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A nurse is caring for a client who reports indications of preterm labor. Which of the following findings are risk factors of this conditions? (Select all that apply). a. UTI b. Multifetal pregnancy c. Oligohydramnios d. Diabetes mellitus e. Uterine abnormalities

A B D E

The nurse should teach a pregnant woman that which substances are teratogens? (Select all that apply) a. Cigarette smoke b. Isotretinoin (Retin A) c. Vitamin C d. Salicylic acid e. Rubella

A B E (Vitamin C and salicylic acid are not known teratogens.)

A pregnant woman reports that she is still playing tennis at 32 weeks of gestation. The nurse would be most concerned regarding what this woman consumes during and after tennis matches. Which is the MOST important? A. Several glasses of fluid B. Extra protein sources, such as peanut butter C. Salty foods to replace lost sodium D. Easily digested sources of carbohydrate

A

A pregnant woman's amniotic membranes rupture. Prolapsed cord is suspected. Which intervention is the nurse's top priority? a. Place the woman in the knee-chest position. b. Cover the cord in a sterile towel saturated with warm normal saline. c. Prepare the woman for a cesarean birth. d. Start oxygen by face mask.

A

A school nurse is providing teaching to an adolescent about levonorgestrel contraception. Which of the following information should the nurse include in the teaching? a. "You should take the medication within 72 hours following unprotected sexual intercourse." b. "You should avoid taking this medication if you are on an oral contraceptive." c. "If you don't start your period within 5 days of taking this medication, you will need a pregnancy test." d. "One dose of this medication will prevent you from becoming pregnant for 14 days after taking it."

A

Baby-friendly hospitals mandate that infants be put to breast within what time frame after birth? a. 1 hour b. 30 minutes c. 2 hours d. 4 hours

A

Dinah is now perspiring profusely and shaky. She feels she can't cope any longer. She pushes away her husband as he tries to rub her back. An increased amount of bloody show is present. She suddenly vomits. Even without a cervical examination, what phase of labor is Dinah most likely in? a. Transition phase b. active c. latent d. Stage 4

A

The pituitary hormone that stimulates the secretion of milk from the mammary glands is: A. Prolactin B. Oxytocin C. Estrogen D. Progesterone

A

What are the two major complications associated with an epidural? a. maternal hypotension and fetal bradycardia b. maternal hypertension and fetal tachycardia c. hemorrhage and placental insuffiency d. breakthrough pain and increased fetal stress

A

What is a aminocentesis screening for? a. chromosomal abnormalities b. infection of the amniotic sac c. FHR d. contractions

A

Which postpartum conditions are considered medical emergencies that require immediate treatment? a. Inversion of the uterus and hypovolemic shock b. Hypotonic uterus and coagulopathies c. Subinvolution of the uterus and idiopathic thrombocytopenic purpura d. Uterine atony and disseminated intravascular coagulation (DIC)

A

With regard to protein in the diet of pregnant women, nurses should be aware that: A. many protein-rich foods are also good sources of calcium, iron, and b vitamins. B. many women need to increase their protein intake during pregnancy. C. as with carbohydrates and fat, no specific recommendations exist for the amount of protein in the diet. D. high-protein supplements can be used without risk by women on macrobiotic diets.

A

The labor and delivery nurse is admitting a woman complaining of being in labor. The nurse completes the admission database and notes that which factors may prohibit the woman from having a vaginal birth? (Select all that apply.) a. Unstable coronary artery disease b. Previous cesarean birth c. Placenta previa d. Initial blood pressure of 132/87 e. History of three spontaneous abortions

A B C

The breasts of a bottle-feeding woman are engorged. The nurse should tell her to: a. wear a snug, supportive bra. b. allow warm water to soothe the breasts during a shower. c. express milk from breasts occasionally to relieve discomfort. d. place absorbent pads with plastic liners into her bra to absorb leakage.

A (A snug, supportive bra limits milk production and reduces discomfort by supporting the tender breasts and limiting their movement. Cold packs reduce tenderness, whereas warmth would increase circulation, thereby increasing discomfort. Expressing milk results in continued milk production. Plastic liners keep the nipples and areola moist, leading to excoriation and cracking.)

A maternity nurse should be aware of which fact about the amniotic fluid? a. It serves as a source of oral fluid and as a repository for waste from the fetus. b. The volume remains about the same throughout the term of a healthy pregnancy. c. A volume of less than 300 mL is associated with gastrointestinal malformations. d. A volume of more than 2 L is associated with fetal renal abnormalities

A (Amniotic fluid also cushions the fetus and helps maintain a constant body temperature. The volume of amniotic fluid changes constantly. Too little amniotic fluid (oligohydramnios) is associated with renal abnormalities. Too much amniotic fluid (hydramnios) is associated with gastrointestinal and other abnormalities.)

During a client's physical examination, the nurse notes that the lower uterine segment is soft on palpation. The nurse would document this finding as the: A. Hegar sign. B. McDonald sign. C. Chadwick sign. D. Goodell sign.

A (At approximately 6 weeks of gestation, softening and compressibility of the lower uterine segment occur; this is called the Hegar sign)

A nurse is providing care for a client who is at 32 weeks gestation and who has a placentae previa. The nurse notes that the client is actively bleeding. Which of the following types of medications should the nurse anticipate the provider will prescribe? a. Betamethasone b. Indomethacin c. Nifedipine d. Methylergonovine

A (Betamethasone is given to promote lung maturity if delivery is anticipated.)

Your pregnant patient has an STD. This is an example of which category risk factor for reproduction? a. Biophysical b. Psychosocial c. Sociodemographic d. Environmental

A (Biophysical risk factors include PID, HIV/AIDS, any STD, chromosomal abnormalities, hypertension, heart failure, type I diabetes, and obesity. Basically, any medical condition.)

As part of the postpartum assessment, the nurse examines the breasts of a primiparous breastfeeding woman who is 1-day postpartum. Expected findings include: a. little if any change b. leakage of milk at let-down c. swollen, warm, and tender on palpation d. a few blisters and a bruise on each areola e. small amount of clear, yellow fluid expressed

A (Breasts are essentially unchanged for the first 24 hours after birth. Colostrum is present and may leak from the nipples. Leakage of milk occurs after the milk comes in 72 to 96 hours after birth. Engorgement occurs at day 3 or 4 postpartum. A few blisters and a bruise indicate problems with the breastfeeding techniques being used. E. Colostrum, or early milk, a clear, yellow fluid, may be expressed from the breasts during the first 24 hours.)

Clients with gestational diabetes are usually managed by which of the following therapies? A. Diet B. NPH insulin (long-acting) C. Oral hypoglycemic drugs D. Oral hypoglycemic drugs and insulin

A (Clients with gestational diabetes are usually managed by diet alone to control their glucose intolerance. Oral hypoglycemic agents are contraindicated in pregnancy. NPH isn't usually needed for blood glucose control for GDM.)

A maternity nurse is caring for a client with abruptio placenta and is monitoring the client for disseminated intravascular coagulopathy. Which assessment finding is least likely to be associated with disseminated intravascular coagulation? A. Swelling of the calf in one leg B. Prolonged clotting times C. Decreased platelet count D. Petechiae, oozing from injection sites, and hematuria

A (DIC is a state of diffuse clotting in which clotting factors are consumed, leading to widespread bleeding. Platelets are decreased because they are consumed by the process; coagulation studies show no clot formation (and are thus normal to prolonged); and fibrin plugs may clog the microvasculature diffusely, rather than in an isolated area. The presence of petechiae, oozing from injection sites, and hematuria are signs associated with DIC. Swelling and pain in the calf of one leg are more likely to be associated with thrombophlebitis.)

A woman diagnosed with marginal placenta previa gave birth vaginally 15 minutes ago. At the present time she is at the greatest risk for: a. hemorrhage. b. infection. c. urinary retention. d. thrombophlebitis.

A (Hemorrhage is the most immediate risk because the lower uterine segment has limited ability to contract to reduce blood loss. Infection is a risk because of the location of the placental attachment site; however, it is not a priority concern at this time. Placenta previa poses no greater risk for urinary retention than with a normally implanted placenta. There is no greater risk for thrombophlebitis than with a normally implanted placenta.)

A woman with severe preeclampsia has been receiving magnesium sulfate by IV infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature 37.1° C, pulse rate 96 beats/min, respiratory rate 24 breaths/min, blood pressure 155/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the physician, anticipating an order for: a. hydralazine. b. magnesium sulfate bolus c. diazepam. d. calcium gluconate.

A (Hydralazine is an antihypertensive commonly used to treat hypertension in severe preeclampsia. An additional bolus of magnesium sulfate may be ordered for increasing signs of central nervous system irritability related to severe preeclampsia (e.g., clonus) or if eclampsia develops. Diazepam sometimes is used to stop or shorten eclamptic seizures. Calcium gluconate is used as the antidote for magnesium sulfate toxicity. The client is not currently displaying any signs or symptoms of magnesium toxicity.)

A nurse is caring for a client who believes she may be pregnant. Which of the following findings should the nurse identify as a positive sign of pregnancy? a. Palpable fetal movement b. Chadwick's sign c. Positive pregnancy test d. Amenorrhea

A (Palpable fetal movements are a positive sign of pregnancy. Quickening, the client's report of fetal moment, is a presumptive sign of pregnancy. Chadwick's sign is a probably sign of pregnancy. A positive pregnancy test is a probably sign of pregnancy. Amenorrhea is a presumptive sign of pregnancy.)

A 20-year-old woman comes for preconceptual counseling. She wants to get pregnant soon. Which of the following health-promoting habits would have the highest priority at this time? a. Immediate tobacco cessation b. Getting daily exercise c. Stopping all caffeine d. Avoidance of sweets

A (Psychosocial factors affecting pregnancy include smoking, excessive use of caffeine, alcohol and drug abuse, psychological status including impaired mental health, an addictive lifestyle, spouse abuse, and noncompliance with cultural norms. Immediate tobacco cessation would be the highest priority because continued smoking could be teratogenic if the woman should become pregnant. Smoking causes vasoconstriction which restricts the amount of oxygen and nutrients to the rapidly growing fetus. Daily exercise promotes health but would not be the highest priority among these factors. Stopping caffeine and avoiding sweets are important and can be addressed after tobacco cessation.)

In the 12th week of gestation, a client completely expels the products of conception. Because the client is Rh negative, the nurse must: A. Administer RhoGAM within 72 hours B. Make certain she receives RhoGAM on her first clinic visit C. Not give RhoGAM, since it is not used with the birth of a stillborn D. Make certain the client does not receive RhoGAM, since the gestation only lasted 12 weeks.

A (RhoGAM is given within 72 hours postpartum if the client has not been sensitized already.)

A pregnant client in the last trimester has been admitted to the hospital with a diagnosis of severe preeclampsia. A nurse monitors for complications associated with the diagnosis and assesses the client for: a. Any bleeding, such as in the gums, petechiae, and purpura. b. Enlargement of the breasts c. Periods of fetal movement followed by quiet periods d. Complaints of feeling hot when the room is cool

A (Severe Preeclampsia can trigger disseminated intravascular coagulation because of the widespread damage to vascular integrity. Bleeding is an early sign of DIC and should be reported to the M.D.)

A client in the first trimester of pregnancy arrives at a health care clinic and reports that she has been experiencing vaginal bleeding. A threatened abortion is suspected, and the nurse instructs the client regarding management of care. Which statement, if made by the client, indicates a need for further education? a. "I will maintain strict bedrest throughout the remainder of pregnancy." b. "I will avoid sexual intercourse until the bleeding has stopped, and for 2 weeks following the last evidence of bleeding." c. "I will count the number of perineal pads used on a daily basis and note the amount and color of blood on the pad." d. "I will watch for the evidence of the passage of tissue."

A (Strict bed rest throughout the remainder of pregnancy is not required. The woman is advised to curtail sexual activities until the bleeding has ceased, and for 2 weeks following the last evidence of bleeding or as recommended by the physician. The woman is instructed to count the number of perineal pads used daily and to note the quantity and color of blood on the pad. The woman also should watch for the evidence of the passage of tissue.)

The embryonic period is critical because external and internal structures in the fetus are forming. All teratogens should be avoided from a. 4 to 8 weeks. b. 8 to 12 weeks. c. 12 to 16 weeks. d. 16 to 20 weeks.

A (The embryonic period lasts from the beginning of the fourth week to the end of the eighth week. Teratogenicity is a major concern because all external and internal structures are developing in the embryonic period. A woman should avoid exposure to all potential toxins during pregnancy, especially alcohol, tobacco, radiation, and infectious agents. At the end of this period, the embryo has human features. The span of gestation from 8 to 12 weeks, from 12 to 16 weeks, or from 16 to 20 weeks is not within the embryonic stage of fetal development, when teratogenicity is of greatest concern.)

Your client is a 17 year old female that just found out she is 8 weeks gestation. Based on her age, you suspect that she is: a. At risk for problems with reproduction b. Not at risk for problems with reproduction

A (The very young (under 18) and the very old (over 35) are a population that is at risk for problems with reproduction.)

With regard to medications, herbs, shots, and other substances normally encountered, the maternity nurse should be aware that: a. prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus. b. the greatest danger of drug-caused developmental deficits in the fetus is seen in the final trimester. c. killed-virus vaccines (e.g., tetanus) should not be given during pregnancy, but live-virus vaccines (e.g., measles) are permissible. d. no convincing evidence exists that secondhand smoke is potentially dangerous to the fetus.

A (This is especially true for new medications and combinations of drugs. The greatest danger of drug-caused developmental defects exists in the interval from fertilization through the first trimester, when a woman may not realize that she is pregnant. Live-virus vaccines should be part of postpartum care; killed-virus vaccines may be administered during pregnancy. Secondhand smoke is associated with fetal growth restriction and increases in infant mortality.)

Nursing care management for mothers and fathers suffering grief from the loss of their baby includes: (Select all that apply.) a. using therapeutic communication and caring techniques. b. listening as parents tell their story of loss and grief. c. avoiding asking any questions about the loss of parents. d. giving advice from personal experiences. e. insisting parents name the baby in order to be remembered.

A B

The nurse is developing a dietary teaching plan for a patient on a vegetarian diet. The nurse should provide the patient with which examples of protein containing foods? (Select all that apply.) A. Dried beans B. Seeds C. Peanut butter D. Bagel E. Eggs

A B C E

The nurse is caring for a woman who is at 24 weeks of gestation with suspected severe preeclampsia. Which signs and symptoms would the nurse expect to observe? (Select all that apply.) a. Decreased urinary output and irritability b. Transient headache and +1 proteinuria c. Ankle clonus and epigastric pain d. Platelet count of less than 100,000/mm3 and visual problems e. Seizure activity and hypotension

A C D (Decreased urinary output and irritability are signs of severe eclampsia. Ankle clonus and epigastric pain are signs of severe eclampsia. Platelet count of less than 100,000/mm3 and visual problems are signs of severe preeclampsia. A transient headache and +1 proteinuria are signs of preeclampsia and should be monitored. Seizure activity and hyperreflexia are signs of eclampsia.)

A nurse in a prenatal clinic is caring for a client who is in the first trimester of pregnancy. The client's heath record includes this data: G3 T1 P0 A1 L1. How should the nurse interpret this information? (Select all that apply.) a. Client has delivered one newborn at term. b. Client has experienced no preterm labor. c. Client has been through active labor. d. Client has had two prior pregnancies. e. Client has 1 living child.

A D E (P0 indicates the client has had no preterm DELIVERIES.)

When providing nutritional education for a Mexican-American patient with newly diagnosed hypertension, the nurse notes that the patient is nodding "yes" to everything that is being said. With a better understanding of cultural interdependence, a nurse should immediately a. write everything down for the patient to refer to later. b. prompt the patient further to elicit additional questions or concerns. c. call the recognized elder for this patient. d. call the patient's oldest male relative for help with decision making.

B

Why is magnesium sulfate is given to women with preeclampsia and eclampsia? a. To improve patellar reflexes and increase respiratory efficiency b. To prevent and treat convulsions c. To decrease blood pressure readings d. To prevent a boggy uterus and lessen lochial flow

B

A pregnant woman at 7 weeks of gestation complains to her nurse midwife about frequent episodes of nausea during the day with occasional vomiting. She asks what she can do to feel better. The nurse midwife could suggest that the woman: A. drink warm fluids with each of her meals. B. eat a high-protein snack before going to bed. C. keep crackers and peanut butter at her bedside to eat in the morning before getting out of bed. D. schedule three meals and one midafternoon snack a day.

B (A bedtime snack of slowly digested protein is especially important to prevent the occurrence of hypoglycemia during the night that would contribute to nausea)

A nurse is assessing a full-term newborn 15 min after birth. Which of the following findings requires intervention by the nurse? a. HR 168 b. RR 18 c. Tremors d. Fine crackles

B

A nurse is the emergency department is caring for a client who reports abrupt, sharp, right-sided lower quadrant abdominal pain and bright red vaginal bleeding. The client states she missed one menstrual cycle and cannot be pregnancy because she has an intrauterine device. The nurse should suspect which of the following? a. Missed abortion b. Ectopic pregnancy c. Severe preeclampsia d. Hydatidiform mole

B

A nurse teaches a pregnant woman about the presumptive, probable, and positive signs of pregnancy. The woman demonstrates an understanding of the nurse's instructions if she states that a positive sign of pregnancy is: A. a positive pregnancy test. B. fetal movement palpated by the nurse-midwife. C. Braxton Hicks contractions. D. quickening.

B

A pregnant woman experiencing nausea and vomiting should: A. drink a glass of water with a fat-free carbohydrate before getting out of bed in the morning. B. eat small, frequent meals (every 2 to 3 hours). C. increase her intake of high-fat foods to keep the stomach full and coated. D. limit fluid intake throughout the day.

B

A primiparous woman is in the taking-in stage of psychosocial recovery and adjustment following birth. Recognizing the needs of women during this stage, the nurse should: a. foster an active role in the baby's care. b. provide time for the mother to reflect on the events of and her behavior during childbirth. c. recognize the woman's limited attention span by giving her written materials to read when she gets home rather than doing a teaching session now. d. promote maternal independence by encouraging her to meet her own hygiene and comfort needs.

B

In follow-up appointments or visits with parents and their new baby, it may be useful if the nurse can identify parental behaviors that can either facilitate or inhibit attachment. What is a facilitating behavior? a. The parents have difficulty naming the infant. b. The parents hover around the infant, directing attention to and pointing at the infant. c. The parents make no effort to interpret the actions or needs of the infant. d. The parents do not move from fingertip touch to palmar contact and holding.

B

The nurse examines a woman 1 hour after birth. The woman's fundus is boggy, midline, and 1 cm below the umbilicus. Her lochial flow is profuse, with two plum-sized clots. The nurse's initial action would be to: a. place her on a bedpan to empty her bladder. b. massage her fundus. c. call the physician. d. administer Methergine, 0.2 mg IM, which has been ordered prn.

B

The priority nursing intervention for a woman who suffered a perineal laceration is to: a. apply a cold compress. b. establish hemostasis. c. administer analgesia. d. administer a stool softener

B

When are general screenings and ultrasounds initially started for a pregnancy? a. 10 weeks b. 20 weeks c. 40 weeks d. 20 days

B

A pregnant woman with a body mass index (BMI) of 22 asks the nurse how she should be gaining weight during pregnancy. The nurse's BEST response would be to tell the woman that her pattern of weight gain should be approximately: A. a pound a week throughout pregnancy. B. 2 to 5 lbs during the first trimester, then a pound each week until the end of pregnancy. C. a pound a week during the first two trimesters, then 2 lbs per week during the third trimester. D. a total of 25 to 35 lbs.

B (A pound a week is not the correct guideline during pregnancy. A BMI of 22 represents a normal weight. Therefore, a total weight gain for pregnancy would be about 25 to 35 lbs or about 2 to 5 lbs in the first trimester and about 1 lb/wk during the second and third trimesters)

A woman with severe preeclampsia is being treated with an IV infusion of magnesium sulfate. This treatment is considered successful if: a. blood pressure is reduced to prepregnant baseline. b. seizures do not occur. c. deep tendon reflexes become hypotonic. d. diuresis reduces fluid retention.

B (A temporary decrease in blood pressure can occur; however, this is not the purpose of administering this medication. Magnesium sulfate is a central nervous system (CNS) depressant given primarily to prevent seizures. Hypotonia is a sign of an excessive serum level of magnesium. It is critical that calcium gluconate be on hand to counteract the depressant effects of magnesium toxicity. Diuresis is not an expected outcome of magnesium sulfate administration.)

A woman gave birth to a 7-lb, 3-oz boy 2 hours ago. The nurse determines that the woman's bladder is distended because her fundus is now 3 cm above the umbilicus and to the right of the midline. In the immediate postpartum period, the most serious consequence likely to occur from bladder distention is: a. urinary tract infection. b. excessive uterine bleeding. c. a ruptured bladder. d. bladder wall atony.

B (A urinary tract infection may result from overdistention of the bladder, but it is not the most serious consequence. Excessive bleeding can occur immediately after birth if the bladder becomes distended, because it pushes the uterus up and to the side and prevents it from contracting firmly. A ruptured bladder may result from a severely overdistended bladder. However, vaginal bleeding most likely would occur before the bladder reaches this level of overdistention. Bladder distention may result from bladder wall atony. The most serious concern associated with bladder distention is excessive uterine bleeding.)

A woman with severe preeclampsia is receiving a magnesium sulfate infusion. The nurse becomes concerned after assessment when the woman exhibits: a. a sleepy, sedated affect. b. a respiratory rate of 10 breaths/min. c. deep tendon reflexes of 2+. d. absent ankle clonus.

B (Because magnesium sulfate is a central nervous system (CNS) depressant, the client will most likely become sedated when the infusion is initiated. A respiratory rate of 10 breaths/min indicates that the client is experiencing respiratory depression (bradypnea) from magnesium toxicity. Deep tendon reflexes of 2+ are a normal finding. Absent ankle clonus is a normal finding.)

The most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is: a. bleeding. b. intense abdominal pain. c. uterine activity. d. cramping.

B (Bleeding may be present in varying degrees for both placental conditions. Pain is absent with placenta previa and may be agonizing with abruptio placentae. Uterine activity may be present with both placental conditions. Cramping is a form of uterine activity that may be present in both placental conditions.)

Women with an inadequate weight gain during pregnancy are at higher risk of giving birth to an infant with: A. spina bifida. B. intrauterine growth restriction. C. diabetes mellitus. D. Down syndrome.

B (Both normal-weight and underweight women with inadequate weight gain have an increased risk of giving birth to an infant with intrauterine growth restriction)

A nurse in a labor room is assisting with the vaginal delivery of a newborn infant. The nurse would monitor the client closely for the risk of uterine rupture if which of the following occurred? A. Hypotonic contractions B. Forceps delivery C. Schultz delivery D. Weak bearing down efforts

B (Excessive fundal pressure, forceps delivery, violent bearing down efforts, tumultuous labor, and shoulder dystocia can place a woman at risk for traumatic uterine rupture. Hypotonic contractions and weak bearing down efforts do not alone add to the risk of rupture because they do not add to the stress on the uterine wall.)

What statement by a newly delivered woman indicates that she knows what to expect about her menstrual activity after childbirth? a. "My first menstrual cycle will be lighter than normal and then will get heavier every month thereafter." b. "My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles." c. "I will not have a menstrual cycle for 6 months after childbirth." d. "My first menstrual cycle will be heavier than normal and then will be light for several months after."

B (She can expect her first menstrual cycle to be heavier than normal, and the volume of her subsequent cycles to return to prepregnant levels within three or four cycles. This is an accurate statement and indicates her understanding of her expected menstrual activity. Most women experience a heavier than normal flow during the first menstrual cycle, which occurs by 3 months after childbirth. She can expect her first menstrual cycle to be heavier than normal, and the volume of her subsequent cycles to return to prepregnant levels within three or four cycles.)

Cardiovascular system changes occur during pregnancy. Which finding would be considered normal for a woman in her second trimester? A. Less audible heart sounds (S1, S2) B. Increased pulse rate C. Increased blood pressure D. Decreased red blood cell (RBC) production

B (Splitting of S1 and S2 is more audible. Between 14 and 20 weeks of gestation, the pulse increases about 10 to 15 beats/min, which persists to term)

Which description of postpartum restoration or healing times is accurate? a. The cervix shortens, becomes firm, and returns to form within a month postpartum. b. Rugae reappear within 3 to 4 weeks. c. Most episiotomies heal within a week. d. Hemorrhoids usually decrease in size within 2 weeks of childbirth. Which description of postpartum restoration or healing times is accurate? a. The cervix shortens, becomes firm, and returns to form within a month postpartum. b. Rugae reappear within 3 to 4 weeks. c. Most episiotomies heal within a week. d. Hemorrhoids usually decrease in size within 2 weeks of childbirth.

B (The cervix regains its form within days; the cervical os may take longer. Rugae are never again as prominent as in a nulliparous woman. Localized dryness may occur until ovarian function resumes. Most episiotomies take 2 to 3 weeks to heal. Hemorrhoids can take 6 weeks to decrease in size.)

When assessing the fetal heart rate (FHR) of a woman at 30 weeks of gestation, the nurse counts a rate of 82 beats/min. Initially the nurse should: A. recognize that the rate is within normal limits and record it. B. assess the woman's radial pulse. C. notify the physician. D. allow the woman to hear the heartbeat.

B (The expected FHR is 120 to 160 beats/min. The nurse may have inadvertently counted the uterine souffle, the beatlike sound of blood flowing through the uterine blood vessels, which corresponds to the mother's heartbeat)

An ultrasound is performed on a client at term gestation that is experiencing moderate vaginal bleeding. The results of the ultrasound indicate that an abruptio placenta is present. Based on these findings, the nurse would prepare the client for: A. Complete bed rest for the remainder of the pregnancy B. Delivery of the fetus C. Strict monitoring of intake and output D. The need for weekly monitoring of coagulation studies until the time of delivery

B (The goal of management in abruptio placentae is to control the hemorrhage and deliver the fetus as soon as possible. Delivery is the treatment of choice if the fetus is at term gestation or if the bleeding is moderate to severe and the mother or fetus is in jeopardy.)

Felicia is a G 2 P 1001 at 40 weeks gestation who presents to L&D in early labor. Her bag of waters is NOT broken yet. What should the nurse use to assess fetal health? a. tocotransducer b. ultrasound transducer c. cardiotachometer d. Intrauterine pressure transducer

B (The water has not broken yet, so you cannot use the internal fetal monitor. You would use an external monitor to be less evasive to the mother and fetus)

If exhibited by an expectant father, what would be a warning sign of ineffective adaptation to his partner's first pregnancy? a. Views pregnancy with pride as a confirmation of his virility b. Consistently changes the subject when the topic of the fetus/newborn is raised c. Expresses concern that he might faint at the birth of his baby d. Experiences nausea and fatigue, along with his partner, during the first trimester

B (This is an expected view for an expectant father. Persistent refusal to talk about the fetus-newborn may be a sign of a problem and should be assessed further. This is an expected feeling for an expectant father. This is an expected finding with expectant fathers.)

A nurse is reviewing the health record of a client who is pregnant. The provider indicated the client exhibits probable signs of pregnancy. Which of the following findings should the nurse expect? (Select all that apply.) a. Montgomery's glands b. Goodell's sign c. Ballottement d. Chadwick's sign e. Quickening

B C D (Montgomery's glands are a presumptive sign of pregnancy. Goodell's sign is a probable sign of pregnancy. Ballottement is a probable sign of pregnancy. Chadwick's sign is a probable sign of pregnancy. Quickening is a presumptive sign of pregnancy.)

A nurse is providing care for a client who is diagnosed with marginal abroptio placentae. The nurse is aware that which of the following findings are risk factors for developing the condition? (Select all that apply.) a. Fetal position b. Blunt abdominal trauma c. Cocaine use d. Maternal age e. Cigarette smoking

B C E

When helping a woman cope with postpartum blues, the nurse should offer what appropriate suggestions? (Select all that apply.) a. The father should take over care of the baby, because postpartum blues are exclusively a female problem. b. Get plenty of rest. c. Plan to get out of the house occasionally. d. Asking for help will not foster independence. e. Use La Leche League or community mental health centers.

B C E

A nurse is reviewing the medical record of a client who is menopausal. Which of the following findings should the nurse expect? (Select all that apply.) a. Increased vaginal secretions b. Decreased bone density c. Increased HDL level d. Decreased skin elasticity e. Increased pubic hair growth f. Decreased FSH level

B D

A cervical examination at 1300 confirms the transition phase as Dinah is 8/100/0 station.Dinah now states that she would like an epidural. What are some good responses by the nurse? a. immediately go grab the epidural b. Provide the patient only ibuprofen as she is clearly fine c. try other routes of pain relief first before going with an epidural d. Call the physician for a second opinion

C

A nurse at an antepartum clinic is caring for a client who is at 4 months of gestation. The client reports continued nausea and vomiting and scant, prune-colored discharge. She has experienced no weight loss and has a fundal height larger than expected. Which of the following complications should the nurse suspect? a. Hyperemesis gravidarum b. Threatened abortion c. Hydatidiform mole d. Preterm labor

C

A nurse implements a teaching plan for a pregnant client who is newly diagnosed with gestational diabetes. Which statement if made by the client indicates a need for further education? A. "I need to stay on the diabetic diet." B. "I will perform glucose monitoring at home." C. "I need to avoid exercise because of the negative effects of insulin production." D. "I need to be aware of any infections and report signs of infection immediately to my health care provider."

C

A nurse is assessing a newborn who is 12 hr old. Which of the following clinical manifestations requires intervention by the nurse? a. Acrocyanosis of the extremities b. Murmur at the left sternal border c. Substernal chest retractions while sleeping d. Positive Babinski reflex

C

A nurse is caring for a client at 30 weeks gestation who has just been diagnosed with gestational diabetes. The client has a lot of questions about the risks to her baby with GDM. What is the best explanation by the nurse for why her fetus is at risk for macrosomia and hypoglycemia at delivery? a. To prevent macrosomia, you should only gain 11-20 lbs. total during this pregnancy. b. When your blood sugar levels are too high, the insulin that you make can cross the placenta and affect your baby's metabolism. c. Extra sugar (glucose) can cross the placenta to your baby. This may cause your baby to gain extra weight and to have sudden low blood glucose after birth. d. Your baby may be born with diabetes.

C

A nurse is completing the admission assessment of a client who is at 38 weeks gestation and has severe preeclampsia. Which one of the following findings is consistent with the diagnosis of severe preeclampsia? a. Polyuria b. Absence of clonus c. Epigastric pain d. Tachycardia

C

A nurse is teaching a client who has pre gestational type 1 diabetes mellitus about management during pregnancy. Which of the following statements by the client indicates an understanding of the teaching? a. "I should have a goal of maintaining my fasting blood glucose between 100 and 120." b. "I should engage in moderate exercise for 30 minutes if my blood glucose is 250 or greater." c. "I will continue taking my insulin if I experience nausea and vomiting." d. "I will ensure that my bedtime snack is high in refined sugar.

C

A patient who has recently moved to this country states he is frustrated about the pressure to give up his original identity and develop a new cultural identity. The nurse should use which term to best describe this type of cultural change? a. Biculturalism b. Acculturation c. Assimilation d. Ethnicity identification

C

Before the CRNA can get to Dinah's room, she states "I feel like I need to push!". Cervical examination reveals 10 cm/ 100% / +2. Now, what is the role of the nurse? a. call the physician b. conduct a vaginal examination c. prepare the mother for delivery and encourage effective pushing d. Ensure that the mother does not push as she is not ready

C

How many fetal movements should a mother feel within an hour? a. 5 b. 20 c. 10 d. 1

C

The nurse is triaging a Latin-Caribbean patient who is behaving hysterically in the emergency room. The patient is crying, has uncontrollable spasms, and is trembling and shouting. It is important to identify the manifestation of illness in order to effectively treat a patient. The nurse identifies this as a culture-bound syndrome called a. Shenjing shaijo. b. Loco de la cabeza. c. Ataque de nervios. d. Neurasthenia.

C

What is considered a normal rate for regular contractions? a. every 10 minutes b. anything 6 minutes apart or closer c. anything 5 minutes apart or closer d. as long as they are happening its good

C

What is the MSAFP screening test used to assess for? a. infection b. signs of ectopic pregnancy c. neural tube defects and downs syndrome d. to determine if she is indeed pregnant

C

When making a visit to the home of a postpartum woman 1 week after birth, the nurse should recognize that the woman would characteristically: a. express a strong need to review events and her behavior during the process of labor and birth. b. exhibit a reduced attention span, limiting readiness to learn. c. vacillate between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn. d. have reestablished her role as a spouse/partner.

C

Which hematocrit (Hct) and hemoglobin (Hgb) results represent(s) the lowest acceptable values for a woman in the third trimester of pregnancy? A. 38% Hct; 14 g/dL Hgb B. 35% Hct; 13 g/dL Hgb C. 33% Hct; 11 g/dL Hgb D. 32% Hct; 10.5 g/dL Hgb

C

Which measure would be least effective in preventing postpartum hemorrhage? a. Administer Methergine, 0.2 mg every 6 hours for four doses, as ordered b. Encourage the woman to void every 2 hours c. Massage the fundus every hour for the first 24 hours following birth d. Teach the woman the importance of rest and nutrition to enhance healing

C

Which minerals and vitamins usually are recommended to supplement a pregnant woman's diet? A. Fat-soluble vitamins A and D B. Water-soluble vitamins C and B6 C. Iron and folate D. Calcium and zinc

C

A nurse is caring for a pregnant client with Preeclampsia. The nurse prepares a plan of care for the client and documents in the plan that if the client progresses from Preeclampsia to eclampsia, the nurse's first action is to: A. Administer magnesium sulfate intravenously B. Assess the blood pressure and fetal heart rate C. Clean and maintain an open airway D. Administer oxygen by face mask

C (The immediate care during a seizure (eclampsia) is to ensure a patent airway. The other options are actions that follow or will be implemented after the seizure has ceased.)

The nurse is preparing to discharge a 30-year-old woman who has experienced a miscarriage at 10 weeks of gestation. Which statement by the woman would indicate a correct understanding of the discharge instructions? a. "I will not experience mood swings since I was only at 10 weeks of gestation." b. "I will avoid sexual intercourse for 6 weeks and pregnancy for 6 months." c. "I should eat foods that are high in iron and protein to help my body heal." d. "I should expect the bleeding to be heavy and bright red for at least 1 week."

C (After a miscarriage a woman may experience mood swings and depression from the reduction of hormones and the grieving process. Sexual intercourse should be avoided for 2 weeks or until the bleeding has stopped and should avoid pregnancy for 2 months. A woman who has experienced a miscarriage should be advised to eat foods that are high in iron and protein to help replenish her body after the loss. The woman should not experience bright red, heavy, profuse bleeding; this should be reported to the health care provider.)

An expectant father confides in the nurse that his pregnant wife, 10 weeks of gestation, is driving him crazy. "One minute she seems happy, and the next minute she is crying over nothing at all. Is there something wrong with her?" The nurse's BEST response would be: a. "This is normal behavior and should begin to subside by the second trimester." b. "She may be having difficulty adjusting to pregnancy; I will refer her to a counselor that I know." c. "This is called emotional liability and is related to hormone changes and anxiety during pregnancy. The mood swings will eventually subside as she adjusts to being pregnant." d. "You seem impatient with her. Perhaps this is precipitating her behavior."

C (Although this statement is appropriate, it does not answer the father's question. Mood swings are a normal finding in the first trimester; the woman does not need counseling. This is the most appropriate response since it gives an explanation and a time frame for when the mood swings may stop. This statement is judgmental and not appropriate.)

Signs of a threatened abortion (miscarriage) are noted in a woman at 8 weeks of gestation. What is an appropriate management approach for this type of abortion? a. Prepare the woman for a dilation and curettage (D&C). b. Place the woman on bed rest for at least 1 week and reevaluate. c. Prepare the woman for an ultrasound and blood work. d. Comfort the woman by telling her that if she loses this baby, she may attempt to get pregnant again in 1 month.

C (D&C is not considered until signs of the progress to an inevitable abortion are noted or the contents are expelled and incomplete. Bed rest is recommended for 48 hours initially. Repetitive transvaginal ultrasounds and measurement of human chorionic gonadotropin (hCG) and progesterone levels may be performed to determine if the fetus is alive and within the uterus. If the pregnancy is lost, the woman should be guided through the grieving process. Telling the client that she can get pregnant again soon is not a therapeutic response because it discounts the importance of this pregnancy.)

During the first trimester the pregnant woman would be most motivated to learn about: a. fetal development. b. impact of a new baby on family members. c. measures to reduce nausea and fatigue so she can feel better. d. location of childbirth preparation and breastfeeding classes.

C (Fetal development concerns are more apparent in the second trimester when the woman is feeling fetal movement. Impact of a new baby on the family would be appropriate topics for the second trimester when the fetus becomes "real" as its movements are felt and its heartbeat heard. During this trimester a woman works on the task of, "I am going to have a baby." During the first trimester a woman is egocentric and concerned about how she feels. She is working on the task of accepting her pregnancy. Motivation to learn about childbirth techniques and breastfeeding is greatest for most women during the third trimester as the reality of impending birth and becoming a parent is accepted. A goal is to achieve a safe passage for herself and her baby.)

A woman with preeclampsia is receiving magnesium sulfate. The nurse assigned to care for the client determines that the magnesium therapy is effective if: A. Ankle clonus in noted B. The blood pressure decreases C. Seizures do not occur D. Scotomas are present

C (For a client with preeclampsia, the goal of care is directed at preventing eclampsia (seizures). Magnesium sulfate is an anticonvulsant, not an antihypertensive agent. Although a decrease in blood pressure may be noted initially, this effect is usually transient. Ankle clonus indicated hyperreflexia and may precede the onset of eclampsia. Scotomas are areas of complete or partial blindness. Visual disturbances, such as scotomas, often precede an eclamptic seizure.)

A nurse is assessing a pregnant client in the 2nd trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which of the following assessment findings would the nurse expect to note if this condition is present? A. Absence of abdominal pain B. A soft abdomen C. Uterine tenderness/pain D. Painless, bright red vaginal bleeding

C (In abruptio placentae, acute abdominal pain is present. Uterine tenderness and pain accompanies placental abruption, especially with a central abruption and trapped blood behind the placenta. The abdomen will feel hard and boardlike on palpation as the blood penetrates the myometrium and causes uterine irritability. Observation of the fetal monitoring often reveals increased uterine resting tone, caused by failure of the uterus to relax in attempt to constrict blood vessels and control bleeding.)

With regard to the condition and reconditioning of the urinary system after childbirth, nurses should be aware that: a. kidney function returns to normal a few days after birth. b. diastasis recti abdominis is a common condition that alters the voiding reflex. c. fluid loss through perspiration and increased urinary output account for a weight loss of more than 2 kg during the puerperium. d. with adequate emptying of the bladder, bladder tone usually is restored 2 to 3 weeks after childbirth.

C (Kidney function usually returns to normal in about a month. Diastasis recti abdominis is the separation of muscles in the abdominal wall; it has no effect on the voiding reflex. Excess fluid loss through other means occurs as well. Bladder tone usually is restored 5 to 7 days after childbirth.)

A primigravida is receiving magnesium sulfate for the treatment of pregnancy induced hypertension (PIH). The nurse who is caring for the client is performing assessments every 30 minutes. Which assessment finding would be of most concern to the nurse? A. Urinary output of 20 ml since the previous assessment B. Deep tendon reflexes of 2+ C. Respiratory rate of 10 BPM D. Fetal heart rate of 120 BPM

C (Magnesium sulfate depresses the respiratory rate. If the respiratory rate is less than 12 breaths per minute, the physician or other health care provider needs to be notified, and continuation of the medication needs to be reassessed. A urinary output of 20 ml in a 30 minute period is adequate; less than 30 ml in one hour needs to be reported. Deep tendon reflexes of 2+ are normal. The fetal heart rate is WNL for a resting fetus.)

A maternity nurse is preparing for the admission of a client in the 3rd trimester of pregnancy that is experiencing vaginal bleeding and has a suspected diagnosis of placenta previa. The nurse reviews the physician's orders and would question which order? A. Prepare the client for an ultrasound B. Obtain equipment for external electronic fetal heart monitoring C. Obtain equipment for a manual pelvic examination D. Prepare to draw a Hgb and Hct blood sample

C (Manual pelvic examinations are contraindicated when vaginal bleeding is apparent in the 3rd trimester until a diagnosis is made and placental previa is ruled out. Digital examination of the cervix can lead to maternal and fetal hemorrhage. A diagnosis of placenta previa is made by ultrasound. The H/H levels are monitored, and external electronic fetal heart rate monitoring is initiated. External fetal monitoring is crucial in evaluating the fetus that is at risk for severe hypoxia.)

When making a visit to the home of a postpartum woman one week after birth, the nurse should recognize that the woman would characteristically: A. Express a strong need to review events and her behavior during the process of labor and birth B. Exhibit a reduced attention span, limiting readiness to learn C. Vacillate between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn D. Have reestablished her role as a spouse/partner

C (One week after birth the woman should exhibit behaviors characteristic of the taking-hold stage as described in response 3. This stage lasts for as long as 4 to 5 weeks after birth. Responses 1 and 2 are characteristic of the taking-in stage, which lasts for the first few days after birth. Response 4 reflects the letting-go stage, which indicates that psychosocial recovery is complete.)

A pregnant woman demonstrates understanding of the nurse's instructions regarding relief of leg cramps if she: a. Wiggles and points her toes during the cramp. b. Applies cold compresses to the affected leg. c. Extends her leg and dorsiflexes her foot during the cramp. d. Avoids weight bearing on the affected leg during the cramp.

C (Pointing toes can aggravate rather than relieve the cramp. Application of heat is recommended. Extending the leg and dorsiflexing the foot is the appropriate relief for a leg cramp. Bearing weight on the affected leg can help to relieve the leg cramp, so it should not be avoided.)

Following the birth of her baby, a woman expresses concern about the weight she gained during pregnancy and how quickly she can lose it now that the baby is born. The nurse, in describing the expected pattern of weight loss, should begin by telling this woman that: a. return to prepregnant weight is usually achieved by the end of the postpartum period. b. fluid loss from diuresis, diaphoresis, and bleeding accounts for about a 3-lb weight loss. c. the expected weight loss immediately after birth averages about 11 to 13 lbs. d. lactation will inhibit weight loss since caloric intake must increase to support milk production.

C (Prepregnant weight is usually achieved by 2 to 3 months after birth, not within the 6-week postpartum period. Weight loss from diuresis, diaphoresis, and bleeding is about 9 lbs. The expected weight loss immediately following delivery is 11 to 13 lbs, followed by a gradual decrease and a return to prepregnancy weight in 2 to 3 months. Weight loss continues during breastfeeding since fat stores developed during pregnancy and extra calories consumed are used as part of the lactation process.)

You know that which of the following would be an example of a psychosocial risk factor related to reproduction? a. Pelvic Inflammatory Disease (PID) b. Secondhand smoking c. Drug addiction d. Lack of insurance

C (Psychosocial risk factors include: Isolation, anxiety, depression, spousal abuse or inter partner violence, drug and alcohol use and addiction.)

A woman's cousin gave birth to an infant with a congenital heart anomaly. The woman asks the nurse when such anomalies occur during development. Which response by the nurse is most accurate? a. "We don't really know when such defects occur." b. "It depends on what caused the defect." c. "They occur between the third and fifth weeks of development." d. "They usually occur in the first 2 weeks of development."

C (Regardless of the cause, the heart is vulnerable during its period of development, the third to fifth weeks. The cardiovascular system is the first organ system to function in the developing human. Blood vessel and blood formation begins in the third week, and the heart is developmentally complete in the fifth week. This is an inaccurate statement.)

A female patient comes to the clinic at 8 weeks' gestation. She lives in a house beneath electrical power lines, which is located near an oil field. She drinks two caffeinated beverages a day, is a daily beer drinker, and has not stopped eating sweets. She takes a multivitamin and exercises daily. She denies drug use. Which finding in the history has the greatest implication for this patient's plan of care? a. Electrical power lines are a potential hazard to the woman and her fetus. b. Living near an oil field may mean the water supply is polluted. c. Drinking alcohol should be avoided during pregnancy because of its teratogenic effects. d. Eating sweets may cause gestational diabetes or miscarriage.

C (Stages of development include the ovum, the embryo, and the fetus. The embryonic period lasts from the beginning of the fourth week to the end of the eighth week of gestation. Teratogenicity is a major concern because all external and internal structures are developing in the embryonic period. During pregnancy, a woman should avoid exposure to all potential toxins, especially alcohol, tobacco, radiation, and infectious agents. Living beneath power line or near an oil field is not teratogenic in itself. Stopping sweets can be addressed after the alcohol cessation is addressed.)

With regard to afterbirth pains, nurses should be aware that these pains are: a. caused by mild, continual contractions for the duration of the postpartum period. b. more common in first-time mothers. c. more noticeable in births in which the uterus was overdistended. d. alleviated somewhat when the mother breastfeeds.

C (The cramping that causes afterbirth pains arises from periodic, vigorous contractions and relaxations that persist through the first part of the postpartum period. Afterbirth pains are more common in multiparous women because first-time mothers have better uterine tone. A large baby or multiple babies overdistend the uterus. Breastfeeding intensifies afterbirth pain because it stimulates contractions.)

Which measure would be least effective in preventing postpartum hemorrhage? A. Administer Methergine 0.2 mg every 6 hours for 4 doses as ordered B. Encourage the woman to void every 2 hours C. Massage the fundus every hour for the first 24 hours following birth D. Teach the woman the importance of rest and nutrition to enhance healing

C (The fundus should be massaged only when boggy or soft. Massaging a firm fundus could cause it to relax. Responses 1, 2, and 4 are all effective measures to enhance and maintain contraction of the uterus and to facilitate healing.)

A pregnant woman at 10 weeks of gestation jogs three or four times per week. She is concerned about the effect of exercise on the fetus. The nurse should inform her: a. "You don't need to modify your exercising any time during your pregnancy." b. "Stop exercising, because it will harm the fetus." c. "You may find that you need to modify your exercise to walking later in your pregnancy, around the seventh month." d. "Jogging is too hard on your joints; switch to walking now."

C (The nurse should inform the woman that she may need to reduce her exercise level as the pregnancy progresses. Physical activity promotes a feeling of well-being in pregnant women. It improves circulation, promotes relaxation and rest, and counteracts boredom. Typically, running should be replaced with walking around the seventh month of pregnancy. Simple measures should be initiated to prevent injuries, such as warm-up and stretching exercises to prepare the joints for more strenuous exercise.)

The student nurse is giving a presentation about milestones in embryonic development. Which information should he or she include? a. At 8 weeks of gestation, primary lung and urethral buds appear. b. At 12 weeks of gestation, the vagina is open or the testes are in position for descent into the scrotum. c. At 20 weeks of age, the vernix caseosa and lanugo appear. d. At 24 weeks of age, the skin is smooth, and subcutaneous fat is beginning to collect.

C (The primary lung and urethral buds appear at 6 weeks of gestation. The vagina is open or the testes are in position for descent into the scrotum at 16 weeks. Two milestones that occur at 20 weeks are the appearance of the vernix caseosa and lanugo. The appearance of smooth skin occurs at 28 weeks, and subcutaneous fat begins to collect at 30 to 31 weeks.)

A nurse is reviewing formula preparation with parents who plan to bottle-feed their newborn. Which of the following information should the nurse include in the teaching? (Select all that apply.) a. Use a disinfectant wipe to clean the lid of the formula can. b. Store prepared formula in the refrigerator for up to 72 hours. c. Place used bottles in the dishwasher. d. Check the nipple for appropriate flow of formula. e. Use tap water to dilute concentrated formula.

C D E

A postpartum woman preparing for discharge asks the nurse about resuming sexual activity. Which information is appropriate to include in the patient teaching? (Select all that apply.) a. Do not perform Kegel exercises to decrease pelvic floor muscle healing time. b. If breastfeeding, sexual interest may be delayed. c. Fatigue may affect interest in sexual activity. d. Sexual activity can usually be safely resumed by 5 to 6 weeks after birth. e. Water-soluble lubrication may increase comfort. f. The female-on-top position may be more comfortable than other positions.

C D E F

A nurse is caring for a pregnant client with severe preeclampsia who is receiving IV magnesium sulfate. Select all nursing interventions that apply in the care for the client. A. Monitor maternal vital signs every 2 hours B. Notify the physician if respirations are less than 18 per minute. C. Monitor renal function and cardiac function closely D. Keep calcium gluconate on hand in case of a magnesium sulfate overdose E. Monitor deep tendon reflexes hourly F. Monitor I and O's hourly G. Notify the physician if urinary output is less than 30 ml per hour.

C D E F G (When caring for a client receiving magnesium sulfate therapy, the nurse would monitor maternal vital signs, especially respirations, every 30-60 minutes and notify the physician if respirations are less than 12, because this would indicate respiratory depression. Calcium gluconate is kept on hand in case of magnesium sulfate overdose, because calcium gluconate is the antidote for magnesium sulfate toxicity. Deep tendon reflexes are assessed hourly. Cardiac and renal function is monitored closely. The urine output should be maintained at 30 ml per hour because the medication is eliminated through the kidneys.)

A 22-year-old woman pregnant with a single fetus has a preconception body mass index (BMI) of 24. When she was seen in the clinic at 14 weeks of gestation, she had gained 1.8 kg (4 lbs) since conception. How would the nurse interpret this? A. This weight gain indicates possible gestational hypertension. B. This weight gain indicates that the woman's infant is at risk for intrauterine growth restriction (IUGR). C. This weight gain cannot be evaluated until the woman has been observed for several more weeks. D. The woman's weight gain is appropriate for this stage of pregnancy.

D

A married couple present to the preconceptual clinic with questions about how a fetus's chromosomal sex is established. What is the nurse's best response? a. At ovulation, chromosomal sex is established. b. At ejaculation, chromosomal sex is established. c. At climax, chromosomal sex is established. d. At fertilization, chromosomal sex is established.

D

A nurse in a prenatal clinic is reviewing results from recent one-hour oral glucose tolerance tests. Which one of the 4 pregnant clients needs to be scheduled for a follow-up, diagnostic three-hour glucose tolerance test? a. One hour GTT result: 115 mg/dl b. One hour GTT result: 95 mg/dl c. One hour GTT result: 125 mg/dl d. One hour GTT result: 160 mg/dl

D

A nurse is assessing a patient with preeclampsia who delivered 12 hours ago. Which of the following assessments would indicate that the condition has not yet resolved? a. blood pressure reading at prenatal baseline b. adequate urinary output and no proteinuria c. presence of 1-2+ deep tendon reflexes d. patient complaints of blurred vision and headache D

D

A nurse is caring for a client who has a diagnosis of ruptured ectopic pregnancy. Which of the following findings is seen with this condition? a. No alteration in menses b. Transvaginal ultrasound indicating a fetus in the uterus c. Serum progesterone greater than the expected reference range d. Report of severe shoulder pain

D

A nurse is caring for a newborn immediately following birth. Which of the following nursing interventions is the highest priority? a. Initiating breastfeeding b. Performing the initial bath c. Giving a vitamin K injection d. Covering the newborns head with a cap

D

A nurse is planning care for a client who is 2 hr postpartum. Which of the following interventions should the nurse plan to implement during the taking-hold phase of postpartum behavioral adjustment? a. Discuss contraceptive options with the client and her partner b. Repeat information to ensure client understanding c. Listen to the client and her partner as they reflect upon the birth experience d. Demonstrate the client how to perform a newborn bath

D

A nurse is preparing to collect a blood specimen from a newborn via a heel stick. Which of the following techniques should the nurse use to help minimize the pain of the procedure for the newborn? a. Apply a cool pack for 10 min to the heel prior to the puncture. b. Request a prescription for IM analgesic. c. Use a manual lance blade to pierce the skin. d. Place the newborn skin to skin on the mother's chest.

D

A nurse is reviewing discharge teaching with a client who has premature rupture of membranes at 26 weeks gestation. Which of the following instruction should the nurse include in the teaching? a. Use a condom with sexual intercourse. b. Avoid bubble bath solution when taking a tub bath. c. Wipe from the back to front when performing perineal hygiene. d. Keep a daily record of fetal kick counts.

D

Dinah and her husband are spending time with their newborn, skin to skin, while the provider awaits the delivery of the placenta. What stage of labor is this? What is the nurse's role during this time? a. Stage 2; nurse can now attend to other patients b. Stage 3; nurse takes baby away for lab draws c. Stage 2; encourages breast feeding d. Stage 3; nurse conducts APGAR scores and takes vitals

D

On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. The nurse's first action is to: a. begin an IV infusion of Ringer's lactate solution. b. assess the woman's vital signs. c. call the woman's primary health care provider. d. massage the woman's fundus.

D

Over-the-counter (OTC) pregnancy tests usually rely on which technology to test for human chorionic gonadotropin (hCG)? A. Radioimmunoassay B. Radioreceptor assay C. Latex agglutination test D. Enzyme-linked immunosorbent assay (ELISA)

D

Postpartum women experience an increased risk for urinary tract infection. A prevention measure the nurse could teach the postpartum woman would be to: a. acidify the urine by drinking three glasses of orange juice each day. b. maintain a fluid intake of 1 to 2 L/day. c. empty her bladder every 4 hours throughout the day. d. perform perineal care on a regular basis.

D

Two hours after giving birth a primiparous woman becomes anxious and complains of intense perineal pain with a strong urge to have a bowel movement. Her fundus is firm at the umbilicus and midline. Her lochia is moderate rubra with no clots. The nurse suspects: a. bladder distention b. uterine atony c. constipation d. hematoma formation

D

When counseling a client about getting enough iron in her diet, the maternity nurse should tell her that: A. milk, coffee, and tea aid iron absorption if consumed at the same time as iron. B. iron absorption is inhibited by a diet rich in vitamin C. C. iron supplements are permissible for children in small doses. D. constipation is common with iron supplements.

D

A nurse in the postpartum unit is caring for a client who has just delivered a newborn infant following a pregnancy with placenta previa. The nurse reviews the plan of care and prepares to monitor the client for which of the following risks associated with placenta previa? A. Disseminated intravascular coagulation B. Chronic hypertension C. Infection D. Hemorrhage

D (Because the placenta is implanted in the lower uterine segment, which does not contain the same intertwining musculature as the fundus of the uterus, this site is more prone to bleeding.)

A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of: a. eclamptic seizure. b. rupture of the uterus. c. placenta previa. d. placental abruption. A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of: a. eclamptic seizure. b. rupture of the uterus. c. placenta previa. d. placental abruption.

D (Eclamptic seizures are evidenced by the presence of generalized tonic-clonic convulsions. Uterine rupture presents as hypotonic uterine activity, signs of hypovolemia, and in many cases the absence of pain. Placenta previa presents with bright red, painless vaginal bleeding. Uterine tenderness in the presence of increasing tone may be the earliest finding of premature separation of the placenta (abruptio placentae or placental abruption). Women with hypertension are at increased risk for an abruption.)

A nurse at a prenatal clinic is caring for a client who suspects she may be pregnant and asks the nurse how the provider will confirm her pregnancy. The nurse should inform the client that which of the following lab tests will be used to confirm her pregnancy? a. A blood test for the presence of estrogen b. A blood test for the amount of circulating progesterone c. A urine test for the presence of human chorionic somatomammotropin d. A urine test for the presence of human chorionic gonadotropin

D (HCG is excreted by the placenta and promotes the excretion of progesterone and estrogen. This hormone is the basis for pregnancy testing.)

Postbirth uterine/vaginal discharge, called lochia: a. is similar to a light menstrual period for the first 6 to 12 hours. b. is usually greater after cesarean births. c. will usually decrease with ambulation and breastfeeding. d. should smell like normal menstrual flow unless an infection is present.

D (Lochia flow should approximate a heavy menstrual period for the first 2 hours and then steadily decrease. Less lochia usually is seen after cesarean births. Lochia usually increases with ambulation and breastfeeding. An offensive odor usually indicates an infection.)

If exhibited by a pregnant woman, what represents a positive sign of pregnancy? A. Morning sickness B. Quickening C. Positive pregnancy test D. Fetal heartbeat auscultated with Doppler/fetoscope

D (Morning sickness and quickening, along with amenorrhea and breast tenderness, are presumptive signs of pregnancy; subjective findings are suggestive but not diagnostic of pregnancy)

You are working with a college student who is planning to become sexually active. She is requesting a reliable method of birth control that could be easily discontinued if necessary. Which option should be given the strongest recommendation? a. Intrauterine device (IUD) b. Coitus interruptus c. Natural family planning d. Oral contraceptive pills

D (Oral contraceptive pills prevent ovulation, are easy to stop, and are 99% effective in pregnancy prevention. Intrauterine devices, coitus interruptus, and natural family planning will not prevent ovulation; they should not be recommended for this college student who desires a reliable method of birth control that can be easily discontinued.)

A woman who is 14 weeks pregnant tells the nurse that she always had a glass of wine with dinner before she became pregnant. She has abstained during her first trimester and would like to know if it is safe for her to have a drink with dinner now. The nurse tells her: a. "Because you're in your second trimester, there's no problem with having one drink with dinner." b. "One drink every night is too much. One drink three times a week should be fine." c. "Because you're in your second trimester, you can drink as much as you like." d. "Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy."

D (Regardless of which trimester the woman has reached, no amount of alcohol during pregnancy has been deemed safe for the fetus. Neither one drink per night nor three drinks per week is a safe recommendation. Although the first trimester is a crucial period of fetal development, pregnant women of all gestations are counseled to eliminate all alcohol from their diet. A safe level of alcohol consumption during pregnancy has not yet been established. Although the consumption of occasional alcoholic beverages may not be harmful to the mother or her developing fetus, complete abstinence is strongly advised.)

Four hours after a difficult labor and birth, a primiparous woman refuses to feed her baby, stating that she is too tired and just wants to sleep. The nurse should: A. Tell the woman she can rest after she feeds her baby B. Recognize this as a behavior of the taking-hold stage C. Record the behavior as ineffective maternal-newborn attachment D. Take the baby back to the nursery, reassuring the woman that her rest is a priority at this time

D (Response 1 does not take into consideration the need for the new mother to be nurtured and have her needs met during the taking-in stage. The behavior described is typical of this stage and not a reflection of ineffective attachment unless the behavior persists. Mothers need to reestablish their own well-being in order to effectively care for their baby.)

An expectant couple asks the nurse about intercourse during pregnancy and if it is safe for the baby. The nurse should tell the couple that: a. intercourse should be avoided if any spotting from the vagina occurs afterward. b. intercourse is safe until the third trimester. c. safer-sex practices should be used once the membranes rupture. d. intercourse and orgasm are often contraindicated if a history or signs of preterm labor are present.

D (Some spotting can normally occur as a result of the increased fragility and vascularity of the cervix and vagina during pregnancy. Intercourse can continue as long as the pregnancy is progressing normally. Safer-sex practices are always recommended; rupture of the membranes may require abstaining from intercourse. Uterine contractions that accompany orgasm can stimulate labor and would be problematic if the woman were at risk for or had a history of preterm labor.)

Which of the following symptoms occurs with a hydatidiform mole? A. Heavy, bright red bleeding every 21 days B. Fetal cardiac motion after 6 weeks gestation C. Benign tumors found in the smooth muscle of the uterus D. "Snowstorm" pattern on ultrasound with no fetus or gestational sac

D (The chorionic villi of a molar pregnancy resemble a snowstorm pattern on ultrasound. Bleeding with a hydatidiform mole is often dark brown and may occur erratically for weeks or months.)

In order to reassure and educate pregnant clients about changes in their blood pressure, maternity nurses should be aware that: A. a blood pressure cuff that is too small produces a reading that is too low; a cuff that is too large produces a reading that is too high. B. shifting the client's position and changing from arm to arm for different measurements produces the most accurate composite blood pressure reading at each visit. C. the systolic blood pressure increases slightly as pregnancy advances; the diastolic pressure remains constant. D. compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the latter stage of term pregnancy.

D (This compression also leads to varicose veins in the legs and vulva)

A pregnant woman at 32 weeks of gestation complains of feeling dizzy and light-headed while her fundal height is being measured. Her skin is pale and moist. The nurse's initial response would be to: a. assess the woman's blood pressure and pulse. b. have the woman breathe into a paper bag. c. raise the woman's legs. d. turn the woman on her side.

D (Vital signs can be assessed next. Breathing into a paper bag is the solution for dizziness related to respiratory alkalosis associated with hyperventilation. Raising her legs will not solve the problem since pressure will still remain on the major abdominal blood vessels, thereby continuing to impede cardiac output. During a fundal height measurement the woman is placed in a supine position. This woman is experiencing supine hypotension as a result of uterine compression of the vena cava and abdominal aorta. Turning her on her side will remove the compression and restore cardiac output and blood pressure.)

Which findings would be a source of concern if noted during the assessment of a woman who is 12 hours' postpartum? (Select all that apply.) a. Postural hypotension b. Temperature of 100.4° F c. Bradycardia—pulse rate of 55 beats/min d. Pain in left calf with dorsiflexion of left foot e. Lochia rubra with foul odor

D E

True or false: Initially, menstrual periods are irregular, unpredictable, painless, and anovulatory (no ovum is released from the ovary).

True

Define VEAL CHOP

Variabile decelerations - Cord compression Early decelerations - Head compression Accelerations - Okay Late accelerations - Placental Insufficiency