NURS 320 Exam 1

A pregnant patient would like to know a good food source of calcium other than dairy products. Which answer by the nurse is best? a. Legumes b. Yellow vegetables c. Lean meat d. Whole grains

ANS: A Although dairy products contain the greatest amount of calcium, it also is found in legumes, nuts, dried fruits, and some dark green leafy vegetables. Yellow vegetables are rich in vitamin A. Lean meats are rich in protein and phosphorus. Whole grains are rich in zinc and magnesium.

To increase the absorption of iron in a pregnant woman, the nurse teaches her that iron preparations should be given with a. milk. b. tea. c. orange juice. d. coffee.

ANS: C A vitamin C source may increase the absorption of iron. The calcium and phosphorus in milk decrease iron absorption. Tannin in the tea reduces the absorption of iron. Coffee reduces iron absorption.

A pregnant woman's diet consists almost entirely of whole grain breads and cereals, fruits, and vegetables. The nurse should be most concerned about this woman's intake of which nutrient? a. Calcium b. Protein c. Vitamin B12 d. Folic acid

ANS: C This diet is consistent with that followed by a strict vegetarian (vegan). Vegans consume only plant products. Because vitamin B12 is found in foods of animal origin, this diet is deficient in vitamin B12. Depending upon the woman's food choices this diet may be adequate in calcium, protein, and folic acid.

Which information regarding amniotic fluid is important for the nurse to understand? a.Amniotic fluid serves as a source of oral fluid and a repository for waste from the fetus. b.Volume of the amniotic fluid remains approximately the same throughout the term of a healthy pregnancy. c.The study of fetal cells in amniotic fluid yields little information. d.A volume of more than 2 L of amniotic fluid is associated with fetal renal abnormalities.

ANS: A Amniotic fluid serves as a source of oral fluid, serves as a repository for waste from the fetus, cushions the fetus, and helps maintain a constant body temperature. The volume of amniotic fluid constantly changes. The study of amniotic fluid yields information regarding the sex of the fetus and the number of chromosomes. Too much amniotic fluid (hydramnios) is associated with gastrointestinal and other abnormalities.

The nurse is teaching prenatal clients about avoiding substances or conditions that can harm the fetus. Which should the nurse include in the teaching session. select all a. elimination of alcohol b. avoidance of supplemental folic acid replacement c. stabilization of blood glucose levels in a diabetic client with insulin d. avoidance of nonurgent radiologic procedures during the pregnancy e. avoidance of maternal hyperthermia to temperatures of 37.8ºC (100ºF)

A, C, D, E

A patient has the nursing diagnosis: Imbalanced Nutrition: Less Than Body Requirements related to diet choices inadequate to meet nutrient requirements of pregnancy. What goal is most appropriate for this diagnosis? a. Weight change from 135 pounds to 165 pounds at delivery b. Take daily supplements consistently. c. Decrease intake of snack foods. d. Increase intake of complex carbohydrates.

ANS: A A weight gain of 30 lb is one indication that the patient has gained a sufficient amount for the nutritional needs of pregnancy. A daily supplement is not the best goal for this patient. It does not meet the basic need of proper nutrition during pregnancy. Decreasing snack foods may be the problem and should be assessed. However, assessing the weight gain is the best method of monitoring nutritional intake for this pregnancy. Increasing the intake of complex carbohydrates is important for this patient, but monitoring the weight gain should be the end goal.

A nurse who works in the ED is assigned to a client who is experiencing heavy vaginal bleeding at 12 weeks gestation. An ultrasound has confirmed the absence of a fetal heart rate, and the client is scheduled for a dilation and evacuation of the pregnancy. The nurse refuses to provide any further care for this client based on moral principles. What is the nurse managers initial response to the nurse. a. I recall you sharing that information in your interview. I will arrange for another nurse to take report on this client. b. Because we are shorthanded today, you have to continue to provide care. There is no one else available to provide care for this client. c. I understand your point of view. You were hired to work here in the ED so you had to know this situation was possible d. Abandonment is a serious issue. I have to advise you to continue to provide care for this client.

A. I recall you sharing that information in your interview. I will arrange for another nurse to take report on this client. rationale: Nurses do not have to provide care if the care is in violation of their moral, ethical, or religious principles.

Which statement made by the nurse is evidence of therapeutic communication for a couple who is undergoing genetic counseling and very concerned about the possibility of having a child with a birth defect as a result of a strong family history on both sides of the family a. It is important to ask other members of your family for any information they can provide that will help obtain more insight into the health history. b. given what you have told me, there is little that anyone can do to improve outcomes c. Although you may feel that you have no options, I cant really discuss these matters as only the physician can provide you with information d. Do you have all your forms filled out correctly? This will make the review easier to accomplish.

A. It is important to ask other members of your family for any information they can provide that will help obtain more insight into the health history.

An infant is born with blood type AB. The father is type A and the mother is type B. The father asks why the baby has a blood type different from that of the parents. The nurses answer should be based on the knowledge that which is true a. both A and B blood types are dominant. b. Types A and B are recessive when linked together c. the baby has a mutation of the parents blood types d. type A is recessive and links more easily with type B.

A. both A and B blood types are dominant. rationale: Types A and B are equally dominant, and the baby can thus inherit one from each parent.

A nurse is admitting a client to the labor and birth unit in early labor who was sent to the facility following her checkup with her health care provider in the office. The client is a gravida 1, para 0, and is at term. No health issues are discerned from the initial assessment, and the nurse prepares to initiate physician orders based on standard procedures. Which action is warranted by the nurse manager in response to this situation a. No action is indicated because the nurse is acting within the scope of practice. b. The nurse manager should intervene and ask the nurse to clarify admission orders directly with the physician c. The nurse manager should review standard procedures with the nurse to validate that orders are being carried out accurately. d. The nurse manager should review the admission procedure with the nurse

A. no action is indicated because the nurse is acting within the scope of practice rationale: standard procedures are often used in labor and birth settings because they are based on physician-directed orders that apply to general admissions

What kind of fetal anomalies are most often associated with oligohydramnios? a.Renal b.Cardiac c.Gastrointestinal d.Neurologic

ANS: A An amniotic fluid volume of less than 300 ml (oligohydramnios) is often associated with fetal renal anomalies. The amniotic fluid volume has no bearing on the fetal cardiovascular system. Gastrointestinal anomalies are associated with hydramnios or an amniotic fluid volume greater than 2 L. The amniotic fluid volume has no bearing on the fetal neurologic system.

A woman in labor passes some thick meconium as her amniotic fluid ruptures. The client asks the nurse where the baby makes the meconium. What is the correct response by the nurse? a.Fetal intestines b.Fetal kidneys c.Amniotic fluid d.Placenta

ANS: A As the fetus nears term, fetal waste products accumulate in the intestines as dark green-to-black, tarry meconium. Meconium is not produced by the fetal kidneys nor should it be present in the amniotic fluid, which may be an indication of fetal compromise. The placenta does not produce meconium.

Which nutritional recommendation about fluids is accurate? a. A woman's daily intake should be 8 to 10 cups, and most of it should be water. b. Coffee should be limited to no more than 2 cups, but tea and cocoa can be consumed without worry. c. Of the artificial sweeteners, only aspartame has not been associated with any maternity health concerns. d. Water with fluoride is especially encouraged because it reduces the child's risk of tooth decay.

ANS: A Eight to 10 cups is the standard for fluids; however, they should be the right fluids. All beverages containing caffeine, including tea, cocoa, and some soft drinks, should be avoided or should be drunk only in limited amounts. Artificial sweeteners, including aspartame, have no ill effects on the normal mother or fetus. However, mothers with phenylketonuria (PKU) should avoid aspartame. No evidence indicates that prenatal fluoride consumption reduces childhood tooth decay. However, it still helps the mother.

A woman asks the nurse, "What protects my baby's umbilical cord from being squashed while the baby's inside of me?" What is the nurse's best response? a."Your baby's umbilical cord is surrounded by connective tissue called Wharton's jelly, which prevents compression of the blood vessels." b."Your baby's umbilical cord floats around in blood and amniotic fluid." c."You don't need to be worrying about things like that." d."The umbilical cord is a group of blood vessels that are very well protected by the placenta."

ANS: A Explaining the structure and function of the umbilical cord is the most appropriate response. Connective tissue called Wharton's jelly surrounds the umbilical cord, prevents compression of the blood vessels, and ensures continued nourishment of the embryo or fetus. The umbilical cord does not float around in blood or fluid. Telling the client not to worry negates her need for information and discounts her feelings. The placenta does not protect the umbilical cord.

An expectant couple attending childbirth classes have questions regarding multiple births since twins "run in the family." What information regarding multiple births is important for the nurse to share? a.Twinning and other multiple births are increasing because of the use of fertility drugs and delayed childbearing. b.Dizygotic twins (two fertilized ova) have the potential to be conjoined twins .c.Identical twins are more common in Caucasian families. d.Fraternal twins are the same gender, usually male.

ANS: A If the parents-to-be are older and have taken fertility drugs, then they would be very interested to know about twinning and other multiple births. Conjoined twins are monozygotic; that is, they are from a single fertilized ovum in which division occurred very late. Identical twins show no racial or ethnic preference, and fraternal twins are more common among African-American women. Fraternal twins can be different genders or the same gender, and identical twins are the same gender.

The nurse caring for a pregnant client is evaluating his or her health teaching regarding fetal circulation. Which statement from the client reassures the nurse that his or her teaching has been effective? a."Optimal fetal circulation is achieved when I am in the side-lying position." b."Optimal fetal circulation is achieved when I am on my back with a pillow under my knees." c."Optimal fetal circulation is achieved when the head of the bed is elevated." d."Optimal fetal circulation is achieved when I am on my abdomen."

ANS: A Optimal circulation is achieved when the woman is lying at rest on her side. Decreased uterine circulation may lead to intrauterine growth restriction. Previously, it was believed that the left lateral position promoted maternal cardiac output, enhancing blood flow to the fetus. However, it is now known that the side-lying position enhances uteroplacental blood flow. If a woman lies on her back with the pressure of the uterus compressing the vena cava, then blood return to the right atrium is diminished. Although having the head of the bed elevated is recommended and ideal for later in pregnancy, the woman still must maintain a lateral tilt to the pelvis to avoid compressing the vena cava. Many women find lying on their abdomen uncomfortable as pregnancy advances. Side-lying is the ideal position to promote blood flow to the fetus.

A new mother asks the nurse about the "white substance" covering her infant. How should the nurse explain the purpose of vernix caseosa? a.Vernix caseosa protects the fetal skin from the amniotic fluid. b.Vernix caseosa promotes the normal development of the peripheral nervous system. c.Vernix caseosa allows the transport of oxygen and nutrients across the amnion. d.Vernix caseosa regulates fetal temperature

ANS: A Prolonged exposure to the amniotic fluid during the fetal period could result in the breakdown of the skin without the protection of the vernix caseosa. Normal development of the peripheral nervous system was dependent on nutritional intake of the mother. The amnion was the inner membrane that surrounded the fetus and was not involved in the oxygen and nutrient exchange. The amniotic fluid helped maintain fetal temperature.

Which statement by a patient indicates that she understands the role of protein in her pregnancy? a. "Protein will help my baby grow." b. "Eating protein will prevent me from becoming anemic." c. "Eating protein will make my baby have strong teeth after he is born." d. "Eating protein will prevent me from being diabetic."

ANS: A Protein is the nutritional element basic to growth. An adequate protein intake is essential to meeting the increasing demands of pregnancy. These demands arise from the rapid growth of the fetus; the enlargement of the uterus, mammary glands, and placenta; the increase in the maternal blood volume; and the formation of amniotic fluid. Iron intake prevents anemia. Calcium intake is needed for fetal bone and tooth development. Eating protein will not prevent diabetes.

The various systems and organs of the fetus develop at different stages. Which statement is most accurate? a.Cardiovascular system is the first organ system to function in the developing human. b.Hematopoiesis originating in the yolk sac begins in the liver at 10 weeks of gestation. c.Body changes from straight to C-shape occurs at 8 weeks of gestation. d.Gastrointestinal system is mature at 32 weeks of gestation.

ANS: A The heart is developmentally complete by the end of the embryonic stage. Hematopoiesis begins in the liver during the sixth week. The body becomes C-shaped at 21 weeks of gestation. The gastrointestinal system is complete at 36 weeks of gestation.

Which development related to the integumentary system is correct? a.Very fine hairs called lanugo appear at 12 weeks of gestation. b.Eyelashes, eyebrows, and scalp hair appear at 28 weeks of gestation. c.Fingernails and toenails develop at 28 weeks of gestation. d.By 32 weeks, scalp hair becomes apparent.

ANS: A Very fine hairs, called lanugo appear first at 12 weeks of gestational age on the fetus' eyebrows and upper lip. By 20 weeks of gestation, lanugo covers the entire body. By 20 weeks of gestation the eyelashes, eyebrows, and scalp hair also begin to grow. By 28 weeks of gestation, the scalp hair is longer than these fine hairs, which is thin and may disappear by term. Fingernails and toenails develop from thickened epidermis, beginning during the 10th week. Fingernails reach the fingertips at 32 weeks of gestation, and the toenails reach the toe tips at 36 weeks of gestation.

Congenital disorders refer to those conditions that are present at birth. These disorders may be inherited and caused by environmental factors or maternal malnutrition. Toxic exposures have the greatest effect on development between 15 and 60 days of gestation. For the nurse to be able to conduct a complete assessment of the newly pregnant client, he or she should be knowledgeable regarding known human teratogens. Which substances might be considered a teratogen? (Select all that apply.) a.Cytomegalovirus (CMV) b.Ionizing radiation c.Hypothermia d.Carbamazepinee.Lead

ANS: A, B, D, E Exposure to radiation and a number of infections may result in profound congenital deformities. These include but are not limited to varicella, rubella, syphilis, parvovirus, CMV, and toxoplasmosis. Certain maternal conditions such as diabetes and phenylketonuria (PKU) may also affect organs and other parts of the embryo during this developmental period. Drugs such as antiseizure medications (e.g., carbamazepine) and some antibiotics, as well as chemicals including lead, mercury, tobacco, and alcohol, may also result in structural and functional abnormalities.

Relating to the fetal circulatory system, which special characteristics allow the fetus to obtain sufficient oxygen from the maternal blood? (Select all that apply.) a.Fetal hemoglobin (Hb) carries 20% to 30% more oxygen than maternal Hb. b.Fetal Hb carries 40% to 50% more oxygen than maternal Hb. c.Hb concentration is 50% higher than that of the mother. d.Fetal heart rate is 110 to 160 beats per minute. e.Fetal heart rate is 160 to 200 beats per minute.

ANS: A, C, D The following three special characteristics enable the fetus to obtain sufficient oxygen from maternal blood: (1) the fetal Hb carries 20% to 30% more oxygen; (2) the concentration is 50% higher than that of the mother; and (3) the fetal heart rate is 110 to 160 beats per minute, a cardiac output that is higher than that of an adult.

The nurse is assisting a normally active pregnant woman in developing a meal plan. Before she got pregnant, she ate 1800 calories a day. How many calories does she need now? a. 2000 b. 2140 c. 2342 d. 2400

ANS: B A woman should increase her daily caloric intake by 340 calories during the second trimester, so this woman needs 2140 daily calories.

In teaching the pregnant adolescent about nutrition, what suggestion by the nurse is best? a. Eliminate common teen snack foods, because they are too high in fat and sodium. b. Work with the teen to include some fast food in a healthy prenatal diet. c. Suggest that she not eat at fast-food restaurants where the foods are of poor nutritional value. d. Realize that most adolescents are unwilling to make dietary changes during pregnancy.

ANS: B Adolescents have some special nutritional needs during pregnancy, but they also need to feel that they fit in with their peers. Working with the teen to develop a healthy diet while including some snack and fast foods has the best chance of providing good nutrition. Telling the teen to eliminate certain foods or restaurants is likely not to work. Including the teen will make her more willing to make dietary changes.

Which pregnant adolescent is most at risk for a nutritional deficit during pregnancy? a. A 15-year-old of normal height and weight b. A 17-year-old who is 10 pounds underweight c. A 16-year-old who is 10 pounds overweight d. A 16-year-old of normal height and weight

ANS: B All adolescents are at nutritional risk during pregnancy, but the adolescent who is pregnant and underweight is most at risk, because she is already deficient in nutrition and must now supply the nutritional intake for both herself and her fetus.

A woman who is 16 weeks pregnant asks the nurse, "Is it possible to tell by ultrasound if the baby is a boy or girl yet?" What is the best answer? a."A baby's sex is determined as soon as conception occurs." b."The baby has developed enough to enable us to determine the sex by examining the genitals through an ultrasound scan." c."Boys and girls look alike until approximately 20 weeks after conception, and then they begin to look different." d."It might be possible to determine your baby's sex, but the external organs look very similar right now."

ANS: B Although gender is determined at conception, the external genitalia of males and females look similar through the ninth week. By the twelfth week, the external genitalia are distinguishable as male or female.

A nurse teaching a prenatal class is discussing nutrition. What foods does the nurse advise pregnant women to avoid? a. Canned white tuna as a preferred choice b. Shark, swordfish, and mackerel c. Treating fish caught in local waterways as the safest d. High levels of mercury in salmon and shrimp

ANS: B As a precaution against ingesting too much mercury, the pregnant patient should avoid eating all of these as well as the less common tilefish. Six ounces a week of canned albacore tuna is acceptable. Pregnant women should check with local authorities on the safety of eating locally caught fish, but if no advisories are in effect, eating them is fine. Salmon and shrimp are fine too up to 12 ounces a week.

Which statement regarding the structure and function of the placenta is correct? a.Produces nutrients for fetal nutrition b.Secretes both estrogen and progesterone c.Forms a protective, impenetrable barrier to microorganisms such as bacteria and viruses d.Excretes prolactin and insulin

ANS: B As one of its early functions, the placenta acts as an endocrine gland, producing four hormones necessary to maintain the pregnancy and to support the embryo or fetus: human chorionic gonadotropin (hCG), human placental lactogen (hPL), estrogen, and progesterone. The placenta does not produce nutrients. It functions as a means of metabolic exchange between the maternal and fetal blood supplies. Many bacteria and viruses can cross the placental membrane.

A patient who is in week 28 of gestation is concerned about her weight gain of 1 pound in 1 week. Which response by the nurse is best? a. "You should try to decrease your amount of weight gain for the next 12 weeks." b. "You have gained an appropriate amount for the number of weeks of your pregnancy." c. "You should not gain any more weight until you reach the third trimester." d. "You have not gained enough weight for the number of weeks of your pregnancy."

ANS: B At 28 weeks, a weight gain of 1 pound in 1 week is within the recommended range of 0.8 to 1 pound per week. The woman should be reassured that this is normal and healthy. The other responses are inaccurate.

A pregnant woman in the perinatal clinic is a recovering anorexic. She is distressed at the emphasis on weight gain. The nurse explains that the most important reason for evaluating the pattern of weight gain in pregnancy is to a. prevent excessive adipose tissue deposits. b. identify potential nutritional problems or complications of pregnancy. c. assess if this woman has relapsed. d. determine cultural influences on the woman's diet.

ANS: B Deviations from the recommended pattern of weight gain may indicate nutritional problems or developing complications. The nurse should assure this patient that monitoring weight gain is a routine part of prenatal care to ensure the baby's well-being. Preventing adipose tissue deposits is not the reason for monitoring weight gain. Determining cultural influences on diet and weight gain is important but not the most important reason.

Which statement concerning neurologic and sensory development in the fetus is correct? a.Brain waves have been recorded on an electroencephalogram as early as the end of the first trimester (12 weeks of gestation). b.Fetuses respond to sound by 24 weeks of gestation and can be soothed by the sound of the mother's voice. c.Eyes are first receptive to light at 34 to 36 weeks of gestation. d.At term, the fetal brain is at least one third the size of an adult brain.

ANS: B Hearing develops early and is fully developed at birth. Brain waves have been recorded at week 8. Eyes are receptive to light at 28 weeks of gestation. The fetal brain is approximately one fourth the size of an adult brain.

The pancreas forms in the foregut during the 5th to 8th week of gestation. A client with poorly controlled gestational diabetes asks the nurse what the effects of her condition will be on the fetus. What is the best response by the nurse? Poorly controlled maternal gestational diabetes will: a.produce fetal hypoglycemia. b.result in a macrocosmic fetus. c.result in a microcosmic fetus. d.enhance lung maturation.

ANS: B Insulin is produced by week 20 of gestation. In the fetus of a mother with uncontrolled diabetes, maternal hypoglycemia produces fetal hypoglycemia and macrocosmia results. Hyperinsulinemia blocks lung maturation, placing the neonate at risk for respiratory distress.

A woman is 15 weeks pregnant with her first baby. She asks how long it will be before she feels the baby move. What is the nurse's best answer? a."You should have felt the baby move by now." b."Within the next month, you should start to feel fluttering sensations." c."The baby is moving; however, you can't feel it yet." d."Some babies are quiet, and you don't feel them move."

ANS: B Maternal perception of fetal movement usually begins 16 to 20 weeks after conception. Because this is her first pregnancy, movement is felt toward the later part of the 16- to 20-week time period. Stating, "you should have felt the baby move by now" is incorrect and may be an alarming statement to the client. Fetal movement should be felt by 16 to 20 weeks. If movement is not felt by the end of that time, then further assessment is necessary.

A newly married couple plans to use the natural family planning method of contraception. Understanding how long an ovum can live after ovulation is important to them. The nurse knows that his or her teaching was effective when the couple responds that an ovum is considered fertile for which period of time? a.6 to 8 hours b.24 hours c.2 to 3 days d.1 week

ANS: B Most ova remain fertile for approximately 24 hours after ovulation, much longer than 6 to 8 hours. However, ova do not remain fertile for 2 to 3 days or are viable for 1 week. If unfertilized by a sperm after 24 hours, the ovum degenerates and is reabsorbed.

Which statement made by a lactating woman leads the nurse to believe that the woman might have lactose intolerance? a. "I always have heartburn after I drink milk." b. "If I drink more than a cup of milk, I get abdominal cramps and bloating." c. "Drinking milk usually makes me break out in hives." d. "Sometimes I notice that I have bad breath after I drink a cup of milk."

ANS: B One problem that can interfere with milk consumption is lactose intolerance, which is the inability to digest milk sugar because of a lack of the enzyme lactose in the small intestine. Milk consumption may cause abdominal cramping, bloating, and diarrhea in such people, although many lactose-intolerant individuals can tolerate small amounts of milk without symptoms. The woman with lactose intolerance is more likely to experience bloating and cramping, not heartburn. A woman who breaks out in hives after consuming milk is more likely to have a milk allergy. Bad breath is not a sign of lactose intolerance.

To prevent GI upset, patients should be instructed to take iron supplements a. on a full stomach. b. at bedtime. c. after eating a meal. d. with milk.

ANS: B Taking iron supplements at bedtime may reduce GI upset. Iron supplements are best absorbed if they are taken when the stomach is empty. Bran, tea, coffee, milk, and eggs may reduce absorption.

The maternity nurse is cognizant of what important structure and function of the placenta? a.As the placenta widens, it gradually thins to allow easier passage of air and nutrients. b.As one of its early functions, the placenta acts as an endocrine gland. c.The placenta is able to keep out most potentially toxic substances, such as cigarette smoke, to which the mother is exposed. d.Optimal blood circulation is achieved through the placenta when the woman is lying on her back or standing.

ANS: B The placenta produces four hormones necessary to maintain the pregnancy: hCG, hPL, estrogen, and progesterone. The placenta widens until 20 weeks of gestation and continues to grow thicker. Toxic substances such as nicotine and carbon monoxide readily cross the placenta into the fetus. Optimal circulation occurs when the woman is lying on her side.

The woman in her third trimester asks the nurse how fast she will lose weight after giving birth. What information from the nurse is most accurate? a. You will lose about 20 pounds immediately. b. By the end of 2 weeks after birth you will have lost about 21 pounds. c. You can go on a diet after your first postnatal checkup. d. Most women do not lose all the weight they gain during pregnancy.

ANS: B The woman can expect to lose 12 pounds immediately after birth and another 9 pounds by the end of the 2nd week, putting her total weight loss at that time around 21 pounds. The woman should wait 3 weeks before going on a diet. Most women lose all but a pound or two after childbirth, but this statement is discouraging to the patient.

Four women are admitted to Labor and Delivery. Which woman met the goal for a healthy weight gain in pregnancy? a. 17 years old, 52 tall, initial weight 116 pounds, today's weight 120 pounds b. 22 years old, 52 tall, initial weight 230 pounds, today's weight 245 pounds c. 24 years old, 53 tall, initial weight 135, today's weight 182 pounds d. 27 years old, 56 tall, initial weight 112 pounds, today's weight 135 pounds

ANS: B This woman was obese at the start of her pregnancy, so a weight gain of 11 to 20 pounds has met the goal (245 230 = 15). Adolescents need to gain enough weight to support both their needs and those of the fetus, so they should gain the recommended amount for normal weight women, so this teen should weigh between 127 and 136, so she clearly did not gain enough weight. The woman who weighed a healthy 135 pounds should not weigh more than 170 pounds, so this woman gained more weight than recommended. The woman who was 56 tall was underweight at conception, so she needed to gain 28 to 40 pounds, which would put her minimum acceptable weight at delivery at 140

The nurse working with pregnant women understands that anorexia and bulimia are associated with which conditions in the newborn? (Select all that apply.) a. Food cravings b. Low birth weight c. Food aversions d. Electrolyte imbalance e. Small for gestational age infants

ANS: B, D, E These conditions are associated with electrolyte imbalance, low birth weight, and small for gestational age infants. All women should be asked about eating disorders, and nurses should watch for behaviors that may indicate disordered eating. Some women eat normally during pregnancy for the sake of the fetus, but others continue their previous dysfunctional eating patterns during pregnancy or in the early postpartum period. Food cravings and aversions are normal for most women during pregnancy. Women may have a strong preference or strong dislike for certain foods. They're generally not harmful, and some, like aversion to alcohol, may be beneficial.

Which statement regarding the development of the respiratory system is a high priority for the nurse to understand? a.The respiratory system does not begin developing until after the embryonic stage. b.The infant's lungs are considered mature when the L/S ratio is 1:1, at approximately 32 weeks of gestation. c.Maternal hypertension can reduce maternal-placental blood flow, accelerating lung maturity. d.Fetal respiratory movements are not visible on ultrasound scans until at least 16 weeks of gestation.

ANS: C A reduction in placental blood flow stresses the fetus, increases blood levels of corticosteroids, and thus accelerates lung maturity. The development of the respiratory system begins during the embryonic phase and continues into childhood. The infant's lungs are considered mature when the L/S ratio is 2:1, at approximately 35 weeks of gestation. Lung movements have been visualized on ultrasound scans at 11 weeks of gestation.

A pregnant woman at 25 weeks of gestation tells the nurse that she dropped a pan last week and her baby jumped at the noise. Which response by the nurse is most accurate? a."That must have been a coincidence; babies can't respond like that." b."The fetus is demonstrating the aural reflex." c."Babies respond to sound starting at approximately 24 weeks of gestation." d."Let me know if it happens again; we need to report that to your midwife."

ANS: C Babies respond to external sound starting at approximately 24 weeks of gestation. Acoustic stimulations can evoke a fetal heart rate response. There is no such thing as an aural reflex. The last statement is inappropriate and may cause undue psychologic alarm to the client.

The nurse is counseling a woman in her third trimester about eating enough protein. If the woman already gets her non-pregnant RDA of protein, how much more does she need in her diet? a. 5 grams/day b. 10 grams/day c. 25 grams/day d. 30 grams/day

ANS: C The current RDA for protein in the non-pregnant woman is 46 grams. To reach the recommendation for protein in the second half of pregnancy (71 grams), the patient needs to add 25 more grams of protein to her diet daily.

The measurement of lecithin in relation to sphingomyelin (lecithin/sphingomyelin [L/S] ratio) is used to determine fetal lung maturity. Which ratio reflects fetal maturity of the lungs? a.1.4:1 b.1.8:1 c.2:1 d.1:1

ANS: C The L/S ratio indicates a 2:1 ratio of lecithin to sphingomyelin, which is an indicator of fetal lung maturity and occurs at approximately the middle of the third trimester. L/S ratios of 1.4:1, 1.8:1, and 1:1 each indicate immaturity of the fetal lungs.

A woman's cousin gave birth to an infant with a congenital heart anomaly. The woman asks the nurse when such anomalies occur during development. Which response by the nurse is most accurate? a."We don't really know when such defects occur." b."It depends on what caused the defect." c."Defects occur between the third and fifth weeks of development." d."They usually occur in the first 2 weeks of development."

ANS: C The cardiovascular system is the first organ system to function in the developing human. Blood vessel and blood formation begins in the third week, and the heart is developmentally complete in the fifth week. "We don't really know when such defects occur" is an inaccurate statement. Regardless of the cause, the heart is vulnerable during its period of development—in the third to fifth weeks; therefore, the statement, "They usually occur in the first 2 weeks of development" is inaccurate.

A client arrives for her initial prenatal examination. This is her first child. She asks the nurse, "How does my baby get air inside my uterus?" What is the correct response by the nurse? a."The baby's lungs work in utero to exchange oxygen and carbon dioxide." b."The baby absorbs oxygen from your blood system." c."The placenta provides oxygen to the baby and excretes carbon dioxide into your bloodstream." d."The placenta delivers oxygen-rich blood through the umbilical artery to the baby's abdomen."

ANS: C The placenta delivers oxygen-rich blood through the umbilical vein, not the artery, to the fetus and excretes carbon dioxide into the maternal bloodstream. The fetal lungs do not function as respiratory gas exchange in utero. The baby does not simply absorb oxygen from a woman's blood system; rather, blood and gas transport occur through the placenta.

A student nurse in the perinatal clinic sees the term "pica" on a woman's chart and asks the registered nurse what this means. What definition is most accurate? a. Intolerance of milk products b. Iron deficiency anemia c. Ingestion of nonfood substances d. Episodes of anorexia and vomiting

ANS: C The practice of eating substances not normally thought of as food is called pica. Clay or dirt and solid laundry starch are the substances most commonly ingested. It is not intolerance of milk products, iron deficiency anemia, or episodes of anorexia and vomiting.

At a routine prenatal visit, the nurse explains the development of the fetus to her client. At approximately ____ weeks of gestation, lecithin is forming on the alveolar surfaces, the eyelids open, and the fetus measures approximately 27 cm crown to rump and weighs approximately 1110 g. The client is how many weeks of gestation at today's visit? a.20 b.24 c.28 d.30

ANS: C These milestones in human development occur at 28 weeks of gestation. These milestones have not occurred by 20 or 24 weeks of gestation but have been reached before 30 weeks of gestation.

What is the most basic information that a nurse should be able to share with a client who asks about the process of conception? a.Ova are considered fertile 48 to 72 hours after ovulation. b.Sperm remain viable in the woman's reproductive system for an average of 12 to 24 hours. c.Conception is achieved when a sperm successfully penetrates the membrane surrounding the ovum. d.Implantation in the endometrium occurs 6 to 10 days after conception

ANS: D After implantation, the endometrium is called the decidua. Ova are considered fertile for approximately 24 hours after ovulation. Sperm remain viable in the woman's reproductive system for an average of 2 to 3 days. Penetration of the ovum by the sperm is called fertilization. Conception occurs when the zygote, the first cell of the new individual, is formed.

Which structure is responsible for oxygen and carbon dioxide transport to and from the maternal bloodstream? a.Decidua basalis b.Blastocyst c.Germ layer d.Chorionic villi

ANS: D Chorionic villi are fingerlike projections that develop out of the trophoblast and extend into the blood-filled spaces of the endometrium. The villi obtain oxygen and nutrients from the maternal bloodstream and dispose carbon dioxide and waste products into the maternal blood. The decidua basalis is the portion of the decidua (endometrium) under the blastocyst where the villi attach. The blastocyst is the embryonic development stage after the morula; implantation occurs at this stage. The germ layer is a layer of the blastocyst.

The major source of nutrients in the diet of a pregnant woman should be composed of a. simple sugars. b. fats. c. fiber. d. complex carbohydrates.

ANS: D Complex carbohydrates supply the pregnant woman with vitamins, minerals, and fiber. The most common simple carbohydrate is table sugar, which is a source of energy but does not provide any nutrients. Fats provide 9 kcal in each gram, in contrast to carbohydrates and proteins, which provide only 4 kcal in each gram. However, fat is not a good source of nutrients. Fiber is supplied mainly by the complex carbohydrates.

A woman who is 8 months pregnant asks the nurse, "Does my baby have any antibodies to fight infection?" What is the most appropriate response by the nurse? a."Your baby has all the immunoglobulins necessary: immunoglobulin G (IgG), immunoglobulin M (IgM), and immunoglobulin A (IgA)." b."Your baby won't receive any antibodies until he is born and you breastfeed him." c."Your baby does not have any antibodies to fight infection." d."Your baby has IgG and IgM."

ANS: D During the third trimester, IgG is the only immunoglobulin that crosses the placenta; it provides passive acquired immunity to specific bacterial toxins. However, the fetus produces IgM by the end of the first trimester. IgA immunoglobulins are not produced by the baby. Therefore, by the third trimester, the fetus has both IgG and IgM. Breastfeeding supplies the newborn infant with IgA.

A pregnant woman is at a picnic and asks a friend of hers, who is a nurse, what foods she can eat. What response by the nurse is best? a. Bologna sandwich b. Hot dog c. Smoked salmon spread d. Cheddar cheese and crackers

ANS: D Hard cheeses like cheddar are safe for the pregnant woman to eat. She should not eat lunch meat or hotdogs unless they are heated until steaming. She should also not eat refrigerated smoked seafood.

Some of the embryo's intestines remain within the umbilical cord during the embryonic period. What is the rationale for this development of the gastrointestinal system? a.Umbilical cord is much larger at this time than it will be at the end of pregnancy. b.Intestines begin their development within the umbilical cord. c.Nutrient content of the blood is higher in this location. d.Abdomen is too small to contain all the organs while they are developing.

ANS: D The abdominal contents grow more rapidly than the abdominal cavity; therefore, part of their development takes place in the umbilical cord. By 10 weeks of gestation, the abdomen is large enough to contain them. Intestines begin their development within the umbilical cord but only because the liver and kidneys occupy most of the abdominal cavity. Blood supply is adequate in all areas.

A pregnant woman's diet may not meet her need for folate. The nurse teaches the woman to take how much folate as a supplement each day? a. 100 to 200 mcg b. 200 to 400 mcg c. 400 to 600 mcg d. 400 to 800 mcg

ANS: D The current recommendation for folate (folic acid) is 400 to 800 mcg (0.4 to 0.8 mg) per day.

Which pregnant woman should have the least weight gain during pregnancy? a. Woman pregnant with twins b. Woman in early adolescence c. Woman shorter than 62 inches or 157 cm d. Woman who was obese before pregnancy

ANS: D The recommended weight gain for overweight or obese women is 11 to 20 pounds. This will provide sufficient nutrients for the fetus. Overweight and obese women should be advised to lose weight prior to conception in order to achieve the best pregnancy outcomes. A higher weight gain in twin gestations may help prevent low birth weights. Adolescents need to gain weight toward the higher acceptable range, which will provide for their own growth as well as for fetal growth. In the past women of short stature were advised to restrict their weight gain; however, evidence to support these guidelines has not been found.

The nurse teaches a pregnant woman that one danger in using nonfood supplementation of nutrients is a. increased absorption of all vitamins. b. development of pregnancy-induced hypertension (PIH). c. increased caloric intake. d. toxic effects on the fetus.

ANS: D The use of supplements in addition to food may increase the intake of some nutrients to doses much higher than the recommended amounts. Overdoses of some nutrients have been shown to cause fetal defects. Supplements do not have better absorption than natural vitamins and minerals. There is no relationship between supplements and PIH. Supplements do not contain significant calories.

The traditional diet of Asian women includes little meat or dairy products and may be low in calcium and iron. The nurse can help the woman increase her intake of these foods by a. emphasizing the need for increased milk intake during pregnancy. b. suggesting she eat more "hot" foods during pregnancy. c. telling her husband that she must increase her intake of fruits and vegetables for the baby's sake. d. suggesting she eat more tofu, bok choy, and broccoli

ANS: D To increase the intake of calcium and iron in a culturally-appropriate way, the nurse can suggest the woman eat more broccoli and tofu for calcium and to eat more tofu and leafy green vegetables such as bok choy for iron.

The nurse explains to the expectant mother that which vitamin or mineral can lead to congenital malformations of the fetus if taken in excess by the mother? a. Zinc b. Vitamin D c. Folic acid d. Vitamin A

ANS: D Zinc, vitamin D, and folic acid are vital to good maternity and fetal health and are highly unlikely to be consumed in excess. Vitamin A, taken in excess, causes a number of problems. An analog of vitamin A appears in prescribed acne medications, which must not be taken during pregnancy.

A 35 yr old client has an amniocentesis performed to find out whether her baby has a chromosomal defect. Which statement indicates that the client understands her situation. a. The doctor will tell me if I should have an abortion when the test results come back. b. When all the lab results come back, my husband and I will make a decision about the pregnancy. c. my mother must not find out about all this testing. If she does, she will think Im having an abortion d. I know there are support groups for parents who have a baby with birth defects, but we have plenty of insurance to cover what we need

B. when all the lab results come back, my husband and I will make a decision about the pregnancy

Matching: a. Two genes are required to produce the trait. b. A single copy of the gene is enough to produce the trait c. only one copy of the gene is needed to cause the disorder in the male 1. autosomal dominant 2. X-linked recessive 3. Autosomal recessive

C - 2 B - 3 A - 1

A nurse is working with a labor client who is in preterm labor and is designated as a high-risk client. The client is very apprehensive and asks the nurse "Is everything going to be all right?" Following birth via an emergency cesarean section, the newborn undergoes resuscitation and does not survive. The client is distraught over the outcome and blames the nurse for telling her that everything would be okay. Which ethical principle did the nurse violate. a. Autonomy b. Fidelity c. Beneficence d. Accountability

b. Fidelity rationale: in this type of situation, the nurse cannot make statements that cannot be kept.

A nurse working in a labor and birth unit is asked to take care of two high-risk clients in the labor and birth suite: a 34 weeks gestation 28 year old gravida, para 2 in preterm labor and a 40 year old gravida 1, para 0 who is severely preeclamptic. The nurse refuses this assignment telling the charge nurse that based on individual client acuity, each client should have one-on-one care. Which ethical principle is the nurse advocating a. accountability b. beneficence c. justice d. fidelity

b. beneficence rationale: In this situation, the clients are each exhibiting significant high-risk conditions and should receive individual nursing care

The nurse is explaining genetics to a group of nursing students. Which are autosomal recessive disorders that the nurse should include in the teaching session. select all a. Hemophelia b. cystic fibrosis c. sickle cell disease d. turners syndrome e. phenylketonuria (PKU) disease

b. cystic fibrosis c. sickle cell disease e. phenylketonuria (PKU) disease

The US ranks 27th in terms of world wide infant mortality rates. Which factor has the greatest impact on decreasing the mortality rate of infants a. providing more womens shelters b. ensuring early and adequate prenatal care c. resolving all language and cultural differences d. enrolling pregnant women in the medicaid program by their eighth month of pregnancy

b. ensuring early and adequate prenatal care rationale: because preterm infants from the largest category of those needing expensive intensive care, early pregnancy intervention is essential for decreasing infant mortality

A nurse is working with a client to obtain information needed for genetic counseling. Which tool will be used to obtain this information a. Braden scale b. genogram c. Chorionic villus sampling (CVS) d. Serum protein electrophoresis

b. genogram rationale: when obtaining information with regard to genetic counseling, it is important to obtain a family history using a genogram or pedigree as the clinical tool

The nurse receives a report on an infant whose analysis indicates 47 total chromosomes, with the abnormality noted at chromosome 21. What additional assessments will the nurse include when evaluating the infant. a. Cleft palate b. protruding tongue c. extra fingers or toes (polydactyly) d. Intellectual development delay

b. protruding tongue rationale: trisomy 21 is associated with a number of notable physical characteristics, including wide-set eyes, flat bridge of the nose, protruding tongue, short neck, small chin, poor muscle tone, and space between the great and second toes.

Which actions by the nurse indicate compliance with the Health Insurance Portability and Accountability Act (HIPPA). Select al la. the nurse posts an update about a client on facebook b. the nurse gives the report to the oncoming nurse in a private area c. the nurse gives information about the clients status over the phone to the clients friend. d. the nurse logs off any computer screen showing client data before leaving the computer unattended e. the nurse puts any documentation with the clients information in the shred bun at the hospital before leaving for the day

b. the nurse gives the report to the oncoming nurse in a private area d. the nurse logs off any computer screen showing client data before leaving the computer unattended e. the nurse puts any documentation with the clients information in the shred bin at the hospital before leaving for the day

A client tells the nurse at a prenatal interview that she has quit smoking, only has a glass of wine with dinner, and has cut down on coffee to four cups a day. Which response by the nurse will be most helpful in promoting a lifestyle change. a. those few things wont cause any trouble. good for you b. you need to do a lot better than that. you are still hurting your baby. c. here are some pamphlets for you to study. They will help you to find more ways to improve d. you have made some good progress toward having a healthy baby. Lets talk about the changes you have made.

d. you have made some good progress toward having a healthy baby. lets talk about the changes you have made. rationale: praising her for making positive changes is an effective technique for motivating client.

Which point should the nurse include when telling a couple about the prenatal diagnosis of genetic disorders a. The diagnosis may be slow and could be inconclusive b. A comprehensive evaluation will result in an accurate diagnosis c. common disorders can be quickly diagnosed through blood tests. d. Diagnosis can be obtained promptly through most hospital laboratories.

a. the diagnosis may be slow and could be inconclusive rationale: even the best efforts at diagnosis do not always yield the information needed to counsel the client.

With regard to an obstetric litigation case, a nurse is working in labor and birth is found to be negligent. Which intervention performed by the nurse indicates that a breach of duty has occurred. a. the nurse did not document fetal heart tones (FHR) during the second stage of labor. b. The client was only provided ice chips during the labor period, which lasted 8 hours c. The nurse allowed the client to use the bathroom rather than a bedpan during the first stage of labor d. The nurse asked family members to leave the room when she prepared to do a pelvic exam on the client.

a. the nurse did not document fetal heart tones (FHR) during the second stage of labor. rationale: a breach of duty is indicated by a nurse (or HCP) failing to provide treatment relative to the standard of care.

A clinical nurse is planning a teaching session for childbearing-age female clients. Which should the nurse include in the teaching session with regard to avoiding exposing a fetus to teratogens. a. Use only category A medications during pregnancy b. Immunizations should be updated during the first trimester of pregnancy. c. use of saunas and hot tubs during pregnancy should be during the winter d. Alcoholic beverages can be consumed in the first and third trimesters.

a. use only category A medications during pregnancy rationale: In well-controlled studies, class A medications have no demonstrated fetal risk

A charge nurse is working on a postpartum unit and discovers that one of the clients did not receive AM care during her shift assessment. The charge nurse questions the nurse assigned to provide care and finds out that the nurse thought that "the client should just do it by herself because she will have to do this at home". On further questioning of the nurse, it is determined that the rest of her assigned clients were provided AM care. The assigned nurse has violated which ethical principle? a. Justice b. truth c. confidentiality d. autonomy

a. Justice rationale: the ethical principle of justice indicates that all clients should be treated equally and fairly.

Which characteristics is related to down syndrome a. Up-slanting eyes b. abnormal genitalia c. bleeding tendency d. edema of extremities

a. Up-slanting eyes

Which step of the nursing process is being used when the nurse decides whether an ethical dilemma exists a. analysis b. planning c. evaluation d. assessment

a. analysis rationale: when a nurse uses the collected data to determine whether an ethical dilemma exists, the data are being analyzed

A couple asks the nurse about the procedure for surrogate parenting. Which correct responses should the nurse give to the couple. select all a. donated embryos can be implanted into the surrogate mother b. the surrogate mother needs to have carried one previous birth to term c. you both need to be infertile to be eligible for surrogate parenting d. conception can take place outside the surrogate mothers body and then implanted e. the surrogate mother can be inseminated artificially with sperm from the intended father.

a. donated embryos can be implanted into the surrogate mother d. conception can take place outside the surrogate mothers body and then implanted e. the surrogate mother can be inseminated artificially with sperm from the intended father.

Testing for the cause of anomalies in a still born infant is being done. The mother angrily asks the nurse how long these tests are going to take. The nurse should understand that the mother is a. exhibiting normal grief behavior b. trying to place blame on someone c. being impatient and unreasonable. d. feeling guilty and blaming herself.

a. exhibiting normal grief behavior. rationale: grief after a fetal loss may initially be expressed as anger.

The nurse is providing care to a patient who was just admitted to the labor and birth unit in active labor at term. The patient informed the nurse that she has not received any prenatal care because "I cannot afford to go to the doctor. And this is my third baby, so I know what to expect." What is the nurses primary concern when developing the patients plan of care. a. Low birth weight. b. oligohydramnios c. gestational diabetes d. gestational hypertension

a. low birth weight rationale: because of adverse living conditions, poor health care, and poor nutrition, infants born to low income women are more likely to begin life with problems such as low birth weight.

A client presents with curly hair and blue eyes. These findings are consistent with a. phenotype b. genotype c. dominant alleles d. recessive traits

a. phenotype rationale: Curly hair is considered to be a dominant trait, whereas blue eyes are considered to be a recessive trait.

A nurse is entering information on the clients electronic health record (EHR) and is called to assist in an emergency situation with regard to another client in the labor and birth suite. The nurse rushes to the scene to assist but leaves the chart open on the computer screen. The emergent client situation is resolved satisfactorily, and the nurse comes back to the computer entry screen to complete charting. At the end of the shift, the nurse manager asks to speak with the nurse and tells her that she is concerned with what happened today on the unit because there was a breach in confidentiality. Which response by the nurse indicates that she understands the nurse managers concerns. a. The nurse acknowledges that she should have made sure that her client was safe before assisting with the emergency. b. The nurse states that she should have logged out of the EHR prior to attending to the emergency. c. The nurse indicates that the unit was understaffed d. The nurse indicates that she changed her password following the clinical emergency to maintain confidentiality.

b. the nurse states that she should have logged out of the EHR prior to attending to the emergency. rationale: with the use of electronic health records, it is necessary to take all steps to maintain confidentiality and limit access to non-health care personnel.

Which statement is true of multifactorial disorders. a. they may not be evident until later in life b. they are usually present and detectable at birth c. the disorders are characterized by multiple defects d. secondary defects are rarely associated with them

b. they are usually present and detectable at birth rationale: multifactorial disorders result from an interaction between a persons genetic susceptibility and environmental conditions that favor development of the defect.

Which client will most likely seek prenatal care a. Janice, 15 yearls old, tells her friends "I dont believe I am pregnant. b. Carol, 28 years old, is in her second pregnancy and abuses drugs and alcohol c. Margaret, 20 years old, is in her first pregnancy and has access to a free prenatal clinic d. Glenda, 30 years old, is in her fifth pregnancy and delivered her last infant at home with the help of her mother and sister

c. Margaret, 20 years old, is in her first pregnancy and has access to a free prenatal clinic rationale: the client who acknowledges the pregnancy early, has access to health care, and has no reason to avoid health care is most likely to seek prenatal care.

The clinic nurse is reviewing charts on prenatal clients. Which client histories should the nurse understand that a referral to a genetic counselor is warranted. select all a. a father who is 35 b. a client having a first baby at age 30 c. a family history of unexplained still births d. a client with a family history of birth defects e. a client who is a carrier of an x-linked disorder.

c. a family history of unexplained still births d. a client with a family history of birth defects e. a client who is a carrier of an x-linked disorder

The clinic nurse often cares for clients who are considering an abortion. Which responsibilities does this nurse have in regard to this issue. select all a. informing the client about pro-life options b. informing the client about pro-choice support groups c. being informed about abortion from a legal standpoint d. being informed about abortion from an ethical standpoint e. recognizing that this issue may result in confusion for the client.

c. being informed about abortion from a legal standpoint d. being informed about abortion from an ethical standpoint e. recognizing that this issue may result in confusion for the client.

Which of the following statements is true regarding late preterm infants. a. These infants are born before 32 weeks gestation and thus are at higher risk than LBW infants b. These infants do better than LBW infants because their weight provides added protection against physiologic stressors. c. Care of these infants has led to increased health care costs compared with LBW infants d. these infants suffer fewer respiratory problems that LBW infants.

c. care of these infants has led to increased health care costs compared with LBW infants. rationale: late preterm infants are born between 34 and 36 weeks and present with more complications than LBW infants, according to evidenced-based practice.

At the present time, surrogate parenting is governed by which of the following a. state law b. federal law c. individual court decision d. protective child services

c. individual court decision rationale: each surrogacy case is decided individually in a court of law

A nurse is working in the area of labor and birth. Her assignment is to take care of a gravida 1 para 0 who presents in early labor at term. Vaginal exam reflects the following: 2cm, cervix posterior, -1 station, and vertex with membranes intact. The client asks the nurse "if she can break her water so that her labor can go faster". The nurses response, based on the ethical principle of nonmaleficence, is which of the following. a. Tell the client that she will have to wait until she has progressed further on the vaginal exam and then she will perform an amniotomy b. Have the client write down her request and then call the physician for an order to implement the amniotomy c. instruct the client that only a physician or certified midwife can perform this procedure. d. Give the client an enema to stimulate labor

c. instruct the client that only a physician or certified midwife can perform this procedure rationale: the ethical principle of nonmaleficence conveys the concept that one should avoid risk taking or harm to others.

Which of the following complications are associated with late preterm infants. select all a. Hyperglycemia b. tachycardia c. jaundice d. thermoregulation problems e. require mechanical ventilation f. feeding problems

c. jaundice d. thermoregulation problems e. require mechanical ventilation f. feeding problems

During the course of obtaining a genetic history from a female client, you note that there is a family history of a genetic disease on the maternal side but no evidence of symptomatology in the client or the clients children, two girls. Which observation can you make related to genetic expression a. Autosomal dominant expression is observed b. x-linked dominant trait is observed c. more information is needed to determine the answer d. autosomal recessive expression is observed and both the children will be carriers of the disease process.

c. more information is needed to determine the answer rationale: because we have no information about the father and/or paternal side, the other stated options do not apply

Identification of a newborns blood indicates type AB. Based on this assessment, which statement is correct a. Each parent had recessive genes for type O. b. one parent had type O and the other parent had type A c. One parent had type A and the other had type B d. each parent had type A

c. one parent had type A and the other had type B

A medical surgical nurse is asked to float to a womens health unit to care for clients who are scheduled for therapeutic abortions. The nurse refuses to accept this assignment and expresses her personal beliefs as being incongruent with this medical practice. The nursing supervisor states that the unit is short-staffed and that they could really use her expertise because it just involves taking care of clients who have undergone a surgical procedure. In consideration of legal and ethical practices, can the nursing supervisor enforce this assignment. a. The staff nurse has the responsibility of accepting any assignment that is made while working for a health care unit, so the nursing supervisor is within his or her rights to enforce this assignment. b. because the unit is short-staffed, the staff nurse should accept the assignment to provide care by benefit of her or his experience to clients who need care c. the staff nurse has expressed a legitimate concern based on his or her feelings; the nursing supervisor does not have the authority to enforce this assignment d. the nursing supervisor should emphasize that this assignment requires care of a surgical client for which the staff nurse is adequately trained and should therefore enforce the assignment.

c. the staff nurse has expressed a legitimate concern based on his or her feelings; the nursing supervisor does not have the authority to enforce this assignment rationale: The Nurse Practice Act allows nurses to refuse assignments that involve practices that they have expressed as being opposed to their religious, cultural, ethical, and/or moral values.

The parents of a child with a karyotype of 47, XY, +21 ask the nurse what this means. Which is an accurate response by the nurse a. This karyotype is for a normal male b. This karyotype is for a normal female c. This karyotype is for a male with down syndrome d. This karyotype is for a female with Turners syndrome.

c. this karyotype is for a male with down syndrome rationale: this child is male because his sex chromosomes are XY. He has one extra copy of chromosome 21 (for a total of 47, instead of 46) resulting in down syndrome.

Which question posed by the nurse will most likely promote the sharing of sensitive information during a genetic counseling interview a. What kind of defects or diseases seem to run in the family. b. how many people in your family are mentally retarded or handicapped c. Did you know that you can always have an abortion if the fetus is abnormal. d. Are there any members of your family who have learning or developmental problems.

d. are there any members of your family who have learning or developmental problems rationale: the nurse should probe gently using layperson oriented terminology, such as learning problems rather than defects or diseases

The nurse is teaching a homeless pregnant teenage about prenatal care. Which should the nurse emphasize in the teaching sessions a. the importance of naming the baby b. risk factors associated with pregnancy c. information about employment opportunities d. eating habits that will provide adequate nutrition

d. eating habits that will provide adequate nutrition rationale: homeless teens are more likely to have poor eating habits, smoke, and have greater risks for preterm labor, anemia, and hypertension during pregnancy and to deliver a low-birth-weight infant.

The nurse is planning a teaching session for staff on ethical theories. Which situation best reflects the deontologic theory. a. approving a physician-assisted suicide b. supporting the transplantation of fetal tissue and organs c. using experimental medications for the treatment of AIDS d. initiating resuscitative measures on a 90 year old patient with terminal cancer.

d. initiating resuscitative measures on a 90 year old patient with terminal cancer. rationale: in the deontologic theory, life must be maintained at all costs, regardless of quality of life.

People who have two copies of the same abnormal autosomal dominant gene will usually be: a. Mildly affected with the disorder. b. infertile and unable to transmit the gene c. carries of the trait but not affected with the disorder. d. more severely affected by the disorder than people with one copy of the gene

d. more severely affected by the disorder than people with one copy of the gene. rationale: people who have two copies of an abnormal gene are usually more severely affected by the disorder because they have no normal gene to maintain normal function

The patient indicates to the clinic nurse that she is trying to become pregnant. The clinic nurse reviews the patients chart and notes the following lab values: blood type-O, RPR nonreactive, rubella nonimmune, HCT 35%. Which lab value is most concerning to the nurse a. HCT 35% b. blood type O- c. RPR nonreactive d. rubella nonimmune

d. rubella nonimmune rationale: rubella nonimmune indicates that the patient does not have immunity against rubella and is therefore susceptible to the infection.

The nurse is interviewing a 6 week pregnant client. The client asks the nurse "why is elective abortion considered an ethical issue". Which is the best response that the nurse should make a. Abortion requires third party consent b. The U.S. Supreme Court ruled that life begins at conception c. Abortion law is unclear about a womans constitutional rights d. There is a conflict between the rights of the woman and the rights of the fetus.

d. there is a conflict between the rights of the woman and the rights of the fetus. rationale: elective abortion is an ethical dilemma because two opposing courses of action are available.

Which statement is true regarding the quality assurance or incident report a. reports are a permanent part of the patients chart b. the report assures the legal department that there is no problem c. the nurses notes should contain this statement: "incident report filed and copy place in chart" d. this report is a form of documentation of an event that may result in legal action

d. this report is a form of documentation of an event that may result in legal action rationale: documentation on the chart should include all factual information regarding the clients condition that would be recorded in any situation

The RN is delegating tasks to the IAP. Which tasks can the nurse delegate. select all a. Teaching the client about breast care b. assessment of a clients lochia and perineal area c. assisting a client to the bathroom for the first time after birth d. vital signs on a postpartum client who delivered the night before e. assisting a postpartum client to take a shower on the second postpartum day

d. vital signs on a postpartum client who delivered the night before e. assisting a postpartum client to take a shower on the second postpartum day