Ch. 10 Promoting Healthy Pregnancy

32. A patient who has a previous diagnosis of round ligament pain is in the clinic for a follow-up visit. Which statement by the patient would indicate that teaching objectives for this problem have been met? A. I have been supporting my uterus with a pillow when resting. B. I have been trying all sorts of over-the-counter medications. C. I havent had any black, tarry stools at all since I was here. D. That black cohosh has really helped with my abdominal pain.

A Round ligament pain is a common discomfort of pregnancy and the nurse can teach self-care measures such as supporting the uterus with a pillow when resting, warm baths, applying heat, and wearing a pregnancy girdle. Pregnant women should be taught to avoid all medications (both prescription and over the counter) without consulting with their health-care provider. Black, tarry stools are not related to round ligament pain. Black cohosh is a uterine stimulant and should be avoided during pregnancy. Cognitive Level: Evaluation/Evaluating Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Evaluation Difficulty: Difficult

39. A woman admitted in labor asks if she can have a doula present with her. The nurse understands that a doula is which of the following? A. A massage therapist with a specialty in labor massage B. A trained labor coach standing in for the womans partner C. A woman who is experienced in labor and provides support to the woman D. Someone who is trained and licensed to deliver babies in the hospital

C A doula is a woman who is experienced in childbirth and who provides physical and emotional support to the mother during labor, birth, and the postpartum period. A doula is not a massage therapist, nor a trained labor coach, and a doula is not licensed to deliver babies. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Caring Difficulty: Easy

30. A pregnant woman is complaining of urinary frequency and is worried about incontinence. Which teaching strategy should the nurse use when counseling this woman? A. Minimize fluid intake during the day. B. Perform sit-ups to strengthen the abdomen. C. Teach the woman how to perform Kegel exercises. D. Void infrequently to train the bladder.

C There are several physiological factors that cause urinary frequency and possible incontinence during pregnancy. Kegel exercises can improve both symptoms. The patient should remain well hydrated and void frequently. Sit-ups will not help with urinary frequency. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Easy

5. A nurse is educating a pregnant woman who has a history of pica about healthier eating. Which nutrients should the nurse include in the teaching plan? (Select all that apply.) A. Calcium B. Folic acid C. Iron D. Vitamin C E. Vitamin D

A, C, D, E Specific nutritional deficiencies associated with pica include deficiencies in iron, calcium zinc, thiamine, niacin, vitamin C, and vitamin D. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate

28. A woman in her second trimester wants to continue her weight-lifting and exercise plan. Which exercise would the nurse advise against participating in? A. Calf stretches B. Weight lifting C. Pelvic tilts D. Walking lunges

D Lunges may injure connective tissue in the pelvic area and should be avoided. The other exercises are acceptable, but the woman should be cautioned to use resistance bands instead of free weights. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Difficulty: Moderate

13. The perinatal nurse would assess which newborn system as a priority after birth if a woman admitted to cocaine use during her pregnancy? A. Cardiovascular system B. Endocrine system C. Integumentary system D. Respiratory system

A Although it is difficult to assess for complications from cocaine because of the likelihood of multi-drug abuse, common complications seen from its use include congenital abnormalities in the skull, brain, face, eyes, intestines, heart, limbs, genitals, and urinary tract. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment/Management of Care Integrated Process: Nursing Process: Assessment Difficulty: Moderate

40. A woman in her third trimester is complaining of numbness and tingling in her fingers. Which action should the nurse take first? A. Assess the woman for hyperventilation. B. Educate her about a thermoskin carpal tunnel glove. C. Facilitate an appointment for a nerve conduction study. D. Reassure her that the condition is temporary.

A Carpal tunnel syndrome is commonly seen in pregnancy and can be caused by either hyperventilation or from nerve compression of the median and ulnar nerves in the arm. If the woman is hyperventilating, the nurse can educate her about conscious control of breathing, which would provide relief quickly and easily. If hyperventilation does not seem to be the causative factor, the nurse can educate her about strategies for symptom control. These methods include maintaining good posture, elevating the hands on pillows when sleeping, wearing a wrist brace, and/or using a thermoskin carpal tunnel glove. Simply reassuring the woman that the condition is temporary does nothing to increase her comfort. A nerve conduction study is not needed at this time, but if the condition persists after childbirth, it could be an option. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Moderate

27. A perinatal clinic nurse educated a pregnant woman about basic prenatal exercises. On a return visit, which statement by the patient indicates that teaching goals have been met? A. I have learned to isolate the right muscle for Kegel exercises. B. Its hard to find 30 minutes a day for exercise, but I have done it. C. Jumping rope is great exercise and keeps my weight in control. D. When I get fatigued with these exercises, I just push through it.

A Kegel exercises are among the basic prenatal exercises taught to all pregnant women. In order to do them correctly, the woman needs to learn to isolate the pubococcygeal (PC) muscle. Women can obtain benefits from exercising as little as 10 minutes a day; jumping rope should be avoided because it involves too much bouncing; and when the pregnant woman is fatigued, she should rest. Cognitive Level: Evaluation/Evaluating Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Evaluation Difficulty: Moderate

29. A pregnant woman lifts weights regularly with a partner. What modification to this activity should the nurse suggest? A. Adjust the weight bench so that it is tilted, not flat. B. Do fewer repetitions by using heavier weights. C. Do not hold your breath for more than 30 seconds. D. Use free weights instead of resistance bands.

A Lifting from a supine position can cause vena cava syndrome and decreased placental perfusion, so the woman should be instructed to adjust the weight bench to a tilted position. Heavy weights can overload the loosened joints, so using lighter weights with more repetitions is recommended. Holding the breath can cause a Valsalva maneuver, which decreases placental perfusion. Resistance bands are preferred to reduce the likelihood of abdominal injury. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate

20. A student nurse asks the faculty about the importance of preconception counseling. Which response by the faculty is best? A. It is the best time to find any conditions that could have a negative effect on a pregnancy. B. Its a good time to educate women about birth control options before they need them. C. Reproductive care is an important part of any womans health care. D. The Centers for Disease Control mandates that all women get preconception care.

A Preconception counseling is an ideal time to identify conditions (physical, psychosocial, environmental, or social) that could lead to a future negative pregnancy outcome. The patient can be educated about the risks and assist in developing a plan to mitigate or avoid them. Providing birth control options can be an important part of preconception care, but this answer is too limited to be the best choice. Stating that reproductive care is important is vague. A goal of Healthy People 2020 is to increase the number of women getting preconception and prenatal care. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Easy

22. A woman in her second trimester continues to smoke a pack of cigarettes a day despite stating that she understands why smoking is bad for her and for her fetus. Which action by the nurse is best? A. Assess the patient for past trauma and abuse. B. Document the information in the patients chart. C. Review prior teaching done regarding smoking. D. Show photos of babies born with abnormalities.

A Research shows that women who continue to smoke during pregnancy often report high levels of trauma and abuse and higher levels of PTSD symptoms. Women who smoke as a coping mechanism are even more likely to smoke during pregnancy (Lopez, Konrath, & Seng, 2011). The nurse should assess for these factors. Documentation is important, but is not the best answer because the nurse does not do anything to assist the patient; documentation alone is the answer only when the data are normal. Reviewing prior teaching may be helpful, but if the nurse does not help the patient address the core issue of smoking, this review will be unhelpful and a waste of time. Showing babies born with abnormalities is demeaning and could be interpreted as threatening. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Assessment Difficulty: Difficult

38. A womans birth plan specifies the Odent method of childbirth. Early in her admission, the woman asks about having an epidural for pain control. Which action by the nurse is best? A. Advise the woman that this will change her birth plan B. Ask why she wants pain control with natural childbirth C. Facilitate having the epidural catheter placed D. Review the breathing techniques for managing pain

A The Odent method involves the womans giving birth in a warm water bath. Not every woman is a candidate for this method, including women who have rupture of the membranes or other complications that require continuous fetal monitoring. Epidural anesthesia requires continuous fetal monitoring, so if she chooses an epidural, she will not be able to use the Odent method. The nurse should advise her of this so that the woman is well informed before making a final decision. Asking why she wants pain control sounds judgmental. Breathing techniques are the primary method of coping with pain in the Lamaze method. If the woman decides to go ahead with the epidural, then by all means the nurse should facilitate its placement. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Difficult

8. An 18-year-old woman at 18 weeks gestation is being seen in the prenatal clinic. Her weight gain is 25 pounds over her prepregnant weight. Which is the perinatal nurses best approach to care at this visit? A. Ask the patient to complete a 3-day dietary recall while she is in the clinic. B. Explain the possible concerns related to excessive weight gain in pregnancy C. Explain to the patient that weight gain is not a concern in pregnancy. D. Teach the patient about the expected normal weight gain during pregnancy.

A This woman has gained much more than the average weight gain in the first trimester (12.5 kg). Nutrition and weight management play an essential role in the development of a healthy pregnancy. Not only does the patient need to have an understanding of the essential nutritional elements, she must also be able to assess and modify her diet for the developing fetus and her own nutritional maintenance. To facilitate this process, it is the nurses responsibility to provide education and counseling concerning dietary intake, weight management, and potentially harmful nutritional practices. The nurse should facilitate this process while the woman is at her appointment. After assessment and mutually planning nutritional goals, the nurse can educate the woman about the possible concerns related to excessive weight gain and teach about the normal trajectory of weight gain during pregnancy. This series of actions follows the nursing process best. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Moderate

14. A new patient is being assessed by the perinatal nurse. For exercise, the woman practices yoga five times a week, walks her dog, and swims. What action should the nurse do first? A. Ask if any yoga positions involve arching the back. B. Explain that swimming is a great exercise for all women. C. Instruct the woman to stop exercising if she gets fatigued. D. Tell her that no extra water is needed if she is swimming.

A Women should adhere to some basic safety guidelines when formulating an exercise program. These guidelines include monitoring the breathing rate; ensuring that the ability to walk and talk comfortably is maintained during the physical activity; stopping the exercise when tired; avoiding exercises that can cause any degree of trauma to the abdomen or those that include rigorous bouncing, arching of the back, or bending beyond a 45-degree angle; and maintaining an adequate fluid intake. Because yoga involves different positions, the nurse should assess whether the patient engages in positions that involve arching the back. Swimming is good exercise and she should stop exercising if she gets fatigued, but asking about positions involves an immediate possible threat to the safety of the fetus. Extra water is needed no matter what type of exercise is being done. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Heath Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Moderate

6. A nurse is conducting a class on the Lamaze method of childbirth. Which core values does this nurse plan to teach? (Select all that apply.) A. A womans ability to give birth can be diminished by the care provider. B. Conscious breathing is the main coping strategy in Lamaze. C. Lamaze birthing is medication free and epidurals are not given. D. The birth coach is only present to provide comfort to the laboring woman. E. Women are capable of and have the wisdom to give birth.

A, B, E The womans innate ability to give birth, the use of conscious breathing as the main coping strategy, and the fact that the womans confidence and ability to give birth can be either enhanced or diminished by the care provider and place of birth are some of the core concepts of the Lamaze method. Lamaze educators provide information on pain control and stress that each woman needs to make the decision about pain management that is best for her. Birth partners are taught to assess the woman for hyperventilation during the transition period of labor. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate

7. A woman is admitted to the hospital with a birth plan that specifies the Bradley method of childbirth. Which actions by the nurse are most appropriate for this patient? (Select all that apply.) A. Assist the woman in conserving energy for childbirth. B. Call the anesthesiologist to place an epidural. C. Ensure the patient has a quiet environment. D. Establish a relationship with the husband-coach. E. Turn the lights down in the patients room.

A, C, D, E The Bradley method emphasizes inward relaxation, allowing the woman to conserve energy for the impending birth. There is an emphasis on darkness, solitude, and quiet in order to reduce stimulation and enhance the calm and comfort needed by the woman. The Bradley method is also known as husband-coached childbirth. The nurse will need to establish a professional, caring relationship with both the woman and her partner. Medication is discouraged in this method. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Difficulty: Moderate

8. A nurse is explaining childbirth education choices to an expectant couple. The nurse explains that although each method is different, all methods emphasize some similar concepts. Which concepts does the nurse describe as similar across different methodologies? (Select all that apply.) A. Biological B. Financial C. Psychosocial D. Relational E. Social

A, C, E Although they are different, all childbirth preparation classes incorporate a holistic approach to childbearing, which encompasses the biological, psychological, and social factors related to the experience. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate

MULTIPLE RESPONSE 1. The nurse teaches the prenatal class attendees about herbal medications that may cause uterine contractions and preterm labor. Which of the following herbal preparations should be avoided because they act as uterine stimulants? (Select all that apply.) A. Black cohosh B. Dong quai C. Ephedra D. Mugwort E. Senna

A, D During preconception counseling and pregnancy, nurses should educate couples to avoid the following common uterine stimulants that may cause preterm labor: barberry, black cohosh, feverfew, goldenseal, mugwort, pennyroyal leaf, and yarrow root. Dong quai is an anticoagulant, ephedra is a cardiac stimulant, and senna can overstimulate digestion and metabolism, causing fluid and electrolyte imbalances. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Teaching/Learning Difficulty: Easy

3. For which diseases does the prenatal nurse recommend a newly pregnant woman be screened? (Select all that apply.) A. Chlamydia B. Hepatitis A C. Mumps D. Rubella E. Varicella

A, D, E Pregnant women should be screened for sexually transmitted infections, hepatitis B, HIV, rubella, and varicella. When contracted during the first trimester, rubella causes a number of fetal deformities. Varicella (chickenpox) is another common childhood disease that may cause problems in the developing embryo and fetus. Therefore, all pregnant women are screened for rubella and varicella. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Moderate

4. An expectant father seems to be ambivalent about the impending birth of his child. Which actions by the nurse are most important? (Select all that apply.) A. Ask the father if he has fears for his partner. B. Assess the woman for intimate partner violence (IPV). C. Call the social worker to assess the fathers financial situation. D. Give the father written information about childbirth. E. Reassure the father that conflicting emotions are normal.

A, E Expectant fathers can experience fears and ambivalence about the womans pregnancy. Some common concerns include fear for the womans safety and health, financial concerns, and worry that he is not ready for this responsibility. The nurse should reassure the father that these feelings are normal and can further the discussion by assessing for these common emotions. There is no indication that either partner suffers from IPV, it is premature to call the social worker before a problem has been identified, and giving the father written information on childbirth may not address his concerns. In addition, the nurse should assess literacy prior to giving written information and should be prepared to discuss it. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Assessment Difficulty: Moderate

37. A nurse is describing various childbirth options to an expectant couple. The woman states I want to do Lamaze because I hear you will have no pain with this method. Which response by the nurse is best? A. If done right, you will have no childbirth pain. B. Lamaze empowers you to cope with the pain. C. No, Lamaze emphasizes epidural pain control. D. Pain is a natural and normal part of childbirth.

B Although Lamaze does teach that pain is a natural and normal part of childbirth, it also empowers the woman with strategies to cope with the pain in positive ways that facilitate the labor and birth process. It does not promise a pain-free childbirth and decisions about medications are left to the woman who has been educated about their effect on childbirth. Stating simply that pain is a normal part of childbirth without elaborating on how it is managed will not alleviate the patients concern. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate

9. A woman comes to the clinic for her 24-week prenatal visit. This is her second pregnancy. The patient does not wish to know her weight and when her clinic record is reviewed, her total weight gain for this pregnancy is 5 pounds. She is very concerned about her changing body shape. What disorder does the nurse suspect? A. Anemia B. Anorexia nervosa C. Gestational diabetes D. Gestational hypertension

B Anorexia nervosa is characterized by a distorted body image and an intense fear of becoming obese. Patients with anorexia nervosa lose weight either by excessive dieting or by purging themselves of calories they have ingested. Because this woman has gained very little weight and has concerns about her body shape, the nurse should suspect anorexia and assess the patient further. Anemia, gestational diabetes, and gestational hypertension do not manifest with these symptoms. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process: Assessment Difficulty: Easy

41. A nurse is assessing a woman pregnant with her third child. She has a history of pregnancy-related varicosities. Which action by the nurse takes priority? A. Advising the woman not to cross her legs while pregnant B. Assessing the womans pedal pulses and circulation C. Having the woman rate her leg pain on a 1-to-10 scale D. Teaching the woman to wear knee-high stockings

B Assessment is the first step of the nursing process, and issues related to airway, breathing, and circulation are priorities for all patients. The nurse should first assess the patients circulation, including pedal pulses, warmth, skin color, and capillary refill. After a circulatory assessment is complete, the nurse should assess pain. After a thorough assessment, the nurse can plan teaching. Self-care measures include not crossing the legs, not wearing constrictive clothing such as knee-high stockings, and elevating the legs at least twice a day. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Nursing Process: Assessment Difficulty: Moderate

19. The prenatal nurse has reviewed a patients 3-day diet recall and notes that the patient typically eats a deli meat sandwich or hot dog, chips, and an apple for lunch. Breakfast consists of cereal, milk, and juice; and dinner contains meat, a starch, vegetables, and a salad. What action by the nurse is most important? . A. Advise the woman to obtain more calories from protein. B. Assess the womans knowledge of proper food handling. C. Discuss adding fish such as tuna or swordfish to the diet. D. Weigh the woman and document her weight in the chart.

B Pregnant women should be taught proper food handling to prevent foodborne illnesses. Deli meats, hot dogs, and luncheon meats should be stored at 40 or less, heated before eating, and consumed within 4 days. Tuna should be eaten in moderation and fish such as shark, swordfish, king mackerel, and tilefish should be avoided in pregnancy because of mercury poisoning. Promoting safety is a priority. The woman may or may not need more calories from protein. Obtaining the patients weight and documentation are important prenatal activities, but are not the best answer because the nurse needs to assess the womans knowledge and practice of safe food handling first. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Moderate

21. A patient in the prenatal clinic had a negative rubella titer. Which action by the nurse is most appropriate? A. Have the laboratory draw rubella titers as a double-check. B. Instruct the woman to avoid anyone who may have the disease. C. Prepare to administer a rubella vaccination to the woman. D. Reassure the woman that rubella has few fetal consequences.

B Rubella (German measles) can cause fetal abnormalities if the pregnant woman contracts it during the first trimester, so all pregnant women are screened for immunity. A positive test means the woman is immune to the disease, whereas a negative test indicates susceptibility to it. The woman needs to avoid people who may be ill with rubella and be immunized after her delivery. There is no need for a double check of the results. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Difficulty: Moderate

26. A pregnant woman has been brought to the emergency department by the rescue squad with symptoms of heat exhaustion after competing in an outdoor race on a hot day. Before discharge, the nurse teaches about appropriate exercise during pregnancy. The husband asks if the womans having heat exhaustion will harm the baby. Which response by the nurse is most accurate? A. Definitely; thats why pregnant women should not do aerobic exercise. B. Fetal temperature depends on moms temperature, so the fetus may be affected. C. The baby is in a fluid environment and wont get overheated. D. Yes, but if we rapidly cool mom down, there wont be any problems.

B The fetus is unable to reduce body temperature through perspiration or other means and instead must rely on the mothers body for temperature regulation. Possible complications of maternal hyperthermia include spontaneous abortion, preterm labor, and fetal distress. The nurse should educate the couple about exercise that wont increase the maternal temperature too much. Complications are possible, not definite; the baby being in a fluid environment does not regulate its temperature, and women who are pregnant can engage in aerobic activity following safety guidelines. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate

2. After questioning a pregnant woman about her fluid intake, the nurse discovers that the patient is drinking four glasses of diet cola per day. Which response by the nurse is best? A. As long as you get enough fluid, soda is all right to drink. B. Less than two cups of caffeine a day is probably OK. C. The major worry with soda is the sugar content. D. You really should switch to decaffeinated colas.

B The primary sources of caffeine for pregnant women are coffee, tea, and soda. Research shows that small amounts of caffeine (less than 2 cups a day) are probably safe; however, higher amounts cause central nervous system stimulation and can increase the chance of spontaneous abortions, stress the fetuss metabolic system, and decrease blood flow to the placenta. Women should be encouraged to restrict their intake of caffeinated beverages and taught that even decaffeinated beverages still contain some caffeine. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate

12. The clinic nurse is assessing a woman in her 30th week of pregnancy. Her fundal height is 23 centimeters. What other assessment finding would the nurse correlate with this condition? A. Blood glucose 112 mg/dL B. Hemoglobin 9.2 g/dL C. Leukorrhea D. Platelet count elevated

B True anemia, or iron-deficiency anemia, occurs when the hemoglobin level drops below 10 g/dL. The bloods decreased oxygen-carrying capacity causes a reduction in oxygen transport to the developing fetus. Decreased fetal oxygen transport has been associated with intrauterine growth restriction and preterm birth. The patients lower-than-expected fundal height measurement could also be indicative of intrauterine growth restriction. The blood glucose, although slightly high, is not related, nor is leukorrhea (a common finding in pregnancy) or an elevated platelet count. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Moderate

6. A nurse is teaching a nonsmoking pregnant woman about the iron tablets she was just prescribed. What information is most important for the nurse to teach the patient? A. Calling the doctor right away for dark, tarry stools B. Drinking at least one glass of orange juice a day C. Stopping the prenatal vitamins while taking iron D. Taking the medication between meals and with milk

B Vitamin C enhances the absorption of iron, and a nonsmoking woman should be able to get sufficient iron from a glass of citrus juice daily. Iron tablets should be taken between meals, using a beverage other than tea, coffee, or milk. Dark, tarry stools are a known side effect of iron. Women on iron should also be on prenatal vitamins. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Integrated Process: Teaching/Learning Difficulty: Difficult

2. A 22-year-old woman is experiencing her third pregnancy. Her obstetrical history includes one first-trimester elective abortion and one first-trimester spontaneous abortion. The patient is a semi-vegetarian who drinks milk and eats yogurt and fish as part of her daily intake. Which of the following should the nurse include in the patients dietary teaching plan? (Select all that apply.) A. Consuming red meat B. Eating foods high in zinc C. Increasing calcium intake D. Restricting sodium E. Taking an iron supplement

B, E Semi-vegetarian diets include fish, poultry, eggs, and dairy products but no beef or pork. Pregnant women who adhere to this diet may consume inadequate amounts of iron and zinc. Most women cannot consume enough iron through their diets while pregnant, so an iron supplement should be suggested. The nurse can also educate the patient about foods high in zinc so that she can increase her intake. Although red meat does contain iron, consuming meat goes against the womans chosen lifestyle and it would be disrespectful of the nurse to suggest this. Increasing calcium and restricting sodium intake are not helpful advice in this situation. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Physiological Integrity: Basic Care and Comfort Integrated Process: Teaching/Learning Difficulty: Difficult

10. A 24-year-old pregnant woman at 26 weeks gestation is experiencing her third pregnancy. The patients obstetric history includes one full-term birth and one preterm birth; both children are alive and well. Today, the patient arrives at the clinic with complaints of fatigue, insomnia, and continuous backache. She reports that she is a nurse on an oncology unit and is worried about continuing to work her 12-hour shifts. What advice by the nurse would be most appropriate? A. Can you ask your manager about light-duty work at your job? B. See if you can take more breaks at work to rest and drink water. C. With your previous premature birth, you might need to reduce your working hours. D. You can continue to work as long as you want to and feel able to.

C Although many women do continue to work throughout their pregnancies, certain medical problems and pregnancy complications are a red flag for the woman to reduce her work hours. Examples of these conditions include back problems, preterm labor (both of which this woman has), diabetes, kidney disease, heart disease, hypertension, and a history of spontaneous abortion. Light duty may be an option in addition to decreasing the work hours. Taking more breaks might be advised as well, but with this womans history and current health complaints she should consider decreasing her working hours. Other factors the nurse should discuss with the patient are the amount of heavy physical labor she does and her exposure to chemotherapeutic agents, both of which are possible environmental hazards to the pregnancy. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Difficulty: Moderate

23. A nurse is reviewing the care plan for a woman in the third trimester of her first pregnancy. Which action by the patient best indicates positive adaptation to the pregnancy and impending motherhood? A. Attended three prenatal classes with her partner to learn about labor B. Continues to exercise, maintains a healthy diet, quit smoking recently C. Educated about pregnancy, fetal growth and development, and motherhood D. Has prepared a well-stocked nursery complete with stimulating toys

C Attending prenatal classes, maintaining a healthy lifestyle, and having a prepared space for the baby are all tasks that indicate some degree of positive adaptation to a pregnancy. However, the best indicator of positive adaptation is when the woman can be described as well educated on pregnancy, growth and development of the fetus, and motherhood. This is much more inclusive than the other individual tasks. Cognitive Level: Evaluation/Evaluating Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Evaluation Difficulty: Moderate

16. The nurse in a family practice clinic is working with a woman of childbearing age who recently was married and has no plans to have children yet. Which action by the nurse is most important? A. Asking the woman when the couple plans to get pregnant B. Encouraging the woman to review her birth control plan C. Instructing the woman to get 0.4 mg of folic acid daily D. Reviewing the womans family history for genetic defects

C Because of the strong connection between folic acid deficiency and the subsequent development of neural tube defects, all women of childbearing age should take a folic acid supplement of at least 400 mcg/day (0.4 mg/day). Because the woman may not realize that she is pregnant early in her pregnancy when neural tube defects occur, prophylactic supplementation is recommended. The other options may be applicable too, but they are not as important as educating the woman about the importance of folic acid. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Teaching/Learning Difficulty: Moderate

42. A student nurse is working in the OB clinic as part of a preceptorship. The student is counseling a woman in her first trimester who complains of insomnia due to nasal congestion. Which action by the student warrants intervention by the students preceptor? A. Advises the woman to use over-the-counter nasal saline spray B. Assesses the patient for other allergy and cold symptoms C. Instructs the woman to use decongestants and antihistamines D. Suggests the woman take a hot, steamy bath at bedtime

C Congestion is a common complaint in pregnancy. Self-care measures include occasional saline drops; hot, steamy showers; increasing fluids;, and using a vaporizer or humidifier. It is important to rule out upper respiratory infections such as colds or allergies when a woman complains of nasal congestion. Women should avoid decongestants in the first trimester. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Nursing Process: Implementation Difficulty: Moderate

5. The prenatal clinic nurse meets with a 30-year-old woman who is experiencing her first pregnancy. The patients quadruple-marker screen result is positive at 17 weeks of gestation. Which action by the nurse is most important? A. Call the social worker for a consultation. B. Document the findings in the womans chart. C. Facilitate a referral to a genetics counselor. D. Prepare the woman for intrauterine death.

C Feedback: All women should be offered screening with maternal serum markers. The triple-marker screen and the quadruple-marker screen test for the presence of alpha-fetoprotein, estradiol, human chorionic gonadotropin, and other markers. These tests screen for potential neural tube defects, Down syndrome, and trisomy 18. If the screen is positive, the woman should be referred to a genetics specialist for counseling and further testing, such as chorionic villus sampling or amniocentesis, should be performed (ACOG, 2007). There is no indication that the woman needs a social work consult or that she will experience intrauterine death. Documentation should be complete, but is not the most important action for the nurse to take. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process: Implementation Difficulty: Difficult

7. A 21-year-old pregnant woman smokes 8 to 10 cigarettes per day. The clinic nurse reviews the patients diet with her and notes that she does not eat fruits or vegetables. Which action should the nurse recommend to this patient? A. Cut down on smoking and eventually quit. B. Eat non-produce sources of vitamin C. C. Take an over-the-counter vitamin C supplement. D. Try to drink one glass of orange juice daily.

C Food sources rich in vitamin C include produce such as red and green sweet peppers, oranges, kiwi fruit, grapefruit, strawberries, Brussels sprouts, cantaloupe, broccoli, sweet potatoes, tomato juice, cauliflower, pineapple, and kale. Most pregnant women are able to meet the recommended daily allowance (80 to 85 mg) by including at least one daily serving of citrus fruit or juice or vitamin Crich food source, but women who smoke need more (NIH, 2011). Although it is important for the woman to quit smoking, this alone will not help her meet her dietary need for Vitamin C. Because she does not eat the primary sources of this vitamin, an over-the-counter supplement would be her best option. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Difficult

36. A nurse is helping a pregnant woman prepare for a planned home birth. What action by the nurse takes priority? A. Advising the woman to get a prescription for pain medication filled beforehand B. Attempting to convince the woman that giving birth at the hospital is a better choice C. Ensuring the woman has safe, rapid, and available transportation to a nearby hospital D. Giving the woman a list of local obstetricians who will assist at a home birth

C Home births are an option for women who have low-risk pregnancies and no labor complications. However, according to a position statement by the American College of Obstetrics and Gynecology (ACOG), women who choose to deliver at home should be well- informed and should ensure access to rapid and timely transportation to the closest hospital in case of emergency (ACOG, 2011). Obstetricians will not deliver babies at home. Although pain management may be an important consideration, this is not as important as ensuring the safety of both mother and baby. Trying to convince the woman to go against her beliefs is disrespectful. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process: Planning Difficulty: Moderate

17. The perinatal nurse recommends muscle-strengthening exercises to a woman who is pregnant for the first time. The woman states that she does not want to be muscle-bound and masculine. What response by the nurse is best? A. As long as you use lighter weights, you wont get muscle-bound. B. OK, what do you think about swimming for exercise then? C. Strengthening muscles will decrease risks of ligament and joint injury. D. Stronger muscles will make the labor process much easier on you.

C Muscle strengthening benefits the woman as she copes with the physical changes of pregnancy, which include weight gain and postural changes. Muscle-strengthening exercises also help to decrease the risk of ligament and joint injury. The other options do not explain this information, making it much less likely she will participate in these exercises. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate

34. A woman who is 26 weeks pregnant has a blood pressure of 158/100 mm Hg. Which action by the nurse is most appropriate? A. Assess the womans risk for other cardiovascular problems. B. Have her rest for 20 minutes, then reassess her blood pressure. C. Obtain a urine dipstick for proteinuria and assess for headache. D. Prepare to teach the woman about anti-hypertensive medication.

C Preeclampsia is defined as a blood pressure greater than 140/90 mm Hg after 20 weeks gestation accompanied by proteinuria. Other signs and symptoms include headache, visual changes, and edema. The nurse should suspect this condition and confirm it with a urine test for protein and by asking about the other symptoms. Assessing for other cardiovascular risk problems and teaching about anti-hypertensive medications are not warranted in this situation. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process: Assessment Difficulty: Moderate

25. A pregnant woman is being discharged from the hospital after an episode of preterm labor that has resolved. She asks the nurse if she can now return to her low-impact aerobics class. Which response by the nurse is best? A. As long as its low impact, it should be OK to return. B. Make sure you can talk while you are exercising. C. Preterm labor is a contraindication for aerobic exercise. D. Wait 72 hours; if you dont have more contractions, its OK.

C Premature labor, along with several other conditions, is an absolute contraindication to aerobic exercise during pregnancy. Although being able to talk while exercising is an important safety tip, this woman should not be engaging in any aerobics for the duration of this pregnancy. Cognitive Level: Applying/Application Content Area: Pediatrics/Maternity Patient Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Teaching/Learning Difficulty: Moderate

33. A pregnant woman in her third trimester presents to the emergency department after fainting upon rising from a supine position. Which activity should the nurse perform first? A. Call the cardiology department for an EKG. B. Determine the fetal heart rate. C. Obtain a blood glucose reading. D. Teach her to rise slowly from a reclining position.

C Supine hypotension is caused by the pressure of the enlarging uterus on the inferior vena cava while the woman is in a supine position. Vena caval compression impedes venous blood flow, reduces the amount of blood in the heart, and decreases cardiac output, causing dizziness and syncope. Pathological causes of supine hypotension include cardiac or respiratory disorders, anemia, hypoglycemia, dehydration, anxiety, and stress. Hypoglycemia can be treated rapidly if that is the cause. The other actions are appropriate as well, but the priority action would be to identify a condition that is readily treatable. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Nursing Process: Implementation Difficulty: Difficult

11. A woman in the perinatal clinic is upset that her impending childbirth will cause her to lose her job. What assessment question by the nurse would yield the most important information regarding this situation? A. After you give birth, you will probably want to quit your job anyway. B. Can you make an appointment with human resources to discuss this? C. Where do you work and how long have you been there? D. Why do you think you will be fired after your baby is born?

C The Family Medical Leave Act of 1993 guarantees most women (and men) 12 weeks of unpaid family leave following the birth or adoption of a child. The employee has the right to return to the job without loss of seniority, pay, or benefits. This act applies to federal, state, or local government organizations and any other organization that has 50 or more employees working within 75 miles of the workplace. The employee must have worked at this job at least 12 months or for at least 1,250 hours in the previous year to be eligible. By asking the woman where she works and how long she has been there, the nurse is assessing if the workplace must adhere to this act. Telling the woman she will probably want to quit her job is dismissive of her concerns. Making an appointment with human resources might be a good suggestion, but only after the nurse has assessed the patients eligibility for the Family Medical Leave Act. Asking why questions is considered a communication barrier, as many people become defensive when questions are worded this way. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Moderate

35. A nurse is planning to teach a prenatal class on the Dick-Read method of childbirth. Which information should the nurse plan to include? A. After birth, the newborn is placed in a tub of warm water. B. Consciously controlled breathing is the main coping strategy. C. Relaxation is vital because pain is caused by fear and tension. D. The Dick-Read method means a totally medication-free birth.

C The founder of the Dick-Read method of childbirth was convinced that the pain associated with labor and birth was caused by tension and fear. These conditions stimulate the womans sympathetic nervous system, decrease blood flow to the uterus, and lead to uterine hypoxia. Relaxation restores the blood flow. Placing the baby in a warm tub of water is a component of the LeBoyer method; consciously controlled breathing as the main coping strategy is part of the Lamaze method; and although Dick-Read did not advocate for the use of pain medication, he did approve it when the woman was unable to relax or was experiencing complications. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate

24. A patient on the postpartum floor of the hospital has a body mass index (BMI) of 38 and just gave birth to a healthy baby girl by Cesarean section. Which action by the nurse takes highest priority? A. Administering pain medication promptly when requested B. Assisting the woman to begin breastfeeding the infant C. Educating the woman about healthy weight loss D. Monitoring the incision site and using strict hand-washing technique

D All of these interventions are appropriate for this patient. However, patient safety is the priority. Women with Level 2 obesity (BMI 3539.9) are at higher risk of wound infection and breakdown. The nurse should place a priority on hand hygiene and close monitoring of the incision. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Safety and Infection Control Integrated Process: Nursing Process: Assessment Difficulty: Difficult

1. The prenatal clinic nurse visits with a 32-year-old man. His partner is pregnant with her first child and is now at 12 weeks of gestation. The man states that he has been experiencing nausea and vomiting, fatigue, and weight gain. Which action by the nurse is most appropriate? A. Ask the womans health-care provider to prescribe the man anti-nausea medication. B. Assess for cancer risk factors, as weight gain and vomiting are unusual together. C. Encourage the man to make an appointment with his primary health-care provider. D. Explain that these symptoms are normal and often seen in men with pregnant partners.

D Couvade syndrome is when a male partner experiences the same maternal signs and symptoms as the woman. The nurse should reassure the man that this is an often-occurring finding. The nurse would not need to encourage the man to make an appointment with his health-care provider unless the symptoms became severe. The womans primary health-care provider does not need to prescribe anti-emetics, nor does the nurse need to assess the man further for cancer risk factors. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Difficulty: Easy

4. The nurse explains to the prenatal class attendees that at full term about 10 to 11% of the maternal weight gain is attributed to which of the following? A. Blood, uterine, and breast tissue B. Fetal tissue C. Maternal reserves D. Placental fluid

D During early pregnancy, maternal weight gain is related to an increased blood volume, which is necessary to supply the enlarging uterus and to support fetal growth and development. As the pregnancy progresses, enlargement of the placenta and fetal body add to the womans increase in weight. By term, maternal extracellular fluid, blood, uterine tissue, and breast tissue comprise 35% of the gestational weight gain; the maternal reserves comprise 27%; fetal tissue comprises 27%; and placental fluid comprises 11% of the total maternal weight gain (Cunningham et al., 2010). Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Easy

31. An expectant couple complains of dyspareunia. Which action by the nurse is best? A. Assess the womans family history and genetic background. B. Explain that this condition is a normal finding during pregnancy. C. Instruct the couple that sex during pregnancy is not advised. D. Suggest sexual positions that might be more comfortable.

D Dyspareunia is painful intercourse that may result from pelvic congestion and impaired circulation caused by the enlarging uterus during pregnancy. The nurse should reassure the couple that having sex during pregnancy is acceptable (unless there are medical reasons to contraindicate it) and suggest positions for sex that might be more comfortable for the woman. There is no reason to assess the womans family history and genetic background. Simply explaining that dyspareunia is normal is dismissive of the couples concern, although they should be reassured that this does sometimes happen and then they should be offered education on ways to alleviate it. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Difficulty: Difficult

15. Which patient would the perinatal nurse assess as being most at risk for maternal attachment problems? A. 18 year-old married woman with a supportive family who lives nearby B. 20-year-old woman with remote history of chlamydia and gonorrhea C. 22-year-old alcoholic who has been sober for 10 years D. 52-year-old unemployed divorced woman who thought she was in menopause

D Maternal attachment to the fetus is an important area to assess and can be useful in identifying families at risk for maladaptive behaviors (Youngkin et al., 2012). The nurse should assess for indicators such as unintended pregnancy, intimate partner violence, difficulties in the partner relationship, sexually transmitted infections, limited financial resources, substance use, adolescence, poor social support systems, low educational level, and the presence of mental conditions that might interfere with the patients ability to bond with and care for the infant. The divorced, unemployed woman experiencing an unexpected pregnancy has the most risk factors. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Moderate

18. The perinatal nurse notes that a patient has the diagnosis of ptyalism. What topic should the nurse include in the patients teaching plan? A. The benefits of acupuncture B. The need to eat more red meat C. The importance of strict vulvar hygiene D. The suggestion to suck on hard candy

D Ptyalism is an excessive production of saliva. Possible helpful strategies include sucking on hard candy, brushing the teeth often, drinking plenty of water in small sips, and consuming small frequent meals with fewer starchy foods. Acupuncture can help with nausea and vomiting, vulvar hygiene would be recommended for leukorrhea, and eating more red meat may help with dietary insufficiencies. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate

3. A perinatal nurse is assessing a pregnant womans medications and finds that one of them is categorized as Category D. What information should the nurse provide this patient? A. Studies have not found human fetal risk, although animal fetuses are harmed by it. B. There are no associated fetal risks with this drug and it is safe to take in pregnancy. C. There havent been any studies of this drug in human fetuses; I wouldnt take it. D. We have to decide if the benefits of this drug outweigh the risk, as it can harm the fetus.

D There are five categories of drugs based on fetal risk: Category A: no associated fetal risk, safe to take during pregnancy; Category B: no associated fetal risk in animals, fetal risk in humans not identified; Category C: evidence of adverse effects in animal fetuses, fetal risk in humans not identified; Category D: evidence of adverse effects and fetal risk in humans, benefits and risks must be considered before prescribing; and Category X: evidence of fetal risk and congenital anomalies in humans, risks outweigh the benefits, should not be prescribed during pregnancy. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Teaching/Learning Difficulty: Moderate