NADN 165 OB - Exam 2, Chapters 9-16

A primipara gave birth to a healthy baby boy yesterday. Her partner, Mr. Lenhart, seemed elated at the birth, calling their friends and family on his cell phone minutes after the birth. He passed out cigars and praised his wife for her efforts. Today, when the nurse walked into their room, her partner seemed anxious around his new son and called for the nurse whenever the baby cried or needed a diaper change. He seemed standoffish when asked to hold his son, and he spent time talking to other fathers in the waiting room, leaving his wife alone in the room. A. Would you consider this behavior to be normal at this time? B. What might the partner be feeling at this time? C. How can the nurse help this new father adjust to his new role?

A. Would you consider Mr. Lenhart's paternal behavior to be normal at this time? Yes, inexperienced first-time fathers are anxious around their newborns because this is a new experience for them and many do not know how to handle or care for their newborns yet. Paternal attachment is a gradual process that occurs over weeks and months. B. What might Mr. Lenhart be feeling at this time? He is probably feeling overwhelmed with this tiny baby and, although he probably wants to help, he is anxious about how or what to do without appearing awkward. C. How can the nurse help this new father adjust to his new role? The nurse can help new fathers adjust to their role by taking time to listen to their concerns and demonstrating how they can become involved in the care of their newborn. Staying in the room and physically supporting the father as he tries out his new role will provide encouragement for him to become involved. The nurse can slowly introduce fathers to the care needs of their newborn and encourage their participation. This supportive role by the nurse can help reduce role strain and enhance family adjustment.

You are assigned to lead a community education class for women in the third trimester of pregnancy to prepare them for upcoming birth. Prepare an outline of topics that should be addressed.

Topics to address in the community education program would include: -Information about the stages of labor, including what to expect -Explanation of risks and benefits about any interventional procedures that might be performed during the labor process -Information about the available pain relief measures -Methods of involvement and participation during the labor and birthing process by partner/doula/family member -Information about variables that may alter or influence the course of labor, including preoperative teaching for cesarean birth

Which is not true about breast-feeding? a. Breast-fed infants experience more obesity and allergies. b. Breast milk is perfectly suited to the infant's nutritional needs. c. Breast milk contains maternal antibodies to stimulate infant's immunity. d. Breast-feeding enhances maternal bonding and attachment.

a. Breast-fed infants experience more obesity and allergies. Based on research, breast-feeding prevents childhood and adult obesity and infants who are breast-fed experience fewer allergies versus those that are bottle-fed. Responses B, C, and D are all true statements about breast-feeding. These responses represent the advantages of breast-feeding.

Which practice would not be included in a physiologic birth? a. Early induction of labor before 39 weeks' gestation b. Freedom of movement for the laboring woman c. Continuous presence and support throughout labor d. Encouraging spontaneous pushing when urge is felt

a. Early induction of labor before 39 weeks' gestation The correct response to this question is A since inducing labor artificially, rather than waiting for spontaneous labor to start doesn't provide for a physiologic birth. Nature should be allowed to take its course without artificial means to initiate labor. Responses B, C, and D all contribute to physiologic birth practices.

Which are cardinal movements of labor include? Select all that apply. a. Extension and rotation b. Descent and engagement c. Presentation and position d. Attitude and lie e. Flexion and expulsion

a. Extension and rotation b. Descent and engagement e. Flexion and expulsion Answers A, B, and E are correct. The cardinal movements of labor by the fetus include engagement, descent, flexion, international rotation, extension, external rotation, and expulsion only. The other choices describe the various fetal positions.

Which assessment finding indicates positive bonding between the parents and their newborn? a. Holding the infant close to the body b. Having visitors hold the infant c. Buying expensive infant clothes d. Requesting that the nurses care for the infant

a. Holding the infant close to the body Desiring to be in close proximity to another human being is all part of the bonding process. Bonding cannot take place with separation of individuals. Closeness is needed by the two people bonding, and not having others hold the infant. Buying or wearing expensive clothes has no emotional effect on a bonding relationship. Requesting that nurses provide care separates the parent from the infant and suggests that the parents lack the desire for closeness with their infant.

When obtaining a blood test for pregnancy, which hormone would the nurse expect the test to measure? a. Human chorionic gonadotropin (hCG) b. Human placental lactogen (hPL) c. Follicle-stimulating hormone (FSH) d. Luteinizing hormone (LH)

a. Human chorionic gonadotropin (hCG). hCG is produced by the trophoblast (outermost layer of the developing blastocyst) and maintains the ovarian corpus luteum (remainder of ovarian follicle after ovulation) by keeping levels of progesterone and estrogen elevated until the placenta can take over that function. hCG is secreted early after conception to signal that fertilization has taken place. Without fertilization, hCG is not detected. Thus, it is the basis for pregnancy tests. hPL is the hormone secreted by the placenta to prepare the breasts for lactation. It is also an antagonist to insulin, competing for receptor sites that force insulin secretion to increase to meet the body's demands. FSH is secreted by the anterior pituitary gland to stimulate the ovary to mature an ovum for ovulation. It is not detected during pregnancy tests. LH is secreted by the pituitary gland. An increase in LH occurs immediately before ovulation and is responsible for release of the ovum. It is not the basis for pregnancy tests.

A laboring woman is admitted to the labor and birth suite at 4-cm dilation. She would be in which phase of labor? a. Latent b. Active c. Late d. Early

a. Latent Cervical dilation of 4 cm indicates that the woman is in the latent phase of the first stage of labor, which lasts from 0 to 6 cm of dilation. The active and late phases are marked by different measurements. There is no early phase.

Which would be considered risk factors for psychological well-being during pregnancy? Select all that apply. a. Limited support system and network of friends and family b. Introverted personality at any point in the pregnancy c. Ambivalence any time during the pregnancy d. High levels of stress due to family discord e. History of previous high-risk pregnancy with complications f. Depression prior to pregnancy and on medication

a. Limited support system and network of friends and family d. High levels of stress due to family discord e. History of previous high-risk pregnancy with complications f. Depression prior to pregnancy and on medication The correct responses for this question are A, D, E, and F because all of these factors will influence the pregnancy outcome in a negative way and the ability to cope with them might become challenging. These factors would be "red flags" in a client's history and counseling and education might be needed during this pregnancy. Responses B and C are both normal emotions that are universally experienced by most pregnant women. They would not indicate a problem.

Which interventions are underutilized in promoting a normal birth? Select all that apply. a. Oral nutrition and fluids in labor b. Open-glottis pushing in the second stage of labor c. Skin-to-skin contact after birth for infant bonding d. Routine artificial rupture of membranes (amniotomy) e. Labor induction with intravenous Pitocin f. Routine episiotomy to shorten labor length

a. Oral nutrition and fluids in labor b. Open-glottis pushing in the second stage of labor c. Skin-to-skin contact after birth for infant bonding The correct responses would include A, B, and C since all of these are evidence-based interventions that are physiologically sound without placing the mother or the neonate in any danger. Food and clear fluids provide hydration and nutrition and give comfort to laboring women. Fasting during labor will increase gastric acid production. Open glottis while pushing allows the woman's body to sense the urge to push naturally. Skin-to-skin contact promotes mother--infant bonding and warmth. Incorrect responses would include D, E, and F since these are artificial means to speed up the labor process which places the mother and newborn in jeopardy. Amniotomy may be associated with umbilical cord prolapse and fetal heart rate decelerations. Episiotomy is associated with an increase in third- and fourth-degree perineal lacerations, discomfort, and healing delays. Induction with Pitocin may cause tetanic contractions causing hypoxia to the fetus.

A 25-year-old woman presents to the clinic with complaints of nausea, vomiting, and urinary frequency. Based on this information, the nurse knows these are most indicative of what type of signs? a. Presumptive signs of pregnancy b. Positive signs of pregnancy c. Probable signs of pregnancy d. Signs of a urinary tract infection

a. Presumptive signs of pregnancy

During pregnancy, which foods should the expectant mother reduce or avoid? a. Raw meat or uncooked shellfish b. Fresh, washed fruits and vegetables c. Whole grains and cereals d. Protein and iron from meat sources

a. Raw meat or uncooked shellfish. Consuming raw meat can increase the pregnant woman's risk of picking up toxoplasmosis, a parasitic infection that can be passed on to her fetus. Although toxoplasmosis may go unnoticed in the pregnant woman, it may cause abortion or result in the birth of an infant with the disease. Uncooked shellfish may contain high levels of mercury, which can damage the fetal central nervous system. Some raw or undercooked can also be contaminated with Listeria, which may result in abortion, stillbirth, or severe illness of the newborn. Raw or undercooked food items should be avoided during pregnancy.

The major purpose of the first postpartum home care visit is to a. identify complications that require interventions. b. obtain a blood specimen for PKU testing. c. complete the official birth certificate. d. support the new parents in their parenting roles.

a. identify complications that require interventions Home visits are usually made within the first week of discharge to assess the mother and newborn. This visit is made primarily to provide the nurse with the opportunity to recognize common biomedical and psychosocial problems or complications. Although not the primary reason, this visit also offers an opportunity to provide support and guidance to the parents in making the adjustment to the change in their lives. The home visit is not the time to complete PKU testing or complete the birth certificate.

The nurse would expect a postpartum woman to experience lochia in which sequence? a. Rubra, alba, serosa b. Rubra, serosa, alba c. Serosa, alba, rubra d. Alba, rubra, serosa

b. Rubra, serosa, alba Lochia discharge from the uterus proceeds in an orderly fashion, regardless of a surgical or vaginal birth. Its color changes from red to pink to whitish cream consistently, unless there is a complication. The correct sequence is rubra (red), then serosa (pink/brownish), and then alba (white, creamy).

What factors would change during a pregnancy if the hormone progesterone were reduced or withdrawn? a. The woman's gums would become red and swollen and would bleed easily. b. The uterus would contract more, and peristalsis would increase. c. Morning sickness would increase and would be prolonged. d. The secretion of prolactin by the pituitary gland would be inhibited.

b. The uterus would contract more, and peristalsis would increase. Progesterone is an essential hormone to maintain the pregnancy and prevent early labor. Progesterone decreases systemic vascular resistance early in pregnancy, leading to a decline in blood pressure. It causes relaxation of the uterus and gastrointestinal smooth muscle, resulting in delayed gastric emptying and calming of the uterus. This relaxation mechanism is vital to reduce uterine contractions.

During the fourth stage of labor, the nurse assesses the woman at frequent intervals after giving childbirth. What assessment data would cause the nurse the most concern? a. Moderate amount of dark red lochia drainage on peripad b. Uterine fundus palpated to the right of the umbilicus c. An oral temperature reading of 100.6°F d. Perineal area bruised and edematous beneath her ice pack

b. Uterine fundus palpated to the right of the umbilicus. A full bladder causes displacement of the uterus above it, and increased bleeding results secondary to the uncontracted status of the uterus. Massaging the uterus will help to make it firm but will not help to bring it back into the midline, since the full bladder is occupying the space the uterus would normally assume. Notifying the primary health care provider is not necessary unless the woman continues to have difficulty voiding and the uterus remains displaced. The normal location of the uterus in the fourth stage of labor is in the midline. Displacement suggests a full bladder, which is not considered a normal finding.

The nurse is instructing the postpartum client who plans to bottle feed her newborn about measures to prevent breast engorgement when she is discharged. Which measure should the nurse include in the teaching plan? a. Decreasing her fluid intake for the first week at home b. Wearing a tight-fitting supportive bra 24 hours daily c. Take a diuretic to release the extra fluid in the breasts d. Manually express the milk that is accumulating

b. Wearing a tight-fitting supportive bra 24 hours daily The correct response is B since wearing a supportive bra will decrease the discomfort and provide support for the heavy breasts. Engorgement will improve within 24 to 48 hours, although the milk supply may take several weeks to resolve. Responses A and C are incorrect since this is harmful advice to give a postpartum woman. Extra intake of fluids is recommended, not a reduction of them to keep her hydrated. Response D is incorrect since no attempt should be made to express milk from the breasts, as this will simply promote milk let down and further milk production and increase engorgement.

The most intense time during labor is during the a. latent phase. b. active phase. c. membranes breaking. d. placental expulsion phase.

b. active phase. During the active phase, the contractions are stronger, and frequency is increased at this time in the laboring process. There is relatively minimal discomfort and/or intensity of contractions during the latent phase, the breaking of membranes, and the placental expulsion phase.

Evidence-based practice applied to the clinical setting improves a. communication between health care professionals. b. client care and overall better outcomes. c. cost-effectiveness of therapeutic treatments. d. ability to carry out a research study by nurses.

b. client care and overall better outcomes.

Immediately after childbirth in the recovery area, the nurse observes the mother's partner's fascination and interest in the new child. This behavior is often termed a. attachment. b. engrossment. c. bonding. d. temperament.

b. engrossment. Partner's or significant others' developing bond with the newborn—a time of intense absorption, preoccupation, and interest—is called engrossment. Responses A, C, and D are incorrect since they are terms typically describing the close relationship between the mother--infant dyad, not the father.

A pregnant client close to term comes in the clinic for an exam. The woman complains about experiencing shortness of breath. The nurse knows that this may be caused by the a. fetus needing more oxygen due to larger size. b. fundus of the uterus pushing the diaphragm upward. c. woman experiencing an allergic reaction because of high histamine levels. d. oxygen partial pressure concentration becoming lower during the third trimester.

b. fundus of the uterus pushing the diaphragm upward. The correct response to this question is B because of anatomical changes that affect breathing. The growing gravid uterus displaces the diaphragm upward which forces the entire thoracic cavity to compensate by increasing its dimensions so that more air can be inspired. Shortness of breath develops in most women during the last month of pregnancy. Response A is incorrect since the placenta is essentially the "lungs" for the growing fetus and thus the exchange of oxygen and carbon dioxide takes place there, not via the maternal respiratory system. Response C is incorrect since there isn't a histamine response taking place in a normal pregnancy to cause an allergy. Response D is incorrect since the partial pressure of oxygen increases throughout pregnancy, not lessens.

Working in a reproductive health services clinic, the nurse is aware that the goal of the Human Genome Project was to a. link specific abnormal genes to specific diseases for better treatment. b. map, sequence, and determine the function of all human genes. c. understand the underlying causes of diseases to transform health care. d. measure the impact of certain chromosomes on disease prevention.

b. map, sequence, and determine the function of all human genes. The goal of the Human Genome Project, which was started in 1990, was to map, sequence, and identify the functions of all human genes to advance genetic testing and gain a better understanding of human diseases. Linking genes to diseases, understanding underlying causes of diseases, and measuring the impact of certain chromosomes on prevention are all potential outcomes of the Human Genome Project, not the original goal of it.

Which assessment would indicate that a woman is in true labor? a. Membranes are ruptured and fluid is clear. b. Presenting part is engaged and not floating. c. Cervix is 4 cm dilated, 90% effaced. d. Contractions last 30 seconds every 5 to 10 minutes.

c. Cervix is 4 cm dilated, 90% effaced. True labor is characterized by contractions occurring at regular intervals that increase in frequency, duration, and intensity. These contractions bring about progressive cervical dilation and effacement. Thus, a cervix dilated to 4 cm and 90% effaced indicates true labor. Rupture of membranes may occur before the onset of labor, at the onset of labor, or at any time during labor and thus is not indicative of true labor. Engagement occurs when the presenting part reaches 0 station; it typically occurs 2 weeks before term in primigravidas and several weeks before the onset of labor or at the beginning of labor for multiparas. Contractions of true labor typically last 30 to 60 seconds and occur approximately every 4 to 6 minutes.

The nurse notes the presence of transient fetal accelerations on the fetal monitoring strip. Which intervention would be most appropriate? a. Reposition the client on the left side. b. Begin 100% oxygen via face mask. c. Document this as indicating a normal pattern. d. Call the health care provider immediately.

c. Document this as indicating a normal pattern. Fetal accelerations denote an intact central nervous system and appropriate oxygenation levels demonstrated by an increase in heart rate associated with fetal movement. Accelerations are a reassuring pattern, so no intervention is needed. Turning the woman on her left side would be an appropriate intervention for a late deceleration pattern. Administering 100% oxygen via face mask would be appropriate for a late or variable deceleration pattern. Since fetal accelerations are a reassuring pattern, no orders are needed from the health care provider, nor does the health care provider need to be notified of this reassuring pattern.

The nurse is assessing Ms. Smith, who gave birth to her first child 5 days ago. What findings would the nurse expect? a. Cream-colored lochia; uterus above the umbilicus b. Bright red lochia with clots; uterus two fingerbreadths below umbilicus c. Light pink or brown lochia; uterus four to five fingerbreadths below umbilicus d. Yellow, mucousy lochia; uterus at the level of the umbilicus

c. Light pink or brown lochia; uterus four to five fingerbreadths below umbilicus The nurse would expect light pink or brown lochia, and the uterus should be four to five fingerbreadths below the umbilicus. Cream-colored lochia wouldn't be seen for about 10 to 14 days after childbirth, thus it wouldn't be observed this early in the postpartum period. The uterus would be involuting downward into the pelvis, thus it would not be above the umbilicus by this timeframe. Bright-red lochia would be observed for up to 3 days post birth, not 5 days later unless there was a problem. The uterus descends into the pelvis at a rate of 1 cm/day, thus the fundus should be 4 to 5 cm (fingerbreadths) below the umbilicus by now.

Which biophysical profile finding indicates poor oxygenation to the fetus? a. Two pockets of amniotic fluid b. Well-flexed arms and legs c. Nonreactive fetal heart rate d. Fetal breathing movements noted

c. Nonreactive fetal heart rate. A nonreactive fetal heart rate is one of the biophysical profile findings that indicate poor oxygenation to the fetus.

What is the first step in determining a couple's risk for a genetic disorder? a. Observing the client and family over time b. Conducting extensive psychological testing c. Obtaining a thorough family health history d. Completing an extensive exclusionary list

c. Obtaining a thorough family health history, because uncovering an individual's family history can identify previous genetic disorders that have a high risk for recurrence in subsequent generations. A is an incorrect response because observing a client and his or her family would be costly and unproductive in diagnosing a genetic disorder; observation would have to take place over several generations to yield results. B is an incorrect response because psychological testing might not uncover genetic predispositions to disorders. D is an incorrect response because excluding the numerous genetic conditions would be a time-consuming and tedious task.

When determining the frequency of contractions, the nurse would measure which period of time? a. Start of one contraction to the start of the next contraction b. Beginning of one contraction to the end of the same contraction c. Peak of one contraction to the peak of the next contraction d. End of one contraction to the beginning of the next contraction

c. Peak of one contraction to the peak of the next contraction. Frequency is measured from the start of one contraction to the start of the next contraction. The duration of a contraction is measured from the beginning of one contraction to the end of that same contraction. The intensity of two contractions is measured by comparing the peak of one contraction with the peak of the next contraction. The resting interval is measured from the end of one contraction to the beginning of the next contraction.

When assessing a postpartum woman, which finding would lead the nurse to suspect postpartum blues? a. Panic attacks and suicidal thoughts b. Anger toward self and infant c. Periodic crying and insomnia d. Obsessive thoughts and hallucinations

c. Periodic crying and insomnia Periodic crying and insomnia are characteristics of postpartum blues, in addition to mood changes, irritability, and increased sensitivity. Panic attacks and suicidal thoughts or anger toward self and the infant would be descriptive of postpartum psychosis, when some women turn this anger toward themselves and have committed suicide or infanticide. Women experiencing postpartum blues do not lose touch with reality. Obsessive thoughts and hallucinations would be more descriptive of postpartum psychosis.

Which activity would the nurse include in the teaching plan for parents with a newborn and an older child to reduce sibling rivalry when the newborn is brought home? a. Punishing the older child for bedwetting behavior b. Sending the sibling to the grandparents' house c. Planning a daily "special time" for the older sibling d. Allowing the sibling to share a room with the infant

c. Planning a daily "special time" for the older sibling An older sibling needs to feel he or she is still loved and not upstaged by the newest family member. Allowing special time for that sibling reinforces the parent's love for him or her also. Regression behavior is common when there is stress in that sibling's life, and punishing him brings attention to negative behavior, possibly reinforcing it. The older sibling might feel he or she is being replaced and is not wanted by the parents when he or she is sent away. Including the older sibling in the care of the newborn is a better way to incorporate the newest member into the family unit. Sharing a room with the infant could lead to feelings of displacement in the sibling. In addition, frequent interruptions during the day and night will awaken the sibling and not allow a full night's sleep or undisturbed nap.

Reva Rubin identified four major tasks that the pregnant woman undertakes to form a mutually gratifying relationship with her infant. What is "binding in?" a. Ensuring safe passage through pregnancy, labor, and birth. b. Seeking acceptance of this infant by others. c. Seeking acceptance of self as mother to the infant. d. Learning to give of oneself on behalf of the infant.

c. Seeking acceptance of self as mother to the infant. Seeking acceptance of self as mother to the infant is the basis for establishing a mutually gratifying relationship between mother and infant. This "binding in" is a process that changes throughout the pregnancy, starting with the mother's acceptance of the pregnancy and then the infant as a separate entity. Ensuring safe passage through pregnancy, labor, and birth focuses on the mother initially and her concern for herself. As the pregnancy progresses, the fetus is recognized and concern for its safety becomes a priority. The mother-infant relationship is not the mother's concern yet. Seeking acceptance of this infant by others includes the world around the mother and how they will integrate this new infant into their world. The infant-maternal relationship is not the focus in this task. Learning to give of oneself on behalf of one's infant focuses on delaying maternal gratification, focusing on the infant's needs before the mother's needs.

By the end of the second stage of labor, the nurse would expect which of the following events? a. The cervix is fully dilated and effaced. b. The placenta is detached and expelled. c. The fetus is born and on mother's chest. d. The woman may request pain medication.

c. The fetus is born and on mother's chest because the second stage of labor is defined as beginning with complete dilation of the cervix (10 cm) and ending with the expulsion of the fetus. Response A is incorrect because the cervix is fully dilated at the start of stage 2, not at the end of it. Response B is incorrect due to the fact that the third stage of labor is defined as the period following the birth of the newborn through the expulsion of the placenta. Response D is incorrect since typically most women desiring pain medication would be requesting it in the active phase of labor in stage 1.

After teaching a group of students about fertilization, the instructor determines that the teaching was successful when the group identifies which as the usual site of fertilization? a. Fundus of the uterus b. Endometrium of the uterus c. Upper portion of fallopian tube d. Follicular tissue of the ovary

c. Upper portion of fallopian tube Scientists have determined that conception/fertilization occurs in the upper portion of the fallopian tube. A is an incorrect response because this is where implantation takes place after fertilization has occurred. B is an incorrect response because this describes the inner lining of the uterus, where implantation takes place, not where fertilization of the ovum and sperm occurs. D is an incorrect response because the sperm does not travel outside the fallopian tube to the ovary, but rather meets the ovum for purposes of fertilization in the fallopian tube.

A nurse is working in a women's health clinic. Genetic counseling would be most appropriate for the woman who a. just had her first miscarriage at 10 weeks. b. is 30 years old and planning to conceive. c. has a history with a close relative with Down syndrome. d. is 18 weeks pregnant with a normal triple screen result.

c. has a history with a close relative with Down syndrome. The family history plays a critical role in identifying genetic disorders. A history of a previous child, parents, or close relative with an inherited disease, congenital abnormalities, metabolic disorders, developmental disorders, or chromosomal abnormalities can indicate an increased risk of genetic disorders; therefore, referral to genetic counseling is appropriate.

Physiologic preparation for labor would be demonstrated by a. a decrease in Braxton Hicks contractions felt by mother. b. weight gain and an increase in appetite by mother. c. lightening, when the fetus drops into true pelvis. d. fetal heart rate accelerations and increased movements.

c. lightening, when the fetus drops into true pelvis. As labor nears, the fetus gets into position by descending into the maternal true pelvis in preparation for birth. The woman will experience heaviness in her lower pelvis and urinary frequency when this occurs. Response A is incorrect since there is an increase in uterine contractions as the uterus becomes more irritable and readies for true labor. Response B is incorrect since most women experience a weight loss and a decrease in appetite close to the start of their labor. Response D is incorrect due to the fact that the fetus is in a cramped environment at term and has limited room to move around. The fetal heart rate would remain within the normal range of 110 to 160 bpm unless there is a problem.

Women recovering from abusive relationships need to learn ways to improve their a. educational levels by getting college degrees. b. earning power so they can move to better neighborhoods. c. self-esteem and communication skills to increase assertiveness. d. relationship skills so they will be better prepared to deal with their partners.

c. self-esteem and communication skills to increase assertiveness. Since feeling better about herself, assertive, and being able to negotiate will lessen her risk for becoming an abused victim again. A is incorrect: going to college will not assure her of not being abused in the future. B is incorrect: she may live in an upscale neighborhood now and a change in location won't prevent her from becoming an abused victim again. D is incorrect: the problem may not have been in any way related to her relationship skills, but fault may have been with substance abuse or a history of abuse in her partner.

When managing a client's pain during labor, nurses should a. make sure the agents given do not prolong labor. b. know that all pain relief measures are similar. c. support the client's decisions and requests. d. not recommend nonpharmacologic methods.

c. support the client's decisions and requests. The entire focus of the labor and birth experience is for the family to make decisions, not the caretakers. The nurse's role is to respect and support those decisions. Decisions about pain management are not based on length of the various stages of labor, but rather on what provides effective pain relief for the laboring woman. Pain relief measures differ. Each individual responds differently and uniquely to various pain relief measures. Not recommending nonpharmacologic measures demonstrates bias on the nurse's part; it is not the nurse's decision to make, but rather the client's.

Which of these activities would best help the postpartum nurse provide culturally sensitive care for the childbearing family? a. Taking a transcultural course b. Caring for only families of the nurse's cultural origin c. Teaching Western beliefs to culturally diverse families d. Educating themselves about diverse cultural practices

d. Educating themselves about diverse cultural practices Nurses need first to become educated about various cultural practices to incorporate them into their care delivery. By gaining an understanding of diverse cultures different from their own, nurses can become sensitive to these different practices and not violate them. Attending a transcultural course might be beneficial, but this would take several weeks to complete and the information is needed much sooner to provide culturally sensitive care for an admitted client and her family. Caring only for families of the nurse's cultural origin would not be possible or realistic in our global, culturally diverse population within the United States. Nurses need to care for every person regardless of their color, creed, or nationality with respect and competence. Teaching diverse cultural families Western beliefs would demonstrate ethnocentric behavior and would not be professional. Each culture needs to be respected and learned about with tolerance and understanding.

A new mother gave birth 12 hours ago. Because this is her first child, which goal planned by the nurse is most appropriate? a. Early discharge for the mother and newborn b. Rapid transition into the role of being a parent/caregiver c. Minimal need for expression of feelings now d. Effective education of both parents before discharge

d. Effective education of both parents before discharge Because both parents will need education about the newborn, how to care for it, and how to care for themselves. Education is essential to help both parents in their transition and adaptation to parenthood. Response A is an incorrect response because that should never be the goal to discharge someone early, but only when they are appropriately prepared and stable. Response B is incorrect because the parenthood role happens over time, not immediately after giving birth and during the hospital stay. Response C is incorrect due to the fact that most postpartum women do wish to express their feelings and this activity should be encouraged, not stifled.

Practicing good oral hygiene is important for all women throughout pregnancy. As a nurse providing anticipatory guidance for pregnant women, what condition can result from periodontal disease if good dental care isn't practiced? a. Postdated pregnancy b. Large-for-gestational-age infant c. Advanced reproductive cancer d. Preterm or low-birth-weight infant

d. Preterm or low-birth-weight infant Infections within the mouth caused by poor oral hygiene spread into the maternal circulatory system and cross into the fetal circulation which inhibits growth and development of the fetus. Their uterine environment is compromised and early birth is a risk. Response A is incorrect due to maternal infections which tend to create a hostile environment resulting in an early birth, not a prolonged gestation. Response B is incorrect because just the opposite happens with the fetal growth becoming compromised due to infections. Response C is incorrect because research has not established an association between periodontal disease and the etiology of any reproductive cancer yet.

What should the nurse do if a victim of intimate partner violence chooses not to disclose information about her abusive relationship during the interview? a. Confront the victim with the physical evidence and telltale signs of abuse. b. Contact family members to tell you about the abusive relationship. c. Call the local police department to inquire about domestic disturbance calls. d. Respect the client's right of self-determination and provide her with resources.

d. Respect the client's right of self-determination and provide her with resources. Since the client has the right not to disclose her abusive relationship to the nurse. Many clients are not ready to do so and they should not be forced to do so at that time. Frequently, trust and rapport must be established first before self-disclosure is forthcoming. Response A is incorrect since the client has the freedom not to disclose this information to the nurse and the client should never be coerced to do so. Response B is incorrect since this would be a breach of client confidentially to inform family members about the nurse's suspicions to gather additional data against the client's wishes. This would be a HIPAA violation. Response C is incorrect since the client isn't willing to reveal her abusive situation; it is a breach of confidentially again to notify the police behind her back to gather more evidence.

Which finding would lead the nurse to suspect that a postpartum woman was developing a complication? a. Fatigue and irritability b. Perineal discomfort and pink discharge c. Pulse rate of 60 bpm d. Swollen, tender, hot area on the breast

d. Swollen, tender, hot area on the breast A swollen, tender area on the breast would indicate mastitis, which would need medical intervention. Fatigue and irritability are not complications of childbearing, but rather the norm during the early postpartum period secondary to infant care demands and lack of sleep on the caretaker's part. Perineal discomfort and lochia serosa are normal physiologic events after childbirth and indicate normal uterine involution. Bradycardia is a normal vital sign for several days after childbirth because of the dramatic circulatory changes that take place with the loss of the placenta at birth and the return of blood back to the central circulation.

Which fish should be limited in a pregnant woman's diet because of its high mercury content? a. Salmon b. Cod c. Shrimp d. Swordfish

d. Swordfish The correct response to this question is D because sword fish typically contains high levels of mercury when compared to other fish species which should be avoided during pregnancy. Responses A, B, and C are fish that have been assessed as having low levels of mercury.

When a client in labor is fully dilated, which instruction would be most effective to assist her in encouraging effective pushing? a. Hold your breath and push through the entire contraction. b. Use chest breathing with the contraction. c. Pant and blow during each contraction. d. Wait until you feel the urge to push.

d. Wait until you feel the urge to push, since nondirected pushing, based on current research, leads to better outcomes for both mother and infant. Holding breath and pushing throughout the entire contraction reduce blood flow and oxygenation to the fetus. Chest breathing is not effective since it doesn't increase abdominal pressure to assist the uterus to contract. Panting and blowing are used to abstain from pushing, which is not what is needed to expel the fetus.

A feeling expressed by most women upon learning they are pregnant is a. acceptance. b. depression. c. jealousy. d. ambivalence.

d. ambivalence. The feeling of ambivalence is experienced by most women when they question their ability to become a mother. Feelings fluctuate between happiness about the pregnancy and anxiety and fear about the prospect of new responsibilities and a new family member. Acceptance usually develops during the second trimester after fetal movement is felt by the mother and the infant becomes real to her. Depression is not a universal feeling experienced by most women unless there is a past history of underlying depression experienced by the woman. Jealousy is not a universal feeling of pregnant women. It can occur in partners, because attention is being diverted from them to the pregnancy and the newborn.

The primary goal of intervention in working with abused women is a. to set up an appointment with a mental health counselor for the victim. b. convince them to set up safety plans to use when they leave. c. help them develop courage and financial support to leave their abusers. d. empower them and improve their self-esteem to regain control of their lives.

d. empower them and improve their self-esteem to regain control of their lives. Giving women the ability to gain control over their lives allows them to make the changes needed to protect themselves and their children. As long as they feel victimized, they will take little action to make change. A is incorrect: being the victim of abuse is not a mental illness, but involves being in circumstances where her courage and self-esteem may be hindered. B is incorrect: leaving the abuser is a process, not an abrupt action, and a great deal of preparation is needed before making this move. C is incorrect: nurses don't have the resources to provide financial support to abused women, but they can make referrals to community agencies that could help with job training.

What anticipatory guidance regarding sexual activity during pregnancy will be included in client teaching? Select all that apply. a. Sexual activity is contraindicated throughout pregnancy. b. Most women don't desire intimacy after the first trimester. c. Sexual activity may continue up until the end of the second trimester. d. Sexual intercourse is prohibited if a history of preterm labor exists. e. Women's sexual desire may change throughout the pregnancy. f. Couples can try a variety of positions of comfort during pregnancy.

e. Women's sexual desire may change throughout the pregnancy. f. Couples can try a variety of positions of comfort during pregnancy. Sexual desire changes throughout pregnancy based on hormones, energy levels, relationship, body image, fears of hurting the fetus, and cultural beliefs. Various positions of comfort for the woman are usually tried for most couples desiring intimacy. Responses A through D are incorrect because unless there is a medical reason why sexual intercourse isn't permitted, sexual activity may be continued throughout a healthy pregnancy.

Breast tissue swelling secondary to vascular congestion after childbirth and preceding lactation describes ___________________.

engorgement

Presumptive (subjective) signs of pregnancy (something they tell you)

fatigue (12 weeks) (could be nursing school) breast tenderness (3-4 weeks) (caffeine use) nausea (getting sick) vomiting (getting sick) lack of menstruation (athlete and run alot) hyperpigmentation (sun) fetal quivering/fluttering (gas not fetal movement) uterine enlargement (cyst, fibroids)

A new nurse assigned to the postpartum mother-baby unit makes a comment to the oncoming shift that a 25-year-old primipara seems lazy and shows no initiative in taking care of herself or her baby. The nurse reported that this new mother talks excessively about her labor and birth experience and seems preoccupied with herself and her needs, not her newborn's care. She wonders if something is wrong with this mother because she seems so self-centered and has to be directed to do everything. A. Is there something to be concerned about in this new mother's behavior? Why or why not? B. What maternal role phase is being described by the nurse? C. What role can the nurse play to support the mother through this phase?

A. Is there something "wrong" with Ms. Griffin's behavior? Why or why not? No, this is typical behavior for a new mother within the first 2 days after giving birth. B. What maternal role phase is being described by the new nurse? This behavior is characteristic of Reva Rubin's taking-in phase, which covers the first 48 hours after childbirth. The new mother is typically focused on her own needs for rest, food, and comfort. New mothers in this phase tend to be passive and take directions/suggestions well from staff. Preoccupation with themselves rather than their newborns is normal during this phase. Their needs must be met before they can begin to care for others. C. What role can the nurse play to support the mother through this phase? The nurse can be supportive through this early phase by providing a restful, quiet environment to facilitate her recovery from childbirth. Providing her with simple guidance and suggestions of how she can care for herself and her newborn will assist the new mother in expanding her focus. Praising her for her accomplishments in care will reinforce it.

Mrs. Bennett has three children under the age of 5 and is 6 months pregnant with her fourth child. She has made repeated unscheduled visits to your clinic with vague somatic complaints regarding the children as well as herself but has missed several scheduled prenatal appointments. On occasion, she has worn sunglasses to cover bruises around her eyes. As a nurse, you sense there is something else bothering her, but she doesn't seem to want to discuss it with you. She appears sad and the children cling to her. a. Outline your conversation when you broach the subject of abuse with this client. b. What is your role as a nurse in caring for a family in which you suspect abuse is occurring? c. What ethical and legal considerations are important in planning care for this family?

A. Outline your conversation when you broach the subject of abuse with this client. Since you suspect abuse, asking a direct question about whether she feels safe in her own home might open up the conversation and allow Mrs. Boggs to talk about the situation. If she denies that there is a problem, reassure her that you care, that you are afraid for her safety, and that she deserves better. Opening the door for discussion is the first step toward change. B. What is your role as a nurse in caring for a family in which you suspect abuse is occurring? Allow Mrs. Boggs to know that you are there for her when she is ready to talk about her situation and that she deserves better than this. If she is unwilling to do so at this time, continue to ask screening questions about abuse on each subsequent visit. Providing her with the National Domestic Violence Hotline number might be helpful. C. What ethical and legal considerations are important in planning care for this family? If you notice that Mrs. Boggs has suffered acute abuse, by law you must report it. You also need to document any injuries to strengthen this case if it were to go to trial. Accurate documentation can also be used as justification for a variety of other actions, such as restraining orders, compensation, and insurance and welfare payments. You have an ethical and legal responsibility to report the abuse and assist the woman; do not ignore it and pass it off as "a private family dispute."

Cindy, a 20-year-old primipara, calls the birthing center where you work as a nurse and reports that she thinks she is in labor because she feels labor pains. Her due date is this week. The midwives have been giving her prenatal care throughout this pregnancy. a. What additional information do you need to respond appropriately? b. What suggestions and recommendations would you make to her? c. What instructions need to be given to guide her decision-making process? d. About what other premonitory signs of labor might the nurse ask? e. What manifestations would be found if Cindy is experiencing true labor?

A. What additional information do you need to respond appropriately? Ask about the frequency and duration of her contractions. Ask about how long she has experienced "labor pains." Ask about any other signs she may have experienced such as bloody show, lightening, backache, ruptured membranes, and so forth. Ask if walking tends to increase or decrease the intensity of contractions. Ask her when she last felt fetal movement. Ask her how far away (distance) she is from the birthing center. Ask her if she has a support person in the home with her. B. What suggestions and recommendations would you make to her? Stay in the comfort of her home environment as long as possible. Advise her to walk as much as possible to see what effect it has on the contractions. Also, tell her to drink fluids to hydrate herself. Review nonpharmacologic comfort measures she can try at home. Tell her to keep in contact with the birthing center staff regarding her experience. C. What instructions need to be given to guide her decision making? Instruct her on how to time the frequency and duration of contractions. Wait until contractions are 5 minutes apart or her membranes rupture to come to the birthing center. Tell her to come to the birthing center when she cannot talk during a contraction. Reinforce all instructions with her support partner. D. About what other premonitory signs of labor might the nurse ask? Has she experienced the feeling of the fetus dropping (lightening) lower down? Has her energy level changed (increased) in the last day or so? Has she noticed any reddish discharge (bloody show) from her vagina? Has she had any episodes of diarrhea within the last 48 hours? Has her "bag of waters" broken or does she feel any leakage? E. What manifestations would be found if Cindy is experiencing true labor? There would be progressive dilation and effacement of her cervix if true labor is occurring. Contraction pain also would not be relieved with walking, and the pain would start in the back and radiate around toward the front of the abdomen. Contractions also would occur regularly, becoming closer together, usually 4 to 6 minutes apart, and last 30 to 60 seconds. If she is experiencing false labor, slight effacement might be present, but not dilation.

Maria, a 27-year-old woman in her last trimester of pregnancy (34 weeks), complains to the clinic nurse that she is constipated and feels miserable most of the time. She reports that she has started taking laxatives, but they don't help much. When questioned about her dietary habits, she replies that she eats beans and rice and drinks tea with most meals. She says she has tried to limit her fluid intake so she doesn't have to go to the bathroom so often. a. What additional information would the nurse need to assess her complaint? b. What interventions would be appropriate for Maria? c. What adaptations will Maria need to make to alleviate her constipation?

A. What additional information would the nurse need to assess her complaint? Ask Maria for a 24-hour food intake recall to assess what other food she eats. Ask Maria if she had this problem before becoming pregnant. Ask Maria if she takes iron supplementation in addition to her prenatal vitamin. Ask Maria how much and what kind of fluid intake she has in 24 hours. Ask Maria whether she engages in any exercise consistently. B. What interventions would be appropriate for Maria? The nurse needs to discuss with her the reasons why she is constipated: heavy gravid uterus compressing the intestines, reduced peristalsis and smooth muscle relaxation secondary to progesterone, low-fiber and fluid intake, and limited exercise. To reduce the problem, Maria will need to make changes in the areas of food, fluid, and exercise. C. What adaptations will Maria need to make to alleviate her constipation? Maria will need to consume high-fiber foods (fruits and vegetables) and increase her fluid intake to 2,000 mL daily to overcome the constipation. In addition, she will need to get off the couch and get some exercise, perhaps walking. Finally, she will need to stop taking stimulant laxatives and change to bulk-forming ones if the increase in high-fiber foods and fluids doesn't work for her.

Sally, age 23, is 9 weeks pregnant. At her clinic visit she says, "I'm so tired I can barely make it home from work. Then once I'm home, I don't have the energy to make dinner." She says she is so sick in the morning that she is frequently late to work and spends much of the day in the bathroom. Sally's current lab work is within normal limits. a. What explanation can the nurse offer Sally about her discomforts? b. What interventions can the nurse offer to Sally?

A. What explanation can the nurse offer Sally about her discomforts? The nurse can explain in simple terms that the new embryo needs a great deal of her glucose and nutrients to grow, and thus her energy level will be affected during early pregnancy; this is why she is feeling tired frequently. The nurse can also inform her that her energy level will increase by the second trimester and she should not feel as drained. B. What interventions can the nurse offer to Sally? Interventions to help Sally cope with her fatigue during her early pregnancy would be for her to plan rest periods throughout the day and make sure she gets a good night's sleep daily. Taking naps on weekends to refresh her may also help her. Also, help with meal preparation would be beneficial.

As a nurse working on a postpartum unit, you enter the room of a 22-year-old primipara and find her chatting on the phone while her newborn is crying loudly in the bassinette, which has been pushed into the bathroom. You pick up and comfort the newborn. While holding the baby, you ask the client if she was aware her newborn was crying. She replies, "That's about all that monkey does since she was born!" You hand the newborn to her and she places the newborn on the bed away from her and continues her phone conversation. A. What is your nursing assessment of this encounter? B. What nursing interventions would be appropriate? C. What specific discharge interventions may be needed?

A. What is your nursing assessment of this encounter? Nursing observations would indicate poor bonding/attachment behaviors between mother and infant based on • Disinterest in holding or being close to infant• Lack of concern for infant's needs • More concerned about phone conversation • Negative comment about newborn ("monkey") B. What nursing interventions would be appropriate? Assess for risk factors in the client—age, outside family support, multiple life stressors, unrealistic expectations of newborn behaviors, level of education, family support system—and determine the client's perception of newborn behaviors and educate her about normal newborn behaviors and mothering activities needed. In addition, model parent care behaviors in caring for a newborn and ascertain the availability of any family support—extended family, neighbors, and community resources. C. What specific discharge interventions may be needed? Based on observations and assessment data, this client would need a referral to the discharge planner, social services department, or local health department for home visit follow-up care. Bonding/attachment behaviors are lacking, possibly placing the newborn at risk for neglect or abuse.

Mary Jones comes to the Women's Health Center, where you work as a nurse. She is in her first trimester of pregnancy and tells you her main complaints are nausea and fatigue, to the point that she wants to sleep most of the time and eats one meal daily. She appears pale and tired. Her mucous membranes are pale. She reports that she gets 8 to 9 hours of sleep each night but still can't seem to stay awake and alert at work. She tells you she knows that she is not eating as she should, but she isn't hungry. Her hemoglobin and hematocrit are low. a. What subjective and objective data do you have to make your assessment? b. What is your impression of this woman? c. What nursing interventions would be appropriate for this client? d. How will you evaluate the effectiveness of your interventions?

A. What subjective and objective data do you have to make your assessment? Subjective data: reports feeling extreme fatigue; sleeps 8 to 9 hours each night; eats poorly Objective data: pale and tired appearance; pale mucous membranes; low H and HB. What is your impression of this woman? She is in her first trimester of pregnancy, when fatigue is a normal complaint due to the diversion of the maternal glucose to the developing fetus. In addition, she is anemic (low H and H) due to eating habits or perhaps pica. It is important for the nurse to report this finding to the health care professional for further investigation of the cause. C. What nursing interventions would be appropriate for this client? Reassure her that the fatigue is a common complaint of pregnancy in the first trimester, but her poor dietary habits are contributing to her fatigue. She is anemic and needs to improve her diet and increase the amount of iron and vitamin C she takes. She also needs to increase her fiber intake to prevent constipation. An iron supplement might be advised by the health care provider to address her anemia. Request that the client keep a food log to bring with her to the next visit to review. A referral for nutritional counseling would be appropriate. D. How will you evaluate the effectiveness of your interventions? To assess compliance with the iron supplement, ask her what color her stools are. If they are dark, then she is taking the iron; if not, she probably isn't. Ask what dietary changes she has made to improve her nutrition by reviewing her food log and making suggestions to increase her iron consumption. Also review the importance of good nutrition for the positive outcome of this pregnancy. Do another H and H level to monitor her anemia.

A 34-year-old single primipara left the hospital after a 36-hour stay with her newborn son. She lives alone in a one-bedroom walk-up apartment. As the postpartum home health nurse visiting her 2 days later, you find: - Tearful client pacing the floor holding her crying son - Home cluttered and in disarray -. Fundus firm and displaced to right of midline - Moderate lochia rubra; episiotomy site clean, dry, and intact - Vital signs within normal range; pain rating less than 3 points on scale of 1 to 10 - Breasts engorged slightly; supportive bra on - Newborn assessment within normal limits - Distended bladder upon palpation; reporting urinary frequency A. Which of these assessment findings warrants further investigation? B. What interventions are appropriate at this time and why? C. What health teaching is needed before you leave this home?

A. Which of these assessment findings warrants further investigation? • Tearful client pacing the floor holding her crying son • Distended bladder upon palpation; reporting urinary frequency • Fundus firm and displaced to right of midline B. What interventions are appropriate at this time and why? It is apparent that this new mother is overwhelmed and does not seem to be coping well with her new parenting role. She may be experiencing postpartum blues as well. She needs support during this critical period. The home care nurse needs to ascertain what family or support systems are available and make contact with them for help. Questioning the mother about previous crying episodes or feeling "down" recently is in order to ascertain whether she is feeling the "blues" in addition to being overwhelmed. If limited resources are available, assigning a home health aide to come daily to assist the client might be needed. Counseling and active listening will be helpful during the home care visit. The uterine fundus is displaced out of the midline as a result of a distended bladder. The bladder needs to be emptied for the uterus to assume midline positioning. The new mother's urinary frequency may be the result of distention secondary to poor bladder tone or a developing urinary tract infection. The nurse should attempt to get the client to void on her own and obtain a clean-catch urine specimen. Checking for bacteria with a chemical reagent strip ("dipstick") is appropriate. Instituting measures to promote voiding—tap water running, forcing fluids, and cranberry juice—also would be appropriate interventions. If a bacterium is found in the clean-catch urine specimen, calling the client's health care provider to obtain an order for medication would be necessary. Otherwise, advising the client to increase her fluid intake and voiding frequently to empty her bladder would be in order. C. What health teaching is needed before you leave this home? Information about postpartum blues should be discussed, emphasizing that it is benign and self-limiting. Assuring Jennifer that this is very common and allowing time for her to vent her frustrations and express her feelings can be very therapeutic. Increasing awareness about postpartum blues can bring it into focus and help her understand this event in her life. In addition, self-care and newborn care measures that allow Jennifer to rest need to be outlined. Suggesting that Jennifer nap when the baby sleeps throughout the day is a start. Attempting to cluster baby care (bathing, feeding, and dressing) might give her additional time for herself. Calling on friends and family to help out should be stressed. Other interventions would include: • Reassurance that her mothering ability is fine and the newborn is healthy • Referral to community home health agency to gain home health aide assistance • Discussions concerning accepting help and support from others • Times and dates of follow-up care appointments • Community resources available to assist her through this time

Prioritize the postpartum mother's needs 4 hours after giving birth by placing a number 1, 2, 3, or 4 in the blank before each need. _________ Learn how to hold and cuddle the infant. _________Watch a baby bath demonstration given by the nurse. _________ Sleep and rest without being disturbed for a few hours. _________ Interaction time (first 30 minutes) with the infant to facilitate bonding.

1. Interaction time (first 30 minutes) with the infant to facilitate bonding 2. Sleep and rest without being disturbed for a few hours 3. Learn how to hold and cuddle the infant 4. Watch a baby bath demonstration given by the nurse

Mr. and Mrs. Martin wish to start a family, but they can't agree on something important: Mr. Martin wants his wife to be tested for cystic fibrosis (CF) to see if she is a carrier. Mr. Martin had a brother with CF and watched his parents struggle with the hardship and the expense of caring for him, and he doesn't want to experience it in his own life. Mr. Martin has found out he is a CF carrier. Mrs. Martin doesn't want to have the test because she figures that once a baby is in their arms, they will be glad, no matter what. a. What information and education should this couple consider before deciding whether to have the test? b. How can you assist this couple in their decision-making process? c. What is your role in this situation if you don't agree with their decision?

A. What information and education should this couple consider before deciding whether to have the test? The nurse needs to outline the facts about the genetic inheritance: • CF is a recessive disorder that affects 1 in every 2,500 babies • It predominantly is seen in white infants and is less common in other races. • Because it is a recessive disorder, Mrs. Martin must also be a carrier to pass it on to their offspring. • If Mrs. Martin is a carrier, their chance of having a child with CF is one in four. • The risk is the same each time they have a child. • Information about the characteristics of cystic fibrosis. B. How can you assist this couple in their decision-making process? Start by providing all the facts about the nature of the inheritance risk. Also, outline all options so the couple can make an informed decision. Options include the following: • The couple does not receive genetic testing and take their chances. • If Mrs. Martin is a CF carrier, then they could choose not to have children or adopt a baby. • Prenatal testing could be done on the fetus to determine whether both its genes carry a CF mutation. If so, the couple could elect to abort the pregnancy. • Use an ovum or sperm from a donor who does not carry CF. • Make a referral to a reproductive technology health facility for the couple to become educated regarding alternatives to maximize their outcome. • Be realistic with this couple about not having any guarantees that another genetic disorder might not occur. • Discuss the expense involved in genetic testing and in vitro fertilization, which probably will not be covered by health insurance. C. What is your role in this situation if you don't agree with their decision? As a nurse, your role is to provide the facts and allow the couple to make their own decision about what they wish to do. They, not the nurse, must live with their decision. Your role is to respect and support whatever this couple decides to do.

A 20-year-old primigravida at term comes to the birthing center in active labor (dilation 7 cm and 80% effaced, -1 station) with ruptured membranes. She states she wants an "all-natural" birth without medication. Her partner is with her and appears anxious but supportive. Upon the admission assessment, this client's prenatal history is unremarkable; vital signs are within normal limits; FHR via Doppler ranges between 140 and 144 bpm and is regular. A. Based on your assessment data and the woman's request not to have medication, what nonpharmacologic interventions could you offer her? B. What positions might be suggested to facilitate fetal descent? Several hours later, the client complains of nausea and turns to her partner and angrily tells him to not touch her and to go away? A. What assessment needs to be done to determine what is happening? B. What explanation can you offer the client's partner regarding the client's change in behavior?

A. Based on your assessment data and the woman's request not to have medication, what nonpharmacologic interventions could you offer her? • Progressive relaxation techniques of locating, then releasing tension from one muscle group at a time until the entire body is relaxed • Visual imagery such as taking a journey in the woman's mind to a relaxing place that is far away from the discomfort of labor • Music to bring about a calming effect as well as a distraction or attention focusing to divert attention away from the laboring process; focusing on sound or rhythm helps release tension and promote relaxation • Massage/acupressure to enhance relaxation, improve circulation, and reduce pain in labor; counterpressure on the lower back to help relieve back pain • Breathing techniques for effective attention-focusing strategies to enhance coping mechanisms during labor B. What positions might be suggested to facilitate fetal descent? • Upright positions such as walking, swaying, slow-dancing with her partner, or leaning over a birthing ball will all enhance comfort and use the force of gravity to facilitate fetal descent. • Kneeling and leaning forward will help relieve back pain. • Pelvic rocking on hands and knees and lunging with one foot elevated on a chair may help with internal fetal rotation and speed a slow labor. A. What assessment needs to be done to determine what is happening? The nurse should perform a vaginal examination to validate that Carrie is in the active phase (6 to 10 cm dilated). B. What explanation can you offer Carrie's partner regarding her change in behavior? Explain to her partner that she is in the active phase of the first stage of labor and that her behavior is typical, since she is having hard contractions frequently. Reassure him not to take Carrie's comments personally, but to stay and be supportive to her.

On the fetal heart monitor, the nurse notices an elevation of the fetal baseline with the onset of contractions. This elevation would describe _____________.

Acceleration—elevation of FHR above the baseline; a category I pattern, which is normal.

Chadwick's sign of pregnancy

Bluish purple discoloration of the cervix, vagina, and labia during pregnancy as a result of increased vascular congestion.

Probable (objective) signs of pregnancy

Braxton Hicks contractions (16-28 weeks) (tightening of uterus) Positive Pregnancy test (4-12 weeks) Abdominal Enlargement (14 weeks) Ballottement (16-28 weeks) - TBD- Goodell's Sign (5 weeks) Chadwick's Sign (6-8 weeks) Hegar's Sign (6-12 weeks

Identify two questions that a nurse would ask a postpartum woman to assess for postpartum blues.

How have you been feeling recently? How has your sleep been? Have you felt low in spirits and/or able to enjoy the things you usually enjoy?

When caring for a client during the active phase of labor without continuous electronic fetal monitoring, the nurse would intermittently assess FHR every a. 15 to 30 minutes. b. 5 to 10 minutes. c. 45 to 60 minutes. d. 60 to 75 minutes.

a. 15 to 30 minutes. Several professional women's health organizations have published guidelines concerning the timing of intermittent FHR assessments during the active stage of labor. The current recommendation is that intermittent FHR is assessed every 15 minutes during the active phase of labor.

Which is a presumptive sign or symptom of pregnancy? a. Restlessness b. Elevated mood c. Urinary frequency d. Low backache

c. Urinary frequency. Urinary frequency occurs during early pregnancy secondary to pressure on the bladder by the expanding uterus. This is one of the presumptive signs of pregnancy. Restlessness or elevated mood is not a sign of pregnancy. As hormones increase during pregnancy, the mood might change, but it is not indicative of pregnancy. Low backache is frequently experienced by many women during the third trimester of pregnancy secondary to the change in their center of gravity, but it is not a presumptive sign of pregnancy.

The nurse is preparing her teaching plan for a woman who has just had her pregnancy confirmed. Which information should be included in it? Select all that apply. a. Prevent constipation by taking a daily laxative. b. Balance your dietary intake by increasing your calories by 300 daily. c. Continue your daily walking routine just as you did before this pregnancy. d. Tetanus, measles, mumps, and rubella vaccines will be given to you now. e. Avoid tub baths now that you are pregnant to prevent vaginal infections. f. Sexual activity is permitted as long as your membranes are intact. g. Increase your consumption of milk to meet your iron needs.

The correct responses to this question are B, C, E, and F b. Balance your dietary intake by increasing your calories by 300 daily. c. Continue your daily walking routine just as you did before this pregnancy. e. Avoid tub baths now that you are pregnant to prevent vaginal infections. f. Sexual activity is permitted as long as your membranes are intact. Pregnant women are to avoid taking medications so the nurse would not recommend a daily laxative. Increasing fluids, exercise and fiber in the diet are better choices to prevent constipation. The vaccinations shown are contraindicated for pregnant women by the CDC. Adverse outcomes could result if given while pregnant. Milk does not provide a good source of iron. Typically, iron and folic acid are supplemented in prenatal vitamins and good food sources to prevent anemia include meats, cereals, cooked beans, spinach, broccoli, and wheat germ.

Prepare a teaching plan for new mothers, outlining the various physiologic changes that will take place after discharge.

The teaching plan might include the following topics: a. Involution of the uterus b. Stages and color of lochia c. Diaphoresis d. Breast changes (lactating and nonlactating) e. Discomforts after birth, such as perineal healing (ice packs, sitz baths), afterpains (analgesics), breast engorgement (supportive bra) f. Follow-up care for the mother

primigravida

a woman who is pregnant for the first time

Which observation would suggest that placental separation is occurring? a. Uterus stops contracting altogether. b. Umbilical cord pulsations stop. c. Uterine shape changes to globular. d. Maternal blood pressure drops.

c. Uterine shape changes to globular. After the placenta separates from the uterine wall, the shape of the uterus changes from discoid to globular. The uterus continues to contract throughout the placental separation process and the umbilical cord continues to pulsate for several minutes after placental separation occurs. Maternal blood pressure is not affected by placental separation because the maternal blood volume has increased dramatically during pregnancy to compensate for blood loss during birth.

A laywoman with a specialized education and experience in assisting women during labor is a ___________________.

doula

Hegar's sign is considered a

probable sign of pregnancy. Softening of the lower uterine segment or isthmus.

Goodells Sign (Probable sign)

softening of cervix at 4-6 weeks

Subjective (presumptive) signs of pregnancy

tired, tender breasts, nausea, vomiting, loss of period, urinary frequency.

Outline instructions you would give to a new mother on how to use her peribottle.

• Wash your hands with soap and water, and dry them. • Fill your peribottle with warm tap water and replace the top. • Straddle the toilet and spray all the water from the peribottle over your perineal area. • Pat the area dry with a clean towel and replace your peripad from front to back. • Place the empty peribottle on the sink for the next time. • Wash your hands with soap and water before leaving the bathroom.

During pregnancy, the plasma volume increases by 50% but the RBC volume increases by only 25% to 33%. This disproportion manifests as ___________________.

physiologic anemia of pregnancy

Which statement might empower abuse victims to take action? a. "You don't deserve to be treated this way." b. "Your children deserve to grow up in a two-parent family." c. "Try to figure out what you do to trigger his abuse and stop it." d. "Give your partner more time to come to his senses about this."

a. "You don't deserve to be treated this way." This statement promotes a sense of self-worth, which may have been destroyed by her abuser in the relationship. This statement indicates to the woman that she has a lot to offer and that she shouldn't put up with this abusive behavior. The victim may not have heard this message before; her abuser may have convinced her that she did deserve the violence. B is incorrect: many children living in violent homes are abused themselves and extremely stressed. No children should live under such stressful circumstances; a two-parent household is not healthy if one is an abuser. C is incorrect: in most cases the woman doesn't trigger the abuse; rather, the abuser has limited control over his anger and does not need to be provoked before lashing out. There is not necessarily a cause-and-effect relationship between the woman's behavior and the violence. D is incorrect: over time the abuse typically escalates rather than lessens; thus, giving the partner more time will not bring him to his senses.

Postpartum breast engorgement occurs 48 to 72 hours after giving birth. What physiologic change influences breast engorgement? a. An increase in blood and lymph supply to the breasts b. An increase in estrogen and progesterone levels c. A dramatic increase in colostrum production d. Fluid retention in the breasts due to the intravenous fluids given during labor

a. An increase in blood and lymph supply to the breasts. Engorgement refers to the swelling of the breast tissue as a result of an increase in blood and lymph supply to produce milk for the newborn. Estrogen and progesterone levels decrease, which allows prolactin to stimulate the glands to secrete milk. Their levels are restored when the first menses returns several weeks or months later, depending on the lactation status of the mother. Colostrum is a lemon-colored fluid secreted by both breasts immediately at birth, and within 4 to 5 days postpartum it gradually changes to transitional milk and finally mature milk by 2 weeks. Colostrum production reduces within days after childbirth as transitional and mature milk, thereby not contributing to breast engorgement.

Monica, a 16-year-old high school student, is here for her first prenatal visit. Her LMP was 2 months ago, and she states she has been "sick ever since." She is 5 ft, 6 in tall and weighs 110 lb. In completing her dietary assessment, the nurse asks about her intake of milk and dairy products. Monica reports that she doesn't like "that stuff" and doesn't want to put on too much weight because it "might ruin my figure." a. In addition to the routine obstetric assessments, which additional ones might be warranted for this client? b. What dietary instruction should be provided to this client based on her history? c. What follow-up monitoring should be included in subsequent prenatal visits?

A. In addition to the routine obstetric assessments, which additional ones might be warranted for this teenager? Calculate Monica's body mass index (BMI) based on height and weight (BMI = 17.8, which places her at high risk for not gaining enough weight during pregnancy). Ask Monica if she takes drugs or alcohol, which might have a negative impact on the pregnancy. Request a 24-hour diet recall, which might reveal low calorie and calcium intake. Ascertain who does the cooking and food purchasing in her house; ask that the person accompany her to the clinic for her next visit for dietary teaching. Explore reasons why she won't drink milk, and provide her with information about other sources of calcium that she might substitute for milk, such as yogurt. B. What dietary instruction should be provided to this teenager based on her history? Stress the importance of gaining weight for the baby's health. Encourage her to eat three meals each day plus three high-fiber snacks. Go over the MyPlate with her to show her selections from each group that she needs to consume daily. Request that she take a peanut butter and jelly sandwich on whole-wheat bread to school to make sure she eats a good lunch each day. Instruct her on limiting her intake of sodas and caffeinated drinks. Encourage her to drink calcium-fortified orange juice for breakfast daily. Reinforce the importance of taking her prenatal vitamin daily. Send her home with printed materials for review. C. What follow-up monitoring should be included in subsequent prenatal visits? Increase the frequency of prenatal visits to every 2 weeks to monitor weight gain for the next few months. Refer Monica and her mother to the nutritionist in the WIC program for a more thorough dietary instruction. Request a 24-hour dietary recall at each prenatal visit to provide a basis for instruction and reinforcement.

When interviewing a woman at her first prenatal visit, the nurse asks about her feelings. The woman replies, "I'm frightened and confused. I don't know whether I want to be pregnant or not. Being pregnant means changing our whole life, and now having somebody to care for all the time. I'm not sure I would be a good mother. Plus, I'm a bit afraid of all the changes that would happen to my body. Is this normal? Am I OK?" a. How should the nurse answer this question? b. What specific information is needed to support the client during this pregnancy?

A. How should the nurse answer this question? The feelings that the woman is describing are those of ambivalence, and they are very common in women when they first learn they are pregnant. The nurse needs to explain this to the woman, emphasizing that it is common for women to question themselves in relation to the pregnancy because it is "unreal" to them during this early period. Fetal movement helps to make the pregnancy a reality. B. What specific information is needed to support the client during this pregnancy? The nurse can be supportive to this woman during this time by providing emotional support and validating the various ambivalent feelings she is experiencing. Her husband and/or family members might also provide support for her.

The nurse walks into the room of a 24-year-old primigravida. She asks the nurse to hand her the bottle sitting on the bedside table, stating, "I'm going to finish it off because my baby only ate half of it 3 hours ago when I fed him." a. What response by the nurse would be appropriate at this time? b. What action should the nurse take? c. What health teaching is needed for this new mother prior to discharge?

A. What response by the nurse would be appropriate at this time? Reply in a sensitive, nonjudgmental manner that this bottle of formula has been sitting out for 3 hours since the last feeding and has not been refrigerated. It may be contaminated and would not be appropriate to feed her baby with now. B. What action should the nurse take? Take the old bottle of formula and tell Lisa that you will get her a fresh bottle for this feeding. Leave the room with the formula bottle and replace it with another one. C. What health teaching is needed for Lisa prior to discharge? A thorough explanation is needed about feeding practices, emphasizing that formula is milk and needs to be refrigerated when not being used for feeding at that time. Leaving formula sit at room temperature for long periods increases the risk of bacterial contamination and may give her infant gastroenteritis. In addition, as the infant grows, more formula will be consumed at each feeding, and making up an approximate amount that will be consumed will become easier for her to avoid waste.

Which is the best time for the genetic assessment of an alpha-fetoprotein (AFP) screening test? a. 12 to 14 weeks' gestation b. 16 to 18 weeks' gestation c. 22 to 24 weeks' gestation d. 28 to 30 weeks' gestation

b. 16 to 18 weeks' gestation

Which suggestion would be most appropriate to include in the teaching plan for a postpartum woman who needs to lose weight? a. Increase fluid intake and acid-producing foods in her diet. b. Avoid empty-calorie foods, breast-feed, and increase exercise. c. Start a high-protein, low-carbohydrate diet, and restrict fluids. d. Eat no snacks or carbohydrates after dinner.

b. Avoid empty-calorie foods, breast-feed, and increase exercise. Because weight loss is based on the principle of intake of calories and output of energy, instructing this woman to avoid high-calorie foods that yield no nutritive value and expending more energy through active exercise would result in weight loss for her. Acid-producing foods (plums, cranberries, and prunes) are typically recommended for women to prevent urinary tract infections to acidify the urine, not for weight-loss purposes. Increasing fluid intake (water) would be good for weight loss because it fills the stomach and reduces hunger sensations; however, this option does not identify which fluids should be increased. Increasing high-calorie juice and soda drinks would be counterproductive to weight-loss measures. Fluid restriction combined with a high-protein diet would increase the risk of gout and formation of kidney stones. Carbohydrates are needed by the body to make ATP and convert it to energy for cellular processes. Limiting snacks might be a good suggestion depending on which ones are selected. Raw fruits and vegetables are excellent high-fiber snacks that will help in an overall weight-loss program.

Which fetal lie is most conducive to a spontaneous vaginal birth? a. Transverse b. Longitudinal c. Perpendicular d. Oblique

b. Longitudinal. A longitudinal lie places the fetus in a vertical position, which would be most conducive for a spontaneous vaginal birth. A transverse lie does not allow for a vaginal birth because the fetus is lying perpendicular to the maternal spine. A perpendicular lie describes the transverse lie, which would not be conducive for a spontaneous birth. An oblique lie would not allow for a spontaneous vaginal birth because the fetus would not fit through the maternal pelvis in this side-lying position.

Down syndrome results from the a. absence of one chromosome in position 21. b. presence of an extra chromosome in position 21. c. absence of both chromosomes in position 21. d. crossing over of the chromosomes in position 21.

b. presence of an extra chromosome in position 21. An extra chromosome is found in position 21 making it a trisomy 21 whereby the infant has three copies of chromosome 21—instead of the usual two copies—in all of his or her cells. The remaining three responses are incorrect since there is no absence of chromosomes present on position 21 and this syndrome is not the result of a crossing over of chromosomes.

As the nurse is explaining the difference between true versus false labor to her childbirth class, she states that the major difference between them is a. discomfort level is greater with false labor. b. progressive cervical changes occur in true labor. c. there is a feeling of nausea with false labor. d. there is more fetal movement with true labor.

b. progressive cervical changes occur in true labor. Progressive cervical changes occur in true labor. This is not the case with false labor.

The first phase of the abuse cycle is characterized by a. the woman provoking the abuser to bring about abuse. b. tension building and verbal or minor battery. c. a honeymoon period that lulls the victim into forgetting. d. an acute episode of physical abuse.

b. tension building and verbal or minor battery. Tension builds within the abuser, and he demonstrates increased anger and violent behavior without any provocation from the woman. This tension-building phase starts the cycle of violence. A is incorrect: typically the woman doesn't provoke the abuser's violent behavior, but he blames her for his lack of anger control. C is incorrect: in the honeymoon phase, the final phase in the cycle of violence, the abuser says he is sorry, he loves her, and it will never happen again. D is incorrect: in the explosion stage of the cycle of violence, the abuser physically harms the woman. This stage follows the tension-building phase.

Which client behavior would raise a "red flag" to the nurse that the client may be a human trafficking victim? a. Looks nurse straight in the eyes when responding to questions b. Appears calm and cooperative during examination c. Acts like it is "no big deal," even with concerning injuries d. Changes into examination gown quickly without hesitation

c. Acts like it is "no big deal," even with concerning injuries

In the taking-in maternal role phase described by Rubin (1984), the nurse would expect the woman's behavior to be characterized in what way? a. Gaining self-confidence b. Adjusting to her new relationships c. Being passive and dependent d. Resuming control over her life

c. Being passive and dependent. According to Reva Rubin, the mother is very passive and is dependent on others to care for her for the first 24 to 48 hours after giving birth. Gaining self-confidence would characterize a mother in the taking-hold phase, during which the mother demonstrates mastery over her own body's functioning and feels more confident in caring for her newborn. Adjustment to relationships does not occur until the third phase, letting go, when the mother begins to separate from the symbiotic relationship she and her newborn enjoyed during pregnancy and birth. Resuming control over her life would denote the second phase of taking hold, during which the mother does resume control over her life and gains self-confidence in her newborn care.

After teaching a group of breast-feeding women about nutritional needs, the nurse determines that the teaching was successful when the women state that they need to increase their intake of which nutrients? a. Carbohydrates and fiber b. Fats and vitamins c. Calories and protein d. Iron-rich foods and minerals

c. Calories and protein Lactating mothers need an extra 500 calories to sustain breast-feeding. An additional 20 g of protein is also needed to help build and regenerate body cells for the lactating woman. Additional intake of carbohydrates or fiber is not suggested for lactation. An increase in fats is not recommended, nor is it needed for breast-feeding. To obtain adequate amounts of vitamins during lactation, women are encouraged to choose a varied diet that includes enriched and fortified grains and cereals, fresh fruits and vegetables, and lean meats and dairy products. An increase in vitamins via supplements is not recommended. Choosing a variety of foods from the food pyramid will provide the lactating woman with adequate iron and minerals.

The nurse teaches the pregnant client how to perform Kegel exercises as a way to accomplish which action? a. Prevent perineal lacerations b. Stimulate labor contractions c. Increase pelvic muscle tone d. Lose pregnancy weight quickly

c. Increase pelvic muscle tone Pelvic floor muscle (PFM) exercises help to tighten and strengthen pelvic floor muscles to improve tone. They can help prevent stress incontinence in women after childbirth. These exercises don't strengthen the perineal area on the outside to prevent lacerations, but rather the internal pelvic floor muscles. PFM exercises have nothing to do with the start of labor for postdate infants. A drop in progesterone levels and an increase in prostaglandins, not exercise, augment labor. PFM exercises don't burn calories.

When a pregnant woman in her third trimester lies on her back and experiences dizziness and light-headedness, the underlying cause of this is ___________________.

compression of the vena cava by the heavy gravid uterus.

After the nurse provides instructions to a postpartum woman about postpartum blues, which statement indicates understanding? a. "I will need to take medication daily to treat the anxiety and sadness." b. "I will call the OB support line only if I start to hear voices." c. "I will contact my doctor if I become dizzy and fell nauseated." d. "I will feel like laughing one minute and crying the next minute."

d. "I will feel like laughing one minute and crying the next minute." because emotional lability is typical of postpartum blues which is usually self-limiting. Response A is incorrect since postpartum blues don't require any medication to treat. Response B is incorrect since this behavior would indicate postpartum psychosis and not merely the "blues." Response C would indicate a physical condition, such as infection, not a mental disorder.

The nurse is counseling a couple, one of whom is affected by an autosomal dominant disorder. They express concerns about the risk of transmitting the disorder. What is the best response by the nurse regarding the risk that their baby may have the disease? a. "You have a one-in-four (25%) chance." b. "The risk is 12.5%, or a one-in-eight chance." c. "The chance is 100%." d. "Your risk is 50%, or a one-in-two chance."

d. "Your risk is 50%, or a one-in-two chance." Autosomal dominant inheritance occurs when a single gene in the heterozygous state is capable of producing the phenotype. The affected person generally has an affected parent, and an affected person generally has a 50% chance of passing the abnormal gene to each of his or her children.

During a clinic visit, a pregnant client at 30 weeks' gestation tells the nurse, "I've had some mild cramps that are pretty irregular. What does this mean?" The cramps are probably a. the beginning of labor in the very early stages. b. an ominous finding indicating that the client is about to have a miscarriage. c. related to overhydration of the woman. d. Braxton Hicks contractions, which occur throughout pregnancy.

d. Braxton Hicks contractions, which occur throughout pregnancy. The uterus is constantly contracting throughout pregnancy, but the contractions are irregular and not usually felt by the woman, nor do they cause dilation of the cervix. Braxton Hicks contractions are not the start of early labor, since there aren't any measurable cervical changes. They are normal throughout the pregnancy, not an ominous sign of an impending abortion. A woman's hydration status is not related to Braxton Hicks contractions; they occur regardless of her fluid status.

The nurse is explaining to a postpartum woman 48 hours after childbirth that the afterpains she is experiencing can be the result of which factor? a. Abdominal cramping as a sign of endometriosis b. A small infant weighing less than 8 lb c. Pregnancies that were too closely spaced d. Contractions of the uterus after birth

d. Contractions of the uterus after birth The direct cause of afterpains is uterine contractions. Mothers experience abdominal pain secondary to contractions, especially when breast-feeding because sucking stimulates the release of oxytocin from the posterior pituitary gland, which causes uterine contractions. There is no association of afterpains with endometriosis. The small size of the newborn wouldn't stretch her uterus, thus would not be a contributing factor to her discomfort now. Pregnancies spaced too close together can contribute to frequent stretching of the uterus, but this is not the cause of afterpains.

A pregnant client's LMP was on August 10. Using Nagele's rule, the nurse calculates that her EDD will be when? a. June 23 b. July 10 c. July 30 d. May 17

d. May 17. Using Nagele rule, 3 months are subtracted and 7 days are added, plus 1 year from the date of the last menstrual period.

The term that describes the return of the uterus to its prepregnant state is _____________.

involution

Nurses play an important role in screening and assessment of any client abuse or violence. Which statement is correct? a. Most clients are extremely reluctant to come forth with private matters. b. Any intimate partner violence questions should be asked in the presence of both partners. c. To invite disclosure, assure the woman that you won't document her statements. d. The best statement to make to the abused victim is, "You don't deserve this."

d. The best statement to make to the abused victim is, "You don't deserve this." Since it informs the client that abuse is not acceptable under any circumstance and it is not provoked by her actions, but by aggression on her partner's quest for power and control over her. Response A is incorrect since many abused women would open up to a trusting nurse if asked in a nonthreatening manner. Response B is incorrect because it would place the abused victim in danger if the perpetrator knew there was knowledge of his actions against the woman. Legal action could be taken against him and it would place the victim in greater risk of additional abuse, injury, or death. Response C is incorrect since documentation of her statements about her abuse is needed for evidence against the abuser in a court of law. Any statements obtained in the nurse's assessment should be documented to build the intimate partner violence case.

A deviated fundus to the right side of the abdomen would indicate a _____________.

full bladder