OB Exam #1

12. A first-time father is experiencing couvade syndrome. He is likely to exhibit which of the following symptoms or behaviors? a. Urinary frequency b. Hypotension c. Bradycardia d. Prostatic hypertrophy

ANS: a Feedback a. Urinary frequency is a common symptom of couvade. b. The father's blood pressure is not usually affected. c. The father's heart rate is not usually affected. d. Prostatic changes are not related to couvade.

You are caring for a woman in labor who is 6 cm dilated with a reassuring FHT pattern and regular strong UCs. The fetal heart rate (FHR) should be: a. Monitored continuously b. Monitored every 15 minutes c. Monitored every 30 minutes d. Monitored every 60 minutes

ANS: c a. Assessment of fetal heart rate (FHR) during the active phase of labor with a reassuring FHR is not indicated continuously.b. Assessment of fetal heart rate (FHR) during the active phase of labor with a reassuring FHR is not indicated every 15 minutes.c. Assessment of fetal heart rate (FHR) during the active phase of labor with a reassuring FHR is indicated every 30 minutes.d. Assessment of fetal heart rate (FHR) during the active phase of labor with a reassuring FHR is indicated every 30 minutes, not every 60 minutes.

A couple who has sought infertility counseling has been told that the man's sperm count is very low. The nurse advises the couple that spermatogenesis is impaired when which of the following occur? a. The testes are overheated. b. The vas deferens is ligated. c. The prostate gland is enlarged. d. The flagella are segmented.

ANS: a Feedback a. Spermatogenesis occurs in the testes. High temperatures harm the development of the sperm. b. When the vas deferens is ligated, a man has had a vasectomy and is sterile. The sterility is not due to impaired spermatogenesis, but rather to the inability of the sperm to migrate to the woman's reproductive track. c. The enlarged prostrate has no effect on spermatogenesis. d. The flagella are the "tails" of the sperm. They are normally divided into the middle segment and an end segment.

The nurse is interviewing a gravid woman during the first prenatal visit. The woman confides to the nurse that she lives with a number of pets. The nurse should advise the woman to be especially careful to refrain from coming in contact with the stool of which of the pets? a. Cat b. Dog c. Hamster d. Bird

ANS: a Feedback a. The patient should refrain from coming in direct contact with cat feces. Cats often harbor toxoplasmosis, a teratogenic illness. b. No pathology has been associated with the feces of pet dogs. c. No pathology has been associated with the feces of pet hamsters. d. No pathology has been associated with the feces of pet birds.

An ultrasound of a fetus' heart shows that "normal fetal circulation is occurring." Which of the following statements is consistent with the finding? a. A right to left shunt is seen between the atria. b. Blood is returning to the placenta via the umbilical vein. c. Blood is returning to the right atrium from the pulmonary system. d. A right to left shunt is seen between the umbilical arteries.

ANS: a Feedback a. This is correct. The foramen ovale is a duct between the atria. In fetal circulation, there is a right to left shunt through the duct. b. Blood returns to the placenta via the umbilical arteries. c. Most of the blood bypasses the pulmonary system. The blood that does enter the pulmonary system returns to the left atrium. d. There is no duct between the umbilical arteries.

A post-cesarean section client has been ordered to receive 500 mL of 5% dextrose in water every 4 hours. The drop factor of the macrodrip tubing is 10 gtt/mL. To what drip rate should the nurse regulate the IV? __________ gtt/min

ANS: 21

Tobacco use during pregnancy is associated with adverse effects on the unborn infant such as intrauterine growth restriction, preterm births, and respiratory problems. By race, which has the highest percentages of smokers? a. American Indian and Alaskan Natives b. Asian or Pacific Islanders c. Non-Hispanic blacks d. Non-Hispanic whites

ANS: a Feedback a. 36% of American Indian and Native American women are cigarette smokers. b. 4.3% of Asian or Pacific Islander women are cigarette smokers. c. 17.1% of non-Hispanic black women are cigarette smokers. d. 19.6% of non-Hispanic white women are cigarette smokers.

An ethical dilemma unique to perinatal nursing is the a. Innate conflict between maternal and fetal rights b. Intensive use of technology c. Shortage of health-care resources d. Risk of violation of the principle of veracity

ANS: a Feedback a. A unique aspect of maternity nursing is that the nurse advocates for two individuals: the woman and the fetus. b. The use of technology is not unique to perinatal nursing. c. Currently, in the United States, decisions in perinatal nursing are not based on resources available. d. In perinatal nursing, the obligation to tell the truth is generally adhered to.

A woman is considered in active labor when: a. Cervical dilation progresses from 4 to 7 cm with effacement of 40% to 80%, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds. b. Cervical dilation progresses to 3 cm with effacement of 30, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds. c. Cervical dilation progresses to 8 cm with effacement of 80%, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds. d. Cervical dilation progresses to 10 cm with effacement of 90%, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds.

ANS: a Feedback a. Characteristics of this phase are the cervix dilates, on an average, 1.2 cm/hr for primiparous women and 1.5 cm/hr for multiparous women. Cervical dilation progresses from 4 to 7 cm with effacement of 40% to 80%. Fetal descent continues and contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds, and discomfort increases. b. Cervical dilation progresses to 3 cm with effacement of 30, indicating the early or latent phase of labor. c. Cervical dilation progresses to 8 cm with effacement of 80%, indicating the transition phase of labor. d. Cervical dilation of 10 cm with effacement is the end of the first stage of labor.

7. The nurse is interviewing a pregnant client who states she plans to drink chamomile tea to ensure an effective labor. The nurse knows that this is an example of: a. Cultural prescription b. Cultural taboo c. Cultural restriction d. Cultural demonstration

ANS: a Feedback a. Correct. Cultural prescription is an expected behavior of the pregnant woman during the childbearing period. b. Taboos are cultural restrictions believed to have serious supernatural consequences. Drinking chamomile tea would not be in this category. c. Restrictions are activities during the childbearing period which are limited for the pregnant woman. Drinking chamomile tea would not be in this category. d. Demonstration is not a term that is used in relation to cultural behaviors. KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Comprehension | Content Area: Maternity | Client Need: Basic Care and Comfort | Difficulty Level: Easy

A nurse working with an infertile couple has made the following nursing diagnosis: Sexual dysfunction related to decreased libido. Which of the following assessments is the likely reason for this diagnosis? a. The couple has established a set schedule for their sexual encounters. b. The couple has been married for more than 8 years. c. The couple lives with one set of parents. d. The couple has close friends who gave birth within the last year.

ANS: a Feedback a. Couples who "schedule" intercourse often complain that their sexual relationship is unsatisfying. b. Years of marriage are not directly related to a couple's sexual relationship. c. The fact that the couple lives with one set of parents is unlikely related to their sexual relationship. d. Although it can be very difficult to be around couples who have become pregnant or have healthy babies, this factor is not usually related to a couple's sexual relationship.

9. A pregnant client at 20 weeks' gestation comes to the clinic for her prenatal visit. Which of the following client statements would indicate a need for further assessment? a. "I hate it when the baby moves." b. "I've started calling my mom every day." c. "My partner and I can't stop talking about the baby." d. "I still don't know much time I'm going to take off work after the baby comes."

ANS: a Feedback a. Experiencing quickening as unpleasant may be a sign of maladaptation to pregnancy and needs further assessment by the nurse. b. This is an expected finding in maternal adaptation and development of the maternal role. c. This is an expected finding in maternal adaptation and development of the maternal role. d. At 20 weeks' gestation, the client still has plenty of time to process this decision.

Tanya, a 30-year-old woman, is being prepared for an elective cesarean birth. The perinatal nurse assists the anesthesiologist with the spinal block and then positions Tanya in a supine position. Tanya's blood pressure drops to 90/52, and there is a decrease in the fetal heart rate to 110 bpm. The perinatal nurse's best response is to: a. Place a wedge under Tanya's left hip. b. Discontinue Tanya's intravenous administration. c. Have naloxone (Narcan) ready for administration. d. Have epinephrine ready for administration.

ANS: a In the event of severe maternal hypotension, the nurse should place the patient in a lateral position or use a wedge under the hip to displace the uterus, elevate the legs, maintain or increase the IV infusion rate, and administer oxygen by face mask at 10 to 12 L/min, or according to institution protocol.

15. Taboos are cultural restrictions that: a. Have serious supernatural consequences b. Have serious clinical consequences c. Have superstitious consequences d. Are functional and neutral practices

ANS: a Taboos are believed to have serious supernatural consequences. Taboos are not known to have clinical or superstitious consequences and are not functional or neutral practices.

14. An example of a cultural prescriptive belief during pregnancy is: a. Remain active during pregnancy b. Coldness in any form should be avoided c. Do not have your picture taken d. Avoid sexual intercourse during the third trimester

ANS: a The belief that the patient should remain active during pregnancy is the only example of a cultural prescriptive belief. All of the other answers are examples of cultural restrictive beliefs.

A post-cesarean birth woman has been diagnosed with paralytic ileus. Which of the following symptoms would the nurse expect to see? a. Abdominal distension b. Polyuria c. Diastasis recti d. Dependent edema

ANS: a The nurse would expect to see a distended abdomen in a client with a paralytic ileus.

During preconception counseling, the clinic nurse explains that the time period when the fetus is most vulnerable to the effects of teratogens occurs from: a. 2 to 8 weeks b. 4 to12 weeks c. 5 to 10 weeks d. 6 to 15 weeks

ANS: a The period of organogenesis lasts from approximately the second until the eighth week of gestation during which time the embryo undergoes rapid growth and differentiation. During organogenesis, the embryo is extremely vulnerable to teratogens such as medications, alcohol, tobacco, caffeine, illegal drugs, radiation, heavy metals, and maternal (TORCH) infections. Structural fetal defects are most likely to occur during this period because exposure to teratogens either before or during a critical period of development of an organ can cause a malformation.

A woman you are caring for in labor requests an epidural for pain relief in labor. Included in your preparation for epidural placement is a baseline set of vital signs. The most common vital sign to change after epidural placement: a. Blood pressure, hypotension b. Blood pressure, hypertension c. Pulse, tachycardia d. Pulse, bradycardia

ANS: a a. Blood pressure, hypotension, as up to 40% of women may experience hypotension. Hypotension is defined as systolic BP <100 mm Hg or 20% decrease in BP from preanesthesia levels. Intravenous bolus is typically given to decrease the incidence of hypotension. b. Blood pressure, hypertension is incorrect because hypotension is the common complication after epidural placement. c. Pulse, tachycardia is incorrect because hypotension is the common complication after epidural placement. d. Pulse, bradycardia is incorrect because hypotension is the common complication after epidural placement.

The provision of support during labor has demonstrated that women experience a decrease in anxiety and a feeling of being in more control. In clinical situations, this has resulted in: a. A decrease in interventions b. Increased epidural rates c. Earlier admission to the hospital d. Improved gestational age

ANS: a a. Studies have shown that with a support person, be it a family member, friend, or professional such as a Doula or nurse, the patient experiences a decrease in anxiety and has a feeling of being in more control. This, in turn, results in a decrease in interventions, a significantly lower level of pain, and an enhanced overall maternal satisfaction.b. There is decreased use of pain medication with continuous labor support.c. There is no evidence that continuous labor support results in earlier admission to the hospital.d. There is no evidence that continuous labor support results in improved gestational age for the fetus.

The best time to give prophylactic antibiotics to the women undergoing cesarean section is: a. One hour before the surgery b. Two hours before the surgery c. Not indicated unless she has an active infection d. At the time the cord is clamped

ANS: a Administration of narrow-spectrum prophylactic antibiotics should occur within 60 minutes prior to the skin incision.

The perinatal nurse listens as Chantal describes her labor and emergency cesarean birth. Providing an opportunity to review this experience may assist Chantal in: a. Her role development in the "letting go" stage b. Decreasing her ambivalence about her labor and birth c. Understanding her guilt involved in her labor and birth d. Developing more positive feelings about her labor and birth

ANS: a Administration of narrow-spectrum prophylactic antibiotics should occur within 60 minutes prior to the skin incision.

The perinatal nurse teaches the student nurse that deep breathing exercises following a cesarean birth are critical to the prevention of (select all that apply): a. Pneumonia b. Atelectasis c. Abdominal distension d. Increased tidal volume

ANS: a, b Incisional pain and abdominal distension often cause patients to adopt shallow breathing patterns that can lead to decreased gas exchange and a reduced tidal volume. To facilitate adequate lung functions, patients should be taught how to perform pulmonary exercises. Expectoration of secretions and deep breathing help prevent common complications including atelectasis and pneumonia. Abdominal distension and gas pains are common after abdominal surgery and result from delayed peristalsis.

Infants whose mothers were obese during pregnancy are at higher risk for which of the following? (Select all that apply.) a. Childhood diabetes b. Heart defects c. Hypospadias d. Respiratory distress

ANS: a, b, c Fetuses and/or infants of women who were obese during pregnancy are at higher risk for spina bifida, health defects, anorectal atresia, hypospadias, intrauterine fetal death, birth injuries related to macrosomia, and childhood obesity and diabetes.

A nurse is caring for a woman who is 4 hours post-cesarean birth for arrest of labor. The labor and operative records indicate that she had premature rupture of membranes followed by 36 hours of labor. Her IV fluid intake for the past 24 hours is 2500 mL. The estimated blood loss is 1500 mL. Based on this data, the woman is at risk for which of the following? (Select all that apply.) a. Fluid volume deficit b. Infection c. Impaired mother-infant attachment d. Falls

ANS: a, b, c, d The woman is at risk for fluid volume deficit related to blood loss and risk for postpartum hemorrhage due to risk of uterine atony. She is at risk for infection related to premature and prolonged rupture of membranes. The woman is at risk for impaired mother-infant attachment related to maternal pain and exhaustion. She is at risk for falls related to anesthesia and orthostatic hypotension.

7. Which of the following statements are true related to teen pregnancies? (Select all that apply.) a. Teen mothers are at higher risk for HIV. b. Teen mothers are at higher risk for hypertensive problems. c. The birth rate for teenaged women has increased in the past 15 years. d. Infants born to teen mothers are at higher risk for health problems.

ANS: a, b, d Health statistics report higher risk for HIV, for hypertensive problems, and for health problems to infants born to teen mothers. Birth rates for teen mothers in all age categories have decreased since 1991.

The perinatal nurse understands that the purpose of combining an opioid with a local anesthetic agent in an epidural is primarily to: a. Increase the total anesthetic volume b. Preserve a greater amount of maternal motor function c. Increase the intensity of the motor and sensory block d. Decrease the number of side effects

ANS: b Combining an opioid with a local anesthetic agent reduces the total amount of anesthetic required and helps to preserve a greater amount of maternal motor function.

The perinatal nurse is preparing a woman for a scheduled cesarean birth. The woman will be receiving spinal anesthesia for the birth. In order to prevent maternal hypotension, the nurse: a. Assists the woman to lie down in a supine position. b. Administers a rapid intravenous infusion of 500 mL of normal saline. c. Assesses blood pressure and pulse every 5 minutes, three times, before the spinal insertion. d. Encourages frequent cleansing breaths after the patient has been placed in the correct position for the anesthesia administration.

ANS: b Complications that may occur with spinal anesthesia block include maternal hypotension, decreased placental perfusion, and an ineffective breathing pattern. Prior to administration, the patient's fluid balance is assessed, and IV fluids are administered to reduce the potential for sympathetic blockade (decreased cardiac output that results from vasodilation with pooling of blood in the lower extremities). Following administration of the anesthetic, the patient's blood pressure, pulse, and respirations and fetal heart rate must be taken and documented every 5 to 10 minutes.

8. Which of the following would be a priority for the nurse when caring for a pregnant woman who has recently emigrated from another country? a. Help her develop a realistic, detailed birth plan. b. Identify her support system. c. Teach her about expected emotional changes of pregnancy. d. Refer her to a doula for labor support.

ANS: b Feedback a. A detailed birth plan may not be culturally appropriate and is not first priority. b. Correct, because lack of social support has been correlated with an increased risk of pregnancy complications and difficult adaptation to pregnancy. Pregnant women who are recent immigrants face many challenges in obtaining needed social support, and the nurse should first identify her support system to plan further interventions and referrals. c. There may be cultural variations in emotional changes of pregnancy. d. The nurse should first identify her support system before planning further interventions and referrals.

Information provided by the nurse that addresses the function of the amniotic fluid is that the amniotic fluid helps the fetus to maintain a normal body temperature and also: a. Facilitates asymmetrical growth of the fetal limbs b. Cushions the fetus from mechanical injury c. Promotes development of muscle tone d. Promotes adherence of fetal lung tissue

ANS: b Feedback a. Amniotic fluid allows for symmetrical fetal growth. b. Amniotic fluid cushions the fetus from mechanical injury. c. Amniotic fluid does not promote muscle tone. d. Amniotic fluid prevents adherence of the amnion to the fetus.

Evidence-based practice is the integration of the best: a. Randomized clinical trials, clinical expertise, and patients' requests b. Research evidence, clinical expertise, and patients' values c. Quantitative research, clinical expertise, and patients' preferences d. Research findings, clinical experience, and patients' preferences

ANS: b Feedback a. Evidence-based practice is the use of evidence that may include research beyond randomized clinical trials. b. These elements are the accepted definition of evidence-based practice. c. Qualitative research, as well as quantitative research, contributes to evidence-based practice. d. Clinical expertise, as well as clinical experience, defines evidence-based practice.

Which of the following statements by a pregnant woman indicates she needs additional teaching on ways to reduce risks to her unborn child from the potential effects of exposure to toxoplasmosis? a. "I will avoid rare lamb." b. "I will wear a mask when cleaning my cat's litter box." c. "I understand that exposure to toxoplasmosis can cause blindness in the baby." d. "I will avoid rare beef."

ANS: b Feedback a. Exposure occurs when the protozoan parasite found in cat feces and uncooked or rare beef and lamb is ingested. b. Correct. Pregnant women and women who are attempting pregnancy should avoid contact with cat feces. Exposure occurs when the protozoan parasite found in cat feces and uncooked or rare beef and lamb is ingested. Wearing a mask will not decrease the risk through ingestion of the parasite. c. Exposure to toxoplasmosis can cause fetal death, mental retardation, and blindness. d. Exposure occurs when the protozoan parasite found in cat feces and uncooked or rare beef and lamb is ingested.

11. A woman presents for prenatal care at 6 weeks' gestation by LMP. Which of the following findings would the nurse expect to see? a. Multiple pillow orthopnea b. Maternal ambivalence c. Fundus at the umbilicus d. Pedal and ankle edema

ANS: b Feedback a. Orthopnea is a common complaint of women during the third trimester. b. Ambivalence is a common feeling of women during the first trimester. c. The fundus should be at the umbilicus at 20 weeks' gestation. d. Dependent edema is a common complaint of women during the third trimester.

The mechanism of labor known as cardinal movements of labor are the positional changes that the fetus goes through to best navigate the birth process. These cardinal movements are: a. Engagement, Descent, Flexion, Extension, Internal rotation, External rotation, Expulsion b. Engagement, Descent, Flexion, Internal rotation, Extension, External rotation, Expulsion c. Engagement, Flexion, Internal rotation, Extension, External rotation, Descent, Expulsion d. Engagement, Flexion, Internal rotation, Extension, External rotation, Flexion, Expulsion

ANS: b Feedback a. The order of the cardinal movements is incorrect.b. Engagement occurs when the greatest diameter of the fetal head passes through the pelvic inlet. Engagement can occur late in pregnancy or early in labor. Descent is the movement of the fetus through the birth canal during the first and second stages of labor. Flexion is when the chin of the fetus moves toward the fetal chest. Flexion occurs when the descending head meets resistance from maternal tissues. This movement results in the smallest fetal diameter to the maternal pelvic dimensions. It typically occurs early in labor. Internal rotation is the movement, the rotation of the fetal head, that aligns the long axis of the fetal head with the long axis of the maternal pelvis. It occurs mainly during the second stage of labor. Extension is the movement facilitated by resistance of the pelvic floor, causing the presenting part to pivot beneath the pubic symphysis and the head to be delivered. This occurs during the second stage of labor. External rotation is when the sagittal suture moves to a transverse diameter and the shoulders align in the anteroposterior diameter. The sagittal suture maintains alignment with the fetal trunk as the trunk navigates through the pelvis. Expulsion is the movement that occurs when the shoulders and remainder of the body are delivered.c. The order of the cardinal movements is incorrect.d. The order of the cardinal movements is incorrect.

10. A pregnant client asks the nurse why she should attend childbirth classes. The nurse's response would be based on which of the following information? a. Attending childbirth class is a good way to make new friends. b. Childbirth classes will help new families develop skills to meet the challenges of childbirth and parenting. c. Attending childbirth classes will help a pregnant woman have a shorter labor. d. Childbirth classes will help a pregnant woman decrease her chance of having a cesarean delivery.

ANS: b Feedback a. There may be a beneficial effect of childbirth classes, but this is not the primary goal of childbirth education. b. Correct. These are the stated goals of childbirth education (ICEA, Lamaze). c. Evidence remains inconclusive regarding linking attendance at childbirth classes with a decreased incidence of cesarean section and shorter labors. d. Evidence remains inconclusive regarding linking attendance at childbirth classes with a decreased incidence of cesarean section and shorter labors. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Psychosocial Integrity | Difficulty Level: Easy

6. Cathy is pregnant for the second time. Her son, Steven, has just turned 2 years old. She asks you what she should do to help him get ready for the expected birth. What is the nurse's most appropriate response? a. Steven will probably not understand any explanations about the arrival of the new baby, so Cathy should do nothing. b. If Steven's sleeping arrangements need to be changed, it should be done well in advance of the birth. c. Steven should come to the next prenatal visit and listen to the fetal heartbeat to encourage sibling attachment. d. Steven should be encouraged to plan an elaborate welcome for the newborn.

ANS: b Feedback a. This applies to very young children under the age of 2. b. Children still sleeping in a crib should be moved to a bed at least 2 months before the baby is due, as this age group is particularly sensitive to disruptions of the physical environment. c. This is not appropriate for a 2-year-old but may be appropriate for older age groups. d. This is not appropriate for a 2-year-old but may be appropriate for older age groups.

17. The clinic nurse visits with Wayne, a 32-year-old man whose partner is pregnant for the first time and is at 12 weeks. Wayne describes nausea and vomiting, fatigue, and weight gain. His symptoms are best described as: a. Influenza b. Couvade syndrome c. Acid reflux d. Cholelithiasis

ANS: b Feedback a. This cluster of symptoms is indicative of couvade syndrome, the experience of maternal signs and symptoms of pregnancy. b. In preparation for parenthood, the male partner moves through a series of developmental tasks. During the first trimester, the father begins to deal with the reality of the pregnancy and may worry about financial strain and his ability to be a good father. Feelings of confusion and guilt often surface with the recognition that he is not as excited about the pregnancy as his partner, and couvade syndrome, the experience of maternal signs and symptoms, may develop. c. This cluster of symptoms is indicative of couvade syndrome, the experience of maternal signs and symptoms of pregnancy. d. This cluster of symptoms is indicative of couvade syndrome, the experience of maternal signs and symptoms of pregnancy.

5. Jane's husband Brian has begun to put on weight. What is this a possible sign of? a. Culturalism syndrome b. Couvade syndrome c. Moratorium phase d. Attachment

ANS: b Feedback a. This is not related to culture. b. Correct. Couvade syndrome has symptoms that mimic changes of pregnancy. c. Moratorium phase represents one of the phases of the father's responses to pregnancy. d. Attachment is reflected in behaviors.

During a cesarean section, which action by the nurse is done to prevent compression of the descending aorta and vena cava? a. Right lateral tilt b. Left lateral tilt c. Elevate head of gurney at 30 degrees d. Administration of IV fluid preload of 500 to 1000 mL

ANS: b Positioning of the patient with a left tilt maintains a left uterine displacement to decrease the risk of aortocaval compression related to compression on the aorta and inferior vena cava due to weight of the gravid uterus.

A clinic nurse explains to the pregnant woman that the amount of amniotic fluid present at 24 weeks' gestation is approximately: a. 500 mL b. 750 mL c. 800 mL d. 1000 mL

ANS: c Amniotic fluid first appears at about 3 weeks. There are approximately 30 mL of amniotic fluid present at 10 weeks' gestation, and this amount increases to approximately 800 mL at 24 weeks' gestation. After that time, the total fluid volume remains fairly stable until it begins to decrease slightly as the pregnancy reaches term.

A nurse is preparing a woman in early labor for an urgent cesarean birth related to breech presentation. Select the best nursing action for reducing the couple's anxiety levels. a. Explain the reason for the need for a cesarean section. b. Inform parents that their baby is in distress. c. Ask the couple to share their concerns. d. Reassure the couple that both the woman and baby are in no danger.

ANS: c By asking the couple to share their concerns, the nurse can address these concerns.

Since 1995 there has been a significant decrease in the rate of infant death related to which of the following: a. Disorders associated with short gestation and low birth weight b. Accidents c. Sudden infant death d. Newborns affected by complications of placenta, cord, and membranes

ANS: c a. The rates of prematurity and low birth weight are increasing. b. The rates of accidents have increased. c. Correct. The rate of infant death related to SIDS has decreased from 87.1 to 47.2. The decrease in rate is partially attributed to placing infants on their backs when sleeping. d. The rates of newborns affected by complications of placenta, cord, and membranes have increased.

4. Which statement best exemplifies adaptation to pregnancy in relation to the adolescent? a. Adolescents adapt to motherhood in a similar way to other childbearing women. b. Social support has very little effect on adolescent adaptation to pregnancy. c. The pregnant adolescent faces the challenge of multiple developmental tasks. d. Pregnant adolescents of all ages can be capable and active participants in health-care decisions.

ANS: c Feedback a. Adolescents must cope with the conflicting developmental tasks of pregnancy and adolescence at the same time. b. Social support has been associated with a more positive adaptation to mothering for adolescents. c. Correct. Pregnant adolescents face conflicting and multiple developmental tasks of pregnancy and adolescence at the same time. d. By late adolescence (ages 17 to 20) this can occur, but early adolescents are oriented toward the present and are self-centered, and often pregnancy at this age is a result of abuse or coercion.

The nurse takes the history of a client, G2 P1, at her first prenatal visit. The client is referred to a genetic counselor, due to her previous child having a diagnosis of __________. a. Unilateral amblyopia b. Subdural hematoma c. Sickle cell anemia d. Glomerular nephritis

ANS: c Feedback a. Amblyopia rarely results from a genetic predisposition. b. A subdural hematoma does not result from a genetic defect. c. Sickle cell anemia is an autosomal recessive illness. This client needs to be seen by a genetic counselor. d. Glomerular nephritis does not result from a genetic defect.

A client is to take Clomiphene Citrate for infertility. Which of the following is the expected action of this medication? a. Decrease the symptoms of endometriosis b. Increase serum progesterone levels c. Stimulate release of FSH and LH d. Reduce the acidity of vaginal secretions

ANS: c Feedback a. Clomiphene Citrate will not reduce a client's symptoms of endometriosis. b. Clomiphene Citrate will not increase a client's progesterone levels. c. Clomiphene Citrate stimulates release of FSH and LH. d. Clomiphene Citrate will not reduce the acidity of vaginal secretions.

A diagnostic test commonly used to assess problems of the fallopian tubes is: a. Endometrial biopsy b. Ovarian reserve testing c. Hysterosalpingogram d. Screening for sexually transmitted infections

ANS: c Feedback a. Endometrial biopsy provides information on the response of the uterus to hormonal signals. b. Ovarian reserve testing is used to assess ovulatory functioning. c. Correct. Hysterosalpingogram provides information on the endocervical canal, uterine cavity, and fallopian tubes. d. STIs can cause adhesions within the fallopian tubes, but screening cannot confirm that adhesions are present.

2. What is the most common expected emotional reaction of a woman to the news that she is pregnant? a. Jealousy b. Acceptance c. Ambivalence d. Depression

ANS: c Feedback a. Others in the family may be jealous of the fetus, but that is not a common maternal response. b. Acceptance of the pregnancy typically occurs later in the pregnancy. c. Ambivalence is a normal expected reaction to the news of pregnancy, whether or not the pregnancy is planned or wanted. d. This would represent an abnormal emotional response to pregnancy.

3. The fetal circulatory structure that connects the pulmonary artery with the descending aorta is known as which of the following? a. Ductus venosus b. Foramen ovale c. Ductus arteriosus d. Internal iliac artery

ANS: c Feedback a. The ductus venosus connects the umbilical vein to the inferior vena cava. b. The foramen ovale is the opening between the right and left atria. c. Correct. d. The internal iliac artery connects the external iliac artery to the umbilical artery.

The clinic nurse knows that the part of the endometrial cycle occurring from ovulation to just prior to menses is known as the: a. Menstrual phase b. Proliferative phase c. Secretory phase d. Ischemic phase

ANS: c Feedback a. The menstrual phase is the time of vaginal bleeding, approximately days 1 to 6. b. The proliferative phase ends the menses through ovulation, approximately days 7 to 14. c. The secretory phases occurs from the time of ovulation to the period just prior to menses, or approximately days 15 to 26. d. The ischemic phase occurs from the end of the secretory phase to the onset of menstruation, approximately days 27 to 28.

In caring for a primiparous woman in labor, one of the factors to evaluate is uterine activity. This is referred to as the __________ of labor. a. Passenger b. Passage c. Powers d. Psyche

ANS: c Feedback a. The passenger refers to the fetus.b. The passage refers to the pelvis and birth canal.c. Powers refer to the contractions.d. Psyche refers to the response of a woman to labor.

1. Sally is in her third trimester and has begun to sing and talk to the fetus. Sally is probably exhibiting signs of: a. Mental illness b. Delusions c. Attachment d. Crisis

ANS: c Feedback a. This is normal maternal-fetal adaptation. b. Delusions are not real, and the fetus is real. c. Correct, because talking to the fetus is a sign of positive maternal adaptation. All other answers indicate pathology. d. Interacting with the fetus in utero represents normal development of attachment to the fetus. KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Comprehension | Content Area: Maternity | Client Need: Psychosocial Integrity | Difficulty Level: Moderate

A neonate born at 36 weeks gestation is classified as which of the following? a. Very premature b. Moderately premature c. Late premature d. Term

ANS: c Feedback a. Very premature is less than 32 weeks' gestation. b. Moderately premature is 32 to 33 completed weeks' gestation. c. Correct. Late premature is 34 to 36 completed weeks' gestation. d. Term is 37 to 42 weeks' gestation.

The labor patient you are caring for is ambulating in the hall. Her vaginal exam 1 hour ago indicated she was 4/70/-1 station. She tells you she has fluid running down her leg. Your priority nursing intervention is to: a. Assess the color, odor, and amount of fluid. b. Assist your patient to the bathroom. c. Assess the fetal heart rate. d. Call the care provider.

ANS: c a. Although assessing the color, odor, and amount of fluid is appropriate, the priority nursing action is to assess the FHR because of the risk of umbilical cord prolapse with rupture of membranes. b. The fluid is probably related to rupture of membranes rather than the patient needing to go to the bathroom to urinate. c. Assessing the fetal heart rate is the first priority because of the risk of umbilical cord prolapse with rupture of membranes. d. Although you may call the care provider, the priority nursing action is to assess the FHR because of the risk of umbilical cord prolapse with rupture of membranes.

Which of the following is a medical indication for a cesarean birth? (Select all that apply.) a. Maternal blood pressure of 130/90 b. Cervical dilation of 1.5 cm per hour during the active phase of labor c. Late deceleration of the fetal heart rate with minimal variability d. Complete placenta previa e. Arrest of fetal descent

ANS: c, d, e A maternal blood pressure of 130/90 may be an indication of mild PHI which is not a medical indication for cesarean birth. Cervical dilation of 1.5 cm/minutes is within normal limits for cervical changes during the active phase. Late decelerations combined with minimal variability in the fetal heart rate reflect fetal intolerance of labor and are an indication for cesarean birth. A complete placenta previa covers the internal os necessitating a cesarean birth. Arrest of fetal descent indicates cephalopelvic disproportion.

The perinatal nurse explains to the student nurse that __________ is the leading cause of infant death in the United States. a. Sudden Infant Death Syndrome b. Respiratory distress of newborns c. Disorders related to short gestation and low birth weight d. Congenital malformations and chromosomal abnormalities

ANS: d

When caring for a primiparous woman being evaluated for admission for labor, a key distinction between true versus false labor is: a. True labor contractions result in rupture of membranes, and with false labor, the membranes remain intact. b. True labor contractions result in increasing anxiety and discomfort, and false labor does not. c. True labor contractions are accompanied by loss of the mucus plug and bloody show, and with false labor there is no vaginal discharge. d. True labor contractions bring about changes in cervical effacement and dilation, and with false labor there are irregular contractions with little or no cervical changes.

ANS: d a. Rupture of membranes can occur prior to labor or during labor. b. A woman's response to labor may not be reflective of her status in labor but is influenced by expectations and emotional status. c. Loss of the mucus plug can occur prior to the onset of labor. d. True labor contractions bring about changes in cervical effacement and dilation, and with false labor there are irregular contractions with little or no cervical changes.

The perinatal nurse explains to the student nurse that a goal of the Healthy People 2020 report is to: a. Increase proportion of infants who are breastfed to 93.1%. b. Increase proportion of infants who are breastfed to 90.7%. c. Increase proportion of infants who are breastfed to 85.6%. d. Increase proportion of infants who are breastfed to 83.9%.

ANS: d A goal of Healthy People 2020 is to increase the proportion of infants who are breastfed from 74% to 81.9%.

A nurse is caring for a woman 10 hours post-cesarean birth. She received a dose of intrathecal morphine at the time of the birth. Which of the following assessment data would require immediate intervention? a. Itching of the palms and feet b. Nausea c. Urinary output of 300 mL in the past 4 hours d. Respiratory rate of 10 breaths/minute

ANS: d Correct. An adverse effect of intrathecal morphine that requires immediate intervention is respiratory distress.

The American Nurses Association Code of Ethics for Nurses directs nurses to provide patient care that is a. Curative b. Utilitarian c. Negotiable d. Respectful

ANS: d Feedback a. Adaptation rather than cure is the goal of nursing. b. Nursing does not define the value of a person by his or her utility. c. The Code of Ethics outlines the nursing profession's nonnegotiable ethical standard. d. Respect for the inherent dignity, worth, and uniqueness of every individual is part of the Code of Ethics.

3. Which of the following women is at the highest risk for health disparity? a. A white, middle-class, 16-year-old woman b. An African American, middle-class, 25-year-old woman c. An African American, upper-middle-class, 19-year-old woman d. An Asian, low-income, 30-year-old woman

ANS: d Feedback a. Although age is a risk factor, income contributes to disparity. b. Although African American women are at increased risk, income accounts for the largest disparity. c. Although age and race contribute to increased risk, income accounts for the largest disparity. d. Although age and race contribute to increased risk, income accounts for the largest disparity.

13. When providing a psychosocial assessment on a pregnant woman at 21 weeks' gestation, the nurse would expect to observe which of the following signs? a. Ambivalence b. Depression c. Anxiety d. Happiness

ANS: d Feedback a. Ambivalence is often seen during the first trimester. b. The nurse would not expect to see depression at any time during the pregnancy. c. The patient may express some anxiety near the time of delivery. d. The nurse would expect the patient to exhibit signs of happiness at this time.

The color of a person's hair is an example of which of the following? a. Genome b. Sex-link inheritance c. Genotype d. Phenotype

ANS: d Feedback a. Genome is an organism's complete set of DNA. b. Sex-link inheritance refers to genes or traits that are located only on the X chromosome. c. Genotype refers to a person's genetic makeup. d. Correct. Phenotype refers to how genes are outwardly expressed, such as eye color, hair color, and height.

A woman at 40 weeks' gestation has a diagnosis of oligohydramnios. Which of the following statements related to oligohydramnios is correct? a. It indicates that there is a 25% increase in amniotic fluid. b. It indicates that there is a 25% reduction of amniotic fluid. c. It indicates that there is a 50% increase in amniotic fluid. d. It indicates that there is a 50% reduction of amniotic fluid.

ANS: d Feedback a. Oligohydramnios is a decrease, not an increase in amniotic fluid. b. Oligohydramnios is a 50% reduction in amniotic fluid. c. Oligohydramnios is a decrease, not an increase in amniotic fluid. d. Correct. Oligohydramnios refers to a decreased amount of amniotic fluid of less than 500 mL at term or 50% reduction of normal amounts.

A major fetal development characteristic at 16 weeks' gestation is: a. The average fetal weight is 450 grams b. Lanugo covers entire body c. Brown fat begins to develop d. Teeth begin to form

ANS: d Feedback a. The average fetal weight at 16 weeks is 200 grams. b. Lanugo is present on the head. c. Brown fat begins to develop at 20 weeks. d. This is the correct answer.

16. Jenny, a 21-year-old single woman, comes for her first prenatal appointment at 31 weeks' gestation with her first pregnancy. The clinic nurse's most appropriate statement is: a. "Jenny, it is late in your pregnancy to be having your first appointment, but it is nice to meet you and I will try to help you get caught up in your care." b. "Jenny, have you had care in another clinic? I can't believe this is your first appointment!" c. "Jenny, by the date of your last menstrual period, you are 31 weeks and now that you are finally here, we need you to come monthly for the next two visits and then weekly." d. "Jenny, by your information, you are 31 weeks' gestation in this pregnancy. Do you have questions for me before I begin your prenatal history and information sharing?"

ANS: d Feedback a. The initial interview time with the patient should be used to build a positive, nonthreatening relationship and to gain her confidence by respecting her choices and advocating for continued prenatal care that is woman centered. b. The initial interview time with the patient should be used to build a positive, nonthreatening relationship and to gain her confidence by respecting her choices and advocating for continued prenatal care and not making assumptions about prior care. The prenatal nurse's objective is to provide a user-friendly service that is efficient, effective, caring, and patient centered. c. The initial interview time with the patient should be used to build a positive, nonthreatening, and nonjudgmental relationship and to gain her confidence by respecting her choices and advocating for continued prenatal care. d. The initial interview time with the patient should be used to build a positive, nonthreatening relationship and to gain her confidence by respecting her choices and advocating for continued prenatal care. The prenatal nurse's objective is to provide a user-friendly service that is efficient, effective, caring, and patient centered.

A nurse is teaching a woman about her menstrual cycle. The nurse states that __________ is the most important change that happens during the secretory phase of the menstrual cycle. a. Maturation of the graafian follicle b. Multiplication of the fimbriae c. Secretion of human chorionic gonadotropin d. Proliferation of the endometrium`

ANS: d Feedback a. The maturation of the graafian follicle occurs during the follicular phase. b. There is no such thing as the multiplication of the fimbriae. c. Human chorionic gonadotropin is secreted by the fertilized ovum during the early weeks of a pregnancy. d. The proliferation of the endometrium occurs during the secretory phase of the menstrual cycle.

Karen, a 26-year-old woman, has come for preconception counseling and asks about caring for her cat as she has heard that she "should not touch the cat during pregnancy." The clinic nurse's best response is: a. It is best if someone other than you changes the cat's litter pan during pregnancy so that you have no risk of toxoplasmosis during pregnancy. b. It is important to have someone else change the litter pan during pregnancy and also avoid consuming raw vegetables. c. Have you had any "flu-like" symptoms since you got your cat? If so, you may have already had toxoplasmosis and there is nothing to worry about. d. Toxoplasmosis is a concern during pregnancy, so it is important to have someone else change the cat's litter pan and also to avoid consuming uncooked meat.

ANS: d Feedback a. The nurse should also explain that the patient should not eat uncooked meat as it is a potential source for toxoplasmosis. b. Raw vegetables are not a source for toxoplasmosis. c. This is not an accurate way to diagnose if the woman has had toxoplasmosis. d. Women need to be aware that Toxoplasma gondii, a single-celled parasite, is responsible for the infection toxoplasmosis. The majority of individuals who become infected with toxoplasmosis are asymptomatic, although when present, symptoms are described as "flu like" and include glandular pain and enlargement and myalgia. Severe toxoplasmosis infection may cause damage to the fetal brain, eyes, or other organs. Toxoplasmosis is usually acquired by consuming raw or poorly cooked meat that has been contaminated with T. gondii. Toxoplasmosis may also be acquired through close contact with feces from an infected animal (usually cats) or soil that has been contaminated with T. gondii.

3. Which of the following information regarding sexual activity would the nurse give a pregnant woman who is 35 weeks' gestation? a. Sexual activity should be avoided from now until 6 weeks postpartum. b. Sexual desire may be affected by nausea and fatigue. c. Sexual desire may be increased due to increased pelvic congestion. d. Sexual activity may require different positions to accommodate the woman's comfort.

ANS: d Feedback a. There are no contraindications to sexual activity during this time for a normally progressing pregnancy. b. Nausea and fatigue affect sexual desire during the first trimester, not the third. c. Increased sexual desire r/t increased pelvic congestion is a characteristic of the second trimester, not the third. d. Correct. An enlarging abdomen creates feelings of awkwardness and bulkiness and may require couples to modify intercourse positions for the pregnant woman's comfort. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Moderate

A nurse is admitting a woman for a scheduled cesarean section. Which of the following assessment data should be immediately reported to the physician? a. White cell count of 11,000 b. Hemoglobin of 11 g/dL c. Hematocrit of 33% d. Platelet count of 97,000

ANS: d Normal range of platelets is 150,000 to 400,000. A low platelet count places the woman at risk for increased bleeding.

A client delivered a 2800-gram neonate 4 hours ago by cesarean section with epidural anesthesia. Which of the following interventions should the nurse perform on the mother at this time? a. Maintain the client flat in bed. b. Assess the client's patellar reflexes. c. Monitor hourly urinary outputs. d. Assess the client's respiratory rate.

ANS: d The client has undergone major abdominal surgery. Her respiratory function should be assessed regularly.

You are in the process of admitting a multiparous woman to labor and delivery from the triage area. One hour ago her vaginal exam was 4/70/0. While completing your review of her prenatal record and completing the admission questionnaire, she tells you she has an urge to have a bowel movement and feels like pushing. Your priority nursing intervention is to: a. Reassure the patient and rapidly complete the admission. b. Assist your patient to the bathroom to have a bowel movement. c. Assess the fetal heart rate and uterine contractions. d. Perform a vaginal exam.

ANS: d a. Completing the admission paperwork is not a priority when birth may be imminent. b. The urge to have a bowel movement is probably related to fetal descent and complete dilation rather than the patient needing to have a bowel movement. c. Doing a vaginal exam is the first priority as birth may be imminent. d. Perform a vaginal exam to assess the progress of labor. The urge to have a bowel movement and feeling like pushing indicate that birth may be imminent.

The Apgar score consists of a rapid assessment of five physiological signs that indicate the physiological status of the newborn and includes: a. Apical pulse strength, respiratory rate, muscle flexion, reflex irritability, and color b. Heart rate, clarity of lungs, muscle tone, reflexes, and color c. Apical pulse strength, respiratory rate, muscle tone, reflex irritability, and color of extremities d. Heart rate, respiratory rate, muscle tone, reflex irritability, and color

ANS: d a. Heart rate, not apical pulse strength, is the criterion for Apgar scoring; muscle tone, not flexion, is assessed. b. Clarity of lungs and reflexes are not assessed as part of Apgar scoring. Neonatal lungs can be congested normally at birth, and reflexes are not assessed. Rather, reflex irritability is assessed, based on response to tactile stimulation. c. Heart rate, not apical pulse strength, is assessed along with respiratory rate, muscle tone, reflex irritability, and color of extremities. d. The Apgar score includes assessment of heart rate based on auscultation, respiratory rate based on observed movement of chest, muscle tone based on degree of flexion and movement of extremities, reflex irritability based on response to tactile stimulation, and color based on observation.

The perinatal nurse is assessing a woman in triage who is 34 + 3 weeks' gestation in her first pregnancy. She is worried about having her baby "too soon," and she is experiencing uterine contractions every 10 to 15 minutes. The fetal heart rate is 136 beats per minute. A vaginal examination performed by the health-care provider reveals that the cervix is closed, long, and posterior. The most likely diagnosis would be: a. Preterm labor b. Term labor c. Back labor d. Braxton-Hicks contractions

ANS: d a. Preterm labor (PTL) is defined as regular uterine contractions and cervical dilation before the end of the 36th week of gestation. Many patients present with preterm contractions, but only those who demonstrate changes in the cervix are diagnosed with preterm labor. b. Term labor occurs after 37 weeks' gestation. c. There is no indication in this scenario that this is back labor. d. Braxton-Hicks contractions are regular contractions occurring after the third month of pregnancy. They may be mistaken for regular labor, but unlike true labor, the contractions do not grow consistently longer, stronger, and closer together, and the cervix is not dilated. Some patients present with preterm contractions, but only those who demonstrate changes in the cervix are diagnosed with preterm labor.

The perinatal nurse knows that the presence of abdominal distension and gas in the post-cesarean birth mother is due to __________.

ANS: delayed peristalsis Delayed peristalsis and constipation commonly occur because of slowed peristalsis associated with pregnancy hormones and childbirth anesthesia. In addition, incisional pain may contribute to a decrease in ambulation which contributes to delayed peristalsis.

The Joint Commission Standard states that the __________, __________, and __________ are accurately identified and clearly communicated during the final verification process before the start of any surgical or invasive procedure.

ANS: site; procedure; patient To decrease the risk of surgery or invasive procedure being done on the wrong patient or in the wrong site, a "time-out" is called, and active communication to verify correct procedure, site, and patient is done just prior to the beginning of surgery or invasive procedure.

The nurse is providing prenatal teaching to a group of diverse pregnant women. One woman, who indicates she smokes two to three cigarettes a day, asks about its impact on her pregnancy. The nurse explains that the most significant risk to the fetus is: a. Respiratory distress at birth b. Severe neonatal anemia c. Low neonatal birth weight d. Neonatal hyperbilirubinemia

C a. Respiratory distress is not the most significant risk to the fetus unless the fetus is also premature. b. Severe neonatal anemia is not associated with pregnancies complicated by cigarette smoking. c. Low neonatal birth weight is the most common complication seen in pregnancies complicated by cigarette smoking. d. Neonatal hyperbilirubinemia is not associated with pregnancies complicated by cigarette smoking.

The positive signs of pregnancy are: a. All physiological and anatomical changes of pregnancy b. All subjective signs of pregnancy c. All those physiological changes perceived by the woman herself d. The objective signs of pregnancy that can only be attributed to the fetus

d a. Physiological and anatomical changes of pregnancy are presumptive signs of pregnancy. b. All subjective signs of pregnancy are the probable signs of pregnancy. c. All those physiological changes perceived by the woman herself are presumptive signs of pregnancy. d. Correct. Positive signs of pregnancy are the objective signs of pregnancy that can only be attributed to the fetus, such as fetal heart tones.

A woman presents to the prenatal clinic at 30 weeks' gestation reporting dysuria, frequency, and urgency with urination. Appropriate nursing actions include: a. Obtain clean-catch urine to assess for a possible urinary tract infection. b. Reassure the woman that the signs are normal urinary changes in the third trimester. c. Teach the woman to decrease fluid intake to manage these symptoms. d. Perform a Leopold's maneuver to assess fetal position and station.

a a. Correct. Dysuria, frequency, and urgency with urination are signs and symptoms of a urinary tract infection, necessitating further assessment and testing. b. These are abnormal urinary symptoms in the third trimester. c. Pregnant women need to increase their fluid intake during pregnancy, and dysuria and urgency are abnormal. d. Assessment of fetal position and station is not an appropriate response to reported signs and symptoms of a urinary tract infection

The clinic nurse uses Leopold maneuvers to determine the fetal lie, presentation, and position. The nurse's hands are placed on the maternal abdomen to gently palpate the fundal region of the uterus. This action is best described as the: a. First maneuver b. Second maneuver c. Third maneuver d. Fourth maneuver

a a. Leopold maneuvers are a four-part clinical assessment method used to determine the lie, presentation, and position of the fetus. The first maneuver determines which fetal body part (e.g., head or buttocks) occupies the uterine fundus. The examiner faces the patient's head and places the hands on the abdomen, using the palmar surface of the hands to gently palpate the fundal region of the uterus. The buttocks feel soft, broad, and poorly defined and move with the trunk. The fetal head feels firm and round and moves independently of the trunk. b. Leopold maneuvers are a four-part clinical assessment method used to determine the lie, presentation, and position of the fetus. The first maneuver is described in this scenario. c. Leopold maneuvers are a four-part clinical assessment method used to determine the lie, presentation, and position of the fetus. The first maneuver is described in this scenario. d. Leopold maneuvers are a four-part clinical assessment method used to determine the lie, presentation, and position of the fetus. The first maneuver is described in this scenario.

A nurse is preparing to monitor a patient who is to receive an amnioinfusion. Which of the following actions should the nurse make at this time? a. Attach the patient to an electronic blood pressure cuff. b. Assist in insertion of an internal uterine pressure catheter. c. Attach the patient to an oxygen saturation monitory. d. Perform an amniotic fluid Nitrazine test.

b. Assist in insertion of an internal uterine pressure catheter. -There is a possibility of uterine rupture during an amnioinfusion. An internal pressure transducer, therefore, must be inserted to monitor the patient's intrauterine pressures.

Lina is an 18-year-old woman at 20 weeks' gestation. This is her first pregnancy. Lina is complaining of fatigue and listlessness. Her vital signs are within a normal range: BP = 118/60, pulse = 70, and respiratory rate 16 breaths per minute. Lina's fundal height is at the umbilicus, and she states that she is beginning to feel fetal movements. Her weight gain is 25 pounds over the prepregnant weight (110 lb), and her height is 5 feet 4 inches. The perinatal nurse's best approach to care at this visit is to: a. Ask Lina to keep a 3-day food diary to bring in to her next visit in 1 week. b. Explain to Lina that weight gain is not a concern in pregnancy, and she should not worry. c. Teach Lina about the expected normal weight gain during pregnancy (approximately 20 pounds by 20 weeks' gestation). d. Explain to Lina the possible concerns related to excessive weight gain in pregnancy, including the risk of gestational diabetes.

a Feedback a. Nutrition and weight management play an essential role in the development of a healthy pregnancy. Not only does the patient need to have an understanding of the essential nutritional elements, she must also be able to assess and modify her diet for the developing fetus and her own nutritional maintenance. To facilitate this process, it is the nurse's responsibility to provide education and counseling concerning dietary intake, weight management, and potentially harmful nutritional practices. To facilitate this process, it is the nurse's responsibility to gather more information on the woman's dietary practices through a food diary. b. Nutrition and weight management play an essential role in the development of a healthy pregnancy. To facilitate this process, it is the nurse's responsibility to provide education and counseling concerning dietary intake, weight management, and potentially harmful nutritional practices. c. Nutrition and weight management play an essential role in the development of a healthy pregnancy. Not only does the patient need to have an understanding of the essential nutritional elements, she must also be able to assess and modify her diet for the developing fetus and her own nutritional maintenance. To facilitate this process, it is the nurse's responsibility to provide education and counseling concerning dietary intake, weight management, and potentially harmful nutritional practices, not just inform the patient of expected normal weight gain d. Nutrition and weight management play an essential role in the development of a healthy pregnancy. Not only does the patient need to have an understanding of the essential nutritional elements, she must also be able to assess and modify her diet for the developing fetus and her own nutritional maintenance. To facilitate this process, it is the nurse's responsibility to provide education and counseling concerning dietary intake, weight management, and potentially harmful nutritional practices.

A 26-year-old woman at 29 weeks' gestation experienced epigastric pain following the consumption of a large meal of fried fish and onion rings. The pain resolved a few hours later. The most likely diagnosis for this symptom is: a. Cholelithiasis b. Influenza c. Urinary tract infection d. Indigestion

a Feedback a. The progesterone-induced prolonged emptying time of bile from the gallbladder, combined with elevated blood cholesterol levels, may predispose the pregnant woman to gallstone formation (cholelithiasis). Pain in the epigastric region following ingestion of a high-fat meal constitutes the major symptom of these conditions. The pain is self-limiting and usually resolves within 2 hours. b. The symptoms described are not associated with influenza. c. The symptoms described are not associated with urinary tract infection. d. Prolonged emptying time of bile from the gallbladder, combined with elevated blood cholesterol levels, make cholelithiasis a more probable diagnosis than indigestion.

The perinatal nurse providing care to a laboring woman recognizes a category II, fetal heart rate racing. The most appropriate initial action is to: a. Assist the laboring woman to the left lateral position. b. Decrease the IV solution. c. Request that the physician/certified nurse-midwife come to the hospital STAT. d. Document the fetal heart rate and variability.

a. Assist the laboring woman to the left lateral position. -Because Category II fetal heart rate patterns could deteriorate, they constitute a risk indicator for fetal hypoxia, the nurse should change the woman's position to her side to increase oxygen to the baby.

The nurse uses the external electronic fetal heart monitor to evaluate fetal status. The fetal heart tracing shows accelerations. Accelerations in the fetal heart rate are: a. Associated with fetal well-being and oxygenation. b. An indication of potential fetal intolerance to labor. c. Never associated with the uterine contraction pattern. d. A reason to notify the HCP.

a. Associated with fetal well-being and oxygenation. -Accelerations are a sign of fetal well-being.

The nurse knows that a FHR monitor printout indicates a Category III abnormal fetal heart rate pattern when: a. Baseline variability is minimal or absent with decelerations. b. FHR mirrors the uterine contractions. c. Occasional periodic accelerations occur. d. Baseline variability is 6 to 25 bpm with decelerations.

a. Baseline variability is minimal or absent with decelerations. -Minimal or absent baseline variability may be an indication of fetal hypoxia.

Which statement correctly describes the nurse's responsibility related to electronic fetal monitoring? a. Teach the woman and her family about the monitoring equipment and discuss any questions they have. b. Report abnormal findings to the care provider before initiating corrective actions. c. Inform the support person that the nurse will be responsible for all comfort measures when the electronic equipment is in place. d. Document the frequency, duration, and intensity of contractions measured by the external device.

a. Teach the woman and her family about the monitoring equipment and discuss any questions they have. -Teaching is an essential part of the nurse's role. Only an IUPC will measure the intensity of uterine contractions.

After assessing the FHR tracing shown below, which of the following interventions should the nurse perform? a. Turn the woman on her side. b. Administer oxygen by nasal cannula. c. Encourage the patient to push with each contraction. d. Provide the patient with caring labor support.

a. Turn the woman on her side. -The woman's position should be changed. The side-lying position is best.

As the nurse explains the purpose of the tocotransducer (Toco), which she places on the abdomen, she states that this monitoring device provides an accurate evaluation of which of the following? a. Uterine hypertonus. b. Frequency of contractions. c. Intensity of contractions. d. Progress of labor.

b. Frequency of contractions. -A tocotransducer measures frequency and duration of uterine contractions.

At the end of her 32-week prenatal visit, a woman reports discomfort with intercourse and tells you shyly that she wants to maintain a sexual relationship with her partner. The best response is to: a. Reassure woman/couple of normalcy of response b. Suggest alternative positions for sexual intercourse and alternative sexual activity to sexual intercourse c. Recommend cessation of intercourse until after delivery due to advanced gestation d. Suggest woman discuss this with her care provider at her next appointment

b a. Although this is a normal response, providing reassurance is not enough. Further intervention is indicated. b. Although shy to discuss this, she wants to maintain a sexual relationship with her partner. Suggesting alternative positions for sexual intercourse and alternative sexual activity to sexual intercourse provides the woman with information to maintain sexual relations. c. She wants to maintain a sexual relationship with her partner, and there are no contraindications to intercourse during a healthy pregnancy. d. The patient is seeking out information and to defer her to her care provider at her next appointment is inappropriate. Additionally, she may not be comfortable discussing this with anyone else.

Folic acid supplementation during pregnancy is to: a. Improve the bone density of pregnant women b. Decrease the incidence of neural tube defects in the fetus c. Decrease the incidence of Down syndrome in the fetus d. Improve calcium uptake in pregnant women

b a. Folic acid is not related to bone density. b. Correct. The use of folic acid has decreased the incidence of neural tube defects by 50%. c. The use of folic acid is not associated with a reduction in Down syndrome. d. Folic acid is not related to calcium uptake in women.

A woman presents to a prenatal clinic appointment at 10 weeks' gestation, in the first trimester of pregnancy. Which of the following symptoms would be considered a normal finding at this point in pregnancy? a. Occipital headache b. Urinary frequency c. Diarrhea d. Leg cramps

b a. Headaches may be benign or, especially if noted after 20 weeks' gestation, may be a symptom of pregnancy-induced hypertension (PIH). b. Urinary frequency is a common complaint of women during their first trimester. c. Diarrhea is rarely seen in pregnancy. Constipation is a common complaint. d. Leg cramps are commonly seen during the second and third trimesters.

Intimate partner violence (IPV) against women consists of actual or threatened physical or sexual violence and psychological and emotional abuse. Screening for IPV during pregnancy is recommended for: a. Pregnant women with a history of domestic violence b. All pregnant women c. All low-income pregnant women d. Pregnant adolescents

b a. Intimate partner violence is underreported by women, necessitating universal screening. b. Correct. AWHONN advocates for universal screening for domestic violence for all pregnant women. Homicide is the most likely cause of death for pregnant or recently pregnant women, and a significant portion of those homicides are committed by their intimate partners. One in six pregnant women reported physical or sexual abuse during pregnancy, seriously impacting maternal and fetal health and infant birth weight. c. IPV crosses all ethnic, racial, religious, and socioeconomic levels. d. IPV crosses all ethnic, racial, religious, and socioeconomic levels.

The clinic nurse talks with Kathy about her possible pregnancy. Kathy has experienced amenorrhea for 2 months, nausea during the day with vomiting every other morning, and breast tenderness. These symptoms are best described as: a. Positive signs of pregnancy b. Presumptive signs of pregnancy c. Probable signs of pregnancy d. Possible signs of pregnancy

b a. Positive signs include fetal heartbeat, visualization of the fetus, and fetal movements palpated by the examiner. b. Presumptive signs of pregnancy include amenorrhea, nausea and vomiting, frequent urination, breast tenderness, perception of fetal movement, skin changes, and fatigue. Probable signs of pregnancy include abdominal enlargement, Piskacek sign, Hegar sign, Goodell sign, Braxton Hicks sign, positive pregnancy test, and ballottement. Positive signs include fetal heartbeat, visualization of the fetus, and fetal movements palpated by the examiner. c. Probable signs of pregnancy include abdominal enlargement, Piskacek sign, Hegar sign, Goodell sign, Braxton Hicks sign, positive pregnancy test, and ballottement. d. Possible signs of pregnancy may vary widely.

The clinic nurse reviews the complete blood count results for a 30-year-old woman who is now 33 weeks' gestation. Tamara's hemoglobin value is 11.2 g/dL, and her hematocrit is 38%. The clinic nurse interprets these findings as: a. Normal adult values b. Normal pregnancy values for the third trimester c. Increased adult values d. Increased values for 33 weeks' gestation

b a. The values are low normal for adults but represent normal findings for pregnant women. b. During pregnancy the woman's hematocrit values may appear low due to the increase in total plasma volume (on average, 50%). Because the plasma volume is greater than the increase in erythrocytes (30%), the hematocrit decreases by about 7%. This alteration is termed "physiologic anemia of pregnancy," or "pseudo-anemia." The hemodilution effect is most apparent at 32 to 34 weeks. The mean acceptable hemoglobin level in pregnancy is 11 to 12 g/dL of blood. c. The values are not increased; they are low normal for adults but represent normal findings for pregnant women. d. The values are not increased; they are low normal for adults but represent normal findings for pregnant women.

The clinic nurse is aware that the pregnant woman's blood volume increases by: a. 20% to 25% b. 30% to 35% c. 40% to 45% d. 50% to 55%

c a. An increase in maternal blood volume begins during the first trimester and peaks at term. The increase approaches 40% to 45%, not 20% to 25%. b. An increase in maternal blood volume begins during the first trimester and peaks at term. The increase approaches 40% to 45, not 30% to 35%. c. An increase in maternal blood volume begins during the first trimester and peaks at term. The increase approaches 40% to 45% and is primarily due to an increase in plasma and erythrocyte volume. Additional erythrocytes, needed because of the extra oxygen requirements of the maternal and placental tissue, ensure an adequate supply of oxygen to the fetus. The elevation in erythrocyte volume remains constant during pregnancy. d. An increase in maternal blood volume begins during the first trimester and peaks at term. The increase approaches 40% to 45%, not as high as 50% to 55%

During a routine prenatal visit in the third trimester, a woman reports she is dizzy and lightheaded when she is lying on her back. The most appropriate nursing action would be to: a. Order an EKG. b. Report this abnormal finding immediately to her care provider. c. Teach the woman to avoid lying on her back and to rise slowly because of supine hypotension. d. Order a nonstress test to assess fetal well-being

c a. This is a normal occurrence in pregnancy and does not indicate pathology. The probable cause of the problem is supine hypotension. b. This is a normal finding that does not warrant immediate notification to her care provider. c. Correct. Teaching the woman to avoid lying on her back because of occlusion of the vena cava with the gravid uterus causes supine hypotension syndrome. d. Antenatal testing is not indicated with supine hypotension

While performing Leopold's maneuvers on a woman in early labor, the nurse palpates a flat area in the fundal region, a hard round mass on the left side, a soft round mass on the right side, and small parts just above the symphysis. The nurse concludes which of the following? a. The fetal position is right occiput posterior. b. The fetal attitude is flexed. c. The fetal presentation is scapular. d. The fetal lie is vertical.

c a. This is a shoulder presentation. b. It is not possible to determine whether the attitude is flexed or not when doing Leopold's maneuvers. c. This is a shoulder presentation. d. The lie is transverse or horizontal

The nurse is caring for a woman, G2 P1001, 40 weeks' gestation, in labor. A 12 PM assessment revealed: cervix 4 cm, 80% effaced, -3 station, and fetal heart 124 with moderate variability. 5 PM assessment: cervix 6 cm, 90% effaced, -3 station, and fetal heart 120 with minimal variability. 10 AM assessment: cervix 8 cm, 100% effaced, -3 station, and fetal heart 124 with absent variability. Based on the assessments, which of the following should the nurse conclude? a. Descent is progressing well. b. Woman is carrying a small-for-gestational age fetus. c. Baby is potentially acidotic. d. Woman should begin to push with next contraction.

c. Baby is potentially acidotic. -The variability is decreasing. This is an indication that the fetus is in distress.

Early decelerations are probably cause by: a. Decreased maternal-fetal exchange. b. Umbilical cord occlusion. c. Momentary increase in intracranial pressure due to head compression. d. Compression of umbilical cord.

c. Momentary increase in intracranial pressure due to head compression. -Early decelerations are related to increased intracranial pressure due to head compression.

Blood volume expansion during pregnancy leads to: a. Iron-deficiency anemia b. Maternal iron stores being insufficient to meet the demands for iron in fetal development c. Plasma fibrin increase of 40% and fibrinogen increase of 50% d. Physiological anemia of pregnancy

d a. Iron-deficiency anemia is treated with iron supplementation. Iron-deficiency anemia is defined as hemoglobin of less than 11 g/dL and hematocrit less than 33%. b. Maternal iron stores that are insufficient to meet the demands for iron in fetal development result in iron-deficiency anemia. c. Hypercoagulation that occurs during pregnancy is to decrease the risk of postpartum hemorrhage. These changes taking place are not related to blood volume expansion. d. Correct. Physiological anemia of pregnancy, also referred to as pseudo-anemia of pregnancy, is due to hemodilution. The increase in plasma volume is relatively larger than the increase in RBCs that results in decreased hemoglobin and hematocrit values.

The clinic nurse talks to a 30-year-old woman at 34 weeks' gestation who complains of having difficulty sleeping. Jayne has noticed that getting back to sleep after she has been up at night is difficult. The nurse's best response is: a. "This is abnormal; it is important that you describe this problem to the doctor." b. "This is normal, and many women have this same problem during pregnancy; try napping for several hours each morning and afternoon." c. "This is abnormal; tell the doctor about this problem because diagnostic testing may be necessary." d. "This is normal in pregnancy, particularly during the third trimester when you also feel fetal movement at night; try napping once a day."

d a. This sleep pattern is a normal finding. b. Sleeping for several hours in the morning and afternoon would contribute to further sleep disturbances at night. c. This sleep pattern is a normal finding. d. Pregnancy sleep patterns are characterized by reduced sleep efficiency, fewer hours of night sleep, frequent awakenings, and difficulty going to sleep. Nurses can advise patients that afternoon napping may help alleviate the fatigue associated with the sleep alterations.