Chapter 9
The nurse places his or her hands on the maternal abdomen to gently palpate the fundal region of the uterus. This action is described as which Leopold maneuver? A. First maneuver B. Second maneuver C. Third maneuver D. Fourth maneuver
A
A nurse is assessing a 40-year old primigravida who is an insulin-dependent diabetic and who smokes. What does the nurse understand about these conditions related to prenatal screening tests? A. Second-trimester markers will be affected but not third-trimester markers. B. The presence of nicotine invalidates the results of most screening tests. C. The woman will have an overall effect of a higher inhibin level. D. There is no significant effect on prenatal screening test results.
C
A nurse is teaching a group of middle school girls about the complications associated with teen pregnancy. What topics should the nurse include? (Select all that apply.) A. Anemia B. Hypertensive problems C. Gestational diabetes D. Preeclampsia E. Preterm birth
A, B, D, E
The perinatal nurse explains to a group of nursing students that there are positive signs of pregnancy. Which of the following does the nurse include in this explanation? (Select all that apply.) A. Fetal heartbeat B. Fetal movement palpated by the examiner C. Intermittent uterine contractions D. Positive pregnancy test E. Visualization of the fetus
A, B, E
The nurse provides increased support to a woman during her first prenatal visit for her current pregnancy. The patient's first pregnancy ended in a miscarriage. The nurse understands that the reasons the patient may be ambivalent about this baby include which of the following? (Select all that apply.) A. Awareness of a new 24-hour responsibility B. Needs related to a second pregnancy C. Potential role/relationship changes D. Previous perinatal loss E. Unresolved grief and mourning
A, C, D, E
A 40-year old primigravida has undergone nuchal translucency screening. The results show a finding of 3.3 mm. What information should the nurse provide the parents? A. The fetus has an open neural tube defect. B. The fetus has an increased risk for genetic disorders. C. These results are inconclusive. D. These results are normal in an older mother.
B
A nurse is reviewing the prenatal care schedule for a woman who is 10 weeks pregnant. When does the nurse advise the woman to return for her next appointment? A. 2 weeks B. 4 weeks C. 6 weeks D. 8 weeks
B
A nurse is assessing a patient for Chadwick's sign. In order to do this correctly, what action does the nurse take? A. Assesses the color of the patient's vaginal mucosa and cervix. B. Feels the patient's abdomen for passive fetal movement. C. Obtains a urine specimen for a pregnancy test. D. Palpates the patient's abdomen for uterine asymmetry.
A
A patient being seen for the first time in the perinatal clinic has multiple complaints, such as fatigue, anger outbursts, chronic pelvic pain, and feelings of anxiety. What action by the nurse is best? A. Assess the woman for a history of sexual assault. B. Document the patient's complaints on the chart. C. Refer the woman to a psychiatric nurse practitioner. D. Review the woman's past medical history with her
A
A patient has had a screening test for gestational diabetes and the 1-hour result is 250 mg/dL. What does the nurse conclude about this patient? A. Results are high; the patient has gestational diabetes. B. Results are inconclusive; will repeat test in one month. C. Results are lower than expected; seek endocrine consult. D. Results are normal; no gestational diabetes.
A
A student asks what the phrase "probable signs of pregnancy" means. The instructor provides which answer? A. Objective signs seen by an examiner; can be from other conditions B. Objective signs seen by an examiner; only caused by pregnancy C. Subjective signs reported by the patient; can be from other conditions D. Subjective signs reported by the patient; only caused by pregnancy
A
A woman asks the perinatal nurse about gestational diabetes because she has been reading about it. The nurse should inform the patient that screening for this condition is usually done at what time during the pregnancy? A. Around 24 to 28 weeks' gestation B. End of the first trimester C. Mid-pregnancy D. Normally offered around week 37
A
The nursing faculty member explains to a class of nursing students that the ethnic/cultural group with the highest rate of teen pregnancy is which group? A. African Americans B. Asian Americans C. European Americans D. Hispanic Americans
A
A woman in the OB clinic complains of multiple, fluid-filled blisters in her genital area that make walking extremely painful. What information should the nurse provide this patient? (Select all that apply.) A. "There are serious adverse fetal effects of this disease." B. "There is no cure for herpes simplex virus infection." C. "Transmission to your baby causes eye infections." D. "You can start antiretroviral medications immediately." E. "We will take blood cultures for a bacterial infection."
A, B
The nurse is explaining to students in the perinatal clinic that some adolescents are at higher risk of teen pregnancy than others. Which teens does the nurse include in these high-risk groups? (Select all that apply.) A. Homeless teens B. Incarcerated teens C. Teens from two-parent homes D. Teens with reliable information E. Teens with religious affiliations
A, B
A nurse is running for public office and plans to fund a comprehensive program to prevent teen pregnancy. When asked how to justify the cost of such a venture, what information could the nurse provide? (Select all that apply.) A. A quarter of teen mothers give birth to a second child within 2 years of the first child. B. Fifty percent of teen mothers go on welfare within 5 years of the birth of their first child. C. Only a small percentage of teen mothers will complete any education beyond high school. D. The rate of teen pregnancy in America is double that of other developed countries. E. There are so many teenage mothers they are overwhelming the health-care system.
A, B, C, D
A nursing instructor informs the class of the many benefits of prenatal care. What benefits does the instructor include? (Select all that apply.) A. Allows women informed decision making B. Decreased pregnancy-related maternal death C. Improved pregnancy outcomes D. Increased cost associated with more frequent visits E. Increased early identification of abnormal findings
A, B, C, E
A student nurse asks the OB clinic nurse why a pregnancy test is needed if a woman has missed several menstrual periods in a row. The nurse explains that amenorrhea can be caused by several conditions other than pregnancy, including which of the following? (Select all that apply.) A. Chronic illness B. Endocrine disorders C. Fatigue D. Infections E. Psychological factors
A, B, D, E
The nurse recognizes that a pregnant adolescent must successfully complete developmental tasks to be an effective mother. Which tasks does the nurse understand this to include? (Select all that apply.) A. Accepting this pregnancy and telling parents/friends B. Growing up and accepting responsibility C. Maintaining her freedom D. Seeing herself as a mother E. Setting reasonable goals for herself
A, B, D, E
A woman comes for her first prenatal appointment at 31 weeks' gestation with her first pregnancy. Which of the following are appropriate statements by the nurse? (Select all that apply.) A. "Do you have questions before I begin your prenatal history and information sharing?" B. "Have you had care in another clinic? I can't believe this is your first appointment!" C. "I am interested in hearing about your life and what prompted you to begin your prenatal care today." D. "It is nice to meet you and I will try to help you get caught up in your prenatal care." E. "Now that you are finally here, we need you to come monthly for the next two visits and then weekly."
A, C, D
A nurse is educating a woman who is 38 years old and experiencing her first pregnancy. When planning care for this woman, what information does the nurse take into consideration? (Select all that apply.) A. Chronic health conditions are more likely in this age group. B. Genetic screening is not recommended for women over age 30. C. Gestational diabetes is seen more frequently in this age group. D. Multiple gestations are rarely seen in women over age 35. E. Older primigravidas are at higher risk for cesarean birth.
A, C, E
A woman is having a triple-screen test during her second trimester of pregnancy. The nurse teaches the patient that this test includes which of the following? (Select all that apply.) A. Free beta-human chorionic gonadotropin B. Inhibin A C. Maternal serum alpha-fetoprotein D. Nuchal translucency testing E. Unconjugated estriol
A, C, E
A pregnant woman in the perinatal clinic is a commercial sex worker and states that she frequently has unprotected sexual intercourse. The nurse should educate this woman about which complications of sexually transmitted diseases (STDs)? (Select all that apply.) A. Ectopic pregnancy B. Frequent multi-fetal pregnancy C. Gestational hypertension D. Preterm labor E. Spontaneous abortion
A, D, E
The nurse advocates for smoking cessation during pregnancy and teaches pregnant women about the effects of tobacco exposure. Which of the following are potential harmful effects of prenatal tobacco use that the nurse should plan to include in the teaching? (Select all that apply.) A. Continued childhood respiratory problems B. Congenital diabetes C. Gestational hypertension D. Preterm labor and birth E. Small-for-gestational-age infant
A, D, E
A nurse is working with a pregnant woman who has the nursing diagnosis of altered family processes. What statement by the patient indicates that a major goal for this diagnosis has been met? A. "At least I'm getting better sleep now that I don't urinate every 2 hours." B. "My husband has been doing more around the house so I can rest more." C. "The kids are really excited about getting a new baby brother or sister." D. "We finally have the nursery painted and furnished so it's ready for baby."
B
A pregnant teen is in the clinic for a prenatal visit. The nurse needs to obtain informed consent. What action by the nurse is best? A. Ask the teen to call a parent and get consent over the phone. B. Have the teen sign the consent and then place it on the chart. C. Let the teen keep her appointment, but limit it to teaching only. D. Tell the teen that she must return with her parent/guardian.
B
A pregnant woman in her first trimester is having her first prenatal visit. She tells the nurse that she takes red raspberry leaf regularly. What response by the nurse is best? A. Discuss the cardiovascular problems associated with this substance. B. Explain that it is safe to use during pregnancy. C. Inform the woman that safety has not been established. D. Tell the woman she should not use it during pregnancy.
B
A woman undergoing her first prenatal visit for a current pregnancy is reluctant to discuss her past obstetrical history with the nurse. Which action by the nurse is best? A. Document the woman's refusal to answer these particular questions in the chart. B. Explain that past obstetrical experiences frequently recur in later pregnancies. C. Inform the woman that the clinic cannot provide comprehensive care without a complete history. D. Tell the woman that you need the information in order to continue with the prenatal visit.
B
A woman who is 32 weeks pregnant has concluded a prenatal visit. The nurse should schedule the next prenatal visit for which gestational week? A. 33 weeks B. 34 weeks C. 38 weeks D. 40 weeks
B
The nurse auscultates fetal heart tones on a woman in her third trimester of pregnancy and counts a heart rate of 92 beats/minute. Which action by the nurse is best? A. Apply oxygen at 6 L/minute. B. Assess the maternal heart rate. C. Document the findings in the chart. D. Turn the woman on her left side.
B
The nurse explains that the childbearing year is an ideal time to make healthy changes for the entire family. Which action does the nurse suggest? A. Avoiding alcohol and smoking B. Creating healthy menus for family meals C. Getting plenty of sleep each night D. Planning a "parents' date night" each week
B
The prenatal nurse believes in advocating for the patient. What action by the nurse best reflects this role? A. Documenting the patient's preferences for childbirth care B. Helping the woman formulate and vocalize questions C. Informing women of options related to labor and birth D. Teaching women about physical changes during pregnancy
B
A nurse assesses the pregnant woman for recreational drug use as part of the first prenatal visit. What harmful effects of recreational drugs does the nurse teach the woman about? (Select all that apply.) A. Cocaine: placenta previa B. Ecstasy: cleft palate C. Marijuana: intrauterine growth restriction D. Methamphetamine: spontaneous abortion E. Heroin: macrosomia
B, C, D
A nurse is caring for a woman who is positive for hepatitis B. What other screening tests does the nurse facilitate for this patient? (Select all that apply.) A. Cytomegalovirus B. Hepatitis B for household members C. Hepatitis B for intimate contacts D. Hepatitis C E. Parvovirus
B, C, D
The student nurse in the perinatal clinic asks why it is so important to screen women for intimate partner violence during the first prenatal visit. What information does the registered nurse provide the student? (Select all that apply.) A. Approximately one in three women has been a victim of abuse. B. Intimate partner violence is more common than preeclampsia. C. Many women may abuse substances to cope with the violence. D. Partners abuse over 300,000 pregnant women each year. E. Violence rarely occurs for the first time during pregnancy.
B, C, D
A nurse is using the RADAR model when working with women in the perinatal clinic. What actions does the nurse include when assessing patients with this model? (Select all that apply.) A. Ask only when injuries are suspicious. B. Assess the patient's safety. C. Document findings in the chart. D. Review options and referrals with the patient. E. Routinely screen every patient.
B, C, D, E
The nurse schedules a patient for her first prenatal appointment with the certified nurse-midwife (CNM) in the clinic. About what topics does the nurse help the patient formulate questions to ask the CNM? (Select all that apply.) A. An opportunity to meet other patients who have delivered with this practice B. The CNM's beliefs and practices concerning epidural anesthesia and episiotomies C. Use of complementary and alternative methods during labor and birth D. What happens if the patient gives birth when the CNM is not available E. Whether the CNM will be available by phone or Internet to answer questions
B, C, D, E
During the first prenatal visit, a nurse teaches a pregnant woman about emergencies for which she needs to be seen immediately. Which situations does the nurse include in this education? (Select all that apply.) A. Headache not associated with visual disturbances B. Low, dull backache or pelvic pressure C. Maternal fever over 100.5°F (38.1°C) D. Nausea and vomiting especially upon arising in the morning E. Reduction in fetal movements
B, C, E
A nurse is counseling a 40-year-old woman about her risks of giving birth to a child with Down syndrome. What information does the nurse provide? A. The risk doesn't go up until you are over 45. B. The risk is less than 1 in 1,000. C. The risk is about 1 in 85. D. The risk is about 1 in 20.
C
A nurse uses the CARE model when working with patients. How can this nurse use the model to help reduce racially related disparities in care for pregnant women? A. Ensure a clear exchange of valuable information. B. Pay due attention to another person. C. Provide resources, authority, or opportunities. D. Support or defend another individual.
C
A patient in the emergency department is complaining of fever, burning with urination, bloody urine, and amenorrhea for 1 month. To evaluate her symptoms, what action by the nurse is best? A. Ask the woman if her menstrual periods are usually regular. B. Collect a urine sample for a pregnancy test. C. Instruct her in obtaining a midstream urine sample. D. Obtain an order for an intravenous pyelogram (x-ray of the urinary tract).
C
A prenatal nurse manager wants to help pregnant women in the clinic decrease their stress. Which action by the manager would be best? A. Conduct childbirth preparation classes on site B. Display pictures of fetal development C. Institute primary nursing care for all patients D. Partner with a counseling service for referrals
C
A woman calls the prenatal clinic to inquire if she should have the seasonal influenza vaccination. What advice should the nurse provide? A. "Flu does not cause many problems in pregnancy." B. "No, vaccinations are not safe in pregnancy." C. "Yes, you should get the flu vaccination." D. "You should wait until your third trimester."
C
A woman has returned to the clinic for her second prenatal visit. Her blood pressure is significantly higher than on her previous visit. What action should the nurse do first? A. Administer oxygen and inform the provider. B. Ask the woman to lie down on the table. C. Ensure that the blood pressure cuff is the appropriate size. D. Take the blood pressure again.
C
A woman in the prenatal clinical is concerned because her partner, who was supportive and excited about becoming pregnant, has suddenly become more withdrawn and seems ambivalent toward the pregnancy. What response by the nurse is best? A. "Are you in a relationship that causes you to be afraid?" B. "Oh don't worry; they all feel this way sometimes." C. "This is a normal reaction to the reality of the pregnancy." D. "Your partner will come around to being excited soon."
C
A woman who is a Jehovah's Witness returns for a second prenatal visit and is discussing her plan of care with the nurse. The patient has returned a signed form in which she refuses all blood products. What action by the nurse is best? A. Advise the woman of potential complications. B. Inform the health-care provider of her choice. C. Place the signed form on the patient's chart. D. Refer the woman to a tertiary birthing center.
C
The clinic nurse talks with a patient about her possible pregnancy. The patient has experienced amenorrhea for 2 months, nausea during the day with vomiting every other morning, and breast tenderness. She is convinced she is pregnant and is reluctant to pay for a pregnancy test. Which action by the nurse is best? A. Agree that these signs usually signal pregnancy so no test is needed. B. Delete the order for the pregnancy test and inform the provider. C. Explain that these symptoms can be caused by other conditions. D. Inform the woman that this is standard procedure and must be done.
C
The nurse explains to a newly diagnosed pregnant woman at 10 weeks' gestation that her rubella titer indicates that she is not immune. Which of the following should the nurse teach the patient? (Select all that apply.) A. Avoid contact with all children until after you have given birth. B. Be retested in 3 months and obtain the vaccination if not immune. C. Do not become pregnant for 4 weeks after you receive the vaccination. D. Receive the rubella vaccine during the postpartum period. E. Seek medical care immediately for fever, runny nose, or rash.
C, D
A nurse has taught a pregnant woman about good nutrition during pregnancy at her first prenatal visit. What statement by the patient indicates that more teaching is needed? A. "I buy a lot of yellow and orange vegetables." B. "I have switched to buying only 1% milk." C. "We eat a lot more poultry these days." D. "We eat salmon once a week at least."
D
A nurse is assessing a woman who is at 29 weeks of gestation. The nurse measures the woman's fundal height, which is 58.42 cm (23 inches). What does the nurse conclude about this information? A. The nurse cannot make a conclusion. B. Fundal height is just right. C. Fundal height is too big. D. Fundal height is too small.
D
A nurse is performing the third Leopold maneuver on a woman who is gravida 3, para 3 and is currently 37 weeks' gestation. The nurse's fingers can be pressed together below the presenting part, which is firm to the touch. What action should the nurse take regarding this assessment data? A. Facilitate a referral to a perinatologist. B. Inform the health-care provider immediately. C. Prepare the woman for a breech delivery. D. Reassure the woman and document the findings.
D
A nurse reads a patient's chart and sees the diagnosis "pediculosis pubis." What does the nurse understand about this condition? A. The patient has abnormal pubic hair growth. B. The patient has an old episiotomy. C. The patient has human papillomavirus. D. The patient has pubic lice.
D
A nurse reads in a pregnant woman's chart that she is "para 3." What does the nurse understand about this woman's obstetrical history? A. Is now in her third trimester B. Currently pregnant with triplets C. Three babies born alive D. Three pregnancies delivered past 24 weeks of gestation
D
The nurse assesses a pregnant patient during the first prenatal visit. Which question by the nurse is the best example of therapeutic communication? A. "Do you understand the prenatal visit schedule?" B. "Do you use drugs or drink alcohol?" C. "Have you experienced quickening?" D. "To begin, what questions may I answer?"
D
The nurse includes screening for intimate partner violence in the first prenatal visit for all patients. Which of the following is an appropriate question for the nurse to ask? A. "I need to ask you, do you feel safe from abuse right now?" B. "Is your partner threatening or harming you in any way right now?" C. "This is something we ask everyone: Do you have any abuse in your life right now?" D. "We ask everyone this: Do you feel safe in your living environment and relationships?"
D
The nurse reads "positive Hegar's sign" in a patient's chart. What can the nurse conclude about the patient? A. Patient had a miscarriage B. Patient is post-partum C. Patient is pregnant D. Patient may be pregnant
D
The nursing student in the perinatal clinic asks the registered nurse why so many pregnant women seem to be stressed despite their "happy" condition. What response by the nurse is best? A. "It's the effect of all those hormones." B. "Many are afraid of labor and birth." C. "Most pregnant women don't feel well." D. "Pregnancy is a developmental crisis."
D
A pregnant woman asks a neighbor who is a nurse about using a midwife instead of a physician for her prenatal, labor, and childbirth care. What information does the neighbor share with the pregnant woman about certified nurse midwives (CNMs)? (Select all that apply.) A. CNMs are able to see women experiencing complications. B. CNM practice is physician dependent. C. There is an increased need for medical interventions with CNMs. D. There is increased patient satisfaction with CNMs. E. There is a lower rate of cesarean births with CNMs.
D, E