chapter 22 womans

A nurse is reviewing a postpartum woman's history and labor and birth record. The nurse determines the need to closely monitor this client for infection based on which factor? • labor less than 3 hours • hemoglobin of 11.5 mg/dl (115 g/L) • placenta removed via manual extraction • multiparity

placenta removed via manual extraction

The nurse instructs the pregnant mother that it will necessary to collect swabs for group B streptococcus at which prenatal visit? • 32 weeks' gestation • 34 weeks' gestation • 36 weeks' gestation • 38 weeks' gestation

36 weeks' gestation

The nurse is preparing a mother for a planned cesarean birth. The nurse ascertains that the mother has previously had a deep vein thrombosis. Heparin is ordered prophylactically. The nurse determines this medication will be administered: • 1 hour after birth. • 8 hours after birth. • 14 hours after birth. • 24 hours after birth.

8 hours after birth

A client in the active phase of labor is diagnosed as having a protracted labor pattern. Which pattern would the nurse assess as indicative of a protracted labor pattern? • arrest of the descent of the fetal head • prolonged deceleration phase • secondary arrest of cervical dilation (dilatation) • delayed descent of the fetal head

delayed descent of the fetal head

A woman with class II heart disease is experiencing an uneventful pregnancy and is now prescribed bed rest at 36 weeks' gestation by her health care provider. The nurse should point out that this is best accomplished with which position? • Lie flat on her back. • Stay in high Fowler position. • Lie in a semi-recumbent position. • Use pillows and wedges to stay in a fully recumbent position.

Lie in a semi-recumbent position.

ACHashimotos thyroiditis is also known by the more common name of chronic lymphocytic thyroiditis and is the cause of most cases of hypothyroidism and women. Untreated hypothyroidism during pregnancy can adversely affect the childs mental development. Is this statement true or false?

T Thyroid-stimulating hormone levels should be tested either before pregnancy or early in pregnancy, and hypothyroidism should be corrected during the first trimester.

The diabetic mother has been in active labor for 9 hours and has only reached 3 cm dilation (dilatation). It has been determined by ultrasound the fetus is very large. The decision has been made to deliver the fetus via cesarean. How much time does the nurse have to prepare the client before the surgery begins? • 15 minutes • 30 minutes • 45 minutes • 60 minutes

30 minutes

A client in labor is agitated and nervous about the birth of her child. The nurse explains to the client that fear and anxiety cause the release of certain compounds that can prolong labor. The nurse is referring to which compounds? • prostaglandins • catecholamines • oxytocin • relaxin

catecholamines

A 37-year-old client experienced a perinatal loss 3 days ago. Which client characteristic would be communicated to the health care provider? • lack of appetite • denial of the death • blaming herself • frequent crying spells

denial of the death

The nurse is monitoring the uterine contractions of a woman in labor. The nurse determines the woman is experiencing hypertonic uterine dysfunction based on which contraction finding? • well coordinated. • poor in quality. • brief. • erratic.

erratic

A primigravida whose labor was initially progressing normally is now experiencing a decrease in the frequency and intensity of her contractions. The nurse would assess the woman for which condition? • a low-lying placenta • fetopelvic disproportion • contraction ring • uterine bleeding

fetopelvic disproportion

A nurse is caring for a client who has been diagnosed with precipitous labor. For which potential fetal complication should the nurse monitor? • facial nerve injury • cephalohematoma • intracranial hemorrhage • facial lacerations

intracranial hemorrhage

The nurse is caring for a woman at 32 weeks' gestation who expresses deep concern because her previous pregnancy ended in a stillbirth. The nurse would encourage the mother to have what screening test? • nonstress test (NST) • contraction stress test • vaginal ultrasound • doppler ultrasound

nonstress test (NST)

The nurse is caring for a laboring mother who is experiencing a protracted active phase of labor. The nurse prepares for which two interventions to assist the mother through this phase of labor? • oxytocin and amniotomy • amniotomy and epidural anesthesia • oxytocin and epidural anesthesia • amniotomy and internal monitoring

oxytocin and amniotomy

The nurse is caring for a mother laboring with her third baby. Suddenly the nurse notes severe fetal bradycardia and the mother becomes hypotensive. For which emergent complication should the nurse direct care to the mother? • uterine rupture • placental abruption • fetal distress • amniotic embolism

uterine rupture

The nurse is caring for a laboring mother who is making little progress with cervical dilation (dilatation). The mother is very anxious and tense. How can the nurse best help this mother? • Provide support. • Provide pain medication. • Reposition the mother. • Teach breathing techniques.

provide support

A pregnant client in labor is having contractions about 4 minutes apart but rarely higher than 20 mm Hg in strength with resting tone ranging from 5 to 8 mm Hg. The client asks what can be done to make contractions more effective. How will the nurse respond to the client? • "Get some rest, because the contractions are hypertonic." • "You may need oxytocin to strengthen contractions." • "Relax, because contractions of this kind will strengthen by themselves." • "Try sitting up a little more erect to make the contractions more regular."

"You may need oxytocin to strengthen contractions."

Diabetes mellitus is a medical condition that could adversely affect pregnancy. Its frequency is increasing along with obesity and abnormal lipid profiles. Women who have GDM in pregnancy have no greater risk of developing type 2 diabetes. Is this statement true or false?

F Women who develop GDM have a 35% to 60% likelihood of developing diabetes in the next 10 to 20 years. About 7% of all pregnancies are affected by GDM with higher rates among African Americans, Latinas, and American Indians.

A mother has delivered her baby 20 minutes ago. Suddenly, the mother becomes very restless. Her previously normal vitals now change to: BP 90/60, HR 110, & RR 8. The mother becomes cyanotic and short of breath. The nurse acts quickly to intervene because she suspects an amniotic fluid embolus has occurred. Place in order the interventions the nurse should take. • 1 Call a code. • 2 Notify the obstetric provider. • 3 Begin oxygen with a nonrebreather mask. • 4 Prepare for intubation. • 5 Increase the IV fluid rate.

Call a code. • Notify the obstetric provider. • Begin oxygen with a nonrebreather mask. • Prepare for intubation. • Increase the IV fluid rate.

The nurse is giving discharge instructions to a mother who has had a cesarean birth. Which instructions should be included in this discharge teaching? Select all that apply • No heavy lifting. • Have sutures removed in 7 days. • May resume driving when comfortable. • Resume a regular diet. • Change the dressing regularly.

• No heavy lifting. • May resume driving when comfortable. • Resume a regular diet.

The nurse is caring for a laboring mother experiencing a precipitous delivery. The nurse would assess the mother for symptoms of which complication? • placental abruption (abruptio placentae) • prolapsed cord • fetal hypoglycemia • poor Apgar scores

placental abruption (abruptio placentae)

A nursing student correctly identifies the causes of labor dysfunction to include which factors? Select all that apply. • problems with the uterus • problems with the mother's diet • problems with the fetus • problems with access to health care • problems with finances

• Problems with the uterus • Problems with the fetus

Which clients should the nurse monitor for fetal demise? Select all that apply. • client with hydramnios • client with multifetal gestation • client who has a prolonged pregnancy • client whose fetus is displaying malpresentation • client with hypertension

• client who has a prolonged pregnancy • client with hypertension

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

D Feedback A Cardiomyopathy produces congestive heart failure during pregnancy. B Rheumatic heart disease can lead to heart failure during pregnancy. C Some congenital heart diseases will produce pulmonary hypertension or endocarditis during pregnancy. D Mitral valve prolapse is a benign condition that is usually asymptomatic.

The laboring mother is 8 cm dilated and continues to want to push with every contraction. The mother asks the nurse why she can't push. What is the nurse's best response? • "If you push against the cervix it will cause it to swell." • "You have to wait until you are fully dilated to push." • "Pushing before it's time won't get the baby her any sooner." • "The baby is not down far enough for you to push." •

"If you push against the cervix it will cause it to swell."

When the pregnant diabetic experiences hypoglycemia while hospitalized, the nurse should have the patient a. Eat 6 saltine crackers. b. Drink 8 oz of orange juice with 2 tsp of sugar added. c. Drink 4 oz of orange juice followed by 8 oz of milk. d. Eat hard candy or commercial glucose wafers.

A Feedback A Crackers provide carbohydrates in the form of polysaccharides. B Orange juice and sugar will increase the blood sugar, but not provide a slow-burning carbohydrate to sustain the blood sugar. C Milk is a disaccharide and orange juice is a monosaccharide. This will provide an increase in blood sugar but will not sustain to level. D This provides only monosaccharides.

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

A Feedback A Poor glycemic control later in pregnancy increases the rate of fetal macrosomia. B Poor glycemic control during the preconception time frame and into the early weeks of the pregnancy is associated with congenital anomalies. C Preterm labor or birth is more likely to occur with severe diabetes and is the greatest risk in women with pregestational diabetes. D Increased weight, or macrosomia, is the greatest risk factor for this woman.

With regard to the association of maternal diabetes and other risk situations affecting mother and fetus, nurses should be aware that a. Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy. b. Hydramnios occurs approximately twice as often in diabetic pregnancies. c. Infections occur about as often and are considered about as serious in diabetic and nondiabetic pregnancies. d. Even mild to moderate hypoglycemic episodes can have significant effects on fetal well-being.

A Feedback A Prompt treatment of DKA is necessary to save the fetus and the mother. B Hydramnios occurs 10 times more often in diabetic pregnancies. C Infections are more common and more serious in pregnant women with diabetes. D Mild to moderate hypoglycemic episodes do not appear to have significant effects on fetal well- being.

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

A, B, C Feedback Correct Congenital anomalies that can occur with AEDs include cleft lip or palate, congenital heart disease, urogenital defects, limb reduction, mental retardation and neural tube defects. This is referred to assess fetal hydantoin syndrome. Incorrect These congenital anomalies are not associated with the use of AEDs.

Diabetes refers to a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin action, insulin secretion or both. Over time diabetes causes significant maternal changes in the microvascular and macrovascular circulations. These complications include (select all that apply) a. Atherosclerosis b. Retinopathy c. IUFD d. Nephropathy e. Neuropathy

A, B, D, E Feedback Correct These structural changes are most likely to affect a variety of systems, including the heart, eyes, kidneys, and nerves. Incorrect Intrauterine fetal death (stillbirth) remains a major complication of diabetes in pregnancy; however, this is a fetal complication.

The nurse is caring for a client in the transition stage of labor. In which scenario would the nurse predict the use of forceps may be used to assist with the birth? • To lessen the mother's pain • The fetus is descending too slowly • Abnormal position of the fetal head • Reduce risk of complications •

Abnormal position of the fetal head

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

B Feedback A Care is supportive and includes bed rest and a high protein, low fat diet. B A person who has a history of high-risk behaviors should be offered the hepatitis B vaccine. C The first trimester is too early to discuss feeding methods with a woman in the high-risk category. D Hepatitis B is transmitted through blood.

Metabolic changes throughout pregnancy that affect glucose and insulin in the mother and the fetus are complicated but important to understand. Nurses should know that a. Insulin crosses the placenta to the fetus only in the first trimester, after which the fetus secretes its own. b. Women with insulin-dependent diabetes are prone to hyperglycemia during the first trimester, because they are consuming more sugar. c. During the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus. d. Maternal insulin requirements steadily decline during pregnancy.

C Feedback A Insulin never crosses the placenta; the fetus starts making its own around the tenth week. B As a result of normal metabolic changes during pregnancy, insulin-dependent women are prone to hypoglycemia (low levels). C Pregnant women develop increased insulin resistance during the second and third trimesters. D Maternal insulin requirements may double or quadruple by the end of pregnancy.

The nurse is caring for a mother laboring with her second baby. Her last vaginal exam revealed 5 cm dilated at -2 station. The nurse notes on the monitor that the fetus is now experiencing severe bradycardia and variable decelerations. What should the nurse do first? • Call for help. • Apply oxygen to the mother. • Notify the obstetric provider. • Lift the head off the cord.

Call for help.

The nurse is caring for a mother who has delivered a stillborn. The mother has expressed a desire to hold the baby but when the nurse enters the room with the baby the mother cries and becomes hysterical. What is the nurse's most important action in this situation? • Provide reassurance to the mother without the baby in the room. • Tell the mother you will return with the baby when she is ready. • Provide information to the family about counseling for the mother. • Leave the baby in the room until the mother is ready.

Provide reassurance to the mother without the baby in the room.

A client has been admitted to the birthing suite in labor. She has been in labor for 12 hours and is dilated to 4 cm. The primary care provider notes that the client is in hypotonic labor. What does this mean? • The uterine contractions may or may not be regular, but the quantity or quality or strength is insufficient to dilate the cervix. • The uterine contractions are irregular, but the quantity or quality or strength is insufficient to dilate the cervix. • The uterine contractions are regular, but the quantity or quality or strength is insufficient to dilate the cervix. • The uterine contractions may or may not be regular, but the quantity or quality or strength is sufficient to dilate the cervix.

The uterine contractions may or may not be regular, but the quantity or quality or strength is insufficient to dilate the cervix.

When a woman in labor has reached 8 cm dilation, the nurse notices the fetal heat rate suddenly slows. On perineal inspection, the nurse observes the fetal cord has prolapsed. The nurse's first action would be to: • turn her to her left side. • place her in a knee-chest position. • Use fingers to press upward on the presenting part. • cover the exposed cord with a dry, sterile wrap.

Use fingers to press upward on the presenting part.

A laboring client is experiencing dysfunctional labor or dystocia due to the malfunction of one or more of the "four Ps" of labor. Which scenario best illustrates a power problem? • The fetus is macrosomic. • The mother is fighting the contractions. • The mother has a small pelvic opening. • Uterine contractions are weak and ineffective.

Uterine contractions are weak and ineffective.

There are several women in active labor on the unit. Which woman is at highest risk for developing hypotonic contractions and therefore will need frequent nursing assessments? • a 21-year-old primipara woman who does not have a support person with her and is very anxious • a 17-year-old primipara requesting more pain medication every 15 to 30 minutes (and not receiving it) even though there is an epidural catheter in place that is working effectively • a G4P3 client who is having twins and wants to experience a "natural birth" • a 37-year-old G2P1 woman being induced whose last ultrasound at 36 weeks' gestation showed oligohydramnios

a G4P3 client who is having twins and wants to experience a "natural birth"

A midforceps birth was required to safely deliver a mother's fetus. This information would be important for the postpartum nurse when assessing the mother for: • ability to void. • amount of lochia. • firmness of the fundus. • episiotomy repair.

ability to void

A client presents to the emergency department at 38 weeks' gestation in pain with bloody vaginal discharge. The nurse and health care provider are quickly assessing the client for the possibility of a uterine rupture. Which best confirms the uterine rupture? • an ultrasound showing an irregularly shaped uterus • palpation of an extrauterine fetus • client verbalizing a "tearing" sensation • vital signs indicating a weak, rapid pulse

an ultrasound showing an irregularly shaped uterus

The mother has suffered an amniotic fluid embolism. She has a sudden onset of tachycardia, weak thready pulses, is pale and diaphoretic. The nurse recognizes these symptoms as: • cardiogenic shock. • hypovolemic shock. • acute respiratory distress syndrome. • respiratory failure.

cardiogenic shock

Which finding would lead the nurse to suspect that the fetus of a woman in labor is in hypertonic uterine dysfunction? • lack of cervical dilation past 2 cm • fetal buttocks as the presenting part • reports of severe back pain • contractions most forceful in the middle of uterus rather than the fundus

contractions most forceful in the middle of uterus rather than the fundus

A mother in labor with ruptured membranes comes to the labor and delivery unit. It is determined that the fetus is in a single footling breech presentation. The nurse assesses the mother for which complication associated with this fetal position? • cord prolapse • uterine atony • placental abruption (abruptio placentae) • brachial plexus injury

cord prolapse

The nurse is assisting a primary care provider to attempt to manipulate the position of the fetus in utero from a breech to cephalic position. What does the nurse inform the client the procedure is called? • internal rotation • external rotation • vaginal manipulation • external cephalic version

external cephalic version

The leading cause of life threatening perinatal infections in the United States is______ (GBS).

group B streptococcus This gram-positive bacteria is colonized in the rectum, anus, vagina, and urethra of pregnant and non-pregnant women. UTI, chorioamnionitis, and endometritis can occur during pregnancy. Transmission to the fetus can cause the most serious of infections. GBS testing of all women should be performed at 35 to 37 weeks of gestation and treatment with antibiotics should be initiated if indicated.

The nurse performs a vaginal exam on a mother in active labor. The cervix has dilated to 5 cm but the fetal head remains at -2 station. The nurse interprets these findings as: • pelvic dystocia. • shoulder dystocia. • cervical edema. • maternal full bladder.

pelvic dystocia.

A nurse is preparing an in-service education program for a group of nurses about dystocia involving problems with the passenger. Which problem would the nurse likely include as the most common? • macrosomia • breech presentation • persistent occiput posterior position • multifetal pregnancy

persistent occiput posterior position

A nurse is conducting an in-service program for a group of labor and birth unit nurses about cesarean birth. The group demonstrates understanding of the information when they identify which conditions as appropriate indications? Select all that apply. • active genital herpes infection • placenta previa • previous cesarean birth • prolonged labor • fetal distress

• active genital herpes infection • placenta previa • previous cesarean birth • fetal distress

A mother having her third baby is to deliver via a repeat cesarean birth. There are factors in the mother's health history that place her at a higher risk for hemorrhage and the need for blood transfusions. Identify these factors. Select all that apply. • multiple cesarean sections • placenta accreta with first delivery • mild preeclampsia • gestational diabetes • breech presentation

• multiple cesarean sections • placenta accreta with first delivery

The mother asks the nurse when an episiotomy is performed. How should the nurse respond? • "The episiotomy is done after the baby is crowning." • "The episiotomy is done before crowning to allow more room for the baby." • "The episiotomy is done when the baby reaches the perineum." • "The episiotomy is only done if the perineum begins to tear." •

"The episiotomy is done after the baby is crowning."

A multipara woman is fully dilated and effaced and has been pushing for over 2 hours. The student nurse observing asks the nurse, "What is causing this to last so long?" Which response by the nurse would be the most accurate? • "The fetal head and shoulders are too large to get through the canal." • "The fetal head is in an abnormal position." • "The fetus probably turned to a breech position at the last minute." • "The woman's bladder is too full, so the fetus cannot descend."

"The fetal head is in an abnormal position."

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

D Feedback A Pancreatic functioning is not affected by pregnancy. B The glucose requirements differ because of the growing fetus. C The pregnant woman should increase her intake by 200 calories a day. D Placental hormones, estrogen, progesterone, and human placental lactogen (HPL) create insulin resistance. Insulin also is broken down more quickly by the enzyme placental insulinase.

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

A Feedback A Insulin needs are reduced in the first trimester due to increased insulin production by the pancreas and increased peripheral sensitivity to insulin. B This statement is accurate and signifies understanding. Insulin resistance begins as early as 14 to 16 weeks of gestation and continues to rise until it stabilizes during the last few weeks of pregnancy. C This statement is correct. During the first trimester maternal blood glucose levels are reduced and the insulin response to glucose is enhanced therefore this is when an episode of hypoglycemia is most likely to occur. D For the non-breastfeeding mother insulin levels return to normal within 7 to 10 days. Lactation utilized maternal glucose, therefore the mothers insulin requirements will remain low during lactation. On completion of weaning the mothers prepregnancy insulin requirement is reestablished.

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

A Feedback A Iron deficiency anemia causes 75% of anemias in pregnancy. It is difficult to meet the pregnancy needs for iron through diet alone. B Reflex bradycardia is a slowing of the heart in response to the blood flow increases immediately after birth. C The most common form of anemia is iron deficiency anemia. D Both thalassemia and sickle cell hemoglobinopathy are hereditary but not directly related or confined to geographic areas.

Prophylaxis of subacute bacterial endocarditis (SBE) is given before and after birth when a pregnant woman has a. Valvular disease b. Congestive heart disease c. Arrhythmias d. Postmyocardial infarction

A Feedback A Prophylaxis for intrapartum endocarditis and pulmonary infection may be provided for women who have mitral valve prolapse. B Prophylaxis for intrapartum endocarditis is not indicated for a patient with congestive heart disease. C Prophylaxis for intrapartum endocarditis is not necessary for a woman with underlying arrhythmias. D A woman who is postmyocardial infarction does not require prophylaxis for intrapartum endocarditis.

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

A Feedback A The fetus is likely to test positive for HIV in the first 6 months until the inherited immunity from the mother wears off. Many of these babies will convert to HIV-negative status. B With the newer drugs, the risk for infection of the fetus has decreased. C The pregnancy will increase the chance of converting. D With the newer drugs, the risk for infection of the fetus has decreased. Also, the life span of an infected newborn has increased.

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

A Feedback A The neonate is at highest risk for hypoglycemia because fetal insulin production is accelerated during pregnancy to metabolize excessive glucose from the mother. At birth, the maternal glucose supply stops and the neonatal insulin exceeds the available glucose, leading to hypoglycemia. B Hypocalcemia is associated with preterm birth, birth trauma, and asphyxia, all common problems of the infant of a diabetic mother. C Excess erythrocytes are broken down after birth, releasing large amounts of bilirubin into the neonates circulation, which results in hyperbilirubinemia. D Because fetal insulin production is accelerated during pregnancy, the neonate shows hyperinsulinemia.

Toxoplasmosis is a protozoal infection transmitted through organisms in raw and undercooked meat or through contact with contaminated cat feces. While providing education to the pregnant woman, the nurse evaluates the learning and understands that the patient requires further instruction when she states a. I will be certain to empty the litter boxes regularly. b. I wont eat raw eggs. c. I had better wash all of my fruits and vegetables. d. I need to be cautious when cooking meat.

A Feedback A The patient should avoid contact with materials that are possibly contaminated with cat feces while pregnant. This includes cat litter boxes, sand boxes, and garden soil. She should wash her hands thoroughly after working with soil or handling animals. B The patient should avoid undercooked eggs and unpasteurized milk. C All fruits and vegetables should be washed thoroughly before eating. D Meat should be cooked thoroughly to an internal temperature of at least 160 F or as high as 180 F for poultry. All surfaces should be washed after they come into contact with uncooked meat. The patient should be instructed not to use the same utensils or cutting board for meat and produce.

Systemic lupus erythematosus is a chronic multisystem inflammatory disease that affects skin, joints, kidney, lungs, CNS, liver, and other organs. Maternal risks include (select all that apply) a. Premature rupture of membranes (PROM) b. Fetal death resulting in stillbirth c. Hypertension d. Preeclampsia e. Renal complications

A, C, D, E Feedback Correct PROM, hypertension, preeclampsia, and renal complications are all maternal risks associated with SLE. Incorrect Stillbirth and prematurity are fetal risks of SLE.

The nurse is caring for a client suspected to have a uterine rupture. The nurse predicts the fetal monitor will exhibit which pattern if this is true? • Late decelerations • Early decelerations • Variable decelerations • Mild decelerations

Late decelerations

While providing care in an obstetric setting, the nurse should understand that postpartum care of the woman with cardiac disease a. Is the same as that for any pregnant woman b. Includes rest, stool softeners, and monitoring of the effect of activity c. Includes ambulating frequently alternating with active range of motion d. Includes limiting visits with the infant to once per day

B Feedback A Care of the woman with cardiac disease in the postpartum period is tailored to the womans functional capacity. B Bed rest may be ordered, with or without bathroom privileges. Bowel movements without stress or strain for the woman are promoted with stool softeners, diet, and fluid. C The woman will be on bed rest to conserve energy and reduce the strain on the heart. D Although the woman may need help caring for the infant, breastfeeding and infant visits are not contraindicated.

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

B Feedback A Frequent episodes of maternal hypoglycemia may occur during the first trimester (not before conception) as a result of hormone changes and the effects on insulin production and usage. B Preconception counseling is particularly important because strict metabolic control before conception and in the early weeks of gestation is instrumental in decreasing the risks of congenital anomalies. C Hydramnios occurs about 10 times more often in diabetic pregnancies than in nondiabetic pregnancies. Typically, it is seen in the third trimester of pregnancy. D Hyperemesis gravidarum may exacerbate hypoglycemic events as the decreased food intake by the mother and glucose transfer to the fetus contribute to hypoglycemia.

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

B Feedback A There is no vaccine available for toxoplasmosis. B Rubella is the only infectious disease for which a vaccine is available. C There is no vaccine available for cytomegalovirus. D There is no vaccine available for herpesvirus type 2.

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

B Feedback A Type 2, sometimes called adult onset diabetes, is the most common. B Type 2 often goes undiagnosed, because hyperglycemia develops gradually and often is not severe. C There are 2 subgroups of gestational diabetes. Type GDM A1 is diet-controlled whereas Type GDM A2 is controlled by insulin and diet. D People do not go back and forth between type 1 and type 2 diabetes.

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

C Feedback A Insulin needs decrease during the first trimester, when nausea, vomiting, and anorexia are a factor. B Insulin needs increase during the second and third trimesters, when the hormones of pregnancy create insulin resistance in maternal cells. C Insulin needs decrease during the first trimester, when nausea, vomiting, and anorexia are a factor. They increase during the second and third trimesters, when the hormones of pregnancy create insulin resistance in maternal cells. D The insulin needs change during the pregnancy.

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

C Feedback A It is more important to have a fixed meal schedule than equal division of food intake. B Approximately 45% of the food eaten should be in the form of carbohydrates. C Having a fixed meal schedule will provide the woman and the fetus with a steadier blood sugar level, provide better balance with insulin administration, and help prevent complications. D Having a fixed meal schedule will provide the woman and the fetus with a steadier blood sugar level, provide better balance with insulin administration, and help prevent complications.

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

C Feedback A Obesity (BMI of 30 or greater) creates a higher risk for gestational diabetes. B A woman younger than 25 generally is not at risk for gestational diabetes mellitus. C Previous birth of a large infant suggests gestational diabetes mellitus. D The person with type 2 diabetes mellitus already is a diabetic and will continue to be so after pregnancy. Insulin may be required during pregnancy because oral hypoglycemia drugs are contraindicated during pregnancy.

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

C Feedback A Weight gain should be kept at a minimum with heart disease. B Iron and folic acid intake is important to prevent anemia. C Activity may need to be limited so that cardiac demand does not exceed cardiac capacity. D Fluid intake should not be limited during pregnancy. She may also be put on a diuretic. Fluid intake is necessary to prevent fluid deficits.

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

C Feedback A Women with sickle cell anemia are not iron deficient. Therefore routine iron supplementation, even that found in prenatal vitamins should be avoided in order to prevent iron overload. B Women with sickle cell trait usually are at greater risk for postpartum endometritis (uterine wall infection); however, this is not likely to occur in pregnancy and is not a sign of crisis. C Women with sickle cell anemia have recurrent attacks (crisis) of fever and pain, most often in the abdomen, joints and extremities. These attacks are attributed to vascular occlusion when RBCs assume the characteristic sickled shape. Crises are usually triggered by dehydration, hypoxia or acidosis. D These women are at an increased risk for UTIs; however, this is not an indication of sickle cell crisis.

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

D Feedback A Acyclovir is used to treat varicella pneumonia. B The baby is already born and has received the immunities. If the mother never had chickenpox, she cannot transmit the immunities to the baby. C Varicella infection occurring in a newborn may be life threatening. D Varicella (chickenpox) is highly contagious. Although the baby inherits immunity from the mother, it would not be safe to expose either the mother or the baby.

When caring for a pregnant woman with suspected cardiomyopathy, the nurse must be alert for signs and symptoms of cardiac decompensation, which include a. A regular heart rate and hypertension b. An increased urinary output, tachycardia, and dry cough c. Shortness of breath, bradycardia, and hypertension d. Dyspnea; crackles; and an irregular, weak pulse

D Feedback A These symptoms are not generally associated with cardiac decompensation. B Of these symptoms, only tachycardia is indicative of cardiac decompensation. C Of these symptoms, only dyspnea is indicative of cardiac decompensation. D Signs of cardiac decompensation include dyspnea; crackles; an irregular, weak, rapid pulse; rapid respirations; a moist, frequent cough; generalized edema; increasing fatigue; and cyanosis of the lips and nail beds.

While performing a vaginal exam on a laboring mother the nurse palpates the cord presenting into the vagina. What are the appropriate actions the nurse would need to take with this emergent complication? Select all that apply. • Elevate the presenting part off the cord. • Turn the mother on her left side. • Call the obstetric provider. • Prepare for an emergency delivery. • Administer a tocolytic. •

Elevate the presenting part off the cord. • Call the obstetric provider. • Prepare for an emergency delivery. • Administer a tocolytic.

During delivery, shoulder dystocia occurs. The nurse assists with the McRoberts maneuver and suprapubic pressure. Place in order the steps in which the nurse would accomplish these procedures. Use all options. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. • 1 Have the mother lie on her back. • 2 Sharply flex the mother's hips. • 3 Pull the mother's knees to the chest. • 4 Push downward above the level of the pubic bone.

Have the mother lie on her back. • Sharply flex the mother's hips. • Pull the mother's knees to the chest. • Push downward above the level of the pubic bone.

A gravida 1 laboring mother has been pushing for 2 hours and has had very little success with descent of the fetal head. What is an important intervention for the nurse to implement to help this mother? • Have the mother stop pushing. • Reposition the mother. • Provide pain relief. • Prepare for cesarean birth.

Have the mother stop pushing.

A nurse is presenting an in-service program about complications that can arise during labor. The nurse determines that the teaching was successful when the group correctly chooses which findings as suggesting an amniotic fluid embolism? Select all that apply. • Sudden onset of respiratory distress • Slow onset of fetal distress • Maternal hypotension • Maternal tachycardia • Acute, continuous abdominal pain •

Sudden onset of respiratory distress • Maternal hypotension • Maternal tachycardia

When preparing a mother for a trial of labor after cesarean (TOLAC), what information should the nurse include in the teaching plan? • There may be a longer active phase of first stage of labor. • There may be a shorter active phase of first stage of labor. • There may be a longer latent phase of labor. • There may be a shorter latent phase of labor.

There may be a longer active phase of first stage of labor.

A client has been in labor for 10 hours, with contractions occurring consistently about 5 minutes apart. The resting tone of the uterus remains at about 9 mm Hg, and the strength of the contractions averages 21 mm Hg. The nurse recognizes which condition in this client? • hypotonic contractions • hypertonic contractions • uncoordinated contractions • Braxton Hicks contractions

hypotonic contractions

A mother who had a cesarean delivery with her second child wishes to deliver her third baby vaginally. The nurse prepares the mother for an induction of labor. Because of the previous cesarean birth the nurse knows which classification of drugs will not be used in the induction process? • prostaglandins • oxytocin • ergot alkaloids • laminaria

prostaglandins

When reviewing the medical record of a postpartum client, the nurse notes that the client has experienced a third-degree laceration. The nurse understands that the laceration extends to which area? • superficial structures above the muscle • through the perineal muscles • through the anal sphincter muscle • through the anterior rectal wall

through the anal sphincter muscle

A client is in active labor. Leopold maneuvers are completed and it is determined that there is a fetal malpresentation. The infant is in a breech position. The health care provider is notified and it is ascertained that the infant is in a frank breech presentation. What type of delivery does this presentation call for? • vaginal delivery • Piper forceps • vacuum delivery • standard forceps

vaginal delivery

The nurse plans to complete a preoperative checklist for the laboring client who requires a cesarean delivery. Which actions should be completed by the nurse? Select all that apply. • Administer antibiotics. • Check hemoglobin and blood type. • Insert a bladder catheter. • Discontinue fetal monitoring. • Place a wedge under the mother's side.

• Administer antibiotics. • Check hemoglobin and blood type. • Insert a bladder catheter. • Place a wedge under the mother's side.

The nurse is teaching a birthing class to pregnant mothers. What information does the nurse teach the mothers about having an upright position during the first stage of labor? Select all that apply. • It will shorten the length of the first stage of labor. • It reduces the rate of surgical vaginal deliveries. • It improves uteroplacental profusion. • It decreases the rate of higher lacerations. • It reduces labor pain.

• It will shorten the length of the first stage of labor. • It reduces the rate of surgical vaginal deliveries. • It improves uteroplacental profusion. • It reduces labor pain.

Group B streptococcus (GBS) infection presents a large risk to the neonate. Which factor should the nurse consider when developing a plan of care related to GBS? Select all that apply. • Preterm labor clients receive prophylactic antibiotics. • Antibiotics must be started 4 hours prior to labor to be effective. • Mothers with previous GBS will be treated with prophylactic antibiotics. • Erythromycin is the primary antibiotic to treat GBS. • Women are screened for GBS in the 32nd week of gestation.

• Preterm labor clients receive prophylactic antibiotics. • Antibiotics must be started 4 hours prior to labor to be effective. • Mothers with previous GBS will be treated with prophylactic antibiotics.

The mother who delivered 60 minutes ago still has not expelled the placenta and the cervix is closing. Nitroglycerin is ordered by the obstetric provider. What nursing care should the nurse provide when administering this drug? Select all that apply. • Provide oxygen. • Blood pressure assessment every 5 minutes. • Continuous pulse oximetry. • Increase IV flow rate. • Continuous HR monitoring.

• Provide oxygen. • Blood pressure assessment every 5 minutes. • Continuous pulse oximetry. • Continuous HR monitoring.

A pregnant woman reports her last child was born by cesarean birth. She questions if she will be required to have a cesarean birth for this current pregnancy. What information should be provided? Select all that apply. • The reason for the previous cesarean birth will aid in determining if a repeated cesarean birth will be performed. • It is safe for women who have had a cesarean birth to have a vaginal birth if that is what she chooses. • The type of incision into the uterus in the previous cesarean birth will be a factor for consideration. • If the previous cesarean birth was due to fetal distress a repeated cesarean birth will be needed. • If the cesarean birth was due to pelvic size a repeated cesarean birth is likely indicated.

• The reason for the previous cesarean birth will aid in determining if a repeated cesarean birth will be performed. • The type of incision into the uterus in the previous cesarean birth will be a factor for consideration. • If the cesarean birth was due to pelvic size a repeated cesarean birth is likely indicated.

A pregnant client tells the nurse that she hopes the baby is not in the breech position because she has heard that this causes difficult labor. What should the nurse include when explaining the reasons for this presentation to the client? Select all that apply. • multiple fetuses • maternal diabetes • fetal birth defects • lax abdominal muscles • fetal age less than 40 weeks

• multiple fetuses • fetal birth defects • lax abdominal muscles • fetal age less than 40 weeks

The nursing student doing a rotation in obstetrics is talking to her preceptor about dystocia. She asks what is meant by the term "expulsive forces," better known as the "powers." The preceptor correctly tells her that the "powers" include which factors? Select all that apply. • presentation • position • mother's age • fetal development • Analgesia

• presentation • position • fetal development

A multipara woman is experiencing a prolonged descent while trying to rest and increase her fluid intake. The nurse suggests that she change position. Which position(s) will be effective for pushing to speed up the descent? Select all that apply. • supine with knees pulled up to chest • semi-Fowler position • lithotomy position • squatting position • standing, leaning against a door frame

• semi-Fowler position • squatting position

The nurse notifies the obstetrical team immediately because the nurse suspects that the pregnant woman may be exhibiting signs and symptoms of amniotic fluid embolism. When reporting this suspicion, which finding(s) would the nurse include in the report? Select all that apply. • significant difficulty breathing • hypertension • tachycardia • pulmonary edema • bleeding with bruising

• significant difficulty breathing • tachycardia • pulmonary edema • bleeding with bruising