RICCI 4,5,8-25

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A nurse is reviewing the medical record of a woman diagnosed with vulvar cancer. Which of the following would the nurse identify as a risk factor for this cancer? (Select all that apply.)

A) Age under 40 years B) HPV 16 exposure C) Monogamous sexual partner D) Hypertension E) Diabetes Ans: B, D, E Feedback: Risk factors associated with vulvar cancer include age over 50 years, history of exposure to HPV 16, multiple sex partners, hypertension, and diabetes.

A client with trichomoniasis is to receive metronidazole (Flagyl). The nurse instructs the client to avoid which of the following while taking this drug?

A) Alcohol B) Nicotine C) Chocolate D) Caffeine Ans: A Feedback: The client should be instructed to avoid consuming alcohol when taking metronidazole because severe nausea and vomiting could occur. There is no need to avoid nicotine, chocolate, or caffeine when taking metronidazole.

A pregnant woman diagnosed with syphilis comes to the clinic for a visit. The nurse discusses the risk of transmitting the infection to her newborn, explaining that this infection is transmitted to the newborn through the:

A) Amniotic fluid B) Placenta C) Birth canal D) Breast milk Ans: B Feedback: The syphilis spirochete can cross the placenta at any time during pregnancy. It is not transmitted via amniotic fluid, passage through the birth canal, or breast milk.

Which of the following nursing actions would be least helpful for a client who is a victim of violence?

A) Assist the client to project her anger. B) Provide information about a safe home and crisis line. C) Teach her about the cycle of violence. D) Discuss her legal and personal rights. Ans: A Feedback: The goal of intervention is to enable the victim to gain control by providing sensitive, predictable care in an accepting setting. Assisting the client to project her anger would not be helpful when the woman needs support and education.

After teaching a group of students about cervical cancer, the instructor determines that the teaching was successful when the students identify which of the following as the area included with a cone biopsy?

A) Clitoris B) Uterine fundus C) Ovarian follicle D) Transformation zone Ans: D Feedback: When a cone biopsy is performed, a cone-shaped section of the cervix is removed. The base of the cone is formed by the ectocervix (outer part of the cervix) and the point or apex of the cone is from the endocervical canal. The transformation zone is contained within the cone sample. A cone biopsy is not obtained from the clitoris, uterine fundus, or ovarian follicle.

When discussing contraceptive options, which method would the nurse recommend as being the most reliable?

A) Coitus interruptus B) Lactational amenorrheal method (LAM) C) Natural family planning D) Intrauterine system Ans: D Feedback: An intrauterine system is the most reliable method because users have to consciously discontinue using them to become pregnant rather than making a proactive decision to avoid conception. Coitus interruptus, LAM, and natural family planning are behavioral methods of contraception and require active participation of the couple to prevent pregnancy. These behavioral methods must be followed exactly as prescribed.

After teaching a group of students about the different methods for contraception, the instructor determines that the teaching was successful when the students identify which of the following as a mechanical barrier method? (Select all that apply.)

A) Condom B) Cervical cap C) Cervical sponge D) Diaphragm E) Vaginal ring Ans: A, B, C, D Feedback: Barrier methods include the condom, cervical cap, cervical sponge and diaphragm. The vaginal ring is considered a hormonal method of contraception.

The nurse discusses various contraceptive methods with a client and her partner. Which method would the nurse explain as being available only with a prescription?

A) Condom B) Spermicide C) Diaphragm D) Basal body temperature Ans: C Feedback: The diaphragm is available only by prescription and must be professionally fitted by a health care provider. Condoms and spermicides are available over the counter. Basal body temperature requires the use of a special thermometer that is available over the counter.

A nurse is working with a victim of intimate partner violence and helping her develop a safety plan. Which of the following would the nurse suggest that the woman take with her? (Select all that apply.)

A) Driver's license B) Social security number C) Cash D) Phone cards E) Health insurance cards Ans: A, B, C, E Feedback: When leaving an abusive relationship, the woman should take her driver's license or photo ID, social security number or green card/work permit, birth certificates, any court papers or orders, credit cards, cash, and health insurance cards. The woman should avoid phone cards because they leave a trail to follow.

After teaching a class on sexual violence, the instructor determines that the teaching was successful when the class identifies which of the following as a type of sexual violence. (Select all that apply.)

A) Female genital cutting B) Bondage C) Infanticide D) Human trafficking E) Rape Ans: A, B, C, D, E Feedback: Female genital cutting, bondage, infanticide, human trafficking, and rape are all examples of sexual violence.

A client is to receive an implantable contraceptive. The nurse describes this contraceptive as containing:

A) Synthetic progestin B) Combined estrogen and progestin C) Concentrated spermicide D) Concentrated estrogen Ans: A Feedback: Implantable contraceptives deliver synthetic progestin that acts by inhibiting ovulation and thickening cervical mucus so sperm cannot penetrate. Implantable contraceptives do not contain combined estrogen and progestin, concentrated spermicide, or concentrated estrogen.

A woman comes to the clinic complaining of a vaginal discharge. The nurse suspects trichomoniasis based on which of the following? (Select all that apply.)

A) Urinary frequency B) Yellow/green discharge C) Joint pain D) Blister-like lesions E) Muscle aches Ans: A, B Feedback: Manifestations of trichomoniasis include a yellow/green or gray frothy or bubbly discharge, dysuria, urinary frequency, and irritation or itching of the genital area. Joint pain suggesting arthritis is associated with gonorrhea. Blister-like lesions and muscle aches would suggest genital herpes.

A postpartum woman who is breast-feeding tells the nurse that she is experiencing nipple pain. Which of the following would be least appropriate for the nurse to suggest?

A) Use of a mild analgesic about 1 hour before breast-feeding B) Application of expressed breast milk to the nipples C) Application of glycerin-based gel to the nipples D) Reinstruction about proper latching-on technique Ans: A Nipple pain is difficult to treat, although a wide variety of topical creams, ointments, and gels are available to do so. This group includes beeswax, glycerin-based products, petrolatum, lanolin, and hydrogel products. Many women find these products comforting. Beeswax, glycerin-based products, and petrolatum all need to be removed before breast-feeding. These products should be avoided in order to limit infant exposure because the process of removal may increase nipple irritation. Mild analgesics such as acetaminophen or ibuprofen are considered relatively safe for breast-feeding mothers. Applying expressed breast milk to nipples and allowing it to dry has been suggested to reduce nipple pain. Usually the pain is due to incorrect latch-on and/or removal of the nursing infant from the breast. Early assistance with breast-feeding to ensure correct positioning can help prevent nipple trauma. In addition, applying expressed milk to nipples and allowing it to dry has been suggested to result in less nipple pain for many women.

Which of the following data on a client's health history would the nurse identify as contributing to the client's risk for an ectopic pregnancy?

A) Use of oral contraceptives for 5 years B) Ovarian cyst 2 years ago C) Recurrent pelvic infections D) Heavy, irregular menses Ans: C In the general population, most cases of ectopic pregnancy are the result of tubal scarring secondary to pelvic inflammatory disease. Oral contraceptives, ovarian cysts, and heavy, irregular menses are not considered risk factors for ectopic pregnancy.

When developing the plan of care for a newborn with an acquired condition, which of the following would the nurse include to promote participation by the parents?

A) Use verbal instructions primarily for explanations B) Assist with decision making process C) Provide personal views about their decisions D) Encourage them to refrain from showing emotions Ans: B Feedback: To promote parental participation, the nurse should assist them with making decisions about treatment, and support their decisions for the newborn's care. Imposing personal views about their decisions is inappropriate and undermines the nurse-client relationship. In addition, the nurse would assess their ability to cope with the diagnosis, encourage them to verbalize their feelings about the newborn's condition and treatment and educate them about the newborn's condition using written information and pictures to enhance understanding.

A pregnant woman is receiving misoprostol to ripen her cervix and induce labor. The nurse assesses the woman closely for which of the following?

A) Uterine hyperstimulation B) Headache C) Blurred vision D) Hypotension Ans: A A major adverse effect of the obstetric use of Cytotec is hyperstimulation of the uterus, which may progress to uterine tetany with marked impairment of uteroplacental blood flow, uterine rupture (requiring surgical repair, hysterectomy, and/or salpingo-oophorectomy), or amniotic fluid embolism. Headache, blurred vision, and hypotension are associated with magnesium sulfate.

Which findings would the nurse expect to find in a client with bacterial vaginosis?

A) Vaginal pH of 3 B) Fish-like odor of discharge C) Yellowish-green discharge D) Cervical bleeding on contact Ans: B Feedback: Manifestations of bacterial vaginosis include a thin, white homogenous vaginal discharge with a characteristic stale fish odor, vaginal pH greater than 4.5, and clue cells on wet-mount examination. A yellowish-green discharge with cervical bleeding on contact would be characteristic of trichomoniasis.

When describing the various types of reproductive tract cancers to a local women's group, which of the following would the nurse identify as the least common type?

A) Vulvar B) Vaginal C) Endometrial D) Ovarian Ans: B Feedback: Of the cancers listed, vaginal cancer is the rarest, with only about 1 out of every 100 cancers of the female reproductive tract. Vulvar cancer represents approximately 5% of female genital cancers. Endometrial cancer is the fourth most common gynecologic malignancy. Ovarian cancer is the eighth most common cancer among women and the fourth most common cause of cancer deaths for women in the United States.

The nurse is teaching a new mother the proper techniques for breastfeeding her newborn. Which of the following is a recommended guideline that should be implemented?

A) Wash the hands and breasts thoroughly prior to breastfeeding. B) Stroke the nipple against the baby's chin to stimulate wide opening of the baby's mouth. C) Bring the baby's wide-open mouth to the breast to form a seal around all of the nipple and areola. D) When finished the mother can break the suction by firmly pulling the baby's mouth away from the nipple. Ans: C Feedback: Before each breastfeeding session, mothers should wash their hands, but it is not necessary to wash the breast in most cases. The mother should then stroke the nipple against the baby's cheek to stimulate opening of the mouth and bring the baby's wide-open mouth to the breast to form a seal around all of the nipple and areola When the infant is finished feeding, the mother can break the suction by inserting her finger into the baby's mouth.

A group of nursing students are preparing a presentation for their class about measures to prevent toxoplasmosis. Which of the following would the students be least likely to include? Select all that apply.

A) Washing raw fruits and vegetables before eating them B) Cooking all meat to an internal temperature of 140° F C) Wearing gardening gloves when working in the soil D) Avoiding contact with a cat's litter box. Ans: B Meats should be cooked to an internal temperature of 160° F. Other measures to prevent toxoplasmosis include peeling or thoroughly washing all raw fruits and vegetables before eating them, wearing gardening gloves when in contact with outdoor soil, and avoiding the emptying or cleaning of a cat's litter box.

A nurse is assessing a newborn who has been classified as small for gestational age. Which of the following would the nurse expect to find? (Select all that apply.)

A) Wasted extremity appearance B) Increased amount of breast tissue C) Sunken abdomen D) Adequate muscle tone over buttocks E) Narrow skull sutures Ans: A, C, E Feedback: Typical characteristics of SGA newborns include a head that is disproportionately large compared to the rest of the body, wasted appearance of the extremities, reduced subcutaneous fat stores, decreased amount of breast tissue, scaphoid abdomen, wide skull sutures, poor muscle tone over buttocks and cheeks, loose and dry skin appearing oversized, and a thin umbilical cord.

A newborn was diagnosed with a congenital heart defect and will undergo surgery at a later time. The nurse is teaching the parents about signs and symptoms that need to be reported. The nurse determines that the parents have understood the instructions when they state that they will report which of the following? (Select all that apply.)

A) Weight loss B) Pale skin C) Fever D) Absence of edema E) Increased respiratory rate Ans: A, C, E Feedback: Signs and symptoms that need to be reported include weight loss, poor feeding, cyanosis, breathing difficulties, irritability, increased respiratory rate, and fever.

Assessment of a woman in labor who is experiencing hypertonic uterine dysfunction would reveal contractions that are:

A) Well coordinated B) Poor in quality C) Rapidly occurring D) Erratic Ans: D Hypertonic contractions occur when the uterus never fully relaxes between contractions, making the contractions erratic and poorly coordinated because more than one uterine pacemaker is sending signals for contraction. Hypotonic uterine contractions are poor in quality and lack sufficient intensity to dilate and efface the cervix. Contractions of precipitous labor occur rapidly such that labor is completed in less than 3 hours.

The nurse is assessing a newborn of a woman who is suspected of abusing alcohol. Which newborn finding would provide additional evidence to support this suspicion?

A) Wide large eyes B) Thin upper lip C) Protruding jaw D) Elongated nose Ans: B Newborn characteristics suggesting fetal alcohol spectrum disorder include thin upper lip, small head circumference, small eyes, receding jaw, and short nose. Other features include a low nasal bridge, short palpebral fissures, flat midface, epicanthal folds, and minor ear abnormalities.

When planning the care of a newborn addicted to cocaine who is experiencing withdrawal, which of the following would be least appropriate to include?

A) Wrapping the newborn snugly in a blanket B) Waking the newborn every hour C) Checking the newborn's fontanels D) Offering a pacifier Ans: B Feedback: Stimuli need to be decreased. Waking the newborn every hour would most likely be too stimulating. Measures such as swaddling the newborn tightly and offering a pacifier help to decrease irritable behaviors. A pacifier also helps to satisfy the newborn's need for nonnutritive sucking. Checking the fontanels provides evidence of hydration.

Which assessment finding would lead the nurse to suspect infection as the cause of a client's PROM?

A) Yellow-green fluid B) Blue color on Nitrazine testing C) Ferning D) Foul odor Ans: D A foul odor of the amniotic fluid indicates infection. Yellow-green fluid would suggest meconium. A blue color on Nitrazine testing and ferning indicate the presence of amniotic fluid.

After teaching a group of students about fetal development, the instructor determines that the teaching was successful when the students identify which of the following as providing the barrier to other sperm after fertilization?

A) Zona pellucida B) Zygote C) Cleavage D) Morula Ans: A Feedback: The zona pellucida is the clear protein layer that acts as a barrier to other sperm once one sperm enters the ovum for fertilization. The zygote refers to the union of the nuclei of the ovum and sperm resulting in the diploid number of chromosomes. Cleavage is another term for mitosis. The morula is the result of four cleavages leading to 16 cells that appear as a solid ball of cells. The morula reaches the uterine cavity about 72 hours after fertilization.

The nurse is discussing the insulin needs of a primiparous client with diabetes who has been using insulin for the past few years. The nurse informs the client that her insulin needs will increase during pregnancy based on the nurse's understanding that the placenta produces:

A) hCG, which increases maternal glucose levels B) hPL, which deceases the effectiveness of insulin C) Estriol, which interferes with insulin crossing the placenta D) Relaxin, which decreases the amount of insulin produced Ans: B hPL acts as an antagonist to insulin, so the mother must produce more insulin to overcome this resistance. If the mother has diabetes, then her insulin need would most likely increase to meet this demand. hCG does not affect insulin and glucose level. Estrogen, not estriol, is believed to oppose insulin. In addition, insulin does not cross the placenta. Relaxin is not associated with insulin resistance.

A gravida 2 para 1 client in the 10th week of her pregnancy says to the nurse, ìI've never urinated as often as I have for the past three weeks.î Which response would be most appropriate for the nurse to make?

A) ìHaving to urinate so often is annoying. I suggest that you watch how much fluid you are drinking and limit it.î B) ìYou shouldn't be urinating this frequently now; it usually stops by the time you're eight weeks pregnant. Is there anything else bothering you?î C) ìBy the time you are 12 weeks pregnant, this frequent urination should no longer be a problem, but it is likely to return toward the end of your pregnancy.î D) ìWomen having their second child generally don't have frequent urination. Are you experiencing any burning sensations?î Ans: C As the uterus grows, it presses on the urinary bladder, causing the increased frequency of urination during the first trimester. This complaint lessens during the second trimester only to reappear in the third trimester as the fetus begins to descend into the pelvis, causing pressure on the bladder.

A woman who delivered a healthy newborn several hours ago asks the nurse, "Why am I perspiring so much?" The nurse integrates knowledge that a decrease in which hormone plays a role in this occurrence? A) Estrogen B) hCG C) hPL D) Progesterone

Ans: A Although hCG, hPL, and progesterone decline rapidly after birth, decreased estrogen levels are associated with breast engorgement and with the diuresis of excess extracellular fluid accumulated during pregnancy.

The nurse is making a follow-up home visit to a woman who is 12 days postpartum. Which of the following would the nurse expect to find when assessing the client's fundus? A) Cannot be palpated B) 2 cm below the umbilicus C) 6 cm below the umbilicus D) 10 cm below the umbilicus

Ans: A By the end of 10 days, the fundus usually cannot be palpated because it has descended into the true pelvis.

The nurse interprets which of the following as evidence that a client is in the taking-in phase? A) Client states, "He has my eyes and nose." B) Client shows interest in caring for the newborn. C) Client performs self-care independently. D) Client confidently cares for the newborn.

Ans: A During the taking-in phase, new mothers when interacting with their newborns spend time claiming the newborn and touching him or her, commonly identifying specific features in the newborn such as "he has my nose" or "his fingers are long like his father's." Independence in self-care and interest in caring for the newborn are typical of the taking-hold phase. Confidence in caring for the newborn is demonstrated during the letting-go phase.

A postpartum client is experiencing subinvolution. When reviewing the woman's labor and birth history, which of the following would the nurse identify as being least significant to this condition? A) Early ambulation B) Prolonged labor C) Large fetus D) Use of anesthetics

Ans: A Factors that inhibit involution include prolonged labor and difficult birth, incomplete expulsion of amniotic membranes and placenta, uterine infection, overdistention of uterine muscles (such as by multiple gestation, hydramnios, or large singleton fetus), full bladder (which displaces the uterus and interferes with contractions), anesthesia (which relaxes uterine muscles), and close childbirth spacing. Factors that facilitate uterine involution include complete expulsion of amniotic membranes and placenta at birth, complication-free labor and birth process, breast-feeding, and early ambulation.

Which of the following would lead the nurse to suspect that a postpartum woman is experiencing a problem? A) Elevated white blood cell count B) Acute decrease in hematocrit C) Increased levels of clotting factors D) Pulse rate of 60 beats/minute

Ans: B Despite a decrease in blood volume after birth, hematocrit levels remain relatively stable and may even increase. An acute decrease is not an expected finding. The WBC count remains elevated for the first 4 to 6 days and clotting factors remain elevated for 2 to 3 weeks. Bradycardia (50 to 70 beats per minute) for the first two weeks reflects the decrease in cardiac output.

A nurse is making a home visit to a postpartum woman who delivered a healthy newborn 4 days ago. The woman's breasts are swollen, hard, and tender to the touch. The nurse documents this finding as which of the following? A) Involution B) Engorgement C) Mastitis D) Engrossment

Ans: B Engorgement is the process of swelling of the breast tissue as a result of an increase in blood and lymph supply as a precursor to lactation (Figure 15.4). Breast engorgement usually peaks in 3 to 5 days postpartum and usually subsides within the next 24 to 36 hours (Chapman, 2011). Engorgement can occur from infrequent feeding or ineffective emptying of the breasts and typically lasts about 24 hours. Breasts increase in vascularity and swell in response to prolactin 2 to 4 days after birth. If engorged, the breasts will be hard and tender to touch. Involution refers to the process of the uterus returning to its prepregnant state. Mastitis refers to an infection of the breasts. Engrossment refers to the bond that develops between the father and the newborn.

A postpartum client who is bottle feeding her newborn asks, "When should my period return?" Which response by the nurse would be most appropriate? A) "It's difficult to say, but it will probably return in about 2 to 3 weeks." B) "It varies, but you can estimate it returning in about 7 to 9 weeks." C) "You won't have to worry about it returning for at least 3 months." D) "You don't have to worry about that now. It'll be quite a while."

Ans: B For the nonlactating woman, menstruation resumes 7 to 9 weeks after giving birth, with the first cycle being anovulatory. For the lactating woman, menses can return anytime from 2 to 18 months after childbirth.

Which of the following would the nurse interpret as being least indicative of paternal engrossment? A) Demonstrating pleasure when touching or holding the newborn B) Identifying imperfections in the newborn's appearance C) Being able to distinguish his newborn from others in the nursery D) Showing feelings of pride with the birth of the newborn

Ans: B Identifying imperfections would not be associated with engrossment. Engrossment is characterized by seven behaviors: visual awareness of the newborn, tactile awareness of the newborn, perception of the newborn as perfect, strong attraction to the newborn, awareness of distinct features of the newborn, extreme elation, and increased sense of self-esteem.

A woman who gave birth 24 hours ago tells the nurse, "I've been urinating so much over the past several hours." Which response by the nurse would be most appropriate? A) "You must have an infection, so let me get a urine specimen." B) "Your body is undergoing many changes that cause your bladder to fill quickly." C) "Your uterus is not contracting as quickly as it should." D) "The anesthesia that you received is wearing off and your bladder is working again."

Ans: B Postpartum diuresis occurs as a result of several mechanisms: the large amounts of IV fluids given during labor, a decreasing antidiuretic effect of oxytocin as its level declines, the buildup and retention of extra fluids during pregnancy, and a decreasing production of aldosterone—the hormone that decreases sodium retention and increases urine production. All these factors contribute to rapid filling of the bladder within 12 hours of birth. Diuresis begins within 12 hours after childbirth and continues throughout the first week postpartum. Rapid bladder filling, possible infection, or effects of anesthesia are not involved.

A group of nursing students are reviewing respiratory system adaptations that occur during the postpartum period. The students demonstrate understanding of the information when they identify which of the following as a postpartum adaptation? A) Continued shortness of breath B) Relief of rib aching C) Diaphragmatic elevation D) Decrease in respiratory rate

Ans: B Respirations usually remain within the normal adult range of 16 to 24 breaths per minute. As the abdominal organs resume their nonpregnant position, the diaphragm returns to its usual position. Anatomic changes in the thoracic cavity and rib cage caused by increasing uterine growth resolve quickly. As a result, discomforts such as shortness of breath and rib aches are relieved.

A postpartum woman who has experienced diastasis recti asks the nurse about what to expect related to this condition. Which response by the nurse would be most appropriate? A) "You'll notice that this will fade to silvery lines." B) "Exercise will help to improve the muscles." C) "Expect the color to lighten somewhat." D) "You'll notice that your shoe size will increase."

Ans: B Separation of the rectus abdominis muscles, called diastasis recti, is more common in women who have poor abdominal muscle tone before pregnancy. After birth, muscle tone is diminished and the abdominal muscles are soft and flabby. Specific exercises are necessary to help the woman regain muscle tone. Fortunately, diastasis responds well to exercise, and abdominal muscle tone can be improved. Stretch marks (striae gravidarum) fade to silvery lines. The darkened pigmentation of the abdomen (linea nigra), face (melasma), and nipples gradually fades. Parous women will note a permanent increase in shoe size.

A father of a newborn tells the nurse, "I may not know everything about being a dad, but I'm going to do the best I can for my son." The nurse interprets this as indicating the father is in which stage of adaptation? A) Expectations B) Transition to mastery C) Reality D) Taking-in

Ans: B The father's statement reflects transition to mastery because he is making a conscious decision to take control and be at the center of the newborn's life regardless of his preparedness. The expectations stage involves preconceptions about how life will be with a newborn. Reality occurs when fathers realize their expectations are not realistic. Taking-in is a phase of maternal adaptation.

The partner of a woman who has given birth to a healthy newborn says to the nurse, "I want to be involved, but I'm not sure that I'm able to care for such a little baby." The nurse interprets this as indicating which of the following stages? A) Expectations B) Reality C) Transition to mastery D) Taking-hold

Ans: B The partner's statement reflects stage 2 (reality), which occurs when fathers or partners realize that their expectations in stage 1 are not realistic. Their feelings change from elation to sadness, ambivalence, jealousy, and frustration. Many wish to be more involved in the newborn's care and yet do not feel prepared to do so. New fathers or partners pass through stage 1 (expectations) with preconceptions about what home life will be like with a newborn. Many men may be unaware of the dramatic changes that can occur when this newborn comes home to live with them. In stage 3 (transition to mastery), the father or partner makes a conscious decision to take control and be at the center of his newborn's life regardless of his preparedness. Taking-hold is a stage of maternal adaptation.

A nursing student is preparing a class presentation about changes in the various body systems during the postpartum period and their effects. Which of the following would the student include as influencing a postpartum woman's ability to void? (Select all that apply.) A) Use of an opioid anesthetic during labor B) Generalized swelling of the perineum C) Decreased bladder tone from regional anesthesia D) Use of oxytocin to augment labor E) Need for an episiotomy

Ans: B, C, D Many women have difficulty feeling the sensation to void after giving birth if they received an anesthetic block during labor (which inhibits neural functioning of the bladder) or if they received oxytocin to induce or augment their labor (antidiuretic effect). These women will be at risk for incomplete emptying, bladder distention, difficulty voiding, and urinary retention. In addition, urination may be impeded by perineal lacerations; generalized swelling and bruising of the perineum and tissues surrounding the urinary meatus; hematomas; decreased bladder tone as a result of regional anesthesia; and diminished sensation of bladder pressure as a result of swelling, poor bladder tone, and numbing effects of regional anesthesia used during labor.

A group of nursing students are reviewing information about maternal and paternal adaptations to the birth of a newborn. The nurse observes the parents interacting with their newborn physically and emotionally. The nurse documents this as which of the following? A) Puerperium B) Lactation C) Attachment D) Engrossment

Ans: C Attachment is a formation of a relationship between a parent and her/his newborn through a process of physical and emotional interactions. Puerperium refers to the postpartum period. Lactation refers to the process of milk secretion by the breasts. Engrossment refers to the bond that develops between the father and the newborn.

A primipara client gave birth vaginally to a healthy newborn girl 48 hours ago. The nurse palpates the client's fundus, expecting it to be at which location? A) Two fingerbreadths above the umbilicus B) At the level of the umbilicus C) Two fingerbreadths below the umbilicus D) Four fingerbreadths below the umbilicus

Ans: C During the first few days after birth, the uterus typically descends downward from the level of the umbilicus at a rate of 1 cm (1 fingerbreadth) per day so that by day 2, it is about 2 fingerbreadths below the umbilicus.

The nurse develops a teaching plan for a postpartum client and includes teaching about how to perform Kegel exercises. The nurse includes this information for which reason? A) Reduce lochia B) Promote uterine involution C) Improve pelvic floor tone D) Alleviate perineal pain

Ans: C Kegel exercises help to improve pelvic floor tone, strengthen perineal muscles, and promote healing, ultimately helping to prevent urinary incontinence later in life. Kegel exercises have no effect on lochia, involution, or pain.

When the nurse is assessing a postpartum client approximately 6 hours after delivery, which finding would warrant further investigation? A) Deep red, fleshy-smelling lochia B) Voiding of 350 cc C) Heart rate of 120 beats/minute D) Profuse sweating

Ans: C Tachycardia in the postpartum woman warrants further investigation. It may indicate hypovolemia, dehydration, or hemorrhage. Deep red, fleshy-smelling lochia is a normal finding 6 hours postpartum. Voiding in small amounts such as less than 150 cc would indicate a problem, but 350 cc would be appropriate. Profuse sweating also is normal during the postpartum period.

A nurse is assessing a postpartum woman's adjustment to her maternal role. Which of the following would the nurse expect to occur first? A) Reestablishing relationships with others B) Demonstrating increasing confidence in care of the newborn C) Assuming a passive role in meeting her own needs D) Becoming preoccupied with the present

Ans: C The first task of adjusting to the maternal role is the taking-in phase in which the mother demonstrates dependent behaviors and assumes a passive role in meeting her own basic needs. During the taking-hold phase, the mother becomes preoccupied with the present. During the letting-go phase, the mother reestablishes relationships with others and demonstrates increased responsibility and confidence in caring for the newborn.

When caring for a mother who has had a cesarean birth, the nurse would expect the client's lochia to be: A) Greater than after a vaginal delivery B) About the same as after a vaginal delivery C) Less than after a vaginal delivery D) Saturated with clots and mucus

Ans: C Women who have had cesarean births tend to have less flow because the uterine debris is removed manually along with delivery of the placenta.

A nurse teaches a postpartum woman about her risk for thromboembolism. Which of the following would the nurse be least likely to include as a factor increasing her risk? A) Increased clotting factors B) Vessel damage C) Immobility D) Increased red blood cell production

Ans: D Clotting factors that increased during pregnancy tend to remain elevated during the early postpartum period. Giving birth stimulates this hypercoagulability state further. As a result, these coagulation factors remain elevated for 2 to 3 weeks postpartum (Silver & Major, 2010). This hypercoagulable state, combined with vessel damage during birth and immobility, places the woman at risk for thromboembolism (blood clots) in the lower extremities and the lungs. Red blood cell production ceases early in the puerperium, which causes mean hemoglobin and hematocrit levels to decrease slightly in the first 24 hours and then rise slowly over the next 2 weeks.

The nurse is developing a teaching plan for a client who has decided to bottle feed her newborn. Which of the following would the nurse include in the teaching plan to facilitate suppression of lactation? A) Encouraging the woman to manually express milk B) Suggesting that she take frequent warm showers to soothe her breasts C) Telling her to limit the amount of fluids that she drinks D) Instructing her to apply ice packs to both breasts every other hour

Ans: D If the woman is not breast-feeding, relief measures for engorgement include wearing a tight supportive bra 24 hours daily, applying ice to her breasts for approximately 15 to 20 minutes every other hour, and not stimulating her breasts by squeezing or manually expressing milk. Warm showers enhance the let-down reflex and would be appropriate if the woman was breast-feeding. Limiting fluid intake is inappropriate. Fluid intake is important for all postpartum women, regardless of the feeding method chosen.

After teaching a group of nursing students about the process of involution, the instructor determines that additional teaching is needed when the students identify which of the following as being involved? A) Catabolism B) Muscle fiber contraction C) Epithelial regeneration D) Vasodilation

Ans: D Involution involves three retrogressive Process: contraction of muscle fibers to reduce those previously stretched during pregnancy; catabolism, which reduces enlarged myometrial cells; and regeneration of uterine epithelium from the lower layer of the decidua after the upper layers have been sloughed off and shed during lochial discharge. Vasodilation is not involved.

A group of students are reviewing the process of breast milk production. The students demonstrate understanding when they identify which hormone as responsible for milk let-down? A) Prolactin B) Estrogen C) Progesterone D) Oxytocin

Ans: D Oxytocin is released from the posterior pituitary to promote milk let-down. Prolactin levels increase at term with a decrease in estrogen and progesterone; estrogen and progesterone levels decrease after the placenta is delivered. Prolactin is released from the anterior pituitary gland and initiates milk production.

A postpartum client comes to the clinic for her 6-week postpartum checkup. When assessing the client's cervix, the nurse would expect the external cervical os to appear: A) Shapeless B) Circular C) Triangular D) Slit-like

Ans: D The external cervical os is no longer shaped like a circle but instead appears as a jagged slit-like opening, often described as a "fish mouth."

A client who is breast-feeding her newborn tells the nurse, "I notice that when I feed him, I feel fairly strong contraction-like pain. Labor is over. Why am I having contractions now?" Which response by the nurse would be most appropriate? A) "Your uterus is still shrinking in size; that's why you're feeling this pain." B) "Let me check your vaginal discharge just to make sure everything is fine." C) "Your body is responding to the events of labor, just like after a tough workout." D) "The baby's sucking releases a hormone that causes the uterus to contract."

Ans: D The woman is describing afterpains, which are usually stronger during breast-feeding because oxytocin released by the sucking reflex strengthens uterine contractions. Afterpains are associated with uterine involution, but the woman's description strongly correlates with the hormonal events of breast-feeding. All women experience afterpains, but they are more acute in multiparous women secondary to repeated stretching of the uterine muscles.

A client is admitted to the labor and birthing suite in early labor. On review of her medical record, the nurse determines that the client's pelvic shape as identified in the antepartal progress notes is the most favorable one for a vaginal delivery. Which pelvic shape would the nurse have noted? A) Platypelloid B) Gynecoid C) Android D) Anthropoid

A nurse is assessing a woman after birth and notes a second-degree laceration. The nurse interprets this as indicating that the tear extends through which of the following? A) Skin B) Muscles of perineal body C) Anal sphincter D) Anterior rectal wall

A nurse is reviewing the fetal heart rate pattern and observes abrupt decreases in FHR below the baseline, appearing as a U-shape. The nurse interprets these changes as reflecting which of the following? A) Early decelerations B) Variable decelerations C) Prolonged decelerations D) Late decelerations

A woman calls the health care facility stating that she is in labor. The nurse would urge the client to come to the facility if the client reports which of the following? A) Increased energy level with alternating strong and weak contractions B) Moderately strong contractions every 4 minutes, lasting about 1 minute C) Contractions noted in the front of abdomen that stop when she walks D) Pink-tinged vaginal secretions and irregular contractions lasting about 30 seconds

A woman in her third trimester comes to the clinic for a prenatal visit. During assessment the woman reports that her breathing has become much easier in the last week but she has noticed increased pelvic pressure , cramping and lower back pain. The nurse determines that which of the following has most likely occurred? A) Cervical dilation B) Lightening C) Bloody show D) Braxton-Hicks contractions

A woman in labor is to receive continuous internal electronic fetal monitoring. The nurse reviews the woman's medical record to ensure which of the following as being required? A) Intact membranes B) Cervical dilation of 2 cm or more C) Floating presenting fetal part D) A neonatologist to insert the electrode

A woman telephones her health care provider and reports that her "water just broke." Which suggestion by the nurse would be most appropriate? A) "Call us back when you start having contractions." B) "Come to the clinic or emergency department for an evaluation." C) "Drink 3 to 4 glasses of water and lie down." D) "Come in as soon as you feel the urge to push."

A woman's amniotic fluid is noted to be cloudy. The nurse interprets this finding as which of the following? A) Normal B) Possible infection C) Meconium passage D) Transient fetal hypoxia

After describing continuous internal electronic fetal monitoring to a laboring woman and her partner, which of the following would indicate the need for additional teaching? A) "This type of monitoring is the most accurate method for our baby." B) "Unfortunately, I'm going to have to stay quite still in bed while it is in place." C) "This type of monitoring can only be used after my membranes rupture." D) "You'll be inserting a special electrode into my baby's scalp."

After teaching a group of students about the maternal bony pelvis, which statement by the group indicates that the teaching was successful? A) The bony pelvis plays a lesser role during labor than soft tissue. B) The pelvic outlet is associated with the true pelvis. C) The false pelvis lies below the imaginary linea terminalis. D) The false pelvis is the passageway through which the fetus travels.

When assessing cervical effacement of a client in labor, the nurse assesses which of the following characteristics? A) Extent of opening to its widest diameter B) Degree of thinning C) Passage of the mucous plug D) Fetal presenting part

When describing the stages of labor to a pregnant woman, which of the following would the nurse identify as the major change occurring during the first stage? A) Regular contractions B) Cervical dilation C) Fetal movement through the birth canal D) Placental separation

Which of the following would be most appropriate for the nurse to suggest about pushing to a woman in the second stage of labor? A) "Lying flat with your head elevated on two pillows makes pushing easier." B) "Choose whatever method you feel most comfortable with for pushing." C) " Let me help you decide when it is time to start pushing." D) "Bear down like you're having a bowel movement with every contraction."

A pregnant woman admitted to the labor and birth suite undergoes rapid HIV testing and is found to be HIV-positive. Which of the following would the nurse expect to include when developing a plan of care for this women? (Select all that apply.) A) Administration of penicillin G at the onset of labor B) Avoidance of scalp electrodes for fetal monitoring C) Refraining from obtaining fetal scalp blood for pH testing D) Adminstering zidovudine at the onset of labor. E) Electing for the use of forceps-assisted delivery

B C D

A nurse is completing the assessment of a woman admitted to the labor and birth suite. Which of the following would the nurse expect to include as part of the physical assessment? (Select all that apply.) A) Current pregnancy history B) Fundal height measurement C) Support system D) Estimated date of birth E) Membrane status F) Contraction pattern

B E F

15. Which of the following would the nurse include when teaching a pregnant woman about chorionic villus sampling? A) "The results should be available in about a week." B) "You'll have an ultrasound first and then the test." C) "Afterwards, you can resume your exercise program." D) "This test is very helpful for identifying spinal defects."

B) "You'll have an ultrasound first and then the test."

5. During a routine prenatal visit, a client, 36 weeks pregnant, states she has difficulty breathing and feels like her pulse rate is really fast. The nurse finds her pulse to be 100 beats per minute (increased from baseline readings of 70 to 74 beats per minute. and irregular, with bilateral crackles in the lower lung bases. Which nursing diagnosis would be the priority for this client? A) Ineffective tissue perfusion related to supine hypotensive syndrome B) Impaired gas exchange related to pulmonary congestion C) Activity intolerance related to increased metabolic requirements D) Anxiety related to fear of pregnancy outcome

B) Impaired gas exchange related to pulmonary congestion

8. A client's last menstrual period was April 11. Using Nagele's rule, her expected date of birth (EDB) would be: A) January 4 B) January 18 C) January 25 D) February 24

B) January 18

10. A client's maternal serum alpha-fetoprotein (MSAFP. level was unusually elevated at 17 weeks. The nurse suspects which of the following? A) Fetal hypoxia B) Open spinal defects C) Down syndrome D) Maternal hypertension

B) Open spinal defects

24. After teaching a group of students about the different perinatal education methods, the instructor determines that the teaching was successful when the students identify which of the following as the Bradley method? A) Psychoprophylactic method B) Partner-coached method C) Natural childbirth method D) Mind prevention method

B) Partner-coached method

19. A nurse is reviewing the medical record of a pregnant woman and notes that she is gravid II. The nurse interprets this to indicate the number of: A) Deliveries B) Pregnancies C) Spontaneous abortions D) Pre-term births

B) Pregnancies

A client has not received any medication during her labor. She is having frequent contractions every 1 to 2 minutes and has become irritable with her coach and no longer will allow the nurse to palpate her fundus during contractions. Her cervix is 8 cm dilated and 90% effaced. The nurse interprets these findings as indicating: A) Latent phase of the first stage of labor B) Active phase of the first stage of labor C) Transition phase of the first stage of labor D) Pelvic phase of the second stage of labor

A nurse is assisting with the delivery of a newborn. The fetal head has just emerged. Which of the following would be done next? A) Suctioning of the mouth and nose B) Clamping of the umbilical cord C) Checking for the cord around the neck D) Drying of the newborn

A nurse is documenting fetal lie of a woman in labor. Which term would the nurse most likely use? A) Flexion B) Extension C) Longitudinal D) Cephalic

A nurse is explaining the use of therapeutic touch as a pain relief measure during labor. Which of the following would the nurse include in the explanation? A) "This technique focuses on manipulating body tissues." B) "The technique requires focusing on a specific stimulus." C) "This technique redirects energy fields that lead to pain." D) "The technique involves light stroking of the abdomen with breathing."

A nurse is providing care to a woman during the third stage of labor. Which of the following would alert the nurse that the placenta is separating? (Select all that apply.) A) Boggy, soft uterus B) Uterus becoming discoid shaped C) Sudden gush of dark blood from the vagina D) Shortening of the umbilical cord

A woman in her 40th week of pregnancy calls the nurse at the clinic and says she's not sure whether she is in true or false labor. Which statement by the client would lead the nurse to suspect that the woman is experiencing false labor? A"I'm feeling contractions mostly in my back." B"My contractions are about 6 minutes apart and regular." C"The contractions slow down when I walk around." D"If I try to talk to my partner during a contraction, I can't."

A woman in labor who received an opioid for pain relief develops respiratory depression. The nurse would expect which agent to be administered? A) Butorphanol B) Fentanyl C) Naloxone D) Promethazine

A woman is admitted to the labor and birthing suite. Vaginal examination reveals that the presenting part is approximately 2 cm above the ischial spines. The nurse documents this finding as: A) +2 station B) 0 station C) -2 station D) Crowning

A woman is in the first stage of labor. The nurse would encourage her to assume which position to facilitate the progress of labor? A) Supine B) Lithotomy C) Upright D) Knee-chest

Assessment of a pregnant woman reveals that the presenting part of the fetus is at the level of the maternal ischial spines. The nurse documents this as which station? A) -2 B) -1 C) 0 D) +1

The nurse is reviewing the medical record of a woman in labor and notes that the fetal position is documented as LSA. The nurse interprets this information as indicating which of the following is the presenting part? A) Occiput B) Face C) Buttocks D) Shoulder

When applying the ultrasound transducers for continuous external electronic fetal monitoring, at which location would the nurse place the transducer to record the FHR? A) Over the uterine fundus where contractions are most intense B) Above the umbilicus toward the right side of the diaphragm C) Between the umbilicus and the symphysis pubis D) Between the xiphoid process and umbilicus

When assessing fetal heart rate, the nurse finds a heart rate of 175 bpm, accompanied by a decrease in variability and late decelerations. Which of the following would the nurse do next? A) Have the woman change her position. B) Administer oxygen. C) Notify the health care provider. D) Continue to monitor the pattern every 15 minutes.

When palpating the fundus during a contraction, the nurse notes that it feels like a chin. The nurse interprets this finding as indicating which type of contraction? A) Intense B) Strong C) Moderate D) Mild

When planning the care of a woman in the active phase of labor, the nurse would anticipate assessing the fetal heart rate at which interval? A) Every 2 to 4 hours B) Every 45 to 60 minutes C) Every 15 to 30 minutes D) Every 10 to 15 minutes

22. A nurse is working with a pregnancy woman to schedule follow-up visits for her pregnancy. Which statement by the woman indicates that she understands the scheduling? A) "I need to make visits every 2 months until I'm 36 weeks pregnant." B) "Once I get to 28 weeks, I have to come twice a month." C) "From now until I'm 28 weeks, I'll be coming once a month." D) "I'll make sure to get a day off every 2 weeks to make my visits."

C) "From now until I'm 28 weeks, I'll be coming once a month."

20. A nurse measures a pregnant woman's fundal height and finds it to be 28 cm. The nurse interprets this to indicate which of the following? A) 14 weeks' gestation B) 20 weeks' gestation C) 28 weeks' gestation D) 36 weeks' gestation

C) 28 weeks' gestation

2. On the first prenatal visit, examination of the woman's internal genitalia reveals a bluish coloration of the cervix and vaginal mucosa. The nurse records this finding as: A) Hegar's sign B) Goodell's sign C) Chadwick's sign D) Homans' sign

C) Chadwick's sign

6. When preparing a woman for an amniocentesis, the nurse would instruct her to do which of the following? A) Shower with an antiseptic scrub. B) Swallow the preprocedure sedative. C) Empty her bladder. D) Lie on her left side.

C) Empty her bladder.

Chapter 13 Labor and Birth Process

Chapter 13 Labor and Birth Process Questions

Chapter 13 Questions

Chapter 14 Nursing Care During Labor and Birth

Chapter 14 Nursing Care During Labor and Birth Questions

A client states, "I think my waters broke! I felt this gush of fluid between my legs." The nurse tests the fluid with Nitrazine paper and confirms membrane rupture if the paper turns: A) Yellow B) Olive green C) Pink D) Blue

A fetus is assessed at 2 cm above the ischial spines. The nurse would document fetal station as: A) +4 B) +2 C) 0 D) -2

A group of nursing students are reviewing the various medications used for pain relief during labor. The students demonstrate understanding of the information when they identify which agent as the most commonly used opioid? A) Butorphanol B) Nalbuphine C) Fentanyl D) Meperidine

A nurse is assessing a woman in labor. Which finding would the nurse identify as a cause for concern during a contraction? A) Heart rate increase from 76 bpm to 90 bpm B) Blood pressure rise from 110/60 mm Hg to 120/74 C) White blood cell count of 12,000 cells/mm3 D) Respiratory rate of 10 breaths /minute

A nurse is caring for several women in labor. The nurse determines that which woman is in the transition phase of labor? A) Contractions every 5 minutes, cervical dilation 3 cm B) Contractions every 3 minutes, cervical dilation 5 cm C) Contractions every 2½ minutes, cervical dilation 7 cm D) Contractions every 1 minute, cervical dilation 9 cm

A woman in labor has chosen to use hydrotherapy as a method of pain relief. Which statement by the woman would lead the nurse to suspect that the woman needs additional teaching? A) "The warmth and buoyancy of the water has a nice relaxing effect." B) "I can stay in the bath for as long as I feel comfortable." C) "My cervix should be dilated more than 5 cm before I try using this method." D) "The temperature of the water should be at least 105° F."

11. When assessing a pregnant woman in her last trimester, which question would be most appropriate to use to gather information about weight gain and fluid retention? A) "What's your usual dietary intake for a typical day?" B) "What size maternity clothes are you wearing now?" C) "How puffy does your face look by the end of a day?" D) "How swollen do your ankles appear before you go to bed?

D) "How swollen do your ankles appear before you go to bed?

9. During a nonstress test, when monitoring the fetal heart rate, the nurse notes that when the expectant mother reports fetal movement, the heart rate increases 15 beats or more above the baseline. The nurse interprets this as: A) Variable decelerations B) Fetal tachycardia C) A nonreactive pattern D) Reactive pattern

D) Reactive pattern

23. A nursing instructor is describing the various childbirth methods. Which of the following would the instructor include as part of the Lamaze method? A) Focus on the pleasurable sensations of childbirth B) Concentration on sensations while turning on to own bodies C) Interruption of the fear-tension-pain cycle D) Use of specific breathing and relaxation techniques

D) Use of specific breathing and relaxation techniques

A nurse is visiting a postpartum woman who delivered a healthy newborn 5 days ago. Which of the following would the nurse expect to find? A) Bright red discharge B) Pinkish brown discharge C) Deep red mucus-like discharge D) Creamy white discharge Ans: B

Lochia serosa is pinkish brown and is expelled 3 to 10 days postpartum. Lochia rubra is a deep-red mixture of mucus, tissue debris, and blood that occurs for the first 3 to 4 days after birth. Lochia alba is creamy white or light brown and consists of leukocytes, decidual tissue, and reduced fluid content and occurs from days 10 to 14 but can last 3 to 6 weeks postpartum.

Week 2

A client's membranes spontaneously ruptured, as evidenced by a gush of clear fluid with a contraction. Which of the following would the nurse do next? A) Check the fetal heart rate. B) Perform a vaginal exam. C) Notify the physician immediately. D) Change the linen saver pad.

A nurse is describing how the fetus moves through the birth canal. Which of the following would the nurse identify as being most important in allowing the fetal head to move through the pelvis? A) Sutures B) Fontanelles C) Frontal bones D) Biparietal diameter

A nurse is describing the different types of regional analgesia and anesthesia for labor to a group of pregnant women. Which statement by the group indicates that the teaching was successful? A) "We can get up and walk around after receiving combined spinal-epidural analgesia." B) "Higher anesthetic doses are needed for patient-controlled epidural analgesia." C) "A pudendal nerve block is highly effective for pain relief in the first stage of labor." D) "Local infiltration using lidocaine is an appropriate method for controlling contraction pain."

A nurse palpates a woman's fundus to determine contraction intensity. Which of the following would be most appropriate for the nurse to use for palpation? A) Finger pads B) Palm of the hand C) Finger tips D) Back of the hand

A woman has just entered the second stage of labor. The nurse would focus care on which of the following? A) Encouraging the woman to push when she has a strong desire to do so B) Alleviating perineal discomfort with the application of ice packs C) Palpating the woman's fundus for position and firmness D) Completing the identification process of the newborn with the mother

A woman in labor received an opioid close to the time of birth. The nurse would assess the newborn for which of the following? A) Respiratory depression B) Urinary retention C) Abdominal distention D) Hyperreflexia

Assessment of a fetus identifies the buttocks as the presenting part, with the legs extended upward. The nurse identifies this as which type of breech presentation? A) Frank B) Full C) Complete D) Footling

Assessment of a woman in labor reveals cervical dilation of 3 cm, cervical effacement of 30%, and contractions occurring every 7 to 8 minutes, lasting about 40 seconds. The nurse determines that this client is in: A) Latent phase of the first stage B) Active phase of the first stage C) Transition phase of the first stage D) Perineal phase of the second stage

During a follow-up prenatal visit, a pregnant woman asks the nurse, "How long do you think I will be in labor?" Which response by the nurse would be most appropriate? A) "It's difficult to predict how your labor will progress, but we'll be there for you the entire time." B) "Since this is your first pregnancy, you can estimate it will be about 10 hours." C) "It will depend on how big the baby is when you go into labor." D) "Time isn't important; your health and the baby's health are key."

The fetus of a nulliparous woman is in a shoulder presentation. The nurse would most likely prepare the client for which type of birth? A) Cesarean B) Vaginal C) Forceps-assisted D) Vacuum extraction

The nurse is performing Leopold's maneuvers to determine fetal presentation, position, and lie. Which action would the nurse do first? A) Feel for the fetal buttocks or head while palpating the abdomen. B) Feel for the fetal back and limbs as the hands move laterally on the abdomen. C) Palpate for the presenting part in the area just above the symphysis pubis. D) Determine flexion by pressing downward toward the symphysis pubis.

The nurse is reviewing the monitoring strip of a woman in labor who is experiencing a contraction. The nurse notes the time the contraction takes from its onset to reach its highest intensity. The nurse interprets this time as which of the following? A) Increment B) Acme C) Peak D) Decrement

The nurse notes persistent early decelerations on the fetal monitoring strip. Which of the following would the nurse do next? A) Continue to monitor the FHR because this pattern is benign. B) Perform a vaginal exam to assess cervical dilation and effacement. C) Stay with the client while reporting the finding to the physician. D) Administer oxygen after turning the client on her left side.

Which of the following is a priority when caring for a woman during the fourth stage of labor? A) Assessing the uterine fundus B) Offering fluids as indicated C) Encouraging the woman to void D) Assisting with perineal care

Which of the following would indicate to the nurse that the placenta is separating? A) Uterus becomes globular B) Fetal head is at vaginal opening C) Umbilical cord shortens D) Mucous plug is expelled

After teaching a group of students about fetal heart rate patterns, the instructor determines the need for additional teaching when the students identify which of the following as indicating normal fetal acid-base status? (Select all that apply.) A) Sinusoidal pattern B) Recurrent variable decelerations C) Fetal bradycardia D) Absence of late decelerations E) Moderate baseline variability

A B C

Which position would be most appropriate for the nurse to suggest as a comfort measure to a woman who is in the first stage of labor? (Select all that apply.) A) Walking with partner support B) Straddling with forward leaning over a chair C) Closed knee-chest position D) Rocking back and forth with foot on chair E) Supine with legs raised at a 90-degree angle

A B D

After teaching a group of students about the factors affecting the labor process, the instructor determines that the teaching was successful when the group identifies which of the following as a component of the true pelvis? (Select all that apply.) A) Pelvic inlet B) Cervix C) Mid pelvis D) Pelvic outlet E) Vagina F) Pelvic floor muscles

A C D

A nurse is preparing a class for pregnant women about labor and birth. When describing the typical movements that the fetus goes through as it travels through the passageway, which of the following would the nurse most likely include? (Select all that apply.) A) Internal rotation B) Abduction C) Descent D) Pronation E) Flexion

A C E

A nurse is preparing a presentation for a group of pregnant women about the labor experience. Which of the following would the nurse most likely include when discussing measures to promote coping for a positive labor experience? (Select all that apply.) A) Presence of a support partner B) View of birth as a stressor C) Low anxiety level D) Fear of loss of control E) Participation in a pregnancy exercise program

A C E

A woman is scheduled to undergo fetal nuchal translucency testing. Which of the following would the nurse include when describing this test?

A) "A needle will be inserted directly into the fetus's umbilical vessel." B) "You'll have an intravaginal ultrasound to measure fluid in the fetus." C) "The doctor will take a sample of fluid from your bag of waters." D) "A small piece of tissue from the fetal part of the placenta is taken." Ans: B Feedback: Fetal nuchal translucency testing involves an intravaginal ultrasound that measures fluid collection in the subcutaneous space between the skin and cervical spine of the fetus. Insertion of a needle into the fetus's umbilical vessel describes percutaneous umbilical blood sampling. Taking a sample of fluid from the amniotic sac (bag of waters) describes an amniocentesis. Obtaining a small tissue specimen from the fetal part of the placenta describes chorionic villus sampling.

After teaching the parents of a newborn with retinopathy of prematurity (ROP) about the disorder and treatment, which statement by the parents indicates that the teaching was successful?

A) "Can we schedule follow-up eye examinations with the pediatric ophthalmologist now?" B) "We can fix the problem with surgery." C) "We'll make sure to administer eye drops each day for the next few weeks." D) "I'm sure the baby will grow out of it." Ans: A Feedback: Parents of a newborn with suspected retinopathy of prematurity (ROP) should schedule follow-up vision screenings with a pediatric ophthalmologist every 2 to 3 weeks, depending on the severity of the findings at the initial examination.

A primipara client who is bottle feeding her baby begins to experience breast engorgement on her third postpartum day. Which instruction would be most appropriate to aid in relieving her discomfort?

A) "Express some milk from your breasts every so often to relieve the distention." B) "Remove your bra to relieve the pressure on your sensitive nipples and breasts." C) "Apply ice packs to your breasts to reduce the amount of milk being produced." D) "Take several warm showers daily to stimulate the milk let-down reflex." Ans: C For the woman with breast engorgement who is bottle feeding her newborn, encourage the use of ice packs to decrease pain and swelling. Expressing milk from the breasts and taking warm showers would be appropriate for the woman who was breast-feeding. Wearing a supportive bra 24 hours a day also is helpful for the woman with engorgement who is bottle feeding.

After teaching a couple about what to expect with their planned cesarean birth, which statement indicates the need for additional teaching?

A) "Holding a pillow against my incision will help me when I cough." B) "I'm going to have to wait a few days before I can start breast-feeding." C) "I guess the nurses will be getting me up and out of bed rather quickly." D) "I'll probably have a tube in my bladder for about 24 hours or so." Ans: B Typically, breast-feeding is initiated early as soon as possible after birth to promote bonding. The woman may need to use alternate positioning techniques to reduce incisional discomfort. Splinting with pillows helps to reduce the discomfort associated with coughing. Early ambulation is encouraged to prevent respiratory and cardiovascular problems and promote peristalsis. An indwelling urinary catheter is typically inserted to drain the bladder. It usually remains in place for approximately 24 hours.

A nurse is assessing a postpartum client who is at home. Which statement by the client would lead the nurse to suspect that the client may be developing postpartum depression?

A) "I just feel so overwhelmed and tired." B) "I'm feeling so guilty and worthless lately." C) "It's strange, one minute I'm happy, the next I'm sad." D) "I keep hearing voices telling me to take my baby to the river." Ans: B Feedback: Indicators for postpartum depression include feelings related to restlessness, worthlessness, guilt, hopeless, and sadness along with loss of enjoyment, low energy level, and loss of libido. Thus, the statement by the mother about feeling guilty and worthless suggest postpartum depression. The statements about being overwhelmed and fatigued and changing moods suggest postpartum blues. The statement about hearing voices suggests postpartum psychosis.

After teaching a woman with a postpartum infection about care after discharge, which client statement indicates the need for additional teaching?

A) "I need to call my doctor if my temperature goes above 100.4°F" B) "When I put on a new pad, I'll start at the back and go forward." C) "If I have chills or my discharge has a strange odor, I'll call my doctor." D) "I'll point the spray of the peribottle so the water flows front to back." Ans: B Feedback: The woman needs additional teaching when she states that she should apply the perineal pad starting at the back and going forward. The pad should be applied using a front-to-back motion. Notifying the health care provider of a temperature above 100.4° F, aiming the peribottle spray so that the flow goes from front to back, and reporting danger signs such as chills or lochia with a strange odor indicate effective teaching.

A nurse is teaching a pregnant woman with preterm premature rupture of membranes who is about to be discharged home about caring for herself. Which statement by the woman indicates a need for additional teaching?

A) "I need to keep a close eye on how active my baby is each day." B) "I need to call my doctor if my temperature increases." C) "It's okay for my husband and me to have sexual intercourse." D) "I can shower but I shouldn't take a tub bath." Ans: C Feedback: The woman with preterm premature rupture of membranes should monitor her baby's activity by performing fetal kick counts daily, check her temperature and report any increases to the health care provider, not insert anything into her vagina or vaginal area, such as tampons or vaginal intercourse, and avoid sitting in a tub bath.

After teaching a postpartum woman about breast-feeding, the nurse determines that the teaching was successful when the woman states which of the following?

A) "I should notice a decrease in abdominal cramping during breast-feeding." B) "I should wash my hands before starting to breast-feed." C) "The baby can be awake or sleepy when I start to feed him." D) "The baby's mouth will open up once I put him to my breast." Ans: B To promote successful breast-feeding, the mother should wash her hands before breast feeding, and make sure that the baby is awake and alert and showing hunger signs. In addition, the mother should lightly tickle the infant's upper lip with her nipple to stimulate the infant to open the mouth wide and then bring the infant rapidly to the breast with a wide-open mouth. The mother also needs to know that her afterpains will increase during breast-feeding.

After teaching a pregnant woman with iron deficiency anemia about her prescribed iron supplement, which statement indicates successful teaching?

A) "I should take my iron with milk." B) "I should avoid drinking orange juice." C) "I need to eat foods high in fiber." D) "I'll call the doctor if my stool is black and tarry." Ans: C Iron supplements can lead to constipation, so the woman needs to increase her intake of fluids and high-fiber foods. Milk inhibits absorption and should be discouraged. Vitamin C-containing fluids such as orange juice are encouraged because they promote absorption. Ideally the woman should take the iron on an empty stomach to improve absorption, but many women cannot tolerate the gastrointestinal discomfort it causes. In such cases, the woman should take it with meals. Iron typically causes the stool to become black and tarry; there is no need for the woman to notify her doctor.

After teaching a woman who has had an evacuation for a hydatidiform mole (molar pregnancy) about her condition, which of the following statements indicates that the nurse's teaching was successful?

A) "I will be sure to avoid getting pregnant for at least 1 year." B) "My intake of iron will have to be closely monitored for 6 months." C) "My blood pressure will continue to be increased for about 6 more months." D) "I won't use my birth control pills for at least a year or two." Ans: A After evacuation of a hydatidiform mole, long-term follow-up is necessary to make sure any remaining trophoblastic tissue does not become malignant. Serial hCG levels are monitored closely for 1 year and the client is urged to avoid pregnancy for 1 year because it can interfere with the monitoring of hCG levels. Iron intake and blood pressure are not important aspects of follow-up after evacuation of a hydatidiform mole. Use of a reliable contraceptive is strongly recommended so that pregnancy is avoided.

A postpartum woman who developed deep vein thrombosis is being discharged on anticoagulant therapy. After teaching the woman about this treatment, the nurse determines that additional teaching is needed when the woman states which of the following?

A) "I will use a soft toothbrush to brush my teeth." B) "I can take ibuprofen if I have any pain." C) "I need to avoid drinking any alcohol." D) "I will call my health care provider if my stools are black and tarry." Ans: B Feedback: Individuals receiving anticoagulant therapy need to avoid use of any over-the-counter products containing aspirin or aspirin-like derivatives such as NSAIDs (ibuprofen) to reduce the risk for bleeding. Using a soft toothbrush and avoiding alcohol are appropriate measures to reduce the risk for bleeding. Black, tarry stools should be reported to the health care provider.

The nurse is teaching a pregnant woman with type 1 diabetes about her diet during pregnancy. Which client statement indicates that the nurse's teaching was successful?

A) "I'll basically follow the same diet that I was following before I became pregnant." B) "Because I need extra protein, I'll have to increase my intake of milk and meat." C) "Pregnancy affects insulin production, so I'll need to make adjustments in my diet." D) "I'll adjust my diet and insulin based on the results of my urine tests for glucose." Ans: C In pregnancy, placental hormones cause insulin resistance at a level that tends to parallel growth of the fetoplacental unit. Nutritional management focuses on maintaining balanced glucose levels. Thus, the woman will probably need to make adjustments in her diet. Protein needs increase during pregnancy, but this is unrelated to diabetes. Blood glucose monitoring results typically guide therapy.

A nurse is assisting the anxious parents of a preterm newborn to cope with the situation. Which statement by the nurse would be least appropriate?

A) "I'll be here to help you all along the way." B) "What has helped you to deal with stressful situations in the past?" C) "Let me tell you about what you will see when you visit your baby." D) "Forget about what's happened in the past and focus on the now." Ans: D Feedback: Instead of telling the parents to forget about what's happened, the nurse should review with them the events that have occurred since birth to help them understand and clarify any misconceptions they might have. Other helpful interventions would include telling the parents that the nurse will be with them because this provides them with a physical presence and support; asking about previous coping strategies that worked so that they can use them now; and explaining what is happening and all the equipment being used so they can understand the situation.

A nurse is teaching a pregnant woman at risk for preterm labor about what to do if she experiences signs and symptoms. The nurse determines that the teaching was successful when the woman states that if she experiences any symptoms, she will do which of the following?

A) "I'll sit down to rest for 30 minutes." B) "I'll try to move my bowels." C) "I'll lie down with my legs raised." D) "I'll drink several glasses of water." Ans: D If the woman experiences any signs and symptoms of preterm labor, she should stop what she is doing and rest for 1 hour, empty her bladder, lie down on her side, drink two to three glasses of water, feel her abdomen and note the hardness of the contraction, and call her health care provider and describe the contraction.

The nurse is providing anticipatory guidance to a mother of a 5-month-old boy about introducing solid foods. Which statement by the mother indicates that effective teaching has occurred?

A) "I'll start with baby oatmeal cereal mixed with low-fat milk." B) "The cereal should be a fairly thin consistency at first." C) "I can puree the meat that we are eating to give to my baby." D) "Once he gets used to the cereal, then we'll try giving him a cup." Ans: B Feedback: Iron-fortified rice cereal mixed with a small amount of formula or breast milk to a fairly thin consistency is typically the first solid food used. As the infant gets older, a thicker consistency is appropriate. Strained, pureed, or mashed meats may be introduced at 10 to 12 months of age. A cup is typically introduced at 6 to 8 months of age regardless of what or how much solid food is being consumed.

A new mother who is breast-feeding her newborn asks the nurse, "How will I know if my baby is drinking enough?" Which response by the nurse would be most appropriate?

A) "If he seems content after feeding, that should be a sign." B) "Make sure he drinks at least 5 minutes on each breast." C) "He should wet between 6 to 12 diapers each day." D) "If his lips are moist, then he's okay." Ans: C Soaking 6 to 12 diapers a day indicates adequate hydration. Contentedness after feeding is not an indicator for adequate hydration. Typically a newborn wakes up 8 to 12 times per day for feeding. As the infant gets older, the time on the breast increases. Moist mucous membranes help to suggest adequate hydration but this is not the best indicator.

A woman with hyperemesis gravidarum asks the nurse about suggestions to minimize nausea and vomiting. Which suggestion would be most appropriate for the nurse to make?

A) "Make sure that anything around your waist is quite snug." B) "Try to eat three large meals a day with less snacking." C) "Drink fluids in between meals rather than with meals." D) "Lie down for about an hour after you eat" Ans: C Suggestions to minimize nausea and vomiting include avoiding tight waistbands to minimize pressure on the abdomen, eating small frequent meals throughout the day, separating fluids from solids by consuming fluids in between meals; and avoiding lying down or reclining for at least 2 hours after eating.

A woman with placenta previa is being treated with expectant management. The woman and fetus are stable. The nurse is assessing the woman for possible discharge home. Which statement by the woman would suggest to the nurse that home care might be inappropriate?

A) "My mother lives next door and can drive me here if necessary." B) "I have a toddler and preschooler at home who need my attention." C) "I know to call my health care provider right away if I start to bleed again." D) "I realize the importance of following the instructions for my care." Ans: B Having a toddler and preschooler at home needing attention suggest that the woman would have difficulty maintaining bed rest at home. Therefore, expectant management at home may not be appropriate. Expectant management is appropriate if the mother and fetus are both stable, there is no active bleeding, the client has readily available access to reliable transportation, and can comprehend instructions.

After reviewing information about postpartum blues, a group of students demonstrate understanding when they state which of the following about this condition?

A) "Postpartum blues is a long-term emotional disturbance." B) "Sleep usually helps to resolve the blues." C) "The mother loses contact with reality." D) "Extended psychotherapy is needed for treatment." Ans: A Postpartum blues are transient emotional disturbances beginning in the first week after childbirth and are characterized by anxiety, irritability, insomnia, crying, loss of appetite, and sadness (Hanley, 2010). These symptoms typically begin 3 to 4 days after childbirth and resolve by day 8 (Mattson & Smith, 2011). These mood swings may be confusing to new mothers but usually are self-limiting. The blues typically resolves with restorative sleep. Postpartum blues are thought to affect up to 75% of all new mothers; this condition is the mildest form of emotional disturbance associated with childbearing (March of Dimes, 2011). The mother maintains contact with reality consistently and symptoms tend to resolve spontaneously without therapy within 1 to 2 weeks.

A mother is concerned about her infant's spitting up. Which suggestion would be most appropriate?

A) "Put the infant in an infant seat after eating." B) "Limit burping to once during a feeding." C) "Feed the same amount but space out the feedings." D) "Keep the baby sitting up for about 30 minutes afterward." Ans: D Feedback: Keeping the baby upright for 30 minutes after the feeding, burping the baby at least two or three times during feedings, and feeding smaller amounts on a more frequent basis may help to decrease spitting up. Positioning the infant in an infant seat compresses the stomach and is not recommended.

A pregnant woman asks the nurse, "I'm a big coffee drinker. Will the caffeine in my coffee hurt my baby?" Which response by the nurse would be most appropriate?

A) "The caffeine in coffee has been linked to birth defects." B) "Caffeine has been shown to cause growth restriction in the fetus." C) "Caffeine is a stimulant and needs to be avoided completely." D) "If you keep your intake to less than 300 mg/day, you should be okay." Ans: D The effect of caffeine intake during pregnancy on fetal growth and development is still unclear. However, a recent study showed that moderate caffeine consumption (less than 300 mg per day) does not appear to be a major contributing factor in miscarriage or preterm birth. The relationship of caffeine to growth restriction remains undetermined. A final conclusion cannot be made at this time as to whether there is a correlation between high caffeine intake and miscarriage due to lack of sufficient studies. Birth defects have not been linked to caffeine consumption,

After teaching a group of nursing students about the impact of pregnancy on the older woman, the instructor determines that the teaching was successful when the students state which of the following?

A) "The majority of women who become pregnant over age 35 experience complications." B) "Women over the age of 35 who become pregnant require a specialized type of assessment." C) "Women over age 35 and are pregnant have an increased risk for spontaneous abortions." D) "Women over age 35 are more likely to have substance abuse problems." Ans: C Numerous studies have shown that increasing maternal age is a risk factor for infertility and spontaneous abortions, gestational diabetes, chronic hypertension, preeclampsia, preterm labor and birth, multiple pregnancy, genetic disorders and chromosomal abnormalities, placenta previa, IUGR, low Apgar scores, and surgical births (Bayrampour & Heaman, 2010). However, even though increased age implies increased complications, most women today who become pregnant after age 35 have healthy pregnancies and healthy newborns. Nursing assessment of the pregnant woman over age 35 is the same as that for any pregnant woman. Women of this age have the same risk for substance abuse as any other age group.

When describing amniotic fluid to a pregnant woman, the nurse would include which of the following?

A) "This fluid acts as transport mechanism for oxygen and nutrients." B) "The fluid is mostly protein to provide nourishment to your baby." C) "This fluid acts as a cushion to help to protect your baby from injury." D) "The amount of fluid remains fairly constant throughout the pregnancy." Ans: C Feedback: Amniotic fluid protects the floating embryo and cushions the fetus from trauma. The placenta acts as a transport mechanism for oxygen and nutrients. Amniotic fluid is primarily water with some organic matter. Throughout pregnancy, amniotic fluid volume fluctuates.

A new mother shows the nurse that her baby grasps her finger when she touches the baby's palm. How might the nurse respond to this information?

A) "This is a primitive reflex known as the plantar grasp." B) "This is a primitive reflex known as the palmar grasp." C) "This is a protective reflex known as rooting." D) "This is a protective reflex known as the Moro reflex." Ans: B Feedback: Primitive reflexes are subcortical and involve a whole-body response. Selected primitive reflexes present at birth include Moro, root, suck, asymmetric tonic neck, plantar and palmar grasp, step, and Babinski. During the palmar grasp, the infant reflexively grasps when the palm is touched. The plantar grasp occurs when the infant reflexively grasps with the bottom of the foot when pressure is applied to the plantar surface. The root reflex occurs when the infant's cheek is stroked and the infant turns to that side, searching with mouth. The Moro reflex is displayed when with sudden extension of the head, the arms abduct and move upward and the hands form a "C."

A new mother expresses concern to the nurse that her baby is crying and grunting when passing stool. What is the nurse's best response to this observation?

A) "This is normal behavior for infants unless the stool passed is hard and dry." B) "This is normal behavior for infants due to the immaturity of the gastrointestinal system." C) "This indicates a blockage in the intestine and must be reported to the physician." D) "This is normal behavior for infants unless the stool passed is black or green." Ans: A Feedback: Due to the immaturity of the gastrointestinal system, newborns and young infants often grunt, strain, or cry while attempting to have a bowel movement. This is not of concern unless the stool is hard and dry. Stool color and texture may change depending on the foods that the infant is ingesting. Iron supplements may cause the stool to appear black or very dark green.

The parent of a 6-month old infant asks the nurse for advice about his son's thumb sucking. What would be the nurse's best response to this parent?

A) "Thumb sucking is a healthy self-comforting activity." B) "Thumb sucking leads to the need for orthodontic braces." C) "Caregivers should pay special attention to the thumb sucking to stop it." D) "Thumb sucking should be replaced with the use of a pacifier." Ans: A Feedback: Thumb sucking is a healthy self-comforting activity. Infants who suck their thumbs or pacifiers often are better able to soothe themselves than those who do not. Studies have not shown that sucking either thumbs or pacifiers leads to the need for orthodontic braces unless the sucking continues well beyond the early school-age period. The infant who has become attached to thumb sucking should not have additional attention drawn to the issue, as that may prolong thumb sucking. Pacifiers should not be used to replace thumb sucking as this habit will also need to be discouraged as the child grows.

25. A pregnant woman in her second trimester tells the nurse, "I've been passing a lot of gas and feel bloated." Which of the following suggestions would be helpful for the woman? Select all that apply. A) "Watch how much beans and onions you eat." B) "Limit the amount of fluid you drink with meals" C) "Try exercising a little more." D) "Some say that eating mints can help." E) "Cut down on your intake of cheeses."

A) "Watch how much beans and onions you eat." C) "Try exercising a little more." D) "Some say that eating mints can help." E) "Cut down on your intake of cheeses." (?)

A nurse is teaching new parents about bathing their newborn. The nurse determines that the teaching was successful when the parents state which of the following?

A) "We can put a tiny bit of lotion on his skin and then rub it in gently." B) "We should avoid using any kind of baby powder." C) "We need to bathe him at least four to five times a week." D) "We should clean his eyes after washing his face and hair." Ans: B Powders should not be used because they can be inhaled, causing respiratory distress. If the parents want to use oils and lotions, have them apply a small amount onto their hand first, away from the newborn; this warms the lotion. Then the parents should apply the lotion or oil sparingly. Parents need to be instructed that a bath two or three times weekly is sufficient for the first year because too frequent bathing may dry the skin. The eyes are cleaned first and only with plain water; then the rest of the face is cleaned with plain water.

A nurse is teaching a postpartum client and her partner about caring for their newborn's umbilical cord site. Which statement by the parents indicates a need for additional teaching?

A) "We can put him in the tub to bathe him once the cord falls off and is healed." B) "The cord stump should change from brown to yellow." C) "Exposing the stump to the air helps it to dry." D) "We need to call the doctor if we notice a funny odor." Ans: B The cord stump should change color from yellow to brown or black. Therefore the parents need additional teaching if they state the color changes from brown to yellow. Tub baths are avoided until the cord has fallen off and the area is healed. Exposing the stump to the air helps it to dry. The parents should notify their primary care provider if there is any bleeding, redness, drainage, or foul odor from the cord stump.

After teaching the parents of a newborn with periventricular hemorrhage about the disorder and treatment, which statement by the parents indicates that the teaching was successful?

A) "We'll make sure to cover both of his eyes to protect them." B) "Our newborn could develop a learning disability later on." C) "Once the bleeding ceases, there won't be any more worries." D) "We need to get family members to donate blood for transfusion." Ans: B Feedback: Periventricular-intraventricular hemorrhage has long-term sequelae such as seizures, hydrocephalus, periventricular leukomalacia, cerebral palsy, learning disabilities, vision or hearing deficits, and mental retardation. Covering the eyes is more appropriate for the newborn receiving phototherapy. The bleeding in the brain can lead to serious long-term effects. Blood transfusions are not used to treat periventricular hemorrhage.

Upon entering the room of a client who has had a spontaneous abortion, the nurse observes the client crying. Which of the following responses by the nurse would be most appropriate?

A) "Why are you crying?" B) "Will a pill help your pain?" C) "I'm sorry you lost your baby." D) "A baby still wasn't formed in your uterus." Ans: C Telling the client that the nurse is sorry for the loss acknowledges the loss to the woman, validates her feelings, and brings the loss into reality. Asking why the client is crying is ineffective at this time. Offering a pill for the pain ignores the client's feelings. Telling the client that the baby wasn't formed is inappropriate and discounts any feelings or beliefs that the client has.

A woman gives birth to a newborn at 36 weeks' gestation. She tells the nurse, "I'm so glad that my baby isn't premature." Which response by the nurse would be most appropriate?

A) "You are lucky to have given birth to a term newborn." B) "We still need to monitor him closely for problems." C) "How do you feel about delivering your baby at 36 weeks?" D) "Your baby is premature and needs monitoring in the NICU." Ans: B Feedback: A baby born at 36 weeks' gestation is considered a late preterm newborn. These newborns face similar challenges as those of preterm newborns and require similar care. Telling the mother that close monitoring is necessary can prevent any misconceptions that she might have and prepare her for what might arise. The baby is not considered a term newborn, nor is the baby considered premature. The decision for care in the NICU would depend on the newborn's status. Asking the woman how she feels about the delivery demonstrates caring but does not address the woman's lack of understanding about her newborn.

Which statement would alert the nurse to the potential for impaired bonding between mother and newborn?

A) "You have your daddy's eyes." B) "He looks like a frog to me." C) "Where did you get all that hair?" D) "He seems to sleep a lot." Ans: B Negative comments may indicate impaired bonding. Pointing out commonalities such as "daddy's eyes" and expressing pride such as "all that hair" are positive attachment behaviors. The statement about sleeping a lot indicates that the mother is assigning meaning to the newborn's actions, another positive attachment behavior.

A new mother is changing the diaper of her 20-hour-old newborn and asks why the stool is almost black. Which response by the nurse would be most appropriate?

A) "You probably took iron during your pregnancy." B) "This is meconium stool, normal for a newborn." C) "I'll take a sample and check it for possible bleeding." D) "This is unusual and I need to report this." Ans: B The mother is describing meconium. Meconium is greenish-black and tarry and usually passed within 12 to 24 hours of birth. This is a normal finding. Iron can cause stool to turn black, but this would not be the case here. The stool is a normal occurrence and does not need to be checked for blood or reported.

A woman is to undergo an amnioinfusion. Which statement would be most appropriate to include when teaching the woman about this procedure?

A) "You'll need to stay in bed while you're having this procedure." B) "We'll give you an analgesic to help reduce the pain." C) "After the infusion, you'll be scheduled for a cesarean birth." D) "A suction cup is placed on your baby's head to help bring it out." Ans: A An amnioinfusion involves the instillation of a volume of warmed, sterile normal saline or Ringer's lactate into the uterus via an intrauterine pressure catheter. The client must remain in bed during the procedure. The use of analgesia is unrelated to this procedure. A cesarean birth is necessary only if the FHR does not improve after the amnioinfusion. Application of a suction cup to the head of the fetus refers to a vacuum-assisted birth.

A client who is HIV-positive is in her second trimester and remains asymptomatic. She voices concern about her newborn's risk for the infection. Which of the following statements by the nurse would be most appropriate?

A) "You'll probably have a cesarean birth to prevent exposing your newborn." B) "Antibodies cross the placenta and provide immunity to the newborn." C) "Wait until after the infant is born and then something can be done." D) "Antiretroviral medications are available to help reduce the risk of transmission." Ans: D Drug therapy is the mainstay of treatment for pregnant women infected with HIV. The goal of therapy is to reduce the viral load as much as possible; this reduces the risk of transmission to the fetus. Decisions about the method of delivery should be based on the woman's viral load, duration of ruptured membranes, progress of labor, and other pertinent clinical factors. The newborn is at risk for HIV because of potential perinatal transmission. Waiting until after the infant is born may be too late.

At which age would the nurse expect to find the beginning of object permanence?

A) 1 month B) 4 months C) 8 months D) 12 months Ans: B Feedback: Object permanence begins to develop between 4 and 7 months of age and is solidified by approximately age 8 months. By age 12 months, the infant knows he or she is separate from the parent or caregiver.

A postpartum woman who is bottle-feeding her newborn asks the nurse, "About how much should my newborn drink at each feeding?" The nurse responds by saying that to feel satisfied, the newborn needs which amount at each feeding?

A) 1 to 2 ounces B) 2 to 4 ounces C) 4 to 6 ounces D) 6 to 8 ounces Ans: B Feedback: Newborns need about 108 cal/kg or approximately 650 cal/day (Dudek, 2010). Therefore, explain to parents that a newborn will need to 2 to 4 ounces to feel satisfied at each feeding.

The nurse is providing care to several pregnant women who may be scheduled for labor induction. The nurse identifies the woman with which Bishop score as having the best chance for a successful induction and vaginal birth?

A) 11 B) 8 C) 6 D) 3 Ans: A The Bishop score helps identify women who would be most likely to achieve a successful induction. The duration of labor is inversely correlated with the Bishop score: a score over 8 indicates a successful vaginal birth. Therefore the woman with a Bishop score of 11 would have the greatest chance for success. Bishop scores of less than 6 usually indicate that a cervical ripening method should be used prior to induction.

When assessing a pregnant woman with heart disease throughout the antepartal period, the nurse would be especially alert for signs and symptoms of cardiac decompensation at which time?

A) 16 to 20 weeks' gestation B) 20 to 24 weeks' gestation C) 24 to 28 weeks' gestation D) 28 to 32 weeks' gestation Ans: D A pregnant woman with heart disease is most vulnerable for cardiac decompensation from 28 to 32 weeks' gestation.

A nurse is providing care to several pregnant women at the clinic. The nurse would screen for group B streptococcus infection in a client at:

A) 16 weeks' gestation B) 28 week' gestation C) 32 weeks' gestation D) 36 weeks' gestation Ans: D According to the CDC guidelines, all pregnant women should be screened for group B streptococcus infection at 35 to 37 weeks' gestation.

A couple comes to the clinic for preconception counseling and care. As part of the visit, the nurse teaches the couple about fertilization and initial development, stating that the zygote formed by the union of the ovum and sperm consists of how many chromosomes?

A) 22 B) 23 C) 44 D) 46 Ans: D Feedback: With fertilization, the ovum, containing 23 chromosomes, and the sperm, containing 23 chromosomes, join, forming a zygote with a diploid number or 46 chromosomes.

A woman is receiving magnesium sulfate as part of her treatment for severe preeclampsia. The nurse is monitoring the woman's serum magnesium levels. Which level would the nurse identify as therapeutic?

A) 3.3 mEq/L B) 6.1 mEq/L C) 8.4 mEq/L D) 10.8 mEq/L Ans: B Although exact levels may vary among agencies, serum magnesium levels ranging from 4 to 7 mEq/L are considered therapeutic, whereas levels more than 8 mEq/dL are generally considered toxic.

Assessment of a newborn's head circumference reveals that it is 34 cm. The nurse would suspect that this newborn's chest circumference would be:

A) 30 cm B) 32 cm C) 34 cm D) 36 cm Ans: B The newborn's chest should be round, symmetric, and 2 to 3 cm smaller than the head circumference. Therefore, this newborn's chest circumference would be 31 to 32 cm to be normal.

The nurse measures the head circumference of a 6-month-old infant. Which measurement would the nurse interpret as most appropriate?

A) 33 cm B) 35 cm C) 43.5 cm D) 47 cm Ans: C Feedback: Head circumference increases rapidly during the first 6 months. In a 6-month-old it is typically 42 to 44.5 cm (16.5 to 17.5 in); at birth it is usually 33 to 35 cm (13 to 14 in); and at 1 year of age it is usually 45 to 47.5 cm (17.7 to 18.7 in).

The nurse is teaching a pregnant woman about recommended weight gain. The woman has a prepregnancy body mass index of 26. The nurse determines that the teaching was successful when the woman states that she should gain no more than which amount during pregnancy?

A) 35 to 40 pounds B) 25 to 35 pounds C) 28 to 40 pounds D) 15 to 25 pounds Ans: D A woman with a body mass index of 26 is considered overweight and should gain no more than 15 to 25 pounds during pregnancy. Women with a body mass index of 18.5 to 24.9 (considered healthy weight) should gain 25 to 35 pounds. A woman with a body mass index less than 18.5 should gain 28 to 40 pounds.

The nurse is assessing the respirations of several newborns. The nurse would notify the health care provider for the newborn with which respiratory rate at rest?

A) 38 breaths per minute B) 46 breaths per minute C) 54 breaths per minute D) 68 breaths per minute Ans: D After respirations are established in the newborn, they are shallow and irregular, ranging from 30 to 60 breaths per minute, with short periods of apnea (less than 15 seconds). Thus a newborn with a respiratory rate below 30 or above 60 breaths per minute would require further evaluation.

A nurse is assisting in the resuscitation of a newborn. The nurse would expect to stop resuscitation efforts when the newborn has no heartbeat and respiratory effort after which time frame?

A) 5 minutes B) 10 minutes C) 15 minutes D) 20 minutes Ans: B Feedback: According to the American Heart Association and American Academy of Pediatrics Guidelines for Neonatal Resuscitation, resuscitation efforts may be stopped if the newborn exhibits no heartbeat and no respiratory effort after 10 minutes of continuous and adequate resuscitation.

17. A biophysical profile has been completed on a pregnant woman. The nurse interprets which score as normal? A) 9 B) 7 C) 5 D) 3

A) 9

A pregnant woman with gestational diabetes comes to the clinic for a fasting blood glucose level. When reviewing the results, the nurse determines that which result indicates good glucose control?

A) 90 mg/dL B) 100 mg/dL C) 110 mg /dL D) 120 mg/dL Ans: A For a pregnant woman with diabetes, the ADA (2012b) recommends maintaining a fasting blood glucose level below 95 mg/dL, with postprandial levels below 140 mg/dL and 2-hour postprandial levels below 120 mg/dL.

Twenty minutes after birth, a baby begins to move his head from side to side, making eye contact with the mother, and pushes his tongue out several times. The nurse interprets this as indicating which of the following?

A) A good time to initiate breast-feeding B) The period of decreased responsiveness preceding sleep C) The need to be alert for gagging and vomiting D) Evidence that the newborn is becoming chilled Ans: A The newborn is demonstrating behaviors indicating the first period of reactivity, which usually begins at birth and lasts for the first 30 minutes. This is a good time to initiate breast-feeding. Decreased responsiveness occurs from 30 to 120 minutes of age and is characterized by muscle relaxation and diminished responsiveness to outside stimuli. There is no indication that the newborn may experience gagging or vomiting. Chilling would be evidenced by tachypnea, decreased activity, and hypotonia.

A primigravida whose labor was initially progressing normally is now experiencing a decrease in the frequency and intensity of her contractions. The nurse would assess the woman for which condition?

A) A low-lying placenta B) Fetopelvic disproportion C) Contraction ring D) Uterine bleeding Ans: B The woman is experiencing dystocia most likely due to hypotonic uterine dysfunction and fetopelvic disproportion associated with a large fetus. A low-lying placenta, contraction ring, or uterine bleeding would not be associated with a change in labor pattern.

The neonatal nurse assesses newborns for iron-deficiency anemia. Which of the following newborns is at highest risk for this disorder?

A) A postterm newborn B) A term newborn with jaundice C) A newborn born to a diabetic mother D) A premature newborn Ans: D Feedback: Maternal iron stores are transferred to the fetus throughout the last trimester of pregnancy. Infants born prematurely miss all or at least a portion of this iron store transfer, placing them at increased risk for iron-deficiency anemia compared with term infants. An infant having jaundice, having been born to a mother with diabetes, or have been born postterm does not significantly place the infant at risk for iron-deficiency anemia.

A woman suspecting she is pregnant asks the nurse about which signs would confirm her pregnancy. The nurse would explain that which of the following would confirm the pregnancy?

A) Absence of menstrual period B) Abdominal enlargement C) Palpable fetal movement D) Morning sickness Ans: C Only positive signs of pregnancy would confirm a pregnancy. The positive signs of pregnancy confirm that a fetus is growing in the uterus. Visualizing the fetus by ultrasound, palpating for fetal movements, and hearing a fetal heartbeat are all signs that make the pregnancy a certainty. Absence of menstrual period and morning sickness are presumptive signs, which can be due to conditions other than pregnancy. Abdominal enlargement is a probable sign.

The nurse is assessing a newborn who is large for gestational age. The newborn was born breech. The nurse suspects that the newborn may have experienced trauma to the upper brachial plexus based on which assessment findings?

A) Absent grasp reflex B) Hand weakness C) Absent Moro reflex D) Facial asymmetry Ans: C Feedback: An injury to the upper brachial plexus, or Erb's palsy, is manifested by adduction, pronation, and internal rotation of the affected extremity, absent shoulder movement, absent Moro reflex and positive grasp reflex. An absent grasp reflex and hand weakness is noted with a lower brachial plexus injury. Facial asymmetry is associated with a cranial nerve injury.

A group of nursing students are reviewing information about cesarean birth. The students demonstrate understanding of the information when they identify which of the following as an appropriate indication? (Select all that apply.)

A) Active genital herpes infection B) Placenta previa C) Previous cesarean birth D) Prolonged labor E) Fetal distress Ans: A, B, C, E The leading indications for cesarean birth are previous cesarean birth, breech presentation, dystocia, and fetal distress. Examples of specific indications include active genital herpes, fetal macrosomia, fetopelvic disproportion, prolapsed umbilical cord, placental abnormality (placenta previa or abruptio placentae), previous classic uterine incision or scar, gestational hypertension, diabetes, positive HIV status, and dystocia. Fetal indications include malpresentation (nonvertex presentation), congenital anomalies (fetal neural tube defects, hydrocephalus, abdominal wall defects), and fetal distress.

An LGA newborn has a blood glucose level of 30 mg/dL and is exhibiting symptoms of hypoglycemia. Which of the following would the nurse do next?

A) Administer intravenous glucose immediately. B) Feed the newborn 2 ounces of formula. C) Initiate blow-by oxygen therapy. D) Place the newborn under a radiant warmer. Ans: A Feedback: If an LGA newborn's blood glucose level is below 40 mg/dL and is symptomatic, continuous infusion of parenteral glucose is needed. Supervised breast-feeding or formula feeding may be initial treatment options in asymptomatic hypoglycemia. Blow-by oxygen would have no effect on glucose levels; it may be helpful in promoting oxygenation. Placing the newborn under a radiant warmer would be a more appropriate measure for cold stress.

A postpartum woman is ordered to receive oxytocin to stimulate the uterus to contract. Which of the following would be most important for the nurse to do?

A) Administer the drug as an IV bolus injection. B) Give as a vaginal or rectal suppository. C) Piggyback the IV infusion into a primary line. D) Withhold the drug if the woman is hypertensive. Ans: C Feedback: When giving oxytocin, it should be diluted in a liter of IV solution and the infusion set up to be piggy-backed into a primary line to ensure that the medication can be discontinued readily if hyperstimulation or adverse effects occur. It should never be given as an IV bolus injection. Methylergonovine is not given if the woman is hypertensive. Dinoprostone is available as a vaginal or rectal suppository.

After presenting a class on measures to prevent postpartum hemorrhage, the presenter determines that the teaching was successful when the class states which of the following as an important measure to prevent postpartum hemorrhage due to retained placental fragments?

A) Administering broad-spectrum antibiotics B) Inspecting the placenta after delivery for intactness C) Manually removing the placenta at delivery D) Applying pressure to the umbilical cord to remove the placenta Ans: B Feedback: After birth, a thorough inspection of the placenta is necessary to confirm its intactness because tears or fragments left inside may indicate an accessory lobe or placenta accreta. These can lead to profuse hemorrhage because the uterus is unable to contract fully. Administering antibiotics would be appropriate for preventing infection, not postpartum hemorrhage. Manual removal of the placenta or excessive traction on the umbilical cord can lead to uterine inversion, which in turn would result in hemorrhage.

The nurse is providing anticipatory guidance to the mother of a 9-month-old girl during a well-baby visit. Which of the following topics would be most appropriate?

A) Advising how to create a toddler-safe home B) Warning about small objects left on the floor C) Cautioning about putting the baby in a walker D) Telling about safety procedures during baths Ans: A Feedback: The most appropriate topic for this mother would be advising her on how to create a toddler-safe home. The child will very soon be pulling herself up to standing and cruising the house. This will give her access to areas yet unexplored. Warning about small objects left on the floor, telling about safety procedures during baths, and cautioning about using baby walkers would no longer be anticipatory guidance as the child has passed these stages.

A woman comes to the clinic because she has been unable to conceive. When reviewing the woman's history, which of the following would the nurse least likely identify as a possible risk factor?

A) Age of 25 years B) History of smoking C) Diabetes since age 15 years D) Weight below standard for height and age Ans: A Feedback: Female risk factors for infertility include age older than 27 years, smoking and alcohol consumption, history of chronic illness such as diabetes, and overweight or underweight, which can disrupt hormonal function.

A nurse is describing the risks associated with prolonged pregnancies as part of an inservice presentation. Which of the following would the nurse be least likely to incorporate in the discussion as an underlying reason for problems in the fetus?

A) Aging of the placenta B) Increased amniotic fluid volume C) Meconium aspiration D) Cord compression Ans: B Fetal risks associated with a prolonged pregnancy include macrosomia, shoulder dystocia, brachial plexus injuries, low Apgar scores, postmaturity syndrome (loss of subcutaneous fat and muscle and meconium staining), and cephalopelvic disproportion. All of these conditions predispose this fetus to birth trauma or a surgical birth. Uteroplacental insufficiency, meconium aspiration, and intrauterine infection contribute to the increased rate of perinatal deaths (Beacock, 2011). As the placenta ages, its perfusion decreases and it becomes less efficient at delivering oxygen and nutrients to the fetus. Amniotic fluid volume also begins to decline by 40 weeks of gestation, possibly leading to oligohydramnios, subsequently resulting in fetal hypoxia and an increased risk of cord compression because the cushioning effect offered by adequate fluid is no longer present. Hypoxia and oligohydramnios predispose the fetus to aspiration of meconium, which is released by the fetus in response to a hypoxic insult (Caughey & Butler, 2010).

A group of students are reviewing information about the effects of substances on the newborn. The students demonstrate understanding of the information when they identify which drug as not being associated with teratogenic effects on the fetus?

A) Alcohol B) Nicotine C) Marijuana D) Cocaine Ans: C Feedback: Marijuana has not been shown to have teratogenic effects on the fetus. Alcohol, nicotine and cocaine do affect the fetus.

While making rounds in the nursery, the nurse sees a 6-hour-old baby girl gagging and turning bluish. Which of the following would the nurse do first?

A) Alert the physician stat and turn the newborn to her right side. B) Administer oxygen via facial mask by positive pressure. C) Lower the newborn's head to stimulate crying. D) Aspirate the oral and nasal pharynx with a bulb syringe. Ans: D Feedback: The nurse's first action would be to suction the oral and nasal pharynx with a bulb syringe to maintain airway patency. Turning the newborn to her right side will not alleviate the blockage due to secretions. Administering oxygen via positive pressure is not indicated at this time. Lowering the newborn's head would be inappropriate.

A nurse is working as part of a committee to establish policies to promote bonding and attachment. Which practice would be least effective in achieving this goal?

A) Allowing unlimited visiting hours on maternity units B) Offering round-the-clock nursery care for all infants C) Promoting rooming-in D) Encouraging infant contact immediately after birth Ans: B Factors that can affect attachment include separation of the infant and parents for long times during the day, such as if the infant was being cared for in the nursery throughout the day. Unlimited visiting hours, rooming-in, and infant contact immediately after birth promote bonding and attachment.

The nurse is providing discharge teaching regarding formula preparation for a new mother. Which of the following guidelines would the nurse include in the teaching plan?

A) Always wash bottles and nipples in hot soapy water and rinse well; do not wash them in the dishwasher. B) Store tightly covered ready-to-feed formula can after opening in refrigerator for up to 24 hours. C) Warm bottle of formula by placing bottle in a container of hot water, or microwaving formula. D) Do not add cereal to the formula in the bottle or sweeten the formula with honey. Ans: D Feedback: Proper formula preparation includes the following: wash nipples and bottles in hot soapy water and rinse well or run nipples and bottles through the dishwasher; store tightly covered ready-to-feed formula can after opening in refrigerator for up to 48 hours; after mixing concentrate or powdered formula, store tightly covered in refrigerator for up to 48 hours; do not reheat and reuse partially used bottles; throw away the unused portion after each feeding; do not add cereal to the formula in the bottle; do not sweeten formula with honey; warm formula by placing bottle in a container of hot water; and do not microwave formula.

When assessing a woman in her first trimester, which emotional response would the nurse most likely expect to find?

A) Ambivalence B) Introversion C) Acceptance D) Emotional lability Ans: A During the first trimester, the pregnant woman commonly experiences ambivalence, with conflicting feelings at the same time. Introversion heightens during the first and third trimesters when the woman's focus is on behaviors that will ensure a safe and healthy pregnancy outcome. Acceptance usually occurs during the second trimester. Emotional lability (mood swings) is characteristic throughout a woman's pregnancy.

A group of students are reviewing the signs of pregnancy. The students demonstrate understanding of the information when they identify which as presumptive signs? (Select all that apply.

A) Amenorrhea B) Nausea C) Abdominal enlargement D) Braxton-Hicks contractions E) Fetal heart sounds Ans: A, B Presumptive signs include amenorrhea, nausea, breast tenderness, urinary frequency and fatigue. Abdominal enlargement and Braxton-Hicks contractions are probable signs of pregnancy. Fetal heart sounds are a positive sign of pregnancy.

A woman with a history of crack cocaine abuse is admitted to the labor and birth area. While caring for the client, the nurse notes a sudden onset of fetal bradycardia. Inspection of the abdomen reveals an irregular wall contour. The client also complains of acute abdominal pain that is continuous. Which of the following would the nurse suspect?

A) Amniotic fluid embolism B) Shoulder dystocia C) Uterine rupture D) Umbilical cord prolapse Ans: C Uterine rupture is associated with crack cocaine use, and generally the first and most reliable sign is sudden fetal distress accompanied by acute abdominal pain, vaginal bleeding, hematuria, irregular wall contour, and loss of station in the fetal presenting part. Amniotic fluid embolism often is manifested with a sudden onset of respiratory distress. Shoulder dystocia is noted when continued fetal descent is obstructed after the fetal head is delivered. Umbilical cord prolapse is noted as the protrusion of the cord alongside or ahead of the presenting part of the fetus.

A woman who is 2 weeks postpartum calls the clinic and says, "My left breast hurts." After further assessment on the phone, the nurse suspects the woman has mastitis. In addition to pain, the nurse would assess for which of the following?

A) An inverted nipple on the affected breast B) No breast milk in the affected breast C) An ecchymotic area on the affected breast D) Hardening of an area in the affected breast Ans: D Feedback: Mastitis is characterized by a tender, hot, red, painful area on the affected breast. An inverted nipple is not associated with mastitis. With mastitis, the breast is distended with milk, the area is inflamed (not ecchymotic), and there is breast tenderness.

A primiparous client is being seen in the clinic for her first prenatal visit. It is determined that she is 11 weeks pregnant. The nurse develops a teaching plan to educate the client about what she will most likely experience during this period. Which of the following would the nurse include?

A) Ankle edema B) Urinary frequency C) Backache D) Hemorrhoids Ans: B The client is in her first trimester and would most likely experience urinary frequency as the growing uterus presses on the bladder. Ankle edema, backache, and hemorrhoids would be more common during the later stages of pregnancy.

The nurse observes an infant interacting with his parents. Which of the following are normal social behavioral developments for this age group? Select all answers that apply.

A) Around 5 months the infant may develop stranger anxiety. B) Around 2 months the infant exhibits a first real smile. C) Around 3 months the infant smiles widely and gurgles when interacting with the caregiver. D) Around 3 months the infant will mimic the parent's facial movements, such as sticking out the tongue. E) Around 3 to 6 months of age the infant may enjoy socially interactive games such as patty-cake and peek-a-boo. F) Separation anxiety may also start in the last few months of infancy. Ans: B, C, D, F Feedback: The infant exhibits a first real smile at age 2 months. By about 3 months of age the infant will start an interaction with a caregiver by smiling widely and possibly gurgling. The 3- to 4-month-old will also mimic the parent's facial movements, such as widening the eyes and sticking out the tongue. Separation anxiety may also start in the last few months of infancy. Around the age of 8 months the infant may develop stranger anxiety. At 6 to 8 months of age the infant may enjoy socially interactive games such as patty-cake and peek-a-boo.

A woman gave birth to a newborn via vaginal delivery with the use of a vacuum extractor. The nurse would be alert for which of the following in the newborn?

A) Asphyxia B) Clavicular fracture C) Caput succedaneum D) Central nervous system injury Ans: C Use of forceps or a vacuum extractor poses the risk of tissue trauma, such as ecchymoses, facial and scalp lacerations, facial nerve injury, cephalhematoma, and caput succedaneum. Asphyxia may be related to numerous causes but it is not associated with use of a vacuum extractor. Clavicular fracture is associated with shoulder dystocia. Central nervous system injury is not associated with the use of a vacuum extractor.

Just after delivery, a newborn's axillary temperature is 94° C. What action would be most appropriate?

A) Assess the newborn's gestational age. B) Rewarm the newborn gradually. C) Observe the newborn every hour. D) Notify the physician if the temperature goes lower. Ans: B A newborn's temperature is typically maintained at 36.5 to 37.5° C (97.7 to 99.7° F). Since this newborn's temperature is significantly lower, the nurse should institute measures to rewarm the newborn gradually. Assessment of gestational age is completed regardless of the newborn's temperature. Observation would be inappropriate because lack of action may lead to a further lowering of the temperature. The nurse should notify the physician of the newborn's current temperature since it is outside normal parameters.

The nurse caring for newborns knows that infants exhibit phenomenal increases in their gross motor skills over the first 12 months of life. Which of the following statements accurately describe the typical infant's achievement of these milestones? Select all answers that apply.

A) At 1 month the infant lifts and turns the head to the side in the prone position. B) At 2 months the infant lifts head and looks around. C) At 6 months the infant pulls to stand up. D) At 7 months the infant sits alone with some use of hands for support. E) At 9 months the infant crawls with the abdomen off the floor. F) At 12 months the infant walks independently. Ans: A, D, E, F Feedback: At 1 month the infant lifts and turns the head to the side in the prone position. At 7 months the infant sits alone with some use of hands for support. At 9 months the infant crawls with the abdomen off the floor. At 12 months the infant walks independently. At 4 months the infant lifts the head and looks around. At 10 months the infant pulls to stand up.

It is determined that a client's blood Rh is negative and her partner's is positive. To help prevent Rh isoimmunization, the nurse anticipates that the client will receive RhoGAM at which time?

A) At 34 weeks' gestation and immediately before discharge B) 24 hours before delivery and 24 hours after delivery C) In the first trimester and within 2 hours of delivery D) At 28 weeks' gestation and again within 72 hours after delivery Ans: D To prevent isoimmunization, the woman should receive RhoGAM at 28 to 32 weeks gestation and again within 72 hours after delivery.

A group of nursing students are reviewing the different types of congenital heart disease in infants. The students demonstrate a need for additional review when they identify which of the following as an example of increased pulmonary blood flow (left-to-right shunting)?

A) Atrial septal defect B) Tetralogy of Fallot C) Ventricular septal defect D) Patent ductus arteriosus Ans: B Feedback: Tetralogy of Fallot is a congenital heart condition that results from decreased, not increased, pulmonary blood flow. Atrial septal defect, ventricular septal defect, and patent ductus arteriosus are heart conditions that involve increased blood flow from higher pressure (left side of heart) to lower pressure (right side of heart), resulting in left-to-right shunting.

Which of the following would be most appropriate for the nurse to do when assisting parents who have experienced the loss of their preterm newborn?

A) Avoid using the terms "death" or "dying." B) Provide opportunities for them to hold the newborn. C) Refrain from initiating conversations with the parents. D) Quickly refocus the parents to a more pleasant topic. Ans: B Feedback: When dealing with grieving parents, nurses should provide them with opportunities to hold the newborn if they desire. In addition, the nurse should provide the parents with as many memories as possible, encouraging them to see, touch, dress, and take pictures of the newborn. These interventions help to validate the parents' sense of loss, relive the experience, and attach significance to the meaning of loss. The nurse should use appropriate terminology, such as "dying," "died," and "death," to help the parents accept the reality of the death. Nurses need to demonstrate empathy and to respect the parents' feelings, responding to them in helpful and supportive ways. Active listening and allowing the parents to vent their frustrations and anger help validate the parents' feelings and facilitate the grieving process.

The nurse strokes the lateral sole of the newborn's foot from the heel to the ball of the foot when evaluating which reflex?

A) Babinski B) Tonic neck C) Stepping D) Plantar grasp Ans: A The Babinski reflex is elicited by stroking the lateral sole of the newborn's foot from the heel toward and across the ball of the foot. The tonic neck reflex is tested by having the newborn lie on his back and then turn his head to one side. The stepping reflex is elicited by holding the newborn upright and inclined forward with the soles of the feet on a flat surface. The plantar grasp reflex is elicited by placing a finger against the area just below the newborn's toes.

The nurse administers RhoGAM to an Rh-negative client after delivery of an Rh-positive newborn based on the understanding that this drug will prevent her from:

A) Becoming Rh positive B) Developing Rh sensitivity C) Developing AB antigens in her blood D) Becoming pregnant with an Rh-positive fetus Ans: B The woman who is Rh-negative and whose infant is Rh-positive should be given Rh immune globulin (RhoGAM) within 72 hours after childbirth to prevent sensitization.

The nurse is preparing a presentation for a local women's group about ways to reduce the risk of reproductive tract cancers. Which of the following would the nurse include?

A) Blood pressure evaluation every 6 months B) Yearly Pap smears starting at age 40 C) Yearly cholesterol screening starting at age 45 D) Consumption of two to three glasses of red wine per day Ans: C Feedback: Staying healthy is a major way to reduce one's risk for cancer. Cholesterol should be checked annually starting at age 45. Blood pressure should be evaluated at least every 2 years. Pap smears are recommended every 1 to 3 years for sexually active women between the ages of 21 and 65. Alcohol should be consumed in moderation (not more than one drink per day), if at all.

Which of the following would alert the nurse to suspect that a preterm newborn is in pain?

A) Bradycardia B) Oxygen saturation level of 94% C) Decreased muscle tone D) Sudden high-pitched cry Ans: D Feedback: The nurse should suspect pain if the newborn exhibits a sudden high-pitched cry, oxygen desaturation, tachycardia, and increased muscle tone.

A newborn is suspected of having fetal alcohol syndrome. Which of the following would the nurse expect to assess?

A) Bradypnea B) Hydrocephaly C) Flattened maxilla D) Hypoactivity Ans: C Feedback: A newborn with fetal alcohol syndrome exhibits characteristic facial features such as microcephaly (not hydrocephaly), small palpebral fissures, and abnormally small eyes, flattened or absent maxilla, epicanthal folds, thin upper lip, and missing vertical groove in the median portion of the upper lip. Bradypnea is not typically associated with fetal alcohol syndrome. Fine and gross motor development is delayed, and the newborn shows poor hand-eye coordination but not hypoactivity.

Which medication would the nurse question if ordered to control a pregnant woman's asthma?

A) Budesonide B) Albuterol C) Salmeterol D) Oral prednisone Ans: D Oral corticosteroids such as prednisone are not preferred in the treatment of asthma during pregnancy. However, they can be used to treat severe asthma attacks during pregnancy. Budesonide, albuterol, and salmeterol are recommended for use during pregnancy to control asthma.

The nurse is teaching a new mother about the drastic growth and developmental changes her infant will experience in the first year of life. Which of the following describes a developmental milestone occurring in infancy?

A) By 6 months of age the infant's brain weighs half that of the adult brain; at age 12 months, the brain weighs 2.5 times what it did at birth. B) Most infants triple their birthweight by 4 to 6 months of age and quadruple their birthweight by the time they are 1 year old. C) The head circumference increases rapidly during the first 6 months: the average increase is about 1 inch per month. D) The heart triples in size over the first year of life; the average pulse rate decreases from 120 to 140 in the newborn to about 100 in the 1-year-old. Ans: A Feedback: By 6 months of age the infant's brain weighs half that of the adult brain; at age 12 months, the brain weighs 2.5 times what it did at birth. Most infants double their birthweight by 4 to 6 months of age and triple their birthweight by the time they are 1 year old. The head circumference increases rapidly during the first 6 months: the average increase is about 0.6 inch (1.5 cm) per month. The heart doubles in size over the first year of life. As the cardiovascular system matures, the average pulse rate decreases from 120 to 140 in the newborn to about 100 in the 1-year-old.

Which of the following would the nurse have readily available for a client who is receiving magnesium sulfate to treat severe preeclampsia?

A) Calcium gluconate B) Potassium chloride C) Ferrous sulfate D) Calcium carbonate Ans: A The antidote for magnesium sulfate is calcium gluconate, and this should be readily available in case the woman has signs and symptoms of magnesium toxicity.

A woman with diabetes is considering becoming pregnant. She asks the nurse whether she will be able to take oral hypoglycemics when she is pregnant. The nurse's response is based on the understanding that oral hypoglycemics:

A) Can be used as long as they control serum glucose levels B) Can be taken until the degeneration of the placenta occurs C) Are usually suggested primarily for women who develop gestational diabetes D) Show promising results but more studies are needed to confirm their effectiveness Ans: D Several studies have used glyburide (Diabeta) with promising results. Many health care providers are using glyburide and metformin as an alternative to insulin therapy because they do not cross the placenta and therefore do not cause fetal/neonatal hypoglycemia. Some oral hypoglycemic medications are considered safe and may be used if nutrition and exercise alone are not adequate. Maternal and newborn outcomes are similar to those seen in women who are treated with insulin. It is essential that oral hypoglycemic agents are further investigated to determine their safety with confidence and provide better treatment options for diabetes in pregnancy.

The nurse is counseling the mother of a newborn who is concerned about her baby's constant crying. What teaching would be appropriate for this mother?

A) Carrying the baby may increase the length of crying. B) Reducing stimulation may decrease the length of crying. C) Using vibration, white noise, or swaddling may increase crying. D) Using a swing or car ride may increase the incidence of crying episodes. Ans: B Feedback: Prolonged crying leads to increased stress among caregivers. Reducing stimulation may decrease the length of crying, and carrying the infant more may be helpful. Some infants respond to the motion of an infant swing or a car ride. Vibration, white noise, or swaddling may also help to decrease fussing in some infants. Parents should try one intervention at a time, taking care not to stimulate the infant excessively in the process of searching for solutions.

After teaching a group of nursing students about variations in newborn head size and appearance, the instructor determines that the teaching was successful when the students identify which of the following as a normal variation? (Select all that apply.)

A) Cephalhematoma B) Molding C) Closed fontanels D) Caput succedaneum E) Posterior fontanel diameter 1.5 cm Ans: A, B, D Normal variations in newborn head size and appearance include cephalhematoma, molding, and caput succedaneum. Microcephaly, closed fontanels, or a posterior fontanel diameter greater than 1 cm are considered abnormal.

A newborn is suspected of developing persistent pulmonary hypertension. The nurse would expect to prepare the newborn for which of the following to confirm the suspicion?

A) Chest x-ray B) Blood cultures C) Echocardiogram D) Stool for occult blood Ans: C Feedback: An echocardiogram is used to reveal right-to-left shunting of blood to confirm the diagnosis of persistent pulmonary hypertension. Chest x-ray would be most likely used to aid in the diagnosis of RDS or TTN. Blood cultures would be helpful in evaluating for neonatal sepsis. Stool for occult blood may be done to evaluate for NEC.

A client with hyperemesis gravidarum is admitted to the facility after being cared for at home without success. Which of the following would the nurse expect to include in the client's plan of care?

A) Clear liquid diet B) Total parenteral nutrition C) Nothing by mouth D) Administration of labetalol Ans: C Typically, on admission, the woman with hyperemesis has oral food and fluids withheld for the first 24 to 36 hours to rest the gut and receives parenteral fluids to rehydrate and reduce the symptoms. Once the condition stabilizes, oral intake is gradually increased. Total parenteral nutrition may be used if the client's condition does not improve with several days of bed rest, gut rest, IV fluids, and antiemetics. Labetalol is an antihypertensive agent that may be used to treat gestational hypertension, not hyperemesis.

A nursing student is preparing a presentation for the class on clubfoot. The student determines that the presentation was successful when the class states which of the following?

A) Clubfoot is a common genetic disorder. B) The condition affects girls more often than boys. C) The exact cause of clubfoot is not known. D) The intrinsic form can be manually reduced. Ans: C Feedback: Clubfoot is a complex, multifactorial deformity with genetic and intrauterine factors. Heredity and race seem to factor into the incidence, but the means of transmission and the etiology are unknown. Most newborns with clubfoot have no identifiable genetic, syndromal, or extrinsic cause. Clubfoot affects boys twice as often as girls. With the intrinsic type, manual reduction is not possible.

A nurse is developing a plan of care for a preterm newborn to address the nursing diagnosis of risk for delayed development. Which of the following would the nurse include? (Select all that apply.)

A) Clustering care to promote rest B) Positioning newborn in extension C) Using kangaroo care D) Loosely covering the newborn with blankets E) Providing nonnutritive sucking Ans: A, C, E Feedback: The nurse would focus the plan of care on developmental care, which includes clustering care to promote rest and conserve energy, using flexed positioning to simulate in utero positioning, using kangaroo care to promote skin to skin sensations, swaddling with a blanket to maintain the flexed position, and providing nonnutritive sucking.

Which of the following findings on a prenatal visit at 10 weeks might lead the nurse to suspect a hydatidiform mole?

A) Complaint of frequent mild nausea B) Blood pressure of 120/84 mm Hg C) History of bright red spotting 6 weeks ago D) Fundal height measurement of 18 cm Ans: D Findings with a hydatidiform mole may include uterine size larger than expected. Mild nausea would be a normal finding at 10 weeks' gestation. Blood pressure of 120/84 would not be associated with hydatidiform mole and depending on the woman's baseline blood pressure may be within acceptable parameters for her. Bright red spotting might suggest a spontaneous abortion.

A 10-week pregnant woman with diabetes has a glycosylated hemoglobin (HbA1C) level of 13%. At this time the nurse should be most concerned about which of the following possible fetal outcomes?

A) Congenital anomalies B) Incompetent cervix C) Placenta previa D) Abruptio placentae Ans: A An HbA1C level of 13% indicates poor glucose control. This, in conjunction with the woman being in the first trimester, increases the risk for congenital anomalies in the fetus. Elevated glucose levels are not associated with incompetent cervix, placenta previa, or abruptio placentae.

A nurse is discussing fetal development with a pregnant woman. The woman is 12 weeks pregnant and asks, "What's happening with my baby?" Which of the following would the nurse integrate into the response? (Select all that apply.)

A) Continued sexual differentiation B) Eyebrows forming C) Startle reflex present D) Digestive system becoming active E) Lanugo present on the head Ans: A, D Feedback: At 12 weeks, sexual differentiation continues and the digestive system shows activity. Eyebrows form and startle reflex is present between weeks 21 and 24. Lanugo on the head appears about weeks 13-16.

After teaching a group of nursing students about a neutral thermal environment, the instructor determines that the teaching was successful when the students identify which of the following as the newborn's primary method of heat production?

A) Convection B) Nonshivering thermogenesis C) Cold stress D) Bilirubin conjugation Ans: B The newborn's primary method of heat production is through nonshivering thermogenesis, a process in which brown fat (adipose tissue) is oxidized in response to cold exposure. Convection is a mechanism of heat loss. Cold stress results with excessive heat loss that requires the newborn to use compensatory mechanisms to maintain core body temperature. Bilirubin conjugation is a mechanism by which bilirubin in the blood is eliminated.

A nurse is explaining to the parents of a child with bladder exstrophy about the care their infant requires. Which of the following would the nurse include in the explanation? (Select all that apply.)

A) Covering the area with a sterile, clear, nonadherent dressing B) Irrigating the surface with sterile saline twice a day C) Monitoring drainage through the suprapubic catheter D) Administering prescribed antibiotic therapy E) Preparing for surgical intervention in about 2 weeks Ans: A, C, D Feedback: Care for an infant with bladder exstrophy includes covering the area with a sterile, clear, nonadherent dressing and irrigating the bladder surface with sterile saline after each diaper change to prevent infection, assisting with insertion and monitoring drainage from suprapubic catheter, administering prescribed antibiotic therapy, and preparing the parents and infant for surgery within 48 hours after birth.

A group of students are reviewing information about genetic inheritance. The students demonstrate understanding of the information when they identify which of the following as an example of an autosomal recessive disorder? (Select all that apply.)

A) Cystic fibrosis B) Phenylketonuria C) Tay-Sachs disease D) Polycystic kidney disease E) Achondroplasia Ans: A, B, C Feedback: Examples of autosomal recessive disorders include cystic fibrosis, phenylketonuria, and Tay-Sachs disease. Polycystic kidney disease and achondroplasia are examples of autosomal dominant diseases.

A nurse suspects that a pregnant client may be experiencing abruption placenta based on assessment of which of the following? (Select all that apply.)

A) Dark red vaginal bleeding B) Insidious onset C) Absence of pain D) Rigid uterus E) Absent fetal heart tones Ans: A, D, E Feedback: Assessment findings associated with abruption placenta include a sudden onset, with concealed or visible bleeding, dark red bleeding, constant pain or uterine tenderness on palpation, firm to rigid uterine tone, and fetal distress or absent fetal heart tones.

A nursing instructor is preparing a class on newborn adaptations. When describing the change from fetal to newborn circulation, which of the following would the instructor most likely include? (Select all that apply.)

A) Decrease in right atrial pressure leads to closure of the foramen ovale. B) Increase in oxygen levels leads to a decrease in systemic vascular resistance. C) Onset of respirations leads to a decrease in pulmonary vascular resistance. D) Increase in pressure in the left atrium results from increases in pulmonary blood flow. E) Closure of the ductus venosus eventually forces closure of the ductus arteriosus. Ans: A, C, D, E When the umbilical cord is clamped, the first breath is taken and the lungs begin to function. As a result, systemic vascular resistance increases and blood return to the heart via the inferior vena cava decreases. Concurrently with these changes, there is a rapid decrease in pulmonary vascular resistance and an increase in pulmonary blood flow (Boxwell, 2010). The foramen ovale functionally closes with a decrease in pulmonary vascular resistance, which leads to a decrease in right-sided heart pressures. An increase in systemic pressure, after clamping of the cord, leads to an increase in left-sided heart pressures. Ductus arteriosus, ductus venosus, and umbilical vessels that were vital during fetal life are no longer needed.

The nurse is assessing a preterm newborn's fluid and hydration status. Which of the following would alert the nurse to possible overhydration?

A) Decreased urine output B) Tachypnea C) Bulging fontanels D) Elevated temperature Ans: C Feedback: Bulging fontanels in a preterm newborn suggest overhydration. Sunken fontanels, decreased urine output, and elevated temperature would suggest dehydration.

A nurse suspects that a postpartum client is experiencing postpartum psychosis. Which of the following would most likely lead the nurse to suspect this condition?

A) Delirium B) Feelings of anxiety C) Sadness D) Insomnia Ans: A Feedback: Postpartum psychosis is at the severe end of the continuum of postpartum emotional disorders. It is manifested by depression that escalates to delirium, hallucinations, anger toward self and infant, bizarre behavior, mania, and thoughts of hurting herself and the infant. Feelings of anxiety, sadness, and insomnia are associated with postpartum depression.

As part of an inservice program, a nurse is describing a transient, self-limiting mood disorder that affects mothers after childbirth. The nurse correctly identifies this as postpartum:

A) Depression B) Psychosis C) Bipolar disorder D) Blues Ans: D Feedback: Postpartum blues are manifested by mild depressive symptoms of anxiety, irritability, mood swings, tearfulness, increased sensitivity, feelings of being overwhelmed, and fatigue. They are usually self-limiting and require no formal treatment other than reassurance and validation of the woman's experience as well as assistance in caring for herself and her newborn. Postpartum depression is a major depressive episode associated with childbirth. Postpartum psychosis is at the severe end of the continuum of postpartum emotional disorders. Bipolar disorder refers to a mood disorder typically involving episodes of depression and mania.

The nurse is educating a first-time mother who has a 1-week-old boy. Which of the following is the most accurate anticipatory guidance?

A) Describing the effect of neonatal teeth on breastfeeding B) Explaining that the stomach holds less than 1 ounce C) Informing that fontanels will close by 6 months D) Telling that the step reflex persists until the child walks Ans: B Feedback: Explaining that the child's stomach holds less than 1 ounce gives the mother a reason for frequent, small feedings and is the most helpful and accurate anticipatory guidance. Telling that the step reflex persists until the child walks and informing that fontanels will close by 6 months are inaccurate. The step reflex disappears at about 2 months and fontanels close between 12 and 18 months. Neonatal teeth are highly unusual and need no explanation unless they occur.

A nurse is massaging a postpartum client's fundus and places the nondominant hand on the area above the symphysis pubis based on the understanding that this action:

A) Determines that the procedure is effective B) Helps support the lower uterine segment C) Aids in expressing accumulated clots D) Prevents uterine muscle fatigue Ans: B Feedback: The nurse places the nondominant hand on the area above the symphysis pubis to help support the lower uterine segment. The hand, usually the dominant hand that is placed on the fundus, helps to determine uterine firmness (and thus the effectiveness of the massage). Applying gentle downward pressure on the fundus helps to express clots. Overmassaging the uterus leads to muscle fatigue.

A woman who is 42 weeks pregnant comes to the clinic. Which of the following would be most important?

A) Determining an accurate gestational age B) Asking her about the occurrence of contractions C) Checking for spontaneous rupture of membranes D) Measuring the height of the fundus Ans: A Incorrect dates account for the majority of prolonged or postterm pregnancies; many women have irregular menses and thus cannot identify the date of their last menstrual period accurately. Therefore, accurate gestational dating via ultrasound is essential. Asking about contractions and checking for ruptured membranes, although important assessments, would be done once the gestational age is confirmed. Measuring the height of the fundus would be unreliable because after 36 weeks, the fundal height drops due to lightening and may no longer correlate with gestational weeks.

Assessment of a postpartum woman experiencing postpartum hemorrhage reveals mild shock. Which of the following would the nurse expect to assess? (Select all that apply.)

A) Diaphoresis B) Tachycardia C) Oliguria D) Cool extremities E) Confusion Ans: A, D Feedback: Signs and symptoms of mild shock include diaphoresis, increased capillary refill, cool extremities, and maternal anxiety. Tachycardia and oliguria suggest moderate shock. Confusion suggests severe shock

The nurse is caring for a 7-month-old girl during a well-child visit. Which of the following interventions is most appropriate for this child?

A) Discussing the type of sippy cup to use B) Advising about increased caloric needs C) Explaining how to prepare table meats D) Describing the tongue extrusion reflex Ans: A Feedback: The cup may be introduced at 6 to 8 months of age. Old-fashioned sippy cups are preferred compared to the new style. The nurse would not advise about increased caloric needs as caloric needs drop at this age. Transition to table meat will not take place until age 10 to 12 months. Tongue extrusion reflex has disappeared at age 4 to 6 months.

A woman who is 12 hours postpartum had a pulse rate around 80 beats per minute during pregnancy. Now, the nurse finds a pulse of 60 beats per minute. Which of these actions should the nurse take?

A) Document the finding, as it is a normal finding at this time. B) Contact the physician, as it indicates early DIC. C) Contact the physician, as it is a first sign of postpartum eclampsia. D) Obtain an order for a CBC, as it suggests postpartum anemia. Ans: A Pulse rates of 40 to 80 beats per minute (bmp) are normal during the first week after birth. This pulse rate is called puerperal bradycardia. During pregnancy, the heavy gravid uterus causes a decreased flow of venous blood to the heart. After giving birth, there is an increase in intravascular volume. The cardiac output is most likely caused by an increased stroke volume from the venous return now. The elevated stroke volume leads to a decreased heart rate.

While changing a female newborn's diaper, the nurse observes a mucus-like, slightly bloody vaginal discharge. Which of the following would the nurse do next?

A) Document this as pseudomenstruation B) Notify the practitioner immediately C) Obtain a culture of the discharge D) Inspect for engorgement Ans: A The nurse should assess pseudomenstruation, a vaginal discharge composed of mucus mixed with blood, which may be present during the first few weeks of life. This discharge requires no treatment. The discharge is a normal finding and thus does not need to be reported immediately. It is not an indication of infection. The female genitalia normally will be engorged, so assessing for engorgement is not indicated.

A pregnant woman undergoes maternal serum alpha-fetoprotein (MSAFP) testing at 16 to 18 weeks' gestation. Which of the following would the nurse suspect if the woman's level is decreased?

A) Down syndrome B) Sickle-cell anemia C) Cardiac defects D) Open neural tube defect Ans: A Feedback: Decreased levels might indicate Down syndrome or trisomy 18. Sickle cell anemia may be identified by chorionic villus sampling. MSAFP levels would be increased with cardiac defects, such as tetralogy of Fallot. A triple marker test would be used to determine an open neural tube defect.

After teaching a pregnant woman with iron deficiency anemia about nutrition, the nurse determines that the teaching was successful when the woman identifies which of the following as being good sources of iron in her diet? (Select all that apply.)

A) Dried fruits B) Peanut butter C) Meats D) Milk E) White bread Ans: A, B, C Feedback: Foods high in iron include meats, green leafy vegetables, legumes, dried fruits, whole grains, peanut butter, bean dip, whole-wheat fortified breads and cereals.

Which of the following, if noted in the maternal history, would the nurse identify as possibly contributing to the birth of an LGA newborn?

A) Drug abuse B) Diabetes C) Preeclampsia D) Infection Ans: B Feedback: Maternal factors that increase the chance of having an LGA newborn include maternal diabetes mellitus or glucose intolerance, multiparity, prior history of a macrosomic infant, postdated gestation, maternal obesity, male fetus, and genetics. Drug abuse is associated with SGA newborns and preterm newborns. A maternal history of preeclampsia and infection would be associated with preterm birth.

After determining that a newborn is in need of resuscitation, which of the following would the nurse do first?

A) Dry the newborn thoroughly B) Suction the airway C) Administer ventilations D) Give volume expanders Ans: A Feedback: If resuscitation is need, the nurse must first stabilize the newborn by drying the newborn thoroughly with a warm towel and provide warmth by placing him or her under a radiant heater to prevent rapid heat loss. Next the newborn's head is placed in a neutral position to open the airway and the airway is cleared with a bulb syringe or suction catheter. Breathing is stimulated. Often handling and rubbing the newborn with a dry towel may be all that is needed to stimulate respirations. Next ventilations and then chest compressions are done. Administration of epinephrine and/or volume expanders is the last step.

After the birth of a newborn, which of the following would the nurse do first to assist in thermoregulation?

A) Dry the newborn thoroughly. B) Put a hat on the newborn's head. C) Check the newborn's temperature. D) Wrap the newborn in a blanket. Ans: A Drying the newborn immediately after birth using warmed blankets is essential to prevent heat loss through evaporation. Then the nurse would place a cap on the baby's head and wrap the newborn. Assessing the newborn's temperature would occur once these measures were initiated to prevent heat loss.

When describing the structures involved in fetal circulation, the nursing instructor describes which structure as the opening between the right and left atrium?

A) Ductus venosus B) Foramen ovale C) Ductus arteriosus D) Umbilical artery Ans: B Feedback: The foramen ovale is the opening between the right and left atrium. The ductus venosus connects the umbilical vein to the inferior vena cava. The ductus arteriosus connects the main pulmonary artery to the aorta. The umbilical artery carries blood to the placenta.

A nurse is assessing a pregnant woman who has come to the clinic. The woman reports that she feels some heaviness in her thighs since yesterday. The nurse suspects that the woman may be experiencing preterm labor based on which additional assessment finding?

A) Dull low backache B) Malodorous vaginal discharge C) Dysuria D) Constipation Ans: C Symptoms of preterm labor are often subtle and may include change or increase in vaginal discharge with mucus, water, or blood in it; pelvic pressure; low, dull backache; nausea, vomiting or diarrhea, and intestinal cramping with or without diarrhea.

A group of nurses are researching information about risk factors for intimate partner violence in men. Which of the following would the nurses expect to find related to the individual person? (Select all that apply.)

A) Dysfunctional family system B) Low academic achievement C) Victim of childhood violence D) Heavy alcohol consumption E) Economic stress Ans: B, C, D Feedback: Individual risk factors associated with intimate partner violence include young age, heavy drinking, low academic achievement, and experience of or witnessing of violence as a child. Dysfunctional family system and economic stress are risk factors associated with the relationship.

A multipara client develops thrombophlebitis after delivery. Which of the following would alert the nurse to the need for immediate intervention?

A) Dyspnea, diaphoresis, hypotension, and chest pain B) Dyspnea, bradycardia, hypertension, and confusion C) Weakness, anorexia, change in level of consciousness, and coma D) Pallor, tachycardia, seizures, and jaundice Ans: A Feedback: Sudden unexplained shortness of breath and complaints of chest pain along with diaphoresis and hypotension suggest pulmonary embolism, which requires immediate action. Other signs and symptoms include tachycardia, apprehension, hemoptysis, syncope, and sudden change in the woman's mental status secondary to hypoxemia. Anorexia, seizures, and jaundice are unrelated to a pulmonary embolism.

The nurse teaches a primigravida client that lightening occurs about 2 weeks before the onset of labor. The mother will most likely experience which of the following at that time?

A) Dysuria B) Dyspnea C) Constipation D) Urinary frequency Ans: D Lightening refers to the descent of the fetal head into the pelvis and engagement. With this descent, pressure on the diaphragm decreases, easing breathing, but pressure on the bladder increases, leading to urinary frequency. Dysuria might indicate a urinary tract infection. Constipation may occur throughout pregnancy due to decreased peristalsis, but it is unrelated to lightening.

A group of nursing students are reviewing information about mastitis and its causes. The students demonstrate understanding of the information when they identify which of the following as the most common cause?

A) E. coli B) S. aureus C) Proteus D) Klebsiella Ans: B Feedback: The most common infectious organism that causes mastitis is S. aureus, which comes from the breast-feeding infant's mouth or throat. E. coli is another, less common cause. E.coli, Proteus, and Klebsiella are common causes of urinary tract infections.

A nurse is preparing a class for a group of young adult women about emergency contraceptives (ECs). Which of the following would the nurse need to stress to the group. Select all that apply.

A) ECs induce an abortion like reaction. B) ECs provide some protection against STIs C) ECs are birth control pills in higher, more frequent doses D) ECs are not to be used in place of regular birth control E) ECs provide little protection for future pregnancies. Ans: C, D, E Feedback: Important points to stress concerning ECs are that ECs do not offer any protection against STIs or future pregnancies; should not be used in place of regular birth control, as they are less effective; are regular birth control pills given at higher doses and more frequently; and are contraindicated during pregnancy (Miller, 2011). Contrary to popular belief, ECs do not induce abortion and are not related to mifepristone or RU-486, the so-called abortion pill approved by the FDA in 2000.

When developing the plan of care for the parents of a newborn, the nurse identifies interventions to promote bonding and attachment based on the rationale that bonding and attachment are most supported by which measure?

A) Early parent-infant contact following birth B) Expert medical care for the labor and birth C) Good nutrition and prenatal care during pregnancy D) Grandparent involvement in infant care after birth Ans: A Optimal bonding requires a period of close contact between the parents and newborn within the first few minutes to a few hours after birth. Expert medical care, nutrition and prenatal care, and grandparent involvement are not associated with the promotion of bonding.

During a routine health check-up, a young adult woman asks the nurse about ways to prevent endometrial cancer. Which of the following would the nurse most likely include? (Select all that apply.)

A) Eating a high-fat diet B) Having regular pelvic exams C) Engaging in daily exercise D) Becoming pregnant E) Using estrogen contraceptives Ans: B, C, D Feedback: Measures to prevent endometrial cancer include eating a low-fat diet, having regular pelvic exams after the age of 21, engaging in daily exercise, becoming pregnant (pregnancy serves as a protective factor), and asking the practitioner about the use of combination estrogen and progestin pills.

Which of the following findings would the nurse interpret as suggesting a diagnosis of gestational trophoblastic disease?

A) Elevated hCG levels, enlarged abdomen, quickening B) Vaginal bleeding, absence of FHR, decreased hPL levels C) Visible fetal skeleton on ultrasound, absence of quickening, enlarged abdomen D) Gestational hypertension, hyperemesis gravidarum, absence of FHR Ans: D Gestational trophoblastic disease may be manifested by early development of preeclampsia (gestational hypertension), severe morning sickness due to high hCG levels, and absence of fetal heart rate or activity. There is no fetus, so quickening and evidence of a fetal skeleton would not be seen. The abdominal enlargement is greater than expected for pregnancy dates, but hCG, not hPL, levels are increased.

The nurse is promoting a healthy diet to guide a mother when feeding her 2-week-old girl. Which of the following is the most effective anticipatory guidance?

A) Encouraging breastfeeding until the sixth month B) Advocating iron supplements with bottle-feeding C) Advising fluid intake per feeding of 5 or 6 ounces D) Discouraging the addition of fruit juice to the diet Ans: D Feedback: Discouraging the addition of fruit juice to the child's diet is the most effective anticipatory guidance. Fruit juice can displace important nutrients from breast milk or formula. Encouraging breastfeeding until the sixth month is only halfway to the Healthy People goal of breastfeeding for the first year. Advising fluid intake per feeding of 5 or 6 ounces is too much for this neonate, but is typical for an infant 4 to 6 months of age. Advocating iron supplements with bottle-feeding is unnecessary so long as the formula is fortified with iron.

A postpartum woman is diagnosed with metritis. The nurse interprets this as an infection involving which of the following? (Select all that apply.)

A) Endometrium B) Decidua C) Myometrium D) Broad ligament E) Ovaries F) Fallopian tubes Ans: A, B, C Feedback: Metritis is an infectious condition that involves the endometrium, decidua, and adjacent myometrium of the uterus. Extension of metritis can result in parametritis, which involves the broad ligament and possibly the ovaries and fallopian tubes, or septic pelvic thrombophlebitis,

The nurse places a warmed blanket on the scale when weighing a newborn. The nurse does so to minimize heat loss via which mechanism?

A) Evaporation B) Conduction C) Convection D) Radiation Ans: B Using a warmed cloth diaper or blanket to cover any cold surface, such as a scale, that touches a newborn directly helps to prevent heat loss through conduction. Drying a newborn and promptly changing wet linens, clothes, or diapers help reduce heat loss via evaporation. Keeping the newborn out of a direct cool draft, working inside an isolette as much as possible, and minimizing the opening of portholes help prevent heat loss via convection. Keeping cribs and isolettes away from outside walls, cold windows, and air conditioners and using radiant warmers while transporting newborns and performing procedures will help reduce heat loss via radiation.

A nurse strongly encourages a pregnant client to avoid eating swordfish and tilefish because these fish contain which of the following?

A) Excess folic acid, which could increase the risk for neural tube defects B) Mercury, which could harm the developing fetus if eaten in large amounts C) Lactose, which leads to abdominal discomfort, gas, and diarrhea D) Low-quality protein that does not meet the woman's requirements Ans: B Nearly all fish and shellfish contain traces of mercury and some contain higher levels of mercury that may harm the developing fetus if ingested by pregnant women in large amounts. Among these fish are shark, swordfish, king mackerel, and tilefish. Folic acid is found in dark green vegetables, baked beans, black-eyed peas, citrus fruits, peanuts, and liver. Folic acid supplements are needed to prevent neural tube defects. Women who are lactose intolerant experience abdominal discomfort, gas, and diarrhea if they ingest foods containing lactose. Fish and shellfish are an important part of a healthy diet because they contain high-quality proteins, are low in saturated fat, and contain omega-3 fatty acids.

A group of nursing students are reviewing the changes in the newborn's lungs that must occur to maintain respiratory function. The students demonstrate understanding of this information when they identify which of the following as the first event?

A) Expansion of the lungs B) Increased pulmonary blood flow C) Initiation of respiratory movement D) Redistribution of cardiac output Ans: C Before the newborn's lungs can maintain respiratory function, the following events must occur: respiratory movement must be initiated; lungs must expand, functional residual capacity must be established, pulmonary blood flow must increase, and cardiac output must be redistributed.

A newborn with severe meconium aspiration syndrome (MAS) is not responding to conventional treatment. Which of the following would the nurse anticipate as possibly necessary for this newborn?

A) Extracorporeal membrane oxygenation (ECMO) B) Respiratory support with a ventilator C) Insertion of a laryngoscope for deep suctioning D) Replacement of an endotracheal tube via x-ray Ans: A Feedback: If conventional measures are ineffective, then the nurse would need to prepare the newborn for ECMO. Hyperoxygenation, ventilatory support, and suctioning are typically used initially to promote tissue perfusion. However, if these are ineffective, ECMO would be the next step.

A postpartum client has a fourth-degree perineal laceration. The nurse would expect which of the following medications to be ordered?

A) Ferrous sulfate (Feosol) B) Methylergonovine (Methergine) C) Docusate (Colace) D) Bromocriptine (Parlodel) Ans: C A stool softener such as docusate (Colace) may promote bowel elimination in a woman with a fourth-degree laceration, who may fear that bowel movements will be painful. Ferrous sulfate would be used to treat anemia. However, it is associated with constipation and would increase the discomfort when the woman has a bowel movement. Methylergonovine would be used to prevent or treat postpartum hemorrhage. Bromocriptine is used to treat hyperprolactinemia.

After the nurse describes fetal circulation to a pregnant woman, the woman asks why her fetus has a different circulation pattern than hers. In planning a response, the nurse integrates understanding of which of the following?

A) Fetal blood is thicker than that of adults and needs different pathways. B) Fetal circulation carries highly oxygenated blood to vital areas first. C) Fetal blood has a higher oxygen saturation and circulates more slowly. D) Fetal heart rates are rapid and circulation time is double that of adults. Ans: B Feedback: Fetal circulation functions to carry highly oxygenated blood to vital areas first while shunting it away from less vital ones. Fetal blood is not thicker than that of adults. Large volumes of oxygenated blood are not needed because the placenta essentially takes over the functions of the lung and liver during fetal life. Although fetal heart rates normally range from 120 to 160 beats per minute, circulation time is not doubled.

A pregnant woman is admitted with premature rupture of the membranes. The nurse is assessing the woman closely for possible infection. Which of the following would lead the nurse to suspect that the woman is developing an infection? (Select all that apply.)

A) Fetal bradycardia B) Abdominal tenderness C) Elevated maternal pulse rate D) Decreased C-reactive protein levels E) Cloudy malodorous fluid Ans: B, C, E Possible signs of infection associated with premature rupture of membranes include elevation of maternal temperature and pulse rate, abdominal/uterine tenderness, fetal tachycardia over 160 bpm, elevated white blood cell count and C-reactive protein levels, and cloudy, foul-smelling amniotic fluid.

A pregnant client undergoing labor induction is receiving an oxytocin infusion. Which of the following findings would require immediate intervention?

A) Fetal heart rate of 150 beats/minute B) Contractions every 2 minutes, lasting 45 seconds C) Uterine resting tone of 14 mm Hg D) Urine output of 20 mL/hour Ans: D Oxytocin can lead to water intoxication. Therefore, a urine output of 20 mL/hour is below acceptable limits of 30 mL/hour and requires intervention. FHR of 150 beats/minute is within the accepted range of 120 to 160 beats/minute. Contractions should occur every 2 to 3 minutes, lasting 40 to 60 seconds. A uterine resting tone greater than 20 mm Hg would require intervention.

A pregnant woman comes to the clinic and tells the nurse that she has been having a whitish vaginal discharge. The nurse suspects vulvovaginal candidiasis, based on which assessment finding?

A) Fever B) Vaginal itching C) Urinary frequency D) Incontinence Ans: B Vaginal secretions become more acidic, white, and thick during pregnancy. Most women experience an increase in a whitish vaginal discharge, called leukorrhea. This is normal except when it is accompanied by itching and irritation, possibly suggesting Candida albicans, a monilial vaginitis, which is a very common occurrence in this glycogen-rich environment. Fever would suggest a more serious infection. Urinary frequency occurs commonly in the first trimester, disappears during the second trimester, and reappears during the third trimester. Incontinence would not be associated with a vulvovaginal candidiasis. Incontinence would require additional evaluation.

The nurse is teaching a group of students about the differences between a full-term newborn and a preterm newborn. The nurse determines that the teaching is effective when the students state that the preterm newborn has:

A) Fewer visible blood vessels through the skin B) More subcutaneous fat in the neck and abdomen C) Well-developed flexor muscles in the extremities D) Greater surface area in proportion to weight Ans: D Feedback: Preterm newborns have large body surface areas compared to weight, which allows an increased transfer of heat from their bodies to the environment. Preterm newborns often have thin transparent skin with numerous visible veins, minimal subcutaneous fat, and poor muscle tone.

A woman with gestational hypertension experiences a seizure. Which of the following would be the priority?

A) Fluid replacement B) Oxygenation C) Control of hypertension D) Delivery of the fetus Ans: B As with any seizure, the priority is to clear the airway and maintain adequate oxygenation both to the mother and the fetus. Fluids and control of hypertension are addressed once the airway and oxygenation are maintained. Delivery of fetus is determined once the seizures are controlled and the woman is stable.

A nurse is preparing a teaching program for a group of pregnant women about preventing infections during pregnancy. When describing measures for preventing cytomegalovirus infection, which of the following would the nurse most likely include?

A) Frequent handwashing B) Immunization C) Prenatal screening D) Antibody titer screening Ans: A Most women are asymptomatic and don't know they have been exposed to CMV. Prenatal screening for CMV infection is not routinely performed. Since there is no therapy that prevents or treats CMV infections, nurses are responsible for educating and supporting childbearing-age women at risk for CMV infection. Stressing the importance of good handwashing and use of sound hygiene practices can help to reduce transmission of the virus. There is no immunization for CMV. Antibody titer levels would be useful for identifying women at risk for rubella.

A nurse is observing a postpartum woman and her partner interact with their newborn. The nurse determines that the parents are developing parental attachment with their newborn when they demonstrate which of the following? (Select all that apply.)

A) Frequently ask for the newborn to be taken from the room B) Identify common features between themselves and the newborn C) Refer to the newborn as having a monkey-face D) Make direct eye contact with the newborn E) Refrain from checking out the newborn's features Ans: B, D Positive behaviors that indicate attachment include identifying common features and making direct eye contact with the newborn. Asking for the newborn to be taken out of the room, referring to the newborn as having a monkey-face and refraining from checking out the newborn's features are negative attachment behaviors.

After teaching a class on date rape, the instructor determines that the teaching was successful when the class identifies which of the following as the most common date rape drug?

A) Gamma hydroxybutyrate B) Liquid ecstasy C) Ketamine D) Rohypnol Ans: D Feedback: Rohypnol is the most common date rape drug. Others include gamma hydroxybutyrate, or liquid ecstasy, and ketamine.

When explaining how a newborn adapts to extrauterine life, the nurse would describe which body systems as undergoing the most rapid changes?

A) Gastrointestinal and hepatic B) Urinary and hematologic C) Respiratory and cardiovascular D) Neurological and integumentary Ans: C Although all the body systems of the newborn undergo changes, respiratory gas exchange along with circulatory modifications must occur immediately to sustain extrauterine life.

A woman hospitalized with severe preeclampsia is being treated with hydralazine to control blood pressure. Which of the following would the lead the nurse to suspect that the client is having an adverse effect associated with this drug?

A) Gastrointestinal bleeding B) Blurred vision C) Tachycardia D) Sweating Ans: C Hydralazine reduces blood pressure but is associated with adverse effects such as palpitation, tachycardia, headache, anorexia, nausea, vomiting, and diarrhea. It does not cause gastrointestinal bleeding, blurred vision, or sweating. Magnesium sulfate may cause sweating.

A nursing instructor is preparing a teaching plan for a group of nursing students about the potential for misuse of genetic discoveries and advances. Which the following would the instructor most likely include?

A) Gene replacement therapy for defective genes B) Individual risk profiling and confidentiality C) Greater emphasis on the causes of diseases D) Slower diagnosis of specific diseases Ans: B Feedback: Individual risk profiling based on an individual's genetic makeup can raise issues related to privacy and confidentiality. Gene replacement therapy for defective genes and a greater emphasis on looking at the causes of disease are considered benefits associated with genetic advances. Rapid, more specific diagnosis of diseases would be possible.

A nurse is describing advances in genetics to a group of students. Which of the following would the nurse least likely include?

A) Genetic diagnosis is now available as early as the second trimester. B) Genetic testing can identify presymptomatic conditions in children. C) Gene therapy can be used to repair missing genes with normal ones. D) Genetic agents may be used in the future to replace drugs. Ans: A Feedback: Genetic diagnosis is now possible very early in pregnancy (see Evidence-Based Practice 10.1). Genetic testing can now identify presymptomatic conditions in children and adults. Gene therapy can be used to replace or repair defective or missing genes with normal ones. Gene therapy has been used for a variety of disorders, including cystic fibrosis, melanoma, diabetes, HIV, and hepatitis (Tamura, Kamuma, Nakazato, et al. 2010). The potential exists for creation of increased intelligence and size through genetic intervention. Recent research using gene therapy shows promise for the generation of insulin-producing cells to cure diabetes (Calne, Gan, & Lee 2010). In the future, genetic agents may replace drugs, general surgery may be replaced by gene surgery, and genetic intervention may replace radiation.

A woman gives birth to a healthy newborn. As part of the newborn's care, the nurse instills erythromycin ophthalmic ointment as a preventive measure related to which STI?

A) Genital herpes B) Hepatitis B C) Syphilis D) Gonorrhea Ans: D Feedback: To prevent gonococcal ophthalmia neonatorum, erythromycin or tetracycline ophthalmic ointment is instilled into the eyes of all newborns. This action is required by law in most states. The ointment is not used to prevent conditions related to genital herpes, hepatitis B, or syphilis.

The nurse observes the stool of a newborn who has begun to breast-feed. Which of the following would the nurse expect to find?

A) Greenish black, tarry stool B) Yellowish-brown, seedy stool C) Yellow-gold, stringy stool D) Yellowish-green, pasty stool Ans: B After feedings are initiated, a transitional stool develops, which is greenish brown to yellowish brown, thinner in consistency, and seedy in appearance. Meconium stool is greenish black and tarry. The last development in the stool pattern is the milk stool. Milk stools of the breast-fed newborn are yellow-gold, loose, and stringy to pasty in consistency, and typically sour-smelling. The milk stools of the formula-fed newborn vary depending on the type of formula ingested. They may be yellow, yellow-green, or greenish and loose, pasty, or formed in consistency, and they have an unpleasant odor.

A nurse is assessing a child with Klinefelter's syndrome. Which of the following would the nurse expect to assess? (Select all that apply.)

A) Gross mental retardation B) Long arms C) Profuse body hair D) Gynecomastia E) Enlarged testicles Ans: B, D Feedback: Manifestations of Klinefelter's syndrome include mild mental retardation, small testicles, infertility, long arms and legs, gynecomastia, scant facial and body hair, and decreased libido.

A pregnant woman tests positive for HBV. Which of the following would the nurse expect to administer?

A) HBV immune globulin B) HBV vaccine C) Acyclovir D) Valacyclovir Ans: A If a woman tests positive for HBV, expect to administer HBV immune globulin (HBIG, Hep-B-Gammagee). The newborn will also receive HBV vaccine (Recombivax-HB, Engerix-B) within 12 hours of birth. Acyclovir or valacyclovir would be used to treat herpes simplex virus infection.

After teaching a class on preventing pelvic inflammatory disease, the instructor determines that the teaching was successful when the class identifies which of the following as an effective method?

A) HIV B) HSV C) HPV D) HAV E) HBV Ans: C Feedback: Vaccines are under development or are undergoing clinical trials for certain STIs, including HIV and HSV. However, the only vaccines currently available are for prevention of HAV, HBV, and HPV infection.

Assessment of a newborn reveals rhythmic spontaneous movements. The nurse interprets this as indicating:

A) Habituation B) Motor maturity C) Orientation D) Social behaviors Ans: B Motor maturity is evidenced by rhythmic, spontaneous movements. Habituation is manifested by the newborn's ability to respond to the environment appropriately. Orientation involves the newborn's response to new stimuli, such as turning the head to a sound. Social behaviors involve cuddling and snuggling into the arms of a parent.

A nurse is assessing a newborn and observes the newborn moving his head and eyes toward a loud sound. The nurse interprets this as which of the following?

A) Habituation B) Motor maturity C) Social behavior D) Orientation Ans: D Orientation refers to the response of newborns to stimuli. It reflects newborns' response to auditory and visual stimuli, demonstrated by their movement of head and eyes to focus on that stimulus. Habituation is the newborn's ability to process and respond to visual and auditory stimuli—that is, how well and appropriately he or she responds to the environment. Habituation is the ability to block out external stimuli after the newborn has become accustomed to the activity. Motor maturity depends on gestational age and involves evaluation of posture, tone, coordination, and movements. These activities enable newborns to control and coordinate movement. When stimulated, newborns with good motor organization demonstrate movements that are rhythmic and spontaneous. Social behaviors include cuddling and snuggling into the arms of the parent when the newborn is held.

While observing the interaction between a newborn and his mother, the nurse notes the newborn nestling into the arms of his mother. The nurse identifies this behavior as which of the following?

A) Habituation B) Self-quieting ability C) Social behaviors D) Orientation Ans: C Social behaviors include cuddling and snuggling into the arms of the parent when the newborn is held. Habituation self-quieting ability refers to newborns' ability to quiet and comfort themselves, such as by hand-to-mouth movements and sucking, alerting to external stimuli and motor activity. Habituation is the newborn's ability to process and respond to visual and auditory stimuli—that is, how well and appropriately he or she responds to the environment. Habituation is the ability to block out external stimuli after the newborn has become accustomed to the activity. Orientation refers to the response of newborns to stimuli, becoming more alert when sensing a new stimulus in their environment.

The nurse is assessing the skin of a newborn and notes a rash on the newborn's face, and chest. The rash consists of small papules and is scattered with no pattern. The nurse interprets this finding as which of the following?

A) Harlequin sign B) Nevus flammeus C) Erythema toxicum D) Port wine stain Ans: C Erythema toxicum (newborn rash) is a benign, idiopathic, generalized, transient rash that occurs in up to 70% of all newborns during the first week of life. It consists of small papules or pustules on the skin resembling flea bites. The rash is common on the face, chest, and back. One of the chief characteristics of this rash is its lack of pattern. It is caused by the newborn's eosinophils reacting to the environment as the immune system matures. Harlequin sign refers to the dilation of blood vessels on only one side of the body, giving the newborn the appearance of wearing a clown suit. It gives a distinct midline demarcation, which is described as pale on the nondependent side and red on the opposite, dependent side. Nevus flammeus or port wine stain is a capillary angioma located directly below the dermis. It is flat with sharp demarcations and is purple-red. This skin lesion is made up of mature capillaries that are congested and dilated.

The nurse institutes measures to maintain thermoregulation based on the understanding that newborns have limited ability to regulate body temperature because they:

A) Have a smaller body surface compared to body mass B) Lose more body heat when they sweat than adults C) Have an abundant amount of subcutaneous fat all over D) Are unable to shiver effectively to increase heat production Ans: D Newborns have difficulty maintaining their body heat through shivering and other mechanisms. They have a large body surface area relative to body weight and have limited sweating ability. Additionally, newborns lack subcutaneous fat to provide insulation.

A nurse is developing a teaching plan for the parents of a newborn. When describing the neurologic development of a newborn to his parents, the nurse would explain that the development occurs in which fashion?

A) Head-to-toe B) Lateral-to-medial C) Outward-to-inward D) Distal-to-caudal Ans: A Neurologic development follows a cephalocaudal (head-to-toe) and proximal-distal (center to outside) pattern.

After teaching new parents about the sensory capabilities of their newborn, the nurse determines that the teaching was successful when they identify which sense as being the least mature?

A) Hearing B) Touch C) Taste D) Vision Ans: D Vision is the least mature sense at birth. Hearing is well developed at birth, evidenced by the newborn's response to noise by turning. Touch is evidenced by the newborn's ability to respond to tactile stimuli and pain. A newborn can distinguish between sweet and sour by 72 hours of age.

During a vaginal exam, the nurse notes that the cervix has a bluish color. The nurse documents this finding as:

A) Hegar's sign B) Goodell's sign C) Chadwick's sign D) Ortolani's sign Ans: C Bluish coloration of the cervix is termed Chadwick's sign. Hegar's sign refers to the softening of the lower uterine segment or isthmus. Goodell's sign refers to the softening of the cervix. Ortolani's sign is a maneuver done to identify developmental dysplasia of the hip in infants.

Assessment of a postpartum client reveals a firm uterus with bright-red bleeding and a localized bluish bulging area just under the skin at the perineum. The woman also is complaining of significant pelvic pain and is experiencing problems with voiding. The nurse suspects which of the following?

A) Hematoma B) Laceration C) Bladder distention D) Uterine atony Ans: A Feedback: The woman most likely has a hematoma based on the findings: firm uterus with bright-red bleeding; localized bluish bulging area just under the skin surface in the perineal area; severe perineal or pelvic pain; and difficulty voiding. A laceration would involve a firm uterus with a steady stream or trickle of unclotted bright-red blood in the perineum. Bladder distention would be palpable along with a soft, boggy uterus that deviates from the midline. Uterine atony would be noted by an uncontracted uterus.

A nurse is reviewing the laboratory test results of a newborn. Which result would the nurse identify as a cause for concern?

A) Hemoglobin 19 g/dL B) Platelets 75,000/uL C) White blood cells 20,000/mm3 D) Hematocrit 52% Ans: B Normal newborn platelets range from 150,00 to 350,000/uL. Normal hemoglobin ranges from 17 to 23g/dL, and normal hematocrit ranges from 46% to 68%. Normal white blood cell count ranges from 10,000 to 30,000/mm3.

After teaching a class about hepatic system adaptations after birth, the instructor determines that the teaching was successful when the class identifies which of the following as the process of changing bilirubin from a fat-soluble product to a water-soluble product?

A) Hemolysis B) Conjugation C) Jaundice D) Hyperbilirubinemia Ans: B The process in which bilirubin is changed from a fat-soluble product to a water-soluble product is called conjugation. Hemolysis involves the breakdown of blood cells. In the newborn, hemolysis of the red blood cells is the principal source of bilirubin. Jaundice is the manifestation of increased bilirubin in the bloodstream. Hyperbilirubinemia refers to the increased level of bilirubin in the blood.

In a woman who is suspected of having a ruptured ectopic pregnancy, the nurse would expect to assess for which of the following as a priority?

A) Hemorrhage B) Jaundice C) Edema D) Infection Ans: A With a ruptured ectopic pregnancy, the woman is at high risk for hemorrhage. Jaundice, edema, and infection are not associated with a ruptured ectopic pregnancy.

A woman comes to the clinic for a routine checkup. A history of exposure to which of the following would alert the nurse that she is at increased risk for cervical cancer?

A) Hepatitis B) Human papillomavirus C) Cytomegalovirus D) Epstein-Barr virus Ans: B Feedback: Human papillomavirus is a major causative factor for cervical cancer. Hepatitis, cytomegalovirus, and Epstein-Barr virus are not associated with the development of cervical cancer.

A group of nursing students are reviewing information about methods used for cervical ripening. The students demonstrate understanding of the information when they identify which of the following as a mechanical method?

A) Herbal agents B) Laminaria C) Membrane stripping D) Amniotomy Ans: B Laminaria is a hygroscopic dilator that is used as a mechanical method for cervical ripening. Herbal agents are a nonpharmacologic method. Membrane stripping and amniotomy are considered surgical methods.

A nursing student is reviewing an article about preterm premature rupture of membranes. Which of the following would the student expect to find as factor placing a woman at high risk for this condition? (Select all that apply.)

A) High body mass index B) Urinary tract infection C) Low socioeconomic status D) Single gestations E) Smoking Ans: B, C, E High-risk factors associated with preterm PROM include low socioeconomic status, multiple gestation, low body mass index, tobacco use, preterm labor history, placenta previa, abruptio placenta, urinary tract infection, vaginal bleeding at any time in pregnancy, cerclage, and amniocentesis.

While assessing a pregnant woman, the nurse suspects that the client may be at risk for hydramnios based on which of the following? (Select all that apply.)

A) History of diabetes B) Complaints of shortness of breath C) Identifiable fetal parts on abdominal palpation D) Difficulty obtaining fetal heart rate E) Fundal height below that for expected gestational age Ans: A, B, D Factors such as maternal diabetes or multiple gestations place the woman at risk for hydramnios. In addition, there is a discrepancy between fundal height and gestational age, such that a rapid growth of the uterus is noted. Shortness of breath may result from overstretching of the uterus due to the increased amount of amniotic fluid. Often, fetal parts are difficult to palpate and fetal heart rate is difficult to obtain because of the excess fluid present.

A nurse is reviewing the medical record of a postpartum client. The nurse identifies that the woman is at risk for a postpartum infection based on which of the following? (Select all that apply.)

A) History of diabetes B) Labor of 12 hours C) Rupture of membranes for 16 hours D) Hemoglobin level 10 mg/dL E) Placenta requiring manual extraction Ans: A, D, E Risk factors for postpartum infection include history of diabetes, labor over 24 hours, hemoglobin less than 10.5 mg/dL, prolonged rupture of membranes (more than 24 hours), and manual extraction of the placenta.

Assessment of a newborn reveals a heart rate of 180 beats/minute. To determine whether this finding is a common variation rather than a sign of distress, what else does the nurse need to know?

A) How many hours old is this newborn? B) How long ago did this newborn eat? C) What was the newborn's birth weight? D) Is acrocyanosis present? Ans: A The typical heart rate of a newborn ranges from 120 to 160 beats per minute with wide fluctuation during activity and sleep. Typically heart rate is assessed every 30 minutes until stable for 2 hours after birth. The time of the newborn's last feeding and his birth weight would have no effect on his heart rate. Acrocyanosis is a common normal finding in newborns.

A woman in her second trimester comes for a follow-up visit and says to the nurse, ìI feel like I'm on an emotional roller-coaster.î Which response by the nurse would be most appropriate?

A) How often has this been happening to you? B) Maybe you need some medication to level things out. C) Mood swings are completely normal during pregnancy. D) Have you been experiencing any thoughts of harming yourself? Ans: C Emotional lability is characteristic throughout most pregnancies. One moment a woman can feel great joy, and within a short time she can feel shock and disbelief. Frequently, pregnant women will start to cry without any apparent cause. Some women feel as though they are riding an emotional roller-coaster. These extremes in emotion can make it difficult for partners and family members to communicate with the pregnant woman without placing blame on themselves for their mood changes. Clear explanations about how common mood swings are during pregnancy are essential.

After teaching a pregnant woman about the hormones produced by the placenta, the nurse determines that the teaching was successful when the woman identifies which hormone produced as being the basis for pregnancy tests?

A) Human placental lactogen (hPL) B) Estrogen (estriol) C) Progesterone (progestin) D) Human chorionic gonadotropin (hCG) Ans: D Feedback: The placenta produces hCG, which is the basis for pregnancy tests. This hormone preserves the corpus luteum and its progesterone production so that the endometrial lining is maintained. Human placental lactogen modulates fetal and maternal metabolism and participates in the development of the breasts for lactation. Estrogen causes enlargement of the woman's breasts, uterus, and external genitalia and stimulates myometrial contractility. Progesterone maintains the endometrium.

When describing genetic disorders to a group of childbearing couples, the nurse would identify which as an example of an autosomal dominant inheritance disorder?

A) Huntington's disease B) Sickle cell disease C) Phenylketonuria D) Cystic fibrosis Ans: A Feedback: Huntington's disease is an example of an autosomal dominant inheritance disorder. Sickle cell disease, phenylketonuria, and cystic fibrosis are examples of autosomal recessive inheritance disorders.

A nurse is counseling a pregnant woman with rheumatoid arthritis about medications that can be used during pregnancy. Which drug would the nurse emphasize as being contraindicated at this time?

A) Hydroxychloroquine B) Nonsteroidal anti-inflammatory drug C) Glucocorticoid D) Methotrexate Ans: D Methotrexate is a FDA Category X drug and is contraindicated during pregnancy. For rheumatoid arthritis, medications are limited to hydroxychloroquine, glucocorticoids, and NSAIDS.

A nurse is assessing a pregnant woman on a routine checkup. When assessing the woman's gastrointestinal tract, which of the following would the nurse expect to find? (Select all that apply.

A) Hyperemic gums B) Increased peristalsis C) Complaints of bloating D) Heartburn E) Nausea Ans: A, C, D, E Gastrointestinal system changes include hyperemic gums due to estrogen and increased proliferation of blood vessels and circulation to the mouth; slowed peristalsis; acid indigestion and heartburn; bloating and nausea and vomiting.

The nurse is reviewing the laboratory test results of a pregnant client. Which one of the following findings would alert the nurse to the development of HELLP syndrome?

A) Hyperglycemia B) Elevated platelet count C) Leukocytosis D) Elevated liver enzymes Ans: D HELLP is an acronym for hemolysis, elevated liver enzymes, and low platelets. Hyperglycemia or leukocytosis is not a part of this syndrome.

When assessing a newborn 1 hour after birth, the nurse measures an axillary temperature of 95.8° F, an apical pulse of 114 beats/minute, and a respiratory rate of 60 breaths/minute. Which nursing diagnosis takes highest priority?

A) Hypothermia related to heat loss during birthing process B) Impaired parenting related to addition of new family member C) Risk for deficient fluid volume related to insensible fluid loss D) Risk for infection related to transition to extrauterine environment Ans: A The newborn's heart rate is slightly below the accepted range of 120 to 160 beats/minute; the respiratory rate is at the high end of the accepted range of 30 to 60 breaths per minute. However, the newborn's temperature is significantly below the accepted range of 97.7 to 99.5° F. Therefore, the priority nursing diagnosis is hypothermia. There is no information to suggest impaired parenting. Additional information is needed to determine if there is a risk for deficient fluid volume or a risk for infection.

A nurse is counseling a mother about the immunologic properties of breast milk. The nurse integrates knowledge of immunoglobulins, emphasizing that breast milk is a major source of which immunoglobulin?

A) IgA B) IgG C) IgM D) IgE Ans: A A major source of IgA is human breast milk. IgG, found in serum and interstitial fluid, crosses the placenta beginning at approximately 20 to 22 weeks' gestation. IgM is found in blood and lymph fluid and levels are generally low at birth unless there is a congenital intrauterine infection. IgE is not found in breast milk and does not play a major role in defense in the newborn.

A newborn has been diagnosed with a Group B streptococcal infection shortly after birth. The nurse understands that the newborn most likely acquired this infection from which of the following?

A) Improper handwashing B) Contaminated formula C) Nonsterile catheter insertion D) Mother's birth canal Ans: D Feedback: Most often, a newborn develops a Group B streptococcus infection during the birthing process when the newborn comes into contact with an infected birth canal. Improper handwashing, contaminated formula, and nonsterile catheter insertion would most likely lead to a late-onset infection, which typically occurs in the nursery due to horizontal transmission.

A mother brings her 12-year-old daughter in for well-visit checkup. During the visit, the nurse is discussing the use of prophylactic HPV vaccine for the daughter. The mother agrees and the daughter receives her first dose. The nurse schedules the daughter for the next dose, which would be given at which time?

A) In 2 month B) In 2 months C) In 3 months D) In 4 months Ans: B Feedback: The HPV vaccine is administered intramuscularly in three separate 0.5-mL doses. The first dose may be given to any individual 9 to 26 years old prior to infection with HPV. The second dose is administered 2 months after the first, and the third dose is given 6 months after the initial dose.

The nurse frequently assesses the respiratory status of a preterm newborn based on the understanding that the newborn is at increased risk for respiratory distress syndrome because of which of the following?

A) Inability to clear fluids B) Immature respiratory control center C) Deficiency of surfactant D) Smaller respiratory passages Ans: C Feedback: A preterm newborn is at increased risk for respiratory distress syndrome (RDS) most commonly because of a surfactant deficiency. Surfactant helps to keep the alveoli open and maintain lung expansion. With a deficiency, the alveoli collapse, predisposing the newborn to RDS. An inability to clear fluids can lead to transient tachypnea. Immature respiratory control centers lead to an increased risk for apnea. Smaller respiratory passages lead to an increased risk for obstruction.

The nurse is assessing a preterm newborn who is in the neonatal intensive care unit (NICU) for signs and symptoms of overstimulation. Which of the following would the nurse be least likely to assess?

A) Increased respirations B) Flaying hands C) Periods of apnea D) Decreased heart rate Ans: A Feedback: Conversely, overstimulation may have negative effects by reducing oxygenation and causing stress. A newborn reacts to stress by flaying the hands or bringing an arm up to cover the face. When overstimulated, such as by noise, lights, excessive handling, alarms, and procedures, and stressed, heart and respiratory rates decrease and periods of apnea or bradycardia may occur.

Which of the following would the nurse expect to assess in a newborn who develops sepsis?

A) Increased urinary output B) Interest in feeding C) Hypothermia D) Wakefulness Ans: C Feedback: Manifestations of sepsis are typically nonspecific and may include hypothermia (temperature instability), oliguria or anuria, lack of interest in feeding, and lethargy.

A client experienced prolonged labor with prolonged premature rupture of membranes. The nurse would be alert for which of the following in the mother and the newborn?

A) Infection B) Hemorrhage C) Trauma D) Hypovolemia Ans: A Feedback: Although hemorrhage, trauma, and hypovolemia may be problems, the prolonged labor with the premature rupture of membranes places the client at high risk for a postpartum infection. The rupture of membranes removes the barrier of amniotic fluid so bacteria can ascend.

A newborn has an Apgar score of 6 at 5 minutes. Which of the following is the priority?

A) Initiating IV fluid therapy B) Beginning resuscitative measures C) Promoting kangaroo care D) Obtaining a blood culture Ans: B Feedback: An Apgar score below 7 at 1 or 5 minutes indicates the need for resuscitation. Intravenous fluid therapy and blood cultures may be done once resuscitation is started. Kangaroo care would be appropriate once the newborn is stable.

A new mother asks the nurse, "Why has my baby lost weight since he was born?" The nurse integrates knowledge of which of the following when responding to the new mother?

A) Insufficient calorie intake B) Shift of water from extracellular space to intracellular space C) Increase in stool passage D) Overproduction of bilirubin Ans: A Normally, term newborns lose 5% to 10% of their birth weight as a result of insufficient caloric intake within the first week after birth, shifting of intracellular water to extracellular space, and insensible water loss. Stool passage and bilirubin have no effect on weight loss.

When performing newborn resuscitation, which action would the nurse do first?

A) Intubate with an appropriate-sized endotracheal tube. B) Give chest compressions at a rate of 80 times per minute. C) Administer epinephrine intravenously. D) Suction the mouth and then the nose. Ans: D Feedback: After placing the newborn's head in a "sniffing" position, the nurse would suction the mouth and then the nose. This is followed by ventilation, circulation (chest compressions), and administration of epinephrine.

A pregnant client in her second trimester has a hemoglobin level of 11 g/dL. The nurse interprets this as indicating which of the following?

A) Iron-deficiency anemia B) A multiple gestation pregnancy C) Greater-than-expected weight gain D) Hemodilution of pregnancy Ans: D Feedback: During pregnancy, the red blood cell count increases along with an increase in plasma volume. However, there is a greater increase in the plasma volume as a result of hormonal factors and sodium and water retention. Thus, the plasma increase exceeds the increase in RBCs, resulting in hemodilution of pregnancy, which is also called physiologic anemia of pregnancy. Changes in maternal iron levels would be more indicative of an iron-deficiency anemia. Although anemia may be present with a multiple gestation, an ultrasound would be a more reliable method of identifying it. Weight gain does not correlate with hemoglobin levels.

Which of the following would alert the nurse to suspect that a newborn has developed NEC?

A) Irritability B) Sunken abdomen C) Clay-colored stools D) Bilious vomiting Ans: D Feedback: The newborn with NEC may exhibit bilious vomiting with lethargy, abdominal distention and tenderness, and bloody stools.

The nurse is performing a health assessment of a 3-month-old Black American boy. For what condition should this infant be monitored based on his race?

A) Jaundice B) Iron deficiency C) Lactose intolerance D) Gastroesophageal reflux disease (GERD) Ans: C Feedback: Many dietary practices are affected by culture, both in the types of food eaten and in the approach to progression of infant feeding. Some ethnic groups tend to be lactose intolerant (particularly blacks, Native Americans, and Asians); therefore, alternative sources of calcium must be offered. Jaundice, iron deficiency, and GERD are not seen at a significantly higher rate in African American infants.

A woman is at 20 weeks' gestation. The nurse would expect to find the fundus at which of the following?

A) Just above the symphysis pubis B) Mid-way between the pubis and umbilicus C) At the level of the umbilicus D) Mid-way between the umbilicus and xiphoid process Ans: C The uterus, which starts as a pear-shaped organ, becomes ovoid as length increases over width. By 20 weeks' gestation, the fundus, or top of the uterus, is at the level of the umbilicus and measures 20 cm. A monthly measurement of the height of the top of the uterus in centimeters, which corresponds to the number of gestational weeks, is commonly used to date the pregnancy.

The nurse is auscultating a newborn's heart and places the stethoscope at the point of maximal impulse at which location?

A) Just superior to the nipple, at the midsternum B) Lateral to the midclavicular line at the fourth intercostal space C) At the fifth intercostal space to the left of the sternum D) Directly adjacent to the sternum at the second intercostals space Ans: B The point of maximal impulse (PMI) in a newborn is a lateral to midclavicular line located at the fourth intercostal space.

A nurse is developing a teaching plan about nutrition for a group of pregnant women. Which of the following would the nurse include in the discussion? (Select all that apply.

A) Keep weight gain to 15 lb B) Eat three meals with snacking C) Limit the use of salt in cooking D) Avoid using diuretics E) Participate in physical activity Ans: B, D, E To promote optimal nutrition, the nurse would recommend gradual and steady weight gain based on the client's prepregnant weight, eating three meals with one or two snacks daily, not restricting the use of salt unless instructed to do so by the health care provider, avoiding the use of diuretics, and participating in reasonable physical activity daily.

Which of the following would the nurse include in the plan of care for a newborn receiving phototherapy?

A) Keeping the newborn in the supine position B) Covering the newborn's eyes while under the bililights C) Ensuring that the newborn is covered or clothed D) Reducing the amount of fluid intake to 8 ounces daily Ans: B Feedback: During phototherapy, the newborn's eyes are covered to protect them from the lights. The newborn is turned every 2 hours to expose all areas of the body to the lights and is kept undressed, except for the diaper area, to provide maximum body exposure to the lights. Fluid intake is increased to allow for added fluid, protein, and calories.

A group of students are reviewing the causes of postpartum hemorrhage. The students demonstrate understanding of the information when they identify which of the following as the most common cause?

A) Labor augmentation B) Uterine atony C) Cervical or vaginal lacerations D) Uterine inversion Ans: B Feedback: The most common cause of postpartum hemorrhage is uterine atony, failure of the uterus to contract and retract after birth. The uterus must remain contracted after birth to control bleeding from the placental site. Labor augmentation is a risk factor for postpartum hemorrhage. Lacerations of the birth canal and uterine inversion may cause postpartum hemorrhage, but these are not the most common cause.

The nurse prepares to administer a gavage feeding for a newborn with transient tachypnea based on the understanding that this type of feeding is necessary for which reason?

A) Lactase enzymatic activity is not adequate. B) Oxygen demands need to be reduced. C) Renal solute lead must be considered. D) Hyperbilirubinemia is likely to develop. Ans: B Feedback: For the newborn with transient tachypnea, the newborn's respiratory rate is high, increasing his oxygen demand. Thus, measures are initiated to reduce this demand. Gavage feedings are one way to do so. With transient tachypnea, enzyme activity and kidney function are not affected. This condition typically resolves within 72 hours. The risk for hyperbilirubinemia is not increased.

A nurse is assessing a postpartum woman. Which finding would cause the nurse to be most concerned?

A) Leg pain on ambulation with mild ankle edema B) Calf pain with dorsiflexion of the foot. C) Perineal pain with swelling along the episiotomy D) Sharp stabbing chest pain with shortness of breath Ans: D Feedback: Sharp stabbing chest pain with shortness of breath suggests pulmonary embolism, an emergency that requires immediate action. Leg pain on ambulation with mild edema suggests superficial venous thrombosis. Calf pain on dorsiflexion of the foot may indicate deep vein thrombosis or a strained muscle or contusion. Perineal pain with swelling along the episiotomy might be a normal finding or suggest an infection. Of the conditions, pulmonary embolism is the most urgent.

Which of the following changes in the musculoskeletal system would the nurse mention when teaching a group of pregnant women about the physiologic changes of pregnancy?

A) Ligament tightening B) Decreased swayback C) Increased lordosis D) Joint contraction Ans: C With pregnancy, the woman's center of gravity shifts forward, requiring a realignment of the spinal curvatures. There is an increase in the normal lumbosacral curve (lordosis). Ligaments of the sacroiliac joints and pubis symphysis soften and stretch. Increased swayback and an upper spine extension to compensate for the enlarging abdomen occur. Joint relaxation and increased mobility occur due to the influence of the hormones relaxin and progesterone.

The nurse is helping a new mother prepare for breastfeeding her infant. During which of the following newborn states of consciousness would the nurse recommended attempting the feeding?

A) Light sleep B) Drowsiness C) Quiet alert state D) Active alert state Ans: C Feedback: A normal newborn will ordinarily move through six states of consciousness: (1) deep sleep: the infant lies quietly without movement; (2) light sleep: the infant may move a little while sleeping and may startle to noises; (3) drowsiness: eyes may close; the infant may be dozing; (4) quiet alert state: the infant's eyes are open wide and the body is calm; (5) active alert state: the infant's face and body move actively; and (6) crying: the infant cries or screams and the body moves in a disorganized fashion. The quiet alert state is the optimal state in which to breastfeed an infant.

The nurse is inspecting the external genitalia of a male newborn. Which of the following would alert the nurse to a possible problem?

A) Limited rugae B) Large scrotum C) Palpable testes in scrotal sac D) Absence of engorgement Ans: A The scrotum usually appears relatively large and should be pink in white neonates and dark brown in neonates of color. Rugae should be well formed and should cover the scrotal sac. There should not be bulging, edema, or discoloration. Testes should be palpable in the scrotal sac and feel firm and smooth and be of equal size on both sides of the scrotal sac.

Assessment of a pregnant woman reveals a pigmented line down the middle of her abdomen. The nurse documents this as which of the following?

A) Linea nigra B) Striae gravidarum C) Melasma D) Vascular spiders Ans: A Linea nigra refers to the darkened line of pigmentation down the middle of the abdomen in pregnant women. Striae gravidarum refers to stretch marks, irregular reddish streaks on the abdomen, breasts, and buttocks. Melasma refers to the increased pigmentation on the face, also known as the mask of pregnancy. Vascular spiders are small, spiderlike blood vessels that appear usually above the waist and on the neck, thorax, face, and arms.

A nurse is completing a postpartum assessment. Which finding would alert the nurse to a potential problem?

A) Lochia rubra with a fleshy odor B) Respiratory rate of 16 breaths per minute C) Temperature of 101° F D) Pain rating of 2 on a scale from 0 to 10 Ans: C : Typically, the new mother's temperature during the first 24 hours postpartum is within the normal range. Some women experience a slight fever, up to 38º C (100.4º F), during the first 24 hours. A temperature above 38º C (100.4º F) at any time or an abnormal temperature after the first 24 hours may indicate infection and must be reported. Foul-smelling lochia or lochia with an unexpected change in color or amount, shortness of breath, or respiratory rate below 16 or above 20 breaths per minute would also be a cause for concern. The goal of pain management is to have the woman's pain scale rating maintained between 0 to 2 points at all times, especially after breast-feeding.

A neonate born to a mother who was abusing heroin is exhibiting signs and symptoms of withdrawal. Which of the following would the nurse assess? (Select all that apply.)

A) Low whimpering cry B) Hypertonicity C) Lethargy D) Excessive sneezing E) Overly vigorous sucking F) Tremors Ans: B, D, F Signs and symptoms of withdrawal, or neonatal abstinence syndrome, include: irritability, hypertonicity, excessive and often high-pitched crying, vomiting, diarrhea, feeding disturbances, respiratory distress, disturbed sleeping, excessive sneezing and yawning, nasal stuffiness, diaphoresis, fever, poor sucking, tremors, and seizures.

When teaching a class of pregnant women about the effects of substance abuse during pregnancy, which of the following would the nurse most likely include?

A) Low-birth-weight infants B) Excessive weight gain C) Higher pain tolerance D) Longer gestational periods Ans: A Substance abuse during pregnancy is associated with low-birth-weight infants, preterm labor, abortion, intrauterine growth restriction, abruptio placentae, neurobehavioral abnormalities, and long-term childhood developmental consequences. Excessive weight gain, higher pain tolerance, and longer gestational periods are not associated with substance abuse.

A home health care nurse is assessing a postpartum woman who was discharged 2 days ago. The woman tells the nurse that she has a low-grade fever and feels "lousy." Which of the following findings would lead the nurse to suspect metritis? (Select all that apply.)

A) Lower abdominal tenderness B) Urgency C) Flank pain D) Breast tenderness E) Anorexia Ans: A, E Feedback: Manifestations of metritis include lower abdominal tenderness or pain on one or both sides, elevated temperature, foul-smelling lochia, anorexia, nausea, fatigue and lethargy, leukocytosis and elevated sedimentation rate. Urgency and flank pain would suggest a urinary tract infection. Breast tenderness may be related to engorgement or suggest mastitis.

A nurse is preparing an inservice education program for a group of nurses about dystocia involving problems with the passenger. Which of the following would the nurse most likely include as the most common problem?

A) Macrosomia B) Breech presentation C) Persistent occiput posterior position D) Multifetal pregnancy Ans: C Common problems involving the passenger include occiput posterior position, breech presentation, multifetal pregnancy, excessive size (macrosomia) as it relates to cephalopelvic disproportion (CPD), and structural anomalies. Of these, persistent occiput posterior is the most common malposition, occurring in about 15% of laboring women.

The nurse would be alert for possible placental abruption during labor when assessment reveals which of the following?

A) Macrosomia B) Gestational hypertension C) Gestational diabetes D) Low parity Ans: B Risk factors for placental abruption include preeclampsia, gestational hypertension, seizure activity, uterine rupture, trauma, smoking, cocaine use, coagulation defects, previous history of abruption, domestic violence, and placental pathology. Macrosomia, gestational diabetes, and low parity are not considered risk factors.

Because a pregnant client's diabetes has been poorly controlled throughout her pregnancy, the nurse would be alert for which of the following in the neonate at birth?

A) Macrosomia B) Hyperglycemia C) Low birth weight D) Hypobilirubinemia Ans: A Poorly controlled diabetes during pregnancy can result in macrosomia due to hyperinsulinemia stimulated by fetal hyperglycemia. Typically the neonate is hypoglycemic due to the ongoing hyperinsulinemia that occurs after the placenta is removed. Infants of diabetic women typically are large and are at risk for hyperbilirubinemia due to excessive red blood cell breakdown.

A nurse is teaching a class on X-linked recessive disorders. Which of the following statements would the nurse most likely include?

A) Males are typically carriers of the disorders. B) No male-to-male transmission occurs. C) Daughters are more commonly affected with the disorder. D) Both sons and daughters have a 50% risk of the disorder. Ans: B Feedback: Most X-linked disorders demonstrate a recessive pattern of inheritance. Males are more affected than females. A male has only one X chromosome and all the genes on his X chromosome will be expressed, whereas a female will usually need both X chromosomes to carry the disease. There is no male-to-male transmission (since no X chromosome from the male is transmitted to male offspring), but any man who is affected will have carrier daughters. If a woman is a carrier, there is a 50% chance that her sons will be affected and a 50% chance that her daughters will be carriers.

Assessment of a pregnant woman and her fetus reveals tachycardia and hypertension. There is also evidence suggesting vasoconstriction. The nurse would question the woman about use of which substance?

A) Marijuana B) Alcohol C) Heroin D) Cocaine Ans: D Cocaine use produces vasoconstriction, tachycardia, and hypertension in both the mother and fetus. The effects of marijuana are not yet fully understood. Alcohol ingestion would lead to cognitive and behavioral problems in the newborn. Heroin is a central nervous system depressant.

Assessment of a pregnant woman reveals oligohydramnios. The nurse would be alert for the development of which of the following?

A) Maternal diabetes B) Placental insufficiency C) Neural tube defects D) Fetal gastrointestinal malformations Ans: B Feedback: A deficiency of amniotic fluid, oligohydramnios, is associated with uteroplacental insufficiency and fetal renal abnormalities. Excess amniotic fluid is associated with maternal diabetes, neural tube defects, and malformations of the gastrointestinal tract and central nervous system.

After teaching a group of nursing students about the possible causes of spontaneous abortion, the instructor determines that the teaching was successful when the students identify which of the following as the most common cause of first trimester abortions?

A) Maternal disease B) Cervical insufficiency C) Fetal genetic abnormalities D) Uterine fibroids Ans: C The causes of spontaneous abortion are varied and often unknown. The most common cause for first-trimester abortions is fetal genetic abnormalities, usually unrelated to the mother. Chromosomal abnormalities are more likely causes in first trimester and maternal disease is more likely in the second trimester. Those occurring during the second trimester are more likely related to maternal conditions, such as cervical insufficiency, congenital or acquired anomaly of the uterine cavity (uterine septum or fibroids), hypothyroidism, diabetes mellitus, chronic nephritis, use of crack cocaine, inherited and acquired thrombophilias, lupus, polycystic ovary syndrome, severe hypertension and acute infection such as rubella virus, cytomegalovirus, herpes simplex virus, bacterial vaginosis, and toxoplasmosis.

The nurse is developing a presentation for a community group of young adults discussing fetal development and pregnancy. The nurse would identify that the sex of offspring is determined at the time of:

A) Meiosis B) Fertilization C) Formation of morula D) Oogenesis Ans: B Feedback: Sex determination occurs at the time of fertilization. Meiosis refers to cell division resulting in the formation of an ovum or sperm with half the number of chromosomes. The morula develops after a series of four cleavages following the formation of the zygote. Oogenesis refers to the development of a mature ovum, which has half the number of chromosomes.

During a physical assessment of a newborn, the nurse observes bluish markings across the newborn's lower back. The nurse documents this finding as which of the following?

A) Milia B) Mongolian spots C) Stork bites D) Birth trauma Ans: B Mongolian spots are blue or purple splotches that appear on the lower back and buttocks of newborns. Milia are unopened sebaceous glands frequently found on a newborn's nose. Stork bites are superficial vascular areas found on the nape of the neck and eyelids and between the eyes and upper lip. Birth trauma would be manifested by bruising, swelling, and possible deformity.

When assessing a postterm newborn, which of the following would the nurse correlate with this gestational age variation?

A) Moist, supple, plum skin appearance B) Abundant lanugo and vernix C) Thin umbilical cord D) Absence of sole creases Ans: C Feedback: A postterm newborn typically exhibits a thin umbilical cord; dry, cracked, wrinkled skin; limited vernix and lanugo; and creases covering the entire soles of the feet.

While performing a physical assessment of a newborn boy, the nurse notes diffuse edema of the soft tissues of his scalp that crosses suture lines. The nurse documents this finding as:

A) Molding B) Microcephaly C) Caput succedaneum D) Cephalhematoma Ans: C Caput succedaneum is localized edema on the scalp, a poorly demarcated soft tissue swelling that crosses the suture lines. Molding refers to the elongated shape of the fetal head as it accommodates to the passage through the birth canal. Microcephaly refers to a head circumference that is 2 standard deviations below average or less than 10% of normal parameters for gestational age. Cephalhematoma is a localized effusion of blood beneath the periosteum of the skull.

The nurse in a community clinic is caring for a 6-month-old boy and his mother. Which of the following is the priority intervention to promote adequate growth?

A) Monitoring the child's weight and height B) Encouraging a more frequent feeding schedule C) Assessing the child's current feeding pattern D) Recommending higher-calorie solid foods Ans: A Feedback: Monitoring the child's weight and height is the priority intervention to promote adequate growth. Encouraging a more frequent feeding schedule, assessing the child's current feeding pattern, and recommending higher-calorie solid foods are interventions when the nursing diagnosis is that nutrition level does not meet body requirements.

When preparing a schedule of follow-up visits for a pregnant woman with chronic hypertension, which of the following would be most appropriate?

A) Monthly visits until 32 weeks, then bi-monthly visits B) Bi-monthly visits until 28 weeks, then weekly visits C) Monthly visits until 20 weeks, then bi-monthly visits D) Bi-monthly visits until 36 weeks, then weekly visits Ans: B For the woman with chronic hypertension, antepartum visits typically occur every 2 weeks until 28 weeks' gestation and then weekly to allow for frequent maternal and fetal surveillance.

After reviewing a client's history, which factor would the nurse identify as placing her at risk for gestational hypertension?

A) Mother had gestational hypertension during pregnancy. B) Client has a twin sister. C) Sister-in-law had gestational hypertension. D) This is the client's second pregnancy. Ans: A A family history of gestational hypertension, such as a mother or sister, is considered a risk factor for the client. Having a twin sister or having a sister-in-law with gestational hypertension would not increase the client's risk. If the client had a history of preeclampsia in her first pregnancy, then she would be at risk in her second pregnancy.

A nurse is observing a postpartum client interacting with her newborn and notes that the mother is engaging with the newborn in the en face position. Which of the following would the nurse be observing?

A) Mother placing the newborn next to bare breast. B) Mother making eye-to-eye contact with the newborn C) Mother gently stroking the newborn's face D) Mother holding the newborn upright at the shoulder Ans: B The en face position is characterized by the mother interacting with the newborn through eye-to-eye contact while holding the newborn.

While talking with a pregnant woman who has undergone genetic testing, the woman informs the nurse that her baby will be born with Down syndrome. The nurse understands that Down syndrome is an example of:

A) Multifactorial inheritance B) X-linked recessive inheritance C) Trisomy numeric abnormality D) Chromosomal deletion Ans: C Feedback: Down syndrome is an example of a chromosomal abnormality involving the number of chromosomes (trisomy numeric abnormality), in particular chromosome 21, in which the individual has three copies of that chromosome. Multifactorial inheritance gives rise to disorders such as cleft lip, congenital heart disease, neural tube defects, and pyloric stenosis. X-linked recessive inheritance is associated with disorders such as hemophilia. Chromosomal deletion is involved with disorders such as cri du chat syndrome.

Which of the following factors in a client's history would alert the nurse to an increased risk for postpartum hemorrhage?

A) Multiparity, age of mother, operative delivery B) Size of placenta, small baby, operative delivery C) Uterine atony, placenta previa, operative procedures D) Prematurity, infection, length of labor Ans: C Risk factors for postpartum hemorrhage include a precipitous labor less than 3 hours, uterine atony, placenta previa or abruption, labor induction or augmentation, operative procedures such as vacuum extraction, forceps, or cesarean birth, retained placental fragments, prolonged third stage of labor greater than 30 minutes, multiparity, and uterine overdistention such as from a large infant, twins, or hydramnios.

A group of nursing students are reviewing the literature in preparation for a class presentation on newborn pain prevention and management. Which of the following would the students be most likely to find about this topic?

A) Newborn pain is frequently recognized and treated B) Newborns rarely experience pain with procedures C) Pain is frequently mistaken for irritability or agitation D) Newborns may be less sensitive to pain than adult. Ans: C Feedback: Assessment of pain in the newborn remains a contentious and vexing problem. According to an international consortium, principles of newborn pain prevention and management include the following: newborn pain frequently goes unrecognized and undertreated; newborns experience pain and analgesics should be given; a procedure considered painful for an adults should also be considered painful for a newborn; newborns may be more sensitive to pain than adults; and pain behavior is frequently mistaken for irritability and agitation.

After teaching a group of nursing students about tocolytic therapy, the instructor determines that the teaching was successful when they identify which drug as being used for tocolysis? (Select all that apply.)

A) Nifedipine B) Terbutaline C) Dinoprostone D) Misoprostol E) Indomethacin Ans: A, B, E Medications most commonly used for tocolysis include magnesium sulfate (which reduces the muscle's ability to contract), terbutaline (Brethine, a beta-adrenergic), indomethacin (Indocin, a prostaglandin synthetase inhibitor), and nifedipine (Procardia, a calcium channel blocker). These drugs are used "off label": this means they are effective for this purpose but have not been officially tested and developed for this purpose by the FDA. Dinoprostone and misoprostol are used to ripen the cervix.

A postpartum client comes to the clinic for her routine 6-week visit. The nurse assesses the client and suspects that she is experiencing subinvolution based on which of the following?

A) Nonpalpable fundus B) Moderate lochia serosa C) Bruising on arms and legs D) Fever Ans: B Feedback: Subinvolution is usually identified at the woman's postpartum examination 4 to 6 weeks after birth. The clinical picture includes a postpartum fundal height that is higher than expected, with a boggy uterus; the lochia fails to change colors from red to serosa to alba within a few weeks. Normally, at 4 to 6 weeks, lochia alba or no lochia would be present and the fundus would not be palpable. Thus evidence of lochia serosa suggests subinvolution. Bruising would suggest a coagulopathy. Fever would suggest an infection.

A client expresses concern that her 2-hour-old newborn is sleepy and difficult to awaken. The nurse explains that this behavior indicates which of the following?

A) Normal progression of behavior B) Probable hypoglycemia C) Physiological abnormality D) Inadequate oxygenation Ans: A From 30 to 120 minutes of age, the newborn enters the second stage of transition, the period of decreased responsiveness or that of sleep or a decrease in activity. More information would be needed to determine if hypoglycemia, a physiologic abnormality, or inadequate oxygenation was present.

The parents of a newborn become concerned when they notice that their baby seems to stop breathing for a few seconds. After confirming the parents' findings by observing the newborn, which of the following actions would be most appropriate?

A) Notify the health care provider immediately. B) Assess the newborn for signs of respiratory distress. C) Reassure the parents that this is an expected pattern. D) Tell the parents not to worry since his color is fine. Ans: B Feedback: Although periods of apnea of less than 20 seconds can occur, the nurse needs to gather additional information about the newborn's respiratory status to determine if this finding is indicative of a developing problem. Therefore, the nurse would need to assess for signs of respiratory distress. Once this information is obtained, then the nurse can notify the health care provider or explain that this finding is an expected one. However, it would be inappropriate to tell the parents not to worry, because additional information is needed. Also, telling them not to worry ignores their feelings and is not therapeutic.

To decrease the pain associated with an episiotomy immediately after birth, which action by the nurse would be most appropriate?

A) Offer warm blankets. B) Encourage the woman to void. C) Apply an ice pack to the site. D) Offer a warm sitz bath. Ans: C An ice pack is the first measure used after a vaginal birth to provide perineal comfort from edema, an episiotomy, or lacerations. Warm blankets would be helpful for the chills that the woman may experience. Encouraging her to void promotes urinary elimination and uterine involution. A warm sitz bath is effective after the first 24 hours.

The nurse is developing a plan of care for a woman who is pregnant with twins. The nurse includes interventions focusing on which of the following because of the woman's increased risk?

A) Oligohydramnios B) Preeclampsia C) Post-term labor D) Chorioamnionitis Ans: B Women with multiple gestations are at high risk for preeclampsia, preterm labor, hydramnios, hyperemesis gravidarum, anemia, and antepartal hemorrhage. There is no association between multiple gestations and the development of chorioamnionitis.

A woman just delivered a healthy term newborn. Upon assessing the umbilical cord, the nurse would identify which of the following as normal? (Select all that apply.)

A) One vein B) Two veins C) One artery D) Two arteries E) One ligament F) Two ligaments Ans: A, D Feedback: The normal umbilical cord contains one large vein and two small arteries.

When assessing several women for possible VBAC, which woman would the nurse identify as being the best candidate?

A) One who has undergone a previous myomectomy B) One who had a previous cesarean birth via a low transverse incision C) One who has a history of a contracted pelvis D) One who has a vertical incision from a previous cesarean birth Ans: B VBAC is an appropriate choice for women who have had a previous cesarean birth with a lower abdominal transverse incision. It is contraindicated in women who have a prior classic uterine incision (vertical), prior transfundal surgery, such as myomectomy, or a contracted pelvis.

A woman experiencing postpartum hemorrhage is ordered to receive a uterotonic agent. Which of the following would the nurse least expect to administer?

A) Oxytocin B) Methylergonovine C) Carboprost D) Terbutaline Ans: D Feedback: Terbutaline is a tocolytic agent used to halt preterm labor. It would not be used to treat postpartum hemorrhage. Oxytocin, methylergonovine, and carboprost are drugs used to manage postpartum hemorrhage.

The nurse is assessing the newborn of a mother who had gestational diabetes. Which of the following would the nurse expect to find? (Select all that apply.)

A) Pale skin color B) Buffalo hump C) Distended upper abdomen D) Excessive subcutaneous fat E) Long slender neck Ans: B, C, D Feedback: Infants of diabetic mothers exhibit full rosy cheeks with a ruddy skin color, short neck, buffalo hump over the nape of the neck, massive shoulders, distended upper abdomen, and excessive subcutaneous fat tissue.

When assessing a newborn's reflexes, the nurse strokes the newborn's cheek and the newborn turns toward the side that was stroked and begins sucking. The nurse documents which reflex as being positive?

A) Palmar grasp reflex B) Tonic neck reflex C) Moro reflex D) Rooting reflex Ans: D The rooting reflex is elicited by stroking the newborn's cheek. The newborn should turn toward the side that was stroked and should begin to make sucking movements. The palmar grasp reflex is elicited by placing a finger on the newborn's open palm. The baby's hand will close around the finger. Attempting to remove the finger causes the grip to tighten. The tonic neck reflex is elicited by having the newborn lie on the back and turning the head to one side. The arm toward which the baby is facing should extend straight away from the body with the hand partially open, whereas the arm on the side away from the face is flexed and the fist is clenched tightly. Reversing the direction to which the face is turned reverses the position. The Moro reflex is elicited by placing the newborn on his or her back, supporting the upper body weight of the supine newborn by the arms using a lifting motion without lifting the newborn off the surface. The arms are released suddenly and the newborn will throw the arms outward and flex the knees and then the arms return to the chest. The fingers also spread to form a C.

When teaching a pregnant client about the physiologic changes of pregnancy, the nurse reviews the effect of pregnancy on glucose metabolism. Which of the following would the nurse include as the underlying reason for the effect?

A) Pancreatic function is affected by pregnancy. B) Glucose is utilized more rapidly during a pregnancy. C) The pregnant woman increases her dietary intake. D) Glucose moves through the placenta to assist the fetus. Ans: D Feedback: The growing fetus has large needs for glucose, amino acids, and lipids, placing demands on maternal glucose stores. During the first half of pregnancy, much of the maternal glucose is diverted to the growing fetus. The pancreas continues to function during pregnancy. However, the placental hormones can affect maternal insulin levels. The demand for glucose by the fetus during pregnancy is high, but it is not necessarily used more rapidly. Placental hormones, not the woman's dietary intake, play a major role in glucose metabolism during pregnancy.

A nurse has been invited to speak at a local high school about adolescent pregnancy. When developing the presentation, the nurse would incorporate information related to which of the following? (Select all that apply.)

A) Peer pressure to become sexually active B) Rise in teen birth rates over the years. C) Latinas as having the highest teen birth rate D) Loss of self-esteem as a major impact E) Majority of teen pregnancies in the 15-17-year-old age group Ans: A, C, D Adolescent pregnancies account for 10% of all births and as such adolescent pregnancy is a major health problem. Peer pressure to become sexually active is a factor that contributes to adolescent pregnancy. Although the incidence of teenage pregnancy has steadily declined since the early 1990s, it continues to be higher in the United States than in any other industrialized country (Alan Guttmacher Institute, 2012b). Teen birth rates in the United States have declined but remain high, especially among Black and Hispanic teens and in southern states. The Latina teen birth rate is the highest of any ethnic group in the United States. The most important impact lies in the psychosocial area as it contributes to a loss of self-esteem, a destruction of life projects, and the maintenance of the circle of poverty. Two-thirds of all teen pregnancies occur among 18-19-year olds.

The nurse is assessing a 12-month-old boy with an English-speaking father and a Spanish-speaking mother. The boy does not say mama or dada yet. Which of the following is the priority intervention?

A) Performing a developmental evaluation of the child B) Encouraging the parents to speak English to the child C) Asking the mother if the child uses Spanish words D) Referring the child to a developmental specialist Ans: C Feedback: Infants in bilingual families may use some words from each language. Therefore, the priority intervention in this situation would be to ask the mother if the child uses Spanish words. There is not enough evidence to warrant performing a developmental evaluation or referring the child to a developmental specialist. Encouraging the parents to speak English to the child is unnecessary if the child is progressing with Spanish first.

A nurse is teaching the mother of a newborn diagnosed with galactosemia about dietary restrictions. The nurse determines that the mother has understood the teaching when she identifies which of the following as needing to be restricted?

A) Phenylalanine B) Protein C) Lactose D) Iodine Ans: C Feedback: Lifelong restriction of lactose is required for galactosemia. Phenylalanine is restricted for those with phenylketonuria. Low protein is needed with maple syrup urine disease. Iodine would not be restricted for any inborn error of metabolism

Assessment of newborn reveals a large protruding tongue, slow reflexes, distended abdomen, poor feeding, hoarse cry, goiter and dry skin. Which of the following would the nurse suspect?

A) Phenylketonuria B) Galactosemia C) Congenital hypothyroidism D) Maple syrup urine disease Ans: C Feedback: The manifestations listed correlate with congenital hypothyroidism. With phenylketonuria, the infant appears normal at birth but by 6 months of age, signs of slow mental development are evident. Vomiting, poor feeding, failure to thrive, overactivity and musty-smelling urine are additional signs. With maple syrup urine disease, signs and symptoms include lethargy, poor feeding, vomiting, weight loss, seizures, shrill cry, shallow respirations, loss of reflexes, and a sweet maple syrup odor to the urine. With galactosemia, manifestations include vomiting, hypoglycemia, hyperbilirubinemia, poor weight gain, cataracts, and frequent infections.

Which of the following would the nurse include when teaching a new mother about the difference between pathologic and physiologic jaundice?

A) Physiologic jaundice results in kernicterus. B) Pathologic jaundice appears within 24 hours after birth. C) Both are treated with exchange transfusions of maternal O- blood. D) Physiologic jaundice requires transfer to the NICU. Ans: B Feedback: Pathologic jaundice appears within 24 hours after birth, whereas physiologic jaundice commonly appears around the third to fourth days of life. Kernicterus is more commonly associated with pathologic jaundice. An exchange transfusion is used only if the total serum bilirubin level remains elevated after intensive phototherapy. With this procedure, the newborn's blood is removed and replaced with nonhemolyzed red blood cells from a donor. Physiologic jaundice often is treated at home.

A newborn is diagnosed with meconium aspiration syndrome. When assessing this newborn, which of the following would the nurse expect to find? (Select all that apply.)

A) Pigeon chest B) Prolonged tachypnea C) Intercostal retractions D) High blood pH level E) Coarse crackles on auscultation Ans: B, C, E Feedback: Assessment findings associated with meconium aspiration syndrome include barrel-shaped chest with an increased anterior-posterior (AP) chest diameter (similar to that found in a client with chronic obstructive pulmonary disease), prolonged tachypnea, progression from mild to severe respiratory distress, intercostal retractions, end-expiratory grunting, and cyanosis. Coarse crackles and rhonchi are noted on lung auscultation.

The nurse is providing anticipatory guidance to a mother to help promote healthy sleep for her 3-week old baby. Which of the following recommended guidelines might be included in the teaching plan?

A) Place the baby on a soft mattress with a firm flat pillow for the head. B) Place the head of the bed near the window to provide fresh air, weather permitting. C) Place the baby on his or her back when sleeping. D) If the baby sleeps through the night, wake him or her up for the night feeding. Ans: C Feedback: Sudden infant death syndrome (SIDS) has been associated with prone positioning of newborns and infants, so the infant should be placed to sleep on the back. The baby should sleep on a firm mattress without pillows or comforters. The baby's bed should be placed away from air conditioner vents, open windows, and open heaters. By 4 months of age night waking may occur, but the infant should be capable of sleeping through the night and does not require a night feeding.

Which of the following would be most appropriate when massaging a woman's fundus?

A) Place the hands on the sides of the abdomen to grasp the uterus. B) Use an up-and-down motion to massage the uterus. C) Wait until the uterus is firm to express clots. D) Continue massaging the uterus for at least 5 minutes. Ans: C Feedback: The uterus must be firm before attempts to express clots are made because application of firm pressure on an uncontracted uterus could lead to uterine inversion. One hand is placed on the fundus and the other hand is placed on the area above the symphysis pubis. Circular motions are used for massage. There is no specified amount of time for fundal massage. Uterine tissue responds quickly to touch, so it is important not to overmassage the fundus.

After teaching a class on the stages of fetal development, the instructor determines that the teaching was successful when the students identify which of the following as a stage? (Select all that apply.)

A) Placental B) Preembryonic C) Umbilical D) Embryonic E) Fetal Ans: B, D, E Feedback: The three stages of fetal development are the preembryonic, embryonic, and fetal stage. Placental and umbilical are not stages of fetal development.

A nursing student is preparing a presentation on minimizing heat loss in the newborn. Which of the following would the student include as a measure to prevent heat loss through convection?

A) Placing a cap on a newborn's head B) Working inside an isolette as much as possible. C) Placing the newborn skin-to-skin with the mother D) Using a radiant warmer to transport a newborn Ans: B To prevent heat loss by convection, the nurse would keep the newborn out of direct cool drafts (open doors, windows, fans, air conditioners) in the environment, work inside an isolette as much as possible and minimize opening portholes that allow cold air to flow inside, and warm any oxygen or humidified air that comes in contact with the newborn. Placing a cap on the newborn's head would help minimize heat loss through evaporation. Placing the newborn skin-to-skin with the mother helps to prevent heat loss through conduction. Using a radiant warmer to transport a newborn helps minimize heat loss through radiation.

The nurse is assisting a postpartum woman out of bed to the bathroom for a sitz bath. Which of the following would be a priority?

A) Placing the call light within her reach B) Teaching her how the sitz bath works C) Telling her to use the sitz bath for 30 minutes D) Cleaning the perineum with the peri-bottle Ans: A Tremendous hemodynamic changes are taking place within the woman, and safety must be a priority. Therefore, the nurse makes sure that the emergency call light is within her reach should she become dizzy or lightheaded. Teaching her how to use the sitz bath, including using it for 15 to 20 minutes, is appropriate but can be done once the woman's safety is ensured. The woman should clean her perineum with a peri-bottle before using the sitz bath, but this can be done once the woman's safety needs are met.

A nurse is developing a plan of care for a newborn with omphalocele. Which of the following would the nurse include?

A) Placing the newborn into a sterile drawstring bowel bag B) Using clean technique for dressing changes C) Preparing the newborn for incision and drainage D) Instituting gavage feedings Ans: A Feedback: An infant with an omphalocele is placed in a sterile drawstring bowel bag that maintains a sterile environment for the exposed contents, allows visualization, reduces heat and moisture loss, and allows heat from radiant warmers to reach the newborn. The newborn is placed feet-first into the bag and the drawstring is secured around the torso. Strict sterile technique is necessary to prevent contamination of the exposed abdominal contents. An orogastric tube attached to low suction is used to prevent intestinal distention. IV therapy is administered to maintain fluid and electrolyte balance and provide a route for antibiotic therapy. Surgery is done to repair the defect, not incise and drain it.

A new mother reports that her newborn often spits up after feeding. Assessment reveals regurgitation. The nurse responds, integrating understanding that this most likely is due to which of the following?

A) Placing the newborn prone after feeding B) Limited ability of digestive enzymes C) Underdeveloped pyloric sphincter D) Relaxed cardiac sphincter Ans: D The cardiac sphincter and nervous control of the stomach is immature, which may lead to uncoordinated peristaltic activity and frequent regurgitation. Placement of the newborn is unrelated to regurgitation. Most digestive enzymes are available at birth, but they are limited in their ability to digest complex carbohydrates and fats; this results in fatty stools, not regurgitation. Immaturity of the pharyngoesophageal sphincter and absence of lower esophageal peristaltic waves, not an underdeveloped pyloric sphincter, also contribute to the reflux of gastric contents.

Which reflex, if found in a 4-month-old infant, would cause the nurse to be concerned?

A) Plantar grasp B) Step C) Babinski D) Neck righting Ans: B Feedback: Appropriate appearance and disappearance of primitive reflexes, along with the development of protective reflexes, indicates a healthy neurologic system. The step reflex is a primitive reflex that appears at birth and disappears at 4 to 8 weeks of age. The plantar grasp reflex is a primitive reflex that appears at birth and disappears at about the age of 9 months. The Babinski reflex is a primitive reflex that appears at birth and disappears around the age of 12 months. The neck righting reflex is a protective reflex that appears around the age of 4 to 6 months and persists.

The fetus of a woman in labor is determined to be in persistent occiput posterior position. Which of the following would the nurse identify as the priority intervention?

A) Position changes B) Pain relief measures C) Immediate cesarean birth D) Oxytocin administration Ans: B Intense back pain is associated with persistent occiput posterior position. Therefore, a priority is to provide pain relief measures. Position changes that can promote fetal head rotation are important after the nurse institutes pain relief measures. Additionally, the woman's ability to cooperate and participate in these position changes is enhanced when she is experiencing less pain. Immediate cesarean birth is not indicated unless there is evidence of fetal distress. Oxytocin would add to the woman's already high level of pain.

A woman comes to the prenatal clinic suspecting that she is pregnant, and assessment reveals probable signs of pregnancy. Which of the following would be included as part of this assessment? (Select all that apply

A) Positive pregnancy test B) Ultrasound visualization of the fetus C) Auscultation of a fetal heart beat D) Ballottement E) Absence of menstruation F) Softening of the cervix Ans: A, D, F Probable signs of pregnancy include a positive pregnancy test, ballottement, and softening of the cervix (Goodell's sign). Ultrasound visualization of the fetus, auscultation of a fetal heart beat, and palpation of fetal movements are considered positive signs of pregnancy. Absence of menstruation is a presumptive sign of pregnancy.

Which finding would indicate to the nurse that a woman's cervix is ripe in preparation for labor induction?

A) Posterior position B) Firm C) Closed D) Shortened Ans: D A ripe cervix is shortened, centered (anterior), softened, and partially dilated. An unripe cervix is long, closed, posterior, and firm.

A postpartum woman is having difficulty voiding for the first time after giving birth. Which of the following would be least effective in helping to stimulate voiding?

A) Pouring warm water over her perineal area B) Having her hear the sound of water running nearby C) Placing her hand in a basin of cool water D) Standing her in the shower with the warm water on Ans: C Helpful measures to stimulate voiding include placing her hand in a basin of warm water, pouring warm water over her perineal area, hearing the sound of running water nearby, blowing bubbles through a straw, standing in the shower with the warm water turned on, and drinking fluids.

After a normal labor and birth, a client is discharged from the hospital 12 hours later. When the community health nurse makes a home visit 2 days later, which finding would alert the nurse to the need for further intervention?

A) Presence of lochia serosa B) Frequent scant voiding C) Fundus firm, below umbilicus D) Milk filling in both breasts Ans: B Infrequent or insufficient voiding may be a sign of infection and is not a normal finding on the second postpartum day. Lochia serosa, a firm fundus below the umbilicus, and milk filling the breasts are expected findings.

In a client's seventh month of pregnancy, she reports feeling ìdizzy, like I'm going to pass out, when I lie down flat on my back.î The nurse integrates which of the following in to the explanation?

A) Pressure of the gravid uterus on the vena cava B) A 50% increase in blood volume C) Physiologic anemia due to hemoglobin decrease D) Pressure of the presenting fetal part on the diaphragm Ans: A The client is describing symptoms of supine hypotension syndrome, which occurs when the heavy gravid uterus falls back against the superior vena cava in the supine position. The vena cava is compressed, reducing venous return, cardiac output, and blood pressure, with increased orthostasis. The increased blood volume and physiologic anemia are unrelated to the client's symptoms. Pressure on the diaphragm would lead to dyspnea.

The nurse is reviewing the medical record of a newborn born 2 hours ago. The nurse notes that the newborn was delivered at 35 weeks' gestation. The nurse would classify this newborn as which of the following?

A) Preterm B) Late preterm C) Full term D) Postterm Ans: B Feedback: A late preterm infant is one born between 34 to 36 6/7 weeks of gestation. A preterm infant is one born before 37 completed weeks' gestation. A full-term infant is one born between 38 to 41 weeks' gestation. A postterm newborn is one born at 42 weeks' gestation or later.

Which of the following would not be considered a risk factor for bronchopulmonary dysplasia (chronic lung disease)?

A) Preterm birth (less than 32 weeks) B) Female gender C) White race D) Sepsis Ans: B Feedback: Male gender is more commonly associated with bronchopulmonary dysplasia. Preterm birth of less than 32 weeks' gestation, sepsis, white race, excessive fluid intake during the first few days of life, severe RDS with mechanical ventilation for more than 1 week, and patent ductus arteriosus are all risk factors associated with chronic lung disease in the newborn.

The nurse places a newborn with jaundice under the phototherapy lights in the nursery to achieve which goal?

A) Prevent cold stress B) Increase surfactant levels in the lungs C) Promote respiratory stability D) Decrease the serum bilirubin level Ans: D Jaundice reflects elevated serum bilirubin levels; phototherapy helps to break down the bilirubin for excretion. Phototherapy has no effect on body temperature, surfactant levels, or respiratory stability.

When planning the care for an SGA newborn, which action would the nurse determine as a priority?

A) Preventing hypoglycemia with early feedings B) Observing for respiratory distress syndrome C) Promoting bonding between the parents and the newborn D) Monitoring vital signs every 2 hours Ans: A Feedback: With the loss of the placenta at birth, the newborn must now assume control of glucose homeostasis. This is achieved by early oral intermittent feedings. Observing for respiratory distress, promoting bonding, and monitoring vital signs, although important, are not the priority for this newborn.

During a prenatal class for a group of new mothers, the nurse is describing the hormones produced by the placenta. Which of the following would the nurse include? (Select all that apply.)

A) Prolactin B) Estriol C) Relaxin D) Progestin E) Human chorionic somatomammotropin Ans: B, C, D, E Feedback: Estriol, relaxin, progestin, and human chorionic somatomammotropin are secreted by the placenta. Prolactin is secreted after delivery for breast-feeding.

A nursing instructor is teaching a class to a group of students about pregnancy, insulin, and glucose. Which of the following would the instructor least likely include as opposing insulin?

A) Prolactin B) Estrogen C) Progesterone D) Cortisol Ans: D Prolactin, estrogen, and progesterone are all thought to oppose insulin. As a result, glucose is less likely to enter the mother's cells and is more likely to cross over the placenta to the fetus. After the first trimester, hPL from the placenta and steroids (cortisol) from the adrenal cortex act against insulin. hPL acts as an antagonist against maternal insulin, and thus more insulin must be secreted to counteract the increasing levels of hPL and cortisol during the last half of pregnancy.

After teaching a group of students about risk factors associated with postpartum hemorrhage, the instructor determines that the teaching was successful when the students identify which of the following as a risk factor? (Select all that apply.)

A) Prolonged labor B) Placenta previa C) Null parity D) Hydramnios E) Labor augmentation Ans: B, D, E Risk factors for postpartum hemorrhage include precipitous labor less than 3 hours, placenta previa or abruption, multiparity, uterine overdistention such as with a large infant, twins, or hydramnios, and labor induction or augmentation. Prolonged labor over 24 hours is a risk factor for postpartum infection.

The nurse is caring for a 4-week-old girl and her mother. Which of the following is the most appropriate subject for anticipatory guidance?

A) Promoting the digestibility of breast milk B) Telling how and when to introduce rice cereal C) Describing root reflex and latching on D) Advising how to choose a good formula Ans: B Feedback: Telling the mother how to introduce rice cereal is the most appropriate subject for anticipatory guidance. Since this mother is already breast- or bottle-feeding her baby, educating her about these subjects would not inform her about what to expect in the next phase of development.

A nurse is developing a plan of care for a woman who is at risk for thromboembolism. Which of the following would the nurse include as the most cost-effective method for prevention?

A) Prophylactic heparin administration B) Compression stocking C) Early ambulation D) Warm compresses Ans: C Feedback: Although compression stockings and prophylactic heparin administration may be appropriate, the most cost-effective preventive method is early ambulation. It is also the easiest method. Warm compresses are used to treat superficial venous thrombosis.

After teaching a group of nursing students about risk factors associated with dystocia, the instructor determines that the teaching was successful when the students identify which of the following as increasing the risk? (Select all that apply.)

A) Pudendal block anesthetic use B) Multiparity C) Short maternal stature D) Maternal age over 35 E) Breech fetal presentation Ans: C, D, E According to the American College of Obstetrics and Gynecology (ACOG, 2009a), factors associated with an increased risk for dystocia include epidural analgesia, excessive analgesia, multiple gestation, hydramnios, maternal exhaustion, ineffective maternal pushing technique, occiput posterior position, longer first stage of labor, nulliparity, short maternal stature (less than 5 feet tall), fetal birth weight (more than 8.8 lb), shoulder dystocia, abnormal fetal presentation or position (breech), fetal anomalies (hydrocephalus), maternal age older than 35 years, high caffeine intake, overweight, gestational age more than 41 weeks, chorioamnionitis, ineffective uterine contractions, and high fetal station at complete cervical dilation.

Assessment of a pregnant woman reveals that she compulsively craves ice. The nurse documents this finding as which of the following?

A) Quickening B) Pica C) Ballottement D) Linea nigra Ans: B Pica refers to the compulsive ingestion of nonfood substances such as ice. Quickening refers to the mother's sensation of fetal movement. Ballottement refers to the feeling of rebound from a floating fetus when an examiner pushes against the woman's cervix during a pelvic examination. Linea nigra refers to the pigmented line that develops in the middle of the woman's abdomen.

A group of students are reviewing risk factors associated with postpartum hemorrhage. The students demonstrate understanding of the information when they identify which of the following as associated with uterine tone? (Select all that apply.)

A) Rapid labor B) Retained blood clots C) Hydramnios D) Operative birth E) Fetal malposition Ans: A, C Feedback: Risk factors associated with uterine tone include hydramnios, rapid or prolonged labor, oxytocin use, maternal fever, or prolonged rupture of membranes. Retained blood clots are a risk factor associated with tissue retained in the uterus. Fetal malposition and operative birth are risk factors associated with trauma of the genital tract.

After teaching parents about their newborn, the nurse determines that the teaching was successful when they identify the development of a close emotional attraction to a newborn by parents during the first 30 to 60 minutes after birth as which of the following?

A) Reciprocity B) Engrossment C) Bonding D) Attachment Ans: C The development of a close emotional attraction to the newborn by parents during the first 30 to 60 minutes after birth describes bonding. Reciprocity is the process by which the infant's capabilities and behavioral characteristics elicit a parental response. Engrossment refers to the intense interest during early contact with a newborn. Attachment refers to the process of developing strong ties of affection between an infant and significant other.

After teaching a group of students about the use of antiretroviral agents in pregnant women who are HIV-positive, the instructor determines that the teaching was successful when the group identifies which of the following as the underlying rationale?

A) Reduction in viral loads in the blood B) Treatment of opportunistic infections C) Adjunct therapy to radiation and chemotherapy D) Can cure acute HIV/AIDS infections Ans: A Drug therapy is the mainstay of treatment and is important in reducing the viral load as much as possible. Viral load directly correlates with the risk of perinatal transmission. Antiretroviral agents do not treat opportunistic infections and are not adjunctive therapy. There is no cure for HIV/AIDS.

A newborn is experiencing cold stress. Which of the following would the nurse expect to assess? (Select all that apply.)

A) Respiratory distress B) Decreased oxygen needs C) Hypoglycemia D) Metabolic alkalosis E) Jaundice Ans: A, C, E Cold stress in the newborn can lead to the following problems if not reversed: depleted brown fat stores, increased oxygen needs, respiratory distress, increased glucose consumption leading to hypoglycemia, metabolic acidosis, jaundice, hypoxia, and decreased surfactant production.

While reviewing a newborn's medical record, the nurse notes that the chest x-ray shows a ground glass pattern. The nurse interprets this as indicative of:

A) Respiratory distress syndrome B) Transient tachypnea of the newborn C) Asphyxia D) Persistent pulmonary hypertension Ans: A Feedback: The chest x-ray of a newborn with RDS reveals a reticular (ground glass) pattern. For TTN, the chest x-ray shows lung overaeration and prominent perihilar interstitial markings and streakings. A chest x-ray for asphyxia would reveal possible structural abnormalities that might interfere with respiration, but the results are highly variable. An echocardiogram would be done to evaluate persistent pulmonary hypertension.

Prior to discharging a 24-hour-old newborn, the nurse assesses her respiratory status. Which of the following would the nurse expect to assess?

A) Respiratory rate 45, irregular B) Costal breathing pattern C) Nasal flaring, rate 65 D) Crackles on auscultation Ans: A Typically, respirations in a 24-hour-old newborn are symmetric, slightly irregular, shallow, and unlabored at a rate of 30 to 60 breaths/minute. The breathing pattern is primarily diaphragmatic. Nasal flaring, rates above 60 breaths per minute, and crackles suggest a problem.

A woman with preterm labor is receiving magnesium sulfate. Which finding would require the nurse to intervene immediately?

A) Respiratory rate of 16 breaths per minute B) Diminished deep tendon reflexes C) Urine output of 45 mL/hour D) Alert level of consciousness Ans: B Diminished deep tendon reflexes suggest magnesium toxicity, which requires immediate intervention. Additional signs of magnesium toxicity include a respiratory rate less than 12 breaths/minute, urine output less than 30 mL/hour, and a decreased level of consciousness.

The nurse completes the initial assessment of a newborn. Which finding would lead the nurse to suspect that the newborn is experiencing difficulty with oxygenation?

A) Respiratory rate of 54 breaths/minute B) Abdominal breathing C) Nasal flaring D) Acrocyanosis Ans: C Nasal flaring is a sign of respiratory difficulty in the newborn. A rate of 54 breaths/minute, diaphragmatic/abdominal breathing, and acrocyanosis are normal findings.

A nurse is developing a teaching plan for a postpartum woman who is breast-feeding about sexuality and contraception. Which of the following would the nurse most likely include? (Select all that apply.)

A) Resumption of sexual intercourse about two weeks after delivery B) Possible experience of fluctuations in sexual interest C) Use of a water-based lubricant to ease vaginal discomfort D) Use of combined hormonal contraceptives for the first three weeks E) Possibility of increased breast sensitivity during sexual activity Ans: B, C, E Typically, sexual intercourse can be resumed once bright-red bleeding has stopped and the perineum is healed from an episiotomy or lacerations. This is usually by the third to the sixth week postpartum. Fluctuations in sexual interest are normal. In addition, breast-feeding women may notice a let-down reflex during orgasm and find that breasts are very sensitive when touched by the partner. Precoital vaginal lubrication may be impaired during the postpartum period, especially in women who are breast-feeding. Use of water-based gel lubricants (KY jelly, Astroglide) can help. The Centers for Disease Control and Prevention recommend that postpartum women not use combined hormonal contraceptives during the first 21 days after childbirth because of the high risk for venous thromboembolism (VTE) during this period.

Review of a primiparous woman's labor and birth record reveals a prolonged second stage of labor and extended time in the stirrups. Based on an interpretation of these findings, the nurse would be especially alert for which of the following?

A) Retained placental fragments B) Hypertension C) Thrombophlebitis D) Uterine subinvolution Ans: C Feedback: The woman is at risk for thrombophlebitis due to the prolonged second stage of labor, necessitating an increased amount of time in bed, and venous pooling that occurs when the woman's legs are in stirrups for a long period of time. These findings are unrelated to retained placental fragments, which would lead to uterine subinvolution, or hypertension.

While caring for a preterm newborn receiving oxygen therapy, the nurse monitors the oxygen therapy duration closely based on the understanding that the newborn is at risk for which of the following?

A) Retinopathy of prematurity B) Metabolic acidosis C) Infection D) Cold stress Ans: A Feedback: Oxygen therapy has been linked the pathogenesis of retinopathy of prematurity and is associated with the duration of oxygen use rather than the concentration of oxygen. Therefore, the nurse monitors the newborn's oxygen therapy closely. Metabolic acidosis may occur due to anaerobic metabolism used for heat production. Infection may occur for numerous reasons, but they are unrelated to oxygen therapy. Cold stress results from problems due to the preterm newborn's inadequate supply of brown fat, decreased muscle tone, and large body surface area.

16. A pregnant woman is scheduled to undergo percutaneous umbilical blood sampling. When discussing this test with the woman, the nurse reviews what can be evaluated with the specimens collected. Which of the following would the nurse include? (Select all that apply.) A) Rh incompatibility B) Fetal acid-base status C) Sex-linked disorders D) Enzyme deficiencies E) Coagulation studies

A) Rh incompatibility B) Fetal acid-base status E) Coagulation studies

A nurse is preparing a presentation for a group of young adult pregnant women about common infections and their effect on pregnancy. When describing the infections, which infection would the nurse include as the most common congenital and perinatal viral infection in the world?

A) Rubella B) Hepatitis B C) Cytomegalovirus D) Parvovirus B19 Ans: C Although rubella, hepatitis B, and parvovirus B19 can affect pregnant women and their fetuses, cytomegalovirus (CMV) is the most common congenital and perinatal viral infection in the world. CMV is the leading cause of congenital infection, with morbidity and mortality at birth and sequelae. Each year approximately 1-7% of pregnant women acquire a primary CMV infection. Of these, about 30-40% transmits infection to their fetuses.

The nurse is assessing a postpartum client's lochia and finds that there is about a 4-inch stain on the perineal pad. The nurse documents this finding as which of the following?

A) Scant B) Light C) Moderate D) Large Ans: B The amount of lochia is described as light or small for an approximately 4-inch stain. Scant refers to a 1- to 2-inch stain of lochia; moderate refers to a 4- to 6-inch stain; and large or heavy refers to a pad that is saturated within 1 hour after changing.

A woman in labor is experiencing hypotonic uterine dysfunction. Assessment reveals no fetopelvic disproportion. Which group of medications would the nurse expect to administer?

A) Sedatives B) Tocolytics C) Oxytocin D) Corticosteroids Ans: C For hypotonic labor, a uterine stimulant such as oxytocin may be ordered once fetopelvic disproportion is ruled out. Sedatives might be helpful for the woman with hypertonic uterine contractions to promote rest and relaxation. Tocolytics would be ordered to control preterm labor. Corticosteroids may be given to enhance fetal lung maturity for women experiencing preterm labor.

The nurse is assessing a woman with abruption placentae who has just given birth. The nurse would be alert for which of the following?

A) Severe uterine pain B) Board-like abdomen C) Appearance of petechiae D) Inversion of the uterus Ans: C Feedback: A complication of abruptio placentae is disseminated intravascular coagulation (DIC), which is manifested by petechiae, ecchymoses, and other signs of impaired clotting. Severe uterine pain, a board-like abdomen, and uterine inversion are not associated with abruptio placentae.

After teaching a group of students about sexual abuse and violence, the instructor determines that the teaching was successful when the students describe incest as involving which of the following?

A) Sexual exploitation by blood or surrogate relatives B) Sexual abuse of individuals over age 18 C) Violent aggressive assault on a person D) Consent between perpetrator and victim. Ans: A Feedback: Incest is any type of sexual exploitation between blood relatives or surrogate relatives before the victim reaches 18 years of age. Rape is a violent, aggressive assault on the victim's body and integrity. Rape is a legal rather than a medical term. It denotes penile penetration of the vagina, mouth, or rectum of the female or male without consent. It may or may not include the use of a weapon.

A nurse suspects that a preterm newborn is having problems with thermal regulation. Which of the following would support the nurse's suspicion? (Select all that apply.)

A) Shallow, slow respirations B) Cyanotic hands and feet C) Irritability D) Hypertonicity E) Feeble cry Ans: A, B, E Feedback: Typically, a preterm newborn that is having problems with thermal regulation is cool to cold to the touch. The hands, feet, and tongue may appear cyanotic. Respirations are shallow or slow, or signs of respiratory distress are present. The newborn is lethargic and hypotonic, feeds poorly, and has a feeble cry. Blood glucose levels are probably low, leading to hypoglycemia, due to the energy expended to keep warm.

Which action would be most appropriate for the nurse to take when a newborn has an unexpected anomaly at birth?

A) Show the newborn to the parents as soon as possible while explaining the defect. B) Remove the newborn from the birthing area immediately. C) Inform the parents that there is nothing wrong at the moment. D) Tell the parents that the newborn must go to the nursery immediately. Ans: A Feedback: When an anomaly is identified at or after birth, parents need to be informed promptly and given a realistic appraisal of the severity of the condition, the prognosis, and treatment options so that they can participate in all decisions concerning their child. Removing the newborn from the area or telling them that the newborn needs to go to the nursery immediately is inappropriate and would only add to the parents' anxieties and fears. Telling them that nothing is wrong is inappropriate because it violates their right to know.

While talking with a woman in her third trimester, which behavior indicates to the nurse that the woman is learning to give of oneself?

A) Showing concern for self and fetus as a unit B) Unconditionally accepting the pregnancy without rejection C) Longing to hold infant D) Questioning ability to become a good mother Ans: D Learning to give of oneself would be demonstrated when the woman questions her ability to become a good mother to the infant. Showing concern for herself and fetus as a unit reflects the task of ensuring safe passage throughout pregnancy and birth. Unconditionally accepting the pregnancy reflects the task of seeking acceptance of the infant by others. Longing to hold the infant reflects the task of seeking acceptance of self in the maternal role to the infant.

The nurse notifies the obstetrical team immediately because the nurse suspects that the pregnant woman may be exhibiting signs and symptoms of amniotic fluid embolism. Which findings would the nurse most likely assess? (Select all that apply.)

A) Significant difficulty breathing B) Hypertension C) Tachycardia D) Pulmonary edema E) Bleeding with bruising Ans: A, C, D, E The clinical appearance is varied, but most women report difficulty breathing. Other symptoms include hypotension, cyanosis, seizures, tachycardia, coagulation failure, disseminated intravascular coagulation, pulmonary edema, uterine atony with subsequent hemorrhage, adult respiratory distress syndrome, and cardiac arrest.

A nurse is assessing a newborn who is about 41/2 hours old. The nurse would expect this newborn to exhibit which of the following? (Select all that apply.)

A) Sleeping B) Interest in environmental stimuli C) Passage of meconium D) Difficulty arousing the newborn E) Spontaneous Moro reflexes Ans: B, C The newborn is in the second period of reactivity, which begins as the newborn awakens and shows an interest in environmental stimuli. This period lasts 2 to 8 hours in the normal newborn (Boxwell, 2010). Heart and respiratory rates increase. Peristalsis also increases. Thus, it is not uncommon for the newborn to pass meconium or void during this period. In addition, motor activity and muscle tone increase in conjunction with an increase in muscular coordination. Spontaneous Moro reflexes are noted during the first period of reactivity. Sleeping and difficulty arousing the newborn reflect the period of decreased responsiveness.

Assessment of a newborn reveals uneven gluteal (buttocks) skin creases and a "clunk" when Ortolani's maneuver is performed. Which of the following would the nurse suspect?

A) Slipping of the periosteal joint B) Developmental hip dysplasia C) Normal newborn variation D) Overriding of the pelvic bone Ans: B A "clunk" indicates the femoral head hitting the acetabulum as the head reenters the area. This, along with uneven gluteal creases, suggests developmental hip dysplasia. These findings are not a normal variation and are not associated with slipping of the periosteal joint or overriding of the pelvic bone.

The nurse is assessing a newborn's eyes. Which of the following would the nurse identify as normal? (Select all that apply.)

A) Slow blink response B) Able to track object to midline C) Transient deviation of the eyes D) Involuntary repetitive eye movement E) Absent red reflex Ans: B, C, D Assessment of the eyes should reveal a rapid blink reflex, ability to track objects to the midline, transient strabismus (deviation or wandering of the eyes independently), searching nystagmus (involuntary repetitive eye movement), and a red reflex.

When describing newborns with birth-weight variations to a group of nursing students, the instructor identifies which variation if the newborn weighs 5.2 lb at any gestational age?

A) Small for gestational age B) Low birth weight C) Very low birth weight D) Extremely low birth weight Ans: B Feedback: A low-birth-weight newborn weighs less than 5.5 lb (2,500 g) but more than 3 lb 5 oz. A very-low-birth-weight newborn would weigh less than 3 lb 5 oz but more than 2 lb 3 oz (1,000 g). An extremely-low-birth-weight newborn weighs less than 2 lb 3 oz (1,000g). A small-for-gestational-age newborn typically weighs less than 5 lb 8 oz (2,500 g) at term.

A group of pregnant women are discussing high-risk newborn conditions as part of a prenatal class. When describing the complications that can occur in these newborns to the group, which would the nurse include as being at lowest risk?

A) Small-for-gestational-age (SGA) newborns B) Large-for-gestational-age (LGA) newborns C) Appropriate-for-gestational-age (AGA) newborns D) Low-birth-weight newborns Ans: C Feedback: Appropriate-for-gestational-age (AGA) newborns are at the lowest risk for any problems. AGA characterizes approximately 80% of newborns and describes a newborn with a normal length, weight, head circumference, and body mass index. The other categories all have an increased risk of complications.

Prenatal testing is used to assess for genetic risks and to identify genetic disorders. In explaining to a couple about an elevated alpha-fetoprotein screening test result, the nurse would discuss the need for:

A) Special care needed for a Down syndrome infant B) A more specific determination of the acid-base status C) Further, more definitive evaluations to conclude anything D) Immediate termination of the pregnancy based on results Ans: C Feedback: Increased maternal serum alpha fetoprotein levels may indicate a neural tube defect, Turner syndrome, tetralogy of Fallot, multiple gestation, omphalocele, gastroschisis, or hydrocephaly. Therefore, additional information and more specific determinations need to be done before any conclusion can be made. Down syndrome is associated with decreased maternal serum alpha fetoprotein levels. This type of testing provides no information about the acid-base status of the fetus. Immediate termination is not warranted; more information is needed.

A nurse is developing a program for pregnant women with diabetes about reducing complications. Which factor would the nurse identify as being most important in helping to reduce the maternal/fetal/neonatal complications associated with pregnancy and diabetes?

A) Stability of the woman's emotional and psychological status B) Degree of glycemic control achieved during the pregnancy C) Evaluation of retinopathy by an ophthalmologist D) Blood urea nitrogen level (BUN) within normal limits Ans: B Therapeutic management for the woman with diabetes focuses on tight glucose control, thereby minimizing the risks to the mother, fetus, and neonate. The woman's emotional and psychological status is highly variable and may or may not affect the pregnancy. Evaluating for long-term diabetic complications such as retinopathy or nephropathy, as evidenced by laboratory testing such as BUN levels, is an important aspect of preconception care to ensure that the mother enters the pregnancy in an optimal state.

A nurse is developing a plan of care for a preterm infant experiencing respiratory distress. Which of the following would the nurse be least likely to include in this plan?

A) Stimulate the infant with frequent handling. B) Keep the newborn in a warmed isolette. C) Administer oxygen using an oxygen hood. D) Give gavage or continuous tube feedings. Ans: C Feedback: For the preterm infant experiencing respiratory distress, the nurse would expect to handle the newborn as little as possible to reduce oxygen requirements. Other appropriate interventions include keeping the infant warm, preferably in a warmed isolette to conserve the baby's energy and prevent cold stress; administer oxygen using an oxygen hood; and provide energy through calories via intravenous dextrose or gavage or continuous tube feedings to prevent hypoglycemia.

The nurse administers vitamin K intramuscularly to the newborn based on which of the following rationales?

A) Stop Rh sensitization B) Increase erythropoiesis C) Enhance bilirubin breakdown D) Promote blood clotting Ans: D Vitamin K promotes blood clotting by increasing the synthesis of prothrombin by the liver. RhoGAM prevents Rh sensitization. Erythropoietin stimulates erythropoiesis. Phototherapy enhances bilirubin breakdown.

The nurse prepares to assess a newborn who is considered to be large for gestational age (LGA). Which of the following would the nurse correlate with this gestational age variation?

A) Strong, brisk motor skills B) Difficulty in arousing to a quiet alert state C) Birth weight of 7 lb 14 oz D) Wasted appearance of extremities Ans: B Feedback: LGA newborns typically are more difficult to arouse to a quiet alert state. They have poor motor skills, have a large body that appears plump and full-sized, and usually weigh more than 8 lb 13 oz at term.

The parents of a preterm newborn being cared for in the neonatal intensive care unit (NICU) are coming to visit for the first time. The newborn is receiving mechanical ventilation and intravenous fluids and medications and is being monitored electronically by various devices. Which action by the nurse would be most appropriate?

A) Suggest that the parents stay for just a few minutes to reduce their anxiety. B) Reassure them that their newborn is progressing well. C) Encourage the parents to touch their preterm newborn. D) Discuss the care they will be giving the newborn upon discharge. Ans: C Feedback: The NICU environment can be overwhelming. Therefore, the nurse should address their reactions and explain all the equipment being used. On entering the NICU, the nurse should encourage the parents to touch, interact, and hold their newborn. Doing so helps to acquaint the parents with their newborn, promotes self-confidence, and fosters parent-newborn attachment. The parents should be allowed to stay for as long as they feel comfortable. Reassurance, although helpful, may be false reassurance at this time. Discussing discharge care can be done later once the newborn's status improves and plans for discharge are initiated.

When reviewing the medical record of a postpartum client, the nurse notes that the client has experienced a third-degree laceration. The nurse understands that the laceration extends to which of the following?

A) Superficial structures above the muscle B) Through the perineal muscles C) Through the anal sphincter muscle D) Through the anterior rectal wall Ans: C A third-degree laceration extends through the anal sphincter muscle. A first-degree laceration involves only the skin and superficial structures above the muscle. A second-degree laceration extends through the perineal muscles. A fourth-degree laceration continues through the anterior rectal wall.

After spontaneous rupture of membranes, the nurse notices a prolapsed cord. The nurse immediately places the woman in which position?

A) Supine B) Side-lying C) Sitting D) Knee-chest Ans: D Pressure on the cord needs to be relieved. Therefore, the nurse would position the woman in a modified Sims, Trendelenburg, or knee-chest position. Supine, side-lying, or sitting would not provide relief of cord compression.

A nursing instructor is describing common problems associated with preterm birth. When describing the preterm newborn's risk for perinatal asphyxia, the instructor includes which of the following as contributing to the newborn's risk? (Select all that apply.)

A) Surfactant deficiency B) Placental deprivation C) Immaturity of the respiratory control centers D) Decreased amounts of brown fat E) Depleted glycogen stores Ans: A, C Feedback: Preterm newborns are at risk for perinatal asphyxia due to surfactant deficiency, unstable chest wall, immaturity of the respiratory control centers, small respiratory passages, and inability to clear mucus from the airways. Placental deprivation places the postterm newborn at risk for perinatal asphyxia. Decreased amounts of brown fat and depleted glycogen stores place the SGA newborn at risk for problems with thermoregulation.

Which of the following would alert the nurse to the possibility of respiratory distress in a newborn?

A) Symmetrical chest movements B) Periodic breathing C) Respirations of 40 breaths/minute D) Sternal retractions Ans: D Sternal retractions, cyanosis, tachypnea, expiratory grunting, and nasal flaring are signs of respiratory distress in a newborn. Symmetrical chest movements and a respiratory rate between 30 to 60 breaths/minute are typical newborn findings. Some newborns may demonstrate periodic breathing (cessation of breathing lasting 5 to 10 seconds without changes in color or heart rate) in the first few days of life.

A group of students are reviewing information about sexually transmitted infections and their effect on pregnancy. The students demonstrate understanding of the information when they identify which infection as being responsible for ophthalmia neonatorum?

A) Syphilis B) Gonorrhea C) Chlamydia D) HPV Ans: B Infection with gonorrhea during pregnancy can cause ophthalmia neonatorum in the newborn from birth through an infected birth canal. Infection with syphilis can cause congenital syphilis in the neonate. Infection with chlamydia can lead to conjunctivitis or pneumonia in the newborn. Exposure to HPV during birth is associated with laryngeal papillomas.

The nurse is developing a discharge teaching plan for a postpartum woman who has developed a postpartum infection. Which of the following would the nurse most likely include in this teaching plan? (Select all that apply.)

A) Taking the prescribed antibiotic until it is finished B) Checking temperature once a week C) Washing hands before and after perineal care D) Handling perineal pads by the edges E) Directing peribottle to flow from back to front Ans: A, C, D Feedback: Teaching should address taking the prescribed antibiotic until finished to ensure complete eradication of the infection; checking temperature daily and notifying the practitioner if it is above 100.4° F; washing hands thoroughly before and after eating, using the bathroom, touching the perineal area, or providing newborn care; handling perineal pads by the edges and avoiding touching the inner aspect of the pad that is against the body; and directing peribottle so that it flows from front to back.

A 6-month-old girl weighs 14.7 pounds during a scheduled check-up. Her birth weight was 8 pounds. Which of the following is the priority nursing intervention?

A) Talking about solid food consumption B) Discouraging daily fruit juice intake C) Increasing the number of breastfeedings D) Discussing the child's feeding patterns Ans: D Feedback: Assessing the current feeding pattern and daily intake is the priority intervention. Talking about solid food consumption may not be appropriate for this child yet. Discouraging daily fruit juice intake or increasing the number of breastfeedings may not be necessary until the situation is assessed.

The nurse is assessing a 4-month-old boy during a scheduled visit. Which of the following findings might suggest a developmental problem?

A) The child does not coo or gurgle. B) The child does not babble or laugh. C) The child never squeals or yells. D) The child does not say dada or mama. Ans: B Feedback: The fact that the child does not babble or laugh might suggest a developmental problem. At 4 to 5 months of age most children are making simple vowel sounds, laughing aloud, doing raspberries, and vocalizing in response to voices. The child should have developed past cooing or gurgling, but is too young to squeal, yell, or say dada or mama.

The nurse is examining a 10-month-old boy who was born 10 weeks early. Which of the following findings is cause for concern?

A) The child has doubled his birthweight. B) The child exhibits plantar grasp reflex. C) The child's head circumference is 19.5 inches. D) No primary teeth have erupted yet. Ans: C Feedback: The child's head size is large for his adjusted age (7.5 months), which would be cause for concern. Birth weight doubles by about 6 months of age. Plantar grasp reflex does not disappear until 9 months adjusted age. Primary teeth may not erupt until 8 months adjusted age.

The nurse is assessing the respiratory system of a newborn. Which of the following anatomic differences place the infant at risk for respiratory compromise? Select all answers that apply.

A) The nasal passages are narrower. B) The trachea and chest wall are less compliant. C) The bronchi and bronchioles are shorter and wider. D) The larynx is more funnel shaped. E) The tongue is smaller. F) There are significantly fewer alveoli. Ans: A, D, F Feedback: In comparison with the adult, in the infant, the nasal passages are narrower, the trachea and chest wall are more compliant, the bronchi and bronchioles are shorter and narrower, the larynx is more funnel shaped, the tongue is larger, and there are significantly fewer alveoli. These anatomic differences place the infant at higher risk for respiratory compromise. The respiratory system does not reach adult levels of maturity until about 7 years of age.

When making a home visit, the nurse observes a newborn sleeping on his back in a bassinet. In one corner of the bassinet is a soft stuffed animal and at the other end is a bulb syringe. The nurse determines that the mother needs additional teaching because of which of the following?

A) The newborn should not be sleeping on his back. B) Stuffed animals should not be in areas where infants sleep. C) The bulb syringe should not be kept in the bassinet. D) This newborn should be sleeping in a crib. Ans: B The nurse should instruct the mother to remove all fluffy bedding, quilts, stuffed animals, and pillows from the crib to prevent suffocation. Newborns and infants should be placed on their backs to sleep. Having the bulb syringe nearby in the bassinet is appropriate. Although a crib is the safest sleeping location, a bassinet is appropriate initially.

The nurse is teaching a new mother about the development of sensory skills in her newborn. Which of the following would alert the mother to a sensory deficit in her child?

A) The newborn's eyes wander and occasionally are crossed. B) The newborn does not respond to a loud noise. C) The newborn's eyes focus on near objects. D) The newborn becomes more alert with stroking when drowsy. Ans: B Feedback: Though hearing should be fully developed at birth, the other senses continue to develop as the infant matures. The newborn should respond to noises. Sight, smell, taste, and touch all continue to develop after birth. The newborn's eyes wander and occasionally cross, and the newborn is nearsighted, preferring to view objects at a distance of 8 to 15 inches. Holding, stroking, rocking, and cuddling calm infants when they are upset and make them more alert when they are drowsy.

The nurse is teaching a group of students about the similarities and differences between newborn skin and adult skin. Which statement by the group indicates that additional teaching is needed?

A) The newborn's skin and that of an adult are similar in thickness. B) The lipid composition of the skin of a newborn and adult is about the same. C) Skin development in the newborn is complete at birth. D) The newborn has more fibrils connecting the dermis and epidermis. Ans: C The newborn and adult epidermis is similar in thickness and lipid composition, but skin development is not complete at birth. Fewer fibrils connect the dermis and epidermis in the newborn when compared with the adult.

The nurse is assessing a pregnant woman in the second trimester. Which of the following tasks would indicate to the nurse that the client is incorporating the maternal role into her personality?

A) The woman demonstrates concern for herself and her fetus as a unit. B) The client identifies what she must give up to assume her new role. C) The woman acknowledges the fetus as a separate entity within her. D) The client demonstrates unconditional acceptance without rejection. Ans: C Incorporation of the maternal role into her personality indicates acceptance by the pregnant woman. In doing so, the woman becomes able to identify the fetus as a separate individual. Demonstrating concern for herself and her fetus as a unit is associated with introversion and more commonly occurs during the third trimester. Identification of what the mother must give up to assume the new role occurs during the first trimester. Demonstrating unconditional acceptance without rejection occurs during the third trimester.

When assessing the postpartum woman, the nurse uses indicators other than pulse rate and blood pressure for postpartum hemorrhage based on the knowledge that:

A) These measurements may not change until after the blood loss is large B) The body's compensatory mechanisms activate and prevent any changes C) They relate more to change in condition than to the amount of blood lost D) Maternal anxiety adversely affects these vital signs Ans: A Feedback: The typical signs of hemorrhage do not appear in the postpartum woman until as much as 1,800 to 2,100 mL of blood has been lost. In addition, accurate determination of actual blood loss is difficult because of blood pooling inside the uterus and on perineal pads, mattresses, and the floor.

The nurse encourages the mother of a healthy newborn to put the newborn to the breast immediately after birth for which reason?

A) To aid in maturing the newborn's sucking reflex B) To encourage the development of maternal antibodies C) To facilitate maternal-infant bonding D) To enhance the clearing of the newborn's respiratory passages Ans: C Breast-feeding can be initiated immediately after birth. This immediate mother-newborn contact takes advantage of the newborn's natural alertness and fosters bonding. This contact also reduces maternal bleeding and stabilizes the newborn's temperature, blood glucose level, and respiratory rate. It is not associated with maturing the sucking reflex, encouraging the development of maternal antibodies, or aiding in clearing of the newborn's respiratory passages.

The nurse is assessing a newborn and suspects that the newborn was exposed to drugs in utero because the newborn is exhibiting signs of neonatal abstinence syndrome. Which of the following would the nurse expect to assess? (Select all that apply.)

A) Tremors B) Diminished sucking C) Regurgitation D) Shrill, high-pitched cry E) Hypothermia F) Frequent sneezing Ans: A, C, D, F Feedback: Signs and symptoms of neonatal abstinence syndrome include tremors, frantic sucking, regurgitation or projectile vomiting, shrill high-pitched cry, fever, and frequent sneezing.

After teaching a group of students about fetal development, the instructor determines that the teaching was successful when the students identify which of the following as essential for fetal lung development?

A) Umbilical cord B) Amniotic fluid C) Placenta D) Trophoblasts Ans: B Feedback: Amniotic fluid is essential for fetal growth and development, especially fetal lung development. The umbilical cord is the lifeline from the mother to the growing embryo. The placenta serves as the interface between the mother and developing fetus. It secretes hormones and supplies the fetus with nutrients and oxygen needed for growth. The trophoblasts differentiate into all the cells that form that placenta.

18. After teaching a group of students about the discomforts of pregnancy, the students demonstrate understanding of the information when they identify which as common during the first trimester? (Select all that apply.) A) Urinary frequency B) Breast tenderness C) Cravings D) Backache E) Leg cramps

A) Urinary frequency B) Breast tenderness C) Cravings

A client is diagnosed with gestational hypertension and is receiving magnesium sulfate. Which finding would the nurse interpret as indicating a therapeutic level of medication?

A) Urinary output of 20 mL per hour B) Respiratory rate of 10 breaths/minute C) Deep tendons reflexes 2+ D) Difficulty in arousing Ans: C With magnesium sulfate, deep tendon reflexes of 2+ would be considered normal and therefore a therapeutic level of the drug. Urinary output of less than 30 mL, a respiratory rate of less than 12 breaths/minute, and a diminished level of consciousness would indicate magnesium toxicity.

A nurse is assessing a pregnant woman with gestational hypertension. Which of the following would lead the nurse to suspect that the client has developed severe preeclampsia?

A) Urine protein 300 mg/24 hours B) Blood pressure 150/96 mm Hg C) Mild facial edema D) Hyperreflexia Ans: D Severe preeclampsia is characterized by blood pressure over 160/110 mm Hg, urine protein levels greater than 500 mg/24 hours and hyperreflexia. Mild facial edema is associated with mild preeclampsia.

The health care provider orders PGE2 for a woman to help evacuate the uterus following a spontaneous abortion. Which of the following would be most important for the nurse to do?

A) Use clean technique to administer the drug. B) Keep the gel cool until ready to use. C) Maintain the client for 1/2 hour after administration. D) Administer intramuscularly into the deltoid area. Ans: C When PGE2 is ordered, the gel should come to room temperature before administering it. Sterile technique should be used and the client should remain supine for 30 minutes after administration. RhoGAM is administered intramuscularly into the deltoid area.

Which of the following descriptions would the nurse include when teaching a client about her scheduled colposcopy?

A) "A gel will be applied to your abdomen and a microphone-like device will be moved over the area to identify problem areas." B) "A solution will be wiped on your cervix to identify any abnormal cells, which will be visualized with a magnifying instrument." C) "Scrapings of tissue will be obtained and placed on slides to be examined under the microscope." D) "After you receive anesthesia, a small device will be inserted into your abdomen near your belly button to obtain tissue samples." Ans: B Feedback: A colposcopy is a microscopic examination of the lower genital tract using a magnifying instrument. Use of a microphone-like device over the abdomen describes an ultrasound. Obtaining tissue scrapings that are examined under a microscope describes a Pap smear. Insertion of a device under anesthesia near the umbilicus describes a biopsy obtained via laparoscopy.

The daughter of a woman who has been diagnosed with ovarian cancer asks the nurse about screening for this cancer. Which response by the nurse would be most appropriate?

A) "Currently there is no reliable screening test for ovarian cancer." B) "A Pap smear is almost always helpful in identifying this type of cancer." C) "There's a blood test for a marker, CA-125, that if elevated indicates cancer." D) "A genetic test for two genes, if positive, will identify the ovarian cancer." Ans: A Feedback: Currently there are no specific clinical guidelines for ovarian cancer screening. A Pap smear is used to screen for cervical cancer. The CA-125 marker may be elevated in women with ovarian cancer, but it is not specific for this cancer and may be elevated in other malignancies. Genetic testing via BRCA-1 and BRCA-2 provides information about a woman's risk but does not predict if the woman will develop cancer.

Which of the following statements would be most appropriate to empower victims of violence to take action?

A) "Give your partner more time to come around." B) "Remember—children do best in two-parent families." C) "Change your behavior so as not to trigger the violence." D) "You are a good person and you deserve better than this." Ans: D Feedback: To help the woman gain control over her life, the nurse should emphasize that abuse is never okay and that the woman did not deserve the abuse or ask for it. Telling the woman to give her partner more time, saying that children need two parents, and suggesting that she change her behavior do not promote control; rather, they attempt to excuse the partner's behavior.

A couple comes to the clinic for a fertility evaluation. The male partner is to undergo a semen analysis. After teaching the partner about this test, which client statement indicates that the client has understood the instructions?

A) "I need to bring the specimen to the lab the day after collecting it." B) "I will place the specimen in a special plastic bag to transport it." C) "I have to abstain from sexual activity for about 1-2 days before the sample." D) "I will withdraw before I ejaculate during sex to collect the specimen." Ans: C Feedback: Semen analysis is the most important indicator of male fertility. The man should abstain from sexual activity for 24 to 48 hours before giving the sample. For a semen examination, the man is asked to produce a specimen by ejaculating into a specimen container and delivering it to the laboratory for analysis within 1 to 2 hours. When the specimen is brought to the laboratory, it is analyzed for volume, viscosity, number of sperm, sperm viability, motility, and sperm shape.

A client is scheduled to have a Pap smear. After the nurse teaches the client about the Pap smear, which of the following client statements indicates successful teaching?

A) "I need to douche the night before with a mild vinegar solution." B) "I will take a bath first thing that morning to make sure I'm clean." C) "I will not engage in sexual intercourse for 48 hours before the test." D) "I will get a clean urine specimen when I first wake up the morning of the test." Ans: C Feedback: The woman should refrain from sexual intercourse for 48 hours before the test because sperm can obscure the specimen. Douching should be avoided for 48 hours before the test to prevent washing away cervical cells, which might be abnormal. Although a bath is an appropriate hygiene measure, it is not required before a Pap smear. Collecting a urine specimen also is not necessary.

A nurse is teaching a woman with genital ulcers how to care for them. Which statement by the client indicates a need for additional teaching?

A) "I need to wash my hands after touching any of the ulcers." B) "I need to abstain from intercourse primarily when the lesions are present." C) "I should avoid applying ice or heat to my genital area." D) "I can try lukewarm sitz baths to help ease the discomfort." Ans: B Feedback: For genital ulcers, the client needs to abstain from intercourse during the prodromal period and when lesions are present. The client should wash her hands after touching the lesions to avoid inoculation and avoid extremes of temperature such as ice packs or hot pads to the genital area. Comfort measures such as lukewarm sitz baths can be helpful.

After the nurse teaches a client about ways to reduce the symptoms of premenstrual syndrome, which client statement indicates a need for additional teaching?

A) "I will make sure to take my estrogen supplements a week before my period." B) "I've signed up for an aerobic exercise class three times a week." C) "I'll cut down on the amount of coffee and colas I drink." D) "I quit smoking about a month ago, so that should help." Ans: A Feedback: Lifestyle changes such as exercising, avoiding caffeine, and smoking cessation are a key component for managing the signs and symptoms of premenstrual syndrome. Estrogen supplements are not used. If medication is necessary, NSAIDs may be used for painful physical symptoms; spironolactone may help with bloating and water retention.

After assessing a woman who has come to the clinic, the nurse suspects that the woman is experiencing dysfunctional uterine bleeding. Which statement by the client would support the nurse's suspicions?

A) "I've been having bleeding off and on that's irregular and sometimes heavy." B) "I get sharp pain in my lower abdomen usually starting soon after my period comes." C) "I get really irritable and moody about a week before my period." D) "My periods have been unusually long and heavy lately." Ans: A Feedback: Dysfunctional uterine bleeding is defined as irregular, abnormal bleeding that occurs with no identifiable anatomic pathology. It is frequently associated with anovulatory cycles, which are common for the first year after menarche and later in life as a woman approaches menopause. Pain occurring with menses refers to dysmenorrhea. Although mood swings may be associated with dysfunctional uterine bleeding, irritability and mood swings are more commonly associated with premenstrual syndrome. Unusually long and heavy periods reflect menorrhagia.

Which of the following statements best indicates that a client has taken self-care measures to reduce her risk for cervical cancer?

A) "I've really cut down on the amount of caffeine I drink every day." B) "I've thrown out all my bubble baths and just use soap and water now." C) "Every time I have sexual intercourse, I douche." D) "My partner always uses a condom when we have sexual intercourse." Ans: D Feedback: Unprotected sexual intercourse is a risk factor for cervical cancer. Use of barrier methods of contraception such as condoms is a key measure for reducing the risk for cervical cancer. Cessation of smoking and drinking alcohol, not caffeine, also are effective measures for risk reduction. Eliminating irritants such as bubble baths is a general measure to reduce perineal irritation and urinary tract infections. Douching has no effect on risk reduction for cervical cancer.

When the nurse is alone with a client, the client says, "It was all my fault. The house was so messy when he got home and I know he hates that." Which response would be most appropriate?

A) "It is not your fault. No one deserves to be hurt. " B) "What else did you do to make him so angry with you?" C) "You need to start to clean the house early in the day." D) "Remember, he works hard and you need to meet his needs." Ans: A Feedback: The nurse needs to communicate nonjudgmental support and explain that no one deserves to be abused. Doing so helps to establish trust and rapport. Asking the woman what she did to make the partner so angry, telling her to clean the house earlier in the day, and telling her that she needs to meet his needs all shift the blame to the victim and are thus inappropriate.

Which of the following instructions would the nurse include when preparing a woman for a Pap smear?

A) "Refrain from sexual intercourse for 1 week before the test." B) "Wear cotton panties on the day of the test." C) "Avoid taking any medications for 24 hours." D) "Do not douche for 48 hours before the test." Ans: D Feedback: The nurse should instruct the woman not to douche for 48 hours before the test to prevent washing away cervical cells, which might be abnormal. Sexual intercourse should be avoided for 48 hours before the test. Wearing cotton panties is unrelated to preparation for a Pap smear. Medications do not need to be withheld before the test.

Which instructions would the nurse include when teaching a woman with pediculosis pubis?

A) "Take the antibiotic until you feel better." B) "Wash your bed linens in bleach and cold water." C) "Your partner doesn't need treatment at this time." D) "Remove the nits with a fine-toothed comb." Ans: D Feedback: The nurse should instruct the client to remove the nits from the hair using a fine-toothed comb. Permethrin cream and lindane shampoo, not antibiotics, are used as treatment. Bedding and clothing should be washed in hot water to decontaminate it. Sexual partners should be treated also, as well as family members who live in close contact with the infected person.

A battered pregnant woman reports to the nurse that her husband has stopped hitting her and promises never to hurt her again. Which of the following is an appropriate response?

A) "That's great. I wish you both the best." B) "The cycle of violence often repeats itself." C) "He probably didn't mean to hurt you." D) "You need to consider leaving him." Ans: B Feedback: The cycle of violence typically increases in frequency and severity as it is repeated over and over again. The woman needs to understand this.

A client with genital herpes simplex infection asks the nurse, "Will I ever be cured of this infection?" Which response by the nurse would be most appropriate?

A) "There is a new vaccine available that prevents the infection from returning." B) "All you need is a dose of penicillin and the infection will be gone." C) "There is no cure, but drug therapy helps to reduce symptoms and recurrences." D) "Once you have the infection, you develop an immunity to it." Ans: C Feedback: Genital herpes is a lifelong viral infection. No cure exists, but antiviral drug therapy helps to reduce or suppress symptoms, shedding, and recurrent episodes. A vaccine is available for HPV infection but not genital herpes. Penicillin is used to treat syphilis. No immunity develops after a genital herpes infection.

When developing a teaching plan for a couple considering contraception options, which of the following statements would the nurse include?

A) "You should select one that is considered to be 100% effective." B) "The best one is the one that is the least expensive and most convenient." C) "A good contraceptive doesn't require a physician's prescription." D) "The best contraceptive is one that you will use correctly and consistently." Ans: D Feedback: For a contraceptive to be most effective, the client must be able to use it correctly and consistently. Even if a method is considered 100% effective, it is not the best choice if the couple does not use it correctly or consistently. Cost is a consideration, but the least expensive method is not necessarily the best choice. The need for a prescription is not relevant to the couple's choice.

The nurse reviews the CD4 cell count of a client who is HIV-positive. A result less than which of the following would indicate to the nurse that the client has AIDS?

A) 1,000 cells/mm3 B) 700 cells/mm3 C) 450 cells/mm3 D) 200 cells/mm3 Ans: D Feedback: When the CD4 T-cell count reaches 200 or less, the person has reached the stage of AIDS according to the CDC. A CD4 T-cell count between 450 and 1,200 is considered normal.

A nurse is conducting a class for a local woman's group about recommendations for a Pap smear. One of the participants asks, "At what age should a woman have her first Pap smear?" The nurse responds by stating that a woman should have her first Pap smear at which age?

A) 18 B) 21 C) 25 D) 28 Ans: B Feedback: According to the American Cancer Society, a woman should have her first Pap smear at age 21.

When developing a presentation for a local community organization on violence, the nurse is planning to include statistics on intimate partner abuse and its effects on children. In what percentage of the cases in which a parent is abused are the children battered also?

A) 50% to 75% B) 25% to 50% C) 10% to 25% D) Less than 5% Ans: A Feedback: In 50% to 75% of cases when a parent is abused, the children are abused as well.

A nurse is reading a journal article about sexual abuse. Which age range would the nurse expect to find as the peak age for such abuse?

A) 7-10 years B) 8-12 years C) 14-18 years D) 18-22 years Ans: B Feedback: Current estimates indicate that 1 of 5 girls is sexually abused, and the peak ages of such abuse are from 8 to 12 years of age. At every age in the life span, females are more likely to be sexually abused by father, brother, family member, neighbor, boyfriend, husband, partner or ex-partner than by a stranger or anonymous assailant.

The nurse is reviewing the medical records of several clients. Which client would the nurse expect to have an increased risk for developing osteoporosis?

A) A woman of African American descent B) A woman who plays tennis twice a week C) A thin woman with small bones D) A woman who drinks one cup of coffee a day Ans: C Feedback: A woman with a small frame and thin bones is at a higher risk for osteoporosis. Caucasian or Asian women, not African American women, are at higher risk for the condition. A woman who plays tennis twice a week is active and thus would be at low risk for osteoporosis. Women who ingest excessive amounts of caffeine are at increased risk.

When assessing a female client for the possibility of vulvar cancer, which of the following would the nurse most likely expect the client to report? (Select all that apply.)

A) Abnormal vaginal bleeding B) Persistent vulvar itching C) History of herpes simplex D) Lesion on the cervix E) Abnormal Pap smear Ans: B, C Feedback: In most cases, the woman with vulvar cancer reports persistent vulvar itching, burning, and edema that does not improve with the use of creams or ointments. A history of condyloma, gonorrhea and herpes simplex are some of the factors for greater risk for vulvar intraepithelial neoplasia. Abnormal vaginal bleeding, lesion on the cervix, or abnormal Pap smear are not associated with vulvar cancer.

In addition to providing privacy, which of the following would be most appropriate initially in situations involving suspected abuse?

A) Allow the client to have a good cry over the situation. B) Tell the client, "Injuries like these don't usually happen by accident." C) Call the police immediately so they can question the victim. D) Ask the abuser to describe his side of the story first. Ans: B Feedback: Communicating support through a nonjudgmental attitude and telling her that no one deserves to be abused are the first steps in establishing trust and rapport. Allowing the client to cry is appropriate after the client is safe, her privacy is protected, and the nurse has emphasized that there is a problem. Notifying the police is done once the assessment reveals suspicion or actual indications of abuse. Asking the abuser to describe his side of the story is inappropriate.

A nurse is describing the criteria needed for the diagnosis of premenstrual dysphoric disorder (PMDD). Which of the following would the nurse include as a mandatory requirement for the diagnosis?

A) Appetite changes B) Sleep difficulties C) Persistent anger D) Chronic fatigue Ans: C Feedback: For the diagnosis of PMDD, the woman must exhibit one or more of the following: affective lability such as sadness, tearfulness, or irritability; anxiety and tension; persistent or marked anger or irritability; and depressed mood and feelings of hopelessness. Other symptoms, although not mandatory for the diagnosis, include increased or decreased appetite, sleep difficulties, chronic fatigue, headache, increased or decreased sexual desire, constipation or diarrhea, and breast swelling and tenderness.

A nurse is assessing a client for possible risk factors for chlamydia and gonorrhea. Which of the following would the nurse identify?

A) Asian American ethnicity B) Age under 25 years C) Married D) Consistent use of barrier contraception Ans: B Feedback: High-risk groups for chlamydia and gonorrhea include single women, women younger than 25 years, African American women, women with a history of STIs, those with new or multiple sex partners, those with inconsistent use of barrier contraception, and women living in communities with high infection rates.

When a nurse suspects that a client may have been abused, the first action should be to:

A) Ask the client about the injuries and if they are related to abuse. B) Encourage the client to leave the batterer immediately. C) Set up an appointment with a domestic violence counselor. D) Ask the suspected abuser about the victim's injuries. Ans: A Feedback: The first step is to screen for abuse and identify the connection between the woman's injuries and abuse. Once abuse is detected, the nurse should immediately isolate the woman to provide privacy and prevent retaliation by the abuser. Encouraging the woman to leave the batterer immediately is not realistic. Setting up an appointment with a counselor would be appropriate once the abuse is detected and the woman is safe. Questioning the suspected abuser might worsen the situation.

When describing an episode, the victim reports that she attempted to calm her partner down to keep things from escalating. This behavior reflects which phase of the cycle of violence?

A) Battering B) Honeymoon C) Tension-building D) Reconciliation Ans: C Feedback: During the first phase, tension-building, the woman attempts to keep the situation from exploding based on her belief that the partner's anger is legitimately directed at her. The battering phase involves the explosion of violence. The honeymoon or reconciliation phase is manifested by a period of calm, loving, contrite behavior on the part of the batterer. The batterer may be genuinely sorry for the pain he caused.

After teaching a group of students about premenstrual syndrome, the instructor determines that additional teaching is needed when the students identify which of the following as a prominent assessment finding?

A) Bloating B) Tension C) Dysphoria D) Weight loss Ans: D Feedback: Irritability, fatigue, bloating, tension, and dysphoria are the most prominent and consistently described manifestations of premenstrual syndrome. Weight gain, not weight loss, is associated with this disorder

A woman is scheduled for diagnostic testing to evaluate for endometrial cancer. The nurse would expect to prepare the woman for which of the following?

A) CA-125 testing B) Transvaginal ultrasound C) Pap smear D) Mammography Ans: B Feedback: A transvaginal ultrasound would be used to evaluate endometrial thickness to determine if an endometrial biopsy is needed. CA-124 testing is a nonspecific blood test used as a tumor marker. A Pap smear is used to screen for cervical cancer. Mammography is used to screen for breast cancer.

The plan of care for a woman diagnosed with a suspected reproductive cancer includes a nursing diagnosis of disturbed body image related to suspected reproductive tract cancer and impact on sexuality as evidenced by the client's statement that she is worried that she won't be the same. Which of the following would be an appropriate outcome for this client?

A) Client will verbalize positive statements about self and sexuality. B) Client will demonstrate understanding of the condition and associated treatment. C) Client will exhibit positive coping strategies related to diagnosis. D) Client will identify misconceptions related to her diagnosis. Ans: A Feedback: An appropriate outcome for disturbed body image would be that the client verbalizes positive statements about herself and her sexuality. Demonstrating understanding of the condition and treatment and identifying misconceptions would be appropriate for a nursing diagnosis of deficient knowledge. Exhibiting positive coping strategies would be appropriate for a nursing diagnosis of anxiety.

The primary goal when working with victims of intimate partner violence is to:

A) Convince them to leave the abuser soon B) Help them cope with their life as it is C) Empower them to regain control of their life D) Arrest the abuser so he or she can't abuse again Ans: C Feedback: The goal of intervention is to enable the victim to gain control over her life. Although the nurse can encourage the woman to leave the abuser, the choice to leave must be made by the woman. The nurse can provide support and assistance with coping, but the ultimate goal is for the woman to become empowered. Arresting the abuser does not necessarily stop the abuse.

A client states that she is to have a test to measure bone mass to help diagnose osteoporosis. The nurse would most likely plan to prepare the client for:

A) DEXA scan B) Ultrasound C) MRI D) Pelvic x-ray Ans: A Feedback: The client most likely will be having a DEXA scan, which is a screening test that calculates the mineral content of the bone at the spine and hip. Ultrasound, MRI, and a pelvic x-ray would be of little help in determining bone mass.

A nurse is caring for a woman who was recently raped. The nurse would expect this woman to experience which of the following first?

A) Denial B) Disorganization C) Reorganization D) Integration Ans: B Feedback: The acute phase of rape recovery is disorganization characterized by shock, fear, disbelief, anger, shame, guilt and feelings of uncleanliness. This is followed by denial (outward adjustment), reorganization, and finally integration and recovery.

During a follow-up visit to the clinic, a victim of sexual assault reports that she has changed her job and moved to another town. She tells the nurse, "I pretty much stay to myself at work and at home." The nurse interprets these findings to indicate that the client is in which phase of rape recovery?

A) Disorganization B) Denial C) Reorganization D) Integration Ans: C Feedback: During the reorganization phase, the survivor attempts to make life adjustments by moving or changing jobs and uses emotional distancing to cope. The disorganization phase is characterized by shock, fear, disbelief, anger, shame, guilt, and feelings of uncleanliness. During the denial or outward adjustment phase, the survivor appears outwardly composed and returns to work or school and refuses to discuss the assault and denies the need for counseling. During the integration and recovery phase, the survivor begins to feel safe and starts to trust others.

Teaching for victims who are recovering from abusive situations must focus on ways to:

A) Enhance their personal appearance and hairstyle B) Develop their creativity and work ethic C) Improve their communication skills and assertiveness D) Plan more nutritious meals to improve their own health Ans: C Feedback: Providing reassurance and support to a victim of abuse is key if the violence is to end. Appropriate actions can help victims express their thoughts and feelings in constructive ways and strengthen their control over their lives. Although interventions related to personal appearance and creativity can enhance the woman's self-esteem, they are not helpful in dealing with the abuse. Planning nutritious meals helps to promote a healthy lifestyle but is ineffective in dealing with the abuse.

A nurse is preparing a presentation for a group of women at the clinic who have been diagnosed with genital herpes. Which of the following would the nurse expect to include as a possible precipitating factor for a recurrent outbreak? (Select all that apply.)

A) Exposure to ultraviolet light B) Exercise C) Use of corticosteroids D) Emotional stress E) Sexual intercourse. Ans: A, C, D, E Feedback: Recurrent genital herpes outbreaks are triggered by precipitating factors such as emotional stress, menses, ultraviolet light exposure, illness, surgery, fatigue, genital trauma, immunosuppression such as from drugs like corticosteroids, and sexual intercourse, but more than half of recurrences occur without a precipitating cause.

A client is scheduled for cryosurgery to remove some abnormal tissue on the cervix. The nurse teaches the client about this treatment, explaining that the tissue will be removed by which method?

A) Freezing B) Cutting C) Burning D) Irradiating Ans: A Feedback: Cryosurgery destroys abnormal cervical tissue by freezing. Conization involves cutting out a cone-shaped section of tissue. Laser therapy destroys cervical tissue by using high-energy light to burn it off. Radiation therapy involves irradiating the tissue for destruction.

A group of students are reviewing information about STIs. The students demonstrate understanding of the information when they identify which of the following as the most common bacterial STI in the United States?

A) Gonorrhea B) Chlamydia C) Syphilis D) Candidiasis Ans: B Feedback: According to the CDC, chlamydia is the most common bacterial STI in the United States. Gonorrhea and syphilis are bacterial infections but not the most common ones. Candidiasis is a fungal infection.

A group of nursing students are reviewing information about vaccines used to prevent STIs. The students would expect to find information about which of the following?

A) HIV B) HSV C) HPV D) HAV E) HBV Ans: C, D, E Feedback: Vaccines are under development or are undergoing clinical trials for certain STIs, including HIV and HSV. However, the only vaccines currently available are for prevention of HAV, HBV, and HPV infection.

When obtaining the health history from a client, which factor would lead the nurse to suspect that the client has an increased risk for sexually transmitted infections (STIs)?

A) Hive-like rash for the past 2 days B) Five different sexual partners C) Weight gain of 5 lbs in 1 year D) Clear vaginal discharge Ans: B Feedback: The number of sexual partners is a risk factor for the development of STIs. A rash could be related to numerous underlying conditions. A weight gain of 5 lbs in one year is not a factor increasing one's risk for STIs. A change in the color of vaginal discharge such as yellow, milky, or curd-like, not clear, would suggest an STI.

Which finding would the nurse expect to find in a client with endometriosis?

A) Hot flashes B) Dysuria C) Fluid retention D) Fever Ans: B Feedback: The client with endometriosis is often asymptomatic, but clinical manifestations include painful urination, pain before and during menstrual periods, pain during or after sexual intercourse, infertility, depression, fatigue, painful bowel movements, chronic pelvic pain, hypermenorrhea, pelvic adhesions, irregular and more frequent menses, and premenstrual spotting. Hot flashes may be associated with premenstrual syndrome or menopause. Fluid retention is associated with premenstrual syndrome. Fever would suggest an infection.

The nurse is presenting a class at a local community health center on violence during pregnancy. Which of the following would the nurse include as a possible complication?

A) Hypertension of pregnancy B) Chorioamnionitis C) Placenta previa D) Postterm labor Ans: B Feedback: Women assaulted during pregnancy are at risk for chorioamnionitis, placental abruption, preterm labor, stillbirth, miscarriage, uterine rupture, and injuries to the mother and fetus. Hypertension of pregnancy is not associated with violence during pregnancy.

A client has an abnormal Pap smear that is classified as ASC-US. Based on the nurse's understanding of this classification, the nurse would expect which of the following?

A) Immediate colposcopy B) Testing for HPV C) Repeat Pap smear in 4 to 6 months D) Cone biopsy Ans: C Feedback: For the classification of ASC-US, the client would have a repeat Pap smear in 4 to 6 months or be referred for a colposcopy. A referral for colposcopy with HPV testing is indicated if the results indicated ASC-H classification. An immediate colposcopy would be indicated for atypical glandular cells and adenocarcinoma in situ. A cone biopsy would be used to evaluate the lesion and may be used as treatment to remove any precancers and very early cancers.

The nurse encourages a female client with human papillomavirus (HPV) to receive continued follow-up care because she is at risk for:

A) Infertility B) Dyspareunia C) Cervical cancer D) Dysmenorrhea Ans: C Feedback: Clinical studies have confirmed that HPV is the cause of essentially all cases of cervical cancer. Therefore, the client needs continued follow-up for Pap smears. HPV is not associated with an increased risk for infertility, dyspareunia, or dysmenorrhea.

A nurse is assisting with the collection of a Pap smear. When collecting the specimen, which of the following is done first?

A) Insertion of the speculum B) Swabbing of the endocervix C) Spreading of the labia D) Insertion of the cytobrush Ans: C Feedback: For a Pap smear, the practitioner obtains a sample by spreading the labia; inserting the speculum; inserting the cytobrush and swabbing the endocervix; and inserting the plastic spatula and swabbing the cervix.

An instructor is describing the development of cervical cancer to a group of students. The instructor determines that the teaching was successful when the students identify which area as most commonly involved?

A) Internal cervical os B) Junction of the cervix and fundus C) Squamous-columnar junction D) External cervical os Ans: C Feedback: Cervical cancer starts with abnormal changes in the cellular lining or surface of the cervix. Typically these changes occur in the squamous-columnar junction of the cervix. Here, cylindrical secretory epithelial cells (columnar) meet the protective flat epithelial cells (squamous) from the outer cervix and vagina in what is termed the transformation zone.

When preparing a woman with suspected vulvar cancer for a biopsy, the nurse expects that the lesion would most likely be located at which area?

A) Labia majora B) Labia minora C) Clitoris D) Prepuce Ans: A Feedback: The diagnosis of vulvar cancer is made by biopsy of the suspicious lesion, which is most commonly found on the labia majora.

When reviewing the medical record of a client diagnosed with endometriosis, which of the following would the nurse identify as a risk factor for this woman?

A) Low fat in the diet B) Age of 14 years for menarche C) Menstrual cycles of 24 days D) Short menstrual flow Ans: C Feedback: Risk factors for developing endometriosis include increasing age, family history of endometriosis in a first-degree relative, short menstrual cycle (less than 28 days), long menstrual flow (more than 1 week), high dietary fat consumption, young age at menarche (younger than age 12), and few (one or two) or no pregnancies.

A group of students are preparing a class discussion about rape and sexual assault. Which of the following would the students include as being most accurate? (Select all that apply.)

A) Most victims of rape tell someone about it. B) Few women falsely cry "rape." C) Women have rape fantasies desiring to be raped. D) A rape victim feels vulnerable and betrayed afterwards. E) Medication and counseling can help a rape victim cope. Ans: B, D, E Feedback: The majority of women never tell anyone about a rape. Almost two thirds of victims never report it to the police. The victim feels vulnerable, betrayed, and insecure after a rape. Few women falsely cry "rape." Reality and fantasy are different and dreams have nothing to do with the brutal violation of rape. Medication can help initially, but counseling is usually needed.

Which finding obtained during a client history would the nurse identify as increasing a client's risk for ovarian cancer?

A) Multiple sexual partners B) Consumption of a high-fat diet C) Underweight D) Grand multiparity (more than five children) Ans: B Feedback: Risk factors for ovarian cancer include a high-fat diet, obesity, nulliparity, early menarche, late menopause, and increasing age. Having multiple sexual partners is a risk factor for cervical cancer.

When developing a teaching plan for a community group about HIV infection, which group would the nurse identify as an emerging risk group for HIV infection?

A) Native Americans B) Heterosexual women C) New health care workers D) Asian immigrants Ans: B Feedback: According to statistics, more than 90% of all HIV infections have resulted from heterosexual intercourse, making heterosexual women particularly vulnerable due to substantial mucosal exposure to seminal fluids. HIV disproportionately affects African American and Hispanic women, but together they represent less than 25% of all U.S. women. New health care workers and Asian immigrants account for only a very small number of HIV-positive cases.

The nurse is reviewing the laboratory test results of a client with dysfunctional uterine bleeding (DUB). Which finding would be of concern?

A) Negative pregnancy test B) Hemoglobin level of 10.1 g/dL C) Prothrombin time of 60 seconds D) Serum cholesterol of 140 mg/dL Ans: B Feedback: A hemoglobin level of 10.1 g/dL suggests anemia, which might occur secondary to prolonged or heavy menses. A negative pregnancy test, a prothrombin time of 60 seconds, and a serum cholesterol level of 140 mg/dL are within normal parameters.

Which approach would be most appropriate when counseling a woman who is a suspected victim of violence?

A) Offer her a pamphlet about the local battered women's shelter. B) Call her at home to ask her some questions about her marriage. C) Wait until she comes in a few more times to make a better assessment. D) Ask, "Have you ever been physically hurt by your partner?" Ans: D Feedback: If violence is suspected, the nurse must use direct or indirect questions to screen for abuse. Asking the woman if she has ever been physically hurt by her partner is most appropriate. Offering her a pamphlet, calling her at home, or waiting until she returns are inappropriate and do not validate the suspicion.

A nurse is presenting a discussion on sexual violence at a local community college. When describing the incidence of sexual violence, the nurse would identify that a woman has which chance of experiencing a sexual assault in her lifetime?

A) One in three B) One in six C) Two in 15 D) Three in 20 Ans: B Feedback: The National Center for Prevention and Control of Sexual Assault estimates that one out of six women will be sexually assaulted sometime in her life, and two thirds of these assaults will not be reported.

A woman has opted to use the basal body temperature method for contraception. The nurse instructs the client that a rise in basal body temperature indicates which of the following?

A) Onset of menses B) Ovulation C) Pregnancy D) Safe period for intercourse Ans: B Feedback: Basal body temperatures typically rise within a day or two after ovulation and remain elevated for approximately 2 weeks, at which point bleeding usually begins. Basal body temperature is not a means for determining pregnancy. Having intercourse while the temperature is elevated would increase the risk of pregnancy.

After discussing various methods of contraception with a client and her partner, the nurse determines that the teaching was successful when they identify which contraceptive method as providing protection against sexually transmitted infections (STIs)?

A) Oral contraceptives B) Tubal ligation C) Condoms D) Intrauterine system Ans: C Feedback: Condoms are a barrier method of contraception. In addition to providing a physical barrier for sperm, they also protect against STIs. Oral contraceptives, tubal ligation, and intrauterine systems provide no protection against STIs.

A client is diagnosed with pelvic inflammatory disease (PID). When reviewing the client's medical record, which of the following would the nurse expect to find? (Select all that apply.)

A) Oral temperature of 100.4 degrees F B) Dysmenorrhea C) Dysuria D) Lower abdominal tenderness E) Discomfort with cervical motion F) Multiparity Ans: B, C, D, E Feedback: History and physical examination findings of PID include dysmenorrhea, dysuria, lower abdominal tenderness, and cervical motion tenderness. Typically the client has a fever above 101 degrees F and is nulliparous.

A nurse at a local community clinic is developing a program to address STI prevention. Which of the following would the nurse least likely include in the program?

A) Outlining safer sexual behavior B) Recommending screening for symptomatic individuals C) Promoting the use of barrier contraceptives D) Offering education about STI transmission Ans: B Feedback: Strategies to prevent STIs include providing basic information about STI transmission, outlining safer sexual behaviors, screening asymptomatic persons with STIs, and promoting the use of barrier contraceptives.

A client comes to the clinic with abdominal pain. Based on her history the nurse suspects endometriosis. The nurse expects to prepare the client for which of the following to confirm this suspicion?

A) Pelvic examination B) Transvaginal ultrasound C) Laparoscopy D) Hysterosalpingogram Ans: C Feedback: The only certain method of diagnosing endometriosis is by seeing it. Therefore, the nurse would expect to prepare the client for a laparoscopy to confirm the diagnosis. A pelvic examination and transvaginal ultrasound are done to assess for endometriosis but do not confirm its presence. Hysterosalpingography aids in identifying tubal problems resulting in infertility.

A nurse is assessing a rape survivor for post-traumatic stress disorder. The nurse asks the woman, "Do you feel as though you are reliving the trauma?" The nurse is assessing for which of the following?

A) Physical symptoms B) Intrusive thoughts C) Avoidance D) Hyperarousal Ans: B Feedback: The question is used to assess the woman for intrusive thoughts that reflect the client reexperiencing the trauma. Physical symptoms would be assessed with questions about sleeping, eating, palpitations and other problems. Avoidance would be reflected in questions involving withdrawal socially, avoiding situations that remind the woman of the rape. Hyperarousal would be noted by irritability and an exaggerated startle response.

When teaching a group of postmenopausal women about hot flashes and night sweats, the nurse would address which of the following as the primary cause?

A) Poor dietary intake B) Estrogen deficiency C) Active lifestyle D) Changes in vaginal pH Ans: B Feedback: Hot flashes and night sweats are classic signs of estrogen deficiency. They are unrelated to dietary intake or active lifestyle. Changes in vaginal pH are associated with genitourinary changes of menopause.

Which of the following would the nurse be least likely to suggest when teaching a group of young women how to reduce their risk for ovarian cancer?

A) Pregnancy B) Oral contraceptives C) Feminine hygiene sprays D) Breast-feeding Ans: C Feedback: Risk reduction strategies include pregnancy, use of oral contraceptives, and breast-feeding. Women should avoid using talc and hygiene sprays on the genital area.

A client who has come to the clinic is diagnosed with endometriosis. Which of the following would the nurse expect the physician to prescribe as a first-line treatment?

A) Progestins B) Antiestrogens C) Gonadotropin-releasing hormone analogues D) NSAIDs Ans: A Feedback: Although progestins, antiestrogens, and gonadotrophin-releasing analogues are used as treatment options for endometriosis, NSAIDS are considered the first-line treatment to reduce pain.

The nurse is developing a plan of care for a client who is receiving highly active antiretroviral therapy (HAART) for treatment of HIV. The goal of this therapy is to:

A) Promote the progression of disease B) Intervene in late-stage AIDS C) Improve survival rates D) Conduct additional drug research Ans: C Feedback: The use of HAART aims to improve the prognosis of HIV/AIDS. Dramatic advances with antiretroviral medication have turned a disease that used to be a death sentence into a chronic, manageable one for individuals who live in countries where antiretroviral therapy is available. Drug therapy does not promote the progression of the disease. It is started at the time of the first infection, not in late-stage AIDS. Treatment advances have been based on research, but drug therapy is not prescribed to conduct additional research.

A nurse is preparing a class for a group of women at a family planning clinic about contraceptives. When describing the health benefits of oral contraceptives, which of the following would the nurse most likely include? (Select all that apply.)

A) Protection against pelvic inflammatory disease B) Reduced risk for endometrial cancer C) Decreased risk for depression D) Reduced risk for migraine headaches E) Improvement in acne Ans: A, B, E Feedback: The health benefits of oral contraceptives include protection against pelvic inflammatory disease, a reduced risk for endometrial cancer, and improvement in acne. Oral contraceptives are associated with an increased risk for depression and migraine headaches.

After teaching a class on sexually transmitted infections, the instructor determines that the teaching was successful when the class identifies which statement as true?

A) STIs can affect anyone if exposed to the infectious organism. B) STIs have been addressed more on a global scale. C) Clients readily view the diagnosis of STI openly. D) Most individuals with STIs are over the age of 30. Ans: A Feedback: STIs know no gender, class, racial, ethnic, or social barriers—all individuals are vulnerable if exposed to the infectious organism. The problem of STIs has still not been tackled adequately on a global scale, and until this is done, numbers worldwide will continue to increase. Given the high value some cultures place on virginity and fidelity, a diagnosis of an STI can be devastating to the woman and her family. Even to suggest a test for STIs can appear inappropriate or offensive. An estimated two thirds of all STIs occur among persons under the age of 25.

After teaching a group of adolescents about HIV, the nurse asks them to identify the major means by which adolescents are exposed to the virus. The nurse determines that the teaching was successful when the group identifies which of the following?

A) Sexual intercourse B) Sharing needles for IV drug use C) Perinatal transmission D) Blood transfusion Ans: A Feedback: Nurses can play a key role in preventing and controlling HIV infection by promoting risk-reduction counseling and offering routine HIV testing to adolescents. Most sexually active youth do not feel that they are at risk of contracting HIV and have never been tested. Obtaining a sexual history and creating an atmosphere that promotes nonjudgmental risk counseling is a key component of the adolescent visit. In light of increasing numbers of people with HIV/AIDS and missed opportunities for HIV testing, the CDC recommends universal and routine HIV testing for all clients seen in health care settings who are 13 to 64 years of age. Sharing contaminated needles, perinatal transmission, and blood transfusions are not associated with adolescents and HIV.

When describing the cycle of violence to a community group, the nurse explains that the first phase usually is:

A) Somehow triggered by the victim's behavior B) Characterized by tension-building and minor battery C) Associated with loss of physical and emotional control D) Like a honeymoon that lulls the victim Ans: B Feedback: The cyclic behavior begins with a time of tension-building arguments, progresses to violence, and settles into a making-up or calm period.

A woman using the cervical mucus ovulation method of fertility awareness reports that her cervical mucus looks like egg whites. The nurse interprets this as which of the following?

A) Spinnbarkeit mucus B) Purulent mucus C) Postovulatory mucus D) Normal preovulation mucus Ans: A Feedback: The client is describing spinnbarkeit mucus, the copious, clear, slippery, smooth, and stretchable mucus that occurs as ovulation approaches. Purulent mucus would be yellow or green and malodorous. Preovulation mucus is clear but not as copious, slippery, and stretchable.

A woman is diagnosed with adenocarcinoma of the endometrium in situ. The nurse interprets this as indicating which of the following about the cancer?

A) Spread to the uterine muscle wall B) Found on the endometrial surface C) Spread to the cervix D) Invaded the bladder Ans: B Feedback: Carcinoma in situ is found only on the endometrial surface. In stage I, the cancer has spread to the uterine muscle wall. In stage II, it has spread to the cervix. In stage IV, it has invaded the bladder mucosa with distant metastases to the lungs, liver, and bone.

Which of the following would the nurse emphasize when teaching postmenopausal women about ways to reduce the risk of osteoporosis?

A) Swimming daily B) Taking vitamin A C) Following a low-fat diet D) Taking calcium supplements Ans: D Feedback: Osteoporosis is a condition in which bone mass declines to such an extent that fractures occur with minimal trauma. Increasing calcium and vitamin D intake is a major preventive measure. Other measures to reduce the risk include engaging in weight-bearing exercise such as walking. Swimming, although a beneficial exercise, is not a weight-bearing exercise. Taking vitamin A supplements would have no effect on preventing bone loss. Following a low-fat diet would be helpful in reducing the risk for cardiovascular disease.

Which of the following measures would the nurse include in the teaching plan for a woman to reduce the risk of osteoporosis after menopause?

A) Taking vitamin supplements B) Eating high-fiber, high-calorie foods C) Restricting fluid to 1,000 mL daily D) Participating in regular daily exercise Ans: D Feedback: Measures to reduce osteoporosis after menopause include daily weight-bearing exercise, increasing calcium and vitamin D intake, and avoiding smoking and excessive alcohol intake. General vitamin supplements may be helpful overall, but they are not specific to reducing the risk of osteoporosis. A diet high in calcium and vitamin D, not fiber and calories, would be appropriate. Restricting fluids would have no effect on preventing osteoporosis.

Which of the following would the nurse describe as a characteristic of the second phase of the cycle of violence?

A) The batterer is contrite and attempts to apologize for the behavior. B) The physical battery is abrupt and unpredictable. C) Verbal assaults begin to escalate toward the victim. D) The victim accepts the anger as legitimately directed at her. Ans: B Feedback: During the second phase of the cycle of violence, the violence explodes and the batterer loses control physically and emotionally. During the honeymoon or third phase, the batterer is contrite and attempts to apologize for the behavior. During the first phase or tension-building phase, verbal or minor battery occurs and the woman often accepts her partner's building anger as legitimately directed toward her.

A woman who is HIV-positive is receiving HAART and is having difficulty with compliance. To promote adherence, which of the following areas would be most important to assess initially?

A) The woman's beliefs and education B) The woman's financial situation and insurance C) The woman's activity level and nutrition D) The woman's family and living arrangements Ans: A Feedback: The most important area to assess initially would be the client's beliefs and knowledge about the disease and its treatment. A common barrier is a lack of understanding about the link between drug resistance and nonadherence. Once this area is assessed, the nurse can assess for other barriers, such as finances and insurance, nutrition and activity level, and family issues, including living arrangements (for example, the woman may be afraid that her HIV status would be revealed if others see her taking medication).

A client is suspected of having endometrial cancer. The nurse would most likely prepare the client for which procedure to confirm the diagnosis?

A) Transvaginal ultrasound B) Colposcopy C) Pap smear D) Endometrial biopsy Ans: D Feedback: An endometrial biopsy is the procedure of choice to make the diagnosis of endometrial cancer. A transvaginal ultrasound may be used to evaluate the endometrial cavity and measure the endometrial thickness to detect endometrial hyperplasia, but it does not confirm the diagnosis. Colposcopy is used to diagnose cervical cancer. A Pap smear screens for abnormal cervical cells.

Assessment of a female client reveals a thick, white vaginal discharge. She also reports intense itching and dyspareunia. Based on these findings, the nurse would suspect that the client has:

A) Trichomoniasis B) Bacterial vaginosis C) Candidiasis D) Genital herpes simplex Ans: C Feedback: A thick, white vaginal discharge accompanied by intense itching and dyspareunia suggest vulvovaginal candidiasis. Trichomoniasis is characterized by a heavy yellow, green, or gray frothy or bubbly discharge. Bacterial vaginosis is manifested by a thin, white homogenous vaginal discharge with a characteristic stale fish-like odor. Genital herpes simplex involves genital ulcers.

The nurse would refer a client, age 54, for follow-up for suspected endometrial carcinoma if she reports which of the following?

A) Use of oral contraceptives between ages 18 and 25 B) Onset of painless, red postmenopausal bleeding C) Menopause occurring at age 46 D) Use of intrauterine device for 3 years Ans: B Feedback: Any episode of bright red, painless bleeding occurring after menopause needs to be investigated. Abnormal uterine bleeding in postmenopausal women should be regarded with suspicion. Oral contraceptive use is associated with cervical cancer. Late menopause (after age 52) is associated with endometrial cancer. Use of an intrauterine device is not associated with endometrial cancer.

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