CHAPTERS 4,5,6,, High risk antepartum Nursing Care

9. An adolescent patient who is 15 weeks pregnant refuses to have an alpha-fetoprotein test performed because, "I don't like needles." Which initial approach does the nurse take to achieve the testing? 1. Insist that testing will be done with or without her cooperation. 2. Explain the testing is important in detecting serious birth defects. 3. Ask an accompanying parent to help persuade the patient. 4. Notify the health care provider of the patient's refusal

ANS: 2 This is correct. The initial approach for the nurse to take is to appeal to the patient about the importance of ensuring that her baby is healthy.

7. The nurse is collecting health information from a patient who is early in the first trimester of pregnancy. Which topic is most important for the nurse to discuss with the patient after learning that the patient works for a commercial cleaning company? 1. Risk related to exposure to environmental toxins 2. Weight limit for lifting during the patient's pregnancy 3. Importance of resting with feet up during the day 4. Reasons for the patient to look for a safer job

ANS: 1 1 This is correct. Exposure to environmental toxins increases the risk for miscarriage, preterm birth, and other complications. The patient's job may involve exposure to solvents and/or cleaning chemicals.

4. The nurse is providing care in a school clinic established for the care of adolescent mothers. When assessing a patient who is 11 years of age and pregnant, which deduction regarding the patient's psychosocial development will the nurse recognize? 1. The adolescent is self-centered and oriented toward the present. 2. At this age, pregnancy is likely a result of attachment to a first love. 3. Moving into the mothering role will be nearly impossible at this age. 4. The role of the grandmother will be as the baby's primary caretaker.

ANS: 1 This is correct. Pregnancy in early adolescence is difficult because the adolescent is self-centered and oriented toward the present, which makes maternal adaptation to pregnancy difficult and interferes with mothering

16. The nurse explains to a patient who has missed a second menstrual cycle that a combination of presumptive and probable signs is used to make a practical diagnosis of pregnancy. Which signs are expected by the nurse when making a practical diagnosis? Select all that apply. 1. Elevated hCG levels in blood and urine 2. Brownish pigmentation on the face 3. Fetal movement detected by the examiner 4. Bluish-purple coloration of vagina and cervix 5. Occasional mild contractions

ANS: 1, 2, 4 1 This is correct. Elevated hCG levels in the patient's blood and urine are probable signs of pregnancy and will be considered when making a practical diagnosis of pregnancy. 2 This is correct. Brownish pigmentation on the patient's forehead, temples, cheeks, and/or upper lip is melisma (chloasma), which is a probable sign of pregnancy and will be considered when making a practical diagnosis of pregnancy. 4 This is correct. Bluish-purple coloration (Chadwick's sign) of the vaginal mucosa, cervix, and vulva occurs at 6 to 8 weeks gestation and is considered a probable sign of pregnancy and will be considered when making a practical diagnosis of pregnancy

15. The nurse is conducting a staff education session about preeclampsia and eclampsia complications. Which statements by the nurse are accurate about HELLP syndrome? Select all that apply. 1. This syndrome destroys red blood cells. 2. This syndrome impacts the amount of platelets. 3. This syndrome decreases a patient's white blood cell (WBC) count. 4. This syndrome decreases a patient's blood urea nitrogen (BUN). 5. This syndrome increases liver enzymes.

ANS: 1, 2, 5 1 This is correct. Hemolysis is part of HELLP syndrome. 2 This is correct. Low platelets are part of HELLP syndrome 5 This is correct. Elevated liver enzymes are part of HELLP syndrome.

5. The nurse is counseling a patient who shares the intention to become pregnant. Which finding during the collection of health information will the nurse feel the least concern to address? 1. The patient smokes a pack of cigarettes a week. 2. The patient lives in a recently renovated house. 3. The patient travels outside the country for work. 4. The patient has a family history of diabetes mellitus.

ANS: 2 This is correct. The fact that the patient lives in a recently renovated house is the least concern to the nurse. If renovation was in process or the house was old and not renovated, the nurse would be concerned about exposure to environmental hazards.

19. A couple informs the nurse they have decided to make arrangements for a home birth. Which criteria will the nurse share with the couple regarding a safe home birth? Select all that apply. 1. The couple must be trained on how to be in control of the birth. 2. The pregnant woman must be in good health with a normal pregnancy. 3. The birthing home must be within a 1-hour drive of a hospital. 4. Adequate medical supplies and resuscitation equipment is available. 5. The birthing room needs to be sterile prior to labor and delivery.

ANS: 2, 4 2 This is correct. The nurse is correct in informing the couple that the woman must be in good health with a normal pregnancy. High-risk pregnancies are not suitable for home births 4 This is correct. The nurse needs to inform the couple that in addition to being attended by a well-trained health care provider, adequate medical supplies and resuscitation equipment need to be in the home

5. The nurse is providing care for a patient who is 42 years of age and in the first trimester of her pregnancy. For which possible complication will the nurse closely monitor the patient and fetus? 1. Elevated blood pressure and proteinuria 2. Indications of maladaptation to pregnancy 3. Alterations in fetal chromosomal studies 4. Subtle indicators of menopause occurring

ANS: 3 This is correct. Due to the patient's age, the nurse will closely monitor for chromosomal alterations in the fetus. Older mothers are a greater risk for fetal chromosome defects.

1. The nurse in a prenatal clinic is reviewing the files of four patients scheduled for visits. Which patient does the nurse identify as having the highest-risk pregnancy? 1. The patient who is 16 years of age just diagnosed with gestational diabetes 2. The patient with preexisting hypertension who is currently pregnant with twins 3. The patient who is 37 years of age, obese, and experiencing pregnancy-induced hypertension 4. The patient who is 28 years of age who delivered a premature neonate 3 years prior

ANS: 3 This is correct. The patient who is 37 years of age, obese, and experiencing pregnancy-induced hypertension has three risk factors: age over 35 years, excessive weight, and a pregnancy-related complication. This is the patient with the highest-risk pregnancy.

9. A patient who is pregnant asks the nurse when her baby is due to be born. The patient reports her last menstrual period (LMP) date as April 14. Using Naegele's rule, the nurse will set the estimated date of delivery (EDD) as what date? 1. July 21 2. January 7 3. July 14 4. January 21

ANS: 4 This is correct. Naegele's rule requires counting back 3 months from the LMP and adding 7 days. This is the correct calculation and EDD.

6. The nurse is assisting a patient who is pregnant to prepare for an MRI scheduled to assess fetal brain development. Which situation causes the nurse to notify the radiology department personnel? 1. The patient had breakfast before the test. 2. The patient reports having an iodine allergy. 3. The patient expresses concern about pain. 4. The patient has a permanent body piercing.

ANS: 4 This is correct. Part of the preparation for an MRI is to have the patient remove all metallic objects before the testing. The fact that the patient has a permanent body piercing will present a problem. The nurse needs to notify the radiology department for the situation.

6. A patient at 30 weeks gestation is exhibiting signs of preterm labor and delivery. The health care provider (HCP) informs the patient that nothing can be done to disrupt this process. The patient is in distress and states, "Why can't something be done to save my baby?" The nurse understands the HCP's decision is likely based on which finding? 1. Ruptured membranes caused an infection. 2. The patient is unstable due to hemorrhage. 3. Fetal age is incompatible with survival. 4. A fetal heartbeat could not be obtained.

ANS: 4 This is correct. The inability to obtain a fetal heart beat is indicative of fetal demise, which does not support measures to stop preterm labor and delivery.

19. A patient in the third trimester of pregnancy reports having heartburn nearly every day. Which recommendations does the nurse make to alleviate the problem? Select all that apply. 1. Consume three moderate-sized meals daily. 2. Sip clear, carbonated beverages when eating. 3. Assume a low Fowler position after meals. 4. Avoid eating 3 hours prior to bedtime. 5. Avoid consuming spicy, fatty, or fried food.

ANS: 4, 5 4 This is correct. When a patient experiences heartburn in the third trimester of pregnancy, the patient should avoid eating at least 3 hours prior to bedtime. 5 This is correct. Spicy, fatty, and/or fried foods can contribute to heartburn, especially in the patient who is in the third trimester of pregnancy. These foods need to be eliminated from the diet.

20. The nurse is performing an NST along with a biophysical profile scoring (BPP) on a patient at 39 weeks gestation. The nurse determines the fetus has a nonreactive NST. The fetus has trunk or limb movement two times; is noted to be opening and closing hands; has a 45-second breathing episode; and has two 2-cm pockets of amniotic fluid. The nurse should assign a BPP score of ____________________/10

ANS: 6 The nurse assigns 2 points for tone, breathing, and amniotic fluid. Zero points are assigned for motion and NST results. The total score is 6/10

18. ____________________ stimulation may be effective in eliciting a change in fetal behavior, fetal startle movements, and increased FHR variability

ANS: Vibroacoustic Vibroacoustic stimulation (VAS) is a screening tool that uses auditory stimulation (with an artificial larynx) to assess fetal well-being with EFM when NST is nonreactive. VAS is only used when the baseline rate is determined to be within normal limits. When deceleration or bradycardia is present, VAS is not an appropriate intervention

19. The ____________________ in conjunction with NST is a strong indicator of fetal status, as it is accurate in detecting fetal hypoxia

ANS: amniotic fluid index The amniotic fluid level is based on fetal urine production, which is the predominate source of amniotic fluid and is directly dependent on renal perfusion. In prolonged fetal hypoxemia, blood is shunted away from fetal kidneys to other vital organs. Persistent decreased blood flow to the fetal kidneys results in reduction of amniotic fluid production and oligohydramnios. The volume of amniotic fluid is measured using ultrasound.

19. A patient is threatening spontaneous abortion at 18 weeks gestation. The patient's two previous pregnancies aborted in the same time frame. The patient states, "They want to sew my cervix shut." The nurse shares the terminology for surgical treatment of incompetent cervix, which is ____________________.

ANS: cerclage Surgical treatment of incompetent cervix is cerclage, a type of purse-string suture placed cervically to reinforce a weak cervix. The standard transvaginal cerclage methods currently used include modifications of the McDonald and Shirodkar techniques.

18. Premature rupture of membranes is defined as rupture of the ____________________ membranes before the onset of labor but at term

ANS: chorioamniotic Premature rupture of membranes (PROM) is rupture of membranes before the onset of labor. Preterm PROM (PPROM) is when membranes rupture before labor and before 37 weeks of gestation. PROM may also refer to prolonged rupture of membranes, which is greater than 24 hours.

20. The more prepared a pregnant woman feels for the birth of her baby will lower her anxiety and fear. The behavior is referred to as ____________________.

ANS: nesting behavior The nurse recognizes that completing preparations for the birth of a child can lower the anxiety and fear a pregnant woman feels about the impending birth. The flurry of activity the woman initiates to finish preparations for the arrival of the neonate is referred to as nesting behavior.

20. When a patient is diagnosed with preeclampsia, one sign that the fetus is at risk for hypoxia is a change in amniotic fluid called ____________________.

ANS: oligohydramnios During preeclampsia, the fetus is at risk for hypoxia. Since amniotic fluid is comprised mostly of fetal urine, low amniotic fluid volume indicates a lack of renal perfusion. When blood is shunted away from the kidneys to other vital organs, low kidney perfusion results in a decrease of urine. The resulting amniotic fluid decrease is oligohydramnios

11. A patient is confirmed to be pregnant. Obstetric history includes two sets of twins born at 30 and 32 weeks gestation, respectively, a singleton birth born at 39 weeks gestation, and two pregnancies lost in the first trimester. In which way will the nurse define the patient's obstetrical history? 1. G4, T3, P2, A2, L3 2. G6, T1, P4, A2, L5 3. G5, T1, P2, A2, L5 4. G6, T4, P0, A4, L3

ANS: 2 This is correct. The nurse will correctly determine that the patient has been pregnant six times; delivered one term neonate; had two set of twins born prematurely for a total of four births; had two spontaneous abortions before 20 weeks gestation; and currently has five living children.

8. The nurse in a prenatal unit is providing care for a patient who experienced PPROM at 32 weeks gestation. Which assessment does the nurse consider unnecessary? 1. Check for cervical dilation 2. Monitor for signs of infection 3. Assess for vaginal bleeding 4. Watch for fetal compromise

ANS: 1 1 This is correct. PPROM places the mother and fetus at risk for infection from migration of bacteria from the vagina and/or introduced from the environment. The nurse will not check the patient for cervical dilation.

18. The nurse is planning an assessment on a patient in the second trimester of pregnancy. For which assessments will the nurse plan? Select all that apply. 1. Urine testing with a dipstick. 2. Presence of dependent edema. 3. Determine EDD by Naegele's rule. 4. Antibody screening for Rh?2- patient. 5. Check for chromosomal abnormalities.

ANS: 1, 2, 4 1 This is correct. During the second trimester, it is common for the nurse to perform urine testing with a dipstick to check for glucose, albumin, and ketones. Mild proteinuria and glycosuria are expected. 2 This is correct. During the second trimester, the nurse should be checking the patient for slight, dependent edema in the lower extremities due to decreased venous return. Upper body edema is abnormal and requires additional evaluation. 3 This is incorrect. The EDD is estimated using Naegele's rule during the first trimester; EDD is determined in the second trimester if the patient is not aware of her last menstrual cycle. 4 This is correct. In the second trimester, the nurse will perform screening needed to determine if the Rh- patient has produced antibodies. If so, the patient will receive the first dose of Rhogam. The patient's Rh factor is determined in the first trimester. 5 This is incorrect. Chromosomal abnormalities are not routinely screened; however, during the early stage of the second trimester, all patients should be offered the screening and diagnostic testing regardless of age or other risk factors.

5. A patient is scheduled for transvaginal ultrasound testing. Which preparation by the nurse is appropriate? 1. Place the patient supine with a pillow beneath her head. 2. Explain that pain at 4 or less on a 0 to10 scale is expected. 3. Ascertain whether the patient has a latex or banana allergy. 4. Request that the patient's partner leave the testing room.

ANS: 3 This is correct. Because the transvaginal ultrasound probe is covered by a latex sheath, the nurse needs to ascertain whether the patient has a latex allergy or has exhibited an allergic response to specific foods such as bananas.

17. The nurse is aware that some ____________________ tests, such as multiple marker screening and ultrasound, are offered to all pregnant women.

ANS: screening The nurse is aware that some screening tests are offered to all pregnant women. Screening tests such as multiple marker screening and ultrasound are performed to identify those who are not affected by a disease or abnormality, and can be referred to as a "rule out" process. Abnormal results on a screening test will warrant diagnostic testing.

3. A patient in the first trimester of pregnancy states, "I don't understand how a term baby can be accommodated by my uterus." Which information by the nurse specifically addresses the patient's comment? 1. The uterus size increases in size 20 times over a nonpregnant uterus. 2. The weight of the uterus increases from 7 g to 1,100 g during pregnancy. 3. About 80% of the increased capacity of the uterus is related to uteroplacental content. 4. About 75% of the increase in uterus size during pregnancy is related to stretching.

ANS: 1 1 This is correct. The information that specifically addresses the patient's comment about how her uterus will accommodate a term baby is clarified with the fact that the uterus increases in size 20 times over the non-pregnant size. 2 This is incorrect. The weight of the uterus does increase from 7 g to 1,100 g; however, this fact does not specifically address the patient's comment. 3 This is incorrect. Eighty percent of the increased uterine capacity is related to uteroplacental content; however, this information does not specifically address the patient's comment. A better factor is the increase in uterine capacity from 10 mL to 5,000 mL. 4 This is incorrect. Both stretching and growth are involved in the increase in the size of the uterus to accommodate the developing fetus. However, an increase from 7 g to 1,000 g supports a greater amount of growth instead of stretching

2. A pregnant patient is at the prenatal clinic for a routine visit at 30 weeks gestation. The nurse monitors the patient for indications of physiological demands by the fetus on the patient. Which finding causes the nurse concern? 1. Hgb of 9.5 g/dL and Hct. of 30% 2. PT of 16.5 seconds 3. WBCs of 16,000 mm3 4. Heart rate up 20 bpm

ANS: 1 1 This is correct. The patient's hemoglobin and hematocrit are below normal for the patient. This finding causes the nurse concern because the increased demand of iron for fetal development results in maternal iron deficiency anemia. 2 This is incorrect. The patient's PT is indicative of hypercoagulability, which is an expected physiological response to pregnancy in anticipation of blood loss during delivery. Normal PT is in the range of 11 to 13.5 seconds. This finding does not cause the nurse concern. 3 This is incorrect. WBC count of 16,000 mm3 is not abnormal in a patient who is at 30 weeks gestation, especially if there are no other indications of infection. The scenario does not indicate manifestations of infection. 4 This is incorrect. A 15 to 20 bpm increase in heart rate is expected due to a 40% increase in cardiac output. This finding does not cause the nurse concern

4. When performing a physical assessment on a patient during the initial prenatal visit, the nurse notes spongy gums prone to bleeding during the oral exam. Which comment by the nurse is appropriate? 1. "Oral bleeding can contribute to anemia." 2. "Dental problems can interfere with nutrition." 3. "Periodontal disease is a risk factor for preterm labor" 4. "You need dental care because pregnancy causes dental problems."

ANS: 1 1 This is incorrect. Oral bleeding would need to be consistent and significant to be a contributing factor to anemia.

10. A patient who is pregnant does not remember the last date of her menstrual period. In which manner does the nurse expect the estimated date of delivery (EDD) to be determined for this patient? 1. Having an ultrasound examination 2. Using the gestational wheel 3. Asking when previous babies were born 4. Obtaining a history of gestational length

ANS: 1 This is correct. A fetal ultrasound will provide information about the fetal development, allowing for an accurate estimated date of delivery (EDD). The nurse expects this manner of determination.

12. The labor and delivery nursing staff is conducting research to determine the benefits of childbirth education (CBE). Which finding does evidence-based practice support? 1. Women who participated in CBE and/or had a birth plan had higher odds of a vaginal delivery. 2. Women who are considered to be at high risk had fewer complications if CBE or a birth plan was used. 3. Women of color, younger in age, and who are multipara respond best to CBE and/or a birth plan. 4. Women with a previous cesarean delivery are more likely to have a vaginal delivery after CBE

ANS: 1 This is correct. According to Afshar et al., 2017, and Gagnon, 2011, women who participated in CBE and/or had a birth plan had higher odds of a vaginal delivery.

8. An Eastern European Jewish couple had two children who died from Tay-Sachs disease. The couple is currently pregnant and have asked for genetic confirmation about this fetus with the intention of early termination if the fetus tests positively. For which reason does the nurse expect chorionic villa sampling to be prescribed? 1. The test is performed as early as 10 weeks gestation. 2. Risks to the fetus and mother are less than other tests. 3. A positive result allows termination during the test. 4. This is the only testing that is disease specific.

ANS: 1 This is correct. Chorionic villa testing can be performed as early as 10 weeks gestation. Given the reproductive history of the couple and their expectations, this is the test the nurse should expect to be prescribed

1. The nurse is providing care for a 45-year-old patient who has just learned she is in the second trimester of pregnancy. The patient thought she was experiencing manifestations of menopause until she recognized fetal movement. Which diagnostic test does the nurse expect to be prescribed for this patient? 1. Amniocentesis 2. Ultrasonography 3. Daily fetal movement count 4. Chorionic villi sampling

ANS: 1 This is correct. Due to the age of the patient and the period of gestation, the nurse expects amniocentesis to be performed. The test is appropriate between 15 and 20 weeks of gestation and for detection of genetic disorders in mothers older than age 35 years.

4. A patient is in her first trimester of her second pregnancy. The patient's first child was born with a trisomy 21 defect. The patient is requesting testing to determine whether the current fetus has the same defect. Which initial testing does the nurse expect the HCP to prescribe? 1. Fetal ultrasound 2. Magnetic resonance imaging 3. Chorionic villa sampling 4. Amniocentesis

ANS: 1 This is correct. Fetal ultrasound in the first trimester of pregnancy can be performed for nuchal translucency, which measures the midsagittal plane with the neck of the fetus to assess the amount of fluid behind the neck. An elevated measurement is associated with trisomy 21. This is the initial test the nurse can expect; results may require further diagnostic testing.

7. A couple announces to their parents that the couple is pregnant. One expectant grandmother says, "Grandchildren will call me by my first name. I am not ready to be a grandmother." Which feelings are being expressed by the grandmother? 1. The pregnancy presents undeniable evidence the grandmother is growing older. 2. The grandmother has specific wishes about how she is to be addressed as a person. 3. The grandmother is most likely teasing and actually feels overwhelming delight. 4. The grandmother has never thought of herself in this role and will adapt with time.

ANS: 1 This is correct. The feelings expressed in the grandmother's comment is in response to undeniable evidence that the grandmother is growing older.

6. A patient in the second trimester of pregnancy seems distressed. With encouragement, the patient states, "I have been totally avoiding physical contact with my husband to avoid prompting any sexual activity." Which statement by the nurse is the best response? 1. "Nonsexual expressions of affection are important for both of you." 2. "Be honest and tell your husband the reason you are avoiding him." 3. "You need to agree to sex in order to prevent infidelity from occurring." 4. "Sex during pregnancy is a healthy and normal display of affection."

ANS: 1 This is correct. The nurse needs to inform the patient that nonsexual expressions are important during pregnancy to both partners.

10. The nurse is providing care to a postpartum patient after an emergency cesarean due to eclampsia. The patient received spinal anesthesia prior to delivery. Magnesium sulfate is infusing 2 g/hr in 100 mL of IV fluid. Which assessment finding will cause the nurse to administer calcium gluconate to the patient via IV push? 1. Serum magnesium level is 10 mg/dL. 2. Patella reflexes are rated at zero. 3. Respiratory rate is 18 breaths/min. 4. Urinary output remains at 30 mL/hr.

ANS: 1 This is correct. The therapeutic serum level of magnesium sulfate is 5 to 7 mg/dL, and the patient's laboratory result is 10 mg/dL. The nurse will give the antidote of calcium gluconate (5 to 10 mEq) by IV over a period of 5 to 10 minutes

14. A patient in the third trimester of pregnancy expresses concern to the nurse about changes to her muscles, joints, and bones. Which conditions does the nurse reassure the patient are normal changes of pregnancy? Select all that apply. 1. Waddling gait 2. Low back pain 3. Increased risk of falls 4. Fractures 5. Severe muscle aches

ANS: 1, 2, 3 1 This is correct. A waddling gait is a normal change during pregnancy and related to increased progesterone and relaxin levels causing softening of joints and increased joint mobility. Widening and increased mobility of the sacroiliac and symphysis pubis result. 2 This is correct. Low back pain is expected during pregnancy and related to increased progesterone and relaxin levels leading to softening of joints and increased joint mobility, resulting in widening and increased mobility of the sacroiliac and symphysis pubis. 3 This is correct. Although it is hazardous, increased risk of falls is expected during pregnancy due to a shift in the center of gravity related to the enlarged uterus. The patient needs to take precautions to avoid falls or activities requiring balance. 4 This is incorrect. Fractures are not expected or normal during pregnancy. 5 This is incorrect. Muscle aches are not normal during pregnancy and may signal an electrolyte imbalance.

16. The nursing staff in a labor and delivery unit has noticed an increase in the number of patients experiencing placental abruption. The nurses begin to review demographics for the patients involved. Which risk factors will the nurses expect? Select all that apply. 1. Hypertensive disorders 2. Uterine fibroids 3. Cigarette smoking 4. Methamphetamine use 5. Abdominal trauma

ANS: 1, 2, 3, 4, 5 1 This is correct. Hypertensive disorders put women at risk for placental abruption during pregnancy. 2 This is correct. Uterine fibroids put women at risk for placental abruption during pregnancy. 3 This is correct. Cigarette smoking puts women at risk for placental abruption during pregnancy. 4 This is correct. Methamphetamine use puts women at risk for placental abruption during pregnancy. 5 This is correct. Abdominal trauma puts women at risk for placental abruption during pregnancy

8. A patient arrives at a maternal health client and tells the nurse she has missed a period and thinks she is pregnant. Which information shared with the nurse is a presumptive sign of pregnancy? 1. Positive results on a home pregnancy test 2. Breast enlargement, tenderness, and tingling 3. First awareness of fetal movements 4. Increased appetite

ANS: 2 This is correct. If the patient experiences breast enlargement, tenderness, and tingling after missing a period, the patient has a presumptive sign of pregnancy. This is considered a subjective finding that occurs 2 to 3 weeks after conception

16. A patient is experiencing pregnancy complications. Which factors will affect the client's ability to manage this situation? Select all that apply. 1. Current health status 2. Perceived threat to self or fetus 3. Previously used coping skills 4. Existence of a support network 5. Implemented nursing interventions

ANS: 1, 2, 3, 4, 5 1 This is correct. The patient's physical condition will impact the patient's ability to manage this situation. 2 This is correct. The patient's perceived threat to herself or the fetus will affect the patient's ability to manage this situation. 3 This is correct. The patient's previously used coping skills will affect the patient's ability to manage this situation. 4 This is correct. The existence of a support network will assist the patient in her ability to manage this situation. 5 This is correct. The recognition of patient needs and the implementation of appropriate nursing interventions will increase that patient's ability to manage this situation.

13. A patient who is at 20 weeks gestation is being prepared for an MRI after a nonconclusive ultrasound testing for suspected brain abnormality related to possible zika virus exposure. Which nursing actions are appropriate for this patient? Select all that apply. 1. Provide information regarding the test. 2. Allow patient to express feelings about her high-risk pregnancy. 3. Promote open communication with her primary health care providers. 4. Encourage patient to think about resolutions for negative testing. 5. Provide psychological support to the patient and her partner.

ANS: 1, 2, 3, 5 1 This is correct. A nursing responsibility related to antenatal testing is to inform the patient of what to expect during the testing. 2 This is correct. A nursing responsibility related to antenatal testing because of a high-risk pregnancy is to provide the patient and her partner with psychological support. The patient is likely to be anxious and should be allowed to express feelings. 3 This is correct. A nursing responsibility related to antenatal testing is always to promote open communication with the patient's primary health care providers. This nursing action is especially important in the event of a high-risk pregnancy. 4 This is incorrect. In this scenario, the nurse needs to refrain from encouraging the patient from thinking of resolutions if the MRI test results indicate manifestations of zika virus. The nurse needs to encourage the patient to make informed decisions when all factors are available. 5 This is correct. All antenatal testing related to high-risk factors causes anxiety and distress; the nurse needs to provide psychological support.

17. The nurse works in a prenatal clinic located in a multicultural city. It is important for the nurse to recognize which cultural beliefs as prescriptive? Select all that apply. 1. The mother will aid the baby's circulation by remaining active during pregnancy. 2. The satisfaction of pregnancy cravings will prevent birthmarks on the baby. 3. The mother invites harm to the fetus during the night by sleeping on her back. 4. A safety pin attached to an undergarment will prevent fetal facial deformities. 5. Drinking too much tea will stimulate the fetus and cause a premature birth.

ANS: 1, 2, 4 1 This is correct. The belief of improving the baby's circulation by the mother remaining active during pregnancy is a prescriptive belief. 2 This is correct. It is a prescriptive belief that satisfying a mother's cravings will prevent birthmarks on the baby. 3 This is incorrect. It is a prescriptive belief that the mother will protect the fetus from harm by sleeping on her back, and not invite harm during the night if in this position. 4 This is correct. It is a prescriptive belief that if a mother attaches a safety pin to an undergarment, the baby will be protected from having a cleft lip or palate. 5

15. The nurse is encouraging cultural sensitivity among the nonmedical personnel in a prenatal clinic. Which type of family does the nurse identify as including children? Select all that apply. 1. Nuclear family 2. Extended family 3. Cohabitating family 4. Dyad family 5. Blended family

ANS: 1, 2, 5 1 This is correct. A nuclear family includes a father, mother, and child. 2 This is correct. An extended family includes three generations, including married brothers and sisters and their children. Extended families do not necessarily live together. 3 This is incorrect. A cohabitating family is an unmarried couple living together, which may or may not include children. 4 This is incorrect. A dyad family is a couple living alone without children. 5 This is correct. A blended family is a combination of two families with children from one or both families and sometimes children of the newly married couple.

14. A pregnant patient tells the nurse that her spouse has been diagnosed with Couvade syndrome. Which manifestations does the nurse suspect the spouse is experiencing? Select all that apply. 1. Nausea from unidentifiable causes 2. Physical rejection of sexual advances 3. Significant recent weight gain 4. Unexplainable abdominal pains 5. Self-imposed social isolation

ANS: 1, 3, 4 1 This is correct. Couvade syndrome is diagnosed when the male experiences some of the same manifestations of pregnancy as a pregnant partner. Nausea is a symptom of Couvade syndrome. 2 This is incorrect. The rejection of sexual advances by the male of a pregnant couple is not a manifestation of Couvade syndrome. Some causes may be fear hurting the woman and/or the fetus, or lack of interest related to the physical changes of pregnancy. 3 This is correct. Couvade syndrome is diagnosed when the male experiences some of the same manifestations of pregnancy as a pregnant partner. Weight gain is a symptom of Couvade syndrome. 4 This is correct. Couvade syndrome is diagnosed when the male experiences some of the same manifestations of pregnancy as a pregnant partner. Abdominal pains are a symptom of Couvade syndrome

15. A patient in the third trimester of pregnancy is instructed on how to perform daily fetal movement count. The nurse needs to inform the patient what to do if fetal movement is decreased. Which patient actions are appropriately recommended by the nurse? Select all that apply. 1. Eat something. 2. Recount movements the next morning. 3. Arrange for a period of rest. 4. Focus on movement for 1 hour. 5. Exercise or take a walk.

ANS: 1, 3, 4 Feedback 1 This is correct. If the fetal movement is decreased from previous counts, the nurse should instruct the patient to eat something, which may stimulate the fetus. 2 This is incorrect. Fetal movement is an indicator of fetal well-being. If the patient notices a decrease in fetal movement, measures need to be taken to stimulate and/or reassess movement. Persistent decreased movement or lack of movement needs to be reported immediately to the HCP. 3 This is correct. If the fetal movement is decreased from previous counts the nurse should instruct the patient to arrange for a period of rest. If the patient is busy or distracted, the fetal movements may not be noticed. 4 This is correct. If the fetal movement is decreased from previous counts the nurse should instruct the patient to focus on fetal movement for a period of 1 hour. Four movements in an hour is reassuring

17. The nurse is preparing a prenatal plan of care for a patient who is in the first trimester of pregnancy. Which long-range goals does the nurse include in the plan of care? Select all that apply. 1. Perform an ongoing assessment of risk status 2. Determine parental outlook on immunizations 3. Build rapport with the childbearing family 4. Make referral to specific resources as needed 5. Implement a risk-appropriate intervention

ANS: 1, 3, 4, 5 1 This is correct. An appropriate long-term goal in a prenatal care plan is to perform an ongoing assessment of risk status of the patient, fetus, and expectant family. 2 This is incorrect. The parenteral outlook regarding immunizations is not an appropriate long-term goal on a prenatal care plan. Attitudes about immunizations can be discussed by health care providers involved with pediatric care. 3 This is correct. An appropriate long-term goal in a prenatal care plan is for the nurse to build a rapport with the child-bearing family. Communication is an important part of prenatal care. 4 This is correct. An appropriate long-term goal in a prenatal care plan is to ascertain and make referrals to specific resources for the fetus, neonate, and family. 5 This is correct. An appropriate long-term goal in a prenatal care plan is for the nurse to implement any risk-appropriate intervention. During the prenatal period, risks can occur and interventions must be implemented in a timely manner.

16. The nurse is reviewing the purpose of a modified BPP for a patient at 38 weeks gestation. The nurse recognizes which determinations can be made through a modified BPP regarding fetal well-being? Select all that apply. 1. The NST is an indicator of short-term fetal well-being. 2. The test is normal if NST is considered to be nonreactive. 3. The test is considered most predictive for perinatal outcomes. 4. The AFI is an indicator of long-term placental function. 5. An AFI of 5 cm is indicative of fetal asphyxia

ANS: 1, 3, 4, 5 1 This is correct. The nurse recognizes the NST indicates short-term fetal well-being. 2 This is incorrect. The nurse recognizes that modified BPP is considered normal if the NST is noted to be reactive, not nonreactive. 3 This is correct. The nurse recognizes a modified BPP is considered to be the most predictive testing for perinatal outcomes; the test measures the two most sensitive indicators (NST and AFI) for fetal well-being. 4 This is correct. The nurse is aware a modified BPP uses the AFI to determine the long-term functionality of the placenta. 5 This is correct. The nurse understands oligohydramnios is associated with increased perinatal mortality, and decreased amniotic fluid may reflect acute or chronic fetal asphyxia. The finding is related to a decrease in renal output as blood is shifted away from the kidneys to other more vital organs in response to asphyxia. Normal AFI is greater than 5 cm.

17. A patient at 35 weeks gestation arrives at the prenatal clinic in physical distress. Assessment reveals hypotension, thready pulse, shallow respirations, pallor, cold and clammy skin, and anxiety. The nurse does not find evidence of vaginal bleeding but suspects placental abruption. For which reason does the nurse call for emergency transport to the hospital? Select all that apply. 1. The patient has all the symptoms of hypovolemia. 2. The patient reports a recent bout with nausea and vomiting. 3. The absence of blood can indicate a concealed hemorrhage. 4. The patient and fetus are at risk of death from hypovolemic shock. 5. The patient states a sudden onset of severe symptoms

ANS: 1, 3, 4, 5 1 This is correct. The presenting manifestations are classic for hypovolemia; the only cardinal symptom missing is the presence of bleeding. 2 This is incorrect. Placental abruption can be accompanied by nausea and vomiting; however, these manifestations alone do not indicate a need for emergency transport. 3 This is correct. In a pregnant patient, the lack of bleeding as evidence to placental abruption is indicative of concealed hemorrhage. 4 This is correct. Hypovolemic shock places both the patient and fetus at risk for death. 5 This is correct. During pregnancy, signs of shock are usually not until 25% to 30% of maternal blood loss has occurred. The patient may be unaware of life-threatening bleeding because of the concealed hemorrhage.

12. A patient just learns that her unborn fetus has a life-threatening condition and is not expected to survive long term. Which does the nurse include in a plan of care to meet psychological needs of the patient and her partner? Select all that apply. 1. Provide time for the patient to talk about her feelings. 2. Encourage the patient's partner to be emotionally strong. 3. Facilitate referrals related to the fetal condition. 4. Monitor patient's condition and adjust visitors accordingly. 5. Ascertain if the patient and partner have previous crisis skills

ANS: 1, 3, 5 1 This is correct. In a time of crisis, a patient needs to be able to express and discuss their feelings in order to meet psychological needs. Providing for adequate time is planning and implementation actions in developing a nursing plan of care. 2 This is incorrect. The patient's partner is expected to be feeling emotionally distressed. Encouraging the partner to be emotionally strong does not fulfill either the patient's or partner's needs. 3 This is correct. Facilitating referrals related to the fetus condition is an implementation action that is appropriate for the patient's plan of care. The patient and partner need reliable sources of information and support. 4 This is incorrect. Monitoring the patient's condition and adjusting visitors accordingly may isolate the patient from her family/support sources. Visitation needs to have flexible guidelines to minimize the patient's isolation from family/support sources. 5 This is correct. Formulation of a solid plan of care always involves assessment. The nurse needs to ascertain if the patient and partner have experienced previous crisis events. The knowledge will guide the nurse to either implement coping strategies or evaluate and implement previous skills.

13. The nurse notes that a patient in the third trimester of pregnancy feels unable to "mother" her unborn child. Which information about the patient helps the nurse identify the sources of the patient's ambivalence? Select all that apply. 1. The patient is estranged from her mother. 2. The patient asks about classes for baby care. 3. The patient expresses a loss of independence. 4. The patient's partner is excited about a baby. 5. The patient expresses disgust about body changes

ANS: 1, 3, 5 1 This is correct. Women who have a positive relationship with their own mothers more easily identify with the role of motherhood. A source of ambivalence for this patient is likely related to her estranged relationship from her own mother. 2 This is incorrect. Asking about classes for baby care is not a sign of ambivalence. 3 This is correct. When the patient expresses unresolved conflict about her loss of independence, which may relate to the demands of motherhood, the nurse identifies a source of ambivalence. 4 This is incorrect. One of the tasks of motherhood is ensuring social acceptance of the baby by significant others; it is unlikely the excitement about the baby by the patient's partner is a source of ambivalence. 5 This is correct. Acceptance of a pregnancy includes acceptance of the related body changes. The patient's expressed disgust about body changes is a likely source of ambivalence.

18. The nurse works in a prenatal clinic that serves a multicultural population. The nurse is culturally aware, and so, which behaviors by a patient are expected due to common restrictive beliefs? Select all that apply. 1. A pregnant woman denies sexual intercourse during her third trimester. 2. A pregnant woman allows a clinic staff member to take a photo of her. 3. A pregnant woman reaches to an overhead shelf to collect her belongings. 4. A pregnant woman avoids sitting in front of a fan or air conditioner. 5. A pregnant woman refuses to watch a televised eclipse of the moon.

ANS: 1, 5 1 This is correct. The nurse expects a pregnant woman to deny sexual intercourse in the last trimester of pregnancy; it is a restrictive belief aimed at preventing respiratory distress in a newborn. 5 This is correct. A restrictive belief states that a pregnant woman should not see an eclipse of the moon; to do so will cause the baby to have a cleft lip or palate

15. The nurse is providing dietary teaching to a patient in the first trimester of pregnancy who is overweight. Which daily dietary suggestions does the nurse make? Select all that apply. 1. One cup of 100% juice and cup of dried fruit. 2. Three cups of raw leafy and 1 cup cooked vegetables 3. One and a half cups of cooked pasta, rice, or cereal 4. Six ounces of lean meat, 2 eggs, and cup of beans 5. One cup of milk, 1 cup of yogurt, and oz of cheese

ANS: 1, 5 1.This is correct. In the first trimester of pregnancy, the patient requires 2 cups of fruit; 1 cup of 100% juice and cup of dried fruit daily is a correct suggestion by the nurse. 5. This is correct. One cup of milk, 1 cup of yogurt, and ounces of cheese is equal to the recommended daily dairy intake. This suggestion by the nurse is correct.

1. A patient arrives for her fourth month prenatal visit and expresses concern because of a leakage of yellow fluid from her breasts. Which topic does the nurse discuss during this visit? 1. Signs of infection 2. Breast changes 3. A change in EDD 4. Suppo

ANS: 2 1 This is incorrect. There is no need to cover signs of infection because of the patient's concern. 2 This is correct. The leakage of yellow fluid from the patient's breasts is a normal change during pregnancy. The patient is experiencing a leakage of colostrum, which is rich in antibodies for the neonate. This manifestation can begin as early as 16 weeks. 3 This is incorrect. The presentation of colostrum does not affect the EDD. 4 This is incorrect. The topic of support bras should take place early in the first trimester due to expected breast enlargement. Covering this topic does not address the patient's concern.

5. A patient at 36 weeks gestation reports a constant dull backache, regular frequent contractions that are painless, and lower abdominal pressure. Physical examination reveals intact membranes and cervical dilation of 3 cm. Which order by the health care provider is unexpected by the nurse? 1. Administer antenatal steroids 2. Obtain fetal fibronectin levels 3. Beta-adrenergic agonist therapy 4. Monitor blood glucose levels

ANS: 2 2 This is correct. Fetal fibronectin is a previously used test, which has a low positive predictive value but a high negative predictive value, thereby making it a useful test to predict those women who will not deliver preterm. The test is considered to be unsuitable for wide-spread testing; the nurse would not expect the health care provider to prescribe this test.

4. The nurse is providing care for a patient at 30 weeks gestation. Which topic related to patient concern or discomfort is most important for the nurse to address? 1. Increased breast enlargement 2. Dizziness when lying supine 3. Dependent edema and varicosities 4. Hyperpigmentation on the face

ANS: 2 2 This is correct. The most important issue for the nurse to address is the patient's experience of dizziness when lying supine. The nurse will provide education about supine and orthostatic hypotension and advise the patient to refrain from supine positioning. The patient needs to be instructed to use side-lying positions

3. The nurse works in a prenatal clinic and interacts with multiple patients from various socioeconomic backgrounds. Which patient does the nurse assess most carefully for a mental health issue? 1. A woman who chooses single parenthood 2. A military veteran who was deployed twice 3. The pregnant partner of a lesbian relationship 4. The mother who is multigestational with triplets

ANS: 2 This is correct. A military veteran who was deployed twice is at greater risk for depression. The nurse ascertains if the patient was treated for PTSD and any signs of mental health issues.

11. The nurse is counseling a couple in the third trimester of pregnancy and recommends the couple attend childbirth education classes. For which reason is the nurse least likely to recommend the classes? 1. The classes will affirm the normalcy of birth. 2. The techniques will enable a medication-free delivery. 3. The classes acknowledge a woman's ability to inherently give birth. 4. The classes explore ways to find strength and comfort during labor

ANS: 2 This is correct. Childbirth classes do not focus on teaching techniques that enable a medication-free delivery. However, the classes may enable the mother to require less medication because of greater understanding of the birthing process.

10. A patient who is at 30 weeks gestation is involved in a car crash. The nurse recognizes that which initial testing will be used to assess fetal well-being? 1. Ultrasonography 2. Nonstress testing 3. Contraction stress test 4. Fetal movement counting

ANS: 2 This is correct. Initially, nonstress testing is used to monitor fetal heart rate patterns and accelerations as an indication of fetal well-being. The heart rate of a physiologically normal fetus with adequate oxygenation and an intact autonomic nervous system accelerates in response to movement. This test is the most widely accepted method to assess fetal well-being after maternal trauma, among other conditions.

10. A couple is planning for the birth of their first child and is discussing the difference between a physician and a midwife. Which information presented by the couple does the nurse validate as being true? 1. Midwives are commonly self-taught without formal training. 2. Physicians provide care for both low- and high-risk patients. 3. Midwives primarily deliver babies in the home setting. 4. Physicians rely on the use of technological procedures for birth.

ANS: 2 This is correct. It is true that physicians are able to manage both low- and high-risk patients during childbirth

8. A mother has a child who is 4 years of age, and she is expecting another child. The mother expresses concern to the nurse about how the older sibling will receive the newborn. Which intervention shared by the mother does the nurse discourage? 1. "I plan to let him hear the baby's heartbeat at the next prenatal visit." 2. "I think that I will just bring the new baby home as a surprise." 3. "I have enrolled him in a sibling preparation class at the hospital." 4. "I let him pick out a gift for the baby, and have one for him from the baby."

ANS: 2 This is correct. The nurse will discourage the mother from bringing a newborn home as a surprise. The older sibling needs time to adjust to the prospect of having a new baby. This action is likely to create a greater lack of acceptance in the older sibling.

13. The nurse is providing care for a patient in the third trimester of pregnancy. Which topic of patient education is most likely to be needed during this time? 1. Update on fetus growth and behavioral patterns 2. Management for commonly experienced discomforts 3. General health maintenance and promotion topics 4. Counseling and guidance about diet and exercise

ANS: 2 This is correct. The patient education most likely needed in the third trimester is related to the management of commonly experienced discomforts. Update of fetal growth and development is appropriate during all trimesters of pregnancy and not specific to the third trimester.General health promotion and health maintenance education is appropriate during all trimesters of pregnancy and not specific to the third trimester. This is incorrect. Counseling about diet and exercise is appropriate during all trimesters of pregnancy and not specific to the third trimester.

11. A patient is scheduled for a contraction stress test (CST) at 36 weeks gestation. The nurse is aware that a successful testing is dependent on which factor? 1. Whether Braxton-Hicks contractions are occurring 2. Whether uterine contractions can be stimulated 3. If the mother is not overly tired or anxious 4. If the fetus is in an awake cycle and active

ANS: 2 This is correct. The success of a CST is dependent on the ability to stimulate uterine contractions. Contractions can be stimulated with careful administration of IV oxytocin or by having the mother brush her nipples for 10 minutes.

7. A patient in the second trimester of pregnancy is scheduled for a Doppler flow study because the health care provider (HCP) is concerned about an assessment finding during a routine prenatal visit. Which finding of concern does the nurse suspect? 1. Fetal movement count is less than 8 per hour. 2. Patient shows no weight gain in 2 weeks. 3. Patient exhibits mild lower extremity edema. 4. Fetal growth is below expectation for gestational age.

ANS: 2 This is correct. There are many variables that can cause a patient not to gain weight in a 2-week period: preexisting obesity or patient actions to maintain a normal weight gain. This finding would not cause the HCP to order a Doppler flow study.

3. The nurse educator is preparing a presentation on preterm labor (PTL) and birth (PTB). Which information does the nurse recognize as being inaccurate? 1. PTB is the leading cause of neonatal mortality and for antenatal hospitalization. 2. PTL is defined as regular uterine contractions resulting in cervical changes before 40 weeks gestation. 3. PTBs result in increased numbers of neonatal and infant deaths and long-term neurological impairment. 4. Average costs for premature/low birthweight infants are more than 10 times as high than for other newborns.

ANS: 2 This is correct. This is the information the nurse needs to recognize as being inaccurate. PTL is defined as regular contractions of the?9?uterus?9?resulting in changes in the?9?cervix before 37 weeks gestation, not before 40 weeks gestation. After 37 weeks, the fetus is no longer considered premature.

14. The nurse is providing pre-amniocentesis teaching for a patient who is at 18 weeks gestation. Which information does the nurse provide? Select all that apply. 1. Positioning on the left side will avoid injury to the fetus. 2. A full bladder will assist in ultrasound visualization. 3. Discomfort will be minimized with a local anesthetic. 4. Avoid lifting heavy objects for a period of 2 weeks. 5. Abdominal cramping and bleeding is normal for 24 hours

ANS: 2, 3 2 This is correct. Because the patient is less than 20 weeks gestation, a full bladder will assist with ultrasound visualization. 3 This is correct. To minimize discomfort as the needle is inserted, the patient will receive local anesthesia.

13. A patient with pregestational diabetes mellitus delivers a neonate who is diagnosed with macrosomia. The nurse is aware that the neonate is at risk for additional long-term conditions related to maternal diabetes mellitus. Which long-term effects may occur? Select all that apply. 1. Shoulder injury related to birth size 2. Development of metabolic syndrome 3. Impaired intellectual development 4. Changes in genetic expression 5. Increased risk for chronic illnesses

ANS: 2, 3, 4, 5 2 This is correct. Long-term risks for a newborn whose mother has pregestational diabetes is for the development of metabolic syndrome. 3 This is correct. Long-term risks for a newborn whose mother has pregestational diabetes is for impaired intellectual development. There can also be an impairment of psychomotor development. 4 This is correct. Long-term risks for a newborn whose mother has pregestational diabetes is for changes in genetic expression related to exposure to hyperglycemia in utero. 5 This is correct. Long-term risks for a newborn whose mother has pregestational diabetes is for an increase in chronic illnesses in later life. This change is related to the previously listed changes in genetic expression.

14. The nurse is assessing a patient at 26 weeks gestation. The patient has chronic hypertension and exhibited hypertension and proteinuria prior to 20 weeks gestation. Previous blood pressure (BP) readings have been in the range of 130 to 140/88 to 90 mm Hg. Due to superimposed preeclampsia, for which additional manifestations will the nurse immediately contact the health care provider? Select all that apply. 1. Laboratory report that shows an elevation of liver enzymes 2. Current blood pressure reading of 162/102 mm Hg 3. Evident pulmonary edema noted with auscultation. 4. Subjective report of severe headache and photophobia 5. Lack of response to verbal and tactile stimulation

ANS: 2, 3, 4, 5 2 This is correct. The patient has significant increase in blood pressure; due to a risk for stroke, the nurse is prompted to immediately contact the health care provider. 3 This is correct. Pulmonary edema can be a symptom of organ failure (cardiac, renal, hepatic). This manifestation will prompt the nurse to contact the health care provider. 4 This is correct. If the client is expressing the presence of a severe headache and photophobia, the nurse needs to be aware of worsening preeclampsia symptoms. The nurse will be prompted to notify the health care provider of these manifestations. 5 This is correct. When the nurse notices a lack of response from the patient to verbal and tactile stimulation, the nurse needs to recognize the possibility of seizure activity. The HCP needs to be notified immediately.

7. A patient undergoes chorionic villa sampling to rule out the presence of a genetic disorder. Following the procedure, the patient experiences iatrogenic PPROM. Which explanation does the nurse provide to promote patient understanding? 1. The rupture of the membranes is from a bacterial infection. 2. The membranes ruptured because the test caused fetal death. 3. The premature rupture of the membranes is a known risk to the test. 4. The membranes ruptured due to the presence of a genetic disorder.

ANS: 3 This is correct. Iatrogenic PPROM is associated with a medical intervention such as the patient's procedure, chorionic villus sampling. The preterm rupture of membranes is a known risk and unpreventable complication related to invasive testing

11. A patient who is in the third trimester of pregnancy is informed that she will need a cesarean hysterectomy and bladder reconstruction due to a placenta defect. Which medical condition does the nurse explain to the patient? 1. Placenta accreta 2. Placenta increta 3. Placenta percreta 4. Placenta previa

ANS: 3 This is correct. Placenta percreta is when invasion of the trophoblast extends into the uterine musculature and can adhere to other pelvic organs (5% of cases)

1. The nurse at a prenatal clinic is aware of the important tasks that each expectant mother will need to address. When an expectant mother states, "I will give up everything I have to make sure this baby is safe and well-cared for," which task is the mother addressing? 1. Expressing an attachment to the child 2. Ensuring safe birth for mother and child 3. Stating a willingness to give of oneself 4. Ensuring social acceptance of the child

ANS: 3 This is correct. The mother's statement specifically addresses the mother's willingness and efforts to make personal sacrifices for the child. The task is that of giving oneself to the demands of motherhood.

2. A patient in the second trimester of pregnancy becomes upset when the health care provider (HCP) schedules several screening tests. The patient voices concern that something is wrong with her baby. Which statement by the nurse will reduce the patient's anxiety? 1. "Multiple screening tests are ordered for every pregnancy." 2. "It is better to identify problems before birth than afterward." 3. "Screening tests are primarily to identify those without disease or abnormality." 4. "Diagnostic testing is a reason for worry because they indicate fetal problems."

ANS: 3 This is correct. The truthful statement that screening tests are primarily to identify those without disease or abnormality will alleviate the patient's anxiety

12. The nurse is assessing a patient who just received confirmation of pregnancy. While collecting information about the patient's medical history, which information alerts the nurse to biophysical risk factors? Select all that apply. 1. The patient is primip who is 38 years of age. 2. The patient smokes two packs of cigarettes weekly. 3. The patient has been a strict vegetarian for 25 years. 4. The patient works as a nuclear medicine technician. 5. The patient is medically treated for rheumatoid arthritis.

ANS: 3, 5 3 This is correct. A nursing responsibility related to antenatal testing is always to promote open communication with the patient's primary health care providers. This nursing action is especially important in the event of a high-risk pregnancy. 4 This is incorrect. In this scenario, the nurse needs to refrain from encouraging the patient from thinking of resolutions if the MRI test results indicate manifestations of zika virus. The nurse needs to encourage the patient to make informed decisions when all factors are available. 5 This is correct. All antenatal testing related to high-risk factors causes anxiety and distress; the nurse needs to provide psychological support.

12. A patient who is pregnant shares details of being in a physically and psychologically abusive relationship with her baby's father. Which statement by the nurse is indicative of AWHONN's standing regarding intimate partner violence (IPV)? 1. "If you are all alone, you need to make arrangements for someone to stay with you." 2. "Your partner needs to come to the office so that we can confront his behavior." 3. "I will call a women's shelter to make arrangement for you to move in immediately." 4. "Let's explore ways to protect you and stop the abuse you have been enduring."

ANS: 4 This is correct. AWHONN promotes safety, support, education, and confidentiality as part of the interventions to protect the woman who is experiencing partner abuse; this statement covers the patient's needs.

2. The nurse is providing prenatal care for a patient who is pregnant with a second child. Which understanding about complexity of a second pregnancy does the nurse use to assist the patient with the acceptance of this pregnancy? 1. Point out that the financial obligation is always less with a second child. 2. Make suggestions of how the first child will be a "helper" with the new baby. 3. Recommend career decisions needed because of additional parenting tasks. 4. Offer strategies for working out a new relationship with the first child

ANS: 4 This is correct. Pregnancy tasks are more complex for the multipara due to the relationship between the mother and the first child. The nurse can offer strategies for remodeling this relationship and help the mother with feelings associated with the needed change.

6. A patient expresses a desire to become pregnant for a second child. The nurse notes that the patient's first child was born with a serious neural tube defect (NTD) and died of complications at 18 months of age. Which recommendation does the nurse make to this client? 1. Folic acid 0.6 mg/day orally 1 month before conception and throughout pregnancy. 2. Folic acid 0.4 mg/day orally started when pregnant and continued throughout pregnancy 3. Folic acid 4 mg/day orally started when pregnant and continued throughout pregnancy 4. Folic acid 4 mg/day orally for 1 month prior to conception through first trimester of pregnancy

ANS: 4 This is correct. The correct dose of folic acid for the patient who previously delivered a neonate with NTD is 4 mg/day for 1 month prior to conception, which is continued through the first trimester. The dose is then reduced to 0.4 mg/day for the remainder of the pregnancy.

9. A pregnant patient and her spouse live in the same home as the spouse's family who is not supportive of the pregnancy. The patient feels the family is ruining the happiness about the pregnancy. Which is the most important determination for the nurse to make? 1. What the potential for improving the current support network is 2. Who will provide the patient the greatest amount of support 3. Whether the couple's finances support moving into a separate location 4. If threatened or actual abuse from household members occur toward the patient

ANS: 4 This is correct. The most important determination for the nurse to make in this scenario is whether the patient is experiencing a threat or actual abuse from the family members.

2. The nurse is interviewing a new patient who is in the first trimester of her second pregnancy. The patient shares that her first child was born at 36 weeks gestation. Which information does the patient share that places the patient at risk for a second premature birth? 1. The first labor was induced due to unresponsive management of hypertension. 2. The health care provider induced labor at the patient's request to avoid holiday interruptions. 3. Labor was induced when the fetus moved from a posterior to an anterior position. 4. The premature labor and birth was unexpected and followed a normal pregnancy.

ANS: 4 This is correct. When premature labor and birth occurs spontaneously, as this one did, there is a good chance the second pregnancy will end in the same manner. A history of delivering preterm is one of the strongest predictors for subsequent preterm births.

9. The nurse in a prenatal clinic is assessing a patient who is at 37 weeks gestation for twins. The patient reports increased discomfort and increased lower pelvic pressure. Which action does the nurse take with this patient? 1. After examination, assures the patient of the absence of contractions 2. Explains to the patient that increased discomfort is expected with twins 3. Performs a digital cervical examination to determine if dilation is occurring 4. Sends the patient to the hospital to be checked for possible signs of labor

ANS: 4 This is correct. With so many variables related to multiple gestation, the nurse needs to send the patient to the hospital to be checked for possible signs of labor.

3. A patient has experienced an uneventful pregnancy but begins to have vaginal spotting at 38 weeks gestation. The health care provider (HCP) suspects placenta previa initiated by cervical thinning. Which testing does the nurse expect the HCP to schedule? 1. Doppler flow studies 2. Nonstress testing 3. Magnetic resonance imaging 4. Ultrasonography studies

ANS: 4 This is incorrect. Ultrasonography studies are appropriate in determining placental placement and possible abnormalities