Pregnancy, labor, childbirth, postpartum- uncomplicated

What should a nurse teach a non-nursing mother to help relieve the discomfort of engorgement? 1. Empty the breasts manually once a day. 2. Apply cold packs to the breasts frequently. 3. Ask the practitioner to prescribe a medication for pain. 4. Loosen the brassiere until the breast swelling has subsided.

2. Apply cold packs to the breasts frequently.

During prenatal classes the nurse teaches the difference between true labor and false labor. How does the nurse explain the difference? 1. Bloody show is rare with false labor. 2. Cervix effaces and dilates during true labor. 3. Membranes rupture at the start of true labor. 4. Fetal movement slows and contractions accelerate with false labor.

2. Cervix effaces and dilates during true labor.

A client is receiving an epidural anesthetic during labor. For which side effect should the nurse monitor the client? 1. Hypertension 2. Urine retention 3. Subnormal temperature 4. Decreased level of consciousness

2. Urine retention

A primigravida who is at 38 weeks' gestation is undergoing a nonstress test. The nurse determines that the baseline fetal heart rate is 130 to 140 beats/min. It rises to 160 on two occasions and 157 once during a 20-minute period. Each of the episodes in which the heart rate is increased lasts 20 seconds. What action should the nurse take? 1. Discontinuing the test because the pattern is reassuring 2. Encouraging the client to drink more fluids to decrease the fetal heart rate 3. Notifying the primary health care provider and preparing for an emergency birth 4. Recording this nonreassuring pattern and continuing the test for further evaluation

1. Discontinuing the test because the pattern is reassuring

A client is admitted in active labor to the birthing center. She is 100% effaced, dilated 3 cm, and at +1 station. What stage of labor does the nurse identify? 1. First 2. Latent 3. Second 4. Transitional

1. First

During labor a client who has been receiving epidural anesthesia has a sudden episode of severe nausea, and her skin becomes pale and clammy. What is the nurse's immediate reaction? 1. Turning the client on her side 2. Notifying the health care provider 3. Checking the vaginal area for bleeding 4. Checking the fetal heart rate every 3 minutes

1. Turning the client on her side

During the postpartum period a client tells a nurse that she has been having leg cramps. Which foods should the nurse encourage the client to eat? 1. Liver and raisins 2. Cheese and broccoli 3. Eggs and lean meats 4. Whole-wheat breads and cereals

2. Cheese and broccoli **The leg cramps may be related to low calcium intake; cheese and broccoli each have a high calcium content.

A nurse is preparing to counsel a client whose two previous pregnancies were uneventful, ending in term vaginal births of healthy children. What should the nurse consider about multiparas with previous uneventful pregnancies before beginning prenatal counseling? 1. Multiparas cope more successfully with pregnancy than do primigravidas. 2. Each pregnancy is a unique experience that is stressful despite multiparity. 3. This pregnancy will provoke a situational crisis because the client has two children at home. 4. Support people play a lesser role because the client has had two prior experiences with pregnancy.

2. Each pregnancy is a unique experience that is stressful despite multiparity.

A negative home pregnancy test may result if the woman performs the test: 1. By saturating the test strip 2.On the first void of the morning 3. 10 days after intercourse took place 4. While taking a prescribed tranquilizer

3. 10 days after intercourse took place

A negative home pregnancy test may result if the woman performs the test: 1. By saturating the test strip 2. On the first void of the morning 3. 10 days after intercourse took place 4. While taking a prescribed tranquilizer

3. 10 days after intercourse took place **The most common error made by women taking home pregnancy tests is to perform the test too early in the pregnancy.

The fetus of a woman in labor is at +1 station. At what place in the pelvic area does the nurse conclude that the presenting part is located? 1. Not yet engaged 2. Entering the pelvic inlet 3. Below the ischial spines 4. Visible at the vaginal opening

3. Below the ischial spines **A +1 station indicates that the fetal presenting part is 1 cm below the ischial spines, which are the points of engagement. Entrance of the pelvic inlet is designated as 0 station or as a negative number. The head must be at +3 to +5 to be visible at the vaginal opening.

A 36-year-old multigravida who is at 14 weeks' gestation is scheduled for an α-fetoprotein test. She asks the nurse, "What does this test do?" The nurse bases the response on the knowledge that this test can reveal: 1. Kidney defects 2. Cardiac anomalies 3. Neural tube defects 4. Urinary tract anomalies

3. Neural tube defects

A nurse is teaching a client to care for her episiotomy after discharge. What priority instruction should the nurse include? 1. Rest with legs elevated at least two times a day. 2. Avoid stair climbing for several days after discharge. 3. Perform perineal care after toileting until healing occurs. 4. Continue sitz baths three times a day if they provide comfort.

3. Perform perineal care after toileting until healing occurs.

A client in labor is receiving an oxytocin (Pitocin) infusion. For which adverse reaction resulting from prolonged administration should the nurse monitor the client? 1. Change in affect 2. Hyperventilation 3. Water intoxication 4. Increased temperature

3. Water intoxication **Oxytocin (Pitocin) has an antidiuretic effect, acting to reabsorb water from the glomerular filtrate.

After the birth of her baby a client tells the nurse, "I'm so cold, and I can't stop shaking." How should the nurse respond? 1. "I'm going to take your temperature right now." 2. "Let me check your uterus to see whether it's firm." 3. "Turn on your side so I can check the amount of lochia." 4. "I'll get you some warm blankets to help make the chill go away."

4. "I'll get you some warm blankets to help make the chill go away."

A pregnant client at 37 weeks' gestation is taught about signs and symptoms that should be reported immediately to the primary care provider. The nurse determines that the client understands the information presented when she states that she will immediately report: 1. Lower back pain 2. White vaginal discharge 3. Irregular strong contractions 4. Leakage of fluid from the vagina

4. Leakage of fluid from the vagina **Leakage may indicate rupture of the amniotic membranes; the client is at risk for an ascending infection from the vagina if birth does not occur within 24 hours or if early treatment is not instituted.

Assign an Apgar score to this infant: heart rate 110, crying vigorously, moves all extremities, cries when suctioned, blue extremities with pink body. Record your answer using a whole number. ______

A heart rate above 100 beats/min scores 2 points , vigorous crying scores 2 points, moving all extremities scores 2 points, reflex irritability scores 2 points, and blue extremities with a pink body scores 1 point, for a total Apgar score of 9.

What are the indicators of nutritional risk in pregnancy in a client who is of normal weight? (Select all that apply.) 1. Smoker 2. Twin gestation 3. Hemoglobin of 12 g/dL 4. Term delivery 2 years ago 5. Caffeine intake of 180 mg/day 6. Fasting blood sugar of 80 mg/dL

1. Smoker 2. Twin gestation

How does the nurse know that a client at 40 weeks' gestation is experiencing true labor? 1. Cervical dilation 2. Membrane rupture 3. Decreased fetal heart rate 4. Intensification of contractions

1. Cervical dilation

The nurse is caring for a pregnant client who is undergoing an ultrasound examination during the first trimester. The nurse explains that an ultrasound during the first trimester is used to: 1. Estimate fetal age 2. Detect hydrocephalus 3. Rule out congenital defects 4. Approximate fetal linear growth

1. Estimate fetal age

A nurse is being oriented to a prenatal clinic after graduation. The new nurse takes a course on several tests during pregnancy. Place the tests in the order in which they should be performed during pregnancy. 1. Fetal movement test 2. Sickle cell screening 3. Group B Streptococcus culture 4. Serum glucose for gestational diabetes 5. α-Fetoprotein (AFP) testing for neural tube defects

2. Sickle cell screening 5. α-Fetoprotein (AFP) testing for neural tube defects 4. Serum glucose for gestational diabetes 1. Fetal movement test 3. Group B Streptococcus culture

What complication should a nurse be alert for in a client receiving an oxytocin (Pitocin) infusion to induce labor? 1. Intense pain 2. Uterine tetany 3. Hypoglycemia 4. mbilical cord prolapse

2. Uterine tetany

A nurse is evaluating the rate of involution of a client's uterus on the second postpartum day. Where does the nurse expect the fundus to be located? 1. At the level of the umbilicus 2. One fingerbreadth above the umbilicus 3. Above and to the right of the umbilicus 4. One or two fingerbreadths below the umbilicus

4. One or two fingerbreadths below the umbilicus

What is the primary outcome for client care in the third stage of labor? 1. Absence of discomfort 2. Firmly contracted uterine fundus 3. Efficient fetal heart beat-to-beat variability 4. Maternal respiratory rate within the expected range

2. Firmly contracted uterine fundus

How should a nurse direct care for a client in the transition phase of the first stage of labor? 1. Decreasing intravenous fluid intake 2. Helping the client maintain control 3. Reducing the client's discomfort with medications 4. Having the client use simple breathing patterns during contractions

2. Helping the client maintain control

A nurse determines that the husband of a client in the early phase of labor understands the teaching from childbirth classes when he helps his wife use the breathing pattern of: 1. Pant-blow 2. Slow-chest 3. Shallow-chest 4. Accelerate-decelerate

2. Slow-chest

A client in labor is experiencing discomfort because her fetus is in the occiput posterior position. What nursing action will help relieve this discomfort? 1. Positioning her on the left side 2. Using effleurage on her abdomen 3. Applying pressure against her sacrum 4. Placing her in the semi-Fowler position

3. Applying pressure against her sacrum

A client who just gave birth has three young children at home. She comments to the nursery nurse that she must prop the baby during feedings when she returns home because she has too much to do and, anyway, holding babies during feedings spoils them. What is the nurse's best response? 1. "You seem concerned about time. Let's talk about it." 2. "That's up to you; you have to do what works for you." 3. "Holding the baby when feeding is important for development." 4. "It's not safe to prop a bottle. The baby could aspirate the fluid."

1. "You seem concerned about time. Let's talk about it."

What is the best nursing intervention to minimize perineal edema after an episiotomy? 1. Applying ice packs 2. Offering warm sitz baths 3. Administering aspirin prn 4. Elevating the hips on a pillow

1. Applying ice packs **Cold causes vasoconstriction and reduces edema by lessening the accumulation of blood and lymph at the episiotomy site; cold also deadens nerve endings and lessens the pain.

During labor a client begins to experience dizziness and tingling of her hands. What should the nurse instruct the client to do? 1. Breathe into her cupped hands 2. Pant during the next three contractions 3. Hold her breath with the next contraction 4. Use a fast, deep, or shallow breathing pattern

1. Breathe into her cupped hands

While caring for a client during labor, the nurse remembers that the second stage of labor: 1. Ends at the time of birth 2. Ends as the placenta is expelled 3. Begins with the transition phase of labor 4. Begins with the onset of strong contractions

1. Ends at the time of birth

In the second stage of labor the nurse should plan to discourage a client from holding her breath longer than 6 seconds while pushing with each contraction. What complication does this prevent? 1. Fetal hypoxia 2. Perineal lacerations 3. Carpopedal spasms 4. Maternal hypertension

1. Fetal hypoxia **Prolonged breath holding at this stage of labor can result in decreased placental/fetal oxygenation, which could lead to fetal hypoxia.

A client at 35 weeks' gestation calls the prenatal clinic, concerned that she has "not felt the baby move as much as usual." The most appropriate recommendation by the nurse is to have the client call the clinic with the results after she has: 1. Drunk a glass of orange juice and timed 10 fetal movements 2. Sat in a tub filled with warm water and then timed 30 fetal movements 3. Taken a nap and counted the number of fetal movements for 20 minutes 4. Walked for 15 minutes and checked to see whether the fetus moved more frequently

1. Drunk a glass of orange juice and timed 10 fetal movements

A client is receiving an oxytocin (Pitocin) infusion for induction of labor. The uterine graph on the electronic monitor indicates no rest period between contractions, and this is confirmed on palpation. What should the nurse do first? 1. Evaluate the fetal heart rate 2. Turn the oxytocin infusion off 3. Place the client in the left-lateral position 4. Prepare the client for an emergency birth

2. Turn the oxytocin infusion off

The transmission of which microorganism that causes maternal mastitis is minimized by frequent handwashing by nursing staff members? 1. Escherichia coli 2. Group B Streptococcus 3. Staphylococcus aureus 4. Chlamydia trachomatis

3. Staphylococcus aureus **Staphylococcus aureus is a resident organism of the skin; it is the causative agent of 95% of the infections that result in maternal mastitis.

At 5 am, 2 hours after a long labor and vaginal birth, a client is transferred to the postpartum unit. What is the nurse's priority when planning morning care for this client? 1. Planning nursing care activities that provide time for the client to rest and sleep 2. Preparing for the probability of hemorrhage by massaging the client's uterus frequently 3. Arranging an individual session in which the client can learn about successful breastfeeding 4. Anticipating safety needs by instructing the client to remain in bed and call for assistance whenever ambulating

1. Planning nursing care activities that provide time for the client to rest and sleep

A nurse observes a laboring client's amniotic fluid and decides that it is the expected color. What finding supports this conclusion? 1. Clear, dark amber colored, and containing shreds of mucus 2. Straw-colored, clear, and containing little white specks 3. Milky, greenish yellow, and containing shreds of mucus 4. Greenish yellow, cloudy, and containing little white specks

2. Straw-colored, clear, and containing little white specks

What is a common problem that affects the client in labor when an external fetal monitor has been applied to her abdomen? 1. Intrusion on movement 2. Inability to take sedatives 3. Interference with breathing techniques 4. Increased frequency of vaginal examinations

1. Intrusion on movement **Because the client is attached to a machine and movement may alter the tracings, movement is discouraged.

The nurse is caring for four clients on the postpartum unit. Which client will most likely state that she is having difficulty sleeping because of afterbirth pains? 1. Multipara who has vaginally delivered three children 2. Primipara whose newborn weighed 7 lb 3. Multipara with effectively controlled diabetes 4. Multipara whose second child was small for gestational age

1. Multipara who has vaginally delivered three children

A client in labor begins to experience contractions 2 to 3 minutes apart and lasting about 45 seconds. Between contractions the nurse identifies a fetal heart rate (FHR) of 100 beats/min on the internal fetal monitor. What is the next nursing action? 1. Notifying the health care provider 2. Resuming continuous fetal heart monitoring 3. Continuing to monitor the maternal vital signs 4. Documenting the fetal heart rate as an expected response to contractions

1. Notifying the health care provider

What actions are part of nursing care during the fourth stage of labor for the client with a fourth-degree laceration? (Select all that apply.) 1. Pain management with oral analgesics 2. Continuous application of a warm pack 3. Assessment of the site every 15 minutes 4. Gentle cleansing with antibacterial cleanser 5. Application of an ice pack for 20-minute intervals 6. Instructing the client in how to promote normal bowel function

1. Pain management with oral analgesics 3. Assessment of the site every 15 minutes 5. Application of an ice pack for 20-minute intervals

Why is it important for a nurse in the prenatal clinic to provide nutritional counseling to all newly pregnant women? 1. Most weight gain is caused by fluid retention. 2. Different cultural groups favor different essential nutrients. 3. Dietary allowances should not increase throughout pregnancy. 4. Pregnant women must adhere to a specific pregnancy dietary regimen.

2. Different cultural groups favor different essential nutrients.

A multigravida of Asian descent weighs 104 lb, having gained 14 pounds during the pregnancy. On her second postpartum day, the client's temperature is 99.2° F (37.3° C). She has had poor dietary intake since admission. What should the nurse do? 1. Ask the nursing supervisor to discuss this with the health care provider 2. Encourage the family to bring in special foods preferred in their culture 3. Order a high protein milkshake as a between-meal snack to stimulate her appetite 4. Explain to the family that the dietitian plans nutritious meals that the client should eat

2. Encourage the family to bring in special foods preferred in their culture

A woman's pregnancy has been uneventful, and she has gained 25 lb. At term her hemoglobin level is 10.6 g/dL and her hematocrit is 31%. What does the nurse identify as the reason for these hemoglobin and hematocrit levels? 1. Infection 2. Hemodilution 3. Nutritional deficits 4. Concealed bleeding

2. Hemodilution **Infection does not lead to a lower hematocrit. The increase in circulating blood volume during pregnancy is reflected in lower hemoglobin and hematocrit readings (physiological anemia of pregnancy). The history reveals no prenatal problems, and weight gain is adequate. In the absence of other significant signs and symptoms, concealed bleeding is unlikely.

Identify the position of the fetus whose buttocks are in the fundus, whose fetal back is on the maternal right side between the midline, and lateral surface of the abdomen, and whose attitude is general flexion. 1. RSA 2. ROA 3. RMA 4. LOA

2. ROA **The fetus is in the ROA (right occiput anterior) position: occiput facing the front on the right side of the mother). It is a vertex delivery. In the RSA (right sacrum anterior) position the buttocks point anteriorly on the mother's right side. RMA (right mentoanterior) is a brow presentation. In LOA (left occiput anterior), another vertex position, the fetus' back is on the mother's left side.

A primipara gives birth to an infant weighing 9 lb 15 oz (4508 g). During labor a midline episiotomy is performed and the client sustains a third-degree laceration. The client tells the nurse that her perineal area is very painful. What should the nurse consider before explaining the reason for the pain? 1. Perineal muscles have been cut. 2. The anal sphincter muscle has been injured. 3. The anterior wall of the rectum has been traumatized. 4. Structures superficial to muscles have been damaged.

2. The anal sphincter muscle has been injured. **A third-degree laceration extends through the perineal muscles and continues through the anal sphincter muscle.

After a client gives birth, what physiological occurrence indicates to the nurse that the placenta is beginning to separate from the uterus and is ready to be expelled? 1. Relaxation of the uterus 2. Descent of the uterus in the abdomen 3. Appearance of a sudden gush of blood 4. Retraction of the umbilical cord into the vagina

3. Appearance of a sudden gush of blood **When the placenta separates from the uterine wall, it tears blood vessels, resulting in a gush of blood from the vagina.

While caring for a client who gave birth 1day ago, the nurse determines that the client's uterine fundus is firm at one fingerbreath below the umbilicus, blood pressure is 110/70 mm Hg, pulse is 72 beats/min, and respirations are 16 breaths/min. The client's perineal pad is saturated with lochia rubra. What is the priority nursing action? 1. Recording these expected findings 2. Obtaining a prescription for an oxytocic medication 3. Asking the client when she last changed the perineal pad 4. Notifying the primary health care provider that the client may be hemorrhaging

3. Asking the client when she last changed the perineal pad **The amount of lochia would be excessive if the pad were saturated in 15 minutes; saturating the pad in 2 hours is considered heavy bleeding.

The nurse is caring for a client whose labor is to be induced. What is the nurse's responsibility when a client's labor is being stimulated with an oxytocin (Pitocin) infusion? 1. Flushing the IV tubing if the flow slows 2. Checking the fetal heart rate every 2 hours 3. Stopping the infusion if contractions become hypertonic 4. Decreasing the infusion rate if hypertonic contractions continue for 15 minutes

3. Stopping the infusion if contractions become hypertonic

A pregnant client arrives at the prenatal clinic, and the nurse obtains her obstetrical history. The client has two children at home, one born at 38 weeks' gestation and the second born at 34 weeks' gestation. She has also had one miscarriage, at 18 weeks, and an elective abortion. Using the GTPAL system, record the client's obstetrical record. 1. G5 T1 P1 A2 L2 2. G4 T2 P2 A1 L4 3. G2 T3 P3 A2 L1 4. G3 T2 P1 A3 L3

1. G5 T1 P1 A2 L2 **G (gravida ) stands for the total number of pregnancies a client has had. Gravida 5 indicates that this is the client's fifth pregnancy. T (term) stands for the number of neonates born at the expected date of birth. The neonate born at 38 weeks' gestation was born at term. P (preterm) stands for the number of neonates born before the expected date of birth. The neonate born at 34 weeks' gestation was born preterm. A (abortion or miscarriage) stands for the birth of a fetus before 20 weeks' gestation. Both the miscarriage and elective abortion are considered abortions. L (living) stands for the number of living children at the time of assessment. The client has two living children.

At 9 pm visiting hours are officially over, but the sister of a newly admitted postpartum client remains at the bedside. What is the most appropriate nursing intervention? 1. Reminding the client's sister that visiting hours are over 2. Getting written permission from the client for her sister to remain 3. Calling the evening nursing supervisor to tactfully handle the situation 4. Encouraging the sister to participate in care as much as the client wishes

4. Encouraging the sister to participate in care as much as the client wishes

A nurse is caring for a client in labor who is receiving epidural anesthesia. For which common side effect of this route of anesthesia should the client be monitored? 1. Sinus tachycardia 2. Urinary frequency 3. Respiratory distress 4. Hypotensive episodes

4. Hypotensive episodes

A client arrives at the prenatal clinic and tells the nurse that she thinks that she is pregnant. The first day of the client's last menstrual period (LMP) was September 14, 2013. Using Naegele's Rule, what date in June 2014 is the client's estimated date of birth (EDB)? Record your answer as a whole number. ______________

Add 7 days to the 1st day of the LMP and subtract 3 months.

A client in her 10th week of pregnancy exhibits presumptive signs of pregnancy that the nurse may detect. (Select all that apply.) 1. Amenorrhea 2. Breast changes 3. Urinary frequency 4. Abdominal enlargement 5. Positive urine pregnancy test

1. Amenorrhea 2. Breast changes 3. Urinary frequency

A pregnant client in the third trimester tells the nurse in the prenatal clinic that she has heartburn after every meal. What explanation should the nurse give about the cause of the heartburn? 1. "The cardiac sphincter relaxes and allows acid to be regurgitated." 2. "In pregnancy, gastric motility increases, causing a burning sensation." 3. "In pregnancy, gastric pH increases, causing acid to enter the esophagus." 4. "In pregnancy, the pyloric sphincter relaxes, allowing acid to enter the intestine."

1. "The cardiac sphincter relaxes and allows acid to be regurgitated."

A pregnant client uses a computer almost continuously during her working hours. This has implications for her plan of care during pregnancy. What should the nurse recommend? 1. "Try to walk around every few hours during the workday." 2. "Ask for time in the morning and afternoon to elevate your legs." 3. "Tell your boss that you won't be able to work beyond the second trimester." 4. "Ask for time in the morning and afternoon so you can go get something to eat."

1. "Try to walk around every few hours during the workday."

After reading that nutrition during pregnancy is important for optimal growth and development of a baby, a pregnant woman asks the nurse what foods she should be eating. The nurse begins the teaching/learning process by: 1. Asking the client what she usually eats at each meal 2. Explaining to the client why spicy foods should be avoided 3. Instructing the client to add calories while continuing to eat a healthy diet 4. Providing the client with a list of foods for reference when planning meals

1. Asking the client what she usually eats at each meal

What does a nurse expect to find when checking the vital signs of a client in the early postpartum period? 1. Bradycardia with no change in respirations 2. Tachycardia with a decrease in respirations 3. Increased basal temperature with a decrease in respirations 4. Decreased basal temperature with an increase in respirations

1. Bradycardia with no change in respirations

A client is concerned about gaining weight during pregnancy. What should the nurse tell the client is the cause of the greatest weight gain during pregnancy? 1. Fetal growth 2. Fluid retention 3. Metabolic alterations 4. Increased blood volume

1. Fetal growth

In the second hour after the client gives birth her uterus is firm, above the level of the umbilicus, and to the right of midline. What is the most appropriate nursing action? 1. Having the client empty her bladder 2. Watching for signs of retained secundines 3. Massaging the uterus vigorously to prevent hemorrhage 4. Explaining to the client that this is a sign of uterine stabilization

1. Having the client empty her bladder **A full bladder elevates the uterus and displaces it to the right. Even though the uterus feels firm, it may relax enough to foster bleeding.

A nurse notes that a client is voiding frequently in small amounts 8 hours after giving birth. What should the nurse conclude about this small output of urine during the early postpartum period? 1. It may indicate retention of urine with overflow. 2. It may be indicative of beginning glomerulonephritis. 3. This is common because less fluid is excreted after birth. 4. This is common because fluid intake diminishes after birth.

1. It may indicate retention of urine with overflow.

A pregnant woman at 6 week's gestation tells the nurse at her first prenatal visit that she uses an over-the-counter herbal product as a health supplement that has been approved by the Food and Drug Administration. What should the nurse recommend to the client? (Select all that apply.) 1. Stop taking the supplement immediately. 2. Discuss the use of the supplement with the practitioner. 3. Increase the dosage of the supplement as pregnancy progresses. 4. Ask the pharmacist whether the supplement is safe for use during pregnancy. 5. Discuss the use of any over-the-counter products with the practitioner.

1. Stop taking the supplement immediately. 2. Discuss the use of the supplement with the practitioner. 5. Discuss the use of any over-the-counter products with the practitioner.

A nurse is checking the external fetal monitor of a client in active labor. Which fetal heart pattern indicates cord compression? 1. Smooth, flat baseline tracings of 135 beats/min 2. Abrupt decreases in fetal heart rate that are unrelated to the contractions 3. Accelerations in the fetal heart rate of 10 beats/min above baseline 4. Decelerations when a contraction begins that return to baseline when the contraction ends

2. Abrupt decreases in fetal heart rate that are unrelated to the contractions

A woman has just received the news that she is pregnant. She is ambivalent about the pregnancy because she had planned to go back to work when her youngest child started school next year. What developmental task of pregnancy must the woman accomplish in the first trimester of pregnancy? 1. Recognize her ambivalence 2. Accept that she is pregnant 3. Prepare for the birth of the baby 4. Recognize the fetus as an individual separate from the mother

2. Accept that she is pregnant

A nurse who is caring for a mother and her newborn infant reviews their record. In light of the data the record contains, what nursing intervention is required? 1. Neonatal blood transfusion 2. Maternal rubella vaccination 3. Maternal RhoGAM injection 4. Neonatal 50% glucose infusion

2. Maternal rubella vaccination

A nurse helps a client to the bathroom to void several times during the first stage of labor. This is done because a full bladder: 1. Is often injured during labor 2. May inhibit the progress of labor 3. Jeopardizes the status of the fetus 4. Predisposes the client to urinary infection

2. May inhibit the progress of labor

A nurse is caring for a client in active labor. What positions should the nurse encourage the client to assume to help promote comfort during back labor? (Select all that apply.) 1. Prone 2. Sitting 3. Supine 4. Lateral 5. Knee-chest

2. Sitting 4. Lateral 5. Knee-chest

Which position does the nurse teach the client to avoid when she experiences back pain during labor? 1. Sims position 2. Supine position 3. Right lateral position 4. Left side-lying position

2. Supine position **Low back pain is aggravated when the mother is in the supine position because fetal pressure on the sacral nerves is increased.

Before a postpartum client is discharged, the nurse advises her about problems that should be reported and then asks her to recall these problems. Identification of which problem identified by the client indicates that the teaching has been effective? 1. Breast engorgement with feelings of fullness 2. Urgency, frequency, and burning on urination 3.Increased amount of lochia after physical activity 4. Dryness and tenderness when intercourse is first resumed

2. Urgency, frequency, and burning on urination **These clinical findings are indicative of a urinary tract infection and should be reported immediately. Engorgement is expected and should subside in a few days.

A registered nurse (RN) on the postpartum unit is providing care to four maternal/infant couplets and is running behind. Which nursing action is best delegated to a licensed practical nurse/licensed vocational nurse (LPN/LVN) who also works on the unit? 1. Discharge teaching for a client who delivered her third infant girl 2 days ago 2. Delivering a clear-liquid dietary tray to a client who had a cesarean section 4 hours ago 3. Administering 2 tablets of acetaminophen and oxycodone (Percocet) to a client who rates her pain as 7 of 10 4. The initial assessment of a client who just delivered an 8 lb 12 oz (3970 g) infant over an intact perineum

3. Administering 2 tablets of acetaminophen and oxycodone (Percocet) to a client who rates her pain as 7 of 10

What is the best nursing action for a client in active labor whose cervix is dilated 4 cm and 100% effaced with the fetal head at 0 station? 1. Document the fetal heart rate every 5 minutes 2. Call the anesthesia department to alert the staff there of an imminent birth 3. Assist the client's coach in helping her with the use of breathing techniques 4. Suggest that the client accept the PRN medication for pain that has been prescribed

3. Assist the client's coach in helping her with the use of breathing techniques

Three weeks after a client gives birth, a deep vein thrombophlebitis develops in her left leg and she is admitted to the hospital for bedrest and anticoagulant therapy. Which anticoagulant does the nurse expect to administer? 1. Clopidogrel (Plavix) 2. Warfarin (Coumadin) 3. Continuous infusion of heparin 4. Intermittent doses of a low molecular weight heparin

3. Continuous infusion of heparin

A client in active labor is rushed from the emergency department to the labor and birth suite screaming, "Knock me out!" Examination reveals that her cervix is dilated 9 cm. What should the nurse say while trying to calm the client? 1. "I'll rub your back—that will help ease your pain." 2. "You'll get a shot when you reach the birthing room." 3. "I'm sure you're in pain, but try to bear with it for the baby's sake." 4. "Medication may interfere with the baby's first breaths; keep breathing."

4. "Medication may interfere with the baby's first breaths; keep breathing."

A client arrives in the birthing room with the fetal caput emerging. What should the nurse say to the client during a contraction? 1. "Push hard." 2. "Hold your breath." 3. "Take slow, deep breaths." 4. "Use the panting-breathing pattern."

4. "Use the panting-breathing pattern."

A 24-year-old client who has been told that she is pregnant is at her first prenatal visit. She is 5 feet 6 inches tall and weighs 130 lb. What should the nutrition plan regarding her daily caloric intake include? 1. 100 more calories during the first trimester 2. 540 more calories during the third trimester 3. 300 more calories during the three trimesters 4. 340 more calories during the second trimester

4. 340 more calories during the second trimester **An extra 340 calories per day during the second trimester is the recommended caloric increase for adult women who are of average weight; this increase will meet the nutritional needs of both fetus and mother during the second trimester.

A postpartum client is being prepared for discharge. The laboratory report indicates that she has a white blood cell (WBC) count of 16,000/dL. What is the next nursing action? 1. Checking with the nurse manager to see whether the client may go home 2. Reassessing the client for signs of infection by taking her vital signs 3. Delaying the client's discharge until the practitioner has conducted a complete examination 4. Placing the report in the client's record because this is an expected postpartum finding

4. Placing the report in the client's record because this is an expected postpartum finding **Leukocytosis (15,000-20,000 mm3 WBC) typically occurs during the postpartum period as a compensatory defense mechanism. There is no need for further intervention, because the client is exhibiting an expected postpartum leukocytosis.

A nurse assesses a new mother who is breastfeeding. The client asks how to care for her nipples. What should the nurse recommend? 1. Putting lanolin cream on the nipples after breastfeeding 2. Applying vitamin E gel to the nipples before breastfeeding 3. Using soap and water to clean the breasts and nipples at least once a day 4. Spreading breast milk on the nipples after the feeding and allowing them to air dry

4. Spreading breast milk on the nipples after the feeding and allowing them to air dry

A couple who recently immigrated from Israel tell a nurse in the prenatal clinic that they are concerned about a genetic disease that is prevalent among Jewish people. Which genetic screening should the nurse expect the health care provider to recommend to determine the possibility of the couple's child's inheriting the disease? 1. Cystic fibrosis 2. Phenylketonuria 3. Turner syndrome 4. Tay-Sachs disease

4. Tay-Sachs disease **Tay-Sachs disease is a genetic disorder transmitted as an autosomal recessive trait that occurs primarily among Ashkenazi Jews. Cystic fibrosis, Phenylketonuria, and Turner syndrome do not have a higher prevalence in the Jewish population.

A pregnant client is making her first antepartum visit. She has a 2-year-old son born at 40 weeks, a 5-year-old daughter born at 38 weeks, and 7-year-old twin daughters born at 35 weeks. She had a spontaneous abortion 3 years ago at 10 weeks. How does the nurse, using the GTPAL format, document the client's obstetric history? 1. G4 T3 P2 A1 L4 2. G5 T2 P2 A1 L4 3. G5 T2 P1 A1 L4 4. G4 T3 P1 A1 L4

3. G5 T2 P1 A1 L4 **5 T2 P1 A1 L4 indicates that there the client has had five pregnancies (twins count as one pregnancy and the current pregnancy counts as one); two term births; one preterm birth (the twins); one abortion; and four living children.

A primigravida is admitted to the birthing unit in active labor. The fetus is in a breech presentation. What physiological response does the nurse expect during this client's labor? 1. Heavy vaginal bleeding 2. Fetal heart rate irregularities 3. Greenish-tinged amniotic fluid 4. Severe back pain with contractions

3. Greenish-tinged amniotic fluid

A client at 22 weeks' gestation asks the nurse how to prevent back pain as her pregnancy progresses. What does the nurse suggest that she wear? 1. Maternity girdle 2. Support stockings 3. Low-heeled shoes 4. Loose-fitting clothing

3. Low-heeled shoes **Low-heeled supportive shoes help maintain the body's center of gravity over the hips, limiting arching of the back that compensates for the increased weight in the abdominal area.

Immediately after the third stage of labor a nurse administers the prescribed oxytocin (Pitocin) infusion. Why is this medication administered? 1. To help the uterus contract 2. To lessen uterine discomfort 3. To aid in the separation of the placenta 4. For the stimulation of breast milk production

1. To help the uterus contract

At 38 weeks' gestation a client is admitted to the birthing unit in active labor, and an external fetal monitor is applied. Late fetal heart rate decelerations begin to appear when her cervix is dilated 6 cm and her contractions are occurring every 4 minutes and lasting 45 seconds. What does the nurse conclude is the cause of these late decelerations? 1. Imminent vaginal birth 2. Uteroplacental insufficiency 3. Pattern of nonprogressive labor 4. Reassuring response to contractions

2. Uteroplacental insufficiency

List the mechanisms of labor in the correct sequence: 1. Flexion 2. Extension 3. Engagement 4. Descent 5. Expulsion 6. Restitution 7. Internal rotation 8. External rotation

3. Engagement 4. Descent 1. Flexion 7. Internal rotation 2. Extension 6. Restitution 8. External rotation 5. Expulsion

A multipara is admitted to the birthing room in active labor. Her temperature is 98° F (36.7° C), pulse 70 beats/min, respirations 18 breaths/min, and blood pressure 126/76 mm Hg. A vaginal examination reveals a cervix that is 90% effaced and 7 cm dilated with the vertex presenting at 2+ station. The client is complaining of pain and asks for medication. Which medication should be avoided because it may cause respiratory depression in the newborn? 1. Naloxone (Narcan) 2. Lorazepam (Ativan) 3. Meperidine (Demerol) 4. Promethazine (Phenergan)

3. Meperidine (Demerol) **Meperidine (Demerol) is an opioid that can cause respiratory depression in the neonate if administered less than 4 hours before birth.

A nurse is teaching a primigravida about how she can identify the onset of labor. What clinical indicator of labor would necessitate the client to call her health care provider? 1. Bloody show and back pressure occurring with no contractions 2. Irregular contractions coming 10 minutes apart 3. Rupture of membranes or contractions 5 minutes apart 4. Contractions 12 minutes apart and lasting about 30 seconds

3. Rupture of membranes or contractions 5 minutes apart

When is it most important for a female client to know that a fetus may be structurally damaged by the ingestion of drugs? 1. During early adolescence 2. Throughout the entire pregnancy 3. When she is planning to become pregnant 4. At the beginning of the first trimester

3. When she is planning to become pregnant

A pregnant client's blood test reveals an increased alpha-fetoprotein (AFP) level. What condition does the nurse suspect that this result indicates? 1. Cystic fibrosis 2. Phenylketonuria 3. Down syndrome 4. Neural tube defect

4. Neural tube defect

A nurse is trying to determine whether a pregnant woman's membranes have ruptured. What findings support the conclusion that they have ruptured? (Select all that apply.) 1. The expelled fluid totals 500 mL. 2. The expelled fluid is light yellow. 3. The expelled fluid smells similar to urine. 4. Nitrazine paper turns blue on contact with the fluid. 5. Microscopic examination of the fluid reveals ferning/

4. Nitrazine paper turns blue on contact with the fluid. 5. Microscopic examination of the fluid reveals ferning/