is not contraindicated in the client? Select all that apply.

Client is not at risk for preterm labor. Client does not face a risk of threatened abortion.

A woman has just confided in the nurse that her partner slapped and kicked her that morning. What is the best response by the nurse? a. "Oh my goodness, I cannot believe that happened to you. You poor thing, I feel terrible for you." b. "Maybe he didn't mean to do it. Have you talked with him about it?" c. "Is this the first and only time he has done anything?" d. "It's very brave of you to tell me all this. Help is available if you choose it."

D

When teaching a group of young adult women about the cycle of violence, the nurse would describe which behavior as eventually disappearing as the violence becomes accelerated over time? a. excessive hostility and friction b. loss of control c. denial of the seriousness of the injuries d. apologies for the pain and abuse

D

Which approach would be most appropriate when counseling a woman who is a suspected victim of violence? a. Offer her a pamphlet about the local battered women's shelter. b. Call her at home to ask her some questions about her marriage. c. Wait until she comes in a few more times to make a better assessment. d. Ask, "Have you ever been physically hurt by your partner?"

D

Which statement is false regarding emergency contraception (EC)? a. EC works by preventing fertilization, ovulation, or implantation. b. EC is most effective if it is taken within 12 hours of rape. c. EC simply contains the same hormones that are found in birth control pills. d. EC will disrupt an established pregnancy if taken within 72 hours.

D

When assessing a pregnant woman in her last trimester, which question would be most appropriate to use to gather information about weight gain and fluid retention? A) "What's your usual dietary intake for a typical day?" B) "What size maternity clothes are you wearing now?" C) "How puffy does your face look by the end of a day?" D) "How swollen do your ankles appear before you go to bed?

D) "How swollen do your ankles appear before you go to bed?

When assessing a woman at follow-up prenatal visits, the nurse would anticipate which of the following to be performed? A) Hemoglobin and hematocrit B) Urine for culture C) Fetal ultrasound D) Fundal height measurement

D) Fundal height measurement

During a nonstress test, when monitoring the fetal heart rate, the nurse notes that when the expectant mother reports fetal movement, the heart rate increases 15 beats or more above the baseline. The nurse interprets this as: A) Variable decelerations B) Fetal tachycardia C) A nonreactive pattern D) Reactive pattern

D) Reactive pattern

A nursing instructor is describing the various childbirth methods. Which of the following would the instructor include as part of the Lamaze method? A) Focus on the pleasurable sensations of childbirth B) Concentration on sensations while turning on to own bodies C) Interruption of the fear-tension-pain cycle D) Use of specific breathing and relaxation techniques

D) Use of specific breathing and relaxation techniques

A client states, "I think my waters broke! I felt this gush of fluid between my legs." The nurse tests the fluid with Nitrazine paper and confirms membrane rupture if the paper turns: A) Yellow B) Olive green C) Pink D) Blue

D. Amniotic fluid is alkaline and turns Nitrazine paper blue. * Nitrazine paper that remains yellow to olive green suggests that the membranes are most likely intact.

A woman in labor has chosen to use hydrotherapy as a method of pain relief. Which statement by the woman would lead the nurse to suspect that the woman needs additional teaching? A) "The warmth and buoyancy of the water has a nice relaxing effect." B) "I can stay in the bath for as long as I feel comfortable." C) "My cervix should be dilated more than 5 cm before I try using this method." D) "The temperature of the water should be at least 105°F."

D. The water temperature should not exceed body temperature. Therefore, a temperature of 105° F would be too warm.

You are a graduate nurse seeing your first cesarean delivery. Why is assessment of the respiratory status especially important with this type of delivery? A. "There is more fluid present in the lungs at birth after a cesarean delivery than after a vaginal delivery." B. "Surfactant may be missing from the lungs depending on the newborn's gestational age." C. "The respiratory centers in the brain have not been stimulated when a newborn is delivered by a cesarean delivery." D. "A newborn delivered by cesarean has less sensory stimulation to breathe."

D. "A newborn delivered by cesarean has less sensory stimulation to breathe." The process of labor stimulates surfactant productions, and much of the fetal lung fluid is squeezed out as the fetus moves down the birth canal. This so-called vaginal squeeze is an important way nature helps to clear the airway in preparation for the first breath. The vaginal squeeze also plays a role in stimulating lung expansion. The pressure of the birth canal on the fetal chest releases immediately when the infant is born. The lowered pressure from chest expansion draws air into the lungs.

Your patient is very conscious of the weight she gained during her pregnancy. She has decided to breastfeed her baby and asks you how many calories a day extra she should be eating so that she and her baby are healthy. She states she does not want to gain any extra weight from over-eating. What would be your best response? A. "You are eating for two now. Besides, you are breastfeeding and you will lose your pregnancy weight very quickly.' B. "You need to keep eating just like when you were pregnant. That gives you about 300 kcal extra everyday." C. You have a nice slender body type. Just eat what you want and you will do fine. D. "You should be eating an extra 200 kcal over what you were eating while you were pregnany."

D. "You should be eating an extra 200 kcal over what you were eating while you were pregnant." Instruct the woman who is not breast-feeding to decrease her caloric intake by approximately 300 kcal per day (i.e., she should reduce her intake to prepregnancy levels). The lactating woman will need to tadd an additional 200 kcal above the pregnancy requirement of 300 kcal per day, for a total of 500 kcal above prepregnancy requirements.

A newborn's axillary temperature is 97.5 F. He has a cap on his head. His T-shirt is damp with spit-up milk. His blanket is laid over him, and several children are in the room running around his bassinet. The room is comfortably warm, and the bassinet is beside the mother's bed away from the window and doors. What are the most likely mechanisms of heat loss for this newborn? A. Conduction and Evaporation B. Conduction and Radiation C. Convection and Radiation D. Convection and Evaporation

D. Convection and evaporation Conductive heat loss occurs when the newborn's skin touches a cold surface, causing body heat to transfer to the colder object. Heat loss by convection happens when air currents blow over the newborn's body. Evaporate heat loss happens when the newborn's skin is wet. As the moisture evaporates from the body surface, the newborn looses body heal along with the moisture. Heat loss also occurs by radiation to a cold object that is close to, but not touching, the newborn.

What sign would indicate an infant was tolerating formula? A. Transitional stools B. Ineffective sucking C. Pasty yellow stools D. Emesis

D. Emesis An infant who is not tolerating formula will often have emesis of old curdled formula. Transitional stools and pasty yellow stools are normal stools that follow meconium. Ineffective sucking does not indicate intolerance to formula but a feeding technique difficulty.

While assessing a newborn you elicit a rooting reflex. How do you do this? A. Putting a nipple into the newborn's mouth B. Stroking the lips of the newborn C. Cuddling the newborn close to your chest D. Gently stroking the cheek of the newborn

D. Gently stroking the cheek of the newborn. Rooting, sucking, and swallowing reflexes are all important to the newborn's nutritional intake. Gently stroking the newborn's cheek brings out the rooting reflex. The newborn demonstrates this reflex by turning toward the touch with an open mouth.

You are the senior nurse on the unit and you are orienting a new graduate LVN/LPN. One of the subjects you want to cover today is a postpartum assessment for a vaginal delivery. What would you need to know to cover during this assessment? A. Nagele sign B. Hegar sign C. Chadwick sign D. Homans sign

D. Homans sign Inspect the extremities for edema, equality of pulses, and capillary refill. Check for Homans sign. Feel along the calf area for any warmth or redness. The calves should be of equal size and warmth bilaterally. There should be no reddened, painful areas, and there should be no pain in the calves when feet are dorsiflexed (negative Homans sign), or when the woman is walking.

The parents of a newborn boy ask you about circumcising their son. They are undecided as to what to do. Which response by the nurse is best? A. Cicumcision is best in order to protect the baby from diseases like cancer. B. If you do not circumcise your baby, he will always have difficulty maintaining adequate hygiene. C. It is best not to circumcise your baby because the procedure is very painful. D. Let me ask the pediatrician to come and talk to you about the procedure.

D. Let me ask the pediatrition to come and talk to you about the procedure. If the parents decide to have their male newborn circumcised, informed consent is necessary. It is the physician's responsibility to obtain informed consent, although you may be responsible for witnessing the parent's signatures to a written documentation of that consent. If the parents have unanswered questions, notify the physician before the procedure is done.

A group of nursing students are reviewing the various medications used for pain relief during labor. The students demonstrate understanding of the information when they identify which agent as the most commonly used opioid? A) Butorphanol B) Nalbuphine C) Fentanyl D) Meperidine

D. Meperidine

To prevent misidentification of a newborn, identification bands are placed on the newborn and on the parents before the newborn is separated from the parents. What information is on all the bands? A. Hospital number, attending physician, and father's name B. Father's name and date and time of birth C. Mother's name and date and time of her birth D. Newborn's sex and date and time of birth.

D. Newborn's sex and date and time of birth Information included on the bands is the mother's name, hospital number, and physician, and newborn's sex, and date and time of birth.

The nurse is assessing the laboring client to determine fetal oxygenation status. What indirect assessment method will the nurse likely use? A. External electronic fetal monitoring B. Fetal blood pH C. Fetal oxygen saturation D. Fetal position

External electronic fetal monitoring is the first option that we use

Blood mixed with mucus seeping from the vagina in the late third trimester is abnormal and should be reported to the physician immediately.

False

A nurse is completing the assessment of a woman admitted to the labor and birth suite.Which of the following would the nurse expect to include as part of the physical assessment? (Select all that apply.) A) Current pregnancy history B) Fundal height measurement C) Support system D) Estimated date of birth E) Membrane status F) Contraction pattern

Fundal height measurement Membrane status Contraction pattern As part of the admission physical assessment, the nurse would assess: - fundal height - membrane status and contractions * Current pregnancy history, support systems, and estimated date of birth would be obtained when collecting the maternal health history.

A pregnant client with a history of spinal injury is being prepared for a cesarean birth. Which method of anesthesia is to be administered to the client? A. Local infiltration B. Epidural block C. Regional anesthesia D. General anesthesia

General anesthesia is administered in emergency cesarean births

A primapara woman has been asking about all the minor body changes she has been experiencing over the first 3 months like nausea, fatigue, breast tenderness, constipation, and abdominal discomfort. The clinic nurse responsible for the documentation related to this woman's reports has identified which diagnosis to be the most relevant in this scenario?

Health-seeking behaviors

A nurse is required to obtain the fetal heart rate (FHR) for a pregnant client. If the presentation is cephalic, which maternal site should the nurse monitor to hear the FHR clearly?

Lower quadrant of the maternal abdomen

A nurse is giving a prenatal class on teratogens that have an affinity for specific body tissues. Which teratogen is accurately paired with the specific body tissue affected?

Mercury attacks the nervous tissue.

A nurse caring for a pregnant client in labor observes that the fetal heart rate is below 110 per minute. Which interventions should the nurse perform?

O2 mask

A woman's amniotic fluid is noted to be cloudy. The nurse interprets this finding as?

Possible infection

The maternal health nurse is caring for a pregnant client with poor dental hygiene habits. Which pregnancy complication does the nurse correlate with the client's habit?

Preterm birth

After teaching a group of students about fetal heart rate patterns, the instructor determines the need for additional teaching when the students identify which of the following as indicating normal fetal acid-base status? (Select all that apply.) A) Sinusoidal pattern B) Recurrent variable decelerations C) Fetal bradycardia D) Absence of late decelerations E) Moderate baseline variability

Sinusoidal pattern Recurrent variable decelerations Fetal bradycardia

A primigravida client has come to the clinic for a prenatal checkup. What teaching topics would help to promote a healthy pregnancy for this client?

Swimming in a pool is a recommended exercise during pregnancy.

In the United States, the highest rate of breastfeeding initiation is among which group of women? A. Hispanic B. Caucasian C. Asian D. Non-Hispanic African American

The breastfeeding initiation rate for Asian women is 83%, for Hispanic women 81% for Caucasian women 72% and for non-hispanic African America women 59% (CDC, 2012).

A nurse working in an OB clinic meets a female who is 4 to 6 weeks pregnant. Lab results reveal she is positive for syphilis, so she is treated with IM penicillin. Later in the pregnancy, she is retested, and her serum titer results continue to increase. How should the nurse interpret these results?

The female has been reinfected with syphilis.

The nurse manager is orienting a new nurse in a clinic at the local prison. Which statements should the nurse manager include regarding the care of incarcerated pregnant clients? Select all that apply.

The nurse should discuss contraception as part of prenatal care. Women who are incarcerated are more likely to have a high-risk pregnancy . The food served by the corrections facility may need to be adjusted for the pregnancy. Incarcerated pregnant women need to be screened for the use of tobacco, drugs, and alcohol. Incarcerated pregnant women need to be screened for sexually transmitted infections, including HIV.

A pregnant woman asks the nurse about using herbal rememdies while she is pregnant. The nurse recommends that the woman talk with her health care provider about their use based on which understanding?

They are not rated with regard to safety during pregnancy.

Which change in the breasts should a nurse recognize as a normal change associated with pregnancy?

Tingling sensations and tenderness

A client in her third trimester reports to the nurse shortness of breath when sleeping. The nurse informs the client that this is normal and occurs because the growing fetus puts pressure on the diaphragm. Which measure should the nurse suggest to help alleviate this problem?

Use extra pillows.

After teaching a woman about healthy lifestyle behaviors during pregnancy, the nurse determines that the teaching was successful based on which statement by the woman about traveling during pregnancy? Select all that apply.

When traveling by car or plane, I need to get up every 1 to 2 hours to prevent clots in my legs." "There isn't any risk associated with air travel, other than being away from my primary provider."

A community health nurse is teaching a group of clients about the zika virus. Which statements by the clients indicate to the nurse that the teaching was effective? Select all that apply.

Zika can be transmitted by mosquitoes, sexual activity, and blood exposure. A pregnant woman with zika may have a baby with microcephaly and other congenital anomalies. It is best for men who have been exposed to zika to wait six months before attempting conception. There is no treatment for newborns with zika, but they will have supportive care based on the defects.

Which pregnant woman should consult with her obstetric provider before continuing an exercise program?

a 33-year-old G5 P1 with a history of incompetent cervix

A woman in her second trimester of pregnancy is beginning to experience more headaches. In addition to suggesting holding an ice pack to the forehead, the health care provider recomends which medication to provide some relief from the pain?

acetaminophen

___________________ describes the irregular variations or absence of fetal heart rate (FHR) due to erroneous causes on the fetal monitor record.

artifact

A nurse is caring for a pregnant client who is in the active phase of labor. At what interval should the nurse monitor the client's vital signs?

every 30 minutes

If the nitrazine test is inconclusive, an additional test, called the ________________ test, can be used to confirm rupture of membranes

fern

During the initial clinic visit for a primapara woman, the nurse reviews the topic of constipation during pregnancy when the woman interjects that she has been "straining forcefully" almost on a daily basis. The nurse offers some measures that may help to prevent the occurrence of which complication?

hemorrhoid development that may eventually need surgical repair

- Green fluid may indicate that the fetus has passed meconium secondary to:

hypoxia, prolonged pregnancy, cord compression, intrauterine growth restriction, maternal hypertension, diabetes, or chorioamnionitis; however, it is considered a normal occurrence if the fetus is in a breech presentation.

During an admission assessment of a client in labor, the nurse observes that there is no vaginal bleeding yet. What nursing intervention is appropriate in the absence of vaginal bleeding? A. Monitor vital signs B. Assess amount of cervical dilation C. Obtain urine speicmen for urinalysis D. Monitor hydration status

if vaginal bleeding is absent during admission assessment, nurse should perform vaginal examination to assess amount of cervical dilation

Amniotic fluid should be clear when the membranes rupture, either spontaneously or artificially through an amniotomy. - Cloudy or foul-smelling amniotic fluid indicates __________ .

infection

A woman in the 34th week of pregnancy says to the nurse, "I still feel like having intercourse with my husband." The woman's pregnancy has been uneventful. The nurse responds based on the understanding that:

it is safe to have intercourse at this time.

FHR is assessed every 30 to 60 minutes during the _________ phase of labor.

latent

Of all of the synthetic opioids ___________ is the most commonly used opioid for the management of pain during labor.

meperidine

Respiratory depression Opioids given close to the time of birth can cause central nervous system depression, including respiratory depression, in the newborn, necessitating the administration of ____________

naloxone.

A pregnant woman has been diagnosed with pica since she eats lead pain chips for their sweetness. The nurse educating this woman should strongly encourage her to abandon this practice because it may have which consequence to the fetus?

neurological challenges

Which occupation may expose a fetus to environmental hazards? Select all that apply.

nurse anesthetist working in a busy oral surgeon's office oncology nurse working in an outpatient chemotherapy unit nurse working for a pulmonologist who administers inhalation ribavirin routinely to the client

The police have brought a young female to the emergency department after they raided a "crack" house and found this female passed out and bleeding from her "bottom." This female is pregnant and is likely bleeding related to which complication of cocaine use during pregnancy? Select all that apply.

premature dislodgement of the placenta spontaneous miscarriage

As part of a 31-year-old client's prenatal care, the nurse is assessing immunization history. Which immunization is most relevant to ensuring a healthy fetus?

rubella

Fetal _______________ as evidenced by a fetal heart rate greater than 160 bpm accompanied by a decrease in variability and late decelerations is an ominous sign indicating the need for prompt intervention.

tachycardia

A woman arrives in the emergency department in active labor. She has not received any prenatal care and reports spending a lot of time in a hot tub to relax. The nurse caring for this woman should prepare for which possible birth defect related to the fetus being exposed to prolonged hyperthermia in a hot tub? Select all that apply.

white, frothy bubbles in baby's mouth coughing or choking during feedings intestines located outside the abdominal wall