OB Test 1 thru McKinney 25

A woman who is 16 weeks pregnant asks the nurse, "Is it possible to tell by ultrasound if the baby is a boy or girl yet?" The best answer is

"The baby has developed enough that we can determine the sex by examining the genitals through ultrasound."

A young patient comes in for her first prenatal examination. This is her first child. She asks "How does my baby get air inside my uterus?" The correct response is

"The placenta provides oxygen to the baby and excretes carbon dioxide into your bloodstream."

The nursing faculty teaches that the placenta produces many hormones necessary for normal pregnancy. These include (Select all that apply.) a. human chorionic gonadotropin (hCG). b. insulin. c. estrogen. d. progesterone. e. testosterone.

A, C, D The placenta produces hCG, estrogen, and progesterone. It does not produce insulin or testosterone.

A maternal-newborn nurse is caring for a mother who just delivered a baby born with Down syndrome. What nursing diagnosis is the most essential in caring for the mother of this infant? a. Disturbed body image b. Interrupted family processes c. Anxiety d. Risk for injury

ANS: B This mother likely will experience a disruption in the family process related to the birth of ababy with an inherited disorder. Family disruption is common, and the strain of having a childwith a serious birth defect may lead to divorce. Siblings may feel neglected because the childwith a disorder requires more of their parents' time and attention.

When the deceleration pattern of the fetal heart rate mirrors the uterine contraction, which nursing action is indicated? a. Administer oxygen by nasal cannula. b. Reposition the woman. c. Apply a fetal scalp electrode. d. Record this reassuring pattern.

ANS: D Feedback A This is an early deceleration; it is reassuring. B This is an early deceleration; it is reassuring. C This is an early deceleration; it is reassuring. D The periodic pattern described is early deceleration that is not associated with fetal compromise and requires no intervention.

14. Which statement related to oogenesis is correct?

At birth, all ova are contained in the female's ovaries.

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

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

To relieve a leg cramp, the patient should be instructed to a. Massage the affected muscle. b. Stretch and point the toe. c. Dorsiflex the foot. d. Apply a warm pack.

C

A step in maternal role attainment that relates to the woman giving up certain aspects of her previous life is termed a. Looking for a fit b. Roleplaying c. Fantasy d. Grief work

D

Which patient situation fails to meet the first requirement of informed consent?

The patient who is confused and disoriented.

which statement related nursing care of the child at home is most correct?

The technology infant can be safely cared for at home

The karyotype of a person is 47, XY, +21

This person is a male with Down syndrome

A pregnant client's biophysical profile score is 8. She asks the nurse to explain the results. What is the nurse's best response? a. "The test results are within normal limits." b. "Immediate birth by cesarean birth is being considered." c. "Further testing will be performed to determine the meaning of this score." d. "An obstetric specialist will evaluate the results of this profile and, within the next week, will inform you of your options regarding birth."

a. "The test results are within normal limits."

One of the assessments performed in the delivery room is checking the umbilical cord for blood vessels. Which finding is considered within normal limits?

a. Two arteries and one vein

The placenta allows exchange of oxygen, nutrients, and waste products between the mother and fetus by

a. contact between maternal blood and fetal capillaries within the chorionic villi.

The nurse is reviewing the procedure for alpha-fetoprotein (AFP) screening with a patient at 16 weeks' gestation. The nurse determines that the patient understands the teaching when she mentions that which fluid will be collected for the initial screening process? a. Urine b. Blood c. Saliva d. Amniotic

b. Blood

After implantation, tiny projections develop out of the trophoblast and extend into the endometrium. These projections are referred to as

chorionic villi.

Elective abortion is considered an ethical issue because

conflict exists between the rights of the fetus and the rights of the mother.

The nursing faculty explains to students that the upper uterus is the best place for the fertilized ovum to implant because it is here that the

developing baby is best nourished.

Maternity nursing care that is based on knowledge gained through research is known as

evidence based practice

In order to prevent neural tube defects, updated recommendations include an intake of 0.4 mg to 0.8 mg of ___________________ each day from one month prior to conception until 8 to 10 weeks of pregnancy.

folic acid

The most basic information a maternity nurse should have concerning conception is

implantation in the endometrium occurs 6 to 10 days after conception.

During a pregnancy group meeting, the nurse teaches patients that the fetal period is best described as one of

maturation of organ systems.

Which principle of teaching should the nurse use to ensure teaching in a family situation

motivate the family with praise and reinforcement

During pregnancy many women become increasingly concerned about their ability to protect and provide for the fetus. This concern is often manifested as _____________.

narcissism

A patient is sent from the physician's office for assessment of oligohydramnios. The nurse is aware that this condition can result in

newborn respiratory distress.

Family centered maternity care developed in response to

parental requests that infants be allowed to remain with them rather than in a nursery

The fastest growing group of homeless people is

single women and their children

While teaching an early pregnancy class, the nurse explains that the morula is a

solid ball composed of the first cells formed after fertilization.

The level of practice a reasonably prudent nurse provides is called

standard of care

The Women, Infants, and Children (WIC) program provides

supplements food supplies to low income, pregnant, or breastfeeding women.

Both members of the expectant couple are carriers for PKU, an autosomal recessive disorder. IN counseling them about the risk to their unborn child, the nurse should tell them that

the child has a 25% chance of being affected.

When explaining twin conception, the nurse points out that dizygotic twins develop from

two fertilized ova and may be the same sex or different sexes.

A woman is 16 weeks pregnant with her first baby. She asks how long it will be before she feels the baby move. The best answer is "Within the next month, you should start to feel fluttering sensations."

"Within the next month, you should start to feel fluttering sensations."

A patient at 34 weeks of gestation has reported to the OB triage unit for assessment ofoligohydramnios. The nurse assigned to care for this patient is aware that prolongedoligohydramnios may result in (Select all that apply.) a. intrauterine limb amputations. b. clubfoot. c. delayed lung development. d. other fetal abnormalities. e. fetal deformations.

. B, C, D Oligohydramnios, an abnormally small volume of amniotic fluid, reduces the cushionsurrounding the fetus and may result in deformations such as clubfoot. Prolongedoligohydramnios interferes with fetal lung development because it does not allow normaldevelopment of the alveoli. Oligohydramnios may not be the primary fetal problem but rathermay be related to other fetal anomalies. This does not lead to intrauterine limb amputations orfetal deformations.

A gravida patient at 32 weeks of gestation reports that she has severe lower back pain. The nurse's assessment should include a. Observation of posture and body mechanics b. Palpation of the lumbar spine c. Exercise pattern and duration d. Ability to sleep for at least 6 hours uninterrupted

A

A patient notices that the doctor writes "positive Chadwick's sign" on her chart. She asks the nurse what this means. The nurse's best response is a. "It refers to the bluish color of the cervix in pregnancy." b. "It means the cervix is softening." c. "The doctor was able to flex the uterus against the cervix." d. "That refers to a positive sign of pregnancy."

A

A pregnant woman's mother is worried that her daughter is not "big enough" at 20 weeks. The nurse palpates and measures the fundal height at 20 cm, which is even with the woman's umbilicus. What should the nurse report to the woman and her mother? a. "The body of the uterus is at the belly button level, just where it should be at this time." b. "You're right. We'll inform the practitioner immediately." c. "When you come for next month's appointment, we'll check you again to make sure that the baby is growing." d. "Lightening has occurred, so the fundal height is lower than expected."

A

During her first prenatal visit to the clinic, a woman gives the following obstetric history: a boy born 9 years ago at full term, twin girls born 5 years ago at 36 weeks, a miscarriage at 9 weeks 2 years ago. The nurse correctly records her obstetric history as A. gravida 4, para 2, aborta 1. B. gravida 3, para 3, aborta 1. C. gravida 4, para 3, aborta 1. D. gravida 3, para 2, aborta 1.

A

Prenatal testing for the human immunodeficiency virus (HIV) is recommended for which women? a. All women, regardless of risk factors b. A woman who has had more than one sexual partner c. A woman who has had a sexually transmitted infection d. A woman who is monogamous with her partner

A

The multiple marker screen is used to assess the fetus for which condition? a. Down syndrome b. Diaphragmatic hernia c. Congenital cardiac abnormality d. Anencephaly

A

The nurse has just started a new shift and is reviewing the chart for her assigned patient. The patient is 6 cm dilated, 100% effaced, -3 station with intact membranes. Ten minutes later, the patient informs the nurse that her membranes have just ruptured. The nurse notices variable decelerations on the monitor. The nurse's next action should be to A perform a vaginal exam. B increase the intravenous fluids and start oxygen. C notify the nurse-midwife. D nothing, this is normal immediately after membranes rupture.

A

The nurse notes that the hemoglobin level of a woman at 35 weeks of gestation is 11.5 g/dL. The nurse's next action should be to A. note that this is within the normal range for pregnancy. B. note that this is within the normal range for an average adult. C. call the physician; this shows mild anemia. D. recall that the RBC count increases slightly during pregnancy.

A

Which comment by a woman in her first trimester indicates ambivalent feelings? a. "I wanted to become pregnant, but I'm scared about being a mother." b. "I haven't felt well since this pregnancy began." c. "I'm concerned about the amount of weight I've gained." d. "My body is changing so quickly."

A

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

A

Following an amniotomy, the priority nursing intervention is to A assess the fetal heart rate. B assess the color and amount of amniotic fluid. C assess the maternal vital signs including temperature. D place dry sheets and pads under the woman.

A An immediate and continuing risk is that the umbilical cord will slip down in the gush of fluid. The cord can be compressed between the fetal presenting part and the woman's pelvis. Nonreassuring FHR patterns may occur. Assessing the color and amount of amniotic fluid, monitoring maternal temperature, and keeping the woman dry are important interventions but not the priority intervention.

One side effect of oxytocin stimulation is hypertonic contractions. This can be detrimental to the fetus because A there is a reduction of placental blood flow. B it produces a prolapsed cord. C it increases maternal renal blood flow. D it decreases maternal blood pressure.

A Hypertonic contractions can reduce placental blood flow and therefore reduce fetal oxygenation. Hypertonic contractions do not increase the risk for prolapsed cord, increased maternal renal blood flow, or decreased blood pressure.

The physician obtains a sample of fetal scalp blood to evaluate the pH. The results of the pH were 7.35. The nurse knows the next action will be A nothing—this is a normal pH. B preparing for delivery—the pH shows acidosis. C preparing for delivery—the pH shows alkalosis. D repeating the pH in 20 minutes, because it is borderline.

A Normal scalp pH of a fetus is 7.25 to 7.35.

The nurse noted that the woman's Bishop score was 9. This indicates that the woman A has a high likelihood of successful induction. B does not have a high likelihood of successful induction. C has a high likelihood of developing gestational diabetes. D does not have a high likelihood of developing gestational diabetes.

A The Bishop scoring system uses five factors to estimate cervical readiness for labor. A score of 8 or greater has a high level of successful induction. The Bishop scoring system does not refer to gestational diabetes.

Proper placement of the tocotransducer for electronic fetal monitoring is A over the uterine fundus. B on the fetal scalp. C inside the uterus. D over the mother's lower abdomen.

A The tocotransducer monitors uterine activity and should be placed over the fundus where the most intensive uterine contractions occur. The internal scalp electrode is placed on the fetal scalp. The intrauterine pressure catheter is placed inside the uterus.

What can be determined only by electronic fetal monitoring? A Variability B Tachycardia C Bradycardia D Fetal response to contractions

A Variability cannot be determined by auscultation, because auscultation provides only an average fetal heart rate as it fluctuates. Tachycardia and bradycardia can be determined by electronic fetal monitoring and auscultation. Fetal response to contractions is best determined by electronic fetal monitoring, but some responses can be determined through auscultation.

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

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

A woman tell the nurse at a prenatal interview that she has quit smoking, only has one glass of wine at dinner, and has cut down to 4 cups of coffee per day. What response by the nurse will be most helpful in promoting this lifestyle change? a. you have made some great progress towards having a healthy baby. Lets talk about the changes that you have made b. You need to do a lot better than that! You may still be hurting your baby right now. c. Here are some pamphlets for you to study. They will help you find more ways to improve. d. Those few things won't cause any trouble. Good for you.

A praising her for making positive changes is an effective technique for motivating a patient.

Which situation reflects a potential ethical dilemma for the nurse?

A labor nurse whose religion opposes abortion that is asked to assist with an elective abortion.

A woman is expecting her second child. She expressed concern to the nurse about how her 4-year-old will adapt to the new baby. The following are some suggestions the nurse should include in her teaching. Select all that apply. A. Come in and listen to the baby's heartbeat. B. Spend more time with grandmother to prepare him for being away from mother during the birth. C. Take a sibling class offered by the hospital. D. Decide which of your toys you would like to give to the new baby.

A, B, C

The nurse has taught a vegetarian pregnant woman foods that are high in iron. Which menuselections demonstrate good understanding of the material? (Select all that apply.) a. Cooked soybeans b. Canned stewed tomatoes c. Raisin bran cereal d. White bread e. Peaches

A, B, C Cooked soybeans, canned stewed tomatoes, and Raisin Bran cereal are all high in iron.

The student learns about shunts that support fetal circulation. Which of the following are included in this support system? (Select all that apply.) a. Ductus venosus b. Foramen ovale c. Ductus arteriosus d. Foramen magnum e. Ductus deferens

A, B, C The ductus venosus, foramen ovale, and ductus arteriosus are part of fetal circulation. The foramen magnum is located at the base of the skull. The ductus (or vas) deferens is part of the male reproductive system.

The nursing faculty explains that the fetus can survive in a low-oxygen environment due to which of the following? (Select all that apply.) a. Fetal hemoglobin carries more oxygen than an adult's. b. The fetus has higher average hemoglobin and hematocrit. c. Hemoglobin carries more oxygen at low partial pressures of carbon dioxide. d. Fetal blood is more acidic than the maternal blood. e. The fetus does not need gas exchange while in utero.

A, B, C The fetus can survive in low oxygen environments due to its hemoglobin being able to carry more oxygen that the mom, having a higher level of hemoglobin and hematocrit, and the fact that hemoglobin can carry more oxygen at low partial pressures of carbon dioxide. Fetal blood is alkaline. The fetus does need gas exchange in utero.

When assessing cultural influences on a pregnant woman's diet, which actions by the nurseare best? (Select all that apply.) a. Learn about traditional foods in that culture. b. Ask the woman how she prepares food. c. Determine if there are specific "pregnancy" foods. d. Assess how traditional the woman is.e. Find out what support she has locally.

A, B, C The nurse should ask about traditional foods in her culture and how she (or others) prepare thefood. In some cultures, specific foods are eaten during pregnancy, and the nurse should determine this as well.

The nurse assesses pregnant women for exposure to human teratogens, including which of the following? (Select all that apply.) a. Infections b. Radiation c. Maternal conditions d. Drugs e. Chemicals

A, B, C, D

A pregnant woman reports that she works in a long-term care setting and is concerned about the impending flu season. She asks about receiving the flu vaccine. As the nurse, you are aware that some immunizations are safe to administer during pregnancy, whereas others are not. Which vaccines could this patient receive? Select all that apply. a. Tetanus b. Hepatitis A and B c. Measles, mumps, rubella (MMR) d. Influenza e. Varicella

A, B, D

Examples of situations when the birth attendant may do an episiotomy include the following. Select all that apply. A Fetal shoulder dystocia B Forceps- or vacuum extractor-assisted births C Breech presentation D Fetus in an occiput posterior position

A, B, D Fetal shoulder dystocia, forceps- or vacuum extractor-assisted births, or a fetus in an occiput posterior position are all indications for an episiotomy. Most breech presentations are delivered by cesarean.

The nurse knows that which of the following chromosomal abnormalities are structural innature? (Select all that apply.) a. Part of a chromosome is missing. b. The material within a chromosome is rearranged. c. One or more sets of chromosomes are added. d. An entire single chromosome is added. e. Two chromosomes adhere to each other.

A, B, E Characteristics of structural abnormalities include part of a chromosome missing or added, rearrangement of material within chromosomes, two chromosomes that adhered to each other,and fragility of a specific site on the X chromosome. The addition of a single chromosome(trisomy), the deletion of a single chromosome (monosomy), and one or more added sets ofchromosomes (polyploidy) are numerical abnormalities.

In some Middle Eastern and African cultures, female genital mutilation is a prerequisite for marriage. Women who now live in North America need care from nurses who are knowledgeable about the procedure and comfortable with the abnormal appearance of her genitalia. When caring for this woman, the nurse can formulate a diagnosis with the understanding that the woman may be at risk for (select all that apply) a. Obstructed labor b. Increased signs of pain response c. Laceration d. Hemorrhage e. Infection

A, C, D, E

The generalist nurse working with child-bearing families understands that his or her practicerelated to genetics includes which of the following? (Select all that apply.) a. Identifying families at risk and providing referrals b. Interpreting genetic test results for the family c. Assessing the couple's concern about genetic alterations d. Helping create a family tree or pedigree. Providing support in all phases of genetic counseling

A, C, D, E The nurse who works with women and families in the childbearing years is in a wonderful position to help identify families at risk and provide referrals, assess concerns, create pedigrees, and provide support. Interpreting genetic test results is provided by those who have advanced training and education in that area and would not be expected of the generalist nurse

During pregnancy there are a number of changes that occur as a direct result of the presence of the fetus. Which of these adaptations meet this criteria? Select all that apply. a. Leukorrhea b. Development of the operculum c. Quickening d. Ballottement e. Lightening

A, C, E

3. The antidote administered to reverse magnesium toxicity is ______________.

ANS: calcium gluconate Calcium gluconate is the antidote necessary to reverse magnesium toxicity. The nurse caring for this patient should keep calcium gluconate in the room along with secured, syringes and needles.

1. Recurrent spontaneous abortion refers to a condition in which a woman experiences three or more consecutive abortions or miscarriages. This is also known as ________ abortion.

ANS: habitual Primary causes are believed to be genetic or chromosomal abnormalities of the fetus. For the mother who repeatedly aborts, the cause is often an anomaly of the reproductive tract such as bicornate uterus or incompetent cervix. Systemic illnesses such as lupus erythematosus and diabetes mellitus have been implicated in this condition as well. Treatment depends entirely on the cause and therefore varies between medical and surgical approaches.

2. The condition in which the placenta is implanted in the lower uterine segment near or over the internal cervical os is _____________.

ANS: placenta previa In placenta previa, the placenta is implanted in the lower uterine segment such that it completely or partially covers the cervix or is close enough to the cervix to cause bleeding when the cervix dilates or the lower uterine segment effaces.

The labor and delivery nurse is using a well-known method to quantify the intensity of labor contractions with internal monitoring. This method is known as MVUs, or ______________.

ANS: Montevideo units The baseline intrauterine pressure for each contraction within a 10-minute period is subtracted from the peak pressure. The resulting pressures (peak subtract baseline) are added together to calculate the Montevideo units

The nurse is caring for a woman in labor at 39 weeks and 5 days of gestation. Her labor progress has slowed due to poor contractions. After discussion with the provider, a decision has been made that she is a good candidate for ___________ of labor

ANS: augmentation Augmentation of labor with oxytocin is considered when labor has begun spontaneously but progress has slowed or stopped. The rate of oxytocin may be lower than that of an induction.

A popular preinduction cervical ripening agent that is Food and Drug Administration (FDA) approved for the treatment of peptic ulcers is __________.

ANS: misoprostol Cytotec This synthetic prostaglandin tablet is used primarily for the prevention of peptic ulcers. Because of its low cost, stability, and ease of use, many facilities use this medication for cervical ripening and the induction of labor. The manufacturer does not intend to seek FDA approval for other indications; however, ACOG supports its use for these purposes.

Before the physician performs an external version, the nurse should expect an order for a a. Tocolytic drug b. Contraction stress test (CST) c. Local anesthetic d. Foley catheter

ANS: A Feedback A A tocolytic drug will relax the uterus before and during version, making manipulation easier. B CST is used to determine the fetal response to stress. C A local anesthetic is not used with external version. D The bladder should be emptied, but catheterization is not necessary.

Which patient status is an acceptable indication for serial oxytocin induction of labor? a. Past 42 weeks' gestation b. Multiple fetuses c. Polyhydramnios d. History of long labors

ANS: A Feedback A Continuing a pregnancy past the normal gestational period is likely to be detrimental to fetal health. B Multiple fetuses overdistend the uterus, making induction of labor high risk. C Polyhydramnios overdistends the uterus, making induction of labor high risk. D History of rapid labors is a reason for induction of labor because of the possibility that the baby would otherwise be born in uncontrolled circumstances.

An important part of fetal surveillance is assessment and documentation of the fetal heart rate during the first stage of labor. In the low-risk patient assessments for variability and periodic changes if using the fetal monitor should be done a. Every 15-30 minutes b. Every 5-15 minutes c. Every 30-60 minutes d. Only before and after ambulation

ANS: A Feedback A During the active first stage of labor, FHR should be assessed every 15-30 minutes just after a contraction. B During the second stage of labor the FHR should be assessed every 5-15 minutes. C This is not an adequate assessment during any stage of labor. D The FHR should also be evaluated both before and during ambulation.

While assisting with a vacuum extraction birth, what should the nurse immediately report to the physician? a. Persistent fetal bradycardia below 100 bpm b. Maternal pulse rate of 100 bpm c. Maternal blood pressure of 120/70 mm Hg d. Decrease in intensity of uterine contractions

ANS: A Feedback A Fetal bradycardia may indicate fetal distress and may require immediate intervention. B Maternal pulse rate may increase due to the pushing process. C This blood pressure is within expected norms for this stage of labor. D The birth is imminent at this point.

Immediately after the forceps-assisted birth of an infant, the nurse should a. Assess the infant for signs of trauma. b. Give the infant prophylactic antibiotics. c. Apply a cold pack to the infant's scalp. d. Measure the circumference of the infant's head.

ANS: A Feedback A Forceps delivery can result in local irritation, bruising, or lacerations of the fetal scalp. B Prophylactic antibiotics are not necessary with a forceps delivery. C This would put the infant at risk for cold stress and would be contraindicated. D Measuring the circumference of the head is part of the initial nursing assessment.

Perinatal nurses are legally responsible for a. Correctly interpreting FHR patterns, initiating appropriate nursing interventions, and documenting the outcomes b. Greeting the patient on arrival, assessing her, and starting an IV line c. Applying the external fetal monitor and notifying the care provider d. Making sure the woman is comfortable

ANS: A Feedback A Nurses who care for women during childbirth are legally responsible for correctly interpreting FHR patterns, initiating appropriate nursing interventions based on those patterns, and documenting the outcomes of those interventions. B These activities should be performed when any patient arrives to the maternity unit. The nurse is not the only one legally responsible for performing these functions. C This is a nursing function that is part of the standard of care for all obstetrical patients. This falls within the RN scope of practice. D Everyone caring for the pregnant woman should ensure that both she and her support partner are comfortable.

Which statement correctly describes the nurse's responsibility related to electronic monitoring? a. Teach the woman and her support person about the monitoring equipment and discuss any questions they have. b. Report abnormal findings to the physician 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.

ANS: A Feedback A Teaching is an essential part of the nurse's role. B Corrective actions should be initiated first in order to correct abnormal findings as quickly as possible. C The support person should still be encouraged to assist with the comfort measures. D Electronic monitoring will record the contractions and FHR response.

The fetal heart rate baseline increases 15 beats per minute after vibroacoustic stimulation. The best interpretation of this is that the fetus is showing a. A reassuring response b. Progressive acidosis c. Parasympathetic stimulation d. A worsening hypoxia

ANS: A Feedback A The fetus with adequate reserve for the stress of labor will usually respond to vibroacoustic stimulation with a temporary increase in the fetal heart rate (FHR) over baseline of 15 bpm for 15 seconds or more. B An increase in the FHR after stimulation is reassuring. C An increase in the FHR after stimulation is a reassuring pattern and does not indicate problems with the parasympathetic nervous system. D An increase in the FHR with stimulation does not indicate hypoxia.

In which situation is a baseline fetal heart rate of 160 to 170 beats per minute be considered a normal finding? a. The fetus is at 28 weeks of gestation. b. The mother has been given an epidural block. c. The mother has a history of fast labors. d. The mother has mild preeclampsia but is not in labor.

ANS: A Feedback A The normal preterm fetus may have a baseline rate slightly higher than the term fetus because of an immature parasympathetic nervous system that does not yet exert a slowing effect on the fetal heart rate (FHR). B Any change in the FHR with an epidural is not considered an expected outcome. C Fast labors should not alter the FHR normally. D Preeclampsia should not cause a normal elevation of the FHR.

The nurse knows that proper placement of the tocotransducer for electronic fetal monitoring is a. Over the uterine fundus b. On the fetal scalp c. Inside uterus d. Over the mother's lower abdomen

ANS: A Feedback A The tocotransducer monitors uterine activity and should be placed over the fundus, where the most intensive uterine contractions occur. B The tocotransducer monitors uterine contractions. C The tocotransducer is for external use. D The most intensive uterine contractions occur at the fundus; this is the best placement area.

Which maternal condition is considered a contraindication for the application of internal monitoring devices? a. Unruptured membranes b. Cervix is dilated to 4 cm c. External monitors are currently being used d. Fetus has a known heart defect

ANS: A Feedback A To apply internal monitoring devices, the membranes must be ruptured. B Cervical dilation of 4 cm permits the insertion of fetal scalp electrodes and intrauterine catheter. C The external monitor can be discontinued after the internal ones are applied. D A compromised fetus should be monitored with the most accurate monitoring devices.

The nurse caring for the woman in labor should understand that absent or minimal variability is classified as either abnormal or indeterminate. Which condition related to decreased variability is considered benign? a. A periodic fetal sleep state b. Extreme prematurity c. Fetal hypoxemia d. Pre-existing neurologic injury

ANS: A Feedback A When the fetus is temporarily in a sleep state there is minimal variability present. Periodic fetal sleep states usually last no longer than 30 minutes. B A woman who presents in labor with extreme prematurity may display a FHR pattern of minimal or absent variability. C Abnormal variability may also be related to fetal hypoxemia and metabolic acidemia. D Congenital anomalies or pre-existing neurologic injury may also present as absent or minimal variability. Other possible causes might be CNS depressant medications, narcotics or general anesthesia.

3. Spontaneous termination of a pregnancy is considered to be an abortion if a. The pregnancy is less than 20 weeks. b. The fetus weighs less than 1000 g. c. The products of conception are passed intact. d. No evidence exists of intrauterine infection.

ANS: A Feedback A An abortion is the termination of pregnancy before the age of viability (20 weeks). B The weight of the fetus is not considered because some fetuses of an older age may have a low birth weight. C A spontaneous abortion may be complete or incomplete. D A spontaneous abortion may be caused by many problems, one being intrauterine infection.

7. The priority nursing intervention when admitting a pregnant woman who has experienced a bleeding episode in late pregnancy is to a. Assess fetal heart rate (FHR) and maternal vital signs. b. Perform a venipuncture for hemoglobin and hematocrit levels. c. Place clean disposable pads to collect any drainage. d. Monitor uterine contractions.

ANS: A Feedback A Assessment of the FHR and maternal vital signs will assist the nurse in determining the degree of the blood loss and its effect on the mother and fetus. B The most important assessment is to check mother/fetal well-being. The blood levels can be obtained later. C It is important to assess future bleeding, but the top priority is mother/fetal well-being. D Monitoring uterine contractions is important, but not the top priority.

27. Approximately 12% to 26% of all clinically recognized pregnancies end in miscarriage. Which is the most common cause of spontaneous abortion? a. Chromosomal abnormalities b. Infections c. Endocrine imbalance d. Immunologic factors

ANS: A Feedback A At least 60% of pregnancy losses result from chromosomal abnormalities that are incompatible with life. B Maternal infection may be a cause of early miscarriage. C Endocrine imbalances such as hypothyroidism or diabetes are possible causes for early pregnancy loss. D Women who have repeated early pregnancy losses appear to have immunologic factors the play a role in spontaneous abortion incidents.

12. Which assessment finding should convince the nurse to "hold" the next dose of magnesium sulfate? a. Absence of deep tendon reflexes b. Urinary output of 100 mL total for the previous 2 hours c. Respiratory rate of 14 breaths/min d. Decrease in blood pressure from 160/100 to 140/85

ANS: A Feedback A Because absence of deep tendon reflexes is a sign of magnesium toxicity, the next scheduled dose should not be administered. Calcium gluconate is the antidote that should be administered. B An hourly output of less than 30 mL could indicate toxicity. C A respiratory rate of less than 12 breaths/min could indicate toxicity. D Decrease in blood pressure is an expected side effect of magnesium sulfate.

19. What order should the nurse expect for a patient admitted with a threatened abortion? a. Bed rest b. Ritodrine IV c. NPO d. Narcotic analgesia every 3 hours, prn

ANS: A Feedback A Decreasing the woman's activity level may alleviate the bleeding and allow the pregnancy to continue. B Ritodrine is not the first drug of choice for tocolytic medications. C There is no reason for having the woman NPO. At times dehydration may produce contractions, so hydration is important. D Narcotic analgesia will not decrease the contractions. It may mask the severity of the contractions.

17. Rh incompatibility can occur if the woman is Rh negative and her a. Fetus is Rh positive b. Husband is Rh positive c. Fetus is Rh negative d. Husband and fetus are both Rh negative

ANS: A Feedback A For Rh incompatibility to occur, the mother must be Rh negative and her fetus Rh positive. B The husband's Rh factor is a concern only as it relates to the possible Rh factor of the fetus. C If the fetus is Rh negative, the blood types are compatible and no problems should occur. D If the fetus is Rh negative, the blood type with the mother is compatible. The husband's blood type does not enter into the problem.

A nurse is creating a pedigree for a couple whose son has Tay-Sachs disease. What information from the pedigree would the nurse most likely find? a. Parental consanguinity b. Disease has skipped a generation. c. Only men have had this disorder. d. Only women have had this disorder.

ANS: A Parental consanguinity increases the risk for autosomal recessive disorders such as Tay-Sachsdisease. The pedigree would not show the disease skipping generations. Males and femalesare equally affected by this disorder.

1. Throughout the world the rate of ectopic pregnancy has increased dramatically over the past 20 years. This is believed to be due primarily to scarring of the fallopian tubes as a result of pelvic infection, inflammation, or surgery. The nurse who suspects that a patient has early signs of ectopic pregnancy should be observing her for symptoms such as (select all that apply) a. Pelvic pain b. Abdominal pain c. Unanticipated heavy bleeding d. Vaginal spotting or light bleeding e. Missed period

ANS: A, B, D, E Feedback Correct A missed period or spotting can easily be mistaken by the patient as early signs of pregnancy. More subtle signs depend on exactly where the implantation occurs. The nurse must be thorough in her assessment because pain is not a normal symptom of early pregnancy. Incorrect As the fallopian tube tears open and the embryo is expelled, the patient often exhibits severe pain accompanied by intraabdominal hemorrhage. This may progress to hypovolemic shock with minimal or even no external bleeding. In about half of women, shoulder and neck pain occurs due to irritation of the diaphragm from the hemorrhage.

MULTIPLE RESPONSE Approximately 60% to 80% of women with one low transverse uterine incision from a previous cesarean birth may have a successful vaginal delivery. Recommendations from ACOG related to VBAC risks include (select all that apply) a. Immediate availability of the obstetric provider b. Delivery at a tertiary care center c. Availability of anesthesia personnel d. Personnel who can assist with the cesarean birth e. Use of misoprostol for cervical ripening

ANS: A, C, D Feedback Correct A VBAC delivery should only be attempted with the obstetric provider in house, and anesthesia along with operative personnel readily available to perform a cesarean birth. Incorrect VBAC deliveries may be done in community hospitals if appropriate policies and guidelines for care are in place. Misoprostol administration is contraindicated in a patient with a previous uterine scar.

MULTIPLE RESPONSE 1. Induction of labor is considered an acceptable obstetric procedure if it is a safe time to deliver the fetus. The charge nurse on the labor and delivery unit is often asked to schedule patients for this procedure and therefore must be cognizant of the specific conditions appropriate for labor induction, including which of the following? Select all that apply. a. Rupture of membranes at or near term b. Convenience of the woman or her physician c. Chorioamnionitis (inflammation of the amniotic sac) d. Postterm pregnancy e. Fetal death

ANS: A, C, D, E Feedback Correct A, C, D, E. These are all acceptable indications for induction. Other conditions include intrauterine growth retardation (IUGR), maternal-fetal blood incompatibility, hypertension, and placental abruption. Incorrect B. Elective inductions for convenience of the woman or her provider are not recommended; however, they have become common. Factors such as rapid labors and living a long distance from a health care facility may be a valid reason in such a circumstance.

2. A patient who has undergone a D&C for early pregnancy loss is likely to be discharged the same day. The nurse must ensure that vital signs are stable, that bleeding has been controlled, and that the woman has adequately recovered from the administration of anesthesia. In order to promote an optimal recovery, discharge teaching should include (select all that apply) a. Iron supplementation b. Resumption of intercourse at 6 weeks post-procedure c. Referral to a support group if necessary d. Expectation of heavy bleeding for at least 2 weeks e. Emphasizing the need for rest

ANS: A, C, E Feedback Correct The woman should be advised to consume a diet high in iron and protein. For many women, iron supplementation also is necessary. Acknowledge that the patient has experienced a loss, albeit early. She can be taught to expect mood swings and possibly depression. Referral to a support group, clergy, or professional counseling may be necessary. Discharge teaching should emphasize the need for rest. Incorrect Nothing should be placed in the vagina for 2 weeks postprocedure. This includes tampons and vaginal intercourse. The purpose of this recommendation is to prevent infection. Should infection occur, antibiotics may be prescribed. The patient should expect a scant, dark discharge for 1 to 2 weeks. Should heavy, profuse, or bright bleeding occur she should be instructed to contact her provider.

Why is continuous electronic fetal monitoring usually used when oxytocin is administered? a. The mother may become hypotensive. b. Uteroplacental exchange may be compromised. c. Maternal fluid volume deficit may occur. d. Fetal chemoreceptors are stimulated.

ANS: B Feedback A Hypotension is not a common side effect of oxytocin. B The uterus may contract more firmly, and the resting tone may be increased with oxytocin use. This response reduces entrance of freshly oxygenated maternal blood into the intervillous spaces, depleting fetal oxygen reserves. C All laboring women are at risk for fluid volume deficit; oxytocin administration does not increase the risk. D Oxytocin affects the uterine muscles.

An indication for an episiotomy would be a woman who a. Has a routine vaginal birth b. Has fetal shoulder dystocia c. Is delivering a preterm infant d. Has a history of rapid deliveries

ANS: B Feedback A Once routine for all vaginal deliveries, the perceived benefits of reducing pain and perineal tearing have not proven true. B An episiotomy is indicated in the situation where the shoulder of the fetus become lodged under the mother symphysis during birth. C A preterm infant is smaller and does not need as much space for delivery. D Rapid deliveries are not an indication for a mediolateral episiotomy.

For which patient should the oxytocin (Pitocin) infusion be discontinued immediately? a. A woman in active labor with contractions every 31 minutes lasting 60 seconds each b. A woman in transition with contractions every 2 minutes lasting 90 seconds each c. A woman in active labor with contractions every 2 to 3 minutes lasting 70 to 80 seconds each d. A woman in early labor with contractions every 5 minutes lasting 40 seconds each

ANS: B Feedback A Oxytocin may assist this woman's contractions to become closer and more efficient. B This woman's contraction pattern represents hyperstimulation, and inadequate resting time occurs between contractions to allow placental perfusion. C There is an appropriate resting period between this woman's contractions. D There is an appropriate resting period between this woman's contractions for her stage of labor.

When positioning the Foley catheter before cesarean birth, the nurse knows that the catheter drainage tube and catheter bag should be a. Positioned on top of the patient's leg b. Placed near the head of the table c. Clamped during the cesarean section d. Positioned at the foot of the surgeon under the sterile drapes

ANS: B Feedback A The drain tube of the catheter should be positioned under her leg to promote drainage and to keep the catheter away from the operative area. B The anesthesia clinician must monitor urine output during the surgery. C Urinary output must be continuously monitored. An early sign of hypovolemia is a decreasing urinary output. D The surgeon might step on the drainage bag if the catheter was below the drapes, and no one could monitor the urine output.

After a forceps-assisted birth, the mother is observed to have continuous bright red lochia but a firm fundus. What other data indicates the presence of a potential vaginal wall hematoma? a. Mild, intermittent perineal pain b. Edema and discoloration of the labia and perineum c. Lack of an episiotomy d. Lack of pain in the perineal area

ANS: B Feedback A The pain with vaginal hematoma is severe and constant. B The nurse should monitor for edema and discoloration. Using a cold application to the labia and perineum reduces pain by numbing the area and limiting bruising and edema for the first 12 hours. C An episiotomy is performed as the fetal head distends the perineum. D The pain associated with vaginal hematoma is severe.

Which event indicates a complication of an external version? a. Maternal pulse rate of 100 bpm b. Fetal bradycardia persisting 10 minutes after the version c. Fetus returning to the original position d. Increased maternal anxiety after the version

ANS: B Feedback A There are few risks to the woman during an external version. B Fetal bradycardia after a version may indicate that the umbilical cord has become compressed, and the fetus is having hypoxia. C The fetus may return to the original position, but this is not a complication of the version. D Anxiety may occur before the version but should decrease after the procedure is completed.

1. The nurse sees a pattern on the fetal monitor that looks similar to early decelerations, but the deceleration begins near the acme of the contraction and continues well beyond the end of the contraction. Which nursing action indicates the proper evaluation of this situation? a. Continue to monitor these early decelerations, which occur as the fetal head is compressed during a contraction. b. This deceleration pattern is associated with uteroplacental insufficiency, so the nurse acts quickly to improve placental blood flow and fetal oxygen supply. c. This pattern reflects variable decelerations. No interventions are necessary at this time. d. Document this reassuring fetal heart rate pattern, but decrease the rate of the intravenous fluid.

ANS: B Feedback A These are late decelerations, not early; therefore interventions are necessary. B This is a description of a late deceleration. Oxygen should be given via snug facemask. Position the woman on her left side to increase placental blood flow. C Variable decelerations are caused by cord compression. A vaginal examination should be performed to identify this potential emergency. D This is not a reassuring pattern, so the intravenous rate should be increased to increase the mother's blood volume.

What is an appropriate response to a woman's comment that she is worried about having a cesarean birth? a. "Don't worry. Everything will be okay." b. "What are your feelings about having a cesarean birth?" c. "I know you're worried, but this is a routine procedure." d. "Patients commonly worry about surgery."

ANS: B Feedback A This answer is stating that the patient's feelings are not important. B Allowing the patient to express her feelings is the most appropriate nursing response. The nurse should never provide the patient with false reassurance or disregard her feelings. C This is belittling the patient's concerns and does not allow her to express her concerns. D This answer is close ended and belittling to the patient's feelings.

The nurse knows that a urinary catheter is added to the instrument table if a forceps-assisted birth is anticipated. What is the correct rationale for this intervention? a. Spontaneous release of urine might contaminate the sterile field. b. An empty bladder provides more room in the pelvis. c. A sterile urine specimen is needed preoperatively. d. A Foley catheter prevents the membranes from spontaneously rupturing.

ANS: B Feedback A Urine is sterile. B Catheterization provides room for the application of the forceps blades and limits bladder trauma. C A clean-catch urinalysis is usually sufficient for preoperative treatment. D The membranes must be ruptured and the cervix completely dilated for a forceps-assisted birth.

A maternal indication for the use of vacuum extraction is a. A wide pelvic outlet b. Maternal exhaustion c. A history of rapid deliveries d. Failure to progress past 0 station

ANS: B Feedback A With a wide pelvic outlet, vacuum extraction is not necessary. B With a mother who is exhausted will be unable to assist with the expulsion of the fetus. C With a rapid delivery, vacuum extraction is not necessary. D A station of 0 is too high for a vacuum extraction.

Which is the most appropriate method of intrapartum fetal monitoring when a woman has a history of hypertension during pregnancy? a. Continuous auscultation with a fetoscope b. Continuous electronic fetal monitoring c. Intermittent assessment with a Doppler transducer d. Intermittent electronic fetal monitoring for 15 minutes each hour

ANS: B Feedback A It is not practical to provide continuous auscultation with a fetoscope. B Maternal hypertension may reduce placental blood flow through vasospasm of the spiral arteries. Reduced placental perfusion is best assessed with continuous electronic fetal monitoring to identify patterns associated with this condition. C This fetus needs continuous monitoring because it is at high risk for complications. D This fetus needs continuous monitoring because it is at high risk for complications.

9. A woman with severe preeclampsia is being treated with bed rest and intravenous magnesium sulfate. The drug classification of this medication is a. Tocolytic b. Anticonvulsant c. Antihypertensive d. Diuretic

ANS: B Feedback A A tocolytic drug does slow the frequency and intensity of uterine contractions but is not used for that purpose in this scenario. B Anticonvulsant drugs act by blocking neuromuscular transmission and depress the central nervous system to control seizure activity. C Decreased peripheral blood pressure is a therapeutic response (side effect) of the anticonvulsant magnesium sulfate. D Diuresis is a therapeutic response to magnesium sulfate.

4. An abortion in which the fetus dies but is retained in the uterus is called _____ abortion. a. Inevitable b. Missed c. Incomplete d. Threatened

ANS: B Feedback A An inevitable abortion means that the cervix is dilating with the contractions. B Missed abortion refers to a dead fetus being retained in the uterus. C An incomplete abortion means that not all of the products of conception were expelled. D With a threatened abortion the woman has cramping and bleeding but not cervical dilation.

24. Which laboratory marker is indicative of disseminated intravascular coagulation (DIC)? a. Bleeding time of 10 minutes b. Presence of fibrin split products c. Thrombocytopenia d. Hyperfibrinogenemia

ANS: B Feedback A Bleeding time in DIC is normal. B Degradation of fibrin leads to the accumulation of multiple fibrin clots throughout the body's vasculature. C Low platelets may occur with but are not indicative of DIC because they may result from other coagulopathies. D Hypofibrinogenemia occurs with DIC.

29. The nurse caring for a woman hospitalized for hyperemesis gravidarum should expect that initial treatment involves a. Corticosteroids to reduce inflammation b. IV therapy to correct fluid and electrolyte imbalances c. An antiemetic, such as pyridoxine, to control nausea and vomiting d. Enteral nutrition to correct nutritional deficits

ANS: B Feedback A Corticosteroids have been used successfully to treat refractory hyperemesis gravidarum, but they are not the expected initial treatment for this disorder. B Initially, the woman who is unable to down clear liquids by mouth requires IV therapy for correction of fluid and electrolyte imbalances. C Pyridoxine is vitamin B6, not an antiemetic. Promethazine, a common antiemetic, may be prescribed. D In severe cases of hyperemesis gravidarum, enteral nutrition via a feeding tube may be necessary to correct maternal nutritional deprivation. This is not an initial treatment for this patient.

2. Which maternal condition always necessitates delivery by cesarean section? a. Partial abruptio placentae b. Total placenta previa c. Ectopic pregnancy d. Eclampsia

ANS: B Feedback A If the mother has stable vital signs and the fetus is alive, a vaginal delivery can be attempted. If the fetus has died, a vaginal delivery is preferred. B In total placenta previa, the placenta completely covers the cervical os. The fetus would die if a vaginal delivery occurred. C The most common ectopic pregnancy is a tubal pregnancy, which is usually detected and treated in the first trimester. D Labor can be safely induced if the eclampsia is under control.

20. What data on a patient's health history places her at risk for an ectopic pregnancy? a. Use of oral contraceptives for 5 years b. Recurrent pelvic infections c. Ovarian cyst 2 years ago d. Heavy menstrual flow of 4 days' duration

ANS: B Feedback A Oral contraceptives do not increase the risk for ectopic pregnancies. B Infection and subsequent scarring of the fallopian tubes prevents normal movement of the fertilized ovum into the uterus for implantation. C Ovarian cysts do not cause scarring of the fallopian tubes. D This will not cause scarring of the fallopian tubes, which is the main risk factor for ectopic pregnancies.

16. A patient with pregnancy-induced hypertension is admitted complaining of pounding headache, visual changes, and epigastric pain. Nursing care is based on the knowledge that these signs indicate a. Anxiety due to hospitalization b. Worsening disease and impending convulsion c. Effects of magnesium sulfate d. Gastrointestinal upset

ANS: B Feedback A These are danger signs and should be treated. B Headache and visual disturbances are due to increased cerebral edema. Epigastric pain indicates distention of the hepatic capsules and often warns that a convulsion is imminent. C She has not been started on magnesium sulfate as a treatment yet. Also, these are not expected effects of the medication. D These are danger signs showing increased cerebral edema and impending convulsion.

8. A pregnant woman is being discharged from the hospital after placement of a cerclage because of a history of recurrent pregnancy loss secondary to an incompetent cervix. Discharge teaching should emphasize that a. Any vaginal discharge should be reported immediately to her care provider. b. The presence of any contractions, rupture of membranes, or severe perineal pressure should be reported. c. She will need to make arrangements for care at home, because her activity level will be restricted. d. She will be scheduled for a cesarean birth.

ANS: B Feedback A Vaginal bleeding needs to be reported to her primary care provider. B Nursing care should stress the importance of monitoring signs and symptoms of preterm labor. C Bed rest is an element of care. However, the woman may stand for periods of up to 90 minutes, which allows her the freedom to see her physician. Home uterine activity monitoring may be used to limit the woman's need for visits and to safely monitor her status at home. D The cerclage can be removed at 37 weeks of gestation (to prepare for a vaginal birth), or a cesarean birth can be planned.

1. The perinatal nurse is giving discharge instructions to a woman, status post suction and curettage secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next 12 months. The best response from the nurse is a. "If you get pregnant within 1 year, the chance of a successful pregnancy is very small. Therefore, if you desire a future pregnancy, it would be better for you to use the most reliable method of contraception available." b. "The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produces during pregnancy. If you were to get pregnant, it would make the diagnosis of this cancer more difficult." c. "If you can avoid a pregnancy for the next year, the chance of developing a second molar pregnancy is rare. Therefore, to improve your chance of a successful pregnancy, it is better not to get pregnant at this time." d. "Oral contraceptives are the only form of birth control that will prevent a recurrence of a molar pregnancy."

ANS: B Feedback A Women should be instructed to use birth control for 1 year after treatment for a hydatidiform mole. Pregnancy raises hCG levels which increases the risk for choriocarcinoma. B This is an accurate statement. Beta-hCG levels will be drawn for 1 year to ensure that the mole is completely gone. There is an increased chance of developing choriocarcinoma after the development of a hydatidiform mole. The goal is to achieve a "zero" hCG level. If the woman were to become pregnant, it may obscure the presence of the potentially carcinogenic cells. C The rationale for avoiding pregnancy for 1 year is to ensure that carcinogenic cells are not present. D Any contraceptive method except an IUD is acceptable.

MULTIPLE RESPONSE 1. Labor is very stressful for the fetus. It is important for the intrapartum nurse to be knowledgeable regarding the mechanisms that regulate the fetal heart rate and keep the brain well oxygenated. When evaluating the patient's progress, the nurse knows that four of the five fetal factors that interact to regulate the heart rate are the a. Uterine activity b. Autonomic nervous system c. Baroreceptors d. Chemoreceptors e. Adrenal glands

ANS: B, C, D, E Feedback Correct The sympathetic and parasympathetic branches of the autonomic nervous system are balanced forces that regulate FHR. Sympathetic stimulation increases the heart rate, while parasympathetic responses, through stimulation of the vagus nerve, reduce the FHR and maintain variability. The baroreceptors stimulate the vagus nerve to slow the FHR and decrease the blood pressure. These are located in the carotid arch and major arteries. The chemoreceptors are cells that respond to changes in oxygen, carbon dioxide, and pH. They are found in the medulla oblongata and the aortic and carotid bodies. The adrenal medulla secretes epinephrine and norepinephrine in response to stress, causing an acceleration in FHR. Incorrect Hypertonic uterine activity can reduce the time available for exchange of oxygen and waste products; however, this is a maternal factor. The fifth fetal factor is the central nervous system. The fetal cerebral cortex causes the heart rate to increase during fetal movement and decrease when the fetus sleeps.

MULTIPLE RESPONSE According to the NICHD Three-Tier System of Fetal Heart Rate Classification, Category III tracings include all FHR tracings not categorized as Category I or II. Which characteristics of the fetal heart belong in Category III? Select all that apply. a. Baseline rate of 110 to 160 bpm b. Tachycardia c. Absent baseline variability NOT accompanied by recurrent decelerations d. Variable decelerations with other characteristics such as shoulders or overshoots e. Absent baseline variability with recurrent variable decelerations f. Bradycardia

ANS: B, D, E, F Feedback Correct These characteristics are all considered non-reassuring or abnormal and belong in Category III. Incorrect A fetal heart rate of 110 to 160 bpm is considered normal and belongs in Category I. Absent baseline variability not accompanied by recurrent decelerations is a Category II characteristic.

How does the available staff influence the selection of either continuous electronic or intermittent auscultation as the fetal-monitoring method? a. There must be a 1:1 nurse-to-patient ratio regardless of the method used. b. Staffing patterns do not influence fetal monitoring choices. c. Use of intermittent auscultation requires a lower nurse-to-patient ratio. d. More nurses are needed when electronic fetal monitoring is used because of increased medical interventions.

ANS: C Feedback A A one-to-one ratio is needed during the second stage of labor or if a high-risk condition exists, regardless of the monitoring method used. B Staffing patterns do plan a role in maintaining safe monitoring practice of the labor patient. C Intermittent auscultation is more staff-intensive. D Less nursing time is needed with electronic monitoring, giving the nurse more time for teaching and supporting the laboring woman.

Surgical, medical, or mechanical methods may be used for labor induction. Which technique is considered a mechanical method of induction? a. Amniotomy b. Intravenous Pitocin c. Transcervical catheter d. Vaginal insertion of prostaglandins

ANS: C Feedback A Amniotomy is a surgical method of augmentation and induction. B Intravenous Pitocin is a medical method of induction. C Placement of a balloon-tipped Foley catheter into the cervix is a mechanical method of induction. Other methods to expand and gradually dilate the cervix include Laminaria tents, Dilapan and Lamicel. D Insertion of prostaglandins is a medical method of induction.

The nurse caring for a woman in labor understands that the primary risk associated with an amniotomy is a. Maternal infection b. Maternal hemorrhage c. Prolapse of the umbilical cord d. Separation of the placenta

ANS: C Feedback A Infection is a risk of amniotomy, but not the primary concern. B Maternal hemorrhage is not associated with amniotomy. C When the membranes are ruptured, the umbilical cord may come downward with the flow of amniotic fluid and become trapped in front of the presenting part. D This may occur if the uterus is overdistended before the amniotomy, but it is not the major concern.

To monitor for potential hemorrhage in the woman who has just had a cesarean birth, the recovery room nurse should a. Maintain an intravenous infusion at 100 mL/hr. b. Assess the abdominal dressings for drainage. c. Assess the uterus for firmness every 15 minutes. d. Monitor her urinary output.

ANS: C Feedback A Maintaining proper fluid balance will not control hemorrhage. B This is an important assessment, but hemorrhage will first be noted vaginally. C Maintaining contraction of the uterus is important in controlling bleeding from the placental site. D This is an important assessment to prevent future hemorrhaging from occurring, but it is not the first priority assessment in the recovery room.

The priority nursing care associated with an oxytocin (Pitocin) infusion is a. Measuring urinary output b. Increasing infusion rate every 30 minutes c. Monitoring uterine response d. Evaluating cervical dilation

ANS: C Feedback A Monitoring urinary output is important with Pitocin, but not the top priority. B The infusion rate may be increased, but only after proper assessment that it is appropriate. C Because of the risk of hyperstimulation, which could result in decreased placental perfusion and uterine rupture, the nurse's priority intervention is monitoring uterine response. D Monitoring labor progression is important, but not the top priority.

When a nonreassuring pattern of the fetal heart rate is noted and the mother is lying on her left side, what nursing action is indicated? a. Lower the head of the bed. b. Place the mother in a Trendelenburg position. c. Change her position to the right side. d. Place a wedge under the left hip.

ANS: C Feedback A Repositioning to the opposite side is the first intervention. If unsuccessful with improving the FHR pattern, further changes in position can be attempted. B The Trendelenburg position is not appropriate for early interventions. If unsuccessful with improving the FHR pattern with other types of position changes, Trendelenburg may be the choice. C Repositioning on the opposite side may relieve compression on the umbilical cord and improve blood flow to the placenta. D The woman is already on her left side, so a wedge on that side is not an appropriate choice.

To provide safe care for the woman, the nurse understands that which condition is a contraindication for an amniotomy? a. Dilation less than 3 cm b. Cephalic presentation c. -2 station d. Right occiput posterior position

ANS: C Feedback A The dilation must be enough to determine labor. B The presenting part should be cephalic. Amniotomy is deferred if the presenting part is higher in the pelvis. C A prolapsed cord can occur if the membranes artificially rupture when the presenting part is not engaged. D This indicates a cephalic presentation, which is appropriate for an amniotomy.

Which method of assessing the fetal heart rate requires the use of a gel? a. Fetoscope b. Tocodynamometer c. Doppler d. Scalp electrode

ANS: C Feedback A The fetoscope does not require the use of gel because ultrasonic transmission is not used. B Tocodynamometer does not require the use of gel. This device monitors uterine contractions. C Doppler is the only listed method involving ultrasonic transmission of fetal heart rates; it requires use of a gel. D The scalp electrode is attached to the fetal scalp; gel is not necessary.

Which nursing action is correct when initiating electronic fetal monitoring? a. Lubricate the tocotransducer with an ultrasound gel. b. Inform the patient that she should remain in the semi-Fowler's position. c. Securely apply the tocotransducer with a strap or belt. d. Determine the position of the fetus before attaching the electrode to the maternal abdomen.

ANS: C Feedback A The tocotransducer does not need gel to operate appropriately. B The patient should be encouraged to move around during labor. C The tocotransducer should fit snugly on the abdomen to monitor uterine activity accurately. D The tocotransducer should be placed at the fundal area of the uterus.

The nurse-midwife is concerned that a woman's uterine activity is too intense and that her obesity is preventing accurate assessment of the actual intrauterine pressure. On the basis of this information, the nurse should obtain a(n) a. Tocotransducer b. Scalp electrode c. Intrauterine pressure catheter d. Doppler transducer

ANS: C Feedback A The tocotransducer measures the uterine pressure externally; this not be accurate with obesity. B A scalp electrode measurers the fetal heart rate (FHR). C An intrauterine pressure catheter can measure actual intrauterine pressure. D A Doppler auscultates the FHR.

The greatest risk to the newborn after an elective cesarean birth is a. Trauma due to manipulation during delivery b. Tachypnea due to maternal anesthesia c. Prematurity due to miscalculation of gestation d. Tachycardia due to maternal narcotics

ANS: C Feedback A There is reduced trauma with a cesarean birth. B Maternal anesthesia may cause respiratory distress. C Regardless of the many criteria used to determine gestational age, inadvertent preterm birth still occurs. D Maternal narcotics may cause respiratory distress.

The nurse notes a pattern of late decelerations on the fetal monitor. The most appropriate action is to a. Continue observation of this reassuring pattern. b. Notify the physician or nurse-midwife. c. Give the woman oxygen by face mask. d. Place the woman in a Trendelenburg position.

ANS: C Feedback A This is not a reassuring pattern; interventions are needed. B Nursing interventions should be initiated before notifying the health care provider. C Late decelerations are associated with reduced placental perfusion. Giving the laboring woman oxygen increases the oxygen saturation in her blood, making more oxygen available to the fetus. D The Trendelenburg position will not increase the placental perfusion.

6. What condition indicates concealed hemorrhage in an abruptio placentae? a. Decrease in abdominal pain b. Bradycardia c. Hard, boardlike abdomen d. Decrease in fundal height

ANS: C Feedback A Abdominal pain may increase. B The patient will have shock symptoms that include tachycardia. C Concealed hemorrhage occurs when the edges of the placenta do not separate. The formation of a hematoma behind the placenta and subsequent infiltration of the blood into the uterine muscle results in a very firm, boardlike abdomen. D The fundal height will increase as bleeding occurs.

23. The primary symptom present in abruptio placentae that distinguishes it from placenta previa is a. Vaginal bleeding b. Rupture of membranes c. Presence of abdominal pain d. Changes in maternal vital signs

ANS: C Feedback A Both may have vaginal bleeding. B Rupture of membranes may occur with both conditions. C Pain in abruptio placentae occurs in response to increased pressure behind the placenta and within the uterus. Placenta previa manifests with painless vaginal bleeding. D Maternal vital signs may change with both if bleeding is pronounced.

13. The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the Pitocin infusion, the nurse reviews the woman's latest laboratory test findings, which reveal a low platelet count, an elevated aspartate transaminase (AST) level, and a falling hematocrit. The nurse notifies the physician, because the lab results are indicative of a. Eclampsia b. Disseminated intravascular coagulation c. HELLP syndrome d. Rh incompatibility

ANS: C Feedback A Eclampsia is determined by the presence of seizures. B DIC is a potential complication associated with HELLP syndrome. C HELLP syndrome is a laboratory diagnosis for a variant of severe preeclampsia that involves hepatic dysfunction characterized by hemolysis (H), elevated liver enzymes (EL), and low platelets (LP). D These are not clinical indications of Rh incompatibility.

14. The nurse is explaining how to assess edema to the nursing students working on the antepartum unit. Which score indicates edema of lower extremities, face, hands, and sacral area? a. +1 edema b. +2 edema c. +3 edema d. +4 edema

ANS: C Feedback A Edema classified as +1 indicates minimal edema of the lower extremities. B Marked edema of the lower extremities is termed +2 edema. C Edema of the extremities, face, and sacral area is classified as +3 edema. D Generalized massive edema (+4) includes accumulation of fluid in the peritoneal cavity.

15. A primigravida is being monitored in her prenatal clinic for preeclampsia. What finding should concern her nurse? a. Blood pressure increase to 138/86 mm Hg b. Weight gain of 0.5 kg during the past 2 weeks c. A dipstick value of 3+ for protein in her urine d. Pitting pedal edema at the end of the day

ANS: C Feedback A Generally, hypertension is defined as a BP of 140/90 or an increase in systolic pressure of 30 mm Hg or 15 mm Hg diastolic pressure. B Preeclampsia may be manifested as a rapid weight gain of more than 2 kg in 1 week. C Proteinuria is defined as a concentration of 1+ or greater via dipstick measurement. A dipstick value of 3+ should alert the nurse that additional testing or assessment should be made. D Edema occurs in many normal pregnancies as well as in women with preeclampsia. Therefore, the presence of edema is no longer considered diagnostic of preeclampsia.

10. What is the only known cure for preeclampsia? a. Magnesium sulfate b. Antihypertensive medications c. Delivery of the fetus d. Administration of acetylsalicylic acid (ASA) every day of the pregnancy

ANS: C Feedback A Magnesium sulfate is one of the medications used to treat but not to cure preeclampsia. B Antihypertensive medications are used to lower the dangerously elevated blood pressures in preeclampsia and eclampsia. C If the fetus is viable and near term, delivery is the only known "cure" for preeclampsia. D Low doses of ASA (60 to 80 mg) have been administered to women at high risk for developing preeclampsia.

28. Methotrexate is recommended as part of the treatment plan for which obstetric complication? a. Complete hydatidiform mole b. Missed abortion c. Unruptured ectopic pregnancy d. Abruptio placentae

ANS: C Feedback A Methotrexate is not indicated or recommended as a treatment option for a complete hydatidiform mole. B Methotrexate is not indicated or recommended as a treatment option for missed abortions. C Methotrexate is an effective, nonsurgical treatment option for a hemodynamically stable woman whose ectopic pregnancy is unruptured and less than 4 cm in diameter. D Methotrexate is not indicated or recommended as a treatment option for abruptio placentae.

21. What finding on a prenatal visit at 10 weeks might suggest a hydatidiform mole? a. Complaint of frequent mild nausea b. Blood pressure of 120/80 mm Hg c. Fundal height measurement of 18 cm d. History of bright red spotting for 1 day, weeks ago

ANS: C Feedback A Nausea increases in a molar pregnancy because of the increased production of hCG. B A woman with a molar pregnancy may have early-onset pregnancy-induced hypertension. C The uterus in a hydatidiform molar pregnancy is often larger than would be expected on the basis of the duration of the pregnancy. D The history of bleeding is normally described as being brownish.

25. A woman taking magnesium sulfate has respiratory rate of 10 breaths/min. In addition to discontinuing the medication, the nurse should a. Vigorously stimulate the woman. b. Instruct her to take deep breaths. c. Administer calcium gluconate. d. Increase her IV fluids.

ANS: C Feedback A Stimulation will not increase the respirations. B This will not be successful in reversing the effects of the magnesium sulfate. C Calcium gluconate reverses the effects of magnesium sulfate. D Increasing her IV fluids will not reverse the effects of the medication.

A couple has been counseled for genetic anomalies. They ask the nurse, "What is karyotyping?" Which of the following is the nurse's best response? a. "Karyotyping will reveal if the baby's lungs are mature." b. "Karyotyping will reveal if your baby will develop normally." c. "Karyotyping will provide information about the number and structure of the chromosomes." d. "Karyotyping will detect any physical deformities the baby has."

ANS: C Karyotyping provides genetic information, such as gender and chromosomal structure. Karyotyping is completed by photographing or using computer imaging to arrange chromosomes in pairs from largest to smallest. The karyotype can then be analyzed.

In practical terms regarding genetic health care, nurses should be aware that a. genetic disorders equally affect people of all socioeconomic backgrounds, races,and ethnic groups. b. genetic health care is more concerned with populations than individuals. c. the most important related nursing function is providing emotional support to thefamily during counseling. d. taking genetic histories is usually only done at large universities and medical centers.

ANS: C Nurses should be prepared to help with a variety of stress reactions from a couple facing thepossibility of a genetic disorder. Although anyone may have a genetic disorder, certaindisorders appear more often in certain ethnic and racial groups. Genetic health care is highlyindividualized, because treatments are based on the phenotypic responses of the individual.

MULTIPLE RESPONSE The baseline fetal heart rate (FHR) is the average rate during a 10-minute segment. Changes in FHR are categorized as periodic or episodic. These patterns include both accelerations and decelerations. The labor nurse is evaluating the patient's most recent 10-minute segment on the monitor strip and notes a late deceleration. This is likely to be caused by which physiologic alteration? Select all that apply. a. Spontaneous fetal movement b. Compression of the fetal head c. Placental abruption d. Cord around the baby's neck e. Maternal supine hypotension

ANS: C, E Feedback Correct Late decelerations are almost always caused by uteroplacental insufficiency. Insufficiency is caused by: uterine tachysystole, maternal hypotension, epidural or spinal anesthesia, IUGR, intraamniotic infection, or placental abruption. Incorrect Spontaneous fetal movement, vaginal examination, fetal scalp stimulation, fetal reaction to external sounds, uterine contractions, fundal pressure and abdominal palpation are all likely to cause accelerations of the FHR. Early decelerations are most often the result of fetal head compression and may be caused by uterine contractions, fundal pressure, vaginal examination and placement of an internal electrode. A variable deceleration is likely caused by umbilical cord compression. This may happen when the cord is around the baby's neck, arm, leg or other body part, a short cord, a knot in the cord or a prolapsed cord.

When preparing a woman for a cesarean birth, the nurse's care should include a. Injection of narcotic preoperative medications b. Full perineal shave preparation c. Straight catheterization to empty the bladder d. Administration of an oral antacid

ANS: D Feedback A A narcotic at this point would put the fetus at high risk for respiratory distress. B Perineal preparation is not necessary for a cesarean section. Some agencies will do an abdominal prep just before the surgery. C The catheterization should be indwelling in order to keep the bladder small during the surgery. D General anesthesia may be needed unexpectedly for cesarean birth. An oral antacid neutralizes gastric acid and reduces potential lung injury if the woman vomits and aspirates gastric contents during anesthesia.

A nurse might be called on to stimulate the fetal scalp a. As part of fetal scalp blood sampling b. In response to tocolysis c. In preparation for fetal oxygen saturation monitoring d. To elicit an acceleration in the FHR

ANS: D Feedback A Fetal scalp blood sampling involves swabbing the scalp with disinfectant before a sample is collected. The nurse would stimulate the fetal scalp to elicit an acceleration of the FHR. B Tocolysis is relaxation of the uterus. The nurse would stimulate the fetal scalp to elicit an acceleration of the FHR. C Fetal oxygen saturation monitoring involves the insertion of a sensor. The nurse would stimulate the fetal scalp to elicit an acceleration of the FHR. D The scalp can be stimulated using digital pressure during a vaginal examination.

The standard of care for obstetrics dictates that an internal version might be used to manipulate the a. Fetus from a breech to a cephalic presentation before labor begins b. Fetus from a transverse lie to a longitudinal lie before cesarean birth c. Second twin from an oblique lie to a transverse lie before labor begins d. Second twin from a transverse lie to a breech presentation during vaginal birth

ANS: D Feedback A For internal version to occur, the cervix needs to be completely dilated. B For internal version to occur, the cervix needs to be dilated. C Internal version is done to turn the second twin after the first twin is born. D Internal version is used only during vaginal birth to manipulate the second twin into a presentation that allows it to be born vaginally.

Increasing the infusion rate of nonadditive intravenous fluids can increase fetal oxygenation primarily by a. Maintaining normal maternal temperature b. Preventing normal maternal hypoglycemia c. Increasing the oxygen-carrying capacity of the maternal blood d. Expanding maternal blood volume

ANS: D Feedback A Increasing fluid volume may alter the maternal temperature only if she is dehydrated. B Most intravenous fluids for laboring women are isotonic and do not add extra glucose. C Oxygen-carrying capacity is increased by adding more red blood cells. D Filling the mother's vascular system makes more blood available to perfuse the placenta and may correct hypotension.

The nurse practicing in a labor setting knows that the woman most at risk for a uterine rupture is a gravida a. 3 who has had two low-segment transverse cesarean births b. 2 who had a low-segment vertical incision for delivery of a 10-pound infant c. 5 who had two vaginal births and two cesarean births d. 4 who has had all cesarean births

ANS: D Feedback A Low-segment transverse cesarean scars do not predispose her to uterine rupture. B Low-segment incisions do not raise the risk of uterine ruptures. C This woman is not a high-risk candidate. D The risk of uterine rupture increases as the number of prior uterine incisions increases. More than 2 previous cesarean births places the woman at increased risk for uterine rupture.

The priority nursing intervention after an amniotomy is to a. Assess the color of the amniotic fluid. b. Change the patient's gown. c. Estimate the amount of amniotic fluid. d. Assess the fetal heart rate.

ANS: D Feedback A This is important, but not the top priority. B This is important for patient comfort, but it is not the top priority. C This is not a top priority for this patient. D The fetal heart rate must be assessed immediately after the rupture of the membranes to determine whether cord prolapse or compression has occurred.

When the mother's membranes rupture during active labor, the fetal heart rate should be observed for the occurrence of which periodic pattern? a. Increase in baseline variability b. Nonperiodic accelerations c. Early decelerations d. Variable decelerations

ANS: D Feedback A This is not an expected occurrence after the rupture of membranes. B Accelerations are considered reassuring; they are not a concern after rupture of membranes. C Early declarations are considered reassuring; they are not a concern after rupture of membranes. D When the membranes rupture, amniotic fluid may carry the umbilical cord to a position where it will be compressed between the maternal pelvis and the fetal presenting part, resulting in a variable deceleration pattern.

When using IA for FHR, nurses should be aware that a. They can be expected to cover only two or three patients when IA is the primary method of fetal assessment. b. The best course is to use the descriptive terms associated with EFM when documenting results. c. If the heartbeat cannot be found immediately, a shift must be made to electronic monitoring. d. Ultrasound can be used to find the fetal heartbeat and reassure the mother if initial difficulty was a factor.

ANS: D Feedback A When used as the primary method of fetal assessment, auscultation requires a nurse-to-patient ratio of one to one. B Documentation should use only terms that can be numerically defined; the usual visual descriptions of EFM are inappropriate. C Locating fetal heartbeats often takes time. Mothers can be reassured verbally and by the ultrasound pictures if that device is used to help locate the heartbeat. D Locating fetal heartbeats often takes time. Mothers can be reassured verbally and by the ultrasound pictures if that device is used to help locate the heartbeat.

18. In which situation is a dilation and curettage (D&C) indicated? a. Complete abortion at 8 weeks b. Incomplete abortion at 16 weeks c. Threatened abortion at 6 weeks d. Incomplete abortion at 10 weeks

ANS: D Feedback A If all the products of conception have been passed (complete abortion), a D&C is not used. B D&C is used to remove the products of conception from the uterus and can be done safely until week 14 of gestation. C If the pregnancy is still viable (threatened abortion), a D&C is not used. D D&C is used to remove the products of conception from the uterus and can be used safely until week 14 of gestation.

30. A woman with preeclampsia has a seizure. The nurse's primary duty during the seizure is to a. Insert an oral airway. b. Suction the mouth to prevent aspiration. c. Administer oxygen by mask. d. Stay with the patient and call for help.

ANS: D Feedback A Insertion of an oral airway during seizure activity is no longer the standard of care. The nurse should attempt to keep the airway patent by turning the patient's head to the side to prevent aspiration. B Once the seizure has ended, it may be necessary to suction the patient's mouth. C Oxygen would be administered after the convulsion has ended. D If a patient becomes eclamptic, the nurse should stay with her and call for help. Nursing actions during a convulsion are directed towards ensuring a patent airway and patient safety.

22. What routine nursing assessment is contraindicated in the patient admitted with suspected placenta previa? a. Monitoring FHR and maternal vital signs b. Observing vaginal bleeding or leakage of amniotic fluid c. Determining frequency, duration, and intensity of contractions d. Determining cervical dilation and effacement

ANS: D Feedback A Monitoring FHR and maternal vital signs is a necessary part of the assessment for this woman. B Monitoring for bleeding and rupture of membranes is not contraindicated with this woman. C Monitoring contractions is not contraindicated with this woman. D Vaginal examination of the cervix may result in perforation of the placenta and subsequent hemorrhage.

11. Which clinical sign is not included in the classic symptoms of preeclampsia? a. Hypertension b. Edema c. Proteinuria d. Glycosuria

ANS: D Feedback A The first indication of preeclampsia is usually an increase in the maternal blood pressure. B The first sign noted by the pregnant woman is a rapid weight gain and edema of the hands and face. C Proteinuria usually develops later than the edema and hypertension. D Spilling glucose into the urine is not one of the three classic symptoms of preeclampsia.

26. A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Nursing care is based on the knowledge that a. Bed rest and analgesics are the recommended treatment. b. She will be unable to conceive in the future. c. A D&C will be performed to remove the products of conception. d. Hemorrhage is the major concern.

ANS: D Feedback A The recommended treatment is to remove the pregnancy before hemorrhaging. B If the tube must be removed, her fertility will decrease but she will not be infertile. C A D&C is done on the inside of the uterine cavity. The ectopic is located within the tubes. D Severe bleeding occurs if the fallopian tube ruptures.

5. A placenta previa in which the placental edge just reaches the internal os is called a. Total b. Partial c. Complete d. Marginal

ANS: D Feedback A With a total placenta previa the placenta completely covers the os. B With a partial previa the lower border of the placenta is within 3 cm of the internal cervical os, but does not completely cover the os. C A complete previa is termed total. The placenta completely covers the internal cervical os. D A placenta previa that does not cover any part of the cervix is termed marginal.

A nurse is seeing a pregnant woman who has had genetic testing on her unborn fetus and has been given the results. The nurse notes the results confirm that the husband could not be thefather. What action by the nurse is best? a. Do not discuss this information with the mother. b. Inform the mother genetic testing does not establish paternity. c. Call the husband immediately to break the news. d. Be available and offer support as the mother absorbs the news.

ANS: D Genetic testing can reveal paternity; hopefully the couple was informed that this can occurbefore the testing was done. The nurse should offer support to the woman as she tries toabsorb the news and determine what to do next.

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

ANS: D The nurse should probe gently by using lay-oriented terminology rather than direct questionsor statements.

As an adjunct to inductions, a number of procedures to ripen the cervix are employed. One of these methods is the vaginal administration of preparations using prostaglandins. Before administering this medication, the nurse should be aware that this class of drug is an appropriate choice for women who have had a prior cesarean birth. Is this statement true or false?

ANS: F Prostaglandins are contraindicated in patients who have had a prior cesarean birth or other uterine surgery. A side effect of prostaglandin administration is hyperstimulation of the uterus. This may result in reduced uterine blood flow to the fetus, impaired gas exchange, and increased risk of uterine rupture. Prostaglandins should also be used with caution in women who have asthma, heart disease, glaucoma, or renal or hepatic dysfunction.

According to the 2008 National Institute of Child Health and Human Development (NICHD) nomenclature, there are four categories of fetal heart rate variability: absent, minimal, moderate, and marked. Is this statement true or false?

ANS: T Absent: the amplitude range is undetectable. Minimal: detectable to less than or equal to 5 bpm. Moderate (normal): 6 to 25 bpm. Marked: a range greater than 25 bpm.

The birth attendant evaluates whether labor and birth are safer for the woman and her fetus than continuing the pregnancy. The Bishop Scoring System remains a popular tool to assist in this task. Is this statement true or false?

ANS: T The Bishop score uses 5 factors to determine readiness for labor (dilation, effacement, consistency, position, and fetal station). The likelihood of a vaginal birth is similar to that of spontaneous labor if the score is greater than 8.

A number of cardiovascular system changes occur during pregnancy. Which finding is considered normal for a woman during pregnancy? a. Cardiac output rises by 25% b. Increased pulse rate c. Increased blood pressure d. Decreased red blood cell (RBC) production

B

A patient in her first trimester complains of nausea and vomiting. She asks, "Why does this happen?" The nurse's best response is a. "It is due to an increase in gastric motility." b. "It may be due to changes in hormones." c. "It is related to an increase in glucose levels." d. "It is caused by a decrease in gastric secretions."

B

A woman is 35 weeks' pregnant during her clinic visit. She complains of numerous vaginal infections during the pregnancy. She tells the nurse, "I'm afraid I have diabetes, because I have some infections." The best response by the nurse would be A. "Diabetes is a possibility. I will set you up for testing." B. "A vaginal infection is a symptom of diabetes, but it also is a problem with normal pregnancies due to the changes in your vaginal area." C. "Itching is a problem with pregnancies and it makes you think you have an infection. The physician can order you some cream to help with the itching and pain." D. "This seems to be a concern with all of our patients today."

B

A woman is concerned that she has developed numerous nosebleeds during this pregnancy. She feels this is a sign of leukemia and wants to be screened. The nurse's response to the woman should be based on the fact that A. leukemia is a major concern during pregnancy. B. nosebleeds are a common occurrence during pregnancy. C. nosebleeds are rare in pregnancy; therefore further assessment is necessary. D. platelet count decreases significantly during pregnancy.

B

A woman is expecting her first baby in 7 months. During the nurse's assessment Anna continues to ask questions about changes in her body. The nurse can recommend which type of class to assist the woman with her questions? A. Preconception class B. Early pregnancy class C. Childbirth preparation class D. Parenting class

B

A woman's last menstrual period was June 10. Her estimated date of delivery (EDD) is a. April 7 b. March 17 c. March 27 d. April 17

B

Early pregnancy classes offered in the first and second trimesters cover a. Phases and stages of labor b. Coping with common discomforts of pregnancy c. Methods of pain relief d. Predelivery and postdelivery care of the patient having a cesarean delivery

B

Mimicry refers to observing and copying the behaviors of other mothers. An example might be a. Babysitting for a neighbor's children b. Wearing maternity clothes before they are needed c. Daydreaming about the newborn d. Imagining oneself as a good mother

B

Physiologic anemia often occurs during pregnancy as a result of a. Inadequate intake of iron b. Dilution of hemoglobin concentration c. The fetus establishing iron stores d. Decreased production of erythrocytes

B

The maternity nurse understands that vascular volume increases 40% to 60% during pregnancy to a. Compensate for decreased renal plasma flow. b. Provide adequate perfusion of the placenta. c. Eliminate metabolic wastes of the mother. d. Prevent maternal and fetal dehydration.

B

The nurse is working in an OB/GYN office and commonly obtains patient histories and performs initial assessments. Which woman is likely to be referred for genetic counseling after her first visit? a. A pregnant woman who will be 40 years or older when her infant is born b. A woman whose partner is 41 years of age c. A patient who carries a Y-linked disorder d. An anxious woman with a normal quadruple screening result

B

The nurse who practices in a prenatal clinic understands that a major concern of lower socioeconomic groups is to a. Maintain group health insurance on their families. b. Meet health needs as they occur. c. Practice preventive health care. d. Maintain an optimistic view of life.

B

Which complaint by a patient at 35 weeks of gestation requires additional assessment? a. Shortness of breath when climbing stairs b. Abdominal pain c. Ankle edema in the afternoon d. Backache with prolonged standing

B

Which finding in the urine analysis of a pregnant woman is considered a variation of normal? a. Proteinuria b. Glycosuria c. Bacteria in the urine d. Ketones in the urine

B

Which situation best describes a man "trying on" fathering behaviors? a. Spending more time with his siblings b. Coaching a Little League baseball team c. Reading books on newborn care d. Exhibiting physical symptoms related to pregnancy

B

Which statement related to changes in the breasts during pregnancy is the most accurate? a. During the early weeks of pregnancy there is decreased sensitivity. b. Nipples and areolae become more pigmented. c. Montgomery tubercles are no longer visible around the nipples. d. Venous congestion of the breasts is more visible in the multiparous woman.

B

Which woman would be most likely to seek prenatal care? a. A 15-year-old who tells her friends, "I don't believe I'm pregnant." b. A 20-year-old who is in her first pregnancy and has access to a free prenatal clinic c. A 28-year-old who is in her second pregnancy and abuses drugs and alcohol d. A 30-year-old who is in her fifth pregnancy and delivered her last infant at home with the help of her mother and sister

B

The nurse is monitoring the fetal heart rate periodically with Doppler auscultation. At the end of a contraction, the fetal heart rate is 100 and gradually increases to 140 within 30 seconds. The nurse would need to assess the rate further, because this is an indication of A low variability. B late deceleration. C early deceleration. D variable deceleration.

B A late deceleration shows a pattern of fetal heart decelerations that begin late in the contraction phase and go back to baseline after the contraction has ended. Low variability cannot be assessed with Doppler auscultation. With early decelerations, the fetal heart rate would be returned to normal by the end of the contraction. With variable deceleration, the nurse would hear a sudden drop in the fetal heart rate and a sudden return to normal rate.

The patient has been diagnosed with hydramnios. When an amniotomy is performed, the nurse is aware that the patient is at risk for which complication? A Placenta previa B Abruptio placentae C Infection D Fetal hypoxia

B Abruptio placentae may occur after an amniotomy if the uterus is distended. Hydramnios will distend the uterus. Placenta previa is not a risk factor associated with hydramnios and/or amniotomy. Infection is a risk factor associated with amniotomy; however, having hydramnios does not increase the risk factor. Fetal hypoxia may occur if abruptio placentae occurs, but it is not a risk factor associated with amniotomy.

In order to monitor for one of the side effects of oxytocin, it is important for the nurse to note the patient's A temperature. B intake and output. C respiratory rate. D deep tendon reflexes.

B Prolonged administration may cause fluid retention. Recording intake and output identifies fluid retention, which precedes water intoxication. Infection, respiratory depression, and alterations in deep tendon reflexes are not a side effect of oxytocin use.

Why should continuous electronic fetal monitoring be used when oxytocin is administered? A The woman may become hypotensive. B Utero-placental exchange may be compromised. C Maternal fluid volume deficit may occur. D Fetal chemoreceptors are stimulated.

B The uterus may contract more firmly, and the resting tone may be increased with oxytocin use. This reduces entrance of freshly oxygenated maternal blood into the intervillous spaces, depleting fetal oxygen reserves. Oxytocin use does not cause hypotension, decrease maternal fluid volume, or stimulate the fetal chemoreceptors.

The nurse sees a pattern on the fetal monitor that looks similar to early decelerations, but the deceleration begins near the acme of the contraction and continues well beyond the end of the contraction. Which nursing action indicates the proper evaluation of this situation? A Continue to monitor these early decelerations, which occur as the fetal head is compressed during a contraction. B This deceleration pattern is associated with utero-placental insufficiency, so the nurse acts quickly to improve placental blood flow and fetal oxygen supply. C This pattern reflects variable decelerations. No interventions are necessary at this time. D Document this reassuring fetal heart rate pattern, but decrease the rate of the intravenous fluid.

B This is a description of a late deceleration. Oxygen should be given via snug face mask. The nurse should position the woman on her side to increase placental blood flow. An early deceleration would end when the contraction phase is over. This pattern continues beyond the end of the contraction. Variable decelerations drop suddenly and return to baseline suddenly. They are caused by cord compression. A vaginal examination should be performed to identify this potential emergency. This pattern is nonreassuring. The intravenous fluid should be increased to increase the woman's blood volume.

A woman is admitted to the birthing unit in labor. Upon assessment, it is noted that she is 3 cm dilated and 80% effaced with intact membranes. The nurse understands that her fetal monitoring will be done by A internal electrodes. B external electrode.

B To use internal electrodes, the woman must be 2 cm dilated and have ruptured membranes. Her membranes are intact. Therefore, external electrode monitoring is the choice for her.

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

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

Which of these conditions may cause the fetal heart rate to be lower during labor? Select all that apply. A Stimulation of the sympathetic nervous system B Stimulation of the baroreceptors, which in turn stimulates the vagus nerve C Prolonged hypoxia, hypercapnia, and acidosis D Stimulation of the parasympathetic nervous system

B, C, D Stimulation of the baroreceptors and the parasympathetic nervous system will lower the heart rate. Initial decreased oxygen content and increased carbon dioxide content will trigger an increase in the heart rate. However, if this condition continues, the heart rate will lower. Stimulation of the sympathetic nervous system increases the heart rate.

A baby is born with blood type AB. His father is type A, his mother is type B. The father asks why the baby has been born with a different blood type than his parents. The nurse's answer should be based on the knowledge that

Both A and B types are dominant baby can inherit one from each parent. This infant has inherited both blood types from the parent and it is not a mutation

While providing education to a primiparous woman regarding the normal changes of pregnancy, it is important for the nurse to explain that the uterus undergoes irregular contractions. These are known as _____________ contractions.

Braxton Hicks

A 36-year-old divorcee with a successful modeling career finds out that her 18-year-old married daughter is expecting her first child. What is a major factor in determining how the woman will respond to becoming a grandmother? a. Her career b. Being divorced c. Her age d. Age of the daughter

C

A patient who is 7 months pregnant states, "I'm worried that something will happen to my baby." The nurse's best response is a. "There is nothing to worry about." b. "The doctor is taking good care of you and your baby." c. "Tell me about your concerns." d. "Your baby is doing fine."

C

A woman in her first trimester of pregnancy can expect to visit her physician every 4 weeks so that a. She develops trust in the health care team. b. Her questions about labor can be answered. c. The condition of the expectant mother and fetus can be monitored. d. Problems can be eliminated.

C

A woman is currently pregnant; she has a 5-year-old son and a 3-year-old daughter. She had one other pregnancy that terminated at 8 weeks. Her gravida and para are a. Gravida 3 para 2 b. Gravida 4 para 3 c. Gravida 4 para 2 d. Gravida 3 para 3

C

A woman tells the nurse she is 16 weeks' pregnant. During the assessment, the nurse measures the fundus of the uterus to be at the umbilicus. The nurse correctly interprets the comparison of the dates with the measurements to be A. not comparable. B. congruent. C. incongruent. D. irrelevant.

C

A woman who is 7 months' pregnant states, "I'm worried that something will happen to my baby." The nurse's best response is A. "There is nothing to worry about." B. "The doctor is taking good care of you and your baby." C. "Tell me about your concerns." D. "Your baby is doing fine."

C

After seeing the physician, the woman is confused about her upcoming induction. She states to the nurse, "The doctor said I would need a gel inserted prior to going into labor. What does that mean?" The nurse's response should be based on knowledge that A a lubricating gel is inserted prior to induction to facilitate the insertion of the electronic monitoring devices. B a gel is inserted prior to induction to stimulate the rupture of the membranes. C a gel is inserted prior to induction to ripen the cervix. a lubricating gel is inserted so that it will not need to be D reapplied prior to each vaginal exam during labor.

C

Alterations in hormonal balance and mechanical stretching are responsible for several changes in the integumentary system during pregnancy. Stretch marks often occur on the abdomen and breasts. These are referred to as a. Chloasma b. Linea nigra c. Striae gravidarum d. Angiomas

C

As a nurse in labor and delivery, you are caring for a Muslim woman during the active phase of labor. You note that when you touch her, she quickly draws away. You should a. Continue to touch her as much as you need to while providing care. b. Assume that she doesn't like you and decrease your time with. c. Limit touching to a minimum, as this may not be acceptable in her culture. d. Ask the charge nurse to reassign you to another patient.

C

Centering pregnancy is an example of an alternative model of prenatal care. Which statement accurately applies to the centering model of care? a. Group sessions begin with the first prenatal visit. b. At each visit blood pressure, weight, and urine dipsticks are obtained by the nurse. c. Eight to 12 women are placed in gestational-age cohort groups. d. Outcomes are similar to traditional prenatal care.

C

During prenatal teaching it is important for the nurse to inform the patient about danger signs in pregnancy. Which sign need to be reported immediately to the health care provider? A. Clear mucous vaginal discharge B. Frequent urination C. Vaginal bleeding D. Backache that occurs after standing for a long period

C

One of the most effective methods for preventing venous stasis is to a. Wear elastic stockings in the afternoons. b. Sleep with the foot of the bed elevated. c. Rest often with the feet elevated. d. Sit with the legs crossed.

C

What comment by a new mother exhibits understanding of her toddler's response to a new sibling? a. "I can't believe he is sucking his thumb again." b. "He is being difficult, and I don't have time to deal with him." c. "My husband is going to stay with the baby so I can take our son to the park tomorrow." d. "When we brought the baby home, we made our son stop sleeping in the crib."

C

Which suggestion is appropriate for the pregnant woman who is experiencing nausea and vomiting? a. Eat only three meals a day so the stomach is empty between meals. b. Drink plenty of fluids with each meal. c. Eat dry crackers or toast before arising in the morning. d. Drink coffee or orange juice immediately on arising in the morning.

C

What factor is a contraindication for induction of labor? A Post term dates B Maternal hypertension C Previous cesarean section with a classic incision D Fetal death

C A classic incision for a cesarean section is a contraindication for induction of labor. Post term dates, maternal hypertension, and fetal death are indications for induction of labor.

After the use of forceps during labor, the nurse should assess the woman for signs of A bladder distention. B uterine atony. C vaginal lacerations. D deep vein thrombosis.

C Maternal risks include laceration or hematoma of the vagina, perineum, or periurethral area. Bladder distention, uterine atony, and deep vein thrombosis are not effects of forceps.

After monitoring the fetal heart rate for 10 minutes, the nurse notices the rate is staying at 175 bpm. The nurse is correct in classifying this baseline rate as A normal. B bradycardia. C tachycardia. D acceleration.

C Tachycardia is a heart rate greater than 160 bpm, persisting for at least 10 minutes. A normal rate averages between 110 and 160 bpm. Bradycardia is a rate less than 110 bpm for at least 10 minutes. An acceleration is an increase in the heart rate that lasts for a short period of time before returning to baseline.

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

C A vitamin C source may increase the absorption of iron. The calcium and phosphorus in milk decrease absorption.

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

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

a 35 yo woman has an amniocentesis performed to find out whether her baby has a chromosomal defect. Which statement by this patient indicates that she understands her situation? a. "The doctor will tell me if I should have an abortion when the test results comeback." b. "I know support groups exist for parents who have a baby with birth defects, butwe have plenty of insurance to cover what we need." c. "When all the lab results come back, my husband and I will make a decision aboutthe pregnancy." d. "My mother must not find out about all this testing. If she does, she will think I'm having an abortion."

C The final decision about genetic testing and the future of the pregnancy lies with the patient. She will involve only those people whom she chooses in her decisions. The final decision about the future of the pregnancy lies with the patient only.

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

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

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

C This diet is consistent with that followed by a strict vegetarian (vegan). Vegans consume onlyplant products. Because vitamin B12 is found in foods of animal origin, this diet is deficient invitamin B12.

A pregnant couple has formulated a birth plan and is reviewing it with the nurse at an expectant parent's class. Which aspect of their birth plan would be considered unrealistic and require further discussion with the nurse? a. "My husband and I have agreed that my sister will be my coach since he becomes anxious with regard to medical procedures and blood. He will be nearby and check on me every so often to make sure everything is OK." b. "We plan to use the techniques taught in the Lamaze classes to reduce the pain experienced during labor." c. "We want the labor and birth to take place in a birthing room. My husband will come in the minute the baby is born." d. "We do not want the fetal monitor used during labor, since it will interfere with movement and doing effleurage."

D

A pregnant woman has come to the emergency department with complaints of nasal congestion and epistaxis. What is the correct interpretation of these symptoms by the practitioner? a. These conditions are abnormal. Refer the patient to an ear, nose, and throat specialist. b. Nasal stuffiness and nosebleeds are caused by a decrease in progesterone. c. Estrogen relaxes the smooth muscles in the respiratory tract, so congestion and epistaxis are within normal limits. d. Estrogen causes increased blood supply to the mucous membranes and can result in congestion and nosebleeds.

D

During a prenatal visit at 36 weeks of gestation, the nurse tested a woman's urine for glucose and protein. The results indicated a trace amount of glucose. The nurse's next action should be to A. retest the urine for accuracy. B. have the woman give another sample for retesting. C. report the results immediately to the physician so further testing can be preformed. D. consider this as a normal result for this stage of pregnancy.

D

The maternal task that begins in the first trimester and continues throughout the neonatal period is called a. Seeking safe passage for herself and her baby b. Securing acceptance of the baby by others c. Learning to give of herself d. Developing attachment with the baby

D

When preparing a woman for a pelvic examination, the nurse notices that she had undergone a genital mutilation. During the examination, the nurse needs to plan for the woman to A. feel embarrassed because of the mutilation. B. be comfortable with the examination. C. be concerned that a full examination will not be possible. D. experience pain and to make her as comfortable as possible.

D

Which factor significantly contributed to the shift from home births to hospital births in the early 20th century? a. Puerperal sepsis was identified as a risk factor in labor and delivery. b. Forceps were developed to facilitate difficult births. c. The importance of early parental-infant contact was identified. d. Technologic developments became available to physicians.

D

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

D

While assessing her patient, what does the nurse interpret as a positive sign of pregnancy? a. Fetal movement felt by the woman b. Amenorrhea c. Breast changes d. Visualization of fetus by ultrasound

D

While the vital signs of a pregnant woman in her third trimester are being assessed, the woman, who is lying supine, complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate? A. Have the patient stand up; retake her blood pressure. B. Have the patient sit down and hold her arm in a dependent position. C. Have the patient lie supine for 5 minutes; recheck her blood pressure on both arms. D. Have the patient turn to her left side; recheck her blood pressure in 5 minutes.

D

While you are assessing the vital signs of a pregnant woman in her third trimester, the patient complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate? a. Have the patient stand up and retake her blood pressure. b. Have the patient sit down and hold her arm in a dependent position. c. Have the patient lie supine for 5 minutes and recheck her blood pressure on both arms. d. Have the patient turn to her left side and recheck her blood pressure in 5 minutes.

D

Internal version might be used to manipulate the A fetus from a breech to a cephalic presentation before labor begins. B fetus from a transverse lie to a longitudinal lie before cesarean birth. C second twin from an oblique lie to a transverse lie before labor begins. D second twin from a transverse lie to cephalic during vaginal birth.

D Internal version is used during vaginal birth to manipulate the fetus into a longitudinal lie (cephalic or breech) that allows it to be born vaginally.

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

D The recommended weight gain for overweight or obese women is 11 to 20 pounds. This willprovide sufficient nutrients for the fetus. Overweight and obese women should be advised tolose weight prior to conception in order to achieve the best pregnancy outcomes. A higherweight gain in twin gestations may help prevent low birth weights. Adolescents need to gainweight toward the higher acceptable range, which will provide for their own growth as well asfor fetal growth.

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

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

A new mother is distresses over the "white substance" covering her infant because it "looks ugly." What action by the nurse is most appropriate?

Explain that the vernix caseosa protects fetal skin from amniotic fluid.

A nurse is teaching a prenatal class. The nurse teaches that during weeks 25 to 28, which fetal development occurs?

Eyes reopen.

A nurse is floated to a different unit. The nurse does not know how to perform a treatment that hs been prescribed for one of their assigned patients. what should this nurse's first action be?

Inform the nursing supervisor

When counseling the newly pregnant woman regarding the option of using a free-standing birthing center for care, the nurse should be aware that this type of care setting includes which advantages

Less expensive than acute care hospitals Access to follow up care - 6 weeks postpartum. Safe, home like births in a familiar setting

People who have two copies of the same abnormal autosomal dominant gene will usually be

More severely affected by the disorder than people with only one copy of the gene

A woman who delivered her baby 6 hours ago complains of a headache and dizziness. The nurse administers and analgesic, but does not perform any assessments. The woman then has a tonic-clonic seizure, falls out of bed and fractures her femur. How would the actions of the nurse be interpreted in relation to standards of care?

Negligent. The nurse failed to assess the patient for any complications

The intrapartum woman sees no need for a routine admission fetal monitoring strip. If she continues to refuse, what is the first action that the nurse should take?

Notify the provider

Pelvic congestion during pregnancy may lead to heightened sexual interest and increased orgasmic experiences. Is this statement true or false?

T

Pregnancy is a hypercoagulable state, where the mother's blood clots more readily. Is this statement true or false?

T

Which nursing intervention is an independent, nurse driven, function of the nurse

Teaching the woman perineal care

Family centered care provides safe, quality care that recognizes and adapts to both the physical and psychosocial needs of the family. Which nursing practice coincides with the principles of FCC?

The assignment includes both mom and baby and increases the nurse's responsibility for education

Which statement is accurate about the development of fetal organs and systems?

The cardiovascular system is the first organ system to function in the developing human.

The mother of a 5 yo inpatient on the pediatric unit asks the nurse to provide information regarding the recommended amount of television that the child should be watching.

The nurse responds that the appropriate time is 1-2 hours per day.

Which setting for childbirth allows the least amount of parent-infant contact?

Traditional hospital birth

21. What does the student learn about recent trends in multiple births?

Twinning is the most common form of multiple pregnancy.

How can a woman avoid exposing her fetus to teratogens?

Use only category A drugs during her pregnancy In well-controlled studies class A drugs have no demonstrated fetal risks.

A nurse wishes to reduce infant mortality in the United States. Which activity would the nurse most likely participate in?

Volunteering to provide prenatal care at a community center

When is the most accurate time to determine gestational age through ultrasound? a. First trimester b. Second trimester c. Third trimester d. No difference in accuracy among the trimesters

a. First trimester

A newly pregnant patient tells the nurse that she has irregular periods and is unsure of when she got pregnant. Scheduling an ultrasound is a standing prescription for the patient's health care provider. When is the best time for the nurse to schedule the patient's ultrasound? a. Immediately b. In 2 weeks c. In 4 weeks d. In 6 weeks

a. Immediately

The clinic nurse is obtaining a health history on a newly pregnant client. Which is an indication for fetal diagnostic procedures if present in the health history? a. Maternal diabetes b. Weight gain of 25 lb c. Maternal age older than 30 d. Previous infant weighing more than 3000 g at birth

a. Maternal diabetes

What does a score of 9 on a biophysical profile signify? a. Normal b. Abnormal c. Equivocal d. Nonreactive

a. Normal

On which aspect of fetal diagnostic testing do parents usually place the most importance? a. Safety of the fetus b. Duration of the test c. Cost of the procedure d. Physical discomfort caused by the procedure

a. Safety of the fetus

Which part of the mature sperm contains the male chromosomes?

a. The head of the sperm

When planning a parenting class, the nurse should explain that the leading cause of death in children 1-4 years old in the united states is

accidental death

Which situation is most conducive to learning

an Asian nurse providing nutritional information to a group of pregnant Asian women.

As a result of changes in health care delivery and funding, a current trend seen in the pediatric setting is

an increase in ambulatory care

With regard to the structure and function of the placenta, the maternity nurse should be aware that

as one of its early functions, the placenta acts as an endocrine gland.

For which client would an L/S ratio of 2:1 potentially be considered to be abnormal? a. A 38-year-old gravida 2, para 1, who is 38 weeks' gestation b. A 24-year-old gravida 1, para 0, who has diabetes c. A 44-year-old gravida 6, para 5, who is at term d. An 18-year-old gravida 1, para 0, who is in early labor at term

b. A 24-year-old gravida 1, para 0, who has diabetes

A biophysical profile is performed on a pregnant client. The following assessments are noted: nonreactive stress test (NST), three episodes of fetal breathing movements (FBMs), limited gross movements, opening and closing of hang indicating the presence of fetal tone, and adequate amniotic fluid index (AFI) meeting criteria. What would be the correct interpretation of this test result? a. A score of 10 would indicate that the results are equivocal. b. A score of 8 would indicate normal results. c. A score of 6 would indicate that birth should be considered as a possible treatment option. d. A score of 9 would indicate reassurance.

b. A score of 8 would indicate normal results.

The results of a contraction stress test (CST) are positive. Which intervention is necessary based on this test result? a. Repeat the test in 1 week so that results can be trended based on this baseline result. b. Contact the health care provider to discuss birth options for the client. c. Send the client out for a meal and repeat the test to confirm that the results are valid. d. Ask the client to perform a fetal kick count assessment for the next 30 minutes and then reassess the client.

b. Contact the health care provider to discuss birth options for the client.

Which complication could occur as a result of percutaneous umbilical blood sampling (PUBS)? a. Postdates pregnancy b. Fetal bradycardia c. Placenta previa d. Uterine rupture

b. Fetal bradycardia

The nurse's role in diagnostic testing is to provide which of the following? a. Advice to the couple b. Information about the tests c. Reassurance about fetal safety d. Assistance with decision making

b. Information about the tests

What does nursing care after amniocentesis include? a. Forcing fluids by mouth b. Monitoring uterine activity c. Placing the client in a supine position for 2 hours d. Applying a pressure dressing to the puncture site

b. Monitoring uterine activity

Which analysis of maternal serum may predict chromosomal abnormalities in the fetus? a. Biophysical profile b. Multiple-marker screening c. Lecithin-to-sphingomyelin ratio d. Blood type and crossmatch of maternal and fetal serum

b. Multiple-marker screening

A pregnant client has received the results of her triple-screen testing and it is positive. She provides you with a copy of the test results that she obtained from the lab. What would the nurse anticipate as being implemented in the client's plan of care? a. No further testing is indicated at this time because results are normal. b. Refer to the physician for additional testing. c. Validate the results with the lab facility. d. Repeat the test in 2 weeks and have the client return for her regularly scheduled prenatal visit.

b. Refer to the physician for additional testing.

Which factor serves as a clinical indicator for a third trimester amniocentesis? a. Sex of the fetus b. Rh isoimmunization c. Placenta previa d. Placental abruption

b. Rh isoimmunization

When is the earliest that chorionic villus sampling can be performed during pregnancy? a. 4 weeks b. 8 weeks c. 10 weeks d. 12 weeks

c. 10 weeks

The primary reason for evaluating alpha-fetoprotein (AFP) levels in maternal serum is to determine whether the fetus has which? a. Hemophilia b. Sickle cell anemia c. A neural tube defect d. A normal lecithin-to-sphingomyelin ratio

c. A neural tube defect

The nurse is preparing a client for a non-stress test (NST). Which interventions should the nurse plan to implement? (Select all that apply.) a. Ensure that the client has a full bladder. b. Plan approximately 15 minutes for the test. c. Have the client sit in a recliner with the head elevated 45 degrees. d. Apply electronic monitoring equipment to the client's abdomen. e. Instruct the client to press an event marker every time she feels fetal movement.

c. Have the client sit in a recliner with the head elevated 45 degrees. d. Apply electronic monitoring equipment to the client's abdomen. e. Instruct the client to press an event marker every time she feels fetal movement.

Which is the major advantage of chorionic villus sampling over amniocentesis? a. It is not an invasive procedure. b. It does not require a hospital setting. c. It requires less time to obtain results. d. It has less risk of spontaneous abortion.

c. It requires less time to obtain results.

A patient at 36 weeks gestation is undergoing a non-stress (NST) test. The nurse observes the fetal heart rate baseline at 135 beats per minute (bpm) and four nonepisodic patterns of the fetal heart rate reaching 160 bpm for periods of 20 to 25 seconds each. How will the nurse record these findings? a. NST positive, nonreassuring b. NST negative, reassuring c. NST reactive, reassuring d. NST nonreactive, nonreassuring

c. NST reactive, reassuring

In preparing a pregnant client for a non-stress test (NST), which of the following should be included in the plan of care? a. Have the client void prior to being placed on the fetal monitor because a full bladder will interfere with results. b. Maintain NPO status prior to testing. c. Position the client for comfort, adjusting the tocotransducer belt to locate fetal heart rate. d. Have an infusion pump prepared with oxytocin per protocol for evaluation.

c. Position the client for comfort, adjusting the tocotransducer belt to locate fetal heart rate.

What is the term for a non-stress test in which there are two or more fetal heart rate accelerations of 15 or more bpm with fetal movement in a 20-minute period? a. Positive b. Negative c. Reactive d. Nonreactive

c. Reactive

A pregnant woman is scheduled to undergo chorionic villus sampling (CVS) based on genetic family history. Which medication does the nurse anticipate will be administered? a. Magnesium sulfate b. Prostaglandin suppository c. RhoGAM if the client is Rh-negative d. Betamethasone

c. RhoGAM if the client is Rh-negative

Which response by the nurse is most appropriate to the statement, "This test isn't my idea, but my husband insists?" a. "It's your decision." b. "Don't worry. Everything will be fine." c. "Why don't you want to have this test?" d. "You're concerned about having this test?"

d. "You're concerned about having this test?"

What is the purpose of initiating contractions in a contraction stress test (CST)? a. Increase placental blood flow. b. Identify fetal acceleration patterns. c. Determine the degree of fetal activity. d. Apply a stressful stimulus to the fetus.

d. Apply a stressful stimulus to the fetus.

What is the purpose of amniocentesis for a client hospitalized at 34 weeks of gestation with pregnancy-induced hypertension? a. Determine if a metabolic disorder is genetic. b. Identify the sex of the fetus. c. Identify abnormal fetal cells. d. Determine fetal lung maturity.

d. Determine fetal lung maturity.

Which nursing intervention is necessary prior to a second-trimester transabdominal ultrasound? a. Perform an abdominal prep. b. Administer a soap suds enema. c. Ensure the client is NPO for 12 hours. d. Instruct the client to drink 1 to 2 quarts of water.

d. Instruct the client to drink 1 to 2 quarts of water.

Which should be considered a contraindication for transcervical chorionic villus sampling? a. Rh-negative mother b. Gestation less than 15 weeks c. Maternal age younger than 35 years d. Positive for group B Streptococcus

d. Positive for group B Streptococcus

When addressing the questions of a newly pregnant woman, the nurse can explain that the CNM is qualified to perform

vaginal deliveries