OB Evolve Questions

While caring for a pregnant patient, the nurse observes that the patient has foul-smelling vaginal discharge and maternal fever. Which type of birthing method does the nurse find suitable for the patient? 1 Vaginal delivery 2 Vacuum-assisted delivery Correct3 Cesarean section delivery 4 Forceps-assisted delivery Foul odor from the vaginal discharge, combined with maternal fever, indicates that the patient has chorioamnionitis. Cesarean delivery is preferred for the patients with chorioamnionitis. Vacuum-assisted delivery is helpful in case of prolonged labor when the mother is not sufficiently capable to bear down the fetus. Vaginal delivery is not possible in this condition because of the increased risk of chorioamnionitis and prolonged labor. Forceps-assisted delivery is useful in case of fetal malpresentation of the head and in case of insufficient efforts by the patient to bear down. 91%of students nationwide answered this question correctly. View Topics 149975591 Confidence: Nailed it Stats Issue with this question? 2. Which factor is most likely to result in fetal hypoxia during a dysfunctional labor? Correct1 Incomplete uterine relaxation 2 Maternal fatigue and exhaustion 3 Maternal sedation with narcotics 4 Administration of tocolytic drugs A high uterine resting tone, with inadequate relaxation between contractions, reduces maternal blood flow to the placenta and decreases fetal oxygen supply. Maternal fatigue usually does not decrease uterine blood flow. Maternal sedation will sedate the fetus but should not decrease blood flow. Tocolytic drugs decrease contractions. This will increase uterine blood flow. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options. Example: If the item relates to and identifies stroke rehabilitation as its focus and only one of the options contains the word stroke in relation to rehabilitation, you are safe in identifying this choice as the correct response. 68%of students nationwide answered this question correctly. View Topics 159754960 Confidence: Nailed it Stats Issue with this question? 5. The nurse finds that the amniotic membranes in a pregnant patient who is in labor have ruptured and that the amniotic fluid is meconium-stained. What should the nurse infer from the findings? The baby has a high risk of presenting with: 1 Shoulder dystocia. 2 Umbilical cord prolapse. Correct3 Aspiration pneumonia. 4 Brachial plexus injury. Some babies may pass meconium even before birth, thus staining the amniotic fluid green. This meconium-stained amniotic fluid can be aspirated in the fetal lungs, increasing the risk of meconium aspiration syndrome, which may cause respiratory depression. Meconium-stained amniotic fluid does not increase the risk of shoulder dystocia. Shoulder dystocia is common when there is fetopelvic disproportion as a result of excessive fetal size or maternal pelvic abnormalities. Umbilical cord prolapse is an obstetric emergency where the umbilical cord lies below the presenting part of the fetus. Brachial plexus injury is common in babies when the vaginal delivery takes place despite shoulder dystocia. 89%of students nationwide answered this question correctly. View Topics 146943996 Confidence: Nailed it Stats Issue with this question? 7. Which technique is least effective for the woman with persistent occipito posterior position? 1 Squat Correct2 Lie supine and relax 3 Sit or kneel, leaning forward with support 4 Rock the pelvis back and forth while on hands and knees Lying supine increases discomfort. The woman typically complains of severe back pain from the pressure of the fetal head (occiput) pressing against her sacrum. Squatting aids both rotation and fetal descent. A sitting or kneeling position may help the fetal head to rotate to occipito anterior. Rocking the pelvis encourages rotation from occipito posterior to occipito anterior. 84%of students nationwide answered this question correctly. View Topics 149975562 Confidence: Nailed it Stats Issue with this question? 8. A nurse is caring for a woman whose labor is being augmented with oxytocin. The nurse recognizes that the oxytocin should be discontinued immediately if there is evidence of: 1 uterine contractions occurring every 8 to 10 minutes. Correct2 a fetal heart rate (FHR) of 180 with absence of variability. 3 the woman needing to void. 4 rupture of the woman's amniotic membranes. An FHR of 180 with absence of variability is non-reassuring. The oxytocin should be discontinued immediately and the physician should be notified. The oxytocin should be discontinued if uterine hyperstimulation occurs. Uterine contractions that occur every 8 to 10 minutes do not qualify as hyperstimulation. The woman needing to void is not an indication to discontinue the oxytocin induction immediately or to call the physician. Unless a change occurs in the FHR pattern that is non-reassuring or the woman experiences uterine hyperstimulation, the oxytocin does not need to be discontinued. The physician should be notified that the woman's membranes have ruptured. 86%of students nationwide answered this question correctly. View Topics 146944703 Confidence: Nailed it Stats Issue with this question? 10. Which nursing action should be initiated first when there is evidence of prolapsed cord? 1 Notify the health care provider. 2 Apply a scalp electrode. 3 Prepare the woman for an emergency cesarean birth. Correct4 Reposition the woman with her hips higher than her head. The priority is to relieve pressure on the cord. Changing the maternal position will shift the position of the fetus so that the cord is not compressed. Notifying the health care provider is a priority but not the first action. Applying a scalp electrode is not appropriate at this time. Preparing the woman for an emergency cesarean birth is not the first priority. Test-Taking Tip: If the question asks for an immediate action or response, all the answers may be correct, so base your selection on identified priorities for action. 75%of students nationwide answered this question correctly. View Topics 159753782 Confidence: Nailed it Stats Issue with this question? 11. The nurse is caring for a 32-year-old pregnant patient who had an onset of labor during 40 weeks' gestation. Following the labor, the nurse finds that the newborn has a low birth weight (LBW). What explanation will the nurse give to the patient as to the etiology of the newborn's LBW? 1 Preterm labor 2 Maternal age 3 Diabetic condition of the patient Correct4 Intrauterine growth restriction (IUGR) The LBW of the newborn is the result of IUGR, a condition of inadequate fetal growth. It may be caused by various conditions, such as gestational hypertension that interferes with uteroplacental perfusion. Interference with uteroplacental perfusion limits the flow of nutrients into the fetus and causes the LBW. The onset of labor is at 40 weeks' gestation, so it is not a preterm labor. The patient's age is normal for pregnancy and therefore is not a reason for the LBW of the child. Infants born to patients with diabetes would have a high birth weight, not a low one. 82%of students nationwide answered this question correctly. View Topics 149975593 Confidence: Nailed it Stats Issue with this question? 12. Which nursing action should be initiated first when there is evidence of prolapsed cord? 1 Notify the health care provider. 2 Apply a scalp electrode. 3 Prepare the woman for an emergency cesarean birth. Correct4 Reposition the woman with her hips higher than her head. The priority is to relieve pressure on the cord. Changing the maternal position will shift the position of the fetus so that the cord is not compressed. Notifying the health care provider is a priority but not the first action. Applying a scalp electrode is not appropriate at this time. Preparing the woman for an emergency cesarean birth is not the first priority . Test-Taking Tip: Key words or phrases in the stem of the question such as first, primary, early, or best are important. Similarly, words such as only, always, never, and all in the alternatives are frequently evidence of a wrong response. As in life, no real absolutes exist in nursing; however, every rule has its exceptions, so answer with care. 76%of students nationwide answered this question correctly. A pregnant patient is receiving tocolytic therapy with magnesium sulfate. Under which patient circumstance would the nurse suggest to discontinue the therapy? 1 Blood pressure is 120/80 mm Hg. Correct2 Respiratory rate is 10 breaths/min. 3 Urine output is 40 mL/hr. Incorrect4 Serum magnesium level is 5 mEq/L. Magnesium sulfate is used as a tocolytic. However, it can cause severe adverse effects. Therefore the nurse should closely monitor the patient. A respiratory rate of 10 breaths/min indicates that the patient has respiratory depression, which is an adverse effect of magnesium sulfate. Therefore the nurse should stop administration of the drug. A blood pressure of 120/80 mm Hg is normal and does not require discontinuation of magnesium sulfate. Urine output of 40 mL/hr indicates normal urine output; therefore the nurse need not discontinue the therapy. The therapeutic serum magnesium level should be 5 mEq/L to exert its action. Therefore, if the serum magnesium level is 5 mEq/L, the nurse need not discontinue the therapy, because it would not cause toxic effects. 83%of students nationwide answered this question correctly. View Topics 159754926 Confidence: Pretty sure Stats Issue with this question? 4. During the active phase of labor, the nurse prepares for the insertion of an intrauterine pressure catheter (IUPC) to a pregnant patient. What patient clinical presentation would be the reason for this intervention? Incorrect1 Amniotic fluid of 300 mL 2 Cervical dilation of 6 cm 3 Complete deprivation of sleep in the patient Correct4 Reduced uterine contractions (UCs) An IUPC is inserted into a pregnant patient in the active phase of labor to evaluate uterine activity (UA) accurately. Intrauterine pressure of less than 25 mm Hg may not be sufficient to cause cervical effacement and dilation. This condition also indicates that the patient has hypotonic uterine dysfunction. If the patient has reduced UCs, the nurse would insert the IUPC. Amniotic fluid of 300 mL (less than 400 mL) is evidence of premature rupture of membranes (PROM) and is not related to hypotonic uterine dysfunction. Cervical dilation of 6 cm (above 4 cm) prompts for treatment of hypertonic uterine dysfunction but not for hypotonic uterine dysfunction. If the patient had lack of sleep, then zolpidem (Ambien) would be administered to facilitate rest and sleep, but this would not warrant the insertion of the IUPC. 77%of students nationwide answered this question correctly. View Topics 159754934 Confidence: Just a guess Stats Issue with this question? 6. A pregnant patient who has chorioamnionitis gave birth to a child through cesarean section. Which medication does the nurse expect the primary health care provider (PHP) to prescribe? 1 Propranolol (Inderal) Correct2 Clindamycin (Cleocin) Incorrect3 Morphine (MS Contin) 4 Terbutaline (Brethine) The pregnant patient had chorioamnionitis before childbirth, which implies that bacteremia may develop in the patient. Because of bacteremia, there may be wound infection or pelvic abscess after cesarean section. Therefore, after cesarean birth, the patient should be given an antibiotic, such as clindamycin (Cleocin), which acts against anaerobic organisms. Propranolol (Inderal), morphine (MS Contin), and terbutaline (Brethine) are not antibiotics and are not administered after childbirth. They are drugs used to treat complications of labor. 77%of students nationwide answered this question correctly. View Topics 159753784 Confidence: Pretty sure Stats Issue with this question? 9. The nurse is assessing a pregnant patient and finds that the patient has inflammation around the teeth and bleeding of the gums. What should the nurse tell the patient after the assessment? Correct1 "You might be at risk for preterm labor." 2 "Your baby might have spina bifida." 3 "You may be at risk of having a miscarriage." Incorrect4 "Your baby might have delayed tooth eruption." According to research, the patients who have periodontal diseases like gingivitis, inflammation around the teeth, and bleeding of gums may have an increased risk of preterm labor. Down syndrome and hypothyroidism would cause a delay in tooth eruption in the infant. Periodontal diseases would not cause miscarriage, because it does not affect fetal development. Spina bifida results from a deficiency of folate, not from maternal periodontal diseases. 80%of students nationwide answered this question correctly. For a woman at 42 weeks of gestation, which finding requires more assessment by the nurse? 1 Fetal heart rate of 116 beats/min 2 Cervix dilated 2 cm and 50% effaced 3 Score of 8 on the biophysical profile Correct4 One fetal movement noted in 1 hour of assessment by the mother Self-care in a postterm pregnancy should include performing daily fetal kick counts three times per day. The mother should feel four fetal movements per hour. If fewer than four movements have been felt by the mother, she should count for 1 more hour. Fewer than four movements in that hour warrants evaluation. A fetal heart rate of 116 beats/min is a normal finding at 42 weeks of gestation. Cervical dilation of 2 cm with 50% effacement is a normal finding in a woman at 42 weeks of gestation. A score of 8 on the BPP is a normal finding in a pregnancy at 42 weeks. 82%of students nationwide answered this question correctly. View Topics 149975587 Confidence: Nailed it Stats Issue with this question? 2. Which technique is least effective for the woman with persistent occipitoposterior position? 1 Squat Correct2 Lie supine and relax 3 Sit or kneel, leaning forward with support 4 Rock the pelvis back and forth while on hands and knees Lying supine increases discomfort. The woman typically complains of severe back pain from the pressure of the fetal head (occiput) pressing against her sacrum. Squatting aids both rotation and fetal descent. A sitting or kneeling position may help the fetal head to rotate to occipitoanterior. Rocking the pelvis encourages rotation from occipitoposterior to occipitoanterior. 85%of students nationwide answered this question correctly. View Topics 159753778 Confidence: Nailed it Stats Issue with this question? 4. During a prenatal visit, the nurse finds that the patient has symptoms of preterm labor. Which nursing intervention is to be followed to prevent thrombophlebitis? Correct1 Teach gentle lower extremity exercises to the patient. 2 Suggest that the patient lie in the supine position in bed. 3 Provide a calm and soothing atmosphere to the patient. 4 Give tocolytic medications as per the physician's prescription. The health care provider may recommend reduced activity or complete bed rest for the patient experiencing preterm labor, depending on the severity of the symptoms. As a result, the patient may be at risk for thrombophlebitis due to limited activity. The nurse should teach the patient how to perform gentle exercises of the lower extremities. Suggesting that the patient lie in the supine position may cause supine hypotension. Instead, the nurse can suggest that the patient lie in a side-lying position to help enhance placental perfusion. The nurse can provide a calm and soothing atmosphere to facilitate coping so as to reduce the patient's anxiety, but this intervention does not prevent thrombophlebitis. Tocolytic medications are given to the patient to inhibit uterine contractions (UCs), but they do not prevent thrombophlebitis. 74%of students nationwide answered this question correctly. View Topics 146944703 Confidence: Nailed it Stats Issue with this question? 5. Which nursing action should be initiated first when there is evidence of prolapsed cord? 1 Notify the health care provider. 2 Apply a scalp electrode. 3 Prepare the woman for an emergency cesarean birth. Correct4 Reposition the woman with her hips higher than her head. The priority is to relieve pressure on the cord. Changing the maternal position will shift the position of the fetus so that the cord is not compressed. Notifying the health care provider is a priority but not the first action. Applying a scalp electrode is not appropriate at this time. Preparing the woman for an emergency cesarean birth is not the first priority. Test-Taking Tip: If the question asks for an immediate action or response, all the answers may be correct, so base your selection on identified priorities for action. 75%of students nationwide answered this question correctly. View Topics 159754960 Confidence: Nailed it Stats Issue with this question? 6. The nurse finds that the amniotic membranes in a pregnant patient who is in labor have ruptured and that the amniotic fluid is meconium-stained. What should the nurse infer from the findings? The baby has a high risk of presenting with: 1 Shoulder dystocia. 2 Umbilical cord prolapse. Correct3 Aspiration pneumonia. 4 Brachial plexus injury. Some babies may pass meconium even before birth, thus staining the amniotic fluid green. This meconium-stained amniotic fluid can be aspirated in the fetal lungs, increasing the risk of meconium aspiration syndrome, which may cause respiratory depression. Meconium-stained amniotic fluid does not increase the risk of shoulder dystocia. Shoulder dystocia is common when there is fetopelvic disproportion as a result of excessive fetal size or maternal pelvic abnormalities. Umbilical cord prolapse is an obstetric emergency where the umbilical cord lies below the presenting part of the fetus. Brachial plexus injury is common in babies when the vaginal delivery takes place despite shoulder dystocia. 89%of students nationwide answered this question correctly. View Topics 159753784 Confidence: Nailed it Stats Issue with this question? 7. The nurse is assessing a pregnant patient and finds that the patient has inflammation around the teeth and bleeding of the gums. What should the nurse tell the patient after the assessment? Correct1 "You might be at risk for preterm labor." 2 "Your baby might have spina bifida." 3 "You may be at risk of having a miscarriage." 4 "Your baby might have delayed tooth eruption." According to research, the patients who have periodontal diseases like gingivitis, inflammation around the teeth, and bleeding of gums may have an increased risk of preterm labor. Down syndrome and hypothyroidism would cause a delay in tooth eruption in the infant. Periodontal diseases would not cause miscarriage, because it does not affect fetal development. Spina bifida results from a deficiency of folate, not from maternal periodontal diseases. 80%of students nationwide answered this question correctly. View Topics 159754926 Confidence: Nailed it Stats Issue with this question? 8. During the active phase of labor, the nurse prepares for the insertion of an intrauterine pressure catheter (IUPC) to a pregnant patient. What patient clinical presentation would be the reason for this intervention? 1 Amniotic fluid of 300 mL 2 Cervical dilation of 6 cm 3 Complete deprivation of sleep in the patient Correct4 Reduced uterine contractions (UCs) An IUPC is inserted into a pregnant patient in the active phase of labor to evaluate uterine activity (UA) accurately. Intrauterine pressure of less than 25 mm Hg may not be sufficient to cause cervical effacement and dilation. This condition also indicates that the patient has hypotonic uterine dysfunction. If the patient has reduced UCs, the nurse would insert the IUPC. Amniotic fluid of 300 mL (less than 400 mL) is evidence of premature rupture of membranes (PROM) and is not related to hypotonic uterine dysfunction. Cervical dilation of 6 cm (above 4 cm) prompts for treatment of hypertonic uterine dysfunction but not for hypotonic uterine dysfunction. If the patient had lack of sleep, then zolpidem (Ambien) would be administered to facilitate rest and sleep, but this would not warrant the insertion of the IUPC. 77%of students nationwide answered this question correctly. View Topics 149975593 Confidence: Nailed it Stats Issue with this question? 9. Which nursing action should be initiated first when there is evidence of prolapsed cord? 1 Notify the health care provider. 2 Apply a scalp electrode. 3 Prepare the woman for an emergency cesarean birth. Correct4 Reposition the woman with her hips higher than her head. The priority is to relieve pressure on the cord. Changing the maternal position will shift the position of the fetus so that the cord is not compressed. Notifying the health care provider is a priority but not the first action. Applying a scalp electrode is not appropriate at this time. Preparing the woman for an emergency cesarean birth is not the first priority . Test-Taking Tip: Key words or phrases in the stem of the question such as first, primary, early, or best are important. Similarly, words such as only, always, never, and all in the alternatives are frequently evidence of a wrong response. As in life, no real absolutes exist in nursing; however, every rule has its exceptions, so answer with care. 76%of students nationwide answered this question correctly. View Topics 159754938 Confidence: Nailed it Stats Issue with this question? 11. While caring for a pregnant patient, the nurse observes that the patient has foul-smelling vaginal discharge and maternal fever. Which type of birthing method does the nurse find suitable for the patient? 1 Vaginal delivery 2 Vacuum-assisted delivery Correct3 Cesarean section delivery 4 Forceps-assisted delivery Foul odor from the vaginal discharge, combined with maternal fever, indicates that the patient has chorioamnionitis. Cesarean delivery is preferred for the patients with chorioamnionitis. Vacuum-assisted delivery is helpful in case of prolonged labor when the mother is not sufficiently capable to bear down the fetus. Vaginal delivery is not possible in this condition because of the increased risk of chorioamnionitis and prolonged labor. Forceps-assisted delivery is useful in case of fetal malpresentation of the head and in case of insufficient efforts by the patient to bear down. 91%of students nationwide answered this question correctly. A pregnant patient has been administered magnesium sulfate as prescribed. Following the assessment, the nurse reports to the primary health care provider (PHP) that the patient's respiratory rate is 11 breaths/min. Which medication administration can the nurse expect from the PHP? 1 Dextrose solution intravenously to the patient Correct2 Calcium gluconate intravenously to the patient Incorrect3 Ringer's lactate solution intravenously to the patient 4 Increased doses of magnesium sulfate to the patient A respiratory rate of 11 breaths/min in the patient who is administered magnesium sulfate indicates magnesium toxicity. Administering calcium gluconate can counteract this. Ringer's lactate solution would help in reduced amniotic fluid levels, but it does not reduce the effect of magnesium sulfate. Dextrose solution is given for the treatment of maternal ketoacidosis. Magnesium sulfate should be discontinued when the respiratory levels are lowered in the pregnant patient. 82%of students nationwide answered this question correctly. View Topics 159754966 Confidence: Just a guess Stats Issue with this question? 10. During the first stage of labor, a pregnant patient complains of having severe back pain. What would the nurse infer about the patient's clinical condition from the observation? 1 Oligohydramnios 2 Chorioamnionitis Incorrect3 Frank breech presentation Correct4 Occipitoposterior position of the fetus If a pregnant patient has severe back pain during the first stage of labor, it indicates that the fetus is in occipitoposterior position. In this position, the fetal head (occiput) exerts pressure and presses against the sacrum of the patient. Oligohydramnios, chorioamnionitis, and frank breech presentation are not associated with typical backache in pregnant women. Oligohydramnios is the presence of low amniotic fluid volume in the pregnant woman. Chorioamnionitis is a bacterial infection of the amniotic cavity, which results in high maternal fever and a foul amniotic fluid odor. If flexed hips and extended knees of fetus are observed, then it is called frank breech presentation (malpresentation). 80%of students nationwide answered this question correctly. View Topics 159754904 Confidence: Pretty sure Stats Issue with this question? 12. While caring for a patient who is treated with terbutaline (Brethine), the nurse tries to reduce pressure on the patient's cervix to prevent preterm labor. Which nursing action would be most relevant? Correct1 Suggesting that the patient lie on her side 2 Infusing Ringer's lactate solution intravenously Incorrect3 Increasing the terbutaline (Brethine) concentration 4 Encouraging drinking a full glass of water periodically The nurse should suggest that the patient lie on her side, because this enhances placental perfusion and reduces the pressure on the cervix. Ringer's lactate solution is infused when amniotic fluid levels are lowered in a pregnant patient. Water intake prevents dehydration during labor, but it does not reduce pressure on the cervix. Nurses should not increase the terbutaline (Brethine) concentration. This may cause adverse effects and can be fatal to the mother and the fetus. 84%of students nationwide answered this question correctly. The nurse is caring for a pregnant patient who has been prescribed terbutaline (Brethine) to relax the uterus. Following the assessment, the nurse informs the primary health care provider (PHP) that it is not safe to administer terbutaline (Brethine) to the patient. Which patient condition leads the nurse to such a conclusion? Correct1 Blood pressure of 80/60 mm Hg 2 Short episode of hyperglycemia 3 Irregular episodes of dysrhythmias 4 Heart rate of less than 120 beats/min Terbutaline (Brethine) relaxes the smooth muscles and inhibits uterine activity (UA). However, the drug can adversely affect the cardiovascular system. Presence of a blood pressure lower than 90/60 mm Hg indicates an adverse effect on the cardiovascular system, and the nurse should stop the treatment to prevent further damage. Short and irregular episodes of hyperglycemia and dysrhythmias are mild and tolerable adverse effects of terbutaline (Brethine), so those conditions would not warrant the discontinuation of the medication. If the patient develops tachycardia greater than 130 beats/min, then the treatment should be stopped. 73%of students nationwide answered this question correctly. View Topics 159754962 Confidence: Pretty sure Stats Issue with this question? 2. The nurse is teaching about the use of primrose oil to a pregnant patient. Which statement would the nurse include in the teaching? "Primrose oil helps: Correct1 Ripen the cervix." 2 Prevent vaginal infections." 3 Reduce the risk of preterm labor." 4 Improve uterine contractions (UCs)." Evening primrose oil is an alternative method used to ripen the cervix of a pregnant patient before labor. Maintaining good hygiene conditions and cleaning the vaginal region regularly prevent vaginal infections. Premature labor risk is not reduced by primrose oil, because it usually occurs as a result of the rupturing of membranes prematurely. UCs or labor stimulations are improved by using castor oil. 72%of students nationwide answered this question correctly. View Topics 159754928 Confidence: Nailed it Stats Issue with this question? 3. Upon reviewing the laboratory reports, the nurse finds that the patient has meconium in the amniotic fluid. What would the nurse infer from this finding? The patient has: 1 A stillbirth. 2 Placental abruption. Correct3 Prolonged pregnancy. 4 Elevated uterine contractions (UCs). Meconium is the stool of the neonate, which is usually observed after the birth. When meconium is observed in amniotic fluid, it signifies that the patient has prolonged pregnancy. A stillbirth signifies the death of the fetus, which is not related to the presence of meconium in the amniotic fluid. Placental abruption causes early birth, whereas lowered estrogen levels cause prolonged birth. Elevated UCs is a sign of labor, which does not cause meconium in the amniotic fluid. 67%of students nationwide answered this question correctly. View Topics 149975581 Confidence: Pretty sure Stats Issue with this question? 4. The labor and delivery nurse is admitting a woman complaining of being in labor. The nurse completes the admission database and notes that which factors may prohibit the woman from having a vaginal birth? Select all that apply. Correct1 Unstable coronary artery disease Correct2 Previous cesarean birth Correct3 Placenta previa 4 Initial blood pressure of 132/87 5 History of three spontaneous abortions Indications for cesarean birth include: maternal: (1) specific cardiac disease (e.g., Marfan syndrome, unstable coronary artery disease) (2) specific respiratory disease (e.g., Guillain-Barré syndrome) (3) conditions associated with increased intracranial pressure (4) mechanical obstruction of the lower uterine segment (tumors, fibroids) (5) mechanical vulvar obstruction (e.g., extensive condylomata) (6) hstory of previous cesarean birth; fetal: (1) abnormal fetal heart rate (FHR) or pattern (2) malpresentation (e.g., breech or transverse lie) (3) active maternal herpes lesions (4) maternal human immunodeficiency virus (HIV) with a viral load of more than 1000 copies/mL (5) congenital anomalies; maternal-fetal: (1) cysfunctional labor (e.g., cephalopelvic disproportion, "failure to progress" in labor) (2) placental abruption (3) placenta previa (4) elective cesarean birth (cesarean on maternal request). The blood pressure can be elevated because of pain and is not necessarily a contraindication to vaginal birth until further assessment is completed. Having a history of three spontaneous abortions is not a contraindication to vaginal birth. 55%of students nationwide answered this question correctly. View Topics 159753796 Confidence: Nailed it Stats Issue with this question? 5. The nurse is instructed to administer 12 mg of betamethasone (Celestone) to a pregnant patient at 30 weeks' gestation. Which nursing intervention should be performed for the safe administration of the drug? 1 Give the medication by oral route. 2 Assess platelet levels after drug administration. 3 Administer increased doses of insulin with the drug. Correct4 Follow a strict time interval of 24 hours between two doses. Betamethasone (Celestone) is an antenatal glucocorticoid that is given intramuscularly (IM) to pregnant women between 24 and 34 weeks' gestation. It is administered to prevent morbidity and mortality associated with preterm labor due to respiratory distress syndrome. Therefore the nurse should administer the drug in two doses with a time interval of 24 hours because optimal fetal benefits start 24 hours after the first injection. The drug cannot be administered orally because it may impair the absorption of the drug; therefore the drug must be given only through the IM injection route. Increased doses of insulin are administered only if the patient has a history of well-controlled blood sugar levels. The drug causes increased blood glucose levels and increased white blood cells (WBCs) but not blood platelet levels. Therefore it is not useful to assess the blood platelet levels in the patient after the drug is administered. 62%of students nationwide answered this question correctly. View Topics 159753750 Confidence: Pretty sure Stats Issue with this question? 6. The nurse is caring for a pregnant patient who is administered magnesium sulfate to prevent preterm labor. Which parameters should the nurse assess in the patient to determine drug toxicity? Select all that apply. 1 Fluid intake Correct2 Respiratory status 3 Body temperature Correct4 Level of consciousness Correct5 Deep tendon reflexes Magnesium sulfate, when used as a tocolytic agent, depresses the central nervous system (CNS). The CNS depressive effect would be enhanced if the drug reaches toxic levels. CNS activity can be determined by assessing the respiratory status, level of consciousness, and deep tendon reflexes. A low respiratory rate, decreased level of consciousness, and slow reflexes indicate magnesium sulfate toxicity. Fluid intake and body temperature are not affected by CNS depression. 67%of students nationwide answered this question correctly. View Topics 159753788 Confidence: Pretty sure Stats Issue with this question? 7. The nurse is assessing a pregnant patient with multifetal gestation. Upon reviewing the medical history, the nurse finds that the patient had preterm delivery during the first pregnancy. What will the nurse do to prevent preterm delivery in the patient during the second pregnancy? Correct1 Suggest that the patient avoids smoking and consuming alcohol. 2 Suggest that the patient increases physical activity to prevent risk. 3 Administer progesterone (Prometrium) suppositories to the patient. 4 Administer a 17-alpha hydroxyprogesterone injection to the patient. To prevent preterm labor, the nurse can suggest health promotion activities to the patient, such as avoiding smoking and alcohol consumption. This helps to promote intrauterine growth and fetal development. The nurse should suggest that the patient get proper rest and care at home. The nurse should not suggest that the patient increase physical activity, which could worsen the condition. Progesterone supplements, such as progesterone (Prometrium) suppositories and 17-alpha hydroxyprogesterone injections, are ineffective in preventing preterm birth in patients with multifetal gestation. 71%of students nationwide answered this question correctly. View Topics 149975558 Confidence: Nailed it Stats Issue with this question? 8. A pregnant woman's amniotic membranes rupture. Prolapsed cord is suspected. Which intervention is the nurse's top priority? Correct1 Placing the woman in the knee-chest position. 2 Covering the cord in a sterile towel saturated with warm normal saline. 3 Preparing the woman for a cesarean birth. 4 Starting oxygen by face mask. The woman is assisted into a position (e.g., modified Sims position, Trendelenburg position, or the knee-chest position) in which gravity keeps the pressure of the presenting part off the cord. If the cord is protruding from the vagina, it may be covered with a sterile towel soaked in saline. Although preparing the woman for a cesarean birth is an appropriate intervention, relieving pressure on the cord is the nursing priority. If the cervix is fully dilated, the nurse should prepare for immediate vaginal birth. Cesarean birth is indicated only if cervical dilation is not complete. The nurse should administer O2 by facial mask at 8 to 10 L/min until birth is complete. This intervention should be initiated after pressure is relieved on the cord. 62%of students nationwide answered this question correctly. View Topics 159754932 Confidence: Pretty sure Stats Issue with this question? 9. The nurse hears the fetal heart tones by placing a fetoscope above the umbilicus of a pregnant patient. What would the nurse infer from this assessment? 1 The head of the fetus will be observed initially during birth. 2 The patient cannot be administered oxytocin (Pitocin) during labor. 3 The patient cannot be administered terbutaline (Brethine) during labor. Correct4 The lower extremities of the fetus will be observed initially during birth. The fetal heart tones are best heard above the umbilicus when the fetus is in a breech position. In the breach position, the lower extremities of the fetus are initially observed during birth. If the fetal heart sounds are heard above the umbilicus, then the head of the fetus will not be observed initially during birth. Administering oxytocin (Pitocin) and terbutaline (Brethine) are mostly related with the uterine activity of the patient. It is not related to the fetal position and heart rate. 68%of students nationwide answered this question correctly. View Topics 159753734 Confidence: Pretty sure Stats Issue with this question? 10. The nurse is teaching a group of pregnant patients about early identification of preterm labor. What signs and symptoms of preterm labor should the nurse include in the teaching? Select all that apply. 1 Upper abdominal pain Correct2 Increased vaginal discharge Correct3 Presence of vaginal bleeding 4 Decreased urinary frequency Correct5 Painful uterine contractions (UCs) Any pregnant patient runs the risk of having preterm labor and should be educated to identify its signs and symptoms. Painful UCs is a sign of preterm labor, caused by the body's attempt to deliver the baby. The patient may show signs of vaginal bleeding from a rupture of the membranes. Preterm labor can also be identified by changes in the color or amount of vaginal discharge. During labor, the vaginal discharge usually increases and becomes brown to red in color. Preterm labor is also characterized by an increase in urine frequency and pain in lower abdomen. Therefore a decrease in urine frequency and upper abdominal pain does not indicate preterm labor. 56%of students nationwide answered this question correctly. The nurse is caring for a pregnant patient who is receiving terbutaline (Brethine) treatment. The primary health care provider (PHP) adds nifedipine (Adalat) to the patient's prescription. How does the nurse administer nifedipine (Adalat) to the patient? 1 Infuse nifedipine (Adalat) along with terbutaline (Brethine). Correct2 Infuse nifedipine (Adalat) only after terbutaline (Brethine) is stopped. 3 Provide a glass full of orange juice before administering nifedipine (Adalat). 4 Provide the patient with calcium supplements before administering nifedipine (Adalat). Nifedipine (Adalat) is a calcium channel blocker that is used to relax the uterine muscles during pregnancy. Therefore the nurse should avoid administering nifedipine (Adalat) along with terbutaline (Brethine), because it causes adverse effects and may alter the heart rate and blood pressure of the patient. Infusing nifedipine (Adalat) along with terbutaline (Brethine) may impair cardiovascular functioning in the patient. Therefore the nurse should avoid infusing the drugs simultaneously. Orange juice is administered to relax the patient during labor. However, it is not necessary to administer it with nifedipine (Adalat). Nifedipine (Adalat) is administered to reduce the calcium activity; no additional calcium supplementation is required. 69%of students nationwide answered this question correctly. View Topics 149975546 Confidence: Nailed it Stats Issue with this question? 12. A laboring woman's amniotic membranes have just ruptured. The immediate action of the nurse is to: Correct1 assess the fetal heart rate (FHR) pattern. 2 perform a vaginal examination. 3 inspect the characteristics of the fluid. 4 assess maternal temperature. The first nursing action after the membranes are ruptured is to check the FHR. Compression of the cord could occur after rupture leading to fetal hypoxia as reflected in an alteration in FHR pattern, characteristically variable decelerations. The same initial action should follow artificial rupture of the membranes (amniotomy). Performing a vaginal examination, inspecting fluid characteristics, and assessing maternal temperature should be done after the FHR and pattern are assessed. 62%of students nationwide answered this question correctly.

Chapter 17

While assessing a newborn immediately after vaginal birth, the mother is concerned that the newborn's head has assumed an abnormal shape. What should the nurse inform the mother of the baby? Select all that apply. CorrectA "Your baby's head should assume a normal shape within 3 days." B "Our physical therapist will be able to fix the shape of your baby's head." C "Our experienced pediatric surgeon will need to perform surgery on your baby's head." D "Applying baby oil daily for 2 weeks should help normalize the shape of your baby's head." CorrectE "This molding of the head allowed your child to adapt to the shape of your pelvis during labor." A change in the shape of the newborn's head during delivery due to slight overlapping of the skull bones is called molding. The shape of the head becomes normal within 3 days. Molding allows the child's head to adapt to the shape of the mother's pelvis. Physical therapy, surgery, or application of baby oil is not required to fix the shape of the newborn's head. The nurse is assessing a client who is 6 months pregnant. The nurse determines that the fetus is lying in a longitudinal position with the sacrum as the presenting part and with general flexion. What fetal position should the nurse document? 1 Cephalic presentation 2 Shoulder presentation Correct3 Complete breech position 4 Single footling breech position While assessing a pregnant client, the nurse should check the fetal lie, fetal attitude, and the presenting part in order to determine the fetal position. If the fetus lies in the longitudinal or vertical position with sacrum and feet as the presenting part and with general flexion it indicates that the fetus is in complete breech position. If the presenting part is the head instead of sacrum, then the fetus is in the cephalic position. If the fetus lies in the longitudinal or vertical position with the sacrum as the presenting part but with only one leg extended at the hip and knee, the fetus is in single footling breech. What intervention must the nurse perform for the patient demonstrating increased anxiety at the onset of labor? 1 Assess the blood pressure every 10 minutes. 2 Instruct the patient to use hypnosis to relieve pain. 3 Reassure the patient that an epidural will ease pain. Correct4 Encourage a support person to stay with the patient. The patient in labor prefers to have a familiar person to support during the labor process. The nurse must encourage the support person to stay with the patient. The nurse need not assess blood pressure every 10 minutes unless the patient is in severe distress. The patient can use hypnosis to relieve pain only if the patient has learnt and practiced the technique. The nurse must not encourage the patient to use an epidural unless the primary health care provider or the patient feels the need for the same. The nurse palpates the fontanels and sutures to determine the fetal presentation. What is the feature of the anterior fontanel? Correct1 It is diamond shaped in appearance. Incorrect2 It measures about 1 cm by 2 cm. 3 It closes after 6 to 8 weeks of birth. 4 It lies near the occipital bone. The anterior fontanel is diamond shaped and measures about 3 cm by 2 cm. It closes by 18 months after birth. It lies at the junction of the sagittal, coronal, and frontal sutures. The posterior fontanel is triangular in shape and measures about 1 cm by 2 cm. It closes 6 to 8 weeks after birth. It lies at the junction of the sutures of the two parietal bones and the occipital bone. What response does the nurse expect when a laboring patient is administered analgesic medication early in labor? Correct1 Painless intrauterine contractions 2 Increased frequency of contractions 3 Increased intensity of contractions 4 Rapid descent of the fetus Uterine contractions are usually independent of external forces. Laboring patients who are administered analgesic medication have normal but painless uterine contractions. However, uterine contractions may decrease in frequency and intensity temporarily, if narcotic analgesic medication is administered early in labor. The first and second stages of labor are lengthened, and the rate of fetal descent slows down. In which stage of labor does the nurse expect the placenta to be expelled? 1 First Incorrect2 Second Correct3 Third 4 Fourth The placenta is expelled in the third stage of labor. The placenta normally separates with the third or fourth strong uterine contraction after the infant has been born. The first stage of labor lasts from the time dilation begins to the time when the cervix is fully dilated. The second stage of labor lasts from the time of full cervical dilation to the birth of the infant. The fourth stage of labor lasts for the first 2 hours after birth. What care must the nurse take when implementing aromatherapy for a patient in labor? 1 Apply oil to the skin and massage. Correct2 Ask the patient to choose the scents. 3 Apply a few drops of oil to the hair. 4 Allow inhalation of warm oil vapors. Certain scents can evoke pleasant memories and feelings of love and security. So, it is helpful if the patient is allowed to choose the scents. The oils must never be applied in full strength directly on to the skin. Most oils should be diluted in a vegetable oil base before use. Inhaling vapors from the oil can lead to unpleasant side effects like nausea or headache. Drops of essential oils can be put on a pillow or on a woman's brow or palms or used as an ingredient in creating massage oil. It is not applied to the hair. What physiologic change can the nurse expect to see in the patient during labor pain? 1 Reduced heart rate 2 Respiratory acidosis Correct3 Pallor and diaphoresis 4 Reduced blood pressure Pallor and diaphoresis is commonly observed in patients during labor pain. Blood pressure tends to increase during labor. The patient consumes more oxygen leading to hyperventilation accompanied by respiratory alkalosis. The nurse must teach the patient to perform rapid shallow breathing techniques during contractions. Intensifying pain may increase maternal heart rate during labor. What are the factors that speed up the dilation of the cervix? Select all that apply. Correct1 Strong uterine contractions 2 Scarring of the cervix Correct3 Pressure by amniotic fluid 4 Prior infection of the cervix Correct5 Force by fetal presenting part Dilation of the cervix occurs by the drawing upward of the musculofibrous components of the cervix, which are, in turn, caused by strong uterine contractions. Pressure exerted by the amniotic fluid while the membranes are intact or by the force applied by the presenting part can promote cervical dilation. Scarring of the cervix may occur following a surgery. Prior infection or surgery may slow cervical dilation. Nurses should be aware of the difference experience can make in labor pain, such as: Correct1 sensory pain for nulliparous women often is greater than for multiparous women during early labor. 2 affective pain for nulliparous women usually is less than for multiparous women throughout the first stage of labor. 3 women with a history of substance abuse experience more pain during labor. 4 multiparous women have more fatigue from labor and therefore experience more pain. Sensory pain is greater for nulliparous women because their reproductive tract structures are less supple. Affective pain is greater for nulliparous women during the first stage but decreases for both nulliparous and multiparous during the second stage. Women with a history of substance abuse experience the same amount of pain as those without such a history. Nulliparous women have longer labors and therefore experience more fatigue. After a vaginal examination, the nurse documents "RSA" on the patient's chart. What does this indicate? The presenting part is the: 1 Sacrum in the left anterior quadrant of the maternal pelvis. 2 Scapula in the right anterior quadrant of the maternal pelvis. Correct3 Sacrum in the right anterior quadrant of the maternal pelvis. 4 Scapula in the left transverse quadrant of the maternal pelvis. Fetal position is denoted by a three-letter abbreviation. The first letter denotes the location of the presenting part in the right (R) or left (L) side of the mother's pelvis. The middle letter stands for the specific presenting part of the fetus: O for occiput, S for sacrum, M for mentum, and Sc for scapula. The third letter stands for the location of the presenting part in relation to the anterior (A), posterior (P), or transverse (T) portion of the maternal pelvis. RSA indicates that the presenting part is the sacrum in the right anterior quadrant of the maternal pelvis. LSA indicates that the presenting part is the sacrum in the left anterior quadrant of the maternal pelvis. RScA shows that the presenting part is the scapula in the right anterior quadrant of the maternal pelvis. LScT indicates that the presenting part is the scapula in the left transverse quadrant of the maternal pelvis. . A woman is in the second stage of labor and has a spinal block in place for pain management. The nurse obtains the woman's blood pressure and notes that it is 20% lower than the baseline level. Which action should the nurse take? 1 Encourage her to empty her bladder. 2 Decrease her intravenous (IV) rate to a keep vein-open rate. Correct3 Turn the woman to the left lateral position or place a pillow under her hip. Incorrect4 No action is necessary because a decrease in the woman's blood pressure is expected. Turning the woman to her left side is the best action to take in this situation because this will increase placental perfusion to the infant while waiting for the doctor's or nurse-midwife's instruction. Encouraging the woman to empty her bladder will not help the hypotensive state and may cause her to faint if she ambulates to the bathroom. The IV rate should be kept at the current rate or increased to maintain the appropriate perfusion. Hypotension indicated by a 20% drop from preblock level is an emergency situation and action must be taken. During a prenatal evaluation, the nurse notes that the patient has a flat pelvis. What term does the nurse use to refer to this type of pelvis? 1 Gynecoid 2 Android 3 Anthropoid Correct4 Platypelloid About 3% of women may have a flat pelvis, which is referred to as a platypelloid pelvis. It is flattened anteroposteriorly and wide transversely. About 50% of women have gynecoid pelvis or the classic female type of pelvis. It is slightly ovoid or transversely rounded. An android pelvis resembles the male pelvis and may be found in 23% of women. It is heart shaped or angulated. The anthropoid pelvis resembles the pelvis of anthropoid apes and may be found in 24% of women. It is oval and wider anteroposteriorly. The nurse is assisting a patient who is prepared to use the paced breathing method. What does the nurse remind the patient to do at the beginning of the breathing pattern? 1 Exhale a deep breath. Correct2 Take a deep relaxing breath. 3 Take 32 breaths per minute. 4 Take three breaths per minute. The patient must remember that all breathing patterns begin with a deep, relaxing "cleansing breath" to "greet the contraction." The patient must then exhale a deep breath to "blow the contraction away." These deep breaths ensure adequate oxygen for the mother and the baby and signal that a contraction is beginning or has ended. The patient must take three to four breaths per minute when performing slow-paced breathing. As contractions increase in frequency and intensity, the patient takes shallow, fast breaths, about 32 to 40 per minute. During the vaginal examination of a laboring patient, the nurse analyzes that the fetus is in the right occiput anterior (ROA) position at -1 station. What is the position of the lowermost portion of the fetal presenting part? 1 2 cm above the ischial spine. Correct2 1 cm above the ischial spine. 3 at the level of the ischial spine. 4 1 cm below the ischial spine. When the lowermost portion of the presenting part is 1 cm above the ischial spine, it is noted as being minus (-)1. When positioned 2 cm above the ischial spine, it is -2 station. At the level of the spines the station is referred to as 0 (zero). When the presenting part is 1 cm below the spines, the station is said to be plus (+)1 What are the factors that enable the baby to initiate respiration immediately after birth? 1 Fetal respiratory movements increase during labor. Correct2 Fetal lung fluid is cleared from the air passage. 3 Arterial carbon dioxide pressure is decreased. 4 Arterial pH and bicarbonate level is increased. Fetal lung fluid is cleared from the air passage as the infant passes through the birth canal during labor and vaginal birth. There is a decrease in fetal respiratory movements during labor. Arterial carbon dioxide pressure (Pco2) increases. There is a decrease in arterial pH and bicarbonate levels. During the prenatal assessment of a patient, the nurse teaches the patient about nonpharmacologic pain management. What does the nurse tell the patient about this method? 1 It is technical and expensive. 2 It requires intensive training. Correct3 It provides the patient with a sense of control. 4 It is used only in stage I of labor. The patient makes choices about the nonpharmacologic pain management methods that are best suited. This provides the patient with a sense of control over childbirth. These measures are relatively simple and inexpensive. They do not require intensive training. However, the patient may obtain best results from the The nurse is caring for a pregnant client who is in the second stage of labor. The nurse instructs the client not to hold her breath or tighten the abdominal muscles while having intense labor pain. What is the rationale for this instruction? To prevent: Correct1 The onset of fetal hypoxia. 2 Maternal hypotension. 3 increased fetal heart rate. 4 Hemorrhoids in the client. While caring for a client who is in the second stage of the labor, the nurse should instruct the client to refrain from performing the Valsalva maneuver. During the Valsalva maneuver, the client holds her breath and tightens the abdominal muscles, which may reduce the oxygen content in the blood and cause fetal hypoxia. Tightening of the abdominal muscles increases the intrathoracic pressure and may cause hypertension in the client, but not hypotension. Due to reduced oxygen supply, the pulse rate may decrease and cause fetal bradycardia, but not tachycardia. The pressure exerted by the fetus on the vaginal wall during the delivery causes hemorrhoids, but these are not The nurse is caring for a patient who is administered local perineal infiltration anesthesia. In what situation does the nurse expect the use of local perineal infiltration anesthesia? When a(n): Correct1 Episiotomy is required. 2 Forceps birth is expected. 3 Cesarean birth is expected. 4 Vacuum extractor is to be used. Local perineal infiltration anesthesia may be used when an episiotomy is to be performed. It may also be used when lacerations must be sutured after birth in a patient who does not have regional anesthesia. Pudendal nerve block is administered late in the second stage of labor if an episiotomy is to be performed or if forceps or a vacuum extractor is to be used to facilitate birth. Low spinal anesthesia (block) may be used for cesarean birth. What intervention does the nurse provide to prevent respiratory alkalosis in the patient with hyperventilation? 1 Provide gentle massage during labor. 2 Provide the patient with nourishment. Correct3 Have the patient breathe into a paper bag. 4 Have the patient breathe at thrice the normal rate. Hyperventilation often occurs during the second phase of labor when pattern-paced breathing is adopted by the patient. The nurse must have the patient breathe into a paper bag held tightly around the mouth and nose. This enables the patient to rebreathe carbon dioxide and replace the bicarbonate ions. The patient also can breathe into cupped hands if no bag is available. Gentle massages during labor enhance comfort and reduce tension. The patient may be provided with nourishment if allowed by the primary health care provider. This provides support to the patient during labor. Maintaining a breathing rate that is no more than twice the normal rate will lessen chances of hyperventilation. What intervention does the nurse perform to provide a relaxed environment for labor? 1 Stand at the bedside. 2 Encourage rapid birth. Correct3 Control sensory stimuli. 4 Demonstrate excitement. The nurse must assist the patient by providing a quiet and relaxed environment. A relaxed environment for labor is created by controlling sensory stimuli, such as light, noise, and temperature, as per the patient's preferences. The nurse must provide reassurance and comfort by sitting rather than standing at the bedside whenever possible. The nurse must not encourage or hurry the patient for rapid birth. The nurse must maintain a calm and unhurried attitude when caring for the patient. The nurse is caring for a patient in the last trimester of pregnancy. What assessments will the patient display related to the effects of fear and anxiety during labor? An increase in: Incorrect1 Blood flow. 2 The progression of labor. 3 Contractions. Correct4 Muscle tension. Fear and excessive anxiety leads to increased muscle tension. It causes more catecholamine secretion. This increases the stimuli to the brain from the pelvis due to increased muscle tension and decreased blood flow. Thus fear and anxiety magnifies the perception of pain. Anxiety does not increase uterine contractions, but reduces the effectiveness of the contractions leading to increased discomfort. This slows the progress of labor. The nurse is caring for a patient who is using fentanyl citrate (Sublimaze) through patient-controlled analgesia (PCA) while in labor. What effects of fentanyl citrate does the nurse expect? 1 Provides long duration of action 2 Requires only a single dose Correct3 Provides quick relief to pain 4 Causes sedation and nausea Fentanyl citrate (Sublimaze) is a potent short-acting opioid agonist analgesic. Therefore it provides quick pain relief. It rapidly crosses the placenta, so it is present in the fetal blood within 1 minute after intravenous maternal administration. It is a short-acting drug, so the patient will require more frequent dosing. It is often administered as a patient controlled analgesic. It has fewer neonatal effects as compared to meperidine, and causes less maternal sedation and nausea. What does the nurse teach a couple expecting their first child about the use of therapeutic touch (TT) to relieve pain during labor? Correct1 TT uses the concept of energy fields within the body. 2 Back massage is found to be beneficial in advanced labor. 3 TT involves the application of pressure to the patient's hips. 4 Prana are thought to be in excess in people who are in pain. Therapeutic touch (TT) uses the concept of energy fields within the body, called prana. Specially trained persons lay hands on to redirect energy fields associated with pain. According to this concept, prana are thought to be deficient in some people who are in pain. Counterpressure is steady pressure applied by a support person to both hips to cope with the sensation of internal pressure. Hand and foot massage is found to be especially relaxing in advanced labor when hyperesthesia limits the patient's tolerance for touch on other parts of the body. When caring for a patient in the first phase of labor, the nurse observes that the patient is experiencing visceral pain. In which area does visceral pain occur? 1 Abdominal wall and thighs 2 Gluteal area and iliac crests 3 Lumbosacral area of the back Correct4 Lower portion of the abdomen Visceral pain in the first stage of laboroccurs in the lower portion of the abdomen. Visceral pain is a result of distention of the lower uterine segment and stretching of cervical tissue as it effaces and dilates. Pressure and traction on uterine tubes, ovaries, ligaments, nerves, and uterine ischemia also cause visceral pain. Pain that originates in the uterus radiates to the gluteal area, iliac crests, abdominal wall, thighs, lumbosacral area of the back, and lower back. This pain is called referred pain When assessing a patient for the possibility of a vaginal birth, what must the nurse keep in mind about the coccyx of the bony pelvis? 1 It is the part above the brim of the bony pelvis. Correct2 It is movable in the latter part of the pregnancy. 3 It has three planes: the inlet, midpelvis, and outlet. Incorrect4 It is ovoid and bound by the pubic arch anteriorly. The coccyx is movable in the latter part of the pregnancy, unless it has been broken and fused to the sacrum during healing. The bony pelvis is separated by the brim into the false and the true pelves. The false pelvis is the part above the brim and plays no part in childbearing. The true pelvis is involved in birth and is divided into three planes: inlet, midpelvis, and outlet. The pelvic outlet is the lower border of the true pelvis. Viewed from below it is the ovoid. It is shaped somewhat like a diamond and bound by the pubic arch anteriorly, the ischial tuberosities laterally, and the tip of the coccyx posteriorly. When monitoring a woman in labor who has just received spinal analgesia, which assessment findings should the nurse report to the health care provider? Select all that apply. Incorrect1 Maternal blood pressure of 108/79 2 Maternal heart rate of 98 Incorrect3 Respiratory rate of 14 breaths/min Correct4 Fetal heart rate of 100 beats/min Correct5 Minimal variability on a fetal heart monitor After induction of the anesthetic , maternal blood pressure, pulse, and respirations and fetal heart rate and pattern must be checked and documented every 5 to 10 minutes. If signs of serious maternal hypotension (e.g., the systolic blood pressure drops to 100 mm Hg or less or the blood pressure falls 20% or more below the baseline) or fetal distress (e.g., bradycardia, minimal or absent variability, late decelerations) develop, emergency care must be given. The nurse is studying the chart of a patient in labor. If the patient's chart indicates "RMA," what is the presenting part? Correct1 Chin 2 Sacrum 3 Scapula 4 Occiput The chin or mentum is the presenting part of the fetus if the chart indicates "RMA." If the sacrum is the presenting part, the middle letter is S. If the scapula is the presenting part, the middle letter is Sc. If the occiput is the presenting part, the middle letter is O. The lab reports of a patient in labor reveal 1+ proteinuria. Which physiologic mechanism is responsible for this lab finding? 1 Increase in cervical dilation Correct2 Breakdown of muscle tissue 3 Increased white blood cell count 4 Stagnation in the area of the vaginal introitus During normal labor, the patient's muscle tissues break down due to increased physical activity. Urine examination shows proteinuria of 1+, which is a normal finding in a patient who is in labor. Nausea and belching occur as a reflex response to full cervical dilation. An increase in white blood cell count does occur during labor; however, it is not related to normal proteinuria in labor. Great distensibility occurs in the area of the vaginal introitus during labor. The nurse is assessing a pregnant client and determines that the client has a round pelvis with moderate depth, straight sidewalls, curved sacrum, and wide subpubic arch. The nurse also finds that the client's ischial spines are blunt. How should the nurse classify the client's pelvis based on these findings? Incorrect1 Android Correct2 Gynecoid 3 Anthropoid 4 Platypelloid Based on the shape, depth, and other characteristics of the pelvis, health care providers classify it into four different types. The presence of a round pelvis with moderate depth, straight sidewalls, curved sacrum, and a wide subpubic arch indicates that the client has a gynecoid pelvis. If the client's pelvis is heart-shaped and has convergent sidewalls with a narrow subpubic arch, then it would be classified as an android pelvis. If the client's pelvis is oval with a narrow subpubic arch, then it would be classified as an anthropoid pelvis. If the client's pelvis is flat with a slightly curved sacrum, then it indicates that the client has a platypelloid pelvis. The nurse assisting a laboring patient is aware that the birth of the fetus is imminent. What is the station of the presenting part? 1 -1 2 +1 3 +3 Correct4 +5 Station is the relationship of the presenting fetal part to an imaginary line drawn between the maternal ischial spines. The placement of the presenting part is measured in centimeters above or below the ischial spines. Birth is imminent when the presenting part is at +4 to +5 cm. When the lowermost portion of the presenting part is 1 cm above the spine, it is noted as minus (-)1. When the presenting part is 1 cm below the spine, the station is said to be plus (+)1. At +3, the presenting part is still descending the birth canal. Birth is imminent when the presenting part is at +4 to +5 cm. The nurse is caring for a patient who is in the third trimester of pregnancy. The patient reports pain in the pelvic joints. What does the nurse recognize as the cause of the pain? Correct1 There is relaxation of the pelvic joints. 2 There is decreased mobility of the ligaments. Incorrect3 The joint of the symphysis pubis is narrowing. 4 The pelvis may not support vaginal birth. In the third trimester of pregnancy, the pelvic joints relax, leading to pain. There is increased mobility of the pelvic joints and ligaments as a result of hormonal influences. Widening of the joint of the symphysis pubis and the resulting instability may cause pain in any or all of the pelvic joints. Pain in the pelvic joints does not indicate that the pelvis may not support vaginal birth. A heart shaped android pelvis may not support spontaneous vaginal birth. With regard to what might be called the tactile approaches to comfort management, nurses should be aware that: Incorrect1 either hot or cold applications may provide relief, but they should never be used together in the same treatment. 2 acupuncture can be performed by a skilled nurse with just a little training. Correct3 hand and foot massage may be especially relaxing in advanced labor when a woman's tolerance for touch is limited. 4 therapeutic touch (TT) uses handheld electronic stimulators that produce sympathetic vibrations A woman in latent labor who is positive for opiates on the urine drug screen is complaining of severe pain. Maternal vital signs are stable, and the fetal heart monitor displays a reassuring pattern. The nurse's most appropriate analgesic for pain control is: Correct1 fentanyl (Sublimaze). 2 promethazine (Phenergan). 3 butorphanol tartrate (Stadol). 4 nalbuphine (Nubain). Fentanyl is a commonly used opioid agonist analgesic for women in labor. It is fast and short acting. This patient may require higher than normal doses to achieve pain relief due to her opiate use. Phenergan is not an analgesic. Phenergan is an ataractic (tranquilizer) that may be used to augment the desirable effects of the opioid analgesics but has few of those drugs' undesirable effects. Stadol is an opioid agonist-antagonist analgesic. Its use may precipitate withdrawals in a patient with a history of opiate use. Nubain is an opioid agonist-antagonist analgesic. Its use may precipitate withdrawals in a patient with a history of opiate use. The nurse is caring for a nulliparous patient in labor. How is the experience for a nulliparous patient different from that of a multiparous patient? The patient experiences: 1 Less sensory pain during early labor. Incorrect2 Greater sensory pain in the second stage of labor. Correct3 Greater fatigue due to longer duration of labor. 4 Greater affective pain in the second stage of labor. Parity influences the perception of labor pain. The nulliparous patient often has longer labor and therefore, greater fatigue. Sensory pain for nulliparous women is often greater than that for multiparous women during early labor, because their reproductive tract structures are less supple. Affective pain in the nulliparous patient is greater in the first stage as compared to a multiparous patient. It decreases for both patients during the second stage of labor. During the second stage of labor, the multiparous patient may experience greater sensory pain than the nulliparous patient. This is because tissues of the multiparous patient are more supple and increase the speed of fetal descent, thereby intensifying the pain. What does the nurse teach a group of expectant mothers about slow-paced breathing? It is: Correct1 Performed at half the normal breathing rate. 2 Initiated at the onset of the first stage of labor. Incorrect3 Beneficial if performed with full concentration. 4 Repeated at the onset of the second stage of labor. Slow-paced breathing is performed at approximately half the patient's normal breathing rate. It is initiated in the first stage of labor when the patient can no longer walk or talk through contractions. Patterned-pace breathing, not slow-paced breathing, is performed during the onset of the second stage of labor. Modified-paced breathing requires the patient to remain alert and concentrate more fully on breathing. Concerning the third stage of labor, nurses should be aware that: Incorrect1 the placenta eventually detaches itself from a flaccid uterus. Correct2 the duration of the third stage may be as short as 3 to 5 minutes. 3 it is important that the dark, roughened maternal surface of the placenta appear before the shiny fetal surface. 4 the major risk for women during the third stage is a rapid heart rate. The duration may be as short as 3 to 5 minutes, although up to 1 hour is considered within normal limits. The third stage of labor lasts from birth of the fetus until the placenta is delivered. The placenta cannot detach itself from a flaccid (relaxed) uterus. Which surface of the placenta comes out first is not clinically important. The major risk for women during the third stage of labor is postpartum hemorrhage. The risk of hemorrhage increases as the length of the third stage increases. In order to assess the health of the mother accurately during labor, the nurse should be aware that: Incorrect1 the woman's blood pressure increases during contractions and falls back to prelabor normal between contractions. 2 use of the Valsalva maneuver is encouraged during the second stage of labor to relieve fetal hypoxia. 3 having the woman point her toes reduces leg cramps. Correct4 the endogenous endorphins released during labor raise the woman's pain threshold and produce sedation. Physiologic anesthesia of the perineal tissues, caused by the pressure of the presenting part, decreases the mother's perception of pain. Blood pressure increases during contractions but remains somewhat elevated between them. Use of the Valsalva maneuver is discouraged during second stage labor because of a number of potentially unhealthy outcomes, including fetal hypoxia. Pointing the toes can cause leg cramps, as can the process of labor itself. What will the nurse mention about the effect of secondary powers during labor to the patient? Correct1 Contractions are expulsive in nature. 2 The intraabdominal pressure is decreased. Incorrect3 Contractions move downward in waves. 4 Contractions begin at pacemaker points. As soon as the presenting part of the fetus touches the pelvic floor, the patient uses secondary powers or bearing-down efforts. This results in contractions that are expulsive in nature. The voluntary bearing-down efforts of the patient also result in increased intraabdominal pressure. Primary powers signal the beginning of labor with involuntary contractions that move downward over the uterus in waves. These contractions begin at pacemaker points in the thickened muscle layers of the upper uterine segment. With regard to systemic analgesics administered during labor, nurses should be aware that: 1 systemic analgesics cross the maternal blood-brain barrier as easily as they do the fetal blood-brain barrier. Correct2 effects on the newborn can include significant neonatal respiratory depression. 3 IM administration is preferred over IV administration. 4 IV patient-controlled analgesia (PCA) results in increased use of an analgesic. Effects depend on the specific drug given, the dosage, and the timing. Systemic analgesics cross the fetal blood-brain barrier more readily than the maternal blood-brain barrier. IV administration is preferred over IM administration because the drug acts faster and more predictably. PCAs result in decreased use of an analgesic. The nurse knows that the second stage of labor, the descent phase, has begun when the: 1 amniotic membranes rupture. Incorrect2 cervix cannot be felt during a vaginal examination. Correct3 woman experiences a strong urge to bear down. 4 presenting part is below the ischial spines. During the descent phase of the second stage of labor, the woman may experience an increase in the urge to bear down. Rupture of membranes has no significance in determining the stage of labor. The second stage of labor begins with full cervical dilation. Many women may have an urge to bear down when the presenting part is below the level of the ischial spines. This can occur during the first stage of labor, as early as 5 cm of dilation After change of shift report, the nurse assumes care of a multiparous patient in labor. The woman is complaining of pain that radiates to her abdominal wall, lower back, buttocks, and down her thighs. Before implementing a plan of care, the nurse should understand that this type of pain is: Incorrect1 visceral. Correct2 referred. 3 somatic. 4 afterpain. As labor progresses the woman often experiences referred pain. This occurs when pain that originates in the uterus radiates to the abdominal wall, the lumbosacral area of the back, the gluteal area, and thighs. The woman usually has pain only during a contraction and is free from pain between contractions. Visceral pain is that which predominates the first stage of labor. This pain originates from cervical changes, distention of the lower uterine segment, and uterine ischemia. Visceral pain is located over the lower portion of the abdomen. Somatic pain is described as intense, sharp, burning, and well localized. This results from stretching of the perineal tissues and the pelvic floor. This occurs during the second stage of labor. Pain experienced during the third stage of labor or afterward during the early postpartum period is uterine. This pain is very similar to that experienced in the first stage of labor. The nurse caring for a patient in labor asks the support person to use heat application for pain relief. Why is heat applied to the body? 1 To relieve muscle spasms 2 To relax anesthetized areas Correct3 To relieve general backache 4 To provide comfort in the chest The application of heat enhances relaxation and reduces pain during labor. Heat application is effective for general backache from fatigue or back pain caused by a posterior presentation. Cold applications, such as cold cloths, frozen gel packs, or ice packs, may be applied to relieve muscle spasms. Cold, not heat, is applied to the chest to increase comfort when the patient feels warm. Neither heat nor cold should be applied over ischemic or anesthetized areas because tissues can be damaged. Nurses can help their patients by keeping them informed about the distinctive stages of labor. What description of the phases of the first stage of labor is accurate? Incorrect1 Latent: mild, regular contractions; no dilation; bloody show; duration of 2 to 4 hours Correct2 Active: moderate, regular contractions; 4 to 7 cm dilation; duration of 3 to 6 hours 3 Lull: no contractions; dilation stable; duration of 20 to 60 minutes 4 Transition: very strong but irregular contractions; 8 to 10 cm dilation; duration of 1 to 2 hours The active phase is characterized by moderate, regular contractions; 4 to 7 cm dilation; and a duration of 3 to 6 hours. The latent phase is characterized by mild to moderate, irregular contractions; dilation up to 3 cm; brownish to pale pink mucus; and a duration of 6 to 8 hours. No official "lull" phase exists in the first stage. The transition phase is characterized by strong to very strong, regular contractions; 8 to 10 cm dilation; and a duration of 20 to 40 minutes. After a pelvic examination of a pregnant woman, the nurse concludes that the client may require a forceps-assisted delivery. What pelvic finding would support this conclusion? 1 Slightly ovoid-shaped. 2 Moderate depth. 3 Blunt ischial spines. Correct4 Subpubic arch is narrow. The presence of a narrow subpubic arch indicates that the client has either an android pelvis or an anthropoid pelvis. In such situations, the fetus may not easily pass through the birth canal and the client may require a forceps-assisted delivery. The presence of a slightly ovoid pelvis with moderate depth and blunt ischial spines indicates a gynecoid pelvis. Women with gynecoid pelvises have wider subpubic arches, which allow the fetus to more easily pass through the birth canal. These clients may not require forceps-assisted deliveries. A patient who is pregnant for the first time is anxious about the pain related to labor. Which physiologic factor does the nurse relate that may increase the intensity of pain during childbirth? Correct1 History of dysmenorrhea 2 Low level of prostaglandin 3 Cramps during menstruation 4 High level of β-endorphins Patients with a history of dysmenorrhea may experience increased pain during childbirth. These patients are known to have high levels of prostaglandin. Low levels of prostaglandin do not increase the intensity of pain during labor. The level of beta (β) endorphins increases during pregnancy and birth. β endorphins are endogenous opioids that reduce pain. Back pain associated with menstruation also increases the likelihood of contraction-related low back pain. The nurse should tell a primigravida that the definitive sign indicating that labor has begun is: Correct1 progressive uterine contractions with cervical change. 2 lightening. Incorrect3 rupture of membranes. 4 passage of the mucous plug (operculum). Regular, progressive uterine contractions that increase in intensity and frequency are the definitive sign of true labor along with cervical change. Lightening is a premonitory sign indicating that the onset of labor is getting closer. Rupture of membranes usually occurs during labor itself. Passage of the mucous plug is a premonitory sign indicating that the onset of labor is getting closer What care must the nurse take when assisting a laboring patient with hydrotherapy? 1 Initiate hydrotherapy in the first stage of labor at 3 cm. Incorrect2 Ensure water is warm at 32.5° to 34° C (90.5° to 93.2°F). 3 Check the fetal heart rate (FHR) with internal electrodes. Correct4 Obtain the approval of the primary health care provider. Agency policy must be consulted to determine if the approval of the laboring woman's primary health care provider is required. The nurse must ensure that all criteria are met in terms of the status of the maternal and fetal unit. Hydrotherapy is usually initiated when the patient is in active labor, at approximately 5 cm. This reduces the risk of a prolonged labor. FHR monitoring is done by Doppler, fetoscope, or wireless external monitor when hydrotherapy is in use. Use of internal electrodes for monitoring FHR is contraindicated in jet hydrotherapy. The temperature of the water should be maintained at 36° to 37° C (96.8° to 98.6° F). What intervention must the nurse perform while caring for a patient who is set to receive spinal anesthesia? Correct1 Assess maternal vital signs. 2 Monitor for signs of toxicity. 3 Keep side rails up on the bed. Incorrect4 Have oxygen readily available. The nurse must assess maternal vital signs, level of hydration, labor progress, and fetal heart rate (FHR) and pattern before the procedure is initiated. This helps to prepare for a possible emergency. When the procedure is initiated, the nurse ensures that oxygen and suction are readily available to ensure airway at all times. While the anesthesia is in effect, the nurse must monitor the patient for signs of toxicity and keep the side rails up on the bed to ensure patient safety. A patient will be administered a pudendal nerve block late in the second stage of labor. What effect of the pudendal nerve block does the nurse expect in the patient? 1 An increase in fetal heart rate (FHR) 2 Patient feels an increase in the bearing-down reflex Incorrect3 Relief of pain from uterine contractions Correct4 Decrease in pain in the vagina and perineum A pudendal nerve block anesthetizes the pudendal nerves peripherally. It relieves pain in the lower vagina, vulva, and perineum. It does not relieve the pain from uterine contractions. The bearing-down reflex is lessened or lost completely. It tends to cause fewer fetal complications and does not affect the FHR. Which factors contribute to an increase in a patient's pain tolerance level? Select all that apply. 1 Need for epidural analgesia Correct2 Use of relaxation techniques Correct3 Desire for natural vaginal birth Correct4 Quiet and relaxed ambience Incorrect5 Use of pharmacologic methods Pain tolerance refers to the level of pain a laboring woman is willing to endure. The factors that influence a woman's pain tolerance level include desire for a natural vaginal birth, use of relaxation techniques for comfort, and the quiet and relaxed ambience during labor. If the patient has reduced pain tolerance, the patient is likely to ask for pharmacologic interventions for pain relief. Epidural analgesia is used to relieve pain experienced during natural vaginal birth. The nurse is assessing a pregnant patient who is paralyzed due to a spinal injury at the level of the twelfth thoracic vertebra. Presently, she is in full-term gestation and under nursing care. What should the nurse inform the patient? Incorrect1 "You may have a prolonged labor." Correct2 "You may have painless uterine contractions." 3 "Your uterus may not contract due to paralysis." 4 "Your baby may develop neurologic problems." The pregnant patient is paralyzed due to a spinal lesion above the twelfth thoracic vertebra. In this case, the patient would not perceive the uterine contractions and thus would have painless uterine contractions. The spinal injury has no effect on the duration of labor. The uterine contractions are not dependent on any external forces, and thus this patient would have normal uterine contractions. Neurologic problems in the fetus are not a complication associated with spinal cord injury. The nurse is teaching a patient, who is pregnant for the first time, about the signals that indicate the beginning of labor. Which sign will the nurse mention as a signal for the beginning of labor? Correct1 Involuntary contractions 2 Pain in the pelvic joints 3 100% effacement of the cervix 4 Full dilation of the cervix Involuntary uterine contractions, or the primary powers, signal the beginning of labor. Pain in the pelvic joints does not signal the beginning of labor. It is a result of the widening of the joint of the symphysis pubis and the resulting instability. The primary powers are responsible for the effacement and dilation of the cervix and the descent of the fetus. Effacement is the shortening and thinning of the cervix during the first stage of the labor. However, 100% effacement would indicate that the patient is well established in the labor process. Dilation of the cervix is the enlargement or widening of the cervical opening and cervical canal. This dilation progresses after the labor has begun. Full cervical dilation marks the end of the first stage of labor. What are the common signs that are observed in the days preceding labor? Select all that apply. Correct1 Persistent low backache 2 Sudden increase in lethargy Correct3 Blood-tinged cervical mucus Incorrect4 Increase in weight up to 1.5 kg Correct5 Profuse vaginal mucus Common signs that precede labor include persistent low backache and sacroiliac distress as a result of relaxation of the pelvic joints. Brownish or blood-tinged cervical mucus may be passed. The vaginal mucus becomes more profuse in response to the extreme congestion of the vaginal mucous membranes. In the days preceding labor, women generally have a sudden surge of energy. They also experience a loss of 0.5 to 1.5 kg in weight. This is caused by water loss resulting from electrolyte shifts that in turn are produced by changes in estrogen and progesterone levels. The nurse is monitoring the fetal heart rate (FHR) of a patient in week 20 of gestation. What FHR can the nurse expect at this stage? Incorrect1 100 beats/min 2 120 beats/min 3 140 beats/min Correct4 160 beats/min The FHR is higher earlier in the gestation. At 20 weeks' gestation, the FHR on an average is 160 beats/min approximately. The rate decreases progressively as the maturing fetus reaches term. An FHR of 100 beats/min is below the normal FHR. The normal range of FHR is 110 to 160 beats/min. An FHR of 120 beats/min at 20 weeks' gestation is not normal. The average FHR at term is 140 beats/min. What intervention must the nurse perform when assisting a patient in labor who has been administered nitrous oxide for analgesia? Incorrect1 Monitor fetal heart rate (FHR) every 2 minutes. 2 Monitor maternal blood pressure every 2 minutes. 3 Instruct the patient to inhale after contraction begins. Correct4 Instruct the patient to breathe normally between contractions. The nurse must instruct the patient to remove the mask and breathe normally between contractions. The use of nitrous oxide does not depress uterine contractions or cause adverse reactions in the fetus and newborn. The nurse need not monitor FHR or maternal blood pressure every 2 minutes. The patient must place the mask over the mouth and nose or insert the mouthpiece 30 seconds before the onset of a contraction (if regular), or as soon as a contraction begins (if irregular). What does the nurse ensure while following the procedure of the intradermal water block? 1 Administer the second injection after 15 minutes. Correct2 Ensure that a bleb appears on the skin after injection. Incorrect3 Inject in two locations on the lower back for pain relief. 4 Use a fine-gauge needle to inject 0.5 mL of sterile water. The nurse ensures that a bleb appears on the skin after the injection. An intradermal water block involves the injection of small amounts of sterile water (0.05 to 0.1 mL) by using a fine- gauge needle. Sterile water is injected into four locations on the lower back: two over each posterior superior iliac spine (PSIS) and two 3 cm below and 1 cm medial to the PSIS. The injections must be administered simultaneously to decrease the pain of the injections. What kind of anesthesia does the nurse expect the primary health care provider to prescribe to a patient who is to have an emergency cesarean birth due to fetal distress? Correct1 General anesthesia Incorrect2 Pudendal nerve block 3 Nitrous oxide with oxygen 4 Local infiltration anesthesia General anesthesia may be necessary if indications necessitate rapid birth (vaginal or emergent cesarean), when there is a pressing need for time and/or primary health care providers to perform a block. Pudendal nerve block is administered late in the second stage of labor. It may be required if an episiotomy is to be performed or if forceps or a vacuum extractor is to be used to facilitate birth. Nitrous oxide mixed with oxygen can be inhaled in 50% or less concentration to provide analgesia during the first and second stages of labor. Local infiltration anesthesia may be used when an episiotomy is to be performed or when lacerations must be sutured after birth in a woman who does not have regional anesthesia. The nurse is briefing a patient who is pregnant for the first time about lightening. Which statement should the nurse mention to describe lightening to the patient? 1 It occurs when true labor is in progress. Correct2 It allows the patient to breathe more easily. 3 It decreases the pressure on the bladder. 4 It leads to decreased urinary frequency. When the fetal head descends into the true pelvis during lightening, the patient will feel less congested and can breathe more easily. In a first-time pregnancy, lightening occurs about 2 weeks before term. In a multiparous pregnancy, lightening may not take place until after the uterine contractions are established and the true labor is in progress. This shift increases the pressure on the bladder and causes a return of urinary frequency. A patient asks the nurse about the use of transcutaneous electrical nerve stimulation (TENS). What does the nurse teach about TENS? 1 It involves the use of one pair of electrodes. 2 It is kept at low intensity during contractions. Correct3 It releases continuous low-intensity impulses. 4 It is useful for pain in the second stage of labor. When TENS is applied for pain relief, the electrodes provide continuous low-intensity electrical impulses or stimuli from a battery-operated device. TENS is most useful for lower back pain during the early first stage of labor. TENS involves the placing of two pairs of flat electrodes on either side of the woman's thoracic and sacral spine. During a contraction, the patient increases the stimulation from low to high intensity by turning the control knobs on the device. A laboring woman becomes anxious during the transition phase of the first stage of labor and develops a rapid and deep respiratory pattern. She complains of feeling dizzy and light-headed. The nurse's immediate response should be to: 1 encourage the woman to breathe more slowly. Correct2 help the woman breathe into a paper bag. 3 turn the woman on her side. 4 administer a sedative. The woman is exhibiting signs of hyperventilation. This leads to a decreased carbon dioxide level and respiratory alkalosis. Rebreathing her air would increase the carbon dioxide level. Telling her to breathe more slowly does not ensure a change in respirations. Turning her on her side will not solve this problem. Administration of a sedative could lead to neonatal depression because this woman, being in the transition phase, is near the birth process. The side-lying position is appropriate for supine hypotension. The nurse is caring for a Native-American patient during labor. What does the nurse keep in mind about the patient's cultural approach to pain? The patient may: Incorrect1 Not exhibit reactions to pain. 2 Be vocal in response to pain. Correct3 Use remedies from indigenous plants. 4 Express pain vocally late in labor. The Native-American patient may use medications or remedies made from ethnic plants. They are often stoic in response to labor pain. Hispanic patients may be stoic until late in labor, when they may become vocal and request pain relief. Chinese patients may not exhibit reactions to pain. Arabian or Middle Eastern patients may be vocal in response to labor pain and request medication for pain relief. A primigravida asks the nurse about signs she can look for that indicate that the onset of labor is getting closer. The nurse should describe: 1 weight gain of 1 to 3 lbs. 2 quickening. 3 fatigue and lethargy. Correct4 bloody show. Passage of the mucous plug (operculum) also termed pink/bloody show occurs as the cervix ripens. Women usually experience a weight loss of 1 to 3 lbs. Quickening is the perception of fetal movement by the mother, which occurs at 16 to 20 weeks of gestation. Women usually experience a burst of energy or the nesting instinct. The nurse is assisting a patient who has just received spinal anesthesia (block). What intervention does the nurse perform to prevent supine hypotension? Correct1 Place a wedge under one of the hips. 2 Place the patient in an upright position. Incorrect3 Position the patient to a supine position. 4 Assist the patient to modified Sims' position. The nurse places a wedge under one of the hips of the patient or tilts the operating table to displace the uterus laterally so as to prevent supine hypotensive syndrome. The patient is assisted to modified Sims' position with back curved to widen the intervertebral space to inject anesthetic solution into the spinal canal. After the anesthetic solution has been injected, the patient may be positioned upright to allow the hyperbaric anesthetic solution to flow downward to obtain the lower level of anesthesia suitable for a vaginal birth. To obtain the higher level of anesthesia desired for cesarean birth, the patient is to be positioned supine with head and shoulders slightly elevated. The nurse is assisting a patient in labor. What breathing pattern must the nurse remind the patient to use when the contractions increase in frequency and intensity in the first phase of labor? 1 Slow-paced breathing Correct2 Modified-paced breathing 3 3:1 pattern-paced breathing 4 4:1 pattern-paced breathing During the first phase of labor, as contractions increase in frequency and intensity, the patient must change breathing patterns to a modified-paced breathing technique. This breathing pattern is shallower and faster than the patient's normal rate of breathing, but should not exceed twice the resting respiratory rate. Slow-paced breathing is performed at approximately half the normal breathing rate and is initiated when the patient can no longer walk or talk through contractions. Patterned-paced breathing is suggested in the second phase of labor. It consists of panting breaths combined with soft blowing breaths at regular intervals. The patterns may vary, the 3:1 pattern is pant, pant, pant, blow and the 4:1 pattern is pant, pant, pant, pant, and blow. What does the nurse teach the patient about the benefits of combining relaxation with walking, slow dancing, or rocking? This method may help: Incorrect1 Distract and divert from pain. 2 Increase abdominal pressure. 3 Manage stress throughout life. Correct4 The baby rotate through the pelvis. When relaxation is combined with an activity such as walking, slow dancing, rocking, and position changes, it helps the baby to rotate through the pelvis. Simple relaxation exercises can help couples with the stresses of pregnancy, childbirth, and adjustment to parenting and can be a form of stress management throughout life. Breathing techniques provide distraction and diversion from pain. It helps to increase abdominal pressure in the second stage of labor and assists in expelling the fetus The nurse is teaching a class on childbirth. What does the nurse teach about signs of local anesthetic toxicity? Select all that apply. Correct1 Tinnitus Correct2 Metallic taste Correct3 Slurred speech 4 Long stage II labor 5 Increased use of oxytocin The central nervous system can be affected if a local anesthetic agent is injected accidentally into a blood vessel leading to local anesthetic toxicity . Signs include metallic taste, tinnitus, and slurred speech. Longer stage II labor and increased use of oxytocin are side effects of epidural and spinal anesthesia. Which condition would the nurse recognize as a contraindication to subarachnoid and epidural blocks? 1 Maternal hypertension Incorrect2 Maternal hypervolemia Correct3 Infection at injection site 4 Reduced intracranial pressure If the patient has an infection at the needle insertion site, subarachnoid or epidural blocks are contraindicated. Infection can spread through the peridural or subarachnoid spaces if the needle traverses an infected area. Maternal hypovolemia, not hypervolemia, leads to increased sympathetic tone to maintain the blood pressure. An anesthetic technique that blocks the sympathetic fibers can produce significant hypotension that can endanger the mother and fetus. Maternal hypotension, not hypertension, is contraindicated for anesthetic blocks. Increased intracranial pressure caused by a mass lesion is a contraindication for anesthetic blocks. The nurse is assessing a patient in labor. The nurse documents the progress in the effacement of the cervix and little increase in descent. Which phase of labor is the patient in? Correct1 Latent phase 2 Active phase 3 Transition phase 4 Descent phase The patient is in the latent phase of the first stage of labor. In this phase, there is more progress in the effacement of the cervix and little increase in the descent of the fetus. In the active and transition phases, there is more rapid dilation of the cervix and increased rate of descent of the presenting part of the fetus. The descent phase, or active pushing phase, occurs in the second stage of labor. In this phase, the patient has a strong urge to bear down as the presenting part of the fetus descends and presses on the stretch receptors of the pelvic floor. The nurse is assessing the vital signs of a patient who is in the fourth stage of labor. The nurse finds that the patient's heart rate has decreased. What would be the most probable reason for the change in heart rate during labor? 1 Cardiac arrest Correct2 Increased cardiac output 3 Postpartum hemorrhage Incorrect4 Low systolic blood pressure The uterus releases blood into the maternal vascular system when it contracts during labor. This rise in the volume of blood in the maternal cardiovascular system causes increased cardiac output, leading to a decrease in heart rate. Heart rate returns to its prelabor levels within the first postpartum hour. The patient does not exhibit any signs of cardiac arrest such as shortness of breath, dizziness, or chest pain. Postpartum hemorrhage can cause an increase in heart rate, which is called reactive tachycardia. The blood pressure is slightly high or normal in the fourth stage of labor. Blood pressure changes in the fourth stage do not affect cardiac output Nurses can advise their patients that which of these signs precede labor? Select all that apply. Correct1 A return of urinary frequency as a result of increased bladder pressure Correct2 Persistent low backache from relaxed pelvic joints Correct3 Stronger and more frequent uterine (Braxton Hicks) contractions 4 A decline in energy, as the body stores up for labor 5 Uterus sinks downward and forward in first-time pregnancies. After lightening, a return of the frequent need to urinate occurs as the fetal position causes increased pressure on the bladder. In the run-up to labor , women often experience persistent low backache and sacroiliac distress as a result of relaxation of the pelvic joints. Before the onset of labor, it is common for Braxton Hicks contractions to increase in both frequency and strength. Bloody show may be passed. A surge of energy is a phenomenon that is common in the days preceding labor. In first-time pregnancies, the uterus sinks downward and forward about 2 weeks before term. The nurse is assisting a patient in labor. What neurologic changes does the nurse expect in the laboring patient? 1 Decreased pain threshold Correct2 Amnesia and sedation 3 Increased perception of pain Incorrect4 Patient is elated between contractions The patient experiences amnesia between contractions in the second stage of labor. Endogenous endorphins produced by the body cause sedation. This also raises the pain threshold. Pressure of the presenting part causes physiologic anesthesia of the perineal tissues. This decreases the perception of pain. At the start of labor, the patient may be euphoric. Euphoria first gives way to increased seriousness. Second, it gives way to amnesia between contractions. Finally, it leads to elation or fatigue after giving birth. The nurse notes that the fetus in a laboring patient is in brow presentation. What is the expected occipitomental diameter? 1 9.25 cm 2 9.5 cm 3 12.00 cm Correct4 13.5 cm In a brow presentation, the presenting part is the mentum or chin. The occipitomental diameter is 13.5 cm at term, which is too large to permit the infant's head to enter the pelvis region of the mother. The biparietal diameter, which is about 9.25 cm at term, is the largest transverse diameter. The smallest anteroposterior diameteris, the suboccipitobregmatic diameter, which is about 9.5 cm at term, is in a vertex presentation. In a sinciput presentation, theoccipitofrontal diameter is about 12.00 cm at term, with moderate extension of the head. After delivering a healthy baby boy with epidural anesthesia, a woman on the postpartum unit complains of a severe headache. Which actions should the nurse anticipate in the woman's plan of care? Select all that apply. 1 Keeping the head of bed elevated at all times Correct2 Administering oral analgesics 3 Avoiding caffeine Correct4 Assisting with a blood patch procedure Correct5 Frequently monitoring vital signs Conservative management for a PDPH includes administration of oral analgesics and methylxanthines (e.g., caffeine or theophylline). Methylxanthines cause constriction of cerebral blood vessels and may provide symptomatic relief. An autologous epidural blood patch is the most rapid, reliable, and beneficial relief measure for PDPH. Close monitoring of vital signs is essential. The nurse should suspect the patient is suffering from a postdural puncture headache (PDPH). Characteristically, assuming an upright position triggers or intensifies the headache, whereas assuming a supine position achieves relief (Hawkins and Bucklin, 2012). When assisting a patient in labor, the nurse expects to observe the cardinal movements that lead to the birth of the baby. Arrange the movements in the order of their occurrence. Incorrect 1. Internal rotation Incorrect 2. Extension Incorrect 3. Descent Incorrect 4. Flexion Incorrect 5. Restitution Incorrect 6. Engagement The cardinal movements that occur in a vertex presentation are engagement, descent, flexion, internal rotation, extension, restitution (external rotation), and finally birth by expulsion. The fetal head is said to be engaged in the pelvic inlet when the biparietal diameter of the head passes through the pelvic inlet. During descent, the presenting part progresses through the pelvis. As soon as the descending head meets resistance from the cervix or pelvic wall or pelvic floor, it undergoes flexion. The fetus flexes such that the chin is brought into closer contact with the fetal chest. Internal rotation begins at the level of the ischial spines but is not completed until the presenting part reaches the lower pelvis. When the fetal head reaches the perineum for birth, it undergoes extension. It is deflected anteriorly by theperineum. Restitution occurs after the head is born.It rotates briefly to the position it occupied when it was engaged in the inlet. The nurse is caring for a patient who had a normal vaginal birth. The patient is concerned about the shape of the infant's head. What does the nurse tell the patient? Select all that apply. Correct1 The bones of the skull continue to grow after birth. Correct2 The shape of the head undergoes molding during labor. Incorrect3 The head assumes its normal shape within a month. 4 The skull bones of an infant are generally firmly united. Correct5 The sutures and fontanels make the skull flexible. The bones of the skull continue to grow for some time after birth to accommodate the infant's brain. During labor, the shape of the head gets molded as the bones undergo a slight overlapping. The sutures and fontanels are membranous structures that unite the skull bones and make the skull flexible. Molding can be extensive, but the heads of most newborns assume their normal shape within 3 days after birth. The skull bones are held together by sutures and fontanels and are not firmly united in an infant. The nurse is performing the pelvic examination of a patient during the prenatal visit. Which pelvic type is least favorable for a vaginal birth? 1 Gynecoid Correct2 Android Incorrect3 Anthropoid 4 Platypelloid The android pelvis is heart shaped and angulated. The sidewalls are convergent, the sacrum is slightly curved, and the terminal portion is often beaked. The subpubic arch is narrow, often resulting in cesarean births or difficult vaginal forceps births. It is least favorable for vaginal birth. The gynecoid pelvis is slightly ovoid or transversely rounded. The sidewalls are straight, and the sacrum is deep and curved. The subpubic arch is wide, thus enabling spontaneous vaginal births. The anthropoid pelvis is oval and wider anteroposteriorly. The sidewalls are straight, sacrum slightly curved. The subpubic arch is narrow and may result in a forceps vaginal birth. The platypelloid pelvis is flattened anteroposteriorly and wide transversely. The sidewalls are straight, the sacrum slightly curved, and the subpubic arch is wide, resulting in s

CH 13, 14

1. After reviewing the laboratory reports of a pregnant patient at term, the primary health care provider (PHP) advised the nurse to administer intravenous (I.V.) fluids to the patient. What is the reason for giving such advice? Correct1 Dehydration 2 Hypertension 3 Maternal hyperglycemic 4 Preterm labor I.V. fluids are administered to increase the amount of fluids and restore the electrolyte balance. As the patient is dehydrated, the PHP advises the nurse to administer I.V. fluids. Administration of I.V. fluids as a medical treatment for the prevention of preterm labor is not indicated unless medical management involves use of therapeutic protocols such as magnesium sulfate. As the patient is at term, preterm labor would not be a factor. Administering fluids may increase the venous pressure, thereby enhancing the blood pressure. Therefore I.V. fluids must not be administered if the patient has hypertension. Other prospective medical management should be initiated if maternal hypertension is noted. I.V. fluids should not be administered to hyperglycemic patients, but rather other prospective medical management should be initiated if maternal hyperglycemia is noted and deemed to be significant. 93%of students nationwide answered this question correctly. View Topics 2. 159721891 Confidence: Just a guess Stats Issue with this question? 2. The nurse places a specialized halogen light near the abdomen of a pregnant patient. What is the rationale for this nursing intervention? 1 To correct maternal uterine activity (UA) 2 To correct maternal orthostatic hypotension 3 To start early deceleration in fetal heart rate (FHR) Correct4 To initiate accelerations in the fetal heart rate (FHR) A specialized halogen light and fetal scalp stimulating methods are used for initiating accelerations in the FHR. Maternal uterine activity (UA) is corrected by administering oxytocin (Pitocin) or tocolytics as prescribed. Halogen light does not have any effect in controlling UA. Maternal hypotension is corrected by changing the position of the patient and by elevating the legs. Early decelerations in the FHR are caused by uterine contractions (UCs), not by placing a halogen light near the pregnant patient's abdomen. 79%of students nationwide answered this question correctly. View Topics 3. 159721863 Confidence: Nailed it Stats Issue with this question? 3. While assessing a pregnant patient who is in labor, the nurse observes W-shaped waves on the fetal heart rate (FHR) monitor. What would the nurse infer from this observation? 1 Placental abruption 2 Dilated cervical layers Correct3 Umbilical cord compression 4 Elevated uterine contractions W-shaped waves in the FHR monitor are indicative of variable decelerations in the FHR. Variable decelerations are seen when the umbilical cord is compressed at the time of labor. Placental abruption and dilated cervical layers do not cause variable decelerations but may cause late decelerations. Similarly, increased rate of uterine contractions may also cause late decelerations in FHR. 78%of students nationwide answered this question correctly. View Topics 4. 159724764 Confidence: Nailed it Stats Issue with this question? 4. After reviewing the urinalysis reports of a pregnant patient, the nurse finds that the patient has preeclampsia. What did the nurse find in the patient's urinalysis report? 1 Nitrites 2 Ketones Correct3 Proteins 4 Leukocytes Urinalysis of the patient during pregnancy helps to assess the patient's health. The presence of proteins in the urine indicates that the patient may have complications, such as preeclampsia. The presence of ketones in the urine sample indicates that the patient has improper nutrition. The presence of leukocytes and nitrates in the urine indicates that the patient has infection. 78%of students nationwide answered this question correctly. View Topics 5. 159721859 Confidence: Nailed it Stats Issue with this question? 5. While assessing a pregnant patient using a fetoscope, the nurse also palpates the abdomen of the patient. What is the purpose of palpating the abdomen of the patient? 1 Detection of fetal heart rate deceleration 2 Evaluation of the severity of the pain caused by active labor 3 Assessment of pain from pressure applied by the fetoscope Correct4 Assessment of changes in fetal heart rate during and after contraction While assessing the fetal heart rate (FHR) with a fetoscope, the nurse palpates the abdomen of the fetus to evaluate uterine contractions (UCs). This is done to detect any changes in the FHR during and after UCs. FHR decelerations are not identified by palpating the abdomen. It is assessed using the electronic fetal monitoring system. Pain perception is a subjective assessment. Moreover, the pressure from the fetoscope is very minimal and does not cause pain. 78%of students nationwide answered this question correctly. View Topics 6. 159721821 Confidence: Pretty sure Stats Issue with this question? 6. On reviewing the fetal reports of a pregnant patient, the nurse finds the fetal lactate levels to be elevated. What fetal clinical condition should the nurse interpret from this finding? Correct1 Acidosis 2 Heart structure defect 3 Cytomegalovirus infection 4 Umbilical cord compression Increased lactate in the blood indicates a prolonged lack of oxygen to the fetus that has led to acidosis. The presence of a structural heart defect, cytomegalovirus infection, and compressed umbilical cord are not associated with increased lactate levels. Bradycardia would indicate a structural heart defect in the fetus. Cytomegalovirus infection causes tachycardia. Umbilical cord compression leads to decelerations in the fetal heart rate (FHR), which is recorded via the electronic fetal monitoring method. 75%of students nationwide answered this question correctly. View Topics 7. 159724754 Confidence: Nailed it Stats Issue with this question? 7. The nurse assesses a pregnant patient and finds that the patient has reduced strength of uterine contractions (UCs). Upon further assessment, the nurse suspects that the patient may have slow progress in labor. Which statement made by the patient indicates the reason for slow progress in labor? 1 "I have a family history of diabetes and hypertension." 2 "I stopped taking folic acid supplements a week ago." 3 "I have been on a diet with high amounts of protein for 15 days." Correct4 "I am worried a lot this time; I had a lot of problems in my last labor." The nurse suspects that the patient may have slow progress in labor after knowing that the patient is worried and stressed, because she had complications in the previous labor. Stress may reduce the progress in the labor by decreasing the levels of catecholamines. This, in turn, reduces the UCs. Family history of diabetes does not affect the labor progression or UCs. Folic acid supplements are necessary for fetal growth and are given early in pregnancy to prevent neural tube defects. They do not affect the birth process. Taking a diet with a high amount of protein may not affect the onset of labor. Moreover, it helps in the fetal growth and development. 79%of students nationwide answered this question correctly. View Topics 8. 159725584 Confidence: Pretty sure Stats Issue with this question? 8. A pregnant patient does not allow her partner to touch her and wants to be left alone. What can the nurse suggest to the patient's partner in this situation? 1 "It is due to depression and loneliness." Correct2 "It is a common behavior during pregnancy." 3 "Massage would help to make your partner relax." 4 "You should leave your partner alone for few days." Many patients experience hyperesthesia or sensitivity to touch during the transition phase of labor and do not allow their partners to touch them. To prevent anxiety of the partner and to provide effective care, the nurse should inform the partner that this behavior is common during pregnancy. The active support of the partner is still required by the patient, so the patient's partner should not leave the patient alone. These are normal emotions during pregnancy, so the nurse not should tell the partner that the patient is depressed or feeling lonely. As the patient has become sensitive to touch, massaging the patient's back may irritate the patient. 92%of students nationwide answered this question correctly. View Topics 9. 159725520 Confidence: Nailed it Stats Issue with this question? 9. The nurse is caring for a pregnant patient. What interventions should the nurse follow to ensure proper hygiene in the patient? Correct1 Clean the perineum of the patient frequently. 2 Clean the patient's teeth with a warm wet cloth. 3 Offer a warm washcloth to the patient for a face wash. 4 Allow cool water to flow on the patient's back for 5 minutes. The patient's perineum should be cleaned frequently to prevent the risk for infection. This helps maintain proper hygiene and provides comfort to the patient. The nurse can clean the patient's teeth with an ice-cold wet washcloth, which helps prevent a feeling of thirst and dryness of the mouth. Using a warm cloth may not be helpful. The patient is offered a cool cloth for wiping her face, which helps prevent diaphoresis. Warm water should be poured on the patient's back to provide relaxation and accelerate labor. Using a warm washcloth for a face wash and placing cool water on the patient's back will not help in providing comfort. 86%of students nationwide answered this question correctly. View Topics 10. 159725573 Confidence: Nailed it Stats Issue with this question? 10. While caring for a multiparous patient in the second stage of labor, the patient reports the urge to defecate. What is the best nursing intervention? 1 Provide a bedpan to the patient to defecate. 2 Place an enema in the rectum of the patient. Correct3 Assess cervical dilation and station of the patient. 4 Use running water to stimulate defection for the patient. A multiparous patient feels an urge to defecate in the second stage of labor due to rectal pressure by the deeply descending presenting part in the pelvis. Rectal pressure may occur even in the absence of stool in the anorectal area. This often means that the patient is about to give birth to the child. Therefore the nurse has to perform vaginal examination of the patient to assess cervical dilation and station. The patient does not really defecate, so providing a bedpan is not necessary. Placing an enema in the rectum of the patient is not a suitable intervention, as it is done to increase peristalsis. Running water is used to stimulate voiding for the patient if there is a risk of urinary elimination. However, it is unrelated to the patient's urge of defecation. 77%of students nationwide answered this question correctly. When using intermittent auscultation (IA) to assess uterine activity, nurses should be aware that: Correct1 the examiner's hand should be placed over the fundus before, during, and after contractions. 2 the frequency and duration of contractions are measured in seconds for consistency. 3 contraction intensity is given a judgment number of 1 to 7 by the nurse and patient together. 4 the resting tone between contractions is described as either placid or turbulent. The assessment includes palpation; duration, frequency, intensity, and resting tone. The duration of contractions is measured in seconds; the frequency is measured in minutes. The intensity of contractions usually is described as mild, moderate, or strong. The resting tone usually is characterized as soft or relaxed. 72%of students nationwide answered this question correctly. Fetal monitoring of a pregnant patient reveals the fetal baseline heart rate is at 170 beats/min. Which maternal condition might the nurse suspect as the cause for this increased fetal heart rate? 1 Hypothermia Incorrect2 Hypoglycemia Correct3 Hyperthermia 4 Hypothyroidism If the fetal heart rate goes above 160 beats/min, this indicates that the fetus has tachycardia. Maternal hyperthermia or fever may cause tachycardia. Maternal hypoglycemia and hypothermia can cause bradycardia in the fetus. Maternal hyperthyroidism can cause tachycardia in the fetus. Hypothyroidism of the mother may not have any effect on the fetal heart rate. 69%of students nationwide answered this question correctly. 1. You are evaluating the fetal monitor tracing of your patient, who is in active labor. Suddenly you see the fetal heart rate (FHR) drop from its baseline of 125 down to 80. You reposition the mother, provide oxygen, increase IV fluid, and perform a vaginal examination. The cervix has not changed. A few minutes have passed, and the FHR remains in the 80s. What additional nursing measures should you take? 1 Notify nursery nurse of imminent birth. 2 Insert a Foley catheter. 3 Start oxytocin (Pitocin). Correct4 Notify the primary health care provider immediately (HCP). If the FHR does not resolve, the primary health care provider should be notified immediately. Notifying the nursery nurse that birth is imminent is not the most important nursing measure at this time. The patient needs to be evaluated by the HCP immediately to determine whether delivery is warranted at this time. If the FHR were to continue in an abnormal or non-reassuring pattern, a cesarean birth may be warranted. This requires the insertion of a Foley catheter; however, the physician must make that determination. Oxytocin may put additional stress on the fetus. To relieve an FHR deceleration, the nurse can reposition the mother, increase IV fluid, and provide oxygen. Also, if oxytocin is infusing, it should be discontinued. 94%of students nationwide answered this question correctly. View Topics 2. 159724775 Confidence: Nailed it Stats Issue with this question? 2. The nurse is caring for a newly admitted nulliparous patient in the ninth month of pregnancy. What should the nurse do to provide effective care? 1 Ask to photograph the memories of childbirth. 2 Restrict the mobility of the patient in the room. Correct3 Explain the various labor stages to the patient. 4 Avoid intervening with the patient's psychological issues. The nurse's primary responsibility is to explain the various stages of labor to the patient in the third trimester. This ensures that the patient is less anxious about the labor and responds well to the instructions. Photographing the patient's memories of childbirth may be done only after obtaining prior permission of the patient and the family. Psychological issues, such as mood swings and depression of the patient, should not be ignored because they play a major role in the birthing process. The patient may be instructed to participate in diversional activities, such as walking and watching television, to reduce the fear and anxiety about labor. 96%of students nationwide answered this question correctly. View Topics 3. 159724781 Confidence: Nailed it Stats Issue with this question? 3. The nurse is caring for a non-English-speaking pregnant patient. What nursing interventions would help explain the procedure of vaginal examination to the patient? Correct1 Call a service for an interpreter. 2 Try to communicate nonverbally. 3 Limit the use of medical terminologies. 4 Ask for the assistance of the hospital staff. It is important that the nurse explain the procedure to the patient. Because the patient does not speak English, it is advisable to call an interpreter. This helps the patient understand the test procedures without any confusion. Nonverbal communication is not useful in this case, because it may cause the patient to become confused. Explaining the medical examination procedure may include complex terms and words. Limiting those words may not help clarify to the patient who does not speak English. Finally, the patient may not feel comfortable in the presence of additional hospital staff. 95%of students nationwide answered this question correctly. View Topics 4. 159725540 Confidence: Pretty sure Stats Issue with this question? 4. The primary health care provider (PHP) advised the nurse to assess the maternal temperature and vaginal discharge of a pregnant patient every 2 hours. What is the reason behind this advice? 1 To evaluate fetal status 2 To know the onset of labor Correct3 To assess for potential risk for infection 4 To prevent fetal hypertension When the membranes rupture, there is a possible risk of infection, as the microorganisms can ascend form the vagina to the uterus. Ruptured membranes can be assessed by monitoring the body temperature and vaginal discharge every 2 hours. The assessment is not used for knowing the onset of labor because it does not indicate the progress of labor. The fetal status is not known by the assessment of the temperature and vaginal show; it may be known by another procedure called Leopold maneuvers. This measure is not done to prevent fetal hypertension, because the maternal body temperature and vaginal discharge does not indicate fetal blood pressure. 81%of students nationwide answered this question correctly. View Topics 5. 149976611 Confidence: Nailed it Stats Issue with this question? 5. Evidence-based care practices designed to support normal labor and birth recommend which practice during the immediate newborn period? 1 The healthy newborn should be taken to the nursery for a complete assessment. 2 After drying, the infant should be given to the mother wrapped in a receiving blanket. Correct3 Encourage skin-to-skin contact of mother and baby. 4 The father or support person should be encouraged to hold the infant while awaiting delivery of the placenta. -The unwrapped infant should be placed on the woman's bare chest or abdomen, then covered with a warm blanket. Skin-to-skin contact keeps the newborn warm, prevents neonatal infection, enhances physiologic adjustment to extrauterine life, and fosters early breastfeeding. Although taking the newborn to the nursery for assessment is the practice in many facilities, it is neither evidence-based nor supportive of family-centered care. Wrapping the infant in a blanket and giving him to the mother is a common practice and more family friendly than separating mother and baby; however, ideally the baby should be placed skin-to-skin. The father or support person is likely anxious to hold and admire the newborn. This can happen after the infant has been placed skin-to-skin and breastfeeding has been initiated. 89%of students nationwide answered this question correctly. View Topics 6. 149976623 Confidence: Nailed it Stats Issue with this question? 6. A woman who is 39 weeks pregnant expresses fear about her impending labor and how she will manage. The nurse's best response is: 1 "Don't worry about it. You'll do fine." Correct2 "It's normal to be anxious about labor. Let's discuss what makes you afraid." 3 "Labor is scary to think about, but the actual experience isn't." 4 "You may have an epidural. You won't feel anything." Discussing the woman's fears allows her to share her concerns with the nurse and is a therapeutic communication tool. Telling the woman not to worry negates her fears and is not therapeutic. Telling the woman that labor is not scary negates her fears and offers a false sense of security. A number of criteria must be met for use of an epidural. Furthermore, many women still experience the feeling of pressure with an epidural. Test-Taking Tip: Practicing a few relaxation techniques may prove helpful on the day of an examination. Relaxation techniques such as deep breathing, imagery, head rolling, shoulder shrugging, rotating and stretching of the neck, leg lifts, and heel lifts with feet flat on the floor can effectively reduce tension while causing little or no distraction to those around you. It is recommended that you practice one or two of these techniques intermittently to avoid becoming tense. The more anxious and tense you become, the longer it will take you to relax. 99%of students nationwide answered this question correctly. View Topics 7. 149976666 Confidence: Nailed it Stats Issue with this question? 7. Fetal well-being during labor is assessed by: Correct1 the response of the fetal heart rate (FHR) to uterine contractions (UCs). 2 maternal pain control. 3 accelerations in the FHR. 4 an FHR greater than 110 beats/min. Fetal well-being during labor is measured by the response of the FHR to UCs . In general, reassuring FHR patterns are characterized by an FHR baseline in the range of 110 to 160 beats/min with no periodic changes, a moderate baseline variability, and accelerations with fetal movement. Maternal pain control is not the measure used to determine fetal well-being in labor. Although FHR accelerations are a reassuring pattern, they are only one component of the criteria by which fetal well-being is assessed. Although an FHR greater than 110 beats/min may be reassuring, it is only one component of the criteria by which fetal well-being is assessed. More information is needed to determine fetal well-being. Test-Taking Tip: Being emotionally prepared for an examination is key to your success. Proper use of this text over an extended period of time ensures your understanding of the mechanics of the examination and increases your confidence about your nursing knowledge. Your lifelong dream of becoming a nurse is now within your reach! You are excited, yet anxious. This feeling is normal. A little anxiety can be good because it increases awareness of reality; but excessive anxiety has the opposite effect, acting as a barrier and keeping you from reaching your goal. Your attitude about yourself and your goals will help keep you focused, adding to your strength and inner conviction to achieve success. 88%of students nationwide answered this question correctly. View Topics 11. 159721853 Confidence: Pretty sure Stats Issue with this question? 11. The nurse is instructed to count the fetal heart rate (FHR) for 30 to 60 seconds after each uterine contraction in a pregnant patient via intermittent auscultation. What does this assessment help to identify? Change in: 1 Placental flow 2 Fetal position Correct3 Baseline heart rate 4 Uterine activity Counting the FHR for 30 to 60 seconds after a uterine contraction (UC) helps to identify the baseline heart rate of the fetus and determine any changes in the pattern of the FHR. Palpating the abdomen will help identify the fetal position. Neither uterine activity (UA) nor placental flow can be identified by assessing the FHR after each UC. UA can be assessed by various methods, such as electronic fetal monitoring and external monitoring. A Doppler flow study under ultrasound visualization is mostly used to assess the placental flow from mother to fetus. 77%of students nationwide answered this question correctly. View Topics 12. 159720751 Confidence: Nailed it Stats Issue with this question? 12. The nurse is teaching a group of nursing students regarding fetal oxygenation. The nurse questions a student, "What happens when oxytocin levels are elevated in the patient?" What would be the most appropriate answer given by the nursing student related to the patient's condition? 1 "Hemoglobin levels will decrease." 2 "Blood glucose levels will increase." 3 "Placenta lowers the blood supply." Correct4 "Uterine contractions (UCs) will increase." An elevated level of oxytocin increases UCs during labor. A reduced hemoglobin level leads to a decreased oxygen supply to the fetus but is not a complication associated with an elevated oxytocin level. Oxytocin has no effect on the blood glucose levels. A family history of diabetes may increase the risk for gestational diabetes in the patient. Conditions such as hypertension in the patient may lower the blood supply to the placenta but are not associated with oxytocin levels. 94%of students nationwide answered this question correctly. View Topics 8. When the nurse observes this fetal heart pattern, the most important nursing action is to: Correct1 document the finding. 2 position mother on left side. 3 apply 10 L of oxygen via face mask. Incorrect4 notify the health care provider. The fetal heart strip shows an early deceleration indicating expected head compression during contractions. Documenting this finding is appropriate. Positioning the woman on the left aside, applying oxygen via a face mask, and notifying the health care provider are correct actions for a late deceleration. 70%of students nationwide answered this question correctly. View Topics 9. 159721889 Confidence: Just a guess Stats Issue with this question? 9. After administering phenylephrine (Neo-Synephrine) as prescribed to a pregnant patient, the nurse places three pillows under the patient's lower extremities. What is the rationale for this intervention? Incorrect1 To reduce the fetal heart rate 2 To reduce the effects of tachysystole 3 To prevent adverse effects of the drug Correct4 To increase the patient's blood pressure Phenylephrine (Neo-Synephrine) is used to treat maternal hypotension. Elevating the lower limbs would supplement the action of the drug and prevent the maternal hypotension to affect the fetus. Tachysystole is reduced by administering terbutaline (Brethine), not by changing the position of the patient. The prescribed dose of phenylephrine (Neo-Synephrine) is unlikely to cause any adverse effects in the patient. Phenylephrine (Neo-Synephrine) has no effect on the fetal heart rate (FHR). 72%of students nationwide answered this question correctly. View Topics 10. 159724783 Confidence: Just a guess Stats Issue with this question? 10. The nurse is caring for a patient in labor with a history of sexual abuse. What interventions should the nurse perform while caring for the patient? Select all that apply. Correct1 Explain the need of the procedures. 2 Ask the patient about past memories. Correct3 Limit the number of invasive examinations. Correct4 Obtain the patient's permission to touch her. 5 Avoid assessing the uterine contractions (UCs). The nurse should be extremely cautious about not saying anything to the patient that would remind her of the history of sexual abuse. Therefore the nurse should not discuss the patient's past memories, as it could be distressing. However, the nurse should explain all the medical procedures that are required during the examination to relieve the patient's anxiety. The health care team should try to limit the number of invasive procedures as they might trigger the sexual abuse memories. The nurse should obtain the patient's permission before touching her to give the patient a sense of control. UCs help to assess the onset of labor. 92%of students nationwide answered this question correctly. 1. 1 "There is an increased risk for postpartum hemorrhage." 2 "There may be a need to reconduct the diagnostic test." 3 "There is an increased risk for requiring a cesarean birth." Correct4 "There will be a small incision on the scalp of the newborn." The fetal blood is collected by making a small incision on the fetal scalp, which is visible in the newborn. This might be disturbing to the patient, but the nurse should help the patient understand the purpose of the test. Postpartum hemorrhage or increased risk for cesarean birth is not associated with this procedure. The test has to be conducted only once, and it does not have to be reconducted. 60%of students nationwide answered this question correctly. View Topics 3. 159725566 Confidence: Nailed it Stats Issue with this question? 3. After performing Leopold maneuvers, the nurse finds that the fetus of a pregnant patient is in occiput posterior position. Which suitable action should the nurse employ while caring for the patient? 1 Help the patient to lie in supine position on the bed. Correct2 Encourage the patient to sit in hands-and-knees position. 3 Place a pillow under the patient's hip when lying in supine position. 4 Ask the patient to lie in lateral position on the opposite side of the fetal spine. The nurse should place the patient in a position that helps the rotation of the fetal occiput from a posterior to an anterior position. Therefore the nurse should encourage the patient to sit in hands-and-knees position, as it increases the pelvic diameter, allowing the head to rotate toward anterior position. The patient should not lie in supine position, as it may cause postural hypotension. Placing a pillow under the patient's hip when lying in supine position helps prevent supine hypotensive syndrome, but does not help in delivering the baby. The nurse should not ask the patient to lie in lateral position on the opposite side of the fetal spine, as it increases counter pressure on the back. Instead, lying in lateral position on the same side of the fetal spine will help the fetus rotate toward the posterior, as the gravity pulls the fetal back forward. 57%of students nationwide answered this question correctly. View Topics 6. 159721881 Confidence: Nailed it Stats Issue with this question? 6. What should be the first step taken by the nurse when assessing fetal heart activity using an ultrasound transducer? 1 Auscultate the apical heart rate of the pregnant patient. 2 Apply some conductive gel on the maternal abdomen. 3 Apply some conductive gel on the ultrasound transducer. Correct4 Locate the maximal intensity area of the fetal heart rate. Before the ultrasonic recording, the nurse should first locate the site on the abdomen where the maximal intensity of the fetal heart rate can be assessed. This should be done to find where the ultrasound transducer head can be placed. The apical heart rate of the patient need not be assessed before this procedure, because this procedure does not interfere with the cardiac activity of the pregnant patient. After finding the site of application, the nurse can apply conductive gel on the transducer and on the abdomen of the patient. 59%of students nationwide answered this question correctly. View Topics 7. 149976619 Confidence: Nailed it Stats Issue with this question? 7. Which test is performed to determine if membranes are ruptured? 1 Urine analysis Correct2 Fern test 3 Leopold maneuvers 4 Artificial rupture of membranes (AROM) In many instances, a sterile speculum examination and a Nitrazine (pH) and fern test are performed to confirm that fluid seepage is indeed amniotic fluid. A urine analysis should be performed on admission to labor and delivery. This test is used to identify the presence of glucose and protein. The nurse performs Leopold maneuvers to identify fetal lie, presenting part, and attitude. AROM is the procedure of artificially rupturing membranes, usually with a device known as an amnihook. Test-Taking Tip: Be aware that information from previously asked questions may help you respond to other examination questions. 77%of students nationwide answered this question correctly. View Topics 8. 159724758 Confidence: Nailed it Stats Issue with this question? 8. The nurse is examining a newly admitted patient who is 39 weeks pregnant and notes that the patient is in the transition phase of labor. Which symptoms does the nurse note to reach this conclusion? 1 No evidence of uterine contractions (UCs) 2 Mild uterine contractions (UCs) Correct3 Strong uterine contractions (UCs) 4 Moderate uterine contractions (UCs) Regular and strong UCs may occur in the transition phase of labor. Absence of uterine contractions means that the labor has not started. Mild UCs can be observed during early labor. Mild to moderate UCs can be observed during the latent and active phases of labor. 76%of students nationwide answered this question correctly. View Topics 10. 159725564 Confidence: Nailed it Stats Issue with this question? 10. The nurse observes that a pregnant patient has a blood glucose level of 180 mg/dL in early labor. Which medication order does the nurse expect to receive from the primary health care provider (PHP)? 1 Lidocaine (Nervocaine) to the patient Correct2 Ringer's lactate solution to the patient 3 Hydromorphone (Dilaudid) to the patient 4 Intravenous (IV) solution containing a small amount of dextrose The blood glucose level of 180 mg/dL indicates that the patient has high blood glucose levels. Therefore the patient has to be administered an electrolyte solution without glucose to prevent the risk of fetal hyperglycemia and hyperinsulinism. Hence, the nurse would expect the PHP to prescribe Ringer's lactate solution to the patient, as it does not increase blood sugar levels. Lidocaine (Nervocaine) is an anesthetic preparation, which may be given during emergency. Hydromorphone (Dilaudid) is an opioid preparation and is not used in treating blood glucose levels in the body. IV solution containing a small amount of dextrose is administered to increase the fatty acid metabolism when the patient has ketosis. It is not useful to treat hyperglycemia. 72%of students nationwide answered this question correctly. View Topics 11. 159726708 Confidence: Pretty sure Stats Issue with this question? 11. Which patients are more susceptible to soft-tissue damage with vaginal deliveries? Select all that apply. 1 Multiparous patients Correct2 Nulliparous patients Correct3 Patients needing forceps delivery 4 Patients with fetal vertex presentation Correct5 Patients with fetal breech presentation A nulliparous patient has rigid perineal tissue making it susceptible to injury. Fetal breech presentation exerts undue pressure on the tissues, increasing the risk of injuries. Forceps delivery also increases the risk of injury due to undue stretch of the perineum. Multiparous patients have stretchable perineal tissues, which are less likely to get injured during childbirth. Fetal vertex presentation causes the least amount of tissue damage. 65%of students nationwide answered this question correctly. View Topics 12. 159725596 Confidence: Just a guess Stats Issue with this question? 12. What change in the cervix is most likely to be observed by the nurse if the patient presents with false labor? Correct1 Posterior position 2 Softened 3 Presence of effacement 4 Dilation False labor pain indicates an unfavorable environment for childbirth. The cervix may be in posterior position, which may not facilitate the passage open for descent of the baby. If the patient has true labor, the cervix is usually well prepared for the childbirth. The cervix becomes soft, effaced, and dilated to facilitate the descent of the baby. 65%of students nationwide answered this question correctly. 2. The primary health care provider prescribes terbutaline (Brethine) for a pregnant patient. As the nurse reviews the patient's medical record, what would be the rationale for this prescription? 1 Blood volume is elevated. 2 Hemoglobin is decreased. Incorrect3 Blood pressure is reduced. Correct4 Contractions are increased. Terbutaline (Brethine) is administered to the patient who has premature labor. It slows down the contractions. Terbutaline (Brethine) has no effect on blood volume, blood pressure, or hemoglobin. Blood volume is elevated by infusing aggressive intravenous infusion or from sodium and water retention. Maternal hypotension, as evidenced by reduced blood pressure, is relieved by elevating the legs during labor. Patients with decreased hemoglobin are treated with iron supplements, not terbutaline (Brethine). 67%of students nationwide answered this question correctly. View Topics 4. 159721849 Confidence: Nailed it Stats Issue with this question? 4. While auscultating for fetal heart tones in a pregnant patient, the nurse observes that there is persistent fetal tachycardia. In which situation would this finding be considered as normal? Correct1 If the patient's body temperature has increased 2 If the tachycardia is caused by late deceleration 3 If the tachycardia is related to minimal variability Incorrect4 If the patient's uterine contractions (UCs) are elevated Accelerations in the fetal heart rate (FHR) are usually episodic, and sometimes they may be persistent. When the patient is febrile, fetal tachycardia is not considered a serious event. The tachycardia would resolve once the patient is afebrile. Elevation in uterine contractions may cause episodic tachycardia, but it would not cause persistent tachycardia. Persistent tachycardia when associated with late deceleration or minimal variability is considered a risk to the fetus. 58%of students nationwide answered this question correctly. View Topics 5. 159725550 Confidence: Just a guess Stats Issue with this question? 5. The nurse is assessing a pregnant patient who was treated with bupivacaine (Marcaine). Which suitable intervention should the nurse perform to prevent the adverse effects of the medication? 1 Ask the patient to reduce the intake of salt. 2 Suggest that the patient change positions frequently. Correct3 Encourage the patient to void at least every 2 hours. Incorrect4 Cleanse the perineal area of the patient to remove any stool. Bupivacaine (Marcaine) is an anesthetic drug and may cause urinary retention and bladder distention due to decreased uterine contractions (UCs). Therefore the nurse should assess the patient for the need to void and encourage her to void every 2 hours. Asking the patient to reduce the intake of salt may not prevent urinary retention. Limiting sodium is helpful in reducing blood pressure and preventing hypertension. The patient is suggested to change positions frequently when the patient's efforts are ineffective in the birthing process. The nurse should cleanse the perineal area of the patient to remove any stool, which helps decrease the risk of infection during bowel elimination. This intervention is not useful in preventing the adverse effects of anesthesia. 53%of students nationwide answered this question correctly. View Topics 9. 159725592 Confidence: Pretty sure Stats Issue with this question? 9. A full-term pregnant patient reports labor pain. What would be the nature of contractions if the patient has false labor? Select all that apply. 1 Do not stop with change in position Correct2 Stop with use of comfort measures Correct3 Stop when the patient starts walking Correct4 Felt in back and abdomen above navel 5 Become stronger and last longer over time The nurse should be able to distinguish between false and true labor. In false labor, the contractions usually stop if the patient is placed in a comfortable position or if the patient walks. Unlike true labor, the contractions of false labor are felt above the navel. The contractions of true labor do not stop with a change in position, and they usually become stronger and last longer over time. 61%of students nationwide answered this question correctly. 2. The patient reports severe lower back pain during labor. Which position does the nurse plan for the patient during childbirth? 1 Lateral position 2 Upright position 3 Semirecumbent position Correct4 Hands-and-knees position The hands-and-knees position is suitable for patients with back pain and for patients experiencing back labor, because it reduces stress on the back. The lateral position can be used when the patient is receiving a back rub, but this position does not offer relief from back pain. An upright position may not have a significant effect on back pain. Therefore this position is not planned for childbirth. The semirecumbent position does not support the back, so back pain may not be relieved. 64%of students nationwide answered this question correctly. View Topics 3. 159721835 Confidence: Nailed it Stats Issue with this question? 3. The nurse is administering an amnioinfusion to a patient with oligohydramnios. What risk should the nurse primarily monitor for during administration? Correct1 Overdistention of the uterus 2 High risk for placental abruption 3 Fetal heart rate (FHR) accelerations 4 Increased uterine contractions (UCs) Oligohydramnios is the condition where the patient has low levels of amniotic fluid. In this condition the nurse should administer an amnioinfusion. During this process the nurse should assess the abdominal size to make sure the patient is not receiving too much fluid. This may cause overdistention of the uterus. This procedure does not affect the uterine activity (UA), placental hemorrhage, or the FHR. Placental abruption would cause conditions such as oligohydramnios. Decelerations in the FHR are observed in oligohydramnios, but accelerations are not. 54%of students nationwide answered this question correctly. View Topics 4. 159725556 Confidence: Nailed it Stats Issue with this question? 4. The nurse palpates the abdomen of a pregnant patient and reports that the fetus lies in longitudinal position with cephalic presentation. Which observation enabled the nurse to report about the fetal position? 1 The presenting part has deeply descended in the pelvis. 2 The cephalic prominence is on the same side as the back. 3 The head is presenting to the true pelvis and is not engaged. Correct4 The head feels round, firm, freely movable, and palpable by ballottement. Leopold maneuvers (abdominal palpation) help identify the degree of descent into the pelvis of the presenting part in a pregnant patient. The head feels round, firm, freely movable, and palpable by ballottement when the fetus has a cephalic or breech presentation. Based on the descent of the presenting part, it may be difficult to infer the fetal position, as the presenting part can be head or buttock. The cephalic prominence on the same side as the back shows that the fetal head is extended and the face is the presenting part. This maneuver is not related to identification of fetal position. If the head is presenting to the true pelvis and is not engaged, then it determines the attitude of fetal head whether flexed or extended. It does not indicate the fetal position. 52%of students nationwide answered this question correctly. View Topics 9. 159725530 Confidence: Nailed it Stats Issue with this question? 9. The student nurse finds that the patient who is in labor has sweat on the upper lip, is shivering in the extremities, and is vomiting. What would the student nurse interpret from these observations? The patient has symptoms of: 1 Postural hypotension. 2 Respiratory depression. 3 Onset of the first stage of labor. Correct4 Onset of the second stage of labor. Sudden appearances of sweat on the upper lip, shaking of the extremities, and vomiting indicate the onset of the second stage of labor. Irregular and mild to moderate uterine contractions (UCs) indicate the onset of the latent phase of the first stage labor. Postural hypotension is characterized by a sudden fall in the blood pressure while changing the position. Respiratory depression is characterized by a decreased rate of respiration. 62%of students nationwide answered this question correctly. 1. The nurse is caring for a pregnant patient and suspects that the primary health care provider (PHP) would recommend a cesarean section. What could be the most probable reason for this? 1 Increased maternal pulse rate Correct2 Body mass index (BMI) is 32 kg/m2 Incorrect3 Elevated blood glucose levels 4 High basal body temperature A pregnant woman may have a higher risk of cesarean birth and cephalopelvic disproportion when the BMI is higher than 30 kg/m2. It indicates that a weight gain of 16 kg or more results in a BMI above 30 kg/m2. Therefore the nurse expects the patient to have cesarean birth because the patient's BMI is 32 (above 30) kg/m2. Increased pulse rate, elevated blood glucose levels, and high temperature do not indicate the need for a cesarean section. These conditions are common during early labor and disappear after childbirth. 59%of students nationwide answered this question correctly. View Topics 5. 159721837 Confidence: Pretty sure Stats Issue with this question? 5. Fetal monitoring of a pregnant patient revealed a regular smooth, undulating wavelike pattern of the fetal heart rate (FHR). What should the nurse infer about the fetus from these results? Correct1 Anemia Incorrect2 Ischemia 3 Hypertension 4 Hypotension A regular smooth, undulating wavelike pattern in the FHR is referred to as a sinusoidal pattern. This uncommon pattern mostly occurs with severe fetal anemia. Ischemia refers to impaired circulation. FHR patterns cannot indicate this condition. Blood pressure levels below 120/80 mm Hg indicate hypotension. Blood pressure levels above 120/80 mm Hg indicate hypertension. The FHR pattern cannot indicate conditions such as hypotension or hypertension. 52%of students nationwide answered this question correctly. View Topics 6. 159721847 Confidence: Just a guess Stats Issue with this question? 6. The nurse is assessing the fetal heart rate (FHR) in a pregnant patient with diabetes during the first stage of labor. At what time intervals should the nurse perform FHR tracing? Incorrect1 5 minutes 2 60 minutes Correct3 15 minutes 4 30 minutes Diabetes is one of the risk factors in pregnancy. If any risk factors are present, the FHR tracing should be evaluated more frequently (every 15 minutes) in the first stage of labor and every 5 minutes in the second stage of labor. FHR should not be evaluated every hour in either low-risk or high-risk patients. In low-risk patients the FHR tracing should be evaluated for every 30 minutes during the first stage of labor. 66%of students nationwide answered this question correctly. View Topics 7. 149976662 Confidence: Just a guess Stats Issue with this question? 7. A nurse caring for a woman in labor understands that increased variability of the fetal heart rate might be caused by: 1 narcotics. 2 barbiturates. Correct3 methamphetamines. Incorrect4 tranquilizers. The use of illicit drugs (such as cocaine or methamphetamines) might cause increased variability . Maternal ingestion of narcotics may be the cause of decreased variability. The use of barbiturates may also result in a significant decrease in variability as these are known to cross the placental barrier. Tranquilizer use is a possible cause of decreased variability in the fetal heart rate. 71%of students nationwide answered this question correctly. View Topics 8. 159724797 Confidence: Just a guess Stats Issue with this question? 8. The laboratory reports of a pregnant patient revealed that the patient has maternal ketosis. Which intravenous medication administration does the nurse expect to be ordered for the patient? 1 Saline solution 2 Glucose solution Correct3 Dextrose solution Incorrect4 Ringer's lactate solution The administration of I.V. dextrose solution increases the fatty acid metabolism and reduces maternal ketosis. Therefore, to provide the required amount of glucose and enhance the metabolism of the fatty acids, I.V. dextrose solution should be administered to the patient. Electrolyte solutions, such as normal saline and Ringer's lactate, can be given to a pregnant patient to provide support during labor. These electrolyte solutions will not be helpful to reduce the maternal ketosis. Excessive maternal glucose levels results in fetal hyperglycemia and hyperinsulinism. Therefore the nurse should not administer I.V. glucose solution to the patient. 49%of students nationwide answered this question correctly. View Topics 10. 159724785 Confidence: Pretty sure Stats Issue with this question? 10. A pregnant patient calls the nurse on the telephone and states that she is having severe pain in her uterus. The patient also tells the nurse that she is worried of having early labor. Which actions are most appropriate for the nurse to perform in this situation? Select all that apply. Incorrect1 Suggest that the patient avoid drinking coffee and tea. 2 Inform the patient that this is a symptom of false labor. Correct3 Suggest that the patient come to the hospital immediately. Correct4 Ask the patient to contact the primary health care provider (PHP). Correct5 Record the time of call and advice given to the patient in the patient's record. The patient informs the nurse of having severe pain in the uterus and the suspicion of having early labor. Nurses should avoid giving any advice to the pregnant patient during the call due to legal liability. Therefore the nurse should suggest that the patient come to the hospital immediately and consult with the PHP. Then, the nurse should record the time of the call and the advice given to the patient in the patient's record. This helps for further reference while planning care for the patient. Taking warm liquids like coffee, tea, and milk provides comfort and helps the patient but does not help with the patient's pain or concerns. The nurse cannot inform the patient that the pain in her uterus is a symptom of false labor without assessing the patient physically. 51%of students nationwide answered this question correctly. View Topics 11. 159721841 Confidence: Just a guess Stats Issue with this question? 11. The nurse is caring for a pregnant patient during labor and documents the strength of uterine contractions (UCs) as "mild" after palpating the patient's abdomen. What reading of the intrauterine pressure catheter (IUPC) would be consistent with the strength of the UCs as assessed by the nurse? Correct1 40 mm Hg 2 60 mm Hg Incorrect3 80 mm Hg 4 100 mm Hg The UCs are assessed by palpating the patient's abdomen and reported as mild, moderate, or strong. The IUPC is an internal mode used to assess uterine activity (UA). The IUPC reading of less than 50 mm Hg is indicative of mild UCs. IUPC readings greater than 50 mm Hg are reported as moderate or strong after palpation. 60%of students nationwide answered this question correctly. View Topics 12. 149976676 Confidence: Just a guess Stats Issue with this question? 12. The nurse's priority action when observing this fetal heart pattern is to: 1 notify the health care provider. Incorrect2 assist with vaginal examination to assess for cord prolapse. Correct3 change maternal position. 4 assist with amnioinfusion. The usual priority is as follows: (1) change maternal position (side to side, knee chest); (2) discontinue oxytocin if infusing; (3) administer oxygen at 8 to 10 L/min by nonrebreather face mask; (4) notify physician or nurse-midwife; (5) assist with vaginal or speculum examination to assess for cord prolapse; (6) assist with amnioinfusion if ordered; (7) assist with birth (vaginal assisted or cesarean) if pattern cannot be corrected. Test-Taking Tip: Key words or phrases in the stem of the question such as first, primary, early, or best are important. Similarly, words such as only, always, never, and all in the alternatives are frequently evidence of a wrong response. As in life, no real absolutes exist in nursing; however, every rule has its exceptions, so answer with care. 70%of students nationwide answered this question correctly. 2. A patient in labor exhibits flushed cheeks. The nurse records the uterine contractions in the patient as being 3 to 5 minutes apart and lasting for about 1 minute. What nursing intervention is most effective to assess the patient's status during this phase of labor? 1 Check blood pressure every 2 hours. Correct2 Note patient's appearance and mood every 15 minutes. 3 Assess the patient's temperature every 2 hours until membranes rupture. 4 Monitor temperature every 4 hours after membranes rupture. The patient is experiencing uterine contractions that are 3 to 5 minutes apart and last for about 60 seconds (1 minute). The patient also exhibits flushed cheeks. These findings indicate that the patient is in the active phase of the first stage of labor. The nursing assessment in the active stage of labor is to check the patient's appearance and mood every 15 minutes, or 4 times in an hour. The patient's mood and energy levels fluctuate, and therefore the nurse should constantly assess them to ensure effective patient care. The patient's blood pressure should be assessed every 30 minutes. The nurse should assess the patient's body temperature every 4 hours until membrane rupture and thereafter every 2 hours. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. 62%of students nationwide answered this question correctly. View Topics 3. 149976646 Confidence: Nailed it Stats Issue with this question? 3. Which finding meets the criteria of a reassuring fetal heart rate (FHR) pattern? 1 FHR does not change as a result of fetal activity. 2 Average baseline rate ranges between 100 and 140 beats/min. 3 Mild late deceleration patterns occur with some contractions. Correct4 Variability averages between 6 to 10 beats/min. Variability indicates a well-oxygenated fetus with a functioning autonomic nervous system. FHR should accelerate with fetal movement. Baseline range for the FHR is 120 to 160 beats/min. Late deceleration patterns are never reassuring, although early and mild variable decelerations are expected, reassuring findings. Test-Taking Tip: What happens if you find yourself in a slump over the examination? Take a time-out to refocus and reenergize! Talk to friends and family who support your efforts in achieving one of your major accomplishments in life. This effort will help you regain confidence in yourself and get you back on track toward the realization of your long-anticipated goal. 62%of students nationwide answered this question correctly. View Topics 4. 159721867 Confidence: Nailed it Stats Issue with this question? 4. The charge nurse instructed a group of student nurses about the monitoring of uterine activity (UA) during labor. Which statement by the student nurse is accurate regarding the calculation of Montevideo units? "They can be calculated: 1 Using a spiral electrode monitoring device." 2 Using a tocotransducer monitoring system." 3 Using an ultrasound transducer machine." Correct4 With an intrauterine pressure catheter (IUPC)." Montevideo units can only be calculated using the internal monitoring of UA. An intrauterine pressure catheter (IUPC) monitors UA internally. Therefore Montevideo units can only be calculated using the IUPC. Spiral electrode monitoring is used for assessing the fetal heart rate (FHR), not UA internally. The tocotransducer monitoring system is used to monitor the UA externally. An ultrasound transducer is also used to monitor the FHR externally. 67%of students nationwide answered this question correctly. View Topics 5. 159721831 Confidence: Pretty sure Stats Issue with this question? 5. After reviewing the umbilical cord acid-base report, the nurse confirms that the fetus has respiratory acidosis. Which reading is consistent with the nurse's conclusion? 1 A base deficit value ≥12 mmol/L 2 Blood glucose levels = 120 mg/dL 3 Arterial pH >7.20 Correct4 Partial pressure carbon dioxide >55 mm Hg If pH 2 >55 mm Hg (elevated), and base deficit value respiratory acidosis. In this case, the partial pressure carbon dioxide >55 mm Hg is indicative of respiratory acidosis. A pH >7.20 and base deficit value ≥12 mmol/L are all considered normal. Blood glucose level is not a part of this acid-base report. 62%of students nationwide answered this question correctly. View Topics 6. 149976607 Confidence: Nailed it Stats Issue with this question? 6. When managing the care of a woman in the second stage of labor, the nurse uses various measures to enhance the progress of fetal descent. These measures include: Correct1 encouraging the woman to try various upright positions, including squatting and standing. 2 telling the woman to start pushing as soon as her cervix is fully dilated. 3 continuing an epidural anesthetic so that pain is reduced and the woman can relax. 4 coaching the woman to use sustained, 10- to 15-second, closed-glottis bearing-down efforts with each contraction. Upright positions and squatting may enhance the progress of fetal descent. Many factors dictate when a woman will begin pushing. Complete cervical dilation is necessary, but it is only one factor. If the fetal head is still in a higher pelvic station, the physician or midwife may allow the woman to "labor down" (allowing more time for fetal descent, thereby reducing the amount of pushing needed) if she is able. The epidural may mask the sensations and muscle control needed for the woman to push effectively. Closed-glottic breathing may trigger the Valsalva maneuver, which increases intrathoracic and cardiovascular pressure, reducing cardiac output and inhibiting perfusion of the uterus and placenta. In addition, holding the breath for longer than 5 to 7 seconds diminishes the perfusion of oxygen across the placenta, resulting in fetal hypoxia. 77%of students nationwide answered this question correctly. View Topics 7. 159725576 Confidence: Nailed it Stats Issue with this question? 7. The nurse is caring for a pregnant patient during labor. What should the nurse do immediately after the child's birth? 1 Ask the mother to hold the infant. Correct2 Dry the infant and place in warm blanket. 3 Record the Apgar scores after 30 minutes. 4 Cut the umbilical cord 3.5 cm above the clamp. The infant should be dried to prevent cold stress due to rapid loss of heat and then covered with a warm blanket. The Apgar score is to be recorded at 1 and 5 minutes after the birth of the infant. Recording it after 30 minutes may lead to failure in assessing the fetal signs. The cord should be cut at 2.5 cm above the placement of the clamp. A newborn may be very slippery to hold, and the mother may not be able to hold the baby due to fatigue. The infant can be given to the mother only after complete drying. 60%of students nationwide answered this question correctly. View Topics 9. 149976636 Confidence: Nailed it Stats Issue with this question? 9. When assessing a fetal heart rate (FHR) tracing, the nurse notes a decrease in the baseline rate from 155 to 110. The rate of 110 persists for more than 10 minutes. The nurse can attribute this decrease in baseline to: 1 maternal hyperthyroidism. Correct2 initiation of epidural anesthesia that resulted in maternal hypotension. 3 maternal infection accompanied by fever. 4 alteration in maternal position from semirecumbent to lateral. Fetal bradycardia is the pattern described and results from the hypoxia that occurs when uteroplacental perfusion is reduced by maternal hypotension. The woman receiving epidural anesthesia needs to be well hydrated before and during induction of the anesthesia to maintain an adequate cardiac output and blood pressure. Hyperthyroidism would result in baseline tachycardia. A maternal fever could cause fetal tachycardia. Assumption of a lateral position enhances placental perfusion and should result in a reassuring FHR pattern. 69%of students nationwide answered this question correctly. View Topics 10. 159720755 Confidence: Nailed it Stats Issue with this question? 10. Which device should the nurse use for monitoring the intensity of uterine contractions (UCs) in a pregnant patient? 1 Tocotransducer 2 Spiral electrode 3 Ultrasound transducer Correct4 Intrauterine pressure catheter (IUPC) An IUPC measures the frequency, duration, and intensity of contractions during the intrapartum period. The device records the pressure at the catheter tip, and the values are expressed in terms of mm Hg. However, for accurate readings, the membranes should be ruptured and the cervix should be dilated. A tocotransducer monitors the frequency and duration of contractions for both antepartum and intrapartum care. This device is placed on the abdomen of the patient. The spiral electrode and ultrasound transducer are used for assessing the fetal heart rate and not the intensity of contractions. The spiral electrode is an invasive mode, whereas an ultrasound transducer is a noninvasive mode. 66%of students nationwide answered this question correctly. View Topics 1. The primary health care provider has asked the nurse to draw blood for an umbilical cord acid-base determination test. What should the nurse do in this situation? 1 Administer terbutaline (Brethine) before the test. Correct2 Collect blood from both the umbilical artery and vein. 3 First perform the fetal scalp stimulating technique. Incorrect4 Collect blood only from the baby's umbilical artery. An umbilical cord acid-base determination test is performed to assess the immediate condition of the neonate after birth if there is an abnormal or confusing fetal heart rate (FHR) tracing found during labor. The nurse should collect blood from both umbilical artery and umbilical vein to perform the test. The fetal scalp stimulating technique is an indirect method to assess the fetal blood pH. This test need not be performed before the acid-base determination test. It is not necessary to administer terbutaline (Brethine), a uterine relaxant, before performing the test; it is administered during the time of labor if uterine contractions are too frequent. 66%of students nationwide answered this question correctly. View Topics 8. 159724793 Confidence: Just a guess Stats Issue with this question? 8. After performing the nitrazine test for pH in a pregnant patient, the nurse finds that the amniotic membranes are ruptured. Which finding led the nurse to confirm the result of the test? 1 pH of 5.0 and yellow in color Correct2 pH of 6.5 and blue-green in color 3 pH of 6.0 and olive-green in color Incorrect4 pH of 5.5 and olive-yellow in color The nurse finds that the amniotic membranes are ruptured because the pH of the vaginal fluid is 6.5 (alkaline) and the color is blue-green. This is because of the presence of amniotic fluid, which is alkaline. Vaginal pH values of 5.0, 5.5, and 6.0 indicate that the fluid is still acidic due to the absence of amniotic fluid. This indicates that the amniotic membranes are probably intact. Therefore these findings do not show that the amniotic membranes are ruptured. 69%of students nationwide answered this question correctly. View Topics 11. 159721843 Confidence: Just a guess Stats Issue with this question? 11. The nurse is helping a pregnant patient during labor by applying fundal pressure. What alteration in the fetal heart rate (FHR) pattern will result from this intervention? Correct1 Early decelerations 2 Late decelerations Incorrect3 Variable decelerations 4 Prolonged decelerations Applying fundal pressure can cause fetal head compression and may cause early decelerations in FHR. Disruption of oxygen transfer from the maternal environment to the fetus may result in late decelerations. Variable decelerations may be observed as a result of umbilical cord compression. If the mechanisms responsible for late or variable decelerations last for an extended period, then they cause prolonged decelerations. 60%of students nationwide answered this question correctly. View Topics 12. 159720759 Confidence: Just a guess Stats Issue with this question? 12. What instructions does the nurse give to a patient when preparing to assess the uterine activity using a tocotransducer? 1 "No water can be taken until after the test." Correct2 "You will sit up at about a 30-degree angle." 3 "Kegal exercises must be done before the test." Incorrect4 "Remain still while the test is being performed." The use of a tocotransducer requires the patient to be sitting in a chair or lying in a bed during the test. The nurse asks the patient to lie in semi-Fowler position, which is sitting up at a 30-degree angle. This helps hold the device to the fundus firmly throughout the test. The patient can drink water before or after the test. Performing exercises before the test will not affect uterine activity and thus should not be instructed to the patient. Because this is not a requirement for the test, the nurse should not ask the patient to stay in a still position. 57%of students nationwide answered this question correctly. 2. The nurse is assessing a pregnant patient in the last week of gestation. The nurse observes that the patient has flushed cheeks, uterine contractions (UCs) of 65 seconds with a frequency of 4 minutes, and pink to bloody mucus. What stage of labor should the nurse infer that the patient is in based on these observations? 1 Latent phase Correct2 Active phase 3 Transition phase 4 Active pushing phase The patient has flushed cheeks, UCs of 65 seconds with a frequency of 4 minutes, and pink to bloody mucus. These symptoms are observed during the active phase of labor. The symptoms of the patient do not correlate with the latent, transition, or active pushing phases (second stage) of labor. In the latent phase of labor, the UCs are 30 to 45 seconds with a frequency of 5 to 30 minutes, and the mucus is pale pink. In the transition phase, the UCs are 45 to 90 seconds with a frequency of 2 to 3 minutes, and the mucus appears bloody. In the active pushing phase of the second stage of labor, the UCs are 90 seconds with a frequency of 2 to 2.5 minutes. 63%of students nationwide answered this question correctly. View Topics 3. 159720767 Confidence: Just a guess Stats Issue with this question? 3. The nurse is assessing a pregnant patie

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The nurse is caring for a patient during labor. Despite a firm and contracted uterine fundus, the patient has frank vaginal bleeding. Which action should the nurse take first? 1 Give stool softeners to the patient. Incorrect2 Wash the vagina with cold water. Correct3 Identify whether there are lacerations in the birth canal. 4 Administer analgesia to alleviate the pain. Lacerations of the birth canal may occur during the delivery of the baby. Continuous bleeding, despite a firm and contracted uterine fundus, indicates that the bleeding is caused by lacerations in the birth canal. Lacerations must be identified and sutured immediately after the birth of the baby to prevent heavy blood loss, which otherwise may result in hypovolemic shock. Once the bleeding is controlled, analgesics must be administered to alleviate the pain. A cold wash is given to alleviate the pain, hasten clot formation, and decrease the inflammation. The patient may have problems with defecation, because it can put stress on the sutured lacerations. Stool softeners are given to assist the patient in reestablishing bowel habits and to reduce the stress that might rupture the sutures During a home visit, the nurse observes that a newborn baby is well attached to the parents. Which infant behavior did the nurse most likely observe in the baby? Correct1 The baby used appealing facial expressions. Incorrect2 The baby sought attention from other adults. 3 The baby's body movements were jerky when touched. 4 The baby was unresponsive to the parents' caregiving. The appealing facial expression of the infant is a normal behavioral pattern and is indicative of the infant's desire to seek the parents' attention. If the infant seeks attention from other adults, it indicates that the infant is not getting required attention from the parents. Jerky movements upon touching indicate that the infant is not reacting in a normal way to the parents and may suggest that the parents are not comfortable while handling the infant. If the infant does not respond properly to the care giving tasks of the parents, it indicates that the infant lacks adequate attachment with the parents. It has been determined after ultrasound that a small piece of the placenta remains in the uterus over an hour after birth, causing the fundus not to be firm and excessive bleeding to continue. Because the patient delivered a large infant with a small dose of intravenous pain medication, what action should the nurse take? Correct1 Preparing the patient for the removal of the retained placental fragment, including the use of anesthesia. 2 Encouraging the consumption of oral fluids to expand the fluid volume. 3 Preventing the mother from nursing her infant until her vital signs are stable. 4 Encouraging the mother to nurse as much as possible to clamp down the fundal vessels. The patient will need to have the retained placental fragment removed under anesthesia because of the time period since delivery. The patient should be nothing by mouth (NPO) at this time because of the expected anesthesia. The infant can nurse, but the retained placental fragment will not allow the uterus to contract. After removal of a retained placenta, the woman is at continued risk for primary pulmonary hypertension (PPH) and infection. Test-Taking Tip: Avoid choosing answers that use words such as always, never, must, all,and none. If you are confused about the question, read the choices, label them true or false, and choose the answer that is the odd one out (i.e., the one false one or the one true one). When a question is framed in the negative (such as "When assessing for pain, you should not "), the false option is the correct choice. A postpartum patient who had a cesarean section reports to the nurse a fever, loss of appetite, pelvic pain, and foul-smelling lochia. Upon assessment, the nurse finds that the patient has an increased pulse rate and uterine tenderness. The laboratory reports indicate significant leukocytosis. What clinical condition should the nurse suspect based on these findings? 1 Cystocele 2 Rectocele 3 Hematoma Correct4 Endometritis Endometritis is a common postpartum infection. It usually begins as a localized infection at the placental site and spreads to the entire endometrium. Fever, loss of appetite, pelvic pain, and foul-smelling lochia are symptoms of endometritis. An increased pulse rate and uterine tenderness are also common in this condition. Therefore the nurse can infer that the patient has endometritis. Cystocele is the protrusion of the bladder downward into the vagina. Rectocele is the herniation of the anterior rectal wall through the relaxed or ruptured vaginal fascia and rectovaginal septum. The symptoms reported by the patient are not indicative of these conditions. Because the nurse does not find any collection of blood in the patient, the patient does not have hematoma. The nurse is caring for a Chinese couple who have a newborn. What patient behavior indicates that the couple lacks interest in developing an attachment with the child? The couple: Correct1 Never talks to the infant. 2 Always calls the infant by name. 3 Allows grandparents to take care of the child. 4 Maintains good eye contact with the infant. The couple does not attempt to talk to the infant. This indicates that they lack interest in developing a bond with the infant. Calling the infant by name indicates the couple is giving importance to the individuality of the infant. In Chinese culture, the newborn is taken care of by the grandparents. This is done to promote rest and recovery in the mother after childbirth. Maintaining eye contact with the infant is a sign of attention by the parents toward the infant. The student nurse is caring for a Chinese patient who delivered a baby via cesarean section. The student nurse is concerned that the grandparents seem more actively involved in the infant's care than the mother. What is the best response from the nurse when the student expresses these concerns? 1 "The grandparents dominate the household." 2 "It should be discussed with the infant's parents." Correct3 "It is a common cultural practice in Chinese families." 4 "The grandparents are more attached with the infant." In Chinese families, if a mother gives birth to a baby through cesarean, then the extended family members, including the grandparents, take active participation in the care of the newborn in order to give the new mother sufficient time to rest and recover. Active participation in the infant's care does not indicate domination of the grandparents, nor does it imply the mother is less attached to the infant. The grandparents taking part in the infant's care is a normal cultural practice and is not a matter of concern to be discussed for this family The nurse is caring for a patient who is diagnosed with disseminated intravascular coagulation. Which finding would indicate that the patient has developed a renal complication? 1 Urine pH less than 6 Correct2 Urine output less than 30 mL/hr 3 Presence of pus cells in the blood 4 Red blood cells in the urine Renal failure is the most significant complication associated with disseminated intravascular coagulation (DIC). A urine volume of less than 30 mL/hr indicates renal failure. The presence of pus cells in the urine indicates renal infection, which is not a complication associated with DIC. The presence of red blood cells in the urine indicates hemorrhage in the renal tubules. The normal pH of urine is 7. A pH of less than 6 indicates that the urine is acidic, which may be caused by diabetes. The nurse is caring for an adolescent postpartum patient. The nurse finds that the adolescent father considers the transition to be very stressful. Which nursing interventions would help the adolescent father have a more comfortable transition? Select all that apply. Asking the father to: Correct1 Participate in the teaching sessions of infant care. 2 Perform all the baby care activities alone. 3 Take responsibility of the household activities. Correct4 Be present during the postpartum home visits. Correct5 Accompany the mother and baby for baby care checkups. During the hospital stay, it is good to include the father in the teaching sessions on infant care. This enables the father to have more knowledge about baby care. Asking the father to be present at the postpartum home visits would assist the couple in reducing the problems with baby care. By accompanying the baby and mother to the baby care checkups, the father can gain knowledge about baby care and can also comfort the mother. This makes the transition easier for the couple. Performing the baby care activities requires the involvement of both parents. It is not good to keep up only with household activities, leaving the baby behind with the mother, because this could cause the father to feel powerless and ridden with guilt. While caring for a postpartum patient with uterine displacement, the nurse suggests the patient perform Kegel exercises at least twice a day. What would be the probable reason for giving this suggestion to the patient? Kegel exercises: 1 Prevent vaginitis. 2 Maintain the vaginal pH. 3 Prevent pressure necrosis. Correct4 Strengthen pelvic muscles. After childbirth the patient may have uterine displacement because of pelvic muscle relaxation and loss of pelvic support. To strengthen the pelvic muscles, the patient must be encouraged to perform Kegel exercises several times a day. Vaginitis and pressure necrosis are caused by the use of pessaries, which provide structural support to the vagina. Kegel exercises do not prevent vaginitis and pressure necrosis. Maintaining proper hygiene and removing the pessaries at night can prevent these complications. Vaginal pH can be maintained by regularly douching the vagina with a weak vinegar solution. The nurse observes that a Spanish-speaking patient of Mexican descent does not like the nurses to lean in and admire her newborn. What is the most likely reason for this behavior? The mother: Correct1 Wants to protect the infant from evil eye. 2 Does not have good attachment with the baby. 3 Feels that the baby may acquire infection. 4 Feels that the baby may become fussy seeing new faces. Mexican mothers may believe that excessive admiration may result in evil eye (mal de ojo). They feel that children are more susceptible to evil eye. This behavior does not indicate that the mother does not have a good attachment with the baby. Similarly, this evasive behavior does not indicate the mother is worried about infection or the baby becoming fussy after exposure to new faces. Which intervention does the nurse expect to be the most effective and least expensive for reducing the risk of urinary tract infections in the patient after the labor? 1 Providing good nutrition after labor 2 Teaching comfort measures after labor Incorrect3 Providing antibiotic therapy before labor Correct4 Maintaining aseptic conditions during labor The most effective and least expensive intervention that helps reduce the risk of infection in the patient is to maintain aseptic conditions during labor. This helps reduce the invasion of microorganisms that may cause urinary tract infections (UTIs). Providing good nutrition helps prevent lethargy and anemia in the patient. Antibiotic therapy can be started if the patient already has a UTI, but they are not safe to be given as a prophylactic treatment during pregnancy, because they have teratogenic effects. Teaching comfort measures does not help in preventing infection. The nurse caring for a patient finds excessive postpartum bleeding caused by uterine atony. Upon further assessment, the nurse finds no improvement in the bleeding after administration of oxytocin (Pitocin). What does the primary health care provider prescribe to the patient? 1 Paroxetine (Paxil) 2 Sertraline (Zoloft) Correct3 Misoprostol (Cytotec) Incorrect4 Mirtazapine (Remeron) Oxytocin (Pitocin) is the primary drug administered to induce uterine contractions (UCs). When the uterus fails to respond to oxytocin, misoprostol (Cytotec) is administered to induce contractions. Paroxetine (Paxil) is an antidepressant drug used in the treatment of postpartum depression. Sertraline (Zoloft) is a selective serotonin reuptake inhibitor (SSRI) that serves as an antidepressant and is administered for postpartum depression. Mirtazapine (Remeron) is a drug used in the treatment of depression. The nurse tells a postpartum patient, "You should stop talking and cooing to your baby now." What is the reason behind this instruction? 1 The infant smiled at the patient. Correct2 The infant was crying incessantly. 3 The infant reached out for the patient. 4 The infant raised an eyebrow upon seeing the patient. Pouting or crying, arching of the back, and general squirming are usually signals to end an interaction with the infant. Therefore the nurse should ask the patient to stop talking and cooing to the infant. The nurse would not give such an instruction to the patient if the infant smiled, reached out for the patient, or raised an eyebrow upon seeing the patient. The infant smiles or laughs when stimulated by game playing. The infant greets parents by waving hands and reaching out for the parents. The infant raises an eyebrow to show loving attention toward the parents. A postpartum patient has uterine atony. What medication does the nurse expect the primary health care provider to prescribe to the patient? Correct1 Oxytocin (Pitocin) 2 Misoprostol (Cytotec) 3 Ergonovine (Ergotrate) 4 Methylergonovine (Methergine) Continuous I.V. infusion of 10 to 40 units of oxytocin (Pitocin) added to 1000 mL of lactated Ringer's or normal saline solution is a primary intervention in the management of postpartum bleeding. Drugs like misoprostol (Cytotec), ergonovine (Ergotrate), and methylergonovine (Methergine) are prescribed only if the patient is not responding to oxytocin (Pitocin). Which statement regarding postpartum depression (PPD) is essential for the nurse to be aware of when attempting to formulate a plan of care? 1 PPD symptoms are consistently severe. 2 This syndrome affects only new mothers. Correct3 PPD can easily go undetected. 4 Only mental health professionals should teach new parents about this condition. PPD can go undetected because parents do not admit voluntarily to this type of emotional distress out of embarrassment, fear, or guilt. PPD symptoms range from mild to severe, with women having good days and bad days. Screening should be done for mothers and fathers. PPD may also occur in new fathers. The nurse should include information on PPD and how to differentiate this from the baby blues for all patients on discharge. Nurses also can urge new parents to report symptoms and seek follow-up care promptly if they occur. The nurse observes that the newborn is responding well to the parent. Which behavior from the newborn did the nurse observe to come to this conclusion? The newborn: Correct1 Was dancing in tune with the parent's voice. 2 Looked at the wall upon hearing the parent's voice. 3 Was not kicking its legs in tune to the parent's voice. 4 Was not waving its arms in tune to the parent's voice. When parents speak, infants tend to get excited and dance in tune with the parent's voice. This indicates that the infant is responding well to the patient. The newborn should ideally look at the parent when the parent tries to communicate. If the newborn looks toward the wall, it indicates that the newborn is not responding well to the parent. If the newborn keeps the upper and lower limbs still when the parent interacts, it indicates that the newborn is not responding well to the patient. After reviewing a patient's medical reports, the nurse finds that the patient has multifetal gestation. What is the most likely complication associated with this? 1 Vaginal hematomas 2 von Willebrand disease (vWD) Correct3 Postpartum hemorrhage (PPH) Incorrect4 Abnormal development of limbs The uterine walls are overstretched in multifetal gestation, so it contracts poorly after birth. This may cause uterine atony leading to postpartum hemorrhage (PPH). Multifetal gestation does not cause vaginal hematomas, von Willebrand disease (vWD), or abnormal limb development of the fetus. Vaginal hematomas occur more commonly in association with a forceps-assisted birth. vWD is a type of hemophilia, which is a hereditary bleeding disorder. Abnormal development of fetal limbs is usually a complication associated with teratogenic drugs. Which postpartum infection is most often contracted by first-time mothers who are breastfeeding? Incorrect1 Endometritis 2 Wound infections Correct3 Mastitis 4 Urinary tract infections (UTIs) Mastitis is an infection in a breast, usually confined to a milk duct. Most women who suffer this are first-time mothers who are breastfeeding. Endometritis is the most common postpartum infection. Incidence is higher after a cesarean birth and not limited to first-time mothers. Wound infections are also a common postpartum complication. Sites of infection include both a cesarean incision and the episiotomy or repaired laceration. The gravidity of the mother and her feeding choice are not factors in the development of a wound infection. UTIs occur in 2% to 4% of all postpartum women. Risk factors include catheterizations, frequent vaginal examinations, and epidural anesthesia. During the postnatal visit, the patient tells the nurse, "I'm feeling irritated and tired. I haven't slept properly for days." The nurse suggests a few interventions to help the patient with relaxation and rest. Which techniques adopted by the patient indicate effective learning? Select all that apply. 1 Installed bright lights in the room Correct2 Asked a family member to stay overnight 3 Organized a small dinner party at her home Correct4 Takes a nap when the baby is sleeping 5 Started drinking coffee 3 times a day After the baby's birth, the patient feels irritated and stressed due to lack of sleep. The nurse should suggest interventions that help the patient rest. For example, if the patient's family can be called upon to help with the household chores while the patient looks after the baby and rests, this can help the patient feel more relaxed in the early days of parenting. The patient should try to adjust her schedule to nap when the baby sleeps if possible. Installing bright lights is not an effective technique, as it does not promote sleep. Organizing a dinner party may increase the number of visitors and guests in the home, which, in turn, can increase the household work, causing the patient to become even more fatigued and tired. Coffee contains caffeine and may cause insomnia by stimulating the central nervous system (CNS). Therefore, drinking coffee 3 times a day does not support relaxation. After massaging the boggy fundus of a patient who delivered a large baby after a prolonged labor with a forceps-assisted birth, the nurse is unable to obtain a firm fundus. What nursing action is indicated at this time? 1 Increase the rate of the intravenous infusion. Correct2 Massage the fundus while another nurse notifies the obstetrician. 3 Change the peripad, replacing it with a double pad. 4 Administer a half-dose of a uterine contracting medication. Fragments of the placenta can remain in the uterus after spontaneous separation of the placenta during the third stage of labor. In this case, the woman will have excessive bleeding and the uterus will feel boggy (soft) because of uterine atony. Ultrasonography can be used to detect placental fragments. The patient should not be left alone because of the boggy uterus, which can lead to hemorrhage. There is an absolute need for further medical intervention. The nurse is caring for a patient who is pregnant with her second child. During the prenatal visits, the nurse teaches the expectant mother about sibling rivalry. Which method should the nurse suggest that the patient adopt in order to prevent sibling rivalry from occurring? Ensure that: 1 Both children sleep in different rooms. Correct2 The older sibling visits the newborn regularly. 3 The older sibling does not touch the newborn. 4 Each of the partners takes responsibility of one sibling. Because the mother spends all of her time taking care of the newborn, the older sibling may feel abandoned and jealous of the newborn. Taking the older sibling to visit the newborn regularly establishes a bond between the two and can prevent sibling rivalry. Making both children sleep in different rooms may not be helpful in facilitating attachment between the newborn and the sibling. Parents should always encourage the older sibling to touch the newborn, because this helps establish a good relationship and prevents sibling rivalry. The older sibling wants the care and attention from both parents, so one parent taking the responsibility of the older child would not help the child feel better. The nurse is caring for a patient whose placenta was removed manually. The nurse finds that the patient has developed an infection. Which category of medication does the nurse expect to be prescribed for the patient? 1 Diuretics 2 Electrolytes Correct3 Antipyretics 4 Anticoagulants When the placenta is removed manually, the patient may develop and infection, which may cause a fever. Therefore antipyretics are prescribed for the patient to reduce the body temperature. Electrolytes and anticoagulants are given when the patient has excessive bleeding. They help prevent hypovolemia and excessive loss of blood. Diuretics are given when the patient has edema caused by fluid retention. While assessing a postpartum patient, the nurse finds that the patient has bonded well with her newborn. Which behavior best indicates that the patient has bonded well? The patient: 1 Wakes the baby to spend more time together. 2 Makes the child sleep in prone position after feeding. Correct3 Correlates the features of the infant with her partner. 4 Always asks her mother to change the infant's diapers. A good indication of bonding may be when the patient identifies characteristics that are similar in both the father and the infant. This indicates that the patient has a special bonding with the child. Waking a sleeping baby is not an indication of good bonding, and the nurse should remind the patient about the baby's need to get plenty of rest. Good bonding is also not demonstrated if the patient places the baby in the prone position after feeding, as this may cause the child to vomit. If the patient asks her mother to change the baby's diaper, it may indicate that the patient is afraid of handling the baby, which is not a good sign of proper bonding. While assessing a postnatal patient, the nurse finds that the patient is a model by profession and is unable to restart her career after childbirth. What can the nurse suggest to the patient to help her feel better about herself? Correct1 "Join a support group for mothers." 2 "Place the infant in a day care center." 3 "Leave the infant with his or her grandparents." 4 "Devote this time to care for the infant." Because of personal aspirations and the inability to achieve them after the childbirth, some women may experience depression and anxiety. Such feelings can hinder the care given by the mother to the infant. To provide moral support, the nurse should refer the patient to support groups. The members of the group can interact with each other and share their feelings. Placing the infant in a day care center may not provide effective care to the infant. Leaving the child with his or her grandparents may not help develop the infant-mother bond; this bond can be developed only if the mother is with the infant. The patient may feel rejected if the nurse becomes judgmental and advises that this is the time to care for the child. Which culturally appropriate beliefs should the maternity nurse use to incorporate parental-infant attachment into the plan of care? Select all that apply. 1 Asian mothers are encouraged to return to work as soon as possible. Correct2 Jordanian mothers have a 40-day lying-in after birth. Correct3 Japanese mothers rest for the first 2 months after childbirth. 4 Encourage Hispanics to eat plenty of fish and pork to increase vitamin intake. 5 Encourage Vietnamese mothers to cuddle with the newborn. Jordanian mothers have a 40-day lying-in after birth, during which their mothers or sisters care for the baby. Japanese mothers rest for the first 2 months after childbirth. Asian mothers must remain at home with the baby up to 30 days after birth and are not supposed to engage in household chores, including care of the baby. Hispanic practice involves many food restrictions after childbirth, such as avoiding fish, pork, and citrus foods. Vietnamese mothers may give minimal care to their babies and refuse to cuddle or further interact with the baby to ward off "evil" spirits. Which postpartum conditions are considered medical emergencies that require immediate treatment? Correct1 Inversion of the uterus and hypovolemic shock 2 Hypotonic uterus and coagulopathies 3 Subinvolution of the uterus and idiopathic thrombocytopenic purpura Incorrect4 Uterine atony and disseminated intravascular coagulation (DIC) Inversion of the uterus and hypovolemic shock are considered medical emergencies. A hypotonic uterus can be managed with massage and oxytocin. Coagulopathies should be identified before birth and treated accordingly. Although subinvolution of the uterus and ITP are serious conditions, they do not always require immediate treatment. ITP can be safely managed with corticosteroids or IV immunoglobulin. DIC and uterine atony are very serious obstetric complications; however, uterine inversion is a medical emergency requiring immediate intervention. During an examination, the nurse finds that a patient has a cystocele. What other associated complication does the nurse expect the patient to have? 1 Rectocele Correct2 Incontinence 3 Genital fistulas 4 Prolapsed uterus Urinary incontinence is a symptom associated with cystocele. A cystocele can damage the bladder neck and urethra, thereby causing incontinence. A patient with a rectocele has problems during defecation. Genital fistulas are abnormal passageways between the vagina and other genital organs. A prolapsed uterus is a condition in which the uterus comes out of the vagina. A 28-year-old multipara delivered a 9 pound, 3 ounce baby girl an hour ago after a 22-hour labor with a forceps-assisted birth. As the patient is holding her daughter, she keeps shifting position and is becoming increasingly irritable and annoyed with everyone in the room. What action should the nurse initially take? 1 Massage the fundus. Correct2 Check her perineal pad. 3 Assess her vital signs. Incorrect4 Check the tone of her fundus. The patient is exhibiting increasing anxiety, which can signal the presence of postpartum hemorrhage. Risk factors for postpartum hemorrhage include a large fetus, prolonged labor, and a forceps-assisted birth. Because vital signs change late, the fastest way to see the amount of current hemorrhage is to check the perineal pad. The fundus would be massaged and additional nursing and medical interventions would be instituted. A pregnant patient reports urine leakage while sneezing or coughing. What does the nurse expect to be the cause of this problem? Correct1 Increased abdominal pressure Incorrect2 Disorders of the bladder and urethra 3 Acquired urinary tract abnormalities 4 Pathologic conditions of the spinal cord As the patient is pregnant, the patient has an increased intra-abdominal pressure. In this condition, the angle between the urethra and the base of the bladder either increases or is lost. This may ultimately lead to incontinence. Urine spurts out when the patient sneezes or coughs. Disorders of the bladder and urethra cause urge incontinence. Pathologic conditions of the spinal cord cause neuropathies, which disturb the control of urine, but are not associated with sneezing. An acquired urinary tract abnormality can also cause impaired urine control, but incontinence is not associated with sneezing or coughing. When a nurse observes profuse postpartum bleeding, the first and most important nursing intervention is to: Incorrect1 call the woman's primary health care provider. 2 administer the standing order for an oxytocic. Correct3 palpate the uterus and massage it if it is boggy. 4 assess maternal blood pressure and pulse for signs of hypovolemic shock. The most important nursing intervention is to stop the bleeding. Once the nurse has applied firm massage of the uterine fundus, the primary health care provider should be notified or the nurse can delegate this task to another staff member. This intervention is appropriate after assessment and immediate steps have been taken to control the bleeding. The initial management of excessive postpartum bleeding is firm massage of the uterine fundus. Vital signs will need to be ascertained after fundal massage has been applied. A pregnant patient with idiopathic thrombocytopenic purpura who is receiving corticosteroid therapy is scheduled for a splenectomy. In what clinical situation would this surgery be beneficial to the patient? If the patient had: Correct1 No improvement from the administration of corticosteroids Incorrect2 An adverse reaction from the administration of corticosteroids 3 Increased platelet count from the administration of corticosteroids 4 Increased white blood cell (WBC) count from the administration of corticosteroids Idiopathic thrombocytopenic purpura (ITP) is a condition characterized by a very low platelet count and is treated by administering corticosteroids. When corticosteroids improve platelet count, patients do not need a splenectomy. However, splenectomy is needed if a patient does not respond to conventional medications. Adverse reactions to corticosteroids are not treated by splenectomy. White blood cell (WBC) count is normal in ITP, and corticosteroids inhibit their production. During the assessment of a postpartum patient, the nurse finds the patient has endometritis. Which medication should be administered in the treatment plan for this patient? Correct1 Clindamycin (Cleocin) 2 Misoprostol (Cytotec) 3 Ergonovine (Ergotrate) 4 Methylergonovine (Methergine) Endometritis is a common postpartum infection. It usually begins as a localized infection at the placental site and spreads to the entire endometrium. Endometritis is usually managed by giving the patient a broad-spectrum antibiotic drug, like Clindamycin (Cleocin). Therefore clindamycin (Cleocin) should be involved in the treatment plan for management of endometritis. Misoprostol (Cytotec), ergonovine (Ergotrate), and methylergonovine (Methergine) are uterotonic drugs used to manage postpartum hemorrhage (PPH) caused by uterine atony. 0. The nurse is caring for a patient during labor. While examining the patient, the nurse palpates a smooth mass through the dilated cervix. The patient also shows signs of hypovolemic shock. What must be the immediate nursing intervention? Incorrect1 Administering tocolytics Correct2 Giving intravenous (I.V.) fluids 3 Administering oxytocin (Pitocin) 4 Pushing the uterus into the pelvic cavity The presence of a smooth mass in the dilated cervix indicates an incomplete inversion of the uterus. The most lethal complications associated with this are hemorrhage and cardiovascular collapse. Because the patient shows signs of hypovolemic shock, fluid resuscitation must be performed immediately to prevent complications of shock. The uterus must be relaxed before attempting the uterine replacement. Tocolytics are administered to relax the uterus. Complete relaxation of the uterus can be obtained with halogenated anesthetics. Oxytocin (Pitocin) is administered after the uterus has been replaced in the pelvic cavity. It produces contractions in the uterus, which prevent reinvolution of the uterus. Once the uterus is relaxed from the tocolytic agents and halogenated anesthetics, the uterus is replaced manually within the pelvic cavity. The nurse is caring for a postpartum patient who had a cesarean delivery. Following the assessment, the nurse reports that the patient has secondary postpartum hemorrhage. Based on which patient findings did the nurse come to this conclusion? 1 Loss of 500 mL of blood within 24 hours of delivery Correct2 Loss of 1250 mL of blood 48 hours after the delivery 3 Hematocrit value reduced by 2% after the delivery 4 Hematocrit values reduced by 5% 6 weeks after the delivery Postpartum hemorrhage (PPH) is characterized by excessive bleeding after childbirth. If a patient has lost more than 1000 mL (1250 mL) of blood after a cesarean section, she is diagnosed with PPH. Based on the onset of bleeding, PPH is divided into two types: primary and secondary. If the bleeding occurs more than 24 hours after delivery, the patient has secondary PPH. Loss of excessive blood within 24 hours of delivery is considered primary PPH. Therefore the loss of 500 mL of blood within 24 hours of delivery does not indicate the patient has secondary PPH. A reduction of the hematocrit value by 10% after the labor indicates that the patient has PPH. Therefore the reduction of hematocrit values by 2% to 7% does not indicate that the patient has PPH Following the assessment of a postpartum patient, the nurse suspects that the patient requires removal of uterine contents using a vacuum suction. Which patient clinical findings led the nurse to this conclusion? Select all that apply. 1 Uterus feels hard. Correct2 Uterus feels boggy. Correct3 Excessive bleeding. Correct4 Placental fragments. 5 Scanty amniotic fluid. When the placenta is retained in the patient, it is typically removed by manual separation. This may leave some placental fragments in the uterus, causing excessive bleeding and making the uterus feel boggy. It may also lead to infection, so the uterine contents must be removed using vacuum suction. Therefore excessive bleeding, a boggy uterus, and the presence of placental fragments in the uterus indicate the need for vacuum suction. Usually the amniotic membrane is ruptured and the amniotic fluid is lost after childbirth, although this may not cause infection. The presence of a hard uterus indicates that the patient is free from infection and uterus atony and does not suggest the need for removing the uterine contents by vacuum suction. The nurse is caring for a postpartum Native American patient who is unwilling to breastfeed the baby until after the breast milk has come in. What will the nurse do in this situation? Correct1 Explain the importance of first milk to the patient. 2 Ask the patient to give formula milk to the infant. 3 Use additional measures for milk ejection in the patient. 4 Apply antiinflammatory ointment around the patient's nipples. Native American patients do not initiate breastfeeding until their breast milk comes in. They avoid feeding the first milk (colostrum) to the child. In this situation, the nurse should inform the patient about the health benefits of feeding colostrum to the child. Mother's milk is the best source of nutrition for the baby; the formula milk is not as nutritious. The mother is also unlikely to have problems ejecting milk. Native American mothers tend to avoid feeding the baby unless the colostrum stops ejecting and the mother starts ejecting milk. Because the patient has not yet started breastfeeding, it is unlikely that the patient has sore nipples, so the nurse would not need to apply antiinflammatory ointment. A woman with a history of a cystocele should contact the health care provider if she experiences: 1 Backache. 2 Constipation. Correct3 Urinary frequency and burning. Incorrect4 Involuntary loss of urine when she coughs. Urinary frequency and burning are symptoms of cystitis, a common problem associated with cystocele. Back pain is a symptom of uterine prolapse. Constipation may be a problem with rectoceles. Involuntary loss of urine during coughing is stress incontinence and is not an emergency. Test-Taking Tip: Calm yourself by closing your eyes, putting down your pencil (or computer mouse), and relaxing. Breathe deeply for a few minutes (or as needed, if you feel especially tense) to relax your body and to relieve tension. A primiparous woman is in the taking-in stage of psychosocial recovery and adjustment following birth. Recognizing the needs of women during this stage, the nurse should: 1 foster an active role in the baby's care. Correct2 provide time for the mother to reflect on the events of and her behavior during childbirth. 3 recognize the woman's limited attention span by giving her written materials to read when she gets home rather than doing a teaching session now. 4 promote maternal independence by encouraging her to meet her own hygiene and comfort needs. Women express a need to review their childbirth experience and evaluate their performance. After the mother's needs are met, she is more able to take an active role, not only in her own care but also in the care of her newborn. Short teaching sessions (using written materials to reinforce the content presented) are a more effective approach. The focus of the taking-in stage is nurturing the new mother by meeting her dependency needs for rest, comfort, hygiene, and nutrition. Test-Taking Tip: After choosing an answer, go back and reread the question stem along with your chosen answer. Does it fit correctly? The choice that grammatically fits the stem and contains the correct information is the best choice. The nurse is caring for a pregnant patient in the late stage of pregnancy. What nursing interventions would facilitate the mother's immediate attachment with the newborn after birth? Select all that apply. Correct1 Explaining the process of attachment to the parents Correct2 Discussing the infant's behavioral pattern with the parents Correct3 Placing the infant with skin-to-skin contact with the parents 4 Instructing the parents to not examine the newborn after birth 5 Explaining to parents of multiple children that all infants are essentially the same The nurse should clearly explain the complexity of the attachment process to the parents. This helps the parents prepare for the process of attachment with the infant. The nurse should discuss the behavioral patterns of the newborn so that the parents can distinguish between normal and abnormal behaviors. Asking the parents to have proper skin contact with the infant enables the infant to get the feel of the mother's skin, thus promoting early attachment. The parents should be allowed to hold and examine the infant after birth, because it promotes caring and ensures that the parents understand about the baby's health. In the case of multiple children, the parents should be taught about the individuality of each infant in order to ensure infant identity. When making a visit to the home of a postpartum woman 1 week after birth, the nurse should recognize that characteristically the woman would: 1 express a strong need to review events and her behavior during the process of labor and birth. 2 exhibit a reduced attention span, limiting readiness to learn. Correct3 vacillate between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn. 4 have reestablished her role as a spouse/partner. Vacillating between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn is characteristic of the taking-in stage, which lasts for the first few days after birth. Expressing a strong need to review events and her behavior during the process of labor and birth is characteristic of the taking-in stage, which lasts for the first few days after birth. One week after birth, the woman should exhibit behaviors characteristic of the taking-hold stage. This stage lasts for as long as 4 to 5 weeks after birth. Reestablishing her role as a spouse/partner reflects the letting-go stage, which indicates that A postpartum patient with hearing impairment asks the nurse, "How will I know when the baby cries?" What does the nurse instruct the parent to do? 1 Stay with the infant throughout the day. 2 Appoint a caretaker to look after the baby throughout the day. Correct3 Fit the infant's room with light devices that indicate when the baby cries. 4 Identify the infant's routine to know when the baby usually cries of hunger and sleep. Parents who have a hearing impairment can be advised to install devices in the infant's room that convert the sound into light. This helps the parents to know when the infant cries. The mother cannot stay with the infant all day, as it may not be possible in a practical sense. Appointing a caretaker may not be as effective as installing the device, and it is not affordable for every family. Identifying the infant's routine to know the usual pattern of feeding and sleeping may not help the parents to know when the baby cries due to inconsistency in behavior. Which statement made by the father of an infant indicates that he is in the phase of confronting reality? 1 "I feel complete when I see my child smile." 2 "I am learning how to change my child's diapers." Incorrect3 "I feel a desire for deep involvement with my child." Correct4 "I am very worried about my ability to take care of my child." The infant's father is in the phase of confronting reality since he is dealing with the expectations associated with the child's birth and his role as a father. It is natural for the father to feel disappointed and frustrated during the phase of confronting reality. The father feels a sense of completeness and meaning in the reaping rewards phase, such as when he sees his child smile. In the phase of creating the role of an involved father, the father learns to care for the infant through activities such as changing diapers. The father experiences a desire for deep emotional involvement with the infant in the expectations and intentions phase. The nurse is caring for a visually impaired patient after the birth of her baby. Which action indicates that the nurse is providing effective care to the patient? The nurse: 1 Gives verbal instructions to the patient about newborn care. 2 Does not allow the patient to touch the facility equipment. 3 Does not hand over the baby to the patient after the birth. Correct4 Orients the patient to the hospital room and the hospital routines. The patient should be oriented to the hospital room, along with the routine in the health care facility. This enables the patient to be comfortable and move about more independently. Verbal explanation may not be sufficient for the patient to understand the procedures as the patient is visually impaired. The patient should be allowed to touch the equipment in her room, because this will help her become more oriented in the environment. The care for the newborn should be demonstrated by touch. The baby is to be handed to the patient after birth, even though the patient is visually challenged. However, the nurse should properly supervise the patient when holding the baby. A patient who had a postpartum hemorrhage is being discharged. What discharge instructions should the nurse give the patient? Select all that apply. Correct1 "Limit your physical activity." Correct2 "Alternate activity and rest periods." 3 "Increase the fat content in your diet." Correct4 "Increase dietary iron and protein." 5 "Increase caffeine content in your diet." The patient needs to limit the amount of physical activity to conserve energy. The patient may feel fatigued and exhausted because of the excessive blood loss during the delivery. To reduce fatigue, the patient should avoid working continuously and alternate activities with sufficient rest periods in between. The patient must increase the amount of dietary iron and protein intake to increase recovery from the blood loss. Increased fat content is not advised, because it may cause cardiovascular problems and weight gain. Moderate caffeine intake is allowed. However, increased caffeine intake is associated with cardiovascular problems. Four days after delivery, the mother reports feeling restless, sad, and unable to sleep. What response should the nurse give to the patient? 1 "These negative feelings will go away within 10 days." 2 "Restrict the number of visitors you have each day." Correct3 "Practice some relaxing techniques." 4 "Let the family take care of the baby more." Based on the reported symptoms, the patient is experiencing the postpartum blues. The nurse should suggest some relaxing techniques to the patient to cope with the symptoms. Usually the postpartum blues subside 10 days after the birth, but it may not be so in all cases. The nurse should not tell the patient that the feelings will go away after few days but should help the patient cope with the symptoms. Restricting the number of visitors to the patient may cause the patient to feel lonely and depressed. Therefore the patient should be instructed to plan the visiting hours and resting hours accordingly. Other family members should look after the baby also. However, this is the crucial time for the mother and baby to bond with each other. The nurse observes that a patient is providing appropriate care to the infant. Which behaviors did the nurse observe in the patient to come to this conclusion? Select all that apply. 1 Waking the infant from sleep Correct2 Talking and gesturing to the infant Correct3 Claiming proudly that their infant is unique Correct4 Constantly touching the infant's palms and smiling 5 Squeezing the nipples continuously while breastfeeding the baby Talking to the infant and making gestures indicates the attachment of the patient to the baby and indicates that the patient is recognizing the infant as an individual. Bragging about the uniqueness of the infant is a common behavior in new parents and indicates that the patient is developing attachment with the infant. Touching the infant's hands and smiling indicates feelings of love and attachment for the infant. If the parents constantly try to wake up the child from sleep, it indicates the parents are nervous or do not understand the needs of the infant for growth and development. Moving or squeezing the nipples continuously while feeding the baby may indicate that the mother wants to feed the baby hurriedly, which is not a sign of good infant care. Thromboembolic conditions that are of concern during the postpartum period include: Select all that apply. 1 Amniotic fluid embolism (AFE). Correct2 Superficial venous thrombosis. Correct3 Deep vein thrombosis. Correct4 Pulmonary embolism. 5 Disseminate intravascular coagulation (DIC). An AFE occurs during the intrapartum period when amniotic fluid containing particles of debris enters the maternal circulation. Although AFE is rare, the mortality rate is as high as 80%. A superficial venous thrombosis includes involvement of the superficial saphenous venous system. With deep vein thrombosis, the involvement varies but can extend from the foot to the iliofemoral region. A pulmonary embolism is a complication of deep vein thrombosis occurring when part of a blood clot dislodges and is carried to the pulmonary artery, where it occludes the vessel and obstructs blood flow to the lungs. DIC is an imbalance between the body's clotting and fibrinolytic systems. It's a pathologic form of clotting that consumes large amounts of clotting factors. A deceased fetus has been removed from a patient through cesarean section. What critical assessment should the nurse continuously monitor in the patient? 1 Blood gases 2 Platelet count Correct3 Blood pressure 4 Respiratory rate More than 100 mL of blood is lost during a cesarean section. Therefore the nurse should continuously monitor the blood pressure of the patient to check the extent of hypovolemia. The platelet count would be reduced because of blood loss. However, its determination would not help to know the extent of the blood loss. The blood gas levels should be checked to detect metabolic or respiratory disorders, which change the pH of the blood. The respiratory rate would be increased because of the blood loss. However, these values would not help determine whether the patient was in hypovolemic shock. Despite popular belief, there is a rare type of hemophilia that affects women of childbearing age. Von Willebrand disease is the most common of the hereditary bleeding disorders and can affect males and females alike. It results from a factor VIII deficiency and platelet dysfunction. Although factor VIII levels increase naturally during pregnancy, there is an increased risk for postpartum hemorrhage from birth until 4 weeks postpartum as levels of von Willebrand factor (vWf) and factor VIII decrease. The treatment that should be considered first for the woman with von Willebrand disease who experiences a postpartum hemorrhage is: 1 cryoprecipitate. 2 factor VIII and vWf. Correct3 desmopressin. 4 hemabate. Cryoprecipitate may be used; however, because of the risk of possible donor viruses, other modalities are considered safer. Treatment with plasma products, such as factor VIII and vWf, are an acceptable option for this patient. Because of the repeated exposure to donor blood products and possible viruses, this is not the initial treatment of choice. Desmopressin is the primary treatment of choice. This hormone can be administered orally, nasally, and intravenously. This medication promotes the release of factor VIII and vWf from storage. Although the administration of this prostaglandin is known to promote contraction of the uterus during postpartum hemorrhage, it is not effective for the patient who presents with a bleeding disorder. The nurse is caring for an Asian patient who had a vaginal delivery. Which nursing intervention would be consistent with the patient's cultural practice regarding postpartum care? 1 Talk privately with the mother about caring for the newborn. Correct2 Ask the patient to not engage in any household activities. Incorrect3 Advise the patient to rest for a full 2 months after the birth. 4 Ask the patient to use the sitz iced bath for episiotomy pain relief. In most Asian communities, the mother may not be involved in the household activities and is given complete rest for 30 days after birth. The baby's grandmother is usually involved in the infant's care, so it is natural for the nurse to include the grandmother when providing instructions about the care of the newborn. Advising the mother to rest for 2 months may not be appropriate advice, because it can cause postpartum complications. Use of a sitz iced bath for pain relief is not advisable for Asian patients, because they often prefer not to bathe during their puerperium. A patient reports having difficulty ejecting milk while breastfeeding the infant. Which nursing interventions would help the patient breastfeed the newborn with greater ease? Select all that apply. Correct1 Teach the patient about the infant's rooting and sucking reflexes. Correct2 Ask the patient to breastfeed the newborn immediately after birth. Correct3 Explain frequent milk expression and kangaroo care to the patient. 4 Talk to the patient about the newborn's capabilities for interaction. 5 Ensure the newborn has good contact with the patient immediately after birth. The patient reports having problems with lactation. Thus the nurse should assist in establishing and maintaining a successful breastfeeding process for the patient. To do this, the nurse should teach the patient about the infant's rooting and sucking reflexes. The patient should be asked to immediately breastfeed the child after birth. Then the nurse has to explain frequent milk expression and kangaroo care to the patient for optimized milk supply. Placing the newborn skin-to-skin with the parent immediately after birth is not useful for breastfeeding. The nurse has to talk to the patient about the infant's capabilities for interaction while teaching the patient how to nurture the infant in the first year of life, but these interventions are not in response to problems with lactation. The nurse is teaching a pregnant patient with venous thromboembolism about measures to prevent aggravation of her symptoms. Which instruction given by the nurse needs to be rectified? 1 "Apply moist heat on the affected area." Incorrect2 "Change your position from time to time." Correct3 "Place your knees in a sharp flexed position." 4 "Feed the baby breast milk; it is not harmful." Venous thromboembolism (VTE) results from the formation of blood clots or a clot inside a blood vessel. Placing the knees in a sharp flexed position would cause pooling of the blood in lower extremities, which would aggravate thromboembolism and thus should be avoided. Application of moist heat at the site of inflammation decreases pain and can be applied. The change in position from time to time would help with proper blood flow. Warfarin sodium (Coumadin) is an anticoagulant that is usually administered for VTE. VTE does not affect lactation; therefore the patient can safely breastfeed the baby. A premature infant is transferred to the neonatal intensive care unit (NICU) immediately after birth. The mother fears that she will not be able to develop a bond with the newborn because she has not even held the baby yet. What would be the best nursing response based on the patient's stated fear? 1 "Visit the baby in the NICU anytime you want." Correct2 "You do not need to hold the baby in order to develop a bond." 3 "Demand a chance to hold the baby; it is your child." 4 "You will develop a bond with the baby once you start breastfeeding." The newborn has been admitted to the NICU, which can make it difficult or even impossible for the parents to interact with and touch the baby. The nurse should reassure the mother that body contact is not the only means of maternal infant attachment. Bonding can also be developed by other means such as talking and showing facial expressions. The mother is allowed to visit the NICU only on specific times in a day, and the nurse should inform the parents of the visiting policies. In some cases, a baby admitted to the NICU may not be healthy enough to be held, so the parents should not demand permission to hold the child. Breastfeeding is not required to initiate the bond between the mother and the infant, so the nurse should not reassure the mother in this way. A patient diagnosed with placenta accreta has uncontrolled bleeding, despite medications. What is the best choice for treatment in this situation? Incorrect1 Massage the uterus. Correct2 Perform a hysterectomy. 3 Replace blood components as needed. 4 Apply traction on the umbilical cord. Placenta accreta is an obstetric complication in which the placenta adheres to and penetrates the myometrium. The patient with placenta accreta is at risk of hemorrhage during childbirth. If bleeding is not stopped after the administration of medication to the patient, a hysterectomy must be performed to prevent further complications. Replacement of blood components is not useful because the patient has uncontrolled bleeding. Massaging the uterus and applying traction to the umbilical cord is helpful to expel the placenta but is not useful when the placenta is adhered to the uterus. Upon assessment the nurse finds that a patient who had a cesarean delivery is at risk of postpartum hemorrhage (PPH). What would be the most likely cause of PPH in this patient? Correct1 Anesthesia 2 Coagulopathy Incorrect3 Placenta previa 4 Chorioamnionitis Anesthesia blocks the neurologic impulses that stimulate uterine contractions (UCs). This causes uterine atony and can lead to PPH. Chorioamnionitis is a serious condition in which the fetal membranes are infected and is associated with other signs, such as fever. Coagulopathy is a clotting disorder that results from protein defects in the plasma that interrupt the coagulation cascade and cause blood coagulation. Placenta previa is an obstetric complication in which the placenta penetrates partially in the lower uterine segment. This is a common complication in pregnant women who smoke and consume cocaine. The nurse arranges a suitable environment for a patient after childbirth. Which actions of the nurse would facilitate mutual gazing of the patient and infant? Select all that apply. Correct1 Dims the lights in the patient's room Incorrect2 Teaches the patient about kangaroo care Correct3 Positions the infant on the patient's breasts 4 Encourages the patient to cuddle the infant Correct5 Delays the instillation of antibiotic into the infant's eye Mutual gazing of the patient and infant can be facilitated by teaching the en face position. In this position, the parent's face and the infant's face are approximately 8 inches apart and are on the same plane. The child may not be able to open its eyes in bright light. Therefore the nurse should dim the lights in the room so that the infant can keep its eyes open in the room. The nurse can facilitate eye contact by positioning the infant on the patient's breasts and keeping the mother's and the infant's faces on the same plane. The nurse should delay the instillation of antibiotic into the infant's eye so that the infant can have eye contact with the parents for some time after birth. Teaching the patient about kangaroo care is to facilitate breastfeeding in the patient. However, it is not helpful for mutual gazing of the patient and infant. Cuddling the infant would help the patient share body warmth with the infant but would not help mutual gazing. After reviewing the laboratory reports, the nurse concludes that a patient has disseminated intravascular coagulation (DIC). Which findings led the nurse to conclude this? Select all that apply. A decrease in: Correct1 Platelet count Correct2 Fibrinogen level Correct3 Proaccelerin level Correct4 Red blood cell count 5 White blood cell count DIC is the result of an imbalance between the clotting and fibrinolytic systems. DIC is caused by diffused clots in the microcirculation that block the small vessels. DIC consumes large amounts of platelets, prothrombin, fibrinogen, and factors V and VII. This causes a decrease in the platelets, fibrinogen, antihemophiliac factor, prothrombin, and proaccelerin. DIC can lead to significant bleeding, which may cause reduction of red blood cells. The levels of white blood cells are not affected in DIC, nor do they interfere with the clotting process While caring for an Algerian patient, the nurse suggests that the patient give kangaroo care to the infant. The mother is unwilling to follow the suggestion of the nurse. What is the reason for this unwillingness? The patient is attempting to: Incorrect1 Protect the infant from evil spirits. 2 Prevent others from touching the baby. Correct3 Protect the infant physically and psychologically. 4 Take adequate rest after the birth of the child. Algerian mothers tightly wrap the infant in swaddling clothes to protect them physically and physiologically, a custom followed by Algerians as a part of the acquaintance process. Algerians follow this custom to give physical and psychological protection but not to protect the infant from evil spirits. Vietnamese mothers interact minimally with the infants to protect them from evil spirits. The mother has to accept the assistance from others, as she alone cannot take care of the baby. Therefore she cannot avoid others touching the infant. Asian and Jordanian mothers hand over the baby to the grandparents immediately after birth. They do this to get some rest after childbirth. The nurse is caring for a postpartum patient with venous thrombosis. What instructions related to precautions to take with anticoagulant therapy should the nurse give to the patient at the time of discharge? 1 "Use contraceptives on a regular basis to prevent pregnancy." 2 "Use only aspirin (Acuprin) when you have significant pain." Incorrect3 "Practice site rotation for administration through the intramuscular (IM) route." Correct4 "Practice site rotation for administration through the subcutaneous (SC) route." When anticoagulants are prescribed to administer subcutaneously (SC), the patient must be educated not to inject the drug at the same site repeatedly, because this may cause tissue necrosis. Oral contraceptives are contraindicated with oral anticoagulants because of the possible risk of thrombosis and teratogenicity. Aspirin (Acuprin) is contraindicated for a patient on oral anticoagulants because of drug interactions and because aspirin increases the clotting time. Intramuscular (IM) injections of anticoagulants are typically not used, and no site rotation is needed if they are administered through the IM route. The nurse is assessing a patient with postpartum hemorrhage (PPH). During the physical assessment, the nurse finds that there are deep lacerations in the cervix. Which observation allows the nurse to conclude that the PPH is caused by cervical lacerations? 1 Dark red blood Correct2 Bright red blood 3 Clots in the blood 4 Foul-smelling blood Bright red blood indicates that hemorrhage was caused by deep lacerations of the cervix. Foul-smelling blood during the postpartum period indicates infection. Bleeding caused by varices or superficial lacerations of the birth canal is dark red. Clots in the blood indicate disseminated intravascular coagulation (DIC). What instructions does the nurse give to a patient who had postpartum hemorrhage and is prescribed warfarin (Coumadin) therapy? Select all that apply. "Avoid: Incorrect1 Feeding breast milk to the baby during the course of therapy." Correct2 Taking naproxen (Anaprox) during the course of therapy." Correct3 Taking aspirin (Ecotrin) for pain relief during the course of therapy." Correct4 Using any products that contain alcohol during the course of therapy." Correct5 Eating large portions of green vegetables during the course of therapy." Green leafy vegetables are good sources of vitamin K, which enhances blood clotting. Becausewarfarin (Coumadin) is used to dissolve a clot, green vegetables can retard its effects. Aspirin (Ecotrin) and naproxen (Anaprox) inhibit synthesis of clotting factors and prolong clotting time and thus aggravate the action of warfarin. Alcohol also enhances the clotting effect, so it, too, should be avoided. Breast milk can be given to the infant, because warfarin has no effect on lactation. The nurse observes that a postpartum patient refuses to cuddle her baby and avoids keeping the baby in the en face position. When the nurse asks for the reason, the patient replies that this is done to ward "evil spirits" off the infant. Which cultural group does the patient belong to? 1 Japanese 2 Algerian 3 Hispanic Correct4 Vietnamese Patients who belong to the Vietnamese cultural group avoid keeping the baby in the en face position because they believe that this helps to ward "evil spirits" off the infant. Japanese, Algerian, and Hispanic groups do not refuse to cuddle their infants. Japanese mothers initiate both breastfeeding and bottle feeding in the infant immediately after birth. Algerian women wrap their babies tightly in swaddling clothes to protect them physically and psychologically. Hispanic women are expected to recuperate after childbirth and get acquainted with the infant. A pregnant patient with preeclampsia reports having spontaneous bleeding from the gums and nose and excessive bleeding from slight trauma. Upon assessment the nurse finds that the patient has tachycardia and diaphoresis. The laboratory reports show decreased levels of fibrinogen and proaccelerin. What would the nurse infer about the patient's clinical condition? 1 Rectocele 2 Endometritis 3 Retroperitoneal hematoma Correct4 Disseminated intravascular coagulation Disseminated intravascular coagulation (DIC) is a pathologic clotting process that consumes large amounts of clotting factors, including platelets, fibrinogen, and prothrombin. Preeclampsia is a common cause of DIC. Spontaneous bleeding from the gums and nose and excessive bleeding from slight trauma are symptoms of DIC. Because the patient has decreased levels of fibrinogen and proaccelerin, the nurse may infer that the patient has DIC. Rectocele is the herniation of the anterior rectal wall through the relaxed or ruptured vaginal fascia and rectovaginal septum. Endometritis is a common postpartum infection, presenting with symptoms of fever, chills, loss of appetite, nausea, fatigue, dullness, pelvic pain, and foul-smelling lochia. Persistent perineal pain, a feeling of pressure in the vagina, and shock are symptoms of retroperitoneal hematoma. The student nurse places the preterm infant on the mother's bare chest and covers it with a warm blanket. As part of the evaluation, the nurse asks the reason for this intervention. Which response indicates the student needs further learning? Correct1 "It reduces the distr

Chapter 20 + 21

A male patient asks the nurse why it is better to purchase condoms that are not lubricated with nonoxynol-9 (a common spermicide). The nurse's most appropriate response is: 1 "The lubricant prevents vaginal irritation." Correct2 "Nonoxynol-9 does not provide protection against sexually transmitted infections, as originally thought; also it has been linked to an increase in the transmission of human immunodeficiency virus (HIV) and can cause genital lesions." 3 "The additional lubrication improves sex." 4 "Nonoxynol-9 improves penile sensitivity." Nonoxynol-9 does not provide protection against sexually transmitted infections. Nonoxynol-9 may cause vaginal irritation. Nonoxynol-9 has no effect on the quality of sexual activity. Nonoxynol-9 has no effect on penile sensitivity. Which response by the nurse is most appropriate when a woman asks, "What contraceptive do you think I should use?" 1 "Your health care provider will know what is best for you." 2 "The male condom is probably the easiest for you to use." 3 "Because you are younger than 40, you should use oral contraceptives." Correct4 "I can discuss the various methods so you can decide what is best for you." The nurse should provide the woman with all the necessary information to make an informed decision, but should not make the decision for her. The nurse can educate the woman about contraception; she does not have to ask the doctor. The nurse should provide information about contraception, not tell her which one to choose. The nurse should educate the woman about different types of contraception, not make the choice for her. What should the nurse stress in teaching a woman to deal with the symptoms of premenstrual syndrome (PMS)? Correct1 Decrease her consumption of caffeine. 2 Drink a small glass of wine with her evening meal. 3 Decrease her fluid intake to prevent fluid retention. 4 Eat three large meals a day to maintain glucose levels. Caffeine increases irritability, insomnia, anxiety, and nervousness. Alcohol aggravates depression and should be avoided. Fluid intake should not be decreased. Three small to moderate meals and three snacks a day can help relieve symptoms. A patient reports severe pain associated with abdominal cramps, backache, vomiting, and headache during the first 2 days of menses. The nurse finds that the patient has been taking diclofenac (Cataflam) to relieve abdominal cramps for the past 2 months. What new prescription might the nurse expect for the patient? 1 Nafarelin (Synarel) 2 Leuprolide (Lupron) Correct3 Ibuprofen (Motrin) 4 Azithromycin (Zithromax) Abdominal cramps, backache, vomiting, and headache during periods are caused by the secretion of prostaglandins in primary dysmenorrhea. Vomiting is also a side effect caused by the use of diclofenac. The primary health care provider will prescribe another NSAID such as ibuprofen, because diclofenac is ineffective in relieving the pain during periods. Nafarelin, leuprolide, and azithromycin are not prescribed for treatment of primary dysmenorrhea. Nafarelin and leuprolide are prescribed for endometriosis. Azithromycin is prescribed for chlamydial infections. STUDY TIP: Focus your study time on the common health problems that nurses most frequently encounter. A woman undergoing evaluation of infertility states, "At least when we're through with all of these tests, we will know what is wrong." The nurse's best response is: 1 "I know the test will identify what is wrong." 2 "I'm sure that once you finish these tests your problem will be resolved." Correct3 "Even with diagnostic testing, infertility remains unexplained in about 20% of couples." 4 "Once you've identified your problem, you may want to look at the option of adoption." Problems with infertility must be approached realistically. Nurses should not make judgments or give false reassurance. Providing accurate information to the couple is the best response. The nurse should not make statements indicating that problems will be resolved, because this gives a false impression. The tests are not always definitive, so the nurse should not give false reassurance. The nurse should not offer her opinion but instead should state the facts. Test-Taking Tip: Do not fret over any one question for too long. If you are having trouble, skip the question and go back to it when you have finished answering the other questions. Which method is used to determine the presence of varicoceles in the testes? 1 Semen analysis Correct2 Scrotal ultrasound 3 Transrectal ultrasound 4 Sperm penetration assay A scrotal ultrasound is used to examine the testes for the presence of varicoceles. It is also used to identify abnormalities in the scrotum and/or the spermatic cord. Semen analysis is used to detect the ability of the sperm to fertilize an egg. Transrectal ultrasound is used to evaluate the ejaculatory ducts, seminal vesicles, and vas deferens. Sperm penetration assay is used to evaluate the ability of the sperm to penetrate an egg Which contraceptive method provides protection against sexually transmitted infections? 1 Oral contraceptives 2 Tubal ligation Correct3 Male or female condoms 4 Intrauterine device (IUD) Because condoms provide the best protection available, they should be used during any potential exposure to a sexually transmitted infection. Only the barrier methods provide some protection from sexually transmitted infections. A tubal ligation is considered a permanent contraceptive method but does not offer any protection against sexually transmitted infections. IUDs are inserted in the uterus but do not block or inhibit sexually transmitted infections. Test-Taking Tip: A psychological technique used to boost your test-taking confidence is to look into a mirror whenever you pass one and say out loud, "I know the material, and I'll do well on the test." Try it; many students have found that it works because it reduces "test anxiety." The nurse is preparing a care plan for a patient diagnosed with hypogonadotropic amenorrhea. The patient does not provide any history of sudden weight loss, eating disorder, or involvement in heavy exercise. What should be the most important goal for this patient? Correct1 To identify the stressor 2 To rule out the possibility of an infection 3 To provide pain relief in the patient 4 To prepare a diet regimen The most common cause of hypogonadotropic amenorrhea is stress. Other causes are severe weight loss (malnourishment), an eating disorder such as anorexia, and strenuous exercises. Because the patient does not have a history of sudden weight loss, an eating disorder, or involvement in heavy exercise, the patient is most likely to be suffering from stress. Therefore the most important goal should be identification of the stressor. Infection of the reproductive system is known to cause abnormal bleeding but is not associated with amenorrhea. Pain is not a symptom associated with hypogonadotropic amenorrhea. Because the patient has no history of an eating disorder or weight loss, it is unlikely that the patient has malnutrition. The nurse is assessing a patient who reports no menses for the past 6 months. Which test should the nurse ask the patient to take? Correct1 Pregnancy test 2 Blood sugar test 3 Thyroid function test 4 Toxicology blood screening The patient last had menses 6 months ago, which indicates that the patient has secondary amenorrhea. The most common cause of secondary amenorrhea is pregnancy. Therefore the nurse should ask the patient to take a pregnancy test. A thyroid function test is used to determine alterations in thyroid hormone levels. A blood sugar test is helpful in finding whether the patient has diabetes mellitus. Toxicology screening is a laboratory investigation to determine whether the patient is involved in illicit drug abuse. Alterations in the thyroid levels, elevated blood sugar levels, and illicit drug use are causes of primary amenorrhea. These factors interrupt the hypothalamic-pituitary-ovarian-uterine axis and thus cause amenorrhea. The procedure in which ova are removed by laparoscopy, mixed with sperm, and the embryo(s) returned to the woman's uterus is: Correct1 In vitro fertilization 2 Tubal embryo transfer 3 Therapeutic insemination 4 Gamete intrafallopian transfer In vitro fertilization is a procedure that is used to bypass blocked or absent fallopian tubes. Tubal embryo transfer places the conceptus into the fallopian tube. Therapeutic insemination uses the partner's sperm or that of a donor and places it directly into the woman. Gamete intrafallopian transfer is when the sperm and ova are placed in the fallopian tube. The drug of choice to treat gonorrhea is: 1 Penicillin G (Pfizerpen). 2 Tetracycline (Achromycin). Correct3 Rocephin (Ceftriaxone). 4 Acyclovir (Zovirax). Ceftriaxone is effective for treatment of all gonococcal infections. Penicillin is used to treat syphilis. Tetracycline is used to treat chlamydial infections. Acyclovir is used to treat herpes genitalis. Which symptom described by a woman is characteristic of premenstrual syndrome (PMS)? Correct1 "I feel irritable and moody a week before my period is supposed to start." 2 "I have lower abdominal pain beginning the third day of my menstrual period." 3 "I have nausea and headaches after my period starts, and they last 2 to 3 days." 4 "I have abdominal bloating and breast pain after a couple days of my period." PMS is a cluster of physical, psychological, and behavioral symptoms that begin in the luteal phase of the menstrual cycle and resolve within a couple of days of the onset of menses. PMS begins in the luteal phase and resolves as menses occurs. It does not start after menses has begun. This complaint is associated with PMS. However, the timing reflected in this statement is inaccurate. PMS begins in the luteal phase and resolves as menses occurs. It does not start after menses has begun. Abdominal bloating and breast pain are likely to occur a few days prior to menses, not after it has begun. The nurse is assessing a patient who is taking oral contraceptives and reports severe pain in the legs. What symptoms should the nurse primarily assess for in the patient? Correct1 Thrombus formation 2 Severe muscle spasms 3 High creatinine levels 4 Hyperglycemic events Patients who take oral contraceptives are at a high risk of developing thromboembolism or blood clots. Therefore the nurse would primarily assess for calf pain warmth and tenderness which indicates thromboembolism. Muscle spasms are not side effects that develop with oral contraceptives. Although the pain is severe in the case of muscle spasms, it can be resolved easily with the help of analgesics. Creatinine levels increase when the kidneys fail to function properly. Oral contraceptives have no effect on kidney function. Oral contraceptives have no effect on blood glucose levels A woman states, "I'm sure that I am suffering from premenstrual syndrome (PMS). How can I get my doctor to take this seriously?" What is the nurse's best response? 1 "Men usually are not sympathetic to PMS sufferers." 2 "You are probably right. You should remind your health care provider of your symptoms every time you visit." 3 "Because you feel certain that you are right, you should just treat yourself with over-the-counter medications." Correct4 "You should keep a daily record of the occurrence and severity of your symptoms for six months." Charting symptoms for several cycles is necessary to make an accurate diagnosis of PMS. Stating that men are not sympathetic to PMS sufferers does not help the woman with the present problem. Listing symptoms for several cycles will help the heath care provider better assess the diagnosis. The woman should not treat herself with over-the-counter medications. With regard to the diagnosis and management of amenorrhea, nurses should be aware that it: 1 probably is the result of a hormone deficiency that can be treated with medication. Correct2 may be caused by stress or excessive exercise or both. 3 likely will require the woman to eat less and exercise more. 4 often goes away on its own. Amenorrhea usually is the result of stress and/or an inappropriate ratio of body fat to lean tissue, possibly as a result of excessive exercise. Management includes counseling and education about the causes and possible lifestyle changes. Amenorrhea may be the result of a decrease in follicle-stimulating hormone (FSH) and luteinizing hormone (LH). In most cases a woman will need to decrease her amount of exercise and increase her body weight in order to resume menstruation. Management of stress and eating disorders is usually necessary to manage this condition. A benign breast condition that includes dilation and inflammation of the collecting ducts is called: 1 fibroadenoma. Correct2 mammary duct ecstasia. 3 intraductal papilloma. 4 chronic cystic disease. Generally occurring in women approaching menopause, mammary duct ectasia results in a firm irregular mass in the breast, enlarged axillary nodes, and nipple discharge. Fibroadenoma is fibrous and glandular tissues. They are felt as firm, rubbery, and freely mobile nodules. Intraductal papillomas develop in the epithelium of the ducts of the breasts; as the mass grows, it causes trauma or erosion within the ducts. Chronic cystic disease causes pain and tenderness. The cysts that form are multiple, smooth, and well delineated. A patient with dysmenorrhea has been prescribed nonsteroidal antiinflammatory drugs (NSAIDs). The patient reports passing dark-colored stools 1 week after starting therapy. What can the nurse interpret from this? The patient: 1 Has developed hemorrhoids. 2 Is allergic to NSAIDs. 3 Has a gastrointestinal infection. Correct4 Has gastrointestinal bleeding. One major adverse effect associated with NSAIDs is gastrointestinal bleeding. This is manifested as dark-colored stools. Hemorrhoids may also cause blood in the stools but are not a complication associated with NSAIDs. Allergic reactions related to NSAIDs are rare. These may manifest as skin rashes and itching. NSAIDs are not associated with gastrointestinal infection. Gastrointestinal infection would be manifested as diarrhea and fever. The nurse teaches a patient how to detect ovulation and suggests having intercourse the day before and on the day of ovulation. Which patient need is the nurse addressing? The patient: Correct1 Is looking for methods to increase the probability of conception. 2 Wants to prevent transmission of sexually transmitted diseases. 3 Is researching methods of contraception to prevent a pregnancy. 4 Needs advice on ways to prevent excessive menstrual bleeding. To increase the probability of conceiving, the nurse should suggest that the patient has intercourse the day before and on the day of ovulation. Preventing sexually transmitted diseases is a patient need addressed by encouraging the use of a condom. When counseling about methods of contraception, the patient is advised to abstain from intercourse during the time of ovulation. If the patient wants to control menstruation, the nurse would counsel the patient regarding the use of birth control pills. The nurse is assessing a 37-year-old patient with secondary infertility. While reviewing the patient's laboratory reports, the nurse finds that the patient has a reduced ovarian reserve. Which laboratory report would the nurse have reviewed? 1 Thyroxine hormone levels 2 Prolactin hormone levels Correct3 Follicle-stimulating hormone levels 4 Human chorionic gonadotropin levels Ovarian reserve refers to the number of viable ova that remain in the ovaries. To assess the ovarian reserve of the patient, the nurse should check the levels of follicle-stimulating hormones on the third day of menstruation. Thyroxine levels indicate the presence of thyroid dysfunction. Although prolactin levels also contribute to anovulation, the follicle-stimulating hormone (FSH) level is considered the primary assessment standard for determining ovarian reserve. Human chorionic gonadotropin hormone levels are used in determining if a patient is pregnant as they are elevated during pregnancy. A woman undergoing evaluation of infertility states, "At least when we're through with all of these tests, we will know what is wrong." The nurse's best response is: 1 "I know the test will identify what is wrong." 2 "I'm sure that once you finish these tests, your problem will be resolved." Correct3 "Even with diagnostic testing, infertility remains unexplained in about 20% of couples." 4 "After you've identified your problem, you may want to look at the option of adoption." Problems with infertility must be approached realistically. Nurses should not make judgments or give false reassurance. Providing accurate information to the couple is the best response. The nurse should not make statements indicating that problems will be resolved, because this gives a false impression. The tests are not always definitive, so the nurse should not give false reassurance. The nurse should not offer her opinion but instead should state the facts. Which contraceptive method is contraindicated in a woman with a history of toxic shock syndrome? 1 Condom 2 Spermicide Correct3 Cervical cap 4 Oral contraceptives The cervical cap may increase the risk of toxic shock syndrome because it may be left in the vagina for a prolonged period. A condom is not contraindicated with a history of toxic shock syndrome. Spermicide is not contraindicated with a history of toxic shock syndrome. Oral contraceptives are not contraindicated with a history of toxic shock syndrome. A man and a woman who have not achieved a successful pregnancy are scheduled to meet with a fertility specialist. Which simple evaluation is usually the first test to be performed? Correct1 Semen analysis 2 Testicular biopsy 3 Endometrial biopsy 4 Hysterosalpingogram Semen analysis is usually the first test to be performed because it is least costly and noninvasive. A testicular biopsy is an invasive examination using a local anesthetic. Endometrial biopsy determines whether the endometrium is responding to ovarian stimulation. Hysterosalpingogram uses contrast medium to evaluate the structure and patency of the uterus and tubes. The nurse is educating a patient about how to use a condom. Which statement by the patient indicates effective learning? Incorrect1 "Sticky and brittle condoms are effective for use." 2 "Condoms should be stored in warm, humid locations." 3 "Condoms should be worn before the penis is erect." Correct4 "Water-based lubricant should be used with condoms." Water-based lubricant is the only lubricant that should be used with condoms as it reduces the risk of the condom breaking. Petroleum-based lubricant should not be used as it may break the condom. Sticky and brittle condoms should not be used as they are not effective. Storing condoms in warm, humid conditions may decrease the effectiveness of the spermicide in the condom. Condoms should be stored in cool, dry locations. Condoms should be worn after the penis is erect, as it is difficult to put on a condom before the penis is erect. A pregnant woman reports severe pain in the abdomen. The Thayer-Martin culture is positive. Which medication might the nurse expect to be prescribed for the patient? 1 Azithromycin (Zithromax) and amoxicillin (Amoxil) Incorrect2 Doxycycline (Vibramycin) and tetracycline (Sumycin) Correct3 Ceftriaxone (Rocephin) and azithromycin (Zithromax) 4 Azithromycin (Zithromax) and doxycycline (Vibramycin) A positive Thayer-Martin culture indicates gonorrheal infection in the patient. Ceftriaxone (Rocephin) and azithromycin (Zithromax) are the drugs prescribed for pregnant women with gonorrhea. Azithromycin (Zithromax) and amoxicillin (Amoxil) are used for pregnant women diagnosed with chlamydia infection. Doxycycline (Vibramycin) and tetracycline (Sumycin) are used for women with syphilis who are allergic to penicillin. Azithromycin (Zithromax) and doxycycline (Vibramycin) are prescribed for women with chlamydia infection. An adolescent reports to the nurse, "I feel severe pain in my stomach and nausea during the first 2 days of my menstrual cycle." What does the nurse suggest to help relieve the patient's symptoms? Select all that apply. 1 "Reduce fluid intake." Correct 2 "Reduce salt intake." Incorrect 3 "Increase sweets in the diet." Correct 4 "Eat plenty of watermelon." 5 "Switch to a nonvegetarian diet." Most women experience symptoms such as nausea and abdominal cramps during the menstrual cycle. Decreasing salt intake during the menstrual cycle helps prevent fluid retention. Natural diuretics such as watermelon reduce fluid accumulation and relieve symptoms such as nausea and abdominal pain. Alternatively, increased fluid intake may minimize the symptoms associated with abdominal discomfort. Sugar and sweets should be avoided because they increase fluid retention and thereby cause bloating. Replacing a nonvegetarian diet with a low-fat vegetarian diet is recommended for minimizing dysmenorrheal symptoms The CDC-recommended medication for the treatment of chlamydia is: Correct1 doxycycline. 2 podofilox. 3 acyclovir. 4 penicillin. Doxycycline is effective for treating chlamydia, but it should be avoided if the woman is pregnant. Podofilox is a recommended treatment for nonpregnant women diagnosed with human papilloma virus infection. Acyclovir is recommended for genital herpes simplex virus infection. Penicillin is not a CDC-recommended medication for chlamydia; it is the preferred medication for syphilis. An infertile woman is about to begin pharmacologic treatment. As part of the regimen, she will take purified follicle-stimulating hormone (FSH) (urofollitropin [Metrodin]). The nurse instructs her that this medication is administered in the form of a/an: 1 intranasal spray. 2 vaginal suppository. Correct3 intramuscular injection. 4 tablet. Urofollitropin is given by intramuscular injection; the dosage may vary. Intranasal spray is not the appropriate route for urofollitropin. Vaginal suppository is not the correct route for urofollitropin. Urofollitropin cannot be given by tablet; it is given only by IM injection. Which surgical procedure involves the removal of a breast tumor along with surrounding tissues? 1 Simple mastectomy Correct2 Partial mastectomy 3 Radical mastectomy Incorrect4 Modified radical mastectomy Partial mastectomy is the removal of breast tumor along with the surrounding tissues. It is the primary treatment in the initial stages of breast cancer (stage I or II). Simple mastectomy involves removal of the entire breast that contains the tumor. Radical mastectomy involves removal of the affected breast and the underlying pectoralis muscles and axillary nodes on the same side of the affected breast. Modified radical mastectomy involves removal of the affected breast tissues, skin, and fascia of the pectoralis muscle and the dissection of the axillary nodes. Which information should the nurse include when teaching a 15-year-old about genital tract infection prevention? Select all that apply. 1 Wear nylon undergarments. Correct 2 Avoid tight-fitting jeans. 3 Use floral scented bath salts. Correct 4 Decrease sugar intake. Correct 5 Do not douche. Correct 6 Limit time spent wearing a wet bathing suit. Patient teaching for the prevention of genital tract infections in women includes the following guidelines: practice genital hygiene; choose underwear or hosiery with a cotton crotch; avoid tight-fitting clothing (especially tight jeans); select cloth car seat covers instead of vinyl; limit the time spent in damp exercise clothes (especially swimsuits, leotards, and tights); limit exposure to bath salts or bubble bath; avoid colored or scented toilet tissue; if sensitive, discontinue use of feminine hygiene deodorant sprays; use condoms; void before and after intercourse; decrease dietary sugar; drink yeast-active milk and eat yogurt (with lactobacilli); do not douche. The mammography report of a 23-year-old patient confirms the presence of a tumor in the breast. On regular follow-up assessments, the nurse finds that the size of the tumor does not change with the phase of the menstrual cycle. What can the nurse infer from this finding? The patient has: Correct1 Fibroadenoma. 2 A thyroid disorder. 3 An intraductal papilloma. 4 Mammary duct ectasia. Fibroadenoma is the most common type of tumor that occurs in adolescents. The tumor present in fibroadenoma does not change in size during the menstrual cycle. Its size increases during pregnancy and decreases with age. Thyroid disorders do not affect the size of the tumor. They may increase the prolactin levels, thus causing nipple discharge. Moreover, thyroid disorders cannot be found on a mammogram. Intraductal papilloma is a rare benign condition that develops at the terminal nipple duct. It is not associated with breast tumor. Therefore the nurse cannot infer that the patient has intraductal papilloma. Mammary duct ectasia is inflammation of the duct behind the nipple. It can be identified by mammogram, but it is not a tumor. The nurse is assessing a patient with amenorrhea. The patient eats very little, is obsessed with having a lean figure, and fears gaining weight. Which test does the nurse expect the health care provider to order to determine whether the patient has female athlete triad syndrome? 1 Anthropometric test 2 Exercise tolerance test 3 Thyroid function test Correct4 Bone mineral density test Female athlete triad syndrome is characterized by anorexia nervosa, amenorrhea, and premature osteoporosis. Because the patient has amenorrhea and anorexia, the nurse should determine whether the patient has osteoporosis. This can be determined by a bone mineral density test. Anthropometric testing includes the measurements of body size and structure. An exercise tolerance test is used to determine the exercise capacity of an individual. Body size measurement and exercise capacity are not factors associated with female athlete triad syndrome. A thyroid function test is used to determine the levels of thyroxine hormone in the body. Abnormalities in thyroxine levels can cause primary amenorrhea. What should the nurse include when educating a patient about the side effects of depot medroxyprogesterone acetate (DMPA) prior to administration? Select all that apply. Correct 1 Breast changes Incorrect 2 Increased libido 3 Weight loss Correct 4 Thromboembolism Correct 5 Irregular vaginal spotting Depot medroxyprogesterone acetate (DMPA) is an effective contraceptive compared to other combined oral contraceptives. It has a long-lasting effect. Breast changes, thromboembolism, and irregular vaginal spotting are side effects of DMPA. DMPA decreases libido and increases body weight. Therefore, increases in libido and weight loss are not side effects of DMPA. A woman is using the basal body temperature (BBT) method of contraception. She calls the clinic and tells the nurse, "My period is due in a few days, and my temperature has not gone up." The nurse's most appropriate response is: 1 "This probably means you're pregnant." 2 "Don't worry; it's probably nothing." 3 "Have you been sick this month?" Correct4 "You probably didn't ovulate during this cycle." Pregnancy cannot occur without ovulation (which is being measured using the BBT method). Dismissing the woman's concerns is not appropriate. Illness would most likely cause an increase in BBT. The absence of a temperature decrease most likely is the result of lack of ovulation. The nurse is conducting a follow-up assessment of a patient with endometriosis who is taking danazol (Danocrine). The patient tells the nurse that she is unwilling to take danazol (Danocrine) in the future. What could be the most likely reason for the patient's unwillingness to use this medication? The medication caused: 1 Amenorrhea in the patient. 2 Abdominal pain in the patient. Correct3 Masculinizing traits in the patient. 4 Temporary infertility in the patient. Danazol (Danocrine) is a mildly androgenic synthetic steroid that suppresses the secretion of follicle-stimulating and luteinizing hormones. It causes masculinizing side effects such as weight gain, edema, decreased breast size, oily skin, and hirsutism. This would affect the patient's appearance. Therefore this is the most likely reason for the patient's unwillingness to adhere to this medication regimen. Amenorrhea is a side effect associated with the use of danazol, but it is temporary (only during the course of therapy) and is unlikely to be the source of distress to the patient. Danazol is helpful in relieving pain associated with endometriosis. Danazol does not cause infertility. However, it is contraindicated in pregnant women because of its teratogenic effects. A patient who is taking an oral contraceptive calls the triage nurse with concerns about side effects of the medication. Which adverse effect of this medication should alert the nurse to inform the patient to immediately stop taking the contraceptive and contact her health care provider? Select all that apply. 1 Nausea 2 Weight loss Correct 3 Visual disturbances Correct 4 Persistent headaches Incorrect 5 Decreased blood pressure Before oral contraceptives are prescribed and periodically throughout hormone therapy, the woman is alerted to stop taking the pill immediately and report any of the following symptoms to her provider. The mnemonic ACHES helps in remembering this list: A: Abdominal pain may indicate a problem with the liver or gallbladder. C: Chest pain or shortness of breath may indicate a possible blood clot or problems with the heart or lungs. H: Headache (sudden or persistent) may be caused by hypertension or cardiovascular accident. E: Eye problems may indicate vascular accident or hypertension. S: Severe leg pain may indicate a thromboembolic event. Nausea is an expected side effect and does not require notification of the health care provider. Weight gain, not weight loss, may occur because of edema. The patient may experience hypertension, not hypotension. The nurse is assessing a 15-year-old high school student who is worried because she has not yet begun menses. The nurse tells the student that she may attain her menses late. What assessment findings might the nurse have noted about the patient? Select all that apply. The patient: 1 Is morbidly obese. 2 Has a thyroid disorder. Correct 3 Has anorexia nervosa. 4 Has type 1 diabetes mellitus. Correct 5 Engages in strenuous sports. Females who have a low body mass index as a result of malnutrition (anorexia) often have delayed onset of menstruation. Females who are involved in strenuous exercises at the time of menarche may also have delayed onset of menstruation. Females who are obese may have early-onset menstruation because of their high body mass index. Females with thyroid disorders or type 1 diabetes mellitus are not known to have a delayed onset of menarche. They are at risk for developing amenorrhea caused by interruption in the hypothalamic-pituitary-ovarian-uterine axis. A married woman has made the decision to use a diaphragm as her primary method of birth control. What instructions should the clinic nurse provide regarding care of, insertion, and removal of the diaphragm? Select all that apply. 1 Remove the diaphragm by catching the rim from below the dome. Correct 2 Avoid using mineral oil body products. Correct 3 On insertion, direct the diaphragm down toward the space below cervix. Incorrect 4 Wash diaphragm monthly with mild soap and water. Correct 5 A dusting of cornstarch is appropriate after drying the diaphragm. Oil-based products can cause the breakdown of the rubber. The diaphragm should be inserted into the vagina, directing it inward and downward as far as it will go to the space behind and below the cervix. The diaphragm should be washed after each use with mild soap and water. Cornstarch may be used. Avoid use of scented talc, body powder, and baby powder because they can weaken the rubber. The diaphragm should not be removed by trying to catch the rim from below the dome On reviewing a patient's menstrual dates, the nurse finds that the amount of time between the patient's menstrual periods has been approximately the same for the past 6 months. The nurse records the patient's fertile period as 7 to 17 days. What is the shortest amount of time between the patient's menstrual periods? Record your answer using a whole number. ________ days The patients who plan for low-cost and nonhormonal contraceptive methods are informed about methods like the calendar rhythm method. The patient's fertile period is noted after observing the regular menstruation cycles for a period of 6 months. The fertile period is calculated by subtracting 18 days from the shortest amount of time between menstrual periods and by subtracting 11 from the longest amount of time between the menstrual periods. The couple is supposed to abstain from sexual intercourse during this period. So when the patient fertile period is from 7 to 17 days, the shortest amount of time between menstrual periods would be 7 + 18 = 25 days. Which medication should the nurse expect to find in the patient's medication profile for the treatment of uterine fibroid tumors? Correct1 Leuprolide acetate (Lupron) 2 Ganirelix acetate (Antagon) 3 Progesterone (Prometrium) 4 Clomiphene citrate (Clomid) Gonadotropin-releasing hormone (GnRH) agonists like leuprolide acetate (Lupron) are used for the treatment of uterine fibroids. These medications desensitize the GnRH agonist receptors and decrease the production of follicle-stimulating hormone (FSH) and ovarian function. Ganirelix acetate (Antagon) is a GnRH antagonist and is used for infertility treatment. Progesterone (Prometrium) is used for treatment of luteal phase inadequacy. Clomiphene citrate (Clomid) is used for ovulation induction and treatment of luteal phase inadequacy. The nurse is teaching a patient about a dietary plan for managing premenstrual dysphoric disorder (PMDD). Which instructions given by the nurse would be beneficial for the patient? Select all that apply. Correct 1 "Eat nuts daily." Correct 2 "Use good-quality vegetable oils for cooking." Correct 3 "Avoid consuming caffeinated beverages." 4 "Include red meat in your daily diet." 5 "Avoid drinking watermelon and cranberry juices." Nuts, vegetables, and vegetable oils are known to reduce the symptoms related to PMDD. Therefore the nurse should include these food items in the diet plan. Caffeinated beverages are likely to aggravate symptoms associated with PMDD. Therefore the nurse should advise the patient to avoid these. Red meat is also known to aggravate the symptoms associated with PMDD. Watermelon and cranberry juices are natural diuretics and reduce water retention in the body. Therefore the nurse should advise the patient to drink these juices regularly. Which medication can be prescribed for a patient with excess prolactin levels? 1 Clomiphene (Clomid) Correct2 Bromocriptine (Parlodel) 3 Leuprolide acetate (Lupron) 4 Ganirelix acetate (Antagon) Increased prolactin levels causes anovulation. Therefore, bromocriptine (Parlodel) must be prescribed to reduce excess prolactin levels. Clomiphene (Clomid) is prescribed for ovulation induction and for the treatment of luteal phase inadequacy. Leuprolide acetate (Lupron) is prescribed for the treatment of uterine fibroids. Ganirelix acetate (Antagon) is prescribed for infertility treatment. A 16-year-old patient with amenorrhea does not want to undergo estrogen therapy. What other possible approaches to treatment might the nurse recommend to the patient? Select all that apply. 1 Vitamin D Correct 2 Biofeedback 3 Acupressure 4 Acupuncture Correct 5 Massage therapy 6 Herbal medications Biofeedback and massage therapy are alternative treatment options in amenorrhea. These interventions are helpful in relieving stress and regulating menstruation. Vitamin D can be used to lower the risk associated with breast cancer. Acupressure and acupuncture are alternative treatment options helpful in relieving dysmenorrheal pain. Herbal preparations are used for menstrual cramps, premenstrual discomfort, breast pain, and menorrhagia. A patient reports pain in the breasts during menses and throughout the month. After assessment, the nurse finds that the patient has been taking oral contraceptives for a long time to regulate menses. What possible effects of oral contraceptives should the nurse educate the patient about? Select all that apply. Incorrect 1 Heavy bleeding Correct 2 Breast tenderness Correct 3 Nausea and vomiting 4 Increased energy levels Incorrect 5 Severe stomach cramps The most common side effects of oral contraceptives are tender breasts and nausea and vomiting. Sore breasts may be caused by the use of oral contraceptives. With the use of contraceptive pills, many women report withdrawal of bleeding on day 3 or day 4 of the period. These pills are effective in reducing heavy blood loss in women with irregular or heavy cycles. The use of contraceptives has no effect on the energy levels of the patient, but it does reduce fatigue by lessening blood loss. Contraceptive pills sometimes cause cramps in the stomach, but the intensity of pain may be negligible. Which symptom should the nurse expect in a female patient who presents with elevated androgen levels? 1 Skin rashes and acne 2 Loss of body hair Correct3 Pigmentation changes 4 Decreased body weight An increase in androgen (male sexual hormone) levels causes pigmentation changes in the patient. This is because the epidermis becomes coarse and thick. Increased androgen levels do not cause hypersensitivity or acne breakouts. Therefore, the patient may have neither skin rashes nor acne. Due to an increase in androgen levels, the patient may have an excessive growth in body hair. Androgen levels do not affect body weight. A gymnast reports she has not had her menstrual period for the past 2 months. After assessment, the nurse finds that the patient is stressed out by excessive training. What advice should the nurse give the patient for managing stress? Select all that apply. Correct 1 "Reduce your physical workout." Correct 2 "Increase your nutrition intake." 3 "Lower your caloric intake." 4 "Engage in regular physical activity." Correct 5 "Meditate or do power yoga." Physical and mental stress are the most common reasons for irregularity in the menstrual cycle. Because gymnastics is a sport that requires physical strength and flexibility, reducing the workout might help the patient lower her stress levels. Increasing nutritional value in the diet may ensure proper body growth and reduce the occurrence of amenorrhea. Meditation or power yoga keeps the mind at peace and decreases stress levels. Lowering the calorie intake would not be appropriate because this may affect the patient's general health. Because the patient is doing rigorous physical training, the nurse need not ask the patient to engage in regular physical activity. Strenuous physical activities can further delay the onset of menstruation. A woman calls the clinic asking the nurse what to do for one missed combined oral contraceptive pill. Which instructions should the nurse give the woman? Select all that apply. Correct 1 No backup method is needed. Correct 2 Take the next dose at the usual time. Correct 3 Take one active pill as soon as possible. 4 Take two pills then resume one tablet daily. Incorrect 5 Use a backup contraceptive for the next seven days. For one missed combined oral contraceptive pill the nurse instructs the woman to continue the pack as usual, take the next dose at the usual time and take one active pill as soon as possible. Two pills should not be taken and no backup contraceptive is necessary. The nurse is assessing a patient who has an unplanned pregnancy even after using contraceptives. The patient uses a barrier technique and lubricants. Which lubricant used by the patient would have reduced the contraceptive effect? 1 Nonoxynol-9 lubricant Incorrect2 Silicon-based lubricant Correct3 Suntan oil as lubricant 4 Water-soluble lubricant Barrier methods such as latex condoms are one among many effective contraceptives. However, the latex condom might break when it is used with lubricants like suntan oil. This would allow the sperm to reach the female cervix and may cause pregnancy. Nonoxynol-9 is a spermicidal lubricant that would reduce sperm activity. The effectiveness of Nonoxynol-9 in preventing pregnancy is high. Silicon-based and water soluble lubricants are suggested to be used along with condoms. Some of them have spermicidal activity, and they do not break the condom. A patient reports heavy blood flow and painful abdominal cramps during the first 2 days of her menstrual cycle. Laboratory reports revealed elevated levels of prostaglandin F2-alpha (PGF2α). What other symptoms does the nurse suspect in this patient? Select all that apply. Correct 1 Headache Incorrect 2 Skin rashes 3 Lower-limb edema Correct 4 Inability to concentrate Correct 5 Excessive sweating Elevated levels of PGF2α result in central nervous system symptoms such as headache and inability to concentrate. Excessive sweating is a systemic response to excessive PGF2α activity. PGF2α does not affect the skin. Therefore skin rashes are not associated with PGF2α activity. PGF2α does not interfere with the osmotic or hydrostatic pressure. Therefore it does not cause lower-limb edema A patient reports abnormal uterine bleeding (AUB). Which further evaluations are necessary to confirm the cause of AUB? Select all that apply. Incorrect 1 Body weight 2 Thyroid levels Correct 3 Immunoassay Correct 4 Urinalysis 5 Blood pressure AUB is usually secondary to systemic diseases and reproductive tract diseases. The investigation for AUB includes enzyme immunoassay, urinalysis, and bacterial culture. Excessive body weight (obesity) and changes in thyroid hormone levels in hyperthyroidism and hypothyroidism cause dysfunctional uterine bleeding (DUB). A change in blood pressure is not a usual cause of abnormal uterine bleeding. Therefore blood pressure monitoring is not useful in diagnosing menstrual disorders. A patient reports fever and painful urination for the past 2 to 3 weeks. The physical examination shows multiple lesions in the vaginal area. The symptoms were relieved after treatment with acyclovir (Zovirax). What advice should the nurse give the patient to prevent secondary infection? 1 "Avoid sexual intercourse for 2 weeks." Incorrect2 "Undergo a Pap test at least once a year." Correct3 "Clean vaginal lesions twice a day with saline." 4 "Wear cotton underwear and loose-fitting clothes." Multiple lesions in the vaginal area, fever, and dysuria are the characteristic symptoms of herpes simplex virus (HSV) infection, which can be treated with acyclovir. The nurse should advise the patient to clean the lesions twice a day with normal saline to prevent secondary HSV infection. This will help keep the affected area clean and aseptic. Avoiding sexual intercourse is recommended during HSV infection, but it will not prevent the occurrence of secondary infections. A Pap test is recommended for infections caused by human papillomavirus (HPV). Wearing cotton underwear and loose-fitting clothes is recommended in those with HPV infection. However, these measures are not useful for preventing the spread of secondary infections. The nurse is reviewing the laboratory results for a patient who has undergone semen testing. The nurse notices that the patient is in the subfertile stage. What is the next step that the nurse should take? Correct1 Plan to have the test repeated 2 Arrange for hormone level tests 3 Schedule a scrotal ultrasound Incorrect4 Counsel about infertility issues A minimum of two seminal analyses are recommended before determining the cause of infertility or referring for further testing. If abnormalities are found during the first test, the nurse should plan for a second seminal analysis after a sufficient interval. If the second semen test also finds the patient to be in the subfertile range, then further investigation is needed. This can include assessing hormonal levels and sending the patient for an ultrasound. The nurse should proceed to counsel the patient only after all the diagnostic tests reveal infertility, not after the initial semen examination. What factors should the nurse assess in the patient with anovoluation? Select all that apply. Incorrect 1 Endometriosis Incorrect 2 Vaginal infections Correct 3 Thyroid disorders Correct 4 Pituitary gland disorders 5 Pancreatic gland disorders Thyroid disorders and pituitary gland disorders are the primary factors causing anovulation. Abnormal activity of these glands could restrict the formation of ova. Endometriosis is the condition that affects peritoneal factors. This condition does not affect the formation of ova, nor does it restrict it. Vaginal infections are treated with medications and have no relation to the ovaries or their functioning. The pancreas secretes insulin and glucagon, which is not related to ovarian activity either. What does the nurse tell a patient who is prescribed nafarelin acetate (Synarel) for endometriosis? Select all that apply. Incorrect 1 "You may have pelvic pain during the therapy." Correct 2 "You may become osteoporotic during the therapy." Correct 3 "You may not be able to conceive while receiving the therapy." Correct 4 "You may feel feverish occasionally during the therapy." 5 "You may have heavy menstrual bleeding during the therapy." Nafarelin acetate (Synarel) is a gonadotropin-releasing hormone (GnRH) agonist drug that is helpful in managing endometriosis. GnRH agonist therapy causes trabecular bone loss. Therefore the patient is susceptible to osteoporosis during the therapy. This drug causes a medically induced menopause that results in anovulation and amenorrhea. Therefore the patient would not be able to conceive while receiving therapy. As estrogen levels become elevated, hot flashes are a common symptom and are associated with GnRH agonist therapy. Therefore the patient may feel feverish occasionally. GnRH agonist therapy helps in relieving pain related to endometriosis, so the patient would not have pelvic pain during therapy. GnRH agonist therapy results in temporary amenorrhea. Therefore the nurse should not tell the patient that she would have heavy menstrual bleeding. Uterine fibroids are commonly associated with heavy menstrual bleeding. The nurse is reviewing the basal body temperature (BBT) report of a patient. The nurse finds that the patient has a 99.14 degree F (37.3 degree C) BBT at the luteal phase of the menstrual cycle. The report shows the same BBT level in the consecutive month. What condition would this indicate? Correct1 Pregnancy Incorrect2 Time of ovulation 3 Delayed ovulation 4 Early menstruation Fluctuations in basal body temperatures are a common observation reported in females during different phases of the menstrual cycle. The BBT is elevated in the luteal phase due to increased progesterone levels and reduces after menses. But the elevated levels tend to remain the same if the patient becomes pregnant. At the time of ovulation, there is a slight reduction followed by an elevation in the BBT level. After the menses, the BBT levels drops down to the regular level and if the ovulation is delayed, the low BBT levels are continued in the entire menstrual cycle. The BBT will not be constantly high if the patient has early menstruation. During a bimanual examination of a patient, the nurse finds abnormal contours of the uterus and uterine tube. What should the nurse infer from these findings? The patient: 1 Is at risk for endometriosis. 2 Is at risk of uterine fibroid. Correct3 Is at risk for an early miscarriage. 4 Has polycystic ovarian disease. Uterine abnormalities increase the risk of early miscarriages. Bimanual examination of internal organs is helpful for identifying any abnormalities in the uterus and fallopian tubes. Abnormality in the contours of the uterus and fallopian tubes indicate that the patient has a risk of an early miscarriage. Endometriosis is a condition in which endometrial tissue appears outside the uterus. It is not caused by abnormal contours of the uterus and fallopian tubes. Uterine fibroids develop as benign tumors in the uterus. Polycystic ovarian disease is a genetic disorder and does not occur due to abnormal contours of the uterus and fallopian tubes. A patient reports a yellow, malodorous discharge from the vagina. What medication does the nurse expect the health care provider to prescribe? 1 Miconazole (Oravig) Correct2 Tinidazole (Tindamax) Incorrect3 Clindamycin (Cleocin) 4 Clotrimazole (Lotrimin) Yellow-to-green, frothy, mucopurulent, copious, and malodorous discharge is indicative of Trichomonas infection. Tinidazole is prescribed to a patient diagnosed with Trichomonas infection. The medication is given for male carriers also because the organism resides in the urethra and prostate gland. Miconazole, clindamycin, and clotrimazole are prescribed for patients diagnosed with Candida infections. These drugs are not effective for Trichomonas infections. The nurse is teaching a patient how to use a diaphragm. The patient asks the nurse, "How do I remove the diaphragm?" The nurse describes the process of removing diaphragm. Arrange the steps of diaphragm removal in sequence. Incorrect 1. Pull the diaphragm carefully in the downward direction. Incorrect 2. Insert forefinger over the top side of the diaphragm. Incorrect 3. Turn the palm of your hand downward and backward. Incorrect 4. Hook forefinger on top of upper rim of the diaphragm. The nurse should describe the diaphragm removal process to the patient in the correct order to prevent injury to the internal organs. Initially while removing the diaphragm, the forefinger must be inserted over the top side of the diaphragm. Then the palm of hand should be turned downward and backward. The third step is to hook the forefinger on the top of the diaphragm near the upper rim. Finally, pull the diaphragm carefully down to remove it. This decreases the chances of tearing the diaphragm with the fingernails. The nurse instructs a nursing student to administer clomiphene (Clomid) to a patient in order to conduct a clomiphene citrate challenge test (CCCT). What instruction should the nurse give to the nursing student before giving this medication to the patient? To administer: Correct1 A 100-mg dose of clomiphene (Clomid) to the patient immediately. Incorrect2 A 500-mg initial dose of clomiphene (Clomid) to the patient. 3 Clomiphene (Clomid) to the patient on the 12th day of the menstrual cycle. 4 Clomiphene (Clomid) to the patient on the 15th day of the menstrual cycle. The clomiphene citrate challenge test is used to assess follicle-stimulating hormone (FSH) levels. From this test, the nurse can determine whether the patient has an adequate ovarian reserve. The nurse instructs the student nurse to administer a 100-mg dose of clomiphene (Clomid) to the patient, as it is the standard dosage. Administering 500 mg may lead to an overdose and side effects in the patient. Therefore, the nurse should not instruct the nursing student to administer 500 mg of clomiphene (Clomid) as the initial dosage. Administering clomiphene (Clomid) on the 12th or 15th day of the menstrual cycle may not be effective and does not affect the levels of follicle-stimulating hormone The nurse is preparing to speak to a group of women who are at risk for developing dysmenorrhea. Which patients should be included in the teaching session? Select all that apply. Patients who: Correct 1 Smoke Incorrect 2 Have a low body mass index 3 Have more than two children Correct 4 Have high stress as a result of work Incorrect 5 Are involved in strenuous exercise Research has proved that women who smoke are more susceptible to dysmenorrhea. Women who are highly stressed are also prone to have dysmenorrhea. Smoking and stress may cause excessive release of prostaglandin F2-alpha (PGF2α), which causes painful uterine contractions. Women who have a low body mass index are not susceptible to dysmenorrhea. Such patients are more likely to have amenorrhea. However, women with a high body mass index are more likely to have primary dysmenorrhea. Multiparous women are not known to have dysmenorrhea. Women who are nulliparous (have no child) are more likely to have dysmenorrhea. Patients who are involved in heavy exercise are not susceptible to dysmenorrhea. They are more likely to have primary amenorrhea. A patient with herpes simplex virus (HSV) infection is treated with 400 mg acyclovir (Zovirax) three times per day for a week. While performing the follow-up assessment of the patient 1 month after therapy, the nurse finds that the symptoms of HSV infection have recurred. What prescription change might the nurse expect for this patient? 1 800 mg acyclovir (Zovirax) daily for 1 year 2 2000 mg valacyclovir (Valtrex) for 1 day Correct3 1200 mg of acyclovir (Zovirax) daily for 5 days 4 750 mg famciclovir (Famvir) daily for 7-10 days The treatment for primary HSV infection in women between 13 and 17 years old is 400 mg acyclovir three times per day for 1 week. For recurrent infection, 400 mg acyclovir three times a day for 5 days is prescribed. That is, 400 × 3 = 1200 mg acyclovir daily for 5 days. Long-term treatment with acyclovir for 1 year is prescribed to suppress the infection. A dose of 2000 mg valacyclovir for 1 day is prescribed to treat HSV infection in nonpregnant women older than 18 years of age. A dosage of 750 mg famciclovir daily for 7-10 days is prescribed to treat primary HSV infection. A patient tells the nurse, "I tend to start gaining weight 1 week before my menstrual cycle begins, and my legs become swollen. My breasts also become very painful. What bothers me most is that I argue with my family members when depressed and irritated." What does the nurse conclude from the patient's history? The patient has: 1 Primary dysmenorrhea. 2 Premenstrual syndrome (PMS). 3 Secondary dysmenorrhea. Correct4 Premenstrual dysphoric disorder (PMDD). Excess weight gain, edema of the lower limbs, breast tenderness, depressed mood, and irritability that persist for 1 week before the onset of menses indicate PMDD. All these symptoms do not occur together in patients with PMS. Because the patient does not report the occurrence of pain during menses, the patient is unlikely to have primary or secondary dysmenorrhea. A patient approaches the primary health care provider due to ovulation problems. The nurse instructs the patient to return for a visit 7 days before the menstrual cycle. What is the reason for these instructions? Correct1 To assess the levels of progesterone in the patient 2 To determine the thickness of the uterine lining 3 To evaluate the viscosity of the cervical mucus 4 To assess the follicle-stimulating hormone (FSH) level Serum progesterone levels are tested seven days before the onset of the next estimated menstrual cycle. This test would help identify the progesterone levels in the patient. It helps to assess the corpus luteum and midluteal-phase progesterone levels as progesterone plays a role in ovulation and the menstrual cycle. The uterine cavity is observed by using an X-ray film during a hysterosalpingogram. This test does not need to be conducted at a particular time. The viscosity of the cervical mucus is assessed to determine if it is conducive for the penetration of the sperm. This can be checked at any point in time. Follicle-stimulating hormone (FSH) levels are determined on day 3 of menstruation to determine ovarian reserve. The nurse is assessing a patient who is undergoing treatment for uterine fibroids. The patient reports constant knee pain. Which medication should the nurse check for in the patient's medication profile? 1 Letrozole (Femara) 2 Progesterone (Camila) 3 Clomiphene citrate (Clomid) Correct4 Leuprolide acetate (Eligard) Leuprolide acetate (Eligard) is used to treat uterine fibroids. This medication causes arthralgia as a side effect. These joint pains usually decrease a few months after treatment. Letrozole (Femara) induces ovulation, which causes hot flashes and also has teratogenic effects. Progesterone (Camila) causes breast tenderness as a side effect, not arthralgia. Clomiphene citrate (Clomid) is used to stimulate the ovulation process. Ovarian enlargement and breast tenderness are observed as its side effects. The nurse is caring a patient who is pregnant as a surrogate mother. What condition would the biological mother have in order to need to use a gestational surrogate? 1 Ovarian failure 2 Tubal blockage 3 Early menopause Correct4 Uterine myoma The patient who carries the fetus for another couple is referred to as a surrogate mother. In conditions like uterine myomas, the fertilized ova cannot be impregnated in the uterus of the biological mother. Therefore, the couple would need a surrogate mother to carry the fetus. A female with ovarian failure can still carry the fetus after in vitro fertilization of the donor oocyte. The genetic investment from the male parent can possibly be observed in the embryo when the oocyte is donated and fertilized with the parent sperm. In conditions like tubal blockage, a female can carry the fetus after it is fertilized in vitro. Genetic investment is possible from both the parents for the embryo. Early menopause is the condition where a female may require a donor oocyte to conceive and can still carry the embryo in her own uterus. The nurse is counseling a patient who has had multiple miscarriages. The nurse explains to the patient that she has developed endometriosis. In which category would this be placed as a cause of infertility? Correct1 Tubal factors 2 Ovarian factors Incorrect3 Uterine factors 4 Cervical factors A series of steps are required for successful conception. Interference in any one of the steps may result in infertility. Tubal factors would be the cause of this patient's infertility. The fertilized embryo was unable to reach the uterus by passing through the fallopian tubes because of the patient's endometriosis. Ovarian factors that cause infertility impair the process of production of healthy oocytes during the menstruation cycle. A successfully formed fertilized embryo signifies that oocytes are healthy. This patient does not have uterine factors that cause infertility since the patient is able to successfully conceive. The uterine factors may affect the process of implantation and nourishment of the embryo in the uterus. The fertilized egg is unable to reach the uterus. Any change in the anatomy of the cervix that affects the movement of the sperm into the uterus indicates a cervical factor. In this patient, the embryo was fertilized. This indicates that the sperm were able to pass through the uterus and fertilize the egg. Therefore it is not a cervical factor. The nurse is speaking to a patient with premenstrual dysphoric disorder (PMDD) about the nonsteroidal antiinflammatory drug (NSAID) she has been prescribed. What should the nurse state as the reason for prescribing this medication to the patient? The medication: 1 Prevents abdominal cramps. Correct2 Reduces breast tenderness. 3 Helps elevate mood. 4 Is used to prevent inflammation of the uterus. NSAIDs are usually prescribed for a patient with PMDD to decrease physical symptoms such as breast tenderness. NSAIDs are also helpful in reducing pain from abdominal cramps, but abdominal cramps are not a symptom associated with PMDD. NSAIDs do not interfere with the serotonin levels in the body. Therefore this drug would not be helpful in elevating the patient's mood. NSAIDs have antiinflammatory properties. However, inflammation of uterine walls is not a pathologic event occurring in premenstrual syndrome. The nursing diagnosis of a patient with endometriosis is "Risk for injury related to disease progression." Which nursing interventions are applicable for this nursing diagnosis? Select all that apply. 1 Assessing pain and discomfort in the patient Incorrect 2 Providing an opportunity for the patient to express feelings Correct 3 Enabling the patient to report any changes in health status Correct 4 Reviewing the side effects of the medications prescribed Incorrect 5 Assessing the patient's knowledge of endometriosis The patient's nursing diagnosis is "Risk for injury related to disease progression." Therefore the most important interventions for this patient would be to recognize the possible causes for changes in the health status. The nurse should enable the patient to report any changes in health status so that the adverse effects can be managed as they occur. The nurse should also teach the patient to identify the side effects of the medication regimen. This would help the patient take the appropriate steps to manage the side effects. Assessment of pain would be the most important intervention if the patient had reported acute pain. Providing an opportunity to the patient to express feelings would be a suitable intervention if the patient had symptoms of depression. Assessment of the patient's knowledge about endometriosis would be appropriate if the patient's nursing diagnosis were related to deficient knowledge. What interventions should the nurse perform while caring for a 16-year-old patient diagnosed with gonococcal infection? Select all that apply. Correct 1 Obtain an order for a serologic test for syphilis. 2 Refer the patient for cryotherapy to remove lesions. Correct 3 Report the infection to the patient's local health authorities. Incorrect 4 Tell the patient to take bed rest in a semi-Fowler position. Correct 5 Administer 100 mg doxycycline (Vibramycin) twice daily. Patients diagnosed with gonococcal infection should be tested for syphilis and chlamydia infection because they are susceptible to these infections. The nurse should report the infection to the local health authority as required by policy or law, because gonorrhea is a communicable disease, and health authorities must be alerted. Doxycycline, 100 mg, is prescribed in patients between 13 and 17 years of age for gonococcal infection. Cryotherapy is recommended for the removal of lesions associated with human papilloma infection. It is not useful in removing the lesions related to gonococcal infection. A semi-Fowler position is helpful in relieving the symptoms of pelvic inflammatory disease. The symptoms of gonococcal infection are not relieved by positioning. Which physical changes should the nurse instruct a female patient to watch for that signal the fertile period? Select all that apply. Correct 1 Mittelschmerz Correct 2 Vulvar fullness Incorrect 3 Pelvic hardness 4 Decreased libido Correct 5 Midcycle spotting Some physiologic changes occur in the body during the fertile period due to the change in hormonal levels. During this period, females may have cramp-like pain before ovulation, called mittelschmerz. During the fertile period, the female feels vulvar fullness. Midcycle spotting is observed during the fertile period. The pelvis becomes tender during the fertile period. The female feels increased libido in the fertile period. Therefore, pelvic hardness and decreased libido are not observed during the fertile period. A nurse counseling a woman with endometriosis understands which statements regarding the management of endometriosis are accurate? Select all that apply. 1 Bone loss from hypoestrogenism is irreversible. Correct 2 Side effects from the steroid danazol include masculinizing traits. Correct 3 Surgical intervention often is needed for severe or acute symptoms. Correct 4 Women without pain and who do not want to become pregnant need no treatment. Correct 5 Women with mild pain who may want a future pregnancy may take nonsteroidal antiinflammatory drugs (NSAIDs). Such masculinizing traits as hirsutism, a deepening voice, and weight gain occur with danazol but are reversible. Surgical intervention often is needed when symptoms are incapacitating. The type of surgery is influenced by the woman's age and desire to have children. Treatment is not needed for women without pain or the desire to have children. Bone loss is mostly reversible within 12 to 18 months after the medication is stopped. In women with mild pain who may desire a future pregnancy, treatment may be limited to use of NSAIDs during menstruation

Chapter 4, Reproductive System Concerns Chapter 5, Infertility, Contraception, and Abortion

Which condition in a pregnant patient with severe preeclampsia is an indication for administering magnesium sulfate? Correct1 Seizure activity 2 Renal dysfunction 3 Pulmonary edema 4 Low blood pressure (BP) Severe preeclampsia may cause seizure activity or eclampsia in the patient, which is treated with magnesium sulfate. Magnesium sulfate is not administered for renal dysfunction and can cause magnesium toxicity in the patient. Pulmonary enema can be prevented by restricting the patient's fluid intake to 125 mL/hr. Increasing magnesium toxicity can cause low BP in the patient. A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of: 1 eclamptic seizure. 2 rupture of the uterus. 3 placenta previa. Correct4 abruptio placentae. Women with hypertension are at increased risk for an abruption . Eclamptic seizures are evidenced by the presence of generalized tonic-clonic convulsions. Uterine rupture presents as hypotonic uterine activity, signs of hypovolemia, and in many cases the absence of pain. Placenta previa presents with bright red, painless vaginal bleeding. Uterine tenderness in the presence of increasing tone may be the earliest finding of premature separation of the placenta (abruptio placentae or placental abruption). During a physical assessment of an at-risk patient, the nurse notes generalized edema, crackles at the base of the lungs, and some pulse irregularity. These are most likely signs of: 1 euglycemia. 2 rheumatic fever. 3 pneumonia. Correct4 cardiac decompensation. Symptoms of cardiac decompensation may appear abruptly or gradually. Euglycemia is a condition of normal glucose levels. These symptoms indicate cardiac decompensation. Rheumatic fever can cause heart problems, but it does not present with these symptoms, which indicate cardiac decompensation. Pneumonia is an inflammation of the lungs and would not likely generate these symptoms, which indicate cardiac decompensation. What intervention does the nurse include while providing care for a pregnant patient with primary pulmonary hypertension (PPH)? 1 Assess the heart valve function. 2 Administer parenteral analgesia. 3 Place the patient in the supine position. Correct4 Assess the patient's blood pressure. Primary pulmonary hypertension is the condition where the blood vessels in the lungs constrict, increasing the pulmonary artery pressure. PPH may impair the blood flow to the lungs, which can be precipitated by hypotension. Therefore, to prevent complications of PPH, the nurse should monitor the patient's blood pressure. Heart valve function is assessed in patients with mitral stenosis to assess for potential risks. During labor, epidural analgesia is administered to the patient to prevent blood loss, because it can result in hypotension. The nurse avoids the supine position to prevent supine hypotension in the patient. The most important instruction to include in a teaching plan for a woman in early pregnancy who has class I heart disease is: 1 She must report any nausea or vomiting. 2 She may experience mild fatigue in early pregnancy. Correct3 She must report any chest discomfort or productive cough. 4 She should plan to increase her daily exercise gradually throughout pregnancy. Angina or a productive cough may signal congestive heart failure or pulmonary edema. Nausea and vomiting are expected in early pregnancy. Mild fatigue is expected in early pregnancy. Depending on the severity of the heart disease, she may need to limit physical activity. The nurse is caring for a pregnant patient who is scheduled for surgery. Which nursing intervention will help provide sufficient fetal oxygenation during the surgery? Correct1 Positioning the patient with a lateral tilt 2 Providing clear liquids before the surgery 3 Palpating uterine contractions (UCs) manually 4 Giving an antacid before administering anesthesia The nurse positions the pregnant patient on the operating table with a lateral tilt to avoid compression of the maternal vena cava. This improves fetal oxygenation during the surgery. Clear liquids are administered to the patient for bowel preparation before the surgery. The nurse may palpate UCs manually to evaluate the fetal status. An antacid is administered to the patient before administering anesthesia to prevent vomiting and aspiration. Which factor is known to increase the risk of gestational diabetes mellitus? Correct1 Previous birth of large infant 2 Maternal age younger than 25 3 Underweight before pregnancy Incorrect4 Previous diagnosis of type 2 diabetes mellitus Previous birth of a large infant suggests gestational diabetes mellitus. A woman younger than 25 is not at risk for gestational diabetes mellitus. Obesity (greater than 90 kg or 198 lb) creates a higher risk for gestational diabetes. The person with type 2 diabetes mellitus already has diabetes and will continue to have it after pregnancy. Insulin may be required during pregnancy because oral hypoglycemia drugs are contraindicated during pregnancy. The nurse observes that intravenous (I.V.) administration of magnesium sulfate has resulted in magnesium toxicity in a pregnant patient with preeclampsia. The nurse immediately discontinues the infusion and reports to the primary health care provider (PHP). For which drug does the nurse obtain a prescription from the PHP? Correct1 Calcium gluconate 2 Nifedipine (Adalat) 3 Hydralazine (Apresoline) 4 Labetalol hydrochloride (Normodyne) The nurse needs to obtain a prescription for calcium gluconate because it acts as an antidote to magnesium toxicity. Nifedipine (Adalat) and labetalol hydrochloride (Normodyne) are antihypertensive medications, which are prescribed for gestational hypertension or severe preeclampsia. Hydralazine (Apresoline) is also an antihypertensive medication used for treating hypertension intrapartum. Which condition does the nurse suspect in a pregnant patient if there is weight loss and the patient's pulse rate is greater than 100 beats/min? 1 Atrial septal defect 2 Macrosomia 3 Phenylketonuria Correct4 Hyperthyroidism Weight loss and a pulse rate greater than 100 beats/min may indicate hyperthyroidism in a pregnant patient. Fatigue and dyspnea in a patient may indicate atrial septal defect. However, these symptoms are also seen in normal pregnancy. Macrosomia is a condition in which an infant's birth weight is more than 4000 to 4500 g. Hypopigmentation of hair, eyes, and skin indicates phenylketonuria. A woman diagnosed with marginal placenta previa gave birth vaginally 15 minutes ago. At the present time, she is at the greatest risk for: Correct1 hemorrhage. 2 infection. 3 urinary retention. 4 thrombophlebitis. Hemorrhage is the most immediate risk because the lower uterine segment has limited ability to contract to reduce blood loss. Infection is a risk because of the location of the placental attachment site; however, it is not a priority concern at this time. Placenta previa poses no greater risk for urinary retention than with a normally implanted placenta. There is no greater risk for thrombophlebitis than with a normally implanted placenta. At 37 weeks of gestation, the patient is in a severe automobile crash where her abdomen was hit by the steering wheel and her seat belt. What priority action would the emergency room nurse expect to perform upon the patient's arrival at the hospital? 1 Stay with the patient, assure a patent airway is present, and keep the patient as calm as possible. 2 Move the patient's skirt to determine if any vaginal bleeding is present, find out who to call, and monitor the level of consciousness. Correct3 Assess the patient's vital signs, determine location and severity of pain, and establish continual fetal heart rate monitoring. 4 Obtain arterial blood gases, obtain a hemoglobin and hematocrit,and oxygen saturation rate. Full assessment of the patient and her fetus are essential and include vital signs, continual fetal heart rate monitoring, determining the location and severity of pain, whether any vaginal bleeding is dark red or bright red, and the status of the abdomen, which would be expected to be rigid or "board like." Staying with the patient, assuring a patent airway is present, and keeping the patient as calm as possible would be appropriate at the crash site before the arrival of emergency medical services (EMS). The current status of the patient and fetus are thepriority. The health care provider would prescribe the arterial blood gases and other laboratory work after the patient is assessed and stabilized. Which instruction should the nurse include when teaching a pregnant woman with class II heart disease? 1 Advise her to gain at least 30 pounds. Correct2 Instruct her to avoid strenuous activity. 3 Inform her of the need to limit fluid intake. 4 Explain the importance of a diet high in calcium. Activity may need to be limited so that cardiac demand does not exceed cardiac capacity. Weight gain should be kept to a minimum with heart disease. Fluid intake is necessary to prevent fluid deficits. Fluid intake should not be limited during pregnancy. She may also be put on a diuretic. Iron and folic acid intake is important to prevent anemia. A blunt abdominal trauma causes fetal hemorrhage in a pregnant patient. The nurse finds that the patient is Rh negative. What action does the nurse take? 1 Initiate magnesium sulfate per protocol. 2 Administer oxytocin (pitocin). Correct3 Administer prescribed Rho (D) immunoglobulin. 4 Prepare the patient for magnetic resonance imaging (MRI). The nurse administers the prescribed Rho(D) immunoglobulin to the patient to protect the patient from isoimmunization. The nurse needs to obtain a prescription for magnesium sulfate if there are eclamptic seizures in a patient with preeclampsia. Oxytocin (Pitocin) is administered to prevent bleeding after birth or the evacuation of the uterus. Magnetic resonance imaging (MRI) is used to assess injuries in a patient after trauma. A patient at 37 weeks gestation is admitted with a placental abruption after a motor vehicle accident. Which assessment data are most indicative of her condition worsening? Correct1 Pulse (P) 112, respiration (R) 32, blood pressure (BP) 108/60; fetal heart rate (FHR) 166--178 2 P 98, R 22, BP 110/74; FHR 150--162 3 P 88, R 20, BP 114/70; FHR 140--158 4 P 80, R 18, BP 120/78; FHR 138--150 Bleeding is the most dangerous problem, which impacts the mother's well-being as well as that of her fetus. The decreasing blood volume would cause increases in pulse and respirations and a decrease in blood pressure. The fetus often responds to decreased oxygenation as a result of bleeding, causing a decrease in perfusion. This causes the fetus' heart rate to increase above the normal range of 120--160 beats per minute. The other options have measurements that are in the "normal" range and would not reflect a deterioration of the patient's physical status. Which medication does the nurse expect to find prescribed for a pregnant patient who requires anticoagulant therapy for recurrent venous thrombosis? Correct1 Enoxaparin (Lovenox) Incorrect2 Warfarin (Coumadin) 3 Terbutaline (Brethine) 4 Oxytocin (Pitocin) Enoxaparin (Lovenox) is prescribed for a pregnant patient for recurrent venous thrombosis, because it does not cross the placenta and has no teratogenic effects associated with its use. Warfarin (Coumadin) is generally not prescribed, because it causes fetal bone and eye anomalies and cognitive impairment. Terbutaline (Brethine) is not prescribed for pregnant patients, because it may cause tachycardia, irregular pulse, myocardial ischemia, and pulmonary edema. Oxytocin (Pitocin) is administered to induce labor. At 37 weeks of gestation, the patient is in a severe automobile crash where her abdomen was hit by the steering wheel and her seat belt. What actions would the emergency room nurse expect to perform upon the patient's arrival at the hospital? 1 Stay with the patient, assure a patent airway is present, and keep the patient as calm as possible. 2 Move the patient's skirt to determine if any vaginal bleeding is present, find out who to call, and monitor the level of consciousness. Correct3 Assess the patient's vital signs, determine location and severity of pain, and establish continual fetal heart rate monitoring. 4 Obtain arterial blood gases, obtain a hemoglobin and hematocrit, and oxygen saturation rate. Full assessment of the patient and her fetus are essential and include vital signs, continual fetal heart rate monitoring, determining the location and severity of pain, whether any vaginal bleeding is dark red or bright red, and the status of the abdomen, which would be expected to be rigid or "board like." Staying with the patient, assuring a patent airway is present, and keeping the patient as calm as possible would be appropriate at the crash site before the arrival of emergency medical services (EMS). The current status of the patient and fetus are thepriority. The health care provider would prescribe the arterial blood gases and other laboratory work after the patient is assessed and stabilized. A labor and delivery nurse is in the process of admitting a patient who is 39 and at 5 weeks' gestation with a diagnosis of preeclampsia. The nurse has evaluated vital signs, weight, and deep tendon reflexes. Although the presence of edema is no longer included in the definition of preeclampsia, it is an important component of the nurse's evaluation. Edema is assessed for distribution, degree and pitting. Although the amount of edema is difficult to quantify, it is important to record the relative degrees of edema formation. From the graphic below, please select the illustration that best displays +3 edema.159718697 1 A Incorrect2 B Correct3 C 4 D The graphic illustrates a depth of 6 mm when the nurse applies finger pressure to the swollen area. This measurement indicates a +3 measurement for edema. Upon applying finger pressure, a 2 mm depression would be the equivalent of a +1, a 4 mm depression, a +2, and an 8 mm depression a +4. A pregnant patient reports abdominal pain in the right lower quadrant, along with nausea and vomiting. The patient's urinalysis report shows an absence of any urinary tract infection in the patient. A chest x-ray also rules out lower-lobe pneumonia. Which condition does the nurse suspect in the patient? Correct1 Appendicitis 2 Cholelithiasis 3 Placenta previa Incorrect4 Uterine rupture Abdominal pain in the right lower quadrant, accompanied by nausea and vomiting, indicates appendicitis in a pregnant patient. Cholelithiasis is characterized by right upper quadrant pain. Placenta previa is a condition wherein the placenta is implanted in the lower uterine segment covering the cervix, which causes bleeding when the cervix dilates. Uterine rupture is seen in a pregnant patient as a result of trauma, which may cause fetal death. A pregnant patient after 20 weeks' gestation reports painless, bright red vaginal bleeding. Upon assessment, the nurse finds that the patient's vital signs are normal. Which condition does the nurse suspect in the patient? 1 Eclampsia 2 Preeclampsia 3 Pyelonephritis Correct4 Placenta previa Placenta previa is indicated by painless, bright red vaginal bleeding during the second or third trimester of pregnancy. The patient's vital signs may be normal even after blood loss, because a pregnant patient can lose up to 40% of the blood volume without any signs of shock. Eclampsia is the onset of seizure activity in a patient with preeclampsia. Preeclampsia is indicated by hypertension and proteinuria after 20 weeks' gestation. Pyelonephritis is an infection caused by Escherichia coli organism, which is identified by fever, shaking chills, and aching in the lumbar area of the back. After being rehydrated in the emergency department, a 24 year-old primipara in her 18th week of pregnancy is at home and is to rest at home for the next two days and take in small but frequent fluids and food as possible. Discharge teaching at the hospital by the nurse has been effective if the patient makes which statement? Correct1 "I'm going to eat five to six small servings per day, which contain such foods and fluids as tea, crackers, or a few bites of baked potato." 2 "A strip of bacon and a fried egg will really taste good as long as I eat them slowly." 3 "As long as I eat small amounts and allow enough time for digestion, I can eat almost anything, like barbequed chicken or spaghetti." 4 "I'm going to stay only on clear fluids for the next 24 hours and then add dairy products like eggs and milk." Once the vomiting has stopped, feedings are started in small amounts at frequent intervals. In the beginning, limited amounts of oral fluids and bland foods such as crackers, toast, or baked chicken are offered. Clear fluids alone do not contain enough calories and contain no protein. Most women are able to take nourishment by mouth after several days of treatment. They should be encouraged to eat small, frequent meals and foods that sound appealing (e.g., nongreasy, dry, sweet, and salty foods). What instruction does the nurse give to a pregnant patient who takes iron supplements and is also prescribed levothyroxine (Synthroid) (T4)? 1 "Perform your aerobic exercises after taking levothyroxine (T4)." Correct2 "Take iron supplements and levothyroxine (T4) at different times." 3 "Lower the levothyroxine (T4) dosage as the pregnancy progresses." 4 "Discontinue the iron supplements in case of nausea or vomiting." The nurse advises the patient to take the supplements and T4 at different times, because the iron supplements decrease the absorption of T4. The T4 dosage is increased as the pregnancy progresses because of increased estrogen levels. Iron supplements are not discontinued, because discontinuing the supplements may increase chances of anemia. Instead, iron is administered parenterally if the patient is unable to take iron supplements orally. Aerobic exercises do not affect the drug action of T4. Aerobic exercises are prescribed for patients with diabetes. In planning for the care of a 30-year-old woman with pregestational diabetes, the nurse recognizes that the most important factor affecting pregnancy outcome is the: 1 mother's age. 2 number of years since diabetes was diagnosed. 3 amount of insulin required prenatally. Correct4 degree of glycemic control during pregnancy. Although advanced maternal age may pose some health risks, for the woman with pregestational diabetes the most important factor remains the degree of glycemic control during pregnancy. The number of years since diagnosis is not as relevant to outcomes as the degree of glycemic control. The key to reducing risk in the pregestational diabetic woman is not the amount of insulin required but rather the level of glycemic control. Women with excellent glucose control and no blood vessel disease should have good pregnancy outcomes. A pregnant woman is being examined by the nurse in the outpatient obstetric clinic. The nurse suspects systemic lupus erythematosus (SLE) after the examination reveals which symptoms? Select all that apply. Correct 1 Muscle aches 2 Hyperactivity Correct 3 Weight changes Correct 4 Fever 5 Hypotension Common symptoms, including myalgias, fatigue, weight change, and fevers, occur in nearly all women with SLE at some time during the course of the disease. Fatigue, rather than hyperactivity, is a common sign of SLE. Hypotension is not a characteristic sign of SLE. Although a diagnosis of SLE is suspected based on clinical signs and symptoms, it is confirmed by laboratory testing that demonstrates the presence of circulating autoantibodies. As with other autoimmune diseases, SLE is characterized by a series of exacerbations (flares) and remissions (Chin and Branch, 2012). A pregnant woman with cardiac disease is informed about signs of cardiac decompensation. She should be told that the earliest sign of decompensation is most often: 1 orthopnea. Correct2 decreasing energy levels. 3 moist frequent cough and frothy sputum. 4 crackles (rales) at the bases of the lungs on auscultation. Decreasing energy level (fatigue) is an early finding of heart failure. Care must be taken to recognize it as a warning rather than a typical change of the third trimester. Cardiac decompensation is most likely to occur early in the third trimester, during childbirth, and during the first 48 hours following birth. Orthopnea, a moist, frequent cough, and crackles and rales appear later when a failing heart reduces renal perfusion and fluid accumulates in the pulmonary interstitial space, leading to pulmonary edema. A pregnant woman with type 1 diabetes is on rapid-acting, short-acting, and intermediate-acting insulin injections. Which are rapid and short-acting insulins? Select all that apply. 1 NPH (Novolin N) Correct 2 Regular (Humalin) Correct 3 Lispro (Humalog) Correct 4 Aspart (NovoLog) 5 Glargine (Lantus) Humalog and NovoLog are rapid-acting insulins and Humalin is a short-acting insulin. Novolin N is an intermediate-acting insulin and Lantus is a long-acting insulin. A patient with gestational diabetes tells the nurse, "I'm extremely worried that my child will be diabetic, too." Which actions does the nurse take to alleviate the patient's anxiety? Select all that apply. 1 Evaluate the test results to assess fetal growth. Correct 2 Listen to the feelings and concerns of the patient. Correct 3 Provide factual information of risks to the patient. Correct 4 Use therapeutic communication with the patient. Correct 5 Ask the patient to share any fears with the nurse. The nurse listens to the patient's feelings and concerns to assess for any misconception or misinformation that can be causing anxiety. The nurse provides factual information about any risks to the patient to correct any misconceptions. Using therapeutic communication will develop an open relationship that also helps promote trust. The nurse encourages the patient to share concerns with the nursing staff to promote collaboration in the care process. Evaluating test reports for fetal growth will help assess fetal well-being, although it does not help alleviate the patient's fears. Which actions does the nurse take when a pregnant patient has convulsions? Select all that apply. Correct 1 Obtains a prescription for magnesium sulfate Correct 2 Assesses the patient's airway, breathing, and pulse Correct 3 Lowers the bed and turns the patient onto one side 4 Does not leave the patient for more than 10 minutes Correct 5 Raises the side rails of the bed and pads with pillows The nurse obtains a prescription for magnesium sulfate to prevent further convulsions. The nurse assesses the patient's airway, breathing, and pulse to understand the maternal condition. The nurse may need to suction secretions to clear the airway and administer oxygen to maintain sufficient oxygenation in the patient. The nurse lowers the bed and turns the patient onto one side to prevent aspiration of vomitus. The nurse raises the side rails of the bed and pads with pillows to prevent a fall. The nurse may call for help but should not leave the patient's bedside as the patient is in a serious condition. Diabetes in pregnancy puts the fetus at risk in several ways. Nurses should be aware that: Incorrect1 with good control of maternal glucose levels, sudden and unexplained stillbirth is no longer a major concern. Correct2 the most important cause of perinatal loss in diabetic pregnancy is congenital malformations. 3 infants of mothers with diabetes have the same risks for respiratory distress syndrome because of the careful monitoring. 4 at birth, the neonate of a diabetic mother is no longer at any greater risk. Congenital malformations account for 30% to 50% of perinatal deaths. Even with good control, sudden and unexplained stillbirth remains a major concern. Infants of diabetic mothers are at increased risk for respiratory distress syndrome. The transition to extrauterine life often is marked by hypoglycemia and other metabolic abnormalities. During pregnancy, alcohol withdrawal may be treated using: Incorrect1 disulfiram (Antabuse). 2 corticosteroids. Correct3 benzodiazepines. 4 aminophylline. Symptoms that occur during alcohol withdrawal can be managed with short-acting barbiturates or benzodiazepines. Disulfiram is contraindicated in pregnancy because it is teratogenic. Corticosteroids are not used to treat alcohol withdrawal. Aminophylline is not used to treat alcohol withdrawal. What instruction does the nurse provide to a pregnant patient with mild preeclampsia? 1 "You need to be hospitalized for fetal evaluation." 2 "Nonstress testing can be done once every month." Correct3 "Fetal movement counts need to be evaluated daily." 4 "Take complete bed rest during the entire pregnancy." Preeclampsia can affect the fetus and may cause fetal growth restrictions, decreased amniotic fluid volume, abnormal fetal oxygenation, low birth weight, and preterm birth. Therefore the fetal movements need to be evaluated daily. Patients with mild preeclampsia can be managed at home effectively and need not be hospitalized. Nonstress testing is performed once or twice per week to determine fetal well-being. Patients need to restrict activity, but complete bed rest is not advised because it may cause cardiovascular deconditioning, muscle atrophy, and psychological stress. The nurse is preparing to discharge a 30-year-old woman who has experienced a miscarriage at 10 weeks of gestation. Which statement by the woman indicates a correct understanding of the discharge instructions? 1 "I will not experience mood swings since I was only at 10 weeks of gestation." Incorrect2 "I will avoid sexual intercourse for 6 weeks and pregnancy for 6 months." Correct3 "I should eat foods that are high in iron and protein to help my body heal." 4 "I should expect the bleeding to be heavy and bright red for at least 1 week." A woman who has experienced a miscarriage should be advised to eat foods that are high in iron and protein to help replenish her body after the loss. After a miscarriage, a woman may experience mood swings and depression from the reduction of hormones and the grieving process. Sexual intercourse should be avoided for 2 weeks or until the bleeding has stopped and should avoid pregnancy for 2 months. The woman should not experience bright red, heavy, profuse bleeding; this should be reported to the health care provider. Which is the ideal treatment for severe unmanageable hyperthyroidism in a patient who is pregnant? 1 Radioactive iodine Correct2 Subtotal thyroidectomy 3 Methimazole (Tapazole) 4 Propylthiouracil (Propacil) A subtotal thyroidectomy is prescribed for a pregnant patient with severe hyperthyroidism if the drug therapy proves toxic. Oral methimazole and propylthiouracils are prescribed for hyperthyroidism but may be ineffective in severe cases. Radioactive iodine is not used to treat hyperthyroidism in pregnant patients, because it may destroy the fetus's thyroid gland. The nurse observes that maternal hypotension has decreased uterine and fetal perfusion in a pregnant patient. What does the nurse need to assess further to understand the maternal status? 1 D-dimer blood test 2 Kleihauer-Betke (KB) test Correct3 Electronic fetal monitoring Incorrect4 Electrocardiogram reading Electronic fetal monitoring reflects fetal cardiac responses to hypoxia and hypoperfusion and helps to assess maternal status after a trauma. The D-dimer blood test is used to rule out the presence of a thrombus. The KB test is used to evaluate transplacental hemorrhage. Electrocardiogram reading is more useful to assess the cardiac functions in nonpregnant cardiac patients. Which intervention does the nurse implement for a patient immediately after a severe abdominal trauma? Incorrect1 Prep the patient for cesarean birth. Correct2 Send the patient for pelvic computed tomography (CT) scanning. 3 Provide fluids to the patient as part of the protocol for ultrasound examination. 4 Prepare to administer Rho(D) immunoglobulin. Pelvic CT scanning helps visualize extraperitoneal and retroperitoneal structures and the genitourinary tract. The nurse needs to prepare the patient for cesarean birth if there is no evidence of a maternal pulse. Ultrasound examination is not as effective as electronic fetal monitoring for determining placental abruption in the patient after the trauma. Therefore the nurse prepares the patient for a CT scan after a severe abdominal trauma. The nurse needs to administer Rho(D) immunoglobulin in an Rh-negative pregnant trauma patient. This helps protect the patient from isoimmunization Which medication does the primary health care provider ask the nurse to administer to a patient during labor in a vaginal delivery, who has a history of a myocardial infarction (MI)? 1 Oxytocin 2 Diuretics Incorrect3 Anticoagulant Correct4 Epidural analgesia Epidural analgesia is administered during labor to a patient with MI to prevent pain, which can result in tachycardia and increased cardiac demands. Oxytocin is administered to a patient after birth to prevent hemorrhage. Diuretics are administered to prevent fluid retention in a pregnant patient with a heart disease. Anticoagulant therapy is administered for recurrent venous thrombosis in pregnancy. The nurse finds diuresis, weight loss, and muscle atrophy in a pregnant patient with mild preeclampsia. What does the nurse conclude from these findings? The patient: 1 Was mostly on a liquid diet. Correct2 Was on prolonged bed rest. Incorrect3 Has developed HELLP syndrome. 4 Is at risk for placental abruption. Prolonged bed rest in patients with preeclampsia may result in diuresis and fluid, electrolyte, and weight loss. Therefore the nurse advises the patient to restrict activity instead of taking complete bed rest. A liquid diet may contribute to weight loss, but it does not cause diuresis or muscle atrophy. HELLP syndrome is characterized by hemolysis (H), elevated liver enzymes (EL), and low platelet count (LP) in a patient with preeclampsia. Vaginal bleeding will indicate placental abruption in the patient. What does the nurse advise a pregnant patient who is prescribed phenazopyridine (Pyridium) for cystitis? 1 "Avoid sweet foods in diet." Incorrect2 "Limit exposure to sunlight." Correct3 "Do not wear contact lenses." 4 "Restrict oral fluids to 125 mL per hour." Phenazopyridine (Pyridium) colors the tears orange. Therefore the nurse instructs the patient to avoid wearing contact lenses. Sweet foods are avoided in patients with diabetes mellitus, because they can cause fluctuating glucose levels, which may harm the fetus. Exposure to sunlight is avoided when the patient is receiving methotrexate therapy, because it causes photosensitivity. Oral fluids are restricted in patients who are at risk for pulmonary edema. Which statement made by the nursing student about the management of molar pregnancy indicates effective learning? Incorrect1 "Methotrexate therapy is prescribed to abort molar pregnancy." 2 "Expectant management is initiated as per the amount of bleeding." Correct3 "Suction curettage is the safest way of terminating molar pregnancy." 4 "Induction of labor with oxytocic agents is one of the treatment options." In molar pregnancy, the avascular transparent vesicles in the uterus may cause uterine distention. Therefore suction curettage is used for rapid and effective evacuation of the hydatidiform mole. Methotrexate therapy is prescribed to dissolve an ectopic pregnancy. Expectant management is initiated in case of a normal fetus and not molar pregnancy. Induction of labor with oxytocic agents is not a safe method, because it has a risk of embolization of trophoblastic tissue. A woman with severe preeclampsia is receiving a magnesium sulfate infusion. The nurse becomes concerned after assessment when the woman exhibits: 1 a sleepy, sedated affect. Correct2 a respiratory rate of 10 breaths/min. 3 deep tendon reflexes of 2+. 4 absent ankle clonus. A respiratory rate of 10 breaths/min indicates that the patient is experiencing respiratory depression (bradypnea) from magnesium toxicity. Because magnesium sulfate is a central nervous system (CNS) depressant, the woman will most likely become sedated when the infusion is initiated. Deep tendon reflexes of 2+ are a normal finding. Absent ankle clonus is a normal finding. What instruction should the nurse give to a pregnant patient with hyperthyroidism who often gets fatigued and weak as a result of nervousness and hyperactivity? 1 "Ensure that you wear warm clothes." Incorrect2 "Perform aerobic exercises every day." Correct3 "Become involved in reading or a craft." 4 "Avoid going out in the cold or at night." The nurse advises the patient to engage in quiet activities, such as reading or crafting, to prevent fatigue and weakness. Extreme cold temperature is prevented and warm clothing is suggested if the patient has cold intolerance because of hypothyroidism. The patient is hypersensitive to heat and gets easily fatigued; therefore aerobic exercises are not advised. Which test does the nurse evaluate to understand the cause of fatigue, shortness of breath, and dyspnea in a pregnant patient? 1 Nonstress test Correct2 Electrocardiography 3 24-Hour urine collection 4 Glycosylated hemoglobin Fatigue, shortness of breath, and dyspnea in a pregnant patient indicate primary pulmonary hypertension (PPH). Therefore the nurse needs to evaluate electrocardiography results, which diagnose the condition. The 24-hour urine collection is used to evaluate total protein excretion and creatinine clearance in a pregnant patient with diabetes. The nonstress test is used to assess fetal well-being in a pregnant patient with diabetes. The glycosylated hemoglobin test is used to assess glycemic control in a pregnant patient with diabetes. What does the nurse teach a patient with phenylketonuria (PKU) about breastfeeding? Incorrect1 "You should breastfeed your child every 3 to 4 hours." 2 "Eat a phenylalanine-restricted diet for breastfeeding." 3 "Eat wheat products immediately after breastfeeding." Correct4 "You should bottle-feed, because it is not safe to breastfeed." It is not advisable to breastfeed if the patient has PKU, because the milk will contain a high concentration of phenylalanine. The nurse instructs the patient to breastfeed every 3 to 4 hours for patients without PKU. Wheat products contain phenylalanine and are not recommended for patients with PKU. Eating a phenylalanine-restricted diet is effective before conception in order to lower the phenylalanine levels in the patient. When a pregnant woman with diabetes experiences hypoglycemia while hospitalized, what should the nurse have the woman do? 1 Eat a candy bar. Correct2 Eat six saltine crackers or drink 8 oz of milk. Incorrect3 Drink 4 oz of orange juice followed by 8 oz of milk. 4 Drink 8 oz of orange juice with 2 teaspoons of sugar added. Crackers provide carbohydrates in the form of polysaccharides. A candy bar provides only monosaccharides. Milk is a disaccharide and orange juice is a monosaccharide. This will provide an increase in blood sugar but will not sustain to level. Orange juice and sugar will increase the blood sugar, but not provide a slow-burning carbohydrate to sustain the blood sugar. An 8-month-pregnant patient presents with preeclampsia. Which clinical findings in the patient indicate that the disease has progressed to HELLP syndrome? Select all that apply. Correct 1 Hepatic dysfunction Correct 2 Elevated liver enzymes 3 Vaginal bleeding Correct 4 Low platelet count Incorrect 5 Chronic hypertension Hepatic dysfunction in a patient with preeclampsia indicates that the disease has progressed to HELLP syndrome. It can result in both endothelial damage and fibrin deposits in the liver. Hepatic tissue damage results in elevated liver enzymes. Narrowed blood vessels damage the red blood cells (RBCs) and they become hemolyzed, resulting in a decreased RBC and platelet count. Vaginal bleeding is sometimes seen in patients with severe gestational hypertension or those who are at risk for miscarriage. Chronic hypertension is a condition in which patients develop hypertension before the pregnancy. It is not related to HELLP syndrome. The nurse observes that eclampsia has developed in a pregnant patient after starting magnesium sulfate therapy. What action does the nurse take? Correct1 Continue to administer magnesium sulfate per protocol. 2 Administer regional anesthesia to the patient. 3 Administer calcium gluconate simultaneously. 4 Prepare the patient for immediate cesarean birth. The nurse needs to administer additional magnesium sulfate because it will help in treating eclamptic seizures and preventing repeated seizures. Regional anesthesia is not recommended for eclamptic patients because of the risk of maternal complications. Calcium gluconate is administered as an antidote for magnesium toxicity. Immediate cesarean birth is a priority when the patient is in shock after a trauma. What action does the nurse take before performing cardiopulmonary resuscitation (CPR) to revive a pregnant patient undergoing a cardiac arrest? 1 Administer normal saline solution. 2 Assess for fetal-maternal hemorrhage. 3 Call two staff nurses to hold the patient. Correct4 Place a rolled blanket under the patient's hips. The nurse needs to displace the uterus to enhance cardiac output in the patient during CPR. Therefore the nurse places a rolled blanket under the patient's hips, which helps displace the uterus manually. The nurse may administer normal saline solution to a patient who has profound hypovolemia after a trauma for massive fluid resuscitation. Fetal-maternal hemorrhage is a concern in a patient who has experienced a trauma. It is not necessary to have two nurses to hold the patient. The nurse is trained to start the CPR during an emergency. Which hypertensive disorders can occur during pregnancy? Select all that apply. Correct 1 Chronic hypertension Correct 2 Preeclampsia-eclampsia 3 Hyperemesis gravidarum Correct 4 Gestational hypertension 5 Gestational trophoblastic disease Chronic hypertension refers to hypertension that developed in the pregnant patient before 20 weeks' gestation. Preeclampsia refers to hypertension and proteinuria that develops after 20 weeks' gestation. Eclampsia is the onset of seizure activity in a pregnant patient with preeclampsia. Gestational hypertension is the onset of hypertension after 20 weeks' gestation. Gestational trophoblastic disease and hyperemesis gravidarum are not hypertensive disorders. Gestational trophoblastic disease refers to a disorder without a viable fetus that is caused by abnormal fertilization. Hyperemesis gravidarum is excessive vomiting during pregnancy that may result in weight loss and electrolyte imbalance. The nurse is teaching a woman with gestational diabetes the technique to inject insulin. What should the nurse include in the teaching session? Select all that apply. 1 Aspirate before injecting Incorrect 2 Clean injection site with alcohol Correct 3 Insert the needle at a 45- to 90-degree angle Correct 4 Inject insulin slowly Correct 5 After injection, cover site with sterile gauze Insulin should be injected with the short needle inserted at a 45- to 90-degree angle, depending on fatty tissue. Insulin is injected slowly to allow tissue expansion and minimize pressure, which can cause insulin leakage. After injection, the site should be covered with sterile gauze. Gentle pressure should be applied to prevent bleeding. Aspirating when injecting into subcutaneous tissue is not necessary. The injection site should be clean, but using alcohol is not necessary. Which intervention will help prevent the risk of pulmonary edema in a pregnant patient with severe preeclampsia? 1 Assess fetal heart rate (FHR) abnormalities regularly. Incorrect2 Place the patient on bed rest in a darkened environment. Correct3 Restrict total intravenous (I.V.) and oral fluids to 125 mL/hr. 4 Ensure that magnesium sulfate is administered as prescribed. Pulmonary edema may be seen in patients with severe preeclampsia. Therefore the nurse needs to restrict total intravenous (I.V.) and oral fluids to 125 mL/hr. FHR monitoring helps assess any fetal complications. The patient is placed on bed rest in a darkened environment to prevent stress. Magnesium sulfate is administered to prevent eclamptic seizures. Which interventions does the nurse implement to ease the labor process of a pregnant patient with heart disease? Select all that apply. Correct 1 Place the patient in a side-lying position. 2 Use stirrups to facilitate an easy labor. Correct 3 Monitor the patient's oxygen saturation. Correct 4 Maintain a peaceful, calm environment. Correct 5 Provide the patient with a relaxing back rub. The nurse places the patient in a side-lying position to facilitate uterine perfusion. The nurse monitors the patient's oxygen saturation to assess for adequate oxygenation. The nurse maintains a calm environment to minimize the patient's anxiety. The nurse also provides a back massage to comfort the patient. Stirrups are not used because they may prevent compression of the popliteal veins or increase in blood volume in the chest. How does the nurse advise the patient who has given birth to an infant with microcephaly in the past and is now planning for the next child? 1 "There is a higher chance of having a preterm birth." Correct2 "You should be screened for phenylketonuria (PKU)." 3 "There may be a miscarriage in your second pregnancy." Incorrect4 "You must go for genetic counseling before conception." If a patient has given birth to an infant with microcephaly in the past, there is a possibility that the patient has phenylketonuria (PKU). PKU results from a deficiency in the enzyme phenylalanine hydrolase. Preterm birth is a possibility in pregnant women with untreated hypothyroidism. PKU affects brain development and function in the child; it does not cause miscarriage. Genetic counseling is more important for patients who have hereditary disorders, which can be passed on to the child. In caring for the woman with disseminated intravascular coagulation (DIC), what order should the nurse anticipate? Correct1 Administration of blood Incorrect2 Preparation of the woman for invasive hemodynamic monitoring 3 Restriction of intravascular fluids 4 Administration of steroids Primary medical management in all cases of DIC involves correction of the underlying cause, volume replacement, blood component therapy, optimization of oxygenation and perfusion status, and continued reassessment of laboratory parameters. Central monitoring would not be ordered initially in a woman with DIC because this can contribute to more areas of bleeding. Management of DIC includes volume replacement, not volume restriction. Steroids are not indicated for the management of DIC. The most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is: 1 bleeding. Correct2 intense abdominal pain. 3 uterine activity. 4 cramping. Pain is absent with placenta previa but may be agonizing with abruptio placentae. Bleeding may be present in varying degrees for both placental conditions. Uterine activity may be present with both placental conditions. Cramping is a form of uterine activity that may be present in both placental conditions. Which is an important nursing intervention when a patient has an incomplete miscarriage with heavy bleeding? 1 Initiate expectant management at once. Correct2 Prepare the patient for dilation and curettage. 3 Administer the prescribed oxytocin (Pitocin). Incorrect4 Obtain a prescription for ergonovine (Methergine). In the case of an incomplete miscarriage, sometimes there is heavy bleeding and excessive cramping and some part of fetal tissue remains in the uterus. Therefore the nurse needs to prepare the patient for dilation and curettage for the removal of the fetal tissue. Expectant management is initiated if the pregnancy continues after a threatened miscarriage. Oxytocin (Pitocin) is administered to prevent hemorrhage after evacuation of the uterus. Which finding in a urine specimen of a pregnant patient indicates the client has proteinuria? 1 Value of ≥0.5+ protein in a dipstick testing Correct2 Protein concentration that is >300 mg/24 hours Incorrect3 Concentration of ≥1 g protein in a 24-hour urine collection 4 Protein concentration at 10 mg/dL in random urine specimen Proteinuria is determined from dipstick testing on a clean-catch or catheterized urine specimen or evaluation of a 24-hour urine collection. Protein concentration that is >300 mg/24 hours in a 24-hour urine specimen indicates proteinuria. A concentration of ≥5 g protein in a 24-hour urine collection will indicate severe preeclampsia. Protein concentration >30 mg/dL in at least two random urine specimens collected at least 6 hours apart will indicate proteinuria. Value of ≥1+ on dipstick measurement indicates proteinuria. The emergency department nurse is assessing a pregnant trauma victim who just arrived at the hospital. What are the nurse's mostappropriate actions? Select all that apply. 1 Place the patient in a supine position. Correct 2 Assess for point of maximal impulse at fourth intercostal space. Correct 3 Collect urine for urinalysis and culture. Correct 4 Frequent vital sign monitoring. 5 Assist with ambulation to decrease risk of thrombosis. The heart is displaced upward and to the left in pregnant patients. During pregnancy, there is dilation of the ureters and urethra, and the bladder is displaced forward placing the pregnant trauma patient at higher risk for urinary stasis, infection, and bladder trauma. The trauma patient can suffer blood loss and other complications, necessitating frequent monitoring of vital signs. Passive regurgitation may occur if patient is supine, leading to high risk for aspiration.While the pregnant patient is at risk for thrombus formation, the patient must be cleared by the health care provider before ambulating. The pregnant trauma patient is at higher risk for pelvic fracture, and therefore this condition must be ruled out first as well. The nurse is developing the plan of care for a pregnant patient with an underlying history of cardiovascular disease. Which conditions would this patient be at risk for? Select all that apply. Correct 1 Stillbirth Correct 2 Miscarriage 3 Hypoglycemia Incorrect 4 Atrial septal defect Correct 5 Intrauterine growth restriction Stillbirth and miscarriage may occur because of cardiovascular problems in pregnancy. Intrauterine growth restriction results in a pregnant patient with cardiovascular disease because of low oxygen pressure. Hypoglycemia is seen in a pregnant patient with diabetes because a decrease in glucose levels. An atrial septal defect is a congenital birth defect that is not related to underlying maternal cardiac disease. A patient with gestational hypertension is prescribed labetalol hydrochloride (Normodyne) therapy, which is continued after giving birth. What does the nurse instruct the patient about breastfeeding? Correct1 "You may breastfeed the infant if you desire." Incorrect2 "Breastfeeding may cause convulsions in the infant." 3 "Breastfeed only once a day and use infant formulas." 4 "There may be high levels of the drug in the breast milk." Labetalol hydrochloride (Normodyne) has a low concentration in breast milk, so the patient can breastfeed the infant. Breastfeeding is safe and will not cause convulsions or any side effects in the infant. Infant formulas are used only if the mother is unable to breastfeed the infant or if the mother does not desire to breastfeed. Signs of a threatened abortion (miscarriage) are noted in a woman at 8 weeks of gestation. What is an appropriate management approach for this type of abortion? Incorrect1 Prepare the woman for a dilation and curettage (D&C). 2 Place the woman on bed rest for at least 1 week and reevaluate. Correct3 Prepare the woman for an ultrasound and bloodwork. 4 Comfort the woman by telling her that if she loses this baby, she may attempt to get pregnant again in 1 month. Repetitive transvaginal ultrasounds and measurement of human chorionic gonadotropin (hCG) and progesterone levels may be performed to determine if the fetus is alive and within the uterus. If the pregnancy is lost, the woman should be guided through the grieving process. D&C is not considered until signs of the progress to an inevitable abortion are noted or the contents are expelled and incomplete. Bed rest is recommended for 48 hours initially. Telling the woman that she can get pregnant again soon is not a therapeutic response because it discounts the importance of this pregnancy. Which instructions does the nurse give to a patient who is prescribed methotrexate therapy for dissolving the tubal pregnancy? Correct1 "Discontinue folic acid supplements." 2 "Get adequate exposure to sunlight." Incorrect3 "Take stronger analgesics for severe pain." 4 "Vaginal intercourse is safe during the therapy." The nurse advises the patient to discontinue folic acid supplements as they interact with methotrexate and may exacerbate ectopic rupture in the patient. Exposure to sunlight is avoided as the therapy makes the patient photosensitive. Analgesics stronger than acetaminophen are avoided, because they may mask symptoms of tubal rupture. Vaginal intercourse is avoided until the pregnancy is dissolved completely. What does the nurse inform a breastfeeding patient who is taking propylthiouracil (Propacil) for hyperthyroidism? 1 "The medication is likely to decrease milk production." Incorrect2 "Stop breastfeeding the child, and start infant formula." 3 "It can adversely affect the neonate's thyroid function." Correct4 "Take the medication immediately after breastfeeding." The nurse advises the patient to take the medication immediately after breastfeeding to allow a 3- to 4-hour period for the medication to absorb before nursing again. Milk production decreases if there is poor metabolic control, not because of antithyroid medications. It is not necessary to stop breastfeeding or provide infant formula, because there are no side effects of the medication in the infant. The medication also does not adversely affect the neonate's thyroid function because the infant has a normal thyroid function. What does the nurse administer to a patient if there is excessive bleeding after suction curettage? 1 Nifedipine (Procardia) 2 Methyldopa (Aldomet) 3 Hydralazine (Apresoline) Correct4 Ergonovine (Methergine) Ergonovine (Methergine) is an ergot product, which is administered to contract the uterus when there is excessive bleeding after suction curettage. Nifedipine (Procardia) is prescribed for gestational hypertension or severe preeclampsia. Methyldopa (Aldomet) is an antihypertensive medication indicated for pregnant patients with hypertension. Hydralazine (Apresoline) is also an antihypertensive medication used for treating hypertension intrapartum. Which clinical reports does the nurse evaluate to identify ectopic pregnancy in a patient? Select all that apply. Correct 1 Quantitative human chorionic gonadotropin (β-hCG) levels Correct 2 Transvaginal ultrasound Correct 3 Progesterone level 4 Thyroid test reports Incorrect 5 Kleihauer-Betke (KB) test An ectopic pregnancy is indicated when β-hCG levels are >1500 milli-international units/mL but no intrauterine pregnancy is seen on the transvaginal ultrasound. A transvaginal ultrasound is repeated to verify if the pregnancy is inside the uterus. A progesterone level <5 ng/mL indicates ectopic pregnancy. Thyroid test reports need to be evaluated in case the patient has hyperemesis gravidarum, as hyperthyroidism is associated with this disorder. The KB test is used to determine transplacental hemorrhage. What does the nurse include in the plan of care of a patient with a cardiac disorder during the postpartum period? Select all that apply. Correct 1 Monitor oxygen saturation levels. Correct 2 Place the newborn at the bedside. 3 Put the patient on a full liquid diet. Correct 4 Teach the patient how to breastfeed. Correct 5 Have the patient talk to the newborn. The nurse monitors oxygen saturation levels in the patient to assess for adequate oxygenation. The nurse places the infant at the bedside so that the patient can touch the infant without expending energy. This also helps establish an emotional bond. The nurse assists the patient in breastfeeding by positioning the infant correctly for feeding. The nurse encourages the patient to talk to the newborn to involve the mother in the infant's care and help the patient feel vitally important. A fluid diet is not prescribed, because it does not ensure adequate nutrition for the infant. Which action does the nurse take to determine whether the carbohydrate intake is inadequate in a pregnant patient with diabetes? Correct1 Monitor for urine ketones. 2 Evaluate the nonstress test results. 3 Determine the degree of glycosuria. 4 Schedule a baseline fetal sonogram. If a patient with diabetes does not take in enough carbohydrates, the body resorts to breaking down fats for energy. The by-product of fat metabolism is ketones. Therefore the nurse monitors the urine for ketones. The amount of ketones in the urine helps detect inadequate carbohydrate intake. Nonstress tests will help assess the well-being of the fetus. Glycosuria does not accurately reflect the blood glucose levels because of a lowered renal threshold for glucose during pregnancy. The nurse obtains a baseline sonogram to assess gestational age in the first trimester. Which is a priority nursing action when a pregnant patient with severe gestational hypertension is admitted to the health care facility? 1 Prepare the patient for cesarean delivery. 2 Administer intravenous (I.V.) and oral fluids. 3 Provide diversionary activities during bed rest. Correct4 Administer the prescribed magnesium sulfate. The nurse administers the prescribed magnesium sulfate to the patient to prevent eclamptic seizures. I.V. oral fluids are indicated when there is severe dehydration in the patient. It is important to provide diversionary activities during bed rest, but it is secondary in this case. A patient who has experienced a multisystem trauma is prepared for cesarean delivery if there is no evidence of a maternal pulse, which increases the chance of maternal survival. What is a priority nursing action after administering magnesium sulfate to a pregnant patient? 1 Assess the patient's weight. Correct2 Assess serum magnesium level. 3 Restrict fluid intake to 250 mL/hr. Incorrect4 Evaluate fetal movement counts hourly. Magnesium sulfate can cause toxicity in the patient if the renal system does not function properly. Therefore the nurse needs to assess the serum magnesium levels so that prompt action can be taken. The nurse needs to assess the patient's weight if there is a risk for edema. Fluids are restricted if the patient is at risk for edema. Magnesium sulfate does not affect the fetal heart rate (FHR), so assessing fetal movements is not a priority. From 4% to 8% of pregnant women have asthma, making it one of the most common preexisting conditions of pregnancy. Severity of symptoms usually peaks: 1 in the first trimester. Correct2 between 17 to 24 weeks of gestation. Incorrect3 during the last 4 weeks of pregnancy. 4 immediately postpartum. The period between 17 and 24 weeks of pregnancy is associated with the greatest severity of symptoms. Women often have few symptoms of asthma during the first trimester. During the last 4 weeks of pregnancy symptoms often subside. Often issues have resolved by the time the woman gives birth. What does the nurse recommend to a pregnant patient with diabetes who works long, irregular hours? 1 "Eat a snack hourly when at work." 2 "Try taking naps when you are free." Correct3 "Keep fruits or fruit juice available." 4 "Quit working for a while." If the patient has to be away from home for long hours, the nurse advises the patient to carry fruits or fruit juices. They contain simple carbohydrates that help control blood glucose levels. The nurse should not advise the patient to quit working, because it may not be feasible for the patient. Instead, the nurse should encourage the patient to follow a consistent daily schedule. Taking naps when free ensures rest, but it does not help keep glucose levels in check. Eating a snack every hour is not advised, because it may fluctuate blood glucose levels. Instead, three meals and two or three snacks are advised. A pregnant woman at 28 weeks of gestation has been diagnosed with gestational diabetes. The nurse caring for this woman understands that: 1 oral hypoglycemic agents should not be used if the woman is reluctant to give herself insulin. Incorrect2 dietary modifications and insulin are both required for adequate treatment. 3 glucose levels are monitored by testing urine 4 times a day and at bedtime. Correct4 dietary management involves distributing nutrient requirements over three meals and two or three snacks. Small frequent meals over a 24-hour period help decrease the risk for hypoglycemia and ketoacidosis. Oral hypoglycemic agents can be used as an alternative to insulin in women with GDM who require medication in addition to diet for blood glucose control. In some women gestational diabetes can be controlled with dietary modifications alone. Blood, not urine, glucose levels are monitored several times a day. Urine is tested for ketone content; results should be negative. A patient is diagnosed with severe cardiac disease in the fourth week of pregnancy. What should be the nurse's priority? 1 Initiate fetal surveillance twice a week. 2 Assess the patient for signs of heart failure. Correct3 Explain the risks of continuing pregnancy. 4 Tell the patient to end the pregnancy right away. The nurse explains the risks of continuing the pregnancy to help the patient make an informed decision. Fetal surveillance begins after 28 weeks if there are any complications, such as diabetes mellitus, in the patient. The nurse informs the patient about the complications that may arise as the pregnancy progresses. If the pregnancy is continued, the nurse assesses for cardiac decompensation to evaluate if the heart is able to maintain a sufficient cardiac output. The nurse does not ask the patient to terminate the pregnancy. A pregnant patient with chronic hypertension is at risk for placental abruption. Which symptoms of abruption does the nurse instruct the patient to be alert for? Select all that apply. 1 Weight loss Correct 2 Abdominal pain Correct 3 Vaginal bleeding 4 Shortness of breath Correct 5 Uterine tenderness The nurse instructs the pregnant patient to be alert for abdominal pain, vaginal bleeding, and uterine tenderness as these indicates placental abruption. Weight loss indicates fluid and electrolyte loss and not placental abruption. Shortness of breath indicates inadequate oxygen, which is usually seen in a patient who is having cardiac arrest. The quantitative human chorionic gonadotropin (β-hCG) levels are high in a patient who is on methotrexate therapy for dissolving abdominal pregnancy. Which instruction does the nurse give to this patient? Correct1 "Avoid sexual activity." 2 "Avoid next pregnancy." 3 "Avoid feeling sad and low." Incorrect4 "Take folic acid without fail." High β-hCG levels indicate that the abdominal pregnancy is not yet dissolved. Therefore the nurse advises the patient to avoid sexual activity until the β-hCG levels drop and the pregnancy is dissolved completely. If the patient engages in vaginal intercourse, the pelvic pressure may rupture the mass and cause pain. Abdominal pregnancy increases the chances of infertility or recurrent ectopic pregnancy in patients. However, the nurse need not instruct the patient to avoid further pregnancy, because it may increase the feelings of sadness and guilt in the patient. The nurse encourages the patient to share feelings of guilt or sadness related to pregnancy loss. Folic acid is contraindicated with methotrexate therapy, because it may exacerbate ectopic rupture. The prenatal medical record for a pregnant patient with diabetes states that amniotic fluid phosphatidylglycerol is greater than 3%. What does this indicate? Correct1 The fetal lung maturation is normal. 2 The mother may develop hydramnios. 3 There is a chance of fetal macrosomia. 4 The mother is at risk for hypoglycemia. Fetal lung maturation is predicted by the presence by amniotic fluid phosphatidylglycerol. If it is greater than 3%, the fetal lung maturation is normal. The risk for hypoglycemia can be confirmed by evaluating blood glucose levels. The risk for fetal macrosomia is increased if there is poor glycemic control in pregnancy. If hyperglycemia occurs, the patient is at risk for hydramnios. Which medication is ideal for the treatment of systemic lupus erythematosus (SLE) in a pregnant patient? 1 Aspirin (Ecotrin) 2 Azathioprine (Imuran) 3 Prednisone (Deltasone) Correct4 Hydroxychloroquine (Plaquenil) Hydroxychloroquine (Plaquenil) reduces SLE disease activity in a pregnant patient without any adverse effects on the fetus. Aspirin (Ecotrin) is not recommended during pregnancy, because it has an increased risk for premature closure of the fetal ductus arteriosus. Azathioprine (Imuran) is discontinued before conception, because it is fetotoxic. Prednisone (Deltasone) is prescribed to treat SLE during pregnancy, but it increases the risk for bone demineralization, gestational diabetes, preeclampsia, premature rupture of membranes (PROM), and intrauterine growth restriction (IUGR). A 24-year-old primipara, 10 weeks pregnant, who has been experiencing vomiting every morning for the past few weeks, asks the nurse at her check-up how long this "morning sickness" will continue. Which statement by the nurse is most accurate? 1 "It will end by the 15th week of pregnancy." Correct2 "It usually subsides by the 20th week of pregnancy." 3 "It's a very common but not serious problem." Incorrect4 "In some women, it can last throughout the pregnancy and become serious." This discomfort of pregnancy usually subsides by the 20th week of pregnancy. An absolute definite end of vomiting during pregnancy can never be stated. A patient with severe gestational hypertension is prescribed hydralazine (Apresoline). What is a priority nursing intervention in this case? 1 Assess for visual disturbances. 2 Assess airway, breathing, and pulse. Correct3 Assess blood pressure frequently. 4 Prepare the patient for nonstress testing. Hydralazine (Apresoline) is an antihypertensive medication. The nurse assesses the patient's blood pressure (BP) frequently because a precipitous drop in BP can lead to shock and placental abruption. Visual disturbances are symptoms of severe preeclampsia and not a side effect of hydralazine (Apresoline). The nurse needs to assess airway, breathing, and pulse to stabilize a pregnant patient after a convulsion. Nonstress testing is performed once or twice weekly to assess fetal well-being. Which clinical finding in a pregnant patient will indicate proper fetal brain development? 1 Hemoglobin A1c levels greater than 6 Correct2 Normal maternal thyroxine (T4) levels 3 3% amniotic fluid phosphatidylglycerol 4 Fasting glucose levels less than 95 mg/dL Proper fetal brain development depends on normal maternal T4 levels early in pregnancy. Mild maternal hypothyroidism during the first trimester can cause neuropsychological damage in the infant. Hemoglobin A1c levels greater than 6 indicate long-term elevated glucose levels in the patient. A 3% amniotic fluid phosphatidylglycerol indicates proper lung maturation in the fetus. Fasting glucose levels less than 95 mg/dL indicate proper glycemic control in the pregnant patient. Which nursing interventions are included in the plan of care of a pregnant patient with mitral stenosis? Select all that apply. Correct 1 Restrict dietary sodium. Correct 2 Place the patient on bed rest. Correct 3 Assess the echocardiogram. Incorrect 4 Teach passive exercises. Correct 5 Assess respiratory status. Dietary sodium is restricted in a pregnant patient with mitral stenosis to decrease preload. The patient is placed on bed rest to prevent tachycardia. The nurse evaluates echocardiogram reports to assess the atrial and ventricular size and heart valve function. The nurse should auscultate the patient's lung sounds to assess for fluid overload. The nurse does not teach any physical exercise, because activity needs to be limited to prevent tachycardia. Which conditions does the nurse ask the pregnant patient with a cardiac disorder to report immediately? Select all that apply. Correct 1 Urinary tract infection Correct 2 Palpitations and pain Correct 3 Shortness of breath 4 Onset of constipation Incorrect 5 Orthostatic hypotension If a patient with a cardiac disorder acquires infection, the pati

Chapters 11 and 12