Maternal child exam 1 (chpt. 3-10)

3

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. Support bras 2. A change in estimated date of delivery (EDD) 3. Breast changes 4. Signs of infection

4

A patient at 13 weeks' gestation asks the nurse how her baby is nourished during pregnancy. Which information does the nurse use to explain the process to the mother? 1. Fetal waste products and CO2 pass through the placenta to the mother. 2. The placenta is a special organ developed to create nutrients and oxygen. 3. The mother's blood and fetus's blood mix for an exchange of nutrients. 4. Glucose, amino acids, and oxygen pass through the placenta from mother to baby.

3

A patient at 30 weeks' gestation is exhibiting signs of preterm labor (PTL) 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. A fetal heartbeat could not be obtained. 4. Fetal age is incompatible with survival.

3,4,5

A patient at 34 weeks' gestation is in labor with twins. The primary care provider (PCP) decides the fetuses need to be delivered by cesarean. Which medical and nursing interventions will be in place for this delivery? Select all that apply. 1. The fetal heart rate (FHR) for the two fetuses is monitored alternately. 2. The usual personnel to attend delivery are arranged. 3. The placement of a large-bore IV access is ensured. 4. A hospital with a Level II or III nursery is selected. 5. Delivery is attended by two medical personnel.

1

A patient at 34 weeks' gestation is undergoing an ultrasound. The nurse notes that the amniotic fluid is estimated at between 500 and 600 mL. Which deduction does the nurse make from this finding? 1. Oligohydramnios is present. 2. Fluid is normal for gestational age. 3. Polyhydramnios has formed. 4. Follow-up ultrasound is warranted.

2,3,4,5

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 reports a recent bout with nausea and vomiting. 2. The patient has all the symptoms of hypovolemia. 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.

1

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 (HCP) is unexpected by the nurse? 1. Obtain fetal fibronectin levels. 2. Administer antenatal steroids. 3. Begin beta-adrenergic agonist therapy. 4. Monitor blood glucose levels.

1

A patient at 37 weeks' gestation arrives at the labor and delivery unit and reports a rupture of her membranes. Which factor causes the nurse to anticipate the health-care provider (HCP) will prescribe a medical method of labor induction? 1. The fetus is viable and the barrier for a sterile uterine environment is breached 2. The fetus is at risk for "drying out" and causing the mother to have a dry birth. 3. The mother must be maintained on complete bedrest until contractions begin. 4. The mother is at risk for developing an infection and passing it to the fetus.

2

A patient expresses a desire to become pregnant for a second time. 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 4 mg/day orally started when pregnant and continued throughout pregnancy 2. Folic acid 4 mg/day orally for 1 month before conception through the first trimester of pregnancy 3. Folic acid 0.6 mg/day orally 1 month before conception and throughout pregnancy 4. Folic acid 0.4 mg/day orally started when pregnant and continued throughout pregnancy

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 (NST) 3. Ultrasonography studies 4. Magnetic resonance imaging (MRI)

1,5

A patient in the second trimester asks the nurse questions about the Zika virus. Which of the following is correct information to give to the patient? Select all that apply. 1. The Zika virus is spread primarily through infected mosquitos but can also be sexually transmitted from a person who is infected. 2. All persons infected with the Zika virus will experience symptoms of fever, joint pain, rash, or headache. 3. Women traveling to areas known to have active mosquito transmissions of Zika should be advised to receive the Zika vaccine 3 months before travel. 4. If a woman has symptoms of Zika virus before conceiving, she should avoid getting pregnant for at least 1 month. 5. Treatment for Zika consists of rest, fluids, and medication to reduce fever and pain.

1

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. Patient shows no weight gain in 2 weeks. 2. Fetal movement count is less than 8 per hour. 3. Patient exhibits mild lower extremity edema. 4. Fetal growth is below expectation for gestational age.

2

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. "Be honest and tell your husband the reason you are avoiding him." 2. "Nonsexual expressions of affection are important for both of you." 3. "Sex during pregnancy is a healthy and normal display of affection." 4. "You need to agree to sex in order to prevent infidelity from occurring."

1,2,5

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. Low back pain 2. Lordosis 3. Fractures 4. Severe muscle aches 5. Increased risk of falls

1,2,4

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 of 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. Arrange for a period of rest. 3. Recount movements the next morning. 4. Focus on movement for 1 hour. 5. Exercise or take a walk.

1,2,3,4,5

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. Existence of a support network 3. Previously used coping skills 4. Perceived threat to self or fetus 5. Implemented nursing interventions

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 health-care provider (HCP) to prescribe? 1. Amniocentesis 2. Magnetic resonance imaging (MRI) 3. Chorionic villus sampling 4. Fetal ultrasound

2

A patient who is at 39 weeks' gestation is scheduled for amniotomy. The nurse is aware that which criteria must be met before the procedure? 1. Prior amniotic fluid leakage must be validated before the procedure. 2. The fetal head is currently engaged in the maternal pelvis. 3. The nurse must have certification to perform the procedure. 4. Ultrasound indicates the umbilical cord is away from the cervix.

4

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 previa 4. Placenta percreta

2,4,5

The nurse encourages the patient to bring loved ones to be with her during labor because the nurse knows that their presence does which of the following? Select all that apply. 1. Lowers the chance that the patient will breastfeed 2. Reduces the likelihood that a patient will require an epidural 3. Reduces the risk of infection after birth 4. Shortens the length of labor 5. Increases patients' happiness and satisfaction with the outcome of their birth

1

The nurse in labor and delivery is preparing to initiate labor induction with the administration of oxytocin. After research about oxytocin, the nurse is aware of which fact about the drug? 1. Synthetic oxytocin is identical to endogenous oxytocin. 2. Hypothalamus stimulation increases circulating oxytocin. 3. The half-life of oxytocin is 1 hour, supporting close monitoring. 4. Action from IV oxytocin administration is less than 1 minute.

2,5

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 primipara who is 38 years of age. 2. The patient has been a strict vegetarian for 25 years. 3. The patient smokes two packs of cigarettes weekly. 4. The patient works as a nuclear medicine technician. 5. The patient is medically treated for rheumatoid arthritis.

3

The nurse is assisting a patient who is pregnant to prepare for a magnetic resonance imaging (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 has a permanent body piercing. 4. The patient expresses concern about pain.

1,3

The nurse is attending to a patient who just delivered a term fetus who was stillborn. Which nursing interventions will the nurse use to provide emotional support to the couple? Select all that apply. 1. Cut a lock of the neonate's hair and get foot and hand prints. 2. Express the belief that a little angel was sent to heaven. 3. Allow parents unlimited time to hold and touch the neonate. 4. Inquire if the patient had any warning of fetal death. 5. Ask the parents what name they are giving their baby.

3

The nurse is caring for a 24-year-old woman who is G1P0 at 40 weeks, 1 day gestation and in active labor. She has just received an epidural and now complains of "an itchy feeling all over." Her vitals are as follows: heart rate (HR) 120, respiratory rate (RR) 12, blood pressure (BP) 130/74, temperature (T) 98.8, and O2 sat 98%. Which action should the nurse take first? 1. Call the anesthesiologist regarding the patient's oxygen saturation level. 2. Activate emergency response due to the patient's pruritus and tachycardia post-epidural placement. 3. Call the health-care provider (HCP) regarding the patient's pruritus to order an antipruritic medication. 4. Take no further action regarding the patient's complaints, as they are normal after epidural placement.

1,3,5

The nurse is caring for a 30-year-old woman who is G4P2012 at 38 weeks and 5 days' gestation. The nurse is watching her electronic fetal monitor (EFM) strip and notices that for the past 10 minutes the fetus has shown minimal variability. Which actions should the nurse perform? Select all that apply. 1. Check to see if the patient's membranes have been ruptured, as there could be potential cord compression. 2. Check the fetal heart rate (FHR) and connect the minimal variability to fetal bradyasystole. 3. Continue to watch the strip, but know that this could be due to fetal sleep. 4. Recognize that the fetus is 38 weeks and therefore this could be due to fetal maturity. 5. Look to see what the patient's position is and if she is supine; change her to left side lying.

2

The nurse is caring for a 31-year-old female patient who is pregnant at 37 weeks and 5 days' gestation. The patient is having contractions every 3 minutes and was found to have a platypelloid pelvis upon examination. The fetus has an estimated fetal weight of 7 lbs. and is in the left occiput anterior (LOA) position. This patient is laboring on the birth ball, and her mother-in-law is helping her labor. The nurse is concerned about the five Ps and their effect on the patient's labor. Which P is the nurse most likely concerned about based on the patient's history? 1. Passenger 2. Passage 3. Position 4. Psyche

4

The nurse is caring for a 34-year-old woman who is G2P1001 at 39 weeks and 1 day. The patient is an observant Muslim and is in active labor. Which outcome would be the most effective form of applying culturally sensitive communication? 1. Ensuring that the health-care provider (HCP) is present every 2 hours to examine labor progress 2. Making sure that the patient has Kosher meat for her postpartum meal 3. Assuring the patient that her baby is less than 9 lbs 4. Making sure that the patient's modesty is protected

3

The nurse is caring for a baby who is experiencing fetal tachycardia. Which action should the nurse take next? 1. Perform fetal scalp stimulation for 5 seconds. 2. Apply heat packs to the maternal chest and head. 3. Check maternal allergies in the patient chart. 4. Stimulate the fetus with a vibroacoustic device.

1

The nurse is caring for a patient in active labor with significant back pain. The patient has requested nonpharmacological methods of pain relief. The nurse thinks that sterile water injections may help with her pain management. Which of the following explanations should the nurse explain to the patient? 1. "We will inject 0.5 mL of sterile water subcutaneously, and it will last for an hour to 90 minutes." 2. "We will inject 1 mL of sterile water intramuscularly, and it will last for about an hour." 3. "We will inject 1 mL of sterile water subcutaneously, and it will last for about a half hour." 4. "We will inject 0.5 mL of sterile water intramuscularly, and it will last for about 3 hours."

2,3,4

The nurse is caring for a pregnant patient who expresses concern about the effects of electronic fetal monitoring (EFM) on her labor and delivery. Which responses by the nurse would be appropriate in this situation? Select all that apply. 1. "There is a decrease in the incidence of cerebral palsy if a patient has EFM during labor." 2. "There is a reduced rate of seizures if a patient has EFM during labor." 3. "There is an increase in operative vaginal births and the use of continuous EFM." 4. "There is a link between the rate of cesarean sections and continuous EFM." 5. "There is a link between decreased infant mortality and EFM during delivery."

1

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

1,4,5

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

2

The nurse is counseling a 15-year-old pregnant patient at her first prenatal appointment. Which patient teaching by the nurse is appropriate? 1. "Adolescents usually have very effective coping mechanisms." 2. "Your response to pregnancy, labor, and delivery will differ from that of an adult because your cognitive development is not yet complete." 3. "Adolescents' ego integrity is less easily threatened by stress and pain." 4. "Teenagers always have larger babies than older patients."

1

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 techniques will enable a medication-free delivery. 2. The classes will affirm the normalcy of birth. 3. The classes acknowledge a woman's ability to inherently give birth. 4. The classes explore ways to find strength and comfort during labor.

1

The nurse is counseling a couple who just learned their 16-week fetus tested positive for a serious genetic disorder. Which action by the nurse is inappropriate upon learning that the couple plan to continue the pregnancy? 1. Determine whether termination is still a consideration. 2. Explain they will experience grief, which is normal. 3. Provide additional information about the disorder. 4. Refer them to a disorder-specific support group.

1,5

The nurse is counseling a female patient diagnosed with anovulation as a cause of infertility. Which information does the nurse provide to the patient? Select all that apply. 1. Methods for dietary planning 2. Consultation for myomectomy 3. Refrain from unprotected sex 4. Surgical correction of fallopian tubes 5. Instructions for clomiphene citrate

3

The nurse is counseling a female patient who has unsuccessfully attempted to become pregnant through a variety of methods and treatments for infertility. Which psychosocial manifestation is the nurse most likely to recognize? 1. Close connections with extended family 2. Strong intimate relationship with her partner 3. Difficulty accepting pregnancy if it does occur 4. Greater focus on career and job opportunities

3

The nurse is discussing genetically linked diseases with a couple planning a pregnancy. The female states, "I am concerned because there is a history of sickle-cell disease in my family." Which information from the nurse is correct? 1. Any offspring will have the disease. 2. Only male children will have the disease. 3. The male partner needs genetic testing. 4. The couple should not become pregnant.

3,4,5

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. Cohabitating family 2. Dyad family 3. Nuclear family 4. Extended family 5. Blended family

3

The nurse is explaining telemetry to the patient, who has just begun active labor. The patient wants to have a labor in which she is mobile, able to change positions, and can use hydrotherapy. Which response by the nurse is most appropriate? 1. "Telemetry is used mostly for women who are laboring in bed and changing positions every half hour or so." 2. "Unfortunately, you will not be able to use the shower while using telemetry." 3. "We can start using telemetry now, and if there are no problems with the signal, we can continue it throughout your labor until delivery." 4. "The nurses will need to come in and check your telemetry reading every half hour."

3,4

The nurse is helping the patient assume a position for placement of an epidural. Which of the following positions are appropriate for placing an epidural? Select all that apply. 1. Lithotomy position 2. Trendelenburg position 3. Lateral position with head flexed toward chest 4. Sitting position with elbows on knees 5. Prone position

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 premature labor and birth were unexpected and followed a normal pregnancy. 3. Labor was induced when the fetus moved from a posterior to an anterior position. 4. The health-care provider (HCP) induced labor at the patient's request to avoid holiday interruptions.

3

The nurse is looking at an electronic fetal monitor (EFM) strip and sees that the patient is having contractions that are measuring 150 MVU every 10 minutes for the past 2 hours and the fetus is in fetal distress. What would this indicate for next steps? 1. The patient's contractions are adequate, so the main focus should be on resuscitating the fetus with maternal oxygen and maternal position change. 2. The patient's contractions are adequate, so the main focus should be on determining her progress through cervical change. 3. The patient's contractions are inadequate; the provider could consider an amnioinfusion through the intrauterine pressure catheter (IUPC), and once the fetus has improved, contractions need to be augmented to be more effective. 4. The patient's contractions are inadequate; the provider could consider augmenting with Pitocin to be more effective.

2

The nurse is monitoring a patient when the electronic fetal monitor (EFM) strip conveys fetal bradycardia. Which action would be the most urgent for the nurse to take? 1. Check the patient's input and output. 2. Check the mother for vaginal bleeding and severe abdominal pain. 3. Change the mother's position from supine to left lateral. 4. Take a blood pressure to determine if the mother has hypotension.

2

The nurse is monitoring the fetal heart rate (FHR) tracing and sees that her patient has a tracing with a baseline of 120, moderate variability, with absence of decelerations and accelerations. According to the National Institute of Child Health and Human Development tier system, what category tracing does the patient fall into? 1. A Category II tracing 2. A Category I tracing 3. A Category III tracing 4. A Category IV tracing

4,5

The nurse is obtaining a baseline fetal heart rate (FHR). At 1:00 p.m. the baseline FHR was 130, at 1:20 p.m. FHR baseline was 166, and at 1:40 p.m. the baseline FHR was 204. What should the nurse assess from this trend of fetal baselines? Select all that apply. 1. The 1:20 p.m. FHR baseline should be corrected immediately with delivery. 2. The 1:20 p.m. FHR baseline warranted immediate fetal resuscitation. 3. The 1:00 p.m. FHR baseline warranted immediate maternal resuscitation. 4. The 1:00 p.m. FHR baseline warranted no further action. 5. The 1:40 p.m. FHR baseline should be corrected immediately.

2,3,4,5

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. Determine parental outlook on immunizations. 2. Perform an ongoing assessment of risk status. 3. Build rapport with the childbearing family. 4. Make referral to specific resources as needed. 5. Implement a risk-appropriate intervention.

2

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. Epistaxis 2. Dizziness when lying supine 3. Dependent edema and varicosities 4. Hyperpigmentation on the face

3

The nurse is providing care for a patient in the second phase of labor. After more than 4 hours of pushing, the nurse suspects fetal dystocia. Which is the greatest risk related to the nurse's suspected complication? 1. Greater risk for maternal lacerations 2. Fetal injury confirmed by the presence of bruising 3. Neonatal asphyxia related to prolonged labor 4. Increased consideration for a cesarean delivery

1

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. Management for commonly experienced discomforts 2. Update on fetus growth and behavioral patterns 3. General health maintenance and promotion topics 4. Counseling and guidance about diet and exercise

1

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. Alterations in fetal chromosomal studies 2. Indications of maladaptation to pregnancy 3. Elevated blood pressure and proteinuria 4. Subtle indicators of menopause occurring

1

The nurse is providing care for a patient who is admitted for cervical ripening. The health-care provider (HCP) has prescribed the use of a hygroscopic dilator. Which conclusion is the nurse likely to draw from the prescribed method of cervical ripening? 1. The method may be indicative of fetal demise. 2. The patient has a history of cesarean childbirth. 3. This method is quicker than hormonal ripening. 4. This patient is being treated for active herpes.

3,4,5

The nurse is providing care for a patient who is at 42 weeks' gestation. The patient's primary care provider (PCP) is suggesting induction, but the patient is resistant. Which facts can the nurse provide if the patient asks about allowing labor to start spontaneously? Select all that apply. 1. Maternal death rate is higher if the pregnancy is continued beyond 42 weeks. 2. Post-term fetuses are prone to developmental delays related to uterine hypoxia. 3. Stillbirth or newborn death increases in pregnancies beyond 42 weeks. 4. There is a greater chance of developing complications because of larger fetal size. 5. Postmature fetuses have decreased subcutaneous fat and lack vernix and lanugo.

4

The nurse is providing care for a primiparous patient in active labor. Cervical dilation has progressed 0.5 cm in 2 hours. The intrauterine pressure catheter reading is 20 mm Hg. Which action does the nurse anticipate next? 1. Rupture of uterine membranes by the nurse 2. Preparation for a cesarean delivery due to signs of fetal distress 3. Medicating the patient with pain medication to promote uterine rest 4. Augmentation of labor with oxytocin per health-care provider's (HCP's) order

3

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. Moving into the mothering role will be nearly impossible at this age. 2. At this age, pregnancy is likely a result of attachment to a first love. 3. The adolescent is self-centered and oriented toward the present. 4. The role of the grandmother will be as the baby's primary caretaker

2

The nurse is providing care to a patient who is at 41 weeks' gestation. Which factor about the patient does the nurse consider as an indication of late-term or post-term pregnancy? 1. Patient's multiparity status 2. Fetus is identified as a male 3. Delivered two babies at 38 weeks 4. History of regular menstruation

2

The nurse is providing care to a patient who is diagnosed with dystocia related to hypertonic uterine dysfunction. Which medical intervention does the nurse implement for this patient? 1. Explain to the family that the patient needs rest before labor continues. 2. Administer morphine to decrease contractions and promote uterine rest. 3. Assist the patient to relax by providing back and neck massage. 4. Discuss how the patient's fear is interfering with the progression of labor

1,3

The nurse is providing care to a patient who is in labor. The patient's membranes rupture spontaneously, and the nurse notices meconium-stained amniotic fluid. Which actions does the nurse immediately perform? Select all that apply. 1. Alert the neonatal team of a possible meconium aspiration neonate. 2. Promote fetal well-being by placing the patient on her left side. 3. Notify the primary care provider (PCP) about the presence of meconium. 4. Administer oxygen to the mother to help prevent fetal hypoxia. 5. Test the stained fluid for percentage of meconium content.

2

The nurse is providing care to a postpartum patient after an emergency cesarean due to eclampsia. The patient received spinal anesthesia before 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. Patella reflexes are rated at zero. 2. Serum magnesium level is 10 mg/dL. 3. Respiratory rate is 18 breaths/min. 4. Urinary output remains at 30 mL/hr.

1,5

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. A full bladder will assist in ultrasound visualization. 2. Positioning on the left side will avoid injury to the fetus. 3. Abdominal cramping and bleeding is normal for 24 hours. 4. Avoid lifting heavy objects for a period of 2 weeks. 5. Discomfort will be minimized with a local anesthetic.

1

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. Offer strategies for working out a new relationship with the first 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. Point out that the financial obligation is always less with a second child.

1,5

The nurse is providing teaching to a patient in the first trimester of pregnancy. Which of the following education topics/suggestions would be appropriate for the nurse to make? Select all that apply. 1. Include information on nutritional food choices emphasizing fresh fruits and vegetables. 2. Encourage daily intake of 8 to 10 glasses of fluid and up to 800 mg of caffeine per day. 3. Avoid all albacore tuna as it is not safe to eat during pregnancy due to high levels of mercury. 4. Set weight-gain goals to gain between 5 and 10 pounds during the first trimester. 5. Avoid raw sprouts of any kind.

2

The nurse is reviewing the chart of a 35-year-old G4P2012 woman. The patient is at 38 weeks, 4 days and is in active labor with spontaneous rupture of membranes (SROM) and clear fluid 2 hours ago. What action should the nurse take? 1. Monitor the patient's blood pressure, temperature, and respirations every 2 hours. 2. Help the patient change her position from side to side every 30 minutes. 3. Have the patient rate her pain on a scale from 1 to 10 roughly every hour. 4. Monitor the fetal heart tones every hour.

1,2,3,5

The nurse is reviewing the purpose of a modified biophysical profile (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 nonstress test (NST) is an indicator of short-term fetal well-being. 2. The amniotic fluid index (AFI) is an indicator of long-term placental function. 3. The test is considered most predictive for perinatal outcomes. 4. The test is normal if NST is considered to be nonreactive. 5. An AFI of 5 cm is indicative of fetal asphyxia.

1,3,4,5

The nurse is speaking with a pregnant patient who is asking what processes start labor. Which responses by the nurse are appropriate? Select all that apply. 1. There is more pressure on the cervix, which causes the start of contractions by releasing oxytocin. 2. The uterus begins to contract due to a decrease in estrogen. 3. Oxytocin stimulates uterine muscles to contract. 4. The fetus releases a stress hormone, cortisol, and this starts contractions. 5. The placenta begins to age and deteriorate and this triggers the start of contractions.

1,3,4,5

The nurse is teaching the patient about the trends and risks of epidural anesthesia. Which of the following should the nurse relay about the risks of epidural anesthesia? Select all that apply. 1. There is a higher rate of instrumental vaginal delivery. 2. There is a higher rate of spontaneous vaginal delivery. 3. When using an epidural, women are less likely to sweat with a fever. 4. Labor may be longer with an epidural. 5. There is a higher rate of fever and sepsis.

1

The nurse is using the three tier system. A coworker is concerned about a patient whose fetus has an absent baseline and fetus is at risk for acidemia and impending fetal asphyxia. What is the next best step for the nurse? 1. Notify the provider and prepare for urgent delivery. 2. Perform conservative measures. 3. Assist provider in performing a sterile vaginal exam. 4. Increase surveillance of patient.

2,4,5

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 asks about classes for baby care. 2. The patient is estranged from her mother. 3 . The patient's partner is excited about a baby. 4. The patient expresses a loss of independence. 5. The patient expresses disgust about body changes

3

The nurse preceptor is teaching a nursing student about the physiology of the fetal heart rate (FHR) pattern. Which statement by the student indicates successful teaching about this concept? 1. "Vagus nerve stimulation increases FHR and helps maintain variability." 2. "Action of the FHR occurs through the absence of norepinephrine." 3. "The sympathetic nervous system is responsible for heart rate variability." 4. "Baroreceptors are responsible for increasing FHR and fetal blood pressure."

3,4,5

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. Drinking too much tea will stimulate the fetus and cause a premature birth. 2. The mother invites harm to the fetus during the night by sleeping on her back. 3. The satisfaction of pregnancy cravings will prevent birthmarks on the baby. 4. A safety pin attached to an undergarment will prevent fetal facial deformities. 5. The mother will aid the baby's circulation by remaining active during pregnancy.

4

Ephedrine is used to correct which side effect of epidural anesthesia/analgesia? 1. Nausea and vomiting 2. Pruritis 3. Anxiety 4. Hypotension

2

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

1,2,4

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 human chorionic gonadotropin (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

1,2,4

17. A female patient with a history of infertility is scheduled to have a hysterosalpingogram. Which findings can be detected with this procedure? Select all that apply. 1. Tubal occlusions 2. Uterine fibroids 3. Cervical irritation 4. Bicornuate uterus 5. Vaginal infection

1,2,5

17. 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. Unexplainable abdominal pains 3. Self-imposed social isolation 4. Physical rejection of sexual advances 5. Significant recent weight gain

4

A diagnosis of severe preeclampsia is consistent with a 24-hour urine showing protein excretion of: 1. 1 g/L 2. 3 g/L 3. 4 g/L 4. 5 g/L

retraction

The first sign of shoulder dystocia is the___________ of the fetal head against the maternal perineum after delivery of the head.

2

ncluded in the definition of tachysystole is: 1. Contraction duration of less than 40 seconds 2. Contraction frequency of greater than 5 in 10 minutes 3. Contraction intensity of less than 80 mm Hg 4. Resting tone of less than 18 mm Hg

24. The more prepared a pregnant woman feels for the birth of her baby, the more it will lower her anxiety and fear. This behavior is referred to as __________________.

nesting behavior

1,2,4

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. Avoid consuming spicy, fatty, or fried food. 2. Maintain good posture. 3. Assume a low Fowler position after meals. 4. Avoid eating 3 hours before bedtime. 5. Consume three moderate-sized meals daily.

3

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, P3, A2, L3 2. G5, T1, P3, A2, L5 3. G6, T1, P2, A2, L5 4. G6, T4, P0, A4, L3

1

8. 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 37 years of age, obese, and experiencing pregnancy-induced hypertension 2. The patient with preexisting hypertension who is currently pregnant with twins 3. The patient who is 16 years of age just diagnosed with gestational diabetes 4. The patient who is 28 years of age who delivered a premature neonate 3 years prior

3

Findings indicative of progressive fetal hypoxemia are: 1. Late decelerations, moderate variability, and stable baseline rate 2. Prolonged decelerations recovering to baseline and moderate variability 3. Recurrent late or variable decelerations and loss of variability 4. Variable decelerations, moderate variability, and stable baseline rate

3

The nurse works in a urologist's office. A male patient is scheduled for routine fertility testing. For which test does the nurse refrain from making preparation? 1. Sexually transmitted infection (STI) screening 2. Hormonal levels 3. Sexual functioning 4. Ejaculate analysis

3,5

. 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 birthing home must be within a 1-hour drive of a hospital. 3. The pregnant woman must be in good health with a normal pregnancy. 4. The birthing room needs to be sterile before labor and delivery. 5. Adequate medical supplies and resuscitation equipment is available.

1,2,3,4,5

. 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. Abdominal trauma 5. Methamphetamine use

4

A high probability of successful induction of labor is associated with a Bishop score of: 1. Greater than 2 2. Greater than 4 3. Greater than 6 4. Greater than 8

4

A patient who is pregnant expresses a desire to attempt a vaginal delivery after a cesarean birth 2 years before. The primary care provider (PCP) initiates trial of labor after cesarean (TOLAC) and vaginal birth after cesarean (VBAC) screening. The nurse is aware that which patient information will likely disqualify the patient for VBAC? 1. A low transverse uterine scar 2. Patient asks multiple questions 3. First labor needed to be induced 4. Cesarean due to pelvic abnormalities

1

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. Hemoglobin (Hgb) of 9.5 g/dL and hematocrit (Hct) of 30% 2. Resting heart rate up 20 bpm prothrombin time (PT) of 16.5 seconds 3. White blood cells (WBCs) of 16,000 mm3 4. PT of 16.5 seconds

chorioamniotic

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

3

The nurse is assisting the primary care provider (PCP) with a vacuum-assisted delivery because of a prolonged second stage of labor. The nurse will inform the PCP when which guideline of the procedure is met? 1. Extension of the episiotomy is performed. 2. Signs of fetal compromise have resolved. 3. The "three-pull rule" has been achieved. 4. Patient is under full anesthesia status.

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. The pregnant partner of a lesbian relationship 3. A military veteran who was deployed twice 4. The mother who is multigestational with triplets

2

After counseling with an obstetrician about infertility, a couple is advised to undergo testicular sperm aspiration. The nurse is aware that the procedure may be recommended for which infertility? 1. Blocked fallopian tubes 2. Unsuccessful vasectomy reversal 3. Poor cervical mucus production 4. Diminished sperm motility

4

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 villus sampling to be prescribed? 1. This is the only testing that is disease specific. 2. Risks to the fetus and mother are less than with other tests. 3. A positive result allows termination during the test. 4. The test is performed as early as 10 weeks' gestation.

3

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. Ask an accompanying parent to help persuade the patient. 3. Explain the testing is important in detecting serious birth defects. 4. Notify the health-care provider (HCP) of the patient's refusal.

4

An infertile couple learns that the female is unable to produce viable eggs. The male partner suggests the use of a surrogate as a means of having a child. The female states, "I don't want your baby with another woman!" The nurse is aware of which psychosocial issue with this couple? 1. The male blames the female for the infertility . 2. The female is jealous of the surrogate's fertility. 3. The male needs to have a child with his genes. 4. The female is experiencing self-esteem issues.

1,2,3,5

An infertile couple voices concern to the nurse about assisted reproductive technologies (ART). The nurse agrees that ART has created numerous dilemmas. Which potential questions does the nurse discuss with the couple? Select all that apply. 1. Which partner has ownership of the embryos? 2. Should a child be told about donors or surrogates? 3. Are there parental rights for sperm donors? 4. Does a fertility donor have financial obligations? 5. What happens to any surplus embryos?

1

An involuntary urge to push is most likely a sign of: 1. Low fetal station 2. Occiput posterior fetal position 3. Transition 4. Progress of dilation

2

Diagnosis of gestational hypertension requires the presence of hypertension and: 1. Edema 2. Pregnancy 3. Proteinuria 4. Headache

1,2,3,5

During a vaginal delivery, the primary care provider (PCP) notices greenish yellow coloration on the fetal head during crowning. Intrapartum suctioning is performed as soon as the fetus's head is delivered. The nurse understands the aspiration of meconium will have which effects on the neonate's respiratory function? Select all that apply. 1. Result in airway obstruction 2. Contribute to pulmonary hypertension 3. Result in chemical pneumonitis 4. Create strain on cardiac function 5. Cause surfactant dysfunction

3

Ethnocentrism is the belief that: 1. Cultural values are major determinants of one's behavior. 2. Every cultural group has a core or center of common beliefs. 3. Values and practices of one's own culture are superior. 4. Every cultural group shares identical common beliefs

1

Genomic medicine is an emerging medical discipline that involves using genomic information about an individual as part of the individual's clinical care. Which example does the nurse associate with genomic medicine? 1. Screening of neonates for inherited, treatable genetic diseases 2. Creating drugs specifically for the treatment of cancer 3. Conducting trial studies to determine how drugs affect individuals 4. Tracing and gaining knowledge about how genetic mutations occur

3

Intensive management of diabetes in women with pregestational diabetes should begin: 1. Only if planning to breastfeed 2. Postpartum 3. Before conception 4. Third trimester

2

Invasion of the trophoblastic cells into the uterine myometrium is termed placenta: 1. Accreta 2. Increta 3. Percreta 4. Abruption

2

Mercy Ochoa, a 28-year-old Filipino American, is 18 weeks' pregnant. After receiving a prescription for prenatal vitamins, she tells the nurse that her mother has warned her to take only herbal medication during pregnancy. The nurse appropriately: 1. Advises Mercy that the pills are only vitamins and not considered medication. 2. Assesses the significance of Mercy's mother's advice. 3. Reminds her that the vitamins were ordered by the nurse-midwife. 4. Insists that the patient comply with the treatment plan.

4

The electronic fetal monitor (EFM) tracing shows the following: Fetal heart rate (FHR) baseline 166 bpm, moderate variability, and recurrent late decelerations to 100 bpm. Using the Category FHR interpretation system, how should the nurse interpret this tracing? 1. Category I 2. Category II 3. Category III 4. Normal FHR pattern

2

The incidence of abnormal placental adherence is increasing likely due to: 1. Better diagnostic tools such as transvaginal ultrasound 2. Increased rate of cesarean birth 3. More women delaying childbirth until they are older 4. More women initiating childbirth when younger

4

The primary factor that would allow the second stage of labor to continue beyond 2 hours is: 1. An epidural is in place and the woman is comfortable. 2. The woman requests to not have a cesarean birth. 3. The presenting part is stable. 4. As the presenting part descends, the fetal heart rate (FHR) does not suggest fetal compromise.

1

The principal risk factor predictive of preterm birth is: 1. History of preterm birth 2. Low prepregnancy weight 3. Smoking during pregnancy 4. Obesity

chorioamnionitis

The terminology intrauterine inflammation or infection or both or Triple I is now used instead of the term__________

Amniotic fluid index

The___________ in conjunction with the nonstress test (NST) is a strong indicator of fetal status, as it is accurate in detecting fetal hypoxia.

1

What is the definition of sexual orientation? 1. How a person characterizes their emotional and sexual attraction to others 2. How a person currently identifies their sex 3. The sex a person was assigned at birth 4. The orientation of their sexual bias

oligohydramnios

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

3

When part of a set of multiples dies, parents often: 1. Begin grieving immediately 2. Can bond effectively with the survivor 3. Experience paradoxical feelings 4. Experience relief

1,2,4,5

Which actions indicate the nurse is assessing uterine activity? Select all that apply. 1. Feeling the maternal abdomen in between contractions 2. Checking the electronic fetal monitor (EFM) strip to determine if contractions are either 2 or 3 minutes apart 3. Checking the EFM strip to see if the fetus has an elevation of 15 bpm over baseline for 15 seconds twice in a 20-minute period 4. Evaluating that the EFM strip shows 200 MVU every 10 minutes 5. Evaluating that the EFM strip shows that each contraction lasts 1 minute

4

Which of the following is an appropriate question to include on intake and history forms? 1. What is your gender? 2. What sex were you assigned at birth or on your original birth certificate? 3. What is your biological gender? 4. What is your sexual orientation?

4

While providing care for a patient, the nurse notices an erratic fetal heart rate (FHR) recording. What action should the nurse take next? 1. Help the patient move around to help obtain the signal. 2. Remove some of the ultrasound gel from the transducer. 3. Check the mother's cervical progress to see if she is in the second stage of labor. 4. Place the transducer in a different position.

3

A female carries one positive genetic marker for Huntington's disease. Her partner does not have any markers for the disease. For which reason is it so important for this family to identify persons with the genetic marker? 1. The Huntington gene is recessive. 2. All of the couple's offspring will have the disease. 3. Symptoms do not manifest until 30 to 50 years of age. 4. The expression of the disease is varied by individual.

4

A 40-year-old G5P1031 is attending a childbirth education class. During the class, the woman says, "The worst part of contractions with my last labor was when they were at the peak of intensity." The nurse educator correctly explains that the woman is identifying which part of a contraction? 1. When the uterine wall is resistant to indentation 2. The longest part of the contraction 3. Descending of contraction 4. The shortest part of the contraction

4

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 grandmother has never thought of herself in this role and will adapt with time. 2. The grandmother is most likely teasing and actually feels overwhelming delight. 3. The grandmother has specific wishes about how she is to be addressed as a person. 4. The pregnancy presents undeniable evidence the grandmother is growing older.

2

A nonreactive nonstress test (NST) at 39 weeks' gestation is an indication for: 1. Expedited birth 2. Further testing 3. Reassurance about fetal status 4. An urgent cesarean birth

4

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. Fetal movement counting 3. Contraction stress test (CST) 4. Nonstress testing (NST)

2

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. If the mother is not overly tired or anxious 2. Whether uterine contractions can be stimulated 3. Whether Braxton-Hicks contractions are occurring 4. If the fetus is in an awake cycle and active

3

A female patient is concerned about an inability to become pregnant after trying for 1 year. Which information collected during a health history causes the nurse the greatest amount of concern about possible infertility? 1. The patient works as a ballroom dance instructor. 2. The patient is turning 37 years old this year. 3. The patient has hot flashes and mood swings. 4. The patient was treated for a pelvic inflammatory disease (PID) while in college.

3

A medication given to women experiencing a prolonged latent phase to produce a period of rest or sleep is: 1. Butorphanol (Stadol) 2. Promethazine hydrochloride (Phenergan) 3. Morphine sulfate 4. Fentanyl (Sublimaze)

2

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. Ascertain whether the patient has a latex or banana allergy. 3. Explain that pain at 4 or less on a 0 to 10 scale is expected. 4. Request that the patient's partner leave the testing room.

cerclage

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 ___________

1,4,5

A patient just learned 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. Monitor the patient's condition and adjust visitors accordingly. 4. Facilitate referrals related to the fetal condition. 5. Ascertain if the patient and partner have previous crisis skills.

2

The normal fetal heart rate (FHR) baseline rate: 1. Decreases during labor 2. Fluctuates during labor 3. Increases during labor 4. Accelerates during labor

2

The nurse is counseling a patient regarding pregnancy. The patient lost her first two pregnancies in the second trimester of gestation for undetermined reasons. Which initial advice does the nurse provide for this patient? 1. Consider adoption. 2. Seek genetic studies. 3. Plan for fertility tests. 4. Attend grief counseling.

4

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 has a family history of diabetes mellitus. 3. The patient travels outside the country for work. 4. The patient lives in a recently renovated house.

1

An internal fetal monitor has been ordered for Chrissy, a 24-year-old G2P0010 at 38 weeks and 1 day gestation. Her medical history is significant for a history of pregnancy-induced hypertension. Her laboratory values are as follows: Hemoglobin/hematocrit (H/H) 11/30, O negative, rapid plasma reagin (RPR) negative, GBS positive. Based on Chrissy's history and presentation, what action should the nurse take next? 1. Discuss with the health-care provider (HCP) that Chrissy is GBS positive and therefore should not receive an internal monitor. 2. Take the required two blood pressure readings every 15 minutes before insertion of the internal fetal monitor due to her pregnancy-induced hypertension. 3. Discuss with the HCP the fact that Chrissy's blood type is O negative and she should therefore receive RhoGAM before insertion of an internal monitor. 4. Prepare Chrissy for the placement of an internal monitor.

4

The nurse is reading the patient's chart, which indicates the patient has a "gynecoid pelvis." What finding is expected in this patient? 1. Narrower pubic arch 2. Shorter diameter between her coccyx and ischium 3. Smaller inlet 4. Wider outlet

4

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. Ensuring safe birth for mother and child 2. Expressing an attachment to the child 3. Ensuring social acceptance of the child 4. Stating a willingness to give of oneself

3

The nurse educator is in a childbirth education class discussing nonpharmacological ways nurses can assist to enhance labor and spontaneous vaginal delivery. Which of the following facts regarding nonpharmacological approaches will the nurse use to help illustrate its benefits? 1. Using peppermint aromatherapy oils will help promote relaxation. 2. The client can achieve self-hypnosis with the Bradley method. 3. Effleurage is performed in rhythm with breathing during a contraction. 4. Sterile water injections can be very useful for pelvic pain.

1,2,3,5

The nurse-educator is preparing a presentation on fetal heart monitoring. Which of the following should be included? Select all that apply. 1. Intermittent auscultation should be performed every hour in the latent phase. 2. For Category I situations, intermittent electronic fetal monitoring (EFM) should be performed for 10 to 30 minutes every 1 to 2.5 hours. 3. A patient with membranes ruptured over 24 hours should be monitored during the latent phase every 30 minutes, every 15 minutes during the active phase, and every 5 minutes during the second stage. 4. A patient with a previous cesarean section should have EFM for 10 to 30 minutes every 1 to 2.5 hours. 5. A patient with fever should be monitored during the latent phase every 30 minutes, every 15 minutes during the active phase, and every 5 minutes during the second stage.

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 examination. Which comment by the nurse is appropriate? 1. "Oral bleeding can contribute to anemia." 2. "Dental problems can interfere with nutrition." 3. "You need dental care because pregnancy causes dental problems." 4. "Periodontal disease is a risk factor for preterm labor."

1

While reviewing the birth plan of an uncomplicated and healthy patient in active labor, the nurse notices that she wants to have a natural labor and potentially experience hydrotherapy. Which option should the nurse suggest for the patient? 1. Telemetry to allow for the patient to accomplish her birth plan 2. Fetal scalp electrode (FSE) to make sure that her fetus is tolerating the hydrotherapy 3. Intrauterine pressure catheter (IUPC) to make sure that her contractions are adequate to keep labor progressing 4. External electronic fetal monitor (EFM) to make sure that there is continuous monitoring

1

The most common cause of postpartum hemorrhage is: 1. Uterine atony 2. Cervical laceration 3. Placenta accreta 4. Retained placenta

3

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. Physicians rely on the use of technological procedures for birth. 2. Midwives primarily deliver babies in the home setting. 3. Physicians provide care for both low- and high-risk patients. 4. Midwives are commonly self-taught without formal training.

1,2,5

A male patient is diagnosed with low sperm count as the cause of infertility. Which interventions will the nurse recommend to improve the patient's sperm count? Select all that apply. 1. Yoga or relaxation techniques 2. Surgical repair of an inguinal hernia 3. Switch to underwear made from cotton 4. Avoidance of showers with hot water temperature 5. Consultation to change hypertension drugs

3

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

1,2,4,5

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. Impaired intellectual development 2. Development of metabolic syndrome 3. Shoulder injury related to birth size 4. Changes in genetic expression 5. Increased risk for chronic illnesses

2

A pregnant patient and her spouse live in the same home as the spouse's family, which 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. Whether the couple's finances support moving into a separate location 2. If threatened or actual abuse from household members occur toward the patient 3. What the potential for improving the current support network is 4. Who will provide the patient the greatest amount of support

1

A primary method of fetal surveillance during pregnancy is: 1. Fetal kick counts 2. Nonstress testing (NST ) 3. Ultrasonography 4. Fundal height measurement

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. PTBs result in increased numbers of neonatal and infant deaths and long-term neurological impairment. 3. PTL is defined as regular uterine contractions resulting in cervical changes before 40 weeks' gestation. 4. Average costs for premature/low birthweight infants are more than 10 times as high than for other newborns.

1,3,5

The nurse educator is teaching about regional and local anesthesia in a childbirth education class. The nurse should teach that regional anesthesia is used for which of the following? Select all that apply. 1. Epidural with lidocaine for pain in labor 2. Lidocaine 1% for episiotomy 3. Spinal block with lidocaine for a cesarean delivery 4. Lidocaine 1% for episiotomy repair 5. Lidocaine without epinephrine for forceps use

1,4,5

The nurse educator is teaching the nursing student the basic principles of using analgesia by using a patient, Christa, as an example. Which of the following demonstrates the basic principles of analgesia during Christa's labor and delivery? Select all that apply. 1. Christa has been in labor for 4 hours. She has been having contractions every 3 minutes. Contractions last a minute and are intense. She has had cervical change from 3 to 5 cm over the past 4 hours. 2. Local anesthesia in the perineal area was used in conjunction with the epidural throughout labor and delivery. 3. Christa received butorphanol (Stadol) within 3 hours of delivery and the infant experienced neonatal depression. 4. The medication Christa wants is an epidural. After she receives the epidural, the fetal heart rate (FHR) tracing is within normal limits. 5. Christa has a history of opiate abuse and therefore it was understood that she might require higher doses of medications to experience relief.

3

The nurse is teaching a class about embryonic and fetal development to couples in the early stage of pregnancy. For which reason does the nurse emphasize the first 8 weeks of gestation? 1. Pregnancies often abort before or at this time of development 2. Lack of size and movement prevents confirmation of pregnancy. 3. All organ systems are developing during this period. 4. Factors that can interrupt the pregnancy are no longer a concern.

2,3

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 allows a clinic staff member to take a photo of her. 2. A pregnant woman denies sexual intercourse during her third trimester. 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.

2

The nurse works in an infertility clinic and is interviewing a male patient whose partner has been unable to conceive. Which finding obtained during a health history will cause the nurse greatest concern? 1. The patient is a passionate gardener. 2. The patient had a vasectomy reversed. 3. The patient rides a bicycle daily to work. 4. The patient is concerned about infertility

1,2,4,5

The obstetric nurse is assessing the laboring patient for pain. Which of the following should the nurse identify in a pain assessment? Select all that apply. 1. Intensity of contractions 2. Presence of pain in the neck or back 3. Presence of fetal heart rate (FHR) with intermittent auscultation 4. Signs of anxiety 5. Frequency and duration of contractions

2,3

A patient is interested in a pain relief option that she can control during labor. The nurse explains to the patient what pain relief options are available that would meet her needs, and they mutually decide on nitrous oxide. Which of the following does the nurse describe to the patient about the use of nitrous oxide in labor? Select all that apply. 1. "If started, it should be used throughout the entire labor." 2. "There is no effect on the labor progress from active labor to delivery, and therefore you do not need to worry about longer labors with the medication." 3. "The gas takes effect in about 50 seconds after the first breath, and the patient will feel calm." 4. "The nurses will administer it to you during every contraction so we will need to be with you during the entire labor." 5. "It has no trade name and is only available in generic forms.

2

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

4

A patient who has just received confirmation that she is pregnant is distressed because she has a seizure disorder that she manages with carbamazepine. Which is the nurse's greatest concern? 1. The carbamazepine may be discontinued. 2. The pregnancy is likely to end with fetal demise. 3. The fetus will experience loss of vision and hearing. 4. Carbamazepine is teratogenic and causes neural and facial defects.

1,2,4,5

A patient who is at 20 weeks' gestation is being prepared for a magnetic resonance imaging (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. Encourage patient to think about resolutions for negative testing. 4. Promote open communication with her primary health-care providers (HCPs). 5. Provide psychological support to the patient and her partner.

4

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. April 21 2. May 14 3. November 14 4. January 21

1,2,4,5

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 estimated date of delivery (EDD) by Naegele's rule 4. Signs or symptoms of hypertensive disorders 5. Antibody screening for Rh-negative women

6

The nurse is performing a nonstress test (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

1,2,3,4

The nurse is assessing a patient at 26 weeks' gestation. The patient has chronic hypertension and exhibited hypertension and proteinuria before 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 (HCP)? Select all that apply. 1. Lack of response to verbal and tactile stimulation 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. Laboratory report that shows an elevation of liver enzymes

1,2,3,4

The nursing preceptor is teaching the nursing student about fetal tachycardia. Which is true of the maternal reasons for fetal tachycardia? Select all that apply. 1. A urine toxicology screen may reveal recent cocaine use; the nurse should also monitor for placental abruption. 2. Administer terbutaline to the mother for uterine tachysystole; this is self-limiting to when the drug is affecting the mother. 3. Maternal fever is a common sign. 4. Check the chart for a history of maternal mental illness, particularly maternal anxiety; speak with the patient regarding her anxiety and take steps to ease her anxieties. 5. Check the maternal blood pressure, as hypotension is linked to fetal tachycardia; identify the on-call provider.

2

The obstetric nurse is managing her patients while covering for another nurse who is on a break. Which patient is the lowest priority? 1. A patient with a previous cesarean section 2. A patient with Category I fetal heart rate (FHR) tracings 3. A patient with decreased fetal activity 4. A patient with an epidural in place

4

The patient is a 26-year-old G1P0 at 38 weeks, 2 days of gestation. She is at her provider's office for a visit and complains to the nurse of wrist pain, fatigue, increased discharge, and "feeling heavy." Which complaint could be a sign of impending labor? 1. Wrist pain 2. Fatigue 3. Heavy feeling 4. Increased discharge

1

The patient is having an unmedicated childbirth and has begun to bear down. She vocalizes, "The baby is coming!" Which action should the nurse take? 1. Have the patient assume a comfortable and upright position. 2. Help the patient onto all fours. 3. Help the patient in a lithotomy position. 4. Help the patient into a knee-chest position.

1,2,4,5

When assisting with a vacuum-assisted vaginal delivery, the nurse is aware that adherence to which guidelines for the vacuum device will minimize the nurse's liability in vacuum-assisted vaginal births? Select all that apply. 1. Pump up the vacuum manually to the pressure indicated on the pump. 2. Recognize that cup detachment (pop off) is a warning sign. 3. The cup should not be on the fetal head for longer than 5 to 10 minutes. 4. The procedure is timed from insertion of the cup into the vagina until the birth. 5. Understand that pressure should be released between contractions.

1,2,3,4,5

A patient in labor receives high-level regional anesthesia, which inhibits her ability to push during the second state of labor. The primary care provider (PCP) will use forceps to aid in the delivery of the fetus. Which fetal complications is the nurse aware of being related to a forceps birth? Select all that apply. 1. Intracranial hemorrhage 2. Skin lacerations 3. Nerve injuries 4. Cephalohematoma 5. Skull fracture

3

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

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. About 80% of the increased capacity of the uterus is related to uteroplacental content. 2. The weight of the uterus increases from 7 g to 1,100 g during pregnancy. 3. The uterus size increases in size 20 times over a nonpregnant uterus. 4. About 75% of the increase in uterus size during pregnancy is related to stretching

4

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. "Diagnostic testing is a reason for worry because they indicate fetal problems." 4. "Screening tests are primarily to identify those without disease or abnormality."

1

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. Sends the patient to the hospital to be checked for possible signs of labor 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. After examination, assures the patient of the absence of contractions

2

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. Ultrasonography 2. Amniocentesis 3. Daily fetal movement count 4. Chorionic villus sampling

1

The nurse is teaching a prenatal class. For which reason does the nurse emphasize the importance of managing maternal fear during labor? 1. Dystocia is associated with extreme fear. 2. Mothers cannot enjoy the actual birth. 3. Fear promotes feelings of exhaustion. 4. Fear during labor causes postpartum depression.

3

The nurse-educator is instructing on the physiology of fetal heart rate (FHR) patterns. He is showing the students an electronic fetal monitor (EFM) strip, and there is a tracing that is classified as baseline 140 bpm, moderate variability, accelerations, and 2 decelerations. A half hour later, the baseline is 150 bpm, there is minimal variability, accelerations, and 3 decelerations. Which of these findings would the nurse attribute to the parasympathetic nervous system? 1. The baseline changes from 140 bpm to 150 bpm 2. The change from moderate variability to minimal variability 3. The presence of 2 and then 3 decelerations 4. The consistent presence of accelerations

2

The nursing preceptor asks the nursing student how to best determine the intensity of contractions before placing the patient on an electronic fetal monitoring (EFM) strip. How would the nurse assess this? 1. Track the amount of time in between the ending of one contraction and the beginning of another. 2. Palpate the maternal abdomen during a contraction. 3. Palpate the maternal abdomen right after a contraction ceases. 4. Monitor the patient's vocalizations and facial expressions.

vibroacoustic

______________stimulation may be effective in eliciting a change in fetal behavior, fetal startle movements, and increased fetal heart rate (FHR) variability.

3

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 have enrolled him in a sibling preparation class at the hospital." 3. "I think that I will just bring the new baby home as a surprise." 4. "I let him pick out a gift for the baby, and have one for him from the baby."

2

A nurse-preceptor is explaining to a new nurse about the tocodynamometer. The new nurse is looking at the electronic fetal monitor (EFM) paper and sees that, of the two tracked heart rates, the one on the bottom is in the 80s; she is concerned that the fetal heart rate (FHR) is bradycardic. Which of the following should the nurse do first? 1. Give the mother oxygen to increase the fetal heart rate. 2. Check to make sure that the maternal radial pulse is being recorded correctly. 3. Immediately call the provider into the room. 4. Adjust the monitor on the maternal abdomen.

3

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. First awareness of fetal movements 3. Breast enlargement, tenderness, and tingling 4. Increased appetite

4

A patient arrives at labor and delivery for the induction labor for her first child. The patient tells the nurse, "I can't believe how easy this is just to pick a day, sign a paper, and have a baby." Which action does the nurse take before the induction process? 1. Report an incidence of probable malpractice by the health-care provider (HCP). 2. Check the patient's chart for an informed consent. 3. Explain the possible complications of induction to the patient. 4. Call the HCP to validate patient understanding.

2

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 most appropriate regarding intimate partner violence (IPV)? 1. "If you are all alone, you need to make arrangements for someone to stay with you." 2. "Let's explore ways to protect you and stop the abuse you have been enduring." 3. "I will call a women's shelter to make arrangements for you to move in immediately." 4. "Your partner needs to come to the office so that we can confront his behavior."

screening

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