fall 2018 maternal/newborn exam 1

In the 19th century, the most common cause of infant death was __________________.

"infectious diarrhea" (Rationale: Infectious diarrhea was caused by contaminated milk. The mothers used milk from infected cows and did not have refrigeration to prevent further bacteria growth.)

How can a nurse recognize assumptions? What are assumptions?

-Assumptions are ideas, beliefs, or values that are taken for granted without basis in fact or reason. -A list of EVERYTHING known about a specific situation may help in the identification of assumptions. -*Evaluate each item on what ever list to be determined if it is true, whether it could be true, and whether it is untrue or evidence is insufficient to determine its truth.*

What are assumptions and how can a nurse recognize them?

-Assumptions are ideas, beliefs, or values that are taken for granted without basis in fact or reason. -Assumptions lead to examined thoughts or unsound action. -A list of everything known about a specific situation may help in the identification of assumptions. Each item on the list should be analyzed to determine whether it is true, whether it could be true, and weather it is untrue or evidence is insufficient to determine its truth.

What are biases and how can a nurse examine biases?

-Biases are prejudices that sway the mind toward a particular conclusion or course of action on the basis of personal theories or stereotypes. -When faced with a predisposition to judge a person or a group of people ASK QUESTIONS: Why do you think that? What is this was a different person? What if it were different circumstances?

What are some of the concepts behind critical thinking that nurses need to be aware of? What is the purpose of critical thinking? Steps of how critical thinking is learned?

-For effective critical thinking nurses must gain insight into their own thought processes and analyze their own thinking by taking it apart for examination and criticism. -This is recognition and acknowledgement of specific habits and response that may interfere with productive thinking. -Purpose of critical thinking is obviously to help the nurse to make the best clinical judgement. -*ABCDEs of critical thinking include:* *-Assumptions* -examination of personal *BIASES* -analysis of the amount of pressure for *CLOSURE* -examination of how *DATA* are collected and analyzed -evaluation of how *EMOTIONS* may interfere with critical thinking

When is it time to determine the need for closure? How can anxious people overcome premature closure?

-Many people who look for immediate answers might experience a great deal of anxiety until the solution to a problem is solved. -These people may feel pressure to come to a decision to reach closure as soon as possible. *People who feel pressure to reach an early decision or find a quick solution SHOULD NOT DO IT WITH INSUFFICIENT DATA.* -To overcome pressure to reach an early conclusion you need to STOP the judgement. -Acknowledge the uncomfortableness and deliberately wait to make a decision. -Ask a series of questions: What alternatives do we have? What else might work? What information might support this? -*On the flip side, don't wait too long or procrastinate on making decisions*

What are guidelines for successful therapeutic communication?

1.) A restful setting that provides privacy, reduces distractions, and minimizes interruptions is ideal. 2.) Interactions should begin with introduction of yourself and describing your role. 3.) Therapeutic communication should be focused and directed toward meeting the needs expressed by the family. *Use open ended questions or redirect the conversation towards the prime objective.* 4.) Nonverbal behaviors may communicate more powerful messages than spoke words. *Facial expressions and eye movements could confirm or contradict what the woman says.* Avoid finger tapping, twirling a lock of hair, tapping a pen. This may indicate boredom or irritation. Women who are tired or depressed may neglect her own grooming. 5.) Active listening requires that the nurse attends to the words being said. -Make eye contact -have an erect posture with the upper body inclined towards the woman -use minimal cues like nodding, leaning closer, smiling, and expanding on information. -use of touch can be very powerful 6.) Be weary of cultural differences like prolonged eye contact with Asian cultures. Middle Eastern and Native American cultures may be uncomfortable with touch. 7.) Ensure that communication is clarified and that the message is what the sender of the message intended it to be. 8.) Reflect on their feelings that expressed verbally or non-verbally.

What are the following Nursing Specialties: 1.) Certified Nurse-Midwife 2.) Nurse Practitioner -WHNP -FNP -NNP -PNP 3.) Clinical Nurse Specialist.

1.) These are RN's who have completed an extensive program of study and clinical experience. They must pass a certification test. -They provide complete care during pregnancy, childbirth, and the postpartum period. -Only attend to the mother and infant if progress is normal. -They provide counseling and child support for the family. A lot of information regarding well-woman examinations, gynecology services, and family planning information is also included. -The practice approach for a CNM revolves around nonintervention and support. -Controversy over CNM's in the past has since resolved because they are now part of the health care team. 2.) Nurse practitioners are RN's with advanced preparation that allows them to provide primary care for specific groups of clients. -Their scope of practice involves taking a complete health history, performance of physical examinations, ordering and interpret laboratory and other diagnostic studies, and provide primary care/health maintenance/health promotion. -NP's normally work with the physician in regards to administration of Tx and medications. Depending on the state NP's may be able to prescribe some medications. *Women's health nurse practitioner (WHNP)* provides wellness focused primary, reproductive, and gynecologic care of a woman's life span beginning from adolescence. There is also STD screening and providing for family planning. -Women who arrive in an obstetric triage unit are unusually consulted by WHNP because they have non obstetric problems during pregnancy. *Family nurse practitioners (FNP)* are prepared to provide preventive, holistic care for the young and old family members. If pregnancies are NOT complicated they normally follow up on them and provide follow up care. There is normally NO assistance during childbirth. *Neonatal nurse practitioners (NNP)* assist in the care of high risk newborns and immediate post-birth care or NICU. *Pediatric nurse practitioners (PNP)* provide health maintenance care to infants and children who don't require services of the physician. 3.) *Clinical Nurse Specialists (CNS)* are RN's who through study and supervised practice level have acquired expertise in care of childbearing women with very complex problems. -This is normally involved in direct care, consultation, collaboration, coaching, research, and ethical decision making. -Normally don't provide primary care.

c. Deficiency in first weeks of pregnancy may cause spontaneous abortion and neural tube defects

48. Folic acid REF: 146 OBJ: Nursing Process Step: Assessment

a. Necessary for metabolism of calcium

49. Vitamin D REF: 147 OBJ: Nursing Process Step: Assessment

b. Necessary for mineralization of fetal bones and teeth

50. Calcium REF: 148 OBJ: Nursing Process Step: Assessment

b. Important in thyroid function

51. Iodine REF: 148 OBJ: Nursing Process Step: Assessment

a. Important in cell growth and neuromuscular function

52. Magnesium REF: 148 OBJ: Nursing Process Step: Assessment

c. Important in DNA and RNA synthesis

53. Zinc REF: 148 OBJ: Nursing Process Step: Assessment

During a presentation on prenatal care, the student nurse stated, "In 2000 the maternal mortality rate for African-American women was 22." The number "22" in this statement means there have been... A. 22 maternal deaths per 100,000 live births B. 22 serious maternal illnesses per 1000 live births C. 88 maternal deaths per 100 live births D. 88 serious maternal illness per 100 live births

A. 22 maternal deaths per 100,000 live births (Rationale: Maternal mortality rate is based on the number of maternal deaths from childbirth or complications of pregnancy, childbirth, or puerperium per 100,000 live births. It does not deal with serious illnesses. The figure of 88 deaths per 100 live births is incorrect.)

The average man is taller than the average woman at maturity because of A. A longer period of skeletal growth. B. Earlier development of secondary sexual characteristics. C. Earlier onset of the growth spurt. D. Starting puberty at an earlier age.

A. A longer period of skeletal growth * A male's greater height at maturity is the combined result of beginning the growth spurt at a later age and continuing it for a longer period of time

A woman is giving birth to her third child in a setting that allows her husband and children to be actively involved in the process. The nurse caring for her must also consider the husband and the two children as patients and work to meet their needs. This type of setting is termed... A. Family-centered care B. Emergency are C. Hospice care D. Individual care

A. Family-centered care (Rationale: Family-centered care is any setting where the pregnant woman and her family are treated as one unit. The nurse assumes a major role in teaching, counseling, and supporting the family. In emergency care settings, the nurse deals primarily with the patient who is having difficulty. In hospice care settings, the nurse deals with patients who have terminal illnesses. Individual care deals only with the patient and does not include the family.)

Which is a secondary sexual characteristic? A. Female breast development B. Production of sperm C. Maturation of ova D. Secretion of gonadotropin-releasing hormone

A. Female breast development * A secondary sexual characteristic is one not directly related to reproduction, such as development of the characteristic female body form

Some problems associated with hospital births in the early 1960s include the following issues: (Choose all that apply.)... A. Patient teaching was not valued. B. Bonding was hindered due to strong medications given to the mother. C. There was an increased use of midwives. D. The father was not included in the process.

A. Patient teaching was not valued. B. Bonding was hindered due to strong medications given to the mother. D. The father was not included in the process. (Rationale: The nurses primary function was to follow medical orders, so teaching was not valued. Strong medications were given to the patient that left her heavily sedated. Fathers were usually sent to the waiting room. The use of lay midwives was declining at this time and nurse-midwives were not well established.)

A 4-year-old is hospitalized for treatment of pneumonia. The nurse informs the child's mother that the pediatric unit is a Family-Centered Child Care unit. What does this mean for her?... A. She will be allowed input into her child's care. B. She will not be able to stay at night with her child but must stay during the day. C. She will not be allowed to visit her child, because it is considered to cause emotional distress. D. She will be responsible for her child's total care.

A. She will be allowed input into her child's care. (Rationale: Family-Centered Child Care recognizes and respects the pivotal role of the family in the child's life. It supports families and views parents and professionals as equal partners. Family-Centered Child Care units encourage parents to stay with the child around the clock. The child's mother will share care of the child in this setting. Parents and professionals are viewed as equals.)

When comparing the endometrial cycle with the ovarian cycle on day 22,: A. The progesterone level is at its peak, but the LH level is low B. The progesterone level is low, but the FSH level is at its peak C. The estrogen level is low, but the LH level is at its peak D. Both the estrogen level and the LH level are at the peak

A. The progesterone is at its peak, but the LH level is low *Progesterone level will start to decrease in 1 to 2 days in the endometrial cycle. In the ovarian cycle, the LH levels will remain low until day 10 on the next cycle

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

ANS: Braxton Hicks Irregular painless contractions occur throughout pregnancy, although many women do not notice them until the third trimester. Women who are unsure, who have 5 or 6 regular contractions within one hour, or who demonstrate other signs of labor should contact their provider.

A woman who is 36 weeks pregnant reports to the labor and delivery triage area expressing concerns that her baby "is not moving." Along with a non-stress test (NST) the nurse might also use _____________ to determine fetal well-being.

ANS: Vibroacoustic stimulation Also referred to as VAS or acoustic stimulation, the vibroacoustic stimulator (similar to an electronic larynx) is applied to the maternal abdomen over the area of the fetal head. Vibration and sound are emitted for up to 3 seconds and may be repeated. A fetus near term responds by increasing the number of gross body movements, which can be easily seen and felt. The procedure can confirm reassuring NST findings and shorten the length of time necessary to obtain NST data.

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

ANS: folic acid Pregnant women should take 0.6 mg of folic acid daily for the duration of their pregnancy. Women who have given birth to an infant with a neural tube defect previously should take 4 mg of folic acid in the 4 weeks prior to pregnancy and throughout the first trimester.

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

ANS: narcissism Narcissism is an undue preoccupation with one's self and introversion (concentration on one's self and one's body). Selecting the right foods and clothing may be more important than ever before, out of concern for the growing fetus.

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

ANS: A Feedback A Ambivalence refers to conflicting feelings. B This does not reflect conflicting feelings. C By expressing concerns over a normal occurrence, the woman is trying to confirm the pregnancy. D The woman is trying to confirm the pregnancy when she expresses concerns over normal pregnancy changes. She is not expressing conflicting feelings.

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

ANS: A Feedback A An HIV test is recommended for all women, regardless of risk factors. The incidence of perinatal transmission from an HIV-positive mother to her fetus ranges from 25% to 35%. Women who test positive for HIV can then be treated. B All women should be tested for HIV, although this patient is at increased risk of contracting the disease. C Regardless of past sexual history, all women should have an HIV test completed prenatally. D Although this patient is apparently monogamous, an HIV test is still recommended.

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

ANS: A Feedback A At 20 weeks, the fundus is usually located at the umbilical level. Because the uterus grows in a predictable pattern, obstetric nurses should know that the uterus of 20 weeks of gestation is located at the level of the umbilicus. B This is incorrect information. At 20 weeks the uterus should be at the umbilical level. C By avoiding the direction question, this might increase the anxiety of both the mother and grandmother. D The descent of the fetal head (lightening) occurs in late pregnancy.

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

ANS: A Feedback A Correct posture and body mechanics can reduce lower back pain caused by increasing lordosis. B Pregnancy should not cause alterations in the spine. Any assessment for malformation should be done early in the pregnancy. C Certain exercises can help relieve back pain. D Rest is important for well-being, but the main concern with back pain is to assess posture and body mechanics.

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

ANS: A Feedback A Increased vascularity of the pelvic organs during pregnancy results in the bluish color of the cervix, vagina, and labia, called Chadwick's sign. B Softening of the cervix is Goodell's sign. C The softening of the lower segment of the uterus (Hegar's sign) can allow the uterus to be flexed against the cervix. D Chadwick's sign is a probable indication of pregnancy.

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

ANS: A Feedback A The maternal serum level of alpha-fetoprotein is used to screen for Trisomy 18 or 21, neural tube defects, and other chromosomal anomalies. B The quadruple marker test does not detect this fetal anomaly. Additional testing, such as ultrasonography would be required to diagnose diaphragmatic hernia. C Congenital cardiac abnormality would most likely be identified during an ultrasound examination. D The quadruple marker test would not detect anencephaly.

16. What should be the goal of a client with the nursing diagnosis "Imbalanced nutrition: Less than body requirements" (related to diet choices inadequate to meet the nutrient requirements of pregnancy)? a. Gain a total of 30 lb. b. Decrease intake of snack foods. c. Take daily supplements consistently. d. Increase intake of complex carbohydrates.

ANS: A A weight gain of 30 lb is one indication that the client has gained a sufficient amount for the nutritional needs of pregnancy. Decreasing snack food may be the problem and should be assessed. However, assessing the weight gain is the best method of monitoring intake for this pregnancy. A daily supplement is not the best goal for this client. It does not meet the basic need of proper nutrition during pregnancy. Increasing the intake of complex carbohydrates is important for this client, but monitoring the weight gain should be the end goal. PTS: 1 DIF: Cognitive Level: Application REF: 157

17. Which complication of adolescent pregnancy should the nurse plan to monitor? a. Anemia b. Placenta previa c. Abruptio placenta d. Incompetent cervix

ANS: A Adolescent pregnancies are at increased risk for anemia, nutritional deficiencies, pregnancy-associated hypertension, HIV and other STDs, short interval until next pregnancy, and depression. They do not have a higher incidence of placenta previa, abruptio placentae, or incompetent cervix. PTS: 1 DIF: Cognitive Level: Application REF: 479

18. In teaching a pregnant adolescent about nutrition, what should the nurse plan to do? a. Determine the weight gain needed to meet adolescent growth and add 35 lb. b. Suggest that she not eat at fast food restaurants to avoid foods of poor nutritional value. c. Realize that most adolescents are unwilling to make dietary changes during pregnancy. d. Emphasize the need to eliminate common teen snack foods because they are too high in fat and sodium.

ANS: A Adolescents should gain in the upper range of the recommended weight gain. They also need to gain weight that would be expected for their own normal growth. Adolescents are willing to make changes; however, they still need to be like their peers. Eliminating fast foods will make her appear different from her peers. She should be taught to choose foods that add needed nutrients. Changes in the diet should be kept at a minimum and snacks should be included. Snack foods can be included in moderation and other foods added to make up for the lost nutrients. PTS: 1 DIF: Cognitive Level: Application REF: 162

23. A client post-delivery is concerned about getting back to her prepregnancy weight. She had only gained 15 pounds during her pregnancy. Which assessment factor would be of concern at her 6-week postpartum checkup? a. Client has lost 35 pounds during the 6-week period prior to her scheduled checkup. b. Client states that she is eating healthy and limiting intake of processed foods. c. Client relates increased consumption of fruits and vegetables in her diet postbirth. d. Client has resumed her usual exercise pattern of walking around the neighborhood for 10 minutes each night.

ANS: A Although a certain amount of weight loss is expected in the postpartum period, the fact that the reported weight loss is double the amount of weight gained during the pregnancy places the client at risk for malnutrition. Further inquiry is needed. Limiting the intake of processed foods is a healthy dietary alternative to decreasing sodium intake. Increases in fruits and vegetables are a healthy dietary alternative to decrease possible occurrence of hypertension. An exercise program is part of a healthy nutrition approach. PTS: 1 DIF: Cognitive Level: Application REF: 143

13. A pregnant client would like to know a good food source of calcium other than dairy products. Which is the best answer that the nurse should give? a. Legumes b. Lean meat c. Whole grains d. Yellow vegetables

ANS: A Although dairy products contain the greatest amount of calcium, it can also be found in legumes, nuts, dried fruits, and some dark green leafy vegetables. Lean meats are rich in protein and phosphorus. Whole grains are rich in zinc and magnesium. Yellow vegetables are rich in vitamin A. PTS: 1 DIF: Cognitive Level: Application REF: 154

10. Which is the common effect of both smoking and cocaine use on the pregnant client? a. Vasoconstriction b. Increased appetite c. Increased metabolism d. Changes in insulin metabolism

ANS: A Both smoking and cocaine use cause vasoconstriction, which results in impaired placental blood flow to the fetus. Smoking and cocaine use do not increase appetite, change insulin metabolism, or increase metabolism. PTS: 1 DIF: Cognitive Level: Understanding REF: 156

39. A pregnant client has lactose intolerance. What recommendation will the nurse provide to best help the client meet dietary needs for calcium? a. Add foods such as nuts, dried fruit, and broccoli to the diet. b. Consume dairy products but take an over-the-counter anti-gas product. c. Increase the intake of dark leafy vegetables, such as spinach and chard. d. Use powdered milk instead of liquid forms of milk.

ANS: A Calcium is present in legumes, nuts, dried fruits, and broccoli, so these foods can be added to increase calcium intake. Although dark leafy vegetables contain calcium, they also contain oxalates that decrease the availability of calcium. Powdered milk contains lactase, just like the nondehydrated varieties. Milk products can be avoided by those with lactose intolerance because adequate calcium may be obtained from food and supplements. PTS: 1 DIF: Cognitive Level: Understanding REF: 149

1. Which principle of teaching should the nurse use to ensure learning in a family situation? a. Motivate the family with praise and positive feedback. b. Learning is best accomplished with the lecture format. c. Present complex subject material first while the family is alert and ready to learn. d. Families should be taught using medical jargon so they will be able to understand the technical language used by physicians.

ANS: A Praise and positive feedback are particularly important when a family is trying to master a frustrating task such as breastfeeding. A lively discussion stimulates more learning than a straight lecture, which tends to inhibit questions. Learning is enhanced when the teaching is structured to present the simple tasks before the complex material. Even though a family may understand English fairly well, they may not understand the medical terminology or slang terms that are used. PTS: 1 DIF: Cognitive Level: Application REF: 18, 19

37. What will the nurse advise when providing nutrition education to the pregnant client? a. "Every day you need to have at least 6 ounces of protein from sources such as meat, fish, eggs, beans, nuts, soybean products, and tofu." b. "High-dose vitamin A supplements will promote optimal vision while preventing a common cause of blindness in neonates." c. "Meals such as sushi with a cold deli salad made with raw sprouts combine high-fiber foods with protein sources to meet multiple nutritional needs." d. "Vitamin and mineral supplements can meet your nutrient needs if you have inadequate intake because of nausea or a sensation of fullness."

ANS: A Protein sources include meat, poultry, fish, eggs, legumes (e.g., beans, peas, lentils), nuts, and soybean products such as tofu. Pregnant women need 6 to 6.5 oz of protein daily. Vitamin A can cause fetal anomalies of the bones, urinary tract, and central nervous system when taken in high doses. Pregnant women should avoid raw fish and foods such as cold deli salads and raw sprouts. Supplements do not generally contain protein and calories and may lack many necessary nutrients; therefore, they cannot serve as food substitutes. PTS: 1 DIF: Cognitive Level: Application REF: 151

4. In planning sex education classes for the 12- to 15-year-old age group, more emphasis should be placed on which? a. How to set limits for sexual behavior b. The inaccuracy of information from peers c. The use of oral contraceptives to prevent unwanted pregnancy d. The use of condoms to prevent sexually transmitted diseases as well as pregnancy

ANS: A Setting limits for sexual behavior is particularly important for younger teenagers who may be pressured to become sexually active before they are physically and emotionally ready. Oral contraceptives are not the preferred method of birth control for teenagers because they forget to take them, and they do not protect against STIs. The use of condoms is appropriate and an important concept to discuss but should not be the emphasis. PTS: 1 DIF: Cognitive Level: Understanding REF: 477

9. A client at 24 weeks of gestation says she has a glass of wine with dinner every evening. Which is the reason the nurse should give to counsel her to eliminate all alcohol intake? a. The fetus is placed at risk for altered brain growth. b. The fetus is at risk for severe nervous system injury. c. The client will be at risk for abusing other substances as well. d. A daily consumption of alcohol indicates a risk for alcoholism.

ANS: A The brain grows most rapidly in the third trimester and is most vulnerable to alcohol exposure during this time. The major concerns are mental retardation, learning disabilities, high activity level, and short attention span. The risk to the client for abusing other substances is not the major risk for the infant. It has not been proven that daily consumption of alcohol indicates a risk for alcoholism. PTS: 1 DIF: Cognitive Level: Application REF: 487

19. The traditional diet of Asian women includes little meat and few dairy products and may be low in calcium and iron. The nurse can help a client increase her intake of these foods by which action? a. Suggest that she eat more tofu, bok choy, and broccoli. b. Suggest that she eat more hot foods during pregnancy. c. Emphasize the need for increased milk intake during pregnancy. d. Tell her husband that she must increase her intake of fruits and vegetables for the baby's sake.

ANS: A The diet should be improved by increasing foods acceptable to the woman. These foods are common in the Asian diet and are good sources of calcium and iron. Pregnancy is considered hot; therefore, the woman would eat cold foods. Because milk products are not part of this woman's diet, it should be respected and other alternatives offered. Also, lactose intolerance is common. Fruits and vegetables are cold foods and should be included in the diet. In regard to the family dynamics, however, the husband does not dictate to the wife in this culture. PTS: 1 DIF: Cognitive Level: Application REF: 152

8. Which is the most dangerous effect on the fetus of a client who smokes cigarettes while pregnant? a. Intrauterine growth restriction b. Genetic changes and anomalies c. Extensive central nervous system damage d. Fetal addiction to the substance inhaled

ANS: A The major consequences of smoking tobacco during pregnancy are low-birth-weight infants, prematurity, and increased perinatal loss. Cigarettes normally will not cause genetic changes or extensive central nervous system damage. Addiction is not a normal concern with the neonate. PTS: 1 DIF: Cognitive Level: Understanding REF: 486

18. The nurse states to the newly pregnant patient, "Tell me how you feel about being pregnant." Which communication technique is the nurse using with this patient? a. Clarifying b. Paraphrasing c. Reflection d. Structuring

ANS: A The nurse is attempting to follow up and check the accuracy of the patient's message. Paraphrasing is restating words other than those used by the patient. Reflection is verbalizing comprehension of what the patient has said. Structuring takes place when the nurse has set guidelines or set priorities. PTS: 1 DIF: Cognitive Level: Understanding REF: 19

15. When the nurse is alone with a battered client, the client seems extremely anxious and says, "It was all my fault. The house was so messy when he got home and I know he hates that." Which is the best response by the nurse? a. "No one deserves to be hurt. It's not your fault. How can I help you?" b. "What else do you do that makes him angry enough to hurt you?" c. "He will never find out what we talk about. Don't worry. We're here to help you." d. "You have to remember that he is frustrated and angry, so he takes it out on you."

ANS: A The nurse should stress that the client is not at fault. Asking what the woman did to make him angry enough to hurt the client is placing the blame on the woman. The nurse cannot promise that the batterer will not learn of the conversation. Often the batterer will find out about the conversation. Explaining the batterer's actions is placing the blame on the woman and finding excuses for the batterer. PTS: 1 DIF: Cognitive Level: Application REF: 501

6. Which is the step of the nursing process in which the nurse determines the appropriate interventions for the identified nursing diagnosis? a. Planning b. Evaluation c. Assessment d. Intervention

ANS: A The third step in the nursing process involves planning care for problems that were identified during assessment. The evaluation phase is determining whether the goals have been met. During the assessment phase, data are collected. The intervention phase is when the plan of care is carried out. PTS: 1 DIF: Cognitive Level: Understanding REF: 24

35. A client with a BMI of 32 has a positive pregnancy test. What is the maximum number of pounds that the nurse will advise the client to gain during the pregnancy? a. 20 b. 25 c. 28 d. 40

ANS: A The weight gain for obese women is 5 to 9 kg (11 to 20 lb). A BMI of 30 or higher categorizes the client as obese. The other options refer to minimal or maximal weight gain for clients in other BMI categories. PTS: 1 DIF: Cognitive Level: Application REF: 143

9. The client makes the statement: "I'm afraid to take the baby home tomorrow." Which response by the nurse would be the most therapeutic? a. "You're afraid to take the baby home?" b. "Don't you have a mother who can come and help?" c. "You should read the literature I gave you before you leave." d. "I was scared when I took my first baby home, but everything worked out."

ANS: A This response uses reflection to show concern and open communication. The other choices are blocks to communication. Asking if the client has a mother who can come and help blocks further communication with the client. Telling the client to read the literature before leaving does not allow the client to express her feelings further. Sharing your feelings about your experience with a new baby blocks further communication with the client. PTS: 1 DIF: Cognitive Level: Application REF: 18, 19

A nurse determines that a child consistently displays predictable behavior and is regular in performing daily habits. Which temperament is the child displaying? a. Easy b. Slow-to-warm-up c. Difficult d. Shy

ANS: A A Children with an easy temperament are even tempered, predictable, and regular in their habits. They react positively to new stimuli. B The slow-to-warm-up temperament type prefers to be inactive and moody. C A high activity level and adapting slowly to new stimuli are characteristics of a difficult temperament. D Shyness is a personality type and not a characteristic of temperament.

The formula used to guide time-out as a disciplinary method is a. 1 minute per each year of the child's age b. To relate the length of the time-out to the severity of the behavior c. Never to use time-out for a child younger than 4 years d. To follow the time-out with a treat

ANS: A A It is important to structure time-out in a time frame that allows the child to understand why he or she has been removed from the environment. B Relating time to a behavior is subjective and is inappropriate when the child is very young. C Time-out can be used with the toddler. D Negative behavior should not be reinforced with a positive action.

Nursing care after amniocentesis includes: a. Monitoring uterine activity. b. Placing the client in a supine position for 2 hours. c. Applying a pressure dressing to the puncture site. d. Forcing fluids by mouth.

ANS: A A risk with amniocentesis is the onset of spontaneous contractions. The supine position may decrease uterine blood flow; the side-lying position is preferred. Pressure dressings are not necessary. Hydration is important, but the woman has not been NPO so this should not be a problem.

In vitro fertilization-embryo transfer (IVF-ET) is a common approach for women with blocked fallopian tubes or with unexplained infertility and for men with very low sperm counts. A husband and wife have arrived for their pre-procedural interview. The husband asks the nurse to explain what the procedure entails. The nurse's most appropriate response is a. "IVF is a type of assisted reproductive therapy that involves collecting eggs from your wife's ovaries, fertilizing them in the lab with your sperm, and transferring the embryo to her uterus." b. "A donor embryo will be transferred into your wife's uterus." c. "Donor sperm will be used to inseminate your wife." d. "Don't worry about the technical stuff; that's what we are here for."

ANS: A A woman's eggs are collected from her ovaries, fertilized in the laboratory with sperm, and transferred to her uterus after normal embryonic development has occurred

The nurse is explaining the results of a maternal serum alpha-fetoprotein screening test to the woman. The nurse knows the woman does not understand the teaching if she says A. "Since the levels were within normal limits, I know the baby does not have any anomalies." B. "I know that the levels are high, but that does not always mean something is wrong with the baby." C. "Since I am not sure about the date of my last menstrual period, the test results cannot be accurately interpreted." D. "Since the levels are low, my baby may have Down syndrome."

ANS: A A. Alpha-fetoprotein levels are a screening test. Some fetal defects are covered by skin and do not produce elevated levels of AFP. B. MSAFP levels are a screening test and must be viewed as the first step in a series of diagnostic procedures that are indicated if abnormal concentrations are found. C. Inaccurate estimation of gestational age can result in false-positive or false-negative results. D. Low levels are an indication of Down syndrome; more testing is indicated.

The nurse is teaching a woman in her second trimester about an upcoming ultrasonography exam. The nurse knows her teaching has been successful when the woman states A. "I will drink several glasses of water about an hour before I come in for the test." B. "I will empty my bladder just before the test." C. "I will not eat or drink anything for 8 hours prior to coming in for the test." D. "I will plan on staying at the doctor's office for about 2 hours after the test so you can check to make sure the baby was not harmed during the procedure."

ANS: A A. Drinking several glasses of clear fluid 1 hour before the time of the examination will produce a full bladder. The bladder will displace the intestines and elevate the uterus for better visibility. B. The woman needs a full bladder prior to the exam in order to displace the intestines and elevate the uterus for better visibility. C. It is not necessary to be NPO for 8 hours prior to this exam. D. No fetal postprocedure assessments are necessary.

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

ANS: A Although all of these are considerations, parents are usually most concerned about the safety of the fetus. Parents are concerned about the duration, but it is not highest concern. The cost of the procedure is important to parents, especially those without third-party payers, but it is not the highest concern. Discomfort of the procedure is important, especially for the mother, but it is not the highest concern.

An indication for fetal diagnostic procedures is: a. Maternal diabetes. b. Maternal age older than 30. c. Previous infant more than 3000 g at birth. d. Weight gain of 25 lb.

ANS: A Diabetes is a risk factor in pregnancy because of possible impairment of placental perfusion. A maternal age greater than 35 years old is an indication for testing. Having had another infant weighing greater than 4000 g is an indication for testing. Excessive weight gain is an indication for testing. Normal weight gain is 25 to 35 lbs.

Postcoital contraception with Ovral a. Requires that the first dose be taken within 72 hours of unprotected intercourse b. Requires that the woman take second and third doses at 24 and 36 hours after the first dose c. Must be taken in conjunction with an IUD insertion d. Is commonly associated with the side effect of menorrhagia

ANS: A Emergency contraception is most effective when used within 72 hours of intercourse but may be used with lessened effectiveness up to 120 hours later.

The conscious decision on when to conceive or avoid pregnancy throughout the reproductive years is called a. Family planning b. Birth control c. Contraception d. Assisted reproductive therapy

ANS: A Family planning is the process of deciding when and if to have children.

11. The placenta allows exchange of oxygen, nutrients, and waste products between the mother and fetus by a. Contact between maternal blood and fetal capillaries within the chorionic villi b. Interaction of maternal and fetal pH levels within the endometrial vessels c. A mixture of maternal and fetal blood within the intervillous spaces d. Passive diffusion of maternal carbon dioxide and oxygen into the fetal capillaries

ANS: A Feedback A Fetal capillaries within the chorionic villi are bathed with oxygen- and nutrient-rich maternal blood within the intervillous spaces. B The endometrial vessels are part of the uterus. There is no interaction with the fetal blood at this point. C Maternal and fetal blood do not normally mix. 6/14 D Maternal carbon dioxide does not enter into the fetal circulation.

32. A postmenopausal woman who is 54 years old has been diagnosed with two leiomyomas. What assessment finding is most commonly associated with the presence of leiomyomas? a. Abnormal uterine bleeding b. Diarrhea c. Weight loss d. Acute abdominal pain

ANS: A Feedback A Most women are asymptomatic. Abnormal uterine bleeding is the most common symptom of leiomyomas, or fibroids. B Diarrhea is not commonly associated with leiomyomas (fibroids). C Weight loss does not usually occur in the woman with leiomyomas (fibroids). D The patient with leiomyomas (fibroids) is unlikely to experience abdominal pain.

9. A new mother asks the nurse about the "white substance" covering her infant. The nurse explains that the purpose of vernix caseosa is to a. Protect the fetal skin from amniotic fluid. b. Promote normal peripheral nervous system development. c. Allow transport of oxygen and nutrients across the amnion. d. Regulate fetal temperature.

ANS: A Feedback A Prolonged exposure to amniotic fluid during the fetal period could result in breakdown of the skin without the protection of the vernix caseosa. B Normal peripheral nervous system development is dependent on nutritional intake of the mother. C The amnion is the inner membrane that surrounds the fetus. It is not involved in the oxygen and nutrient exchange. D The amniotic fluid aids in maintaining fetal temperature.

1. Which part of the mature sperm contains the male chromosomes? a. The head of the sperm b. The middle portion of the sperm c. X-bearing sperm d. The tail of the sperm

ANS: A Feedback A The head of the sperm contains the male chromosomes that will join the chromosomes of the ovum. B The middle portion of the sperm supplies energy for the tail's whip-like action. C If an X-bearing sperm fertilizes the ovum, the baby will be female. D The tail of the sperm helps propel the sperm toward the ovum

20. The various systems and organs develop at different stages. Which statement is accurate? a. The cardiovascular system is the first organ system to function in the developing human. b. Hematopoiesis originating in the yolk sac begins in the liver at 10 weeks. c. The body changes from straight to C-shaped at 8 weeks. d. The gastrointestinal system is mature at 32 weeks.

ANS: A Feedback A The heart is developmentally complete by the end of the embryonic stage. B Hematopoiesis begins in the liver during the 6th week. C The body becomes C-shaped at 21 weeks. D The gastrointestinal system is complete at 36 weeks.

2. One of the assessments performed in the delivery room is checking the umbilical cord for blood vessels. Which finding is considered within normal limits? a. Two arteries and one vein b. Two arteries and two veins c. Two veins and one artery d. One artery and one vein

ANS: A Feedback A The umbilical cord contains two arteries and one vein to transport blood between the fetus and the placenta. B This option is abnormal and may indicate other anomalies. C Any option other than two arteries and one vein is considered abnormal and requires further assessment. D The presence of one umbilical artery is considered an abnormal finding. This infant would require further assessment for other anomalies.

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

ANS: A Gestational age determination by ultrasonography is increasingly less accurate after the first trimester. Gestational age determination is best done in the first trimester. There is a difference in trimesters when doing a gestational age ultrasonography.

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

ANS: A Maternal serum can be analyzed for abnormal levels of alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), inhibin A, and estriol. The multiple-marker screening may predict chromosomal defects in the fetus. The lecithin-sphingomyelin ratio is used to determine fetal lung maturity. Biophysical profile is used to evaluate fetal status during the antepartum period. Five variables are used, but none are concerned with chromosomal problems. The blood type and crossmatch will not predict chromosomal defects in the fetus.

A physician prescribes clomiphene citrate (Clomid, Serophene) for a woman experiencing infertility. She is very concerned about the risk of multiple births. The nurse's most appropriate response is a. "This is a legitimate concern. Would you like to discuss this further before your treatment begins?" b. "No one has ever had more than triplets with Clomid." c. "Ovulation will be monitored with ultrasound so that this will not happen." d. "Ten percent is a very low risk, so you don't need to worry too much."

ANS: A The incidence of multiple pregnancies with the use of these medications is increased. The patient's concern is legitimate and should be discussed so that she can make an informed decision.

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

ANS: A The normal biophysical score ranges from 8 to 10 points if the amniotic fluid volume is adequate. A normal score allows conservative treatment of high-risk patients. Delivery can be delayed if fetal well-being is indicated. Scores less than 4 would be investigated, and delivery could be initiated sooner than planned. This score is within normal range, and no further testing is required at this time. The results of the biophysical profile are usually available immediately after the procedure is performed.

21. The nurse is teaching a group of nursing students about behaviors that can block or open lines of communication. Which behaviors open the lines of communication? (Select all that apply). a. Sitting at the bedside b. Leaning forward with arms relaxed c. Acknowledging the client's comments or feelings d. Self-disclosing about your personal birth experience e. Holding a laptop computer in front of your body during an interview

ANS: A, B, C Behaviors that open the lines of communication can be described as attending behaviors, which convey the nurse's interest and a sincere desire to understand. Acknowledging the client's comments or feelings is an attending behavior. Nonverbal behaviors are just as powerful as spoken words. The nurse should convey an open attitude, such as sitting at the bedside and leaning forward with arms relaxed while listening. Self-disclosing is inappropriate and closes lines of communication. Holding a laptop on your lap during the interview process is putting a barrier between the nurse and client. PTS: 1 DIF: Cognitive Level: Application REF: 20

24. Many teens wait until the second or even third trimester to seek prenatal care. The nurse should understand that the reasons behind this delay include which of the following? (Select all that apply.) a. Continuing to deny the pregnancy b. Uncertainty about where to go for care c. Lack of realization that they are pregnant d. A desire to gain control over their situation e. Wanting to hide the pregnancy as long as possible

ANS: A, B, C, E Denying the pregnancy, uncertainty about where to go for care, lack of realization of pregnancy, and wanting to hide the pregnancy are all valid reasons for the teen to delay seeking prenatal care. A desire to gain control is not a reason to delay seeking health care. PTS: 1 DIF: Cognitive Level: Analysis REF: 480

Transvaginal ultrasonography is often performed during the first trimester. While preparing your 6-week-gestation client for this procedure, she expresses concerns over the necessity for this test. The nurse should explain that this diagnostic test may be necessary to determine which of the following? Select all that apply. a. Multifetal gestation b. Bicornuate uterus c. Presence and location of pregnancy (intrauterine or elsewhere) d. Amniotic fluid volume e. Presence of ovarian cysts

ANS: A, B, C, E Correct: A, B, C, E. All of these conditions can be determined by transvaginal ultrasound in the first trimester of pregnancy. This procedure is also used for estimating gestational age, confirming fetal viability, identifying fetal abnormalities or chromosomal defects, and identifying the maternal abnormalities mentioned, as well as fibroids. Incorrect: D. Amniotic fluid volume is assessed during the second and third trimester. Conventional ultrasound would be used.

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

ANS: A, B, D Feedback Correct Inactivated vaccines such as those for tetanus, hepatitis A, hepatitis B, and influenza are safe to administer for women who have a risk for contracting or developing the disease. Incorrect Immunizations with live virus vaccines such as MMR, varicella (chickenpox), or smallpox are contraindicated during pregnancy because of the possible teratogenic effects on the fetus.

45. The nurse is teaching a breastfeeding client about substances to avoid while she is breastfeeding. Which substances should the nurse include in the teaching session? (Select all that apply.) a. Caffeine b. Alcohol c. Omega-6 fatty acids d. Appetite suppressants e. Polyunsaturated omega-3 fatty acids

ANS: A, B, D Foods high in caffeine should be limited. Infants of mothers who drink more than two or three cups of caffeinated coffee or the equivalent each day may be irritable or have trouble sleeping. Although the relaxing effect of alcohol was once thought to be helpful to the nursing mother, the deleterious effects of alcohol are too important to consider this suggestion appropriate today. An occasional single glass of an alcoholic beverage may not be harmful, but larger amounts may interfere with the milk ejection reflex and may be harmful to the infant. Nursing mothers should avoid appetite suppressants, which may pass into the milk and harm the infant. The long-chain polyunsaturated omega-3 and omega-6 fatty acids are present in human milk. Therefore, they should be included in the mother's diet during lactation. PTS: 1 DIF: Cognitive Level: Application REF: 158

1. While interviewing a 48-year-old patient during her annual physical examination, the nurse learns that she has never had a mammogram. The American Cancer Society recommends annual mammography screening starting at age 40. Before the nurse encourages this patient to begin annual screening, it is important for her to understand the reasons why women avoid testing. These reasons include (select all that apply) a. Reluctance to hear bad news b. Fear of x-ray exposure c. Belief that lack of family history makes this test unnecessary d. Expense of the procedure e. Having heard that the test is painful

ANS: A, B, D, E Feedback Correct All of these are reasons for women to avoid having a mammogram done. Although the test is expensive, it is usually covered by health insurance, and many communities offer low-cost or free screening to women without insurance. It is important to acknowledge that some discomfort occurs with screening. Scheduling the test immediately at the end of a period makes it less painful. The risk of radiation exposure is minimal to none. Nurses play a vital role in providing information and reassurance to help women overcome these fears. Incorrect Even patients with no family history should have regular screening done. The nurse should emphasize that a combination of breast self-examination and mammography needs to be performed at regular intervals. Women with a family history may need to begin screening at a younger age and have additional testing such as ultrasound performed.

23. Which nursing diagnoses may apply to the childbearing family with special needs? (Select all that apply.) a. Risk for spiritual distress b. Risk for injury c. Readiness for enhanced nutrition d. Ineffective breathing pattern e. Situational low self-esteem

ANS: A, B, E A childbearing family with special needs may be at risk to develop spiritual distress, experience injury, and exhibit situational low self-esteem. There are no supportive data to hypothesize an ineffective breathing pattern and/or readiness for enhanced nutrition. PTS: 1 DIF: Cognitive Level: Application REF: 501

47. The nurse is teaching a pregnant client about food safety during pregnancy and lactation. Which statements by the client indicate she understood the teaching? (Select all that apply.) a. "I will limit my intake of shrimp to 12 oz a week." b. "I will avoid the soft cheeses made with unpasteurized milk." c. "I plan to continue to pack my bologna sandwich for lunch." d. "I am glad I can still go to the sushi bar during my pregnancy." e. "I will not eat any swordfish or shark while I am pregnant or nursing."

ANS: A, B, E Statements that indicate the client understood the teaching are limiting shrimp to 12 oz a week, avoiding soft cheeses, and not eating any swordfish. A bologna sandwich should be avoided unless it is reheated until steaming hot. Raw or undercooked fish should be avoided. PTS: 1 DIF: Cognitive Level: Analysis REF: 151

The nurse is caring for a child from a Middle Eastern family. Which interventions should the nurse include in planning care? Select all that apply. a. Include the father in the decision making. b. Ask for a dietary consult to maintain religious dietary practices. c. Plan for a male nurse to care for a female patient. d. Ask the housekeeping staff to interpret if needed. e. Allow time for prayer.

ANS: A, B, E The man is typically the head of the household in Muslim families. So the father should be included in all decision making. Muslims do not eat pork and do not use alcohol. Many are vegetarians. The dietitian should be consulted for dietary preferences. Compulsory prayer is practiced several times throughout the day. The family should not be interrupted during prayer, and treatments should not be scheduled during this time. Muslim women often prefer a female health care provider because of laws of modesty; therefore, the female patient should not be assigned a male nurse. A housekeeping staff member should not be asked to interpret. When interpreters are used, they should be of the same country and religion, if possible, because of regional differences and hostilities.

46. The nurse is advising a lactose-intolerant pregnant client about calcium intake. Which calcium sources are approximately equivalent to 1 cup of milk? (Select all that apply.) a. cup yogurt b. 1 cup of sherbet c. oz of hard cheese d. cups of ice cream e. cup of low-fat cottage cheese

ANS: A, C, D Calcium sources approximately equivalent to 1 cup of milk include cup yogurt, oz of hard cheese, and cups of ice cream. It takes 3 cups of sherbet and cups of low-fat cottage cheese to equal the calcium equivalent of 1 cup of milk. PTS: 1 DIF: Cognitive Level: Application REF: 149

2. Along with gas exchange and nutrient transfer, the placenta produces many hormones necessary for normal pregnancy. These include (select all that apply) a. Human chorionic gonadotropin (hCG) b. Insulin c. Estrogen d. Progesterone e. Testosterone

ANS: A, C, D Feedback Correct hCG causes the corpus luteum to persist and produce the necessary estrogens and progesterone for the first 6 to 8 weeks. Estrogens cause enlargement of the woman's uterus and breasts; cause growth of the ductal system in the breasts; and, as term approaches, play a role in the initiation of labor. Progesterone causes the endometrium to change, providing early nourishment. Progesterone also protects against spontaneous abortion by suppressing maternal reactions to fetal antigens and reduces unnecessary uterine contractions. Other hormones produced by the placenta include hCT , hCA, and a number of growth factors. Incorrect Human placental lactogen promotes normal nutrition and growth of the fetus and maternal breast development for lactation. This hormone decreases maternal insulin sensitivity and utilization of glucose, making more glucose available for fetal growth. If a Y chromosome is present in the male fetus, hCG causes the fetal testes to secrete testosterone necessary for the normal development of male reproductive structures.

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

ANS: A, C, D, E Feedback Correct The woman is at risk for all of these complications. Female genital mutilation, cutting, or circumcision involves removal of some or all of the external female genitalia. The labia majora are often stitched together over the vaginal and urethral opening as part of this practice. Enlargement of the vaginal opening may be performed before or during the birth. Incorrect The woman is unlikely to give any verbal or nonverbal signs of pain. This lack of response does not indicate lack of pain. In fact, pelvic examinations are likely to be very painful because the introitus is so small and inelastic scar tissue makes the area especially sensitive. A pediatric speculum may be necessary, and the patient should be made as comfortable as possible.

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

ANS: A, C, E Feedback Correct Leukorrhea is a white or slightly gray vaginal discharge that develops in response to cervical stimulation by estrogen and progesterone. Quickening is the first recognition of fetal movements or "feeling life." Quickening is often described as a flutter and is felt earlier in multiparous women than in primiparas. Lightening occurs when the fetus begins to descent into the pelvis. This occurs two weeks before labor in the nullipara and at the start of labor in the multipara. Incorrect Mucous fills the cervical canal creating a plug otherwise known as the operculum. The operculum acts as a barrier against bacterial invasion during the pregnancy. Passive movement of the unengaged fetus is referred to as ballottement.

You (the nurse) are reviewing the educational packet provided to a patient about tubal ligation. What is an important fact you should point out? Select all that apply. a. "It is highly unlikely that you will become pregnant after the procedure." b. "This is an effective form of 100% permanent sterilization. You won't be able to get pregnant." c. "Sterilization offers some form of protection against sexually transmitted diseases." d. "Sterilization offers no protection against sexually transmitted diseases." e. "Your menstrual cycle will greatly increase after your sterilization."

ANS: A, D A woman is unlikely to become pregnant after tubal ligation. Sterilization offers no protection against STDs.

3. The exact cause of breast cancer remains undetermined. Researchers have found that there are a number of common risk factors that increase a woman's chance of developing a malignancy. It is essential for the nurse who provides care to women of any age to be aware of which risk factors? Select all that apply. a. Family history b. Late menarche c. Early menopause d. Race e. Nulliparity or first pregnancy after age 30

ANS: A, D, E Feedback Correct Family history, race, and nulliparity are known risk factors for the development of breast cancer. Others include age, personal history of cancer, high socioeconomic status, sedentary lifestyle, hormone replacement therapy, recent use of oral contraceptives, never having breastfed a child, and drinking more than one alcoholic beverage per day. Incorrect Early menarche and late menopause are risk factors for breast malignancy, not late menarche and early menopause.

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

ANS: B Feedback A April 7 would be subtracting 2 months instead of 3 months and then subtracting 3 days instead of adding 7 days. B To determine the EDD, the nurse uses the first day of the last menstrual period (June 10), subtracts 3 months (March 10), and adds 7 days (March 17). C March is the correct month, but instead of adding 7 days, 17 days were added. D April 17 is subtracting 2 months instead of 3 months.

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

ANS: B Feedback A Babysitting other children is a form of role playing where the woman practices the expected role of motherhood. B Wearing maternity clothes before they are needed helps the expectant mother "feel" what it's like to be obviously pregnant. C Daydreaming is a type of fantasy where the woman "tries on" a variety of behaviors in preparation for motherhood. D Imagining herself as a good mother is the woman's effort to look for a good role fit. She observes behavior of other mothers and compares them with her own expectations.

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

ANS: B Feedback A Cardiac output increases by 50% with half of this rise occurring in the first 8 weeks gestation. B The pulse increases about 15 to 20 beats/min, which persists to term. C In the first trimester, blood pressure usually remains the same as the prepregnancy level, but it gradually decreases up to about 20 weeks of gestation. During the second trimester, both the systolic and diastolic pressures decrease by about 5 to 10 mm Hg. D Production of RBCs accelerates during pregnancy.

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

ANS: B Feedback A Fullness, heightened sensitivity, tingling and heaviness of the breasts occur in the early weeks of gestation in response to increased levels of estrogen and progesterone. B Nipples and areolae become more pigmented, and the nipples become more erectile and may express colostrum. C Montgomery tubercles may be seen around the nipples. These sebaceous glands may have a protective role in that they keep the nipples lubricated for breastfeeding. D Venous congestion in the breasts is more obvious in primigravidas.

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

ANS: B Feedback A Gastric motility decreases during pregnancy. B Nausea and vomiting are believed to be caused by increased levels of hormones, decreased gastric motility, and hypoglycemia. C Glucose levels decrease in the first trimester. D Gastric secretions do decrease, but this is not the main cause of nausea and vomiting.

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

ANS: B Feedback A Inadequate intake of iron may lead to true anemia. B When blood volume expansion is more pronounced and occurs earlier than the increase in red blood cells, the woman will have physiologic anemia, which is the result of dilution of hemoglobin concentration rather than inadequate hemoglobin. C If the woman does not take an adequate amount of iron, true anemia may occur when the fetus pulls stored iron from the maternal system. D There is an increased production of erythrocytes during pregnancy.

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

ANS: B Feedback A Lower socioeconomic groups usually do not have group health insurances. B Because of economic uncertainty, lower socioeconomic groups place more emphasis on meeting the needs of the present rather than on future goals. C They may value health care, but cannot afford preventive health care. D They may struggle for basic needs and often do not see a way to improve their situation. It is difficult to maintain optimism.

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

ANS: B Feedback A Phases and stages of labor are taught in childbirth preparation classes. B Early pregnancy classes focus on the first two trimesters and cover information on adapting to pregnancy, dealing with early discomforts, and understanding what to expect in the months ahead. C Pain control is part of childbirth preparation classes. D This is taught in cesarean birth preparation classes.

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

ANS: B Feedback A Renal plasma flow increases during pregnancy. B The primary function of increased vascular volume is to transport oxygen and nutrients to the fetus via the placenta. C Assisting with pulling metabolic wastes from the fetus for maternal excretion is one purpose of the increased vascular volume. D This is not the primary reason for the increase in volume.

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

ANS: B Feedback A Shortness of breath is an expected finding by 35 weeks. B Abdominal pain may indicate preterm labor or placental abruption. C Ankle edema in the afternoon is a normal finding at this stage of pregnancy. D Backaches while standing is a normal finding during the later stages of pregnancy.

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

ANS: B Feedback A The man normally will seek closer ties with his father. B Interacting with children and assuming the behavior and role of a father best describes a man "trying on" being a father. C Men do not normally read information that is provided in advance. The nurse should be prepared to present the information after the baby is born, when it is more relevant. D This is called couvade.

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

ANS: B Feedback A The presence of protein could indicate kidney disease or preeclampsia. B Small amounts of glucose may indicate "physiologic spilling." C Urinary tract infections are associated with bacteria in the urine. D An increase in ketones indicates that the patient is exercising too strenuously or has an inadequate fluid and food intake.

34. The pregnant woman of normal weight enters her 13th week of pregnancy. If the client eats and exercises as directed, what will the nurse anticipate as the ongoing weight gain for the remaining trimesters? a. 0.3 pound every week b. 1 pound every week c. 1.8 pounds every week d. 2 pounds every week

ANS: B After the first 12 weeks (first trimester), the pregnant woman should gain 0.35 to 0.5 kg (0.8 to 1 lb) per week for the remainder of the pregnancy. PTS: 1 DIF: Cognitive Level: Knowledge REF: 157

20. When planning a diet for a pregnant client, which nutritional interventions should be implemented? a. Fluids should be restricted to 6 glasses a day to minimize fluid retention and occurrence of edema. b. Protein in the diet should be increased to meet growth and development needs. c. Nutrient density should be used only if there are problems with weight gain during the course of the pregnancy. d. Advise the client that the pattern of weight gain is not as important as the overall weight gained during the pregnancy.

ANS: B An increase in protein consumption is recommended as compared with prepregnancy diet recommendations. Fluid intake should be 8 to 10 glasses per day to maintain hydration. Nutrient density should be used throughout the pregnancy to meet increasing caloric needs. The pattern of weight gain is critical in helping identify potential risks associated with the development of fluid retention and preeclampsia. PTS: 1 DIF: Cognitive Level: Application REF: 144

2. During which phase of the cycle of violence does the batterer become contrite and remorseful? a. Battering b. Honeymoon c. Tension-building d. Increased drug taking

ANS: B During the honeymoon phase, the battered person wants to believe that the battering will never happen again, and the batterer will promise anything to get back into the home. During the battering phase, violence actually occurs, and the victim feels powerless. During the tension-building phase, the batterer becomes increasingly hostile, swears, threatens, throws things, and pushes the battered person. Often, the batterer increases the use of drugs during the tension-building phase. PTS: 1 DIF: Cognitive Level: Understanding REF: 499

13. Which statement correctly describes the incidence of intimate partner violence (IPV) in the United States? a. Intimate partner violence seldom occurs during pregnancy. b. Each year about 42.4 million women experience intimate partner violence. c. The largest number of intimate partner violence is in the lower socioeconomic classes. d. Intimate partner violence is second only to automobile accidents as the most frequent cause of injury to women.

ANS: B IPV occurs to approximately 42.4 million women each year. IPV occurs frequently during pregnancy. IPV victims come from all different backgrounds and socioeconomic classes. Intimate partner violence is a more common cause of injury than automobile accidents. PTS: 1 DIF: Cognitive Level: Understanding REF: 497

18. Which antidepressant is no longer recommended for use during pregnancy? a. Sertraline (Zoloft) b. Paroxetine (Paxil) c. Fluoxetine (Prozac) d. Citalopram (Celexa)

ANS: B Paroxetine (Paxil) is no longer recommended for use during pregnancy because there have been reports of congenital malformations. Zoloft, Prozac, and Celexa are antidepressants used during pregnancy, if indicated that without the medication the pregnant client would be at risk for severe depression. PTS: 1 DIF: Cognitive Level: Analysis REF: 487, 488

21. A pregnant client asks the nurse if she should take herbal supplements during pregnancy. What is the best response to her query? a. "As long as you have had no reaction to them in the past, they would be safe to use during pregnancy." b. "Prenatal vitamins are the only things that should be taken during pregnancy." c. "Nutritional supplements will be prescribed by the health care provider based on individual needs." d. "During pregnancy, no supplementation is required because this is considered to be a healthy state."

ANS: B Prenatal vitamins are noted as the standard of care in the medical treatment of pregnancy. A nurse should not encourage the use of herbal supplements to a pregnant client (or to any client) without obtaining information relative to constituent ingredients and assessment of potential interactions. This discussion should include the health care provider as a member of the interdisciplinary team. Nutritional supplements are not indicated during pregnancy, other than prenatal vitamins. During pregnancy, the client will not be able to meet their nutritional needs without the use of prenatal vitamins. PTS: 1 DIF: Cognitive Level: Application REF: 150

27. A pregnant client arrives for her first prenatal visit at the clinic. She tells you that she has been taking an additional 400 mcg of folic acid prior to her pregnancy. Based on information obtained, she is at 8 weeks' gestation. What recommendation would you give regarding folic acid supplementation? a. Have the client continue to take 400 mcg folic acid throughout her pregnancy. b. Tell the client that she no longer has to take additional folic acid because it will be included in her prenatal vitamins. c. Have the client increase her folic acid intake to 1000 mcg throughout the rest of her pregnancy. d. Schedule the client to go for an AFP (alpha-fetoprotein) test.

ANS: B Prenatal vitamins include adequate folic acid supplementation, so clients should not take additional supplementation as long they continue their prenatal vitamins. During pregnancy, the recommendation is to increase the folic acid intake to 600 mcg. 1000 mcg of folic acid would be an excessive dose. The AFP test should be done at 15 to 18 weeks' gestation. This is not clinically indicated because the client is at 8 weeks' gestation. PTS: 1 DIF: Cognitive Level: Application REF: 146

19. The pregnant woman tells the nurse, "I think something may be wrong with my pregnancy." Which statement by the nurse demonstrates therapeutic communication? a. "Most women worry; I felt the same way when I was pregnant." b. "Tell me more about what concerns you about this pregnancy." c. "That is a very common concern, but your pregnancy will turn out just fine." d. "You should focus on taking care of yourself and not worry so much."

ANS: B Questioning is a therapeutic communication technique in which additional information is elicited by using open-ended questions. The remaining options are examples of three behaviors that block communication—inappropriate self-disclosure, providing false reassurance, and giving advice. PTS: 1 DIF: Cognitive Level: Analysis REF: 18

1. A pregnant client who abuses cocaine admits to exchanging sex for her drug habit. This behavior puts her at a greater risk for: a. postmature birth. b. Sexually transmitted diseases. c. Hypotension and vasodilation. d. Depression of the central nervous system.

ANS: B Sex acts exchanged for drugs place the woman at increased risk for sexually transmitted diseases because of having multiple partners and lack of protection. Premature delivery of the infant is one of the most common problems associated with cocaine use during pregnancy. Cocaine causes hypertension and vasoconstriction. Cocaine is a central nervous system stimulant. PTS: 1 DIF: Cognitive Level: Understanding REF: 487

15. Which pregnant adolescent is most at risk for a nutritional deficit during pregnancy? a. A 16-year-old who is 10 lb overweight b. A 17-year-old who is 10 lb underweight c. A 15-year-old of normal height and weight d. A 16-year-old of normal height and weight

ANS: B The adolescent who is pregnant and underweight is most at risk because she is already deficient in nutrition and must now supply the nutritional intake for both herself and her fetus. An overweight pregnant teen is at risk for deficiency but is not at the highest risk. Being underweight is the most risky because she is already deficient. A 15-year-old has special nutritional needs during pregnancy, but she is not at the highest risk for deficiency. A 16-year-old has special nutritional needs during pregnancy, but she is not at the highest risk for deficiency. PTS: 1 DIF: Cognitive Level: Application REF: 151

29. Which client is most at risk for a low-birth-weight infant? a. 22-year-old, 60 inches tall, normal prepregnant weight b. 18-year-old, 64 inches tall, body mass index is <18.5 c. 30-year-old, 78 inches tall, prepregnant weight is 15 lb above the norm d. 35-year-old, 75 inches tall, total weight gain in previous pregnancies was 33 lb

ANS: B The client who has a low prepregnancy weight is associated with preterm labor and low- birth-weight infants. Women who are underweight should gain more during pregnancy to meet the needs of pregnancy as well as their own need to gain weight; clients who have a normal prepregnancy weight, who start pregnancy overweight, or who have a history of excessive weight gain in pregnancy are not at risk for low-birth-weight infants. PTS: 1 DIF: Cognitive Level: Analysis REF: 144

1. When planning a diet with a pregnant client, what should the nurse's first action be? a. Teach the client about MyPlate. b. Review the client's current dietary intake. c. Instruct the client to limit the intake of fatty foods. d. Caution the client to avoid large doses of vitamins, especially those that are fat-soluble.

ANS: B The first action should be to assess the client's current dietary pattern and practices because instruction should be geared to what she already knows and does. Teaching the food guide MyPlate is important but not the first action when planning a diet with a pregnant client. Limiting intake of fatty foods is important in a pregnant client's diet but not the first action. Cautioning about excessive fat-soluble vitamins is important but not the first action. PTS: 1 DIF: Cognitive Level: Application REF: 144

11. The breastfeeding client whose recommended prepregnancy caloric intake was 2000 calories per day would need how many calories per day to meet her current needs? a. 2300 b. 2500 c. 2750 d. 3000

ANS: B The increase for a breastfeeding client is 500 calories above her recommended prepregnancy caloric intake. 2300 calories is not enough to meet her needs. 2750 calories may be too many calories and may lead to weight gain. 3000 calories is too many for this client and will lead to weight gain. PTS: 1 DIF: Cognitive Level: Understanding REF: 151

6. A client in her fifth month of pregnancy asks the nurse, "How many more calories should I be eating daily?" What should the nurse's response be? a. 180 more calories a day b. 340 more calories a day c. 452 more calories a day d. 500 more calories a day

ANS: B The increased nutritional needs of pregnancy can be met with an additional 340 calories per day. 180 calories are not enough to meet the increased nutritional needs of pregnancy. 452 calories are more than the recommended calories for pregnancy. 500 calories are more than the recommended calories for pregnancy. PTS: 1 DIF: Cognitive Level: Application REF: 145

8. A pregnant client asks the nurse if she can double her prenatal vitamin dose because she doesn't like to eat vegetables. What is the nurse's response about the danger of taking excessive vitamins? a. Increases caloric intake b. Has toxic effects on the fetus c. Increases absorption of all vitamins d. Promotes development of pregnancy-induced hypertension (PIH)

ANS: B The use of vitamin supplements in addition to food may increase the intake of some nutrients to doses much higher than the recommended amounts. Overdoses of some vitamins have been shown to cause fetal defects. Vitamin supplements do not contain calories. Vitamin supplements do not have better absorption than natural vitamins and minerals. There is no relationship between vitamin supplements and PIH. PTS: 1 DIF: Cognitive Level: Application REF: 154

32. Identify the appropriate weight gain at 28 weeks' gestation for a client with a normal BMI (body mass index) before pregnancy. a. 10 pounds b. 19 pounds c. 25 pounds d. 30 pounds

ANS: B The woman with a normal BMI before pregnancy will gain approximately 4.4 pounds during the first trimester and 1 pound per week during the second and third trimesters. At 28 weeks, normal weight gain would be 4 pounds during the first trimester and 15 pounds in the second trimester. Ten pounds at 29 weeks gestation is adequate weight gain. Twenty-five and 30 pounds at 28 weeks is excessive weight gain. PTS: 1 DIF: Cognitive Level: Application REF: 143

40. The nurse is reviewing the changes in nutrition related to pregnancy with a 17-year-old who is 12 weeks pregnant. They are specifically focusing on the dairy requirements. What is the nurse's next action? a. Ask, "Do you like milk, yogurt and cheese?" b. Ask, "How many servings from the dairy group do you eat each day?" c. Tell her, "You need to add no less than 3 cups of dairy-based foods each day." d. Inform her, "If you do not like to drink milk, you can eat a spinach salad every day"

ANS: B To individualize the patient's teaching plan, the nurse must first assess the patient's calcium intake. Then the nurse can modify the instructions for adequate calcium intake, based on the patient's actual needs. Milk, yogurt, and cheese are calcium-rich foods but are inappropriate for the lactose-intolerant patient. The adolescent pregnant patient requires more daily calcium than the recommendation of 3 cups per day for the adult woman. Spinach is a source of calcium but it also contains oxalates, which decrease calcium availability. PTS: 1 DIF: Cognitive Level: Analysis REF: 150

30. Changes in the diet of the pregnant client who has phenylketonuria would include: a. adding foods high in vitamin C. b. eliminating drinks containing aspartame. c. restricting protein intake to <20 g a day. d. increasing caloric intake to at least 1800 cal/day.

ANS: B Use of aspartame by women with phenylketonuria can result in fetal brain damage because these women lack the enzyme to metabolize aspartame. Adding vitamin C, restricting protein, and increasing caloric intake are not necessary for the pregnant client with phenylketonuria. PTS: 1 DIF: Cognitive Level: Analysis REF: 145

A pictorial tool that can assist the nurse in assessing aspects of family life related to health care is the a. Genogram b. Ecomap c. Life cycle model d. Human development wheel

ANS: B A A genogram (also known as a pedigree) is a diagram that depicts the relationships of family members over generations. B An ecomap is a pictorial representation of the family structures and their relationships with the external environment. C The life cycle model in no way illustrates a family genogram. This model focuses on stages that a person reaches throughout his or her life. D The human development wheel describes various stages of growth and development rather than a family's relationships to each other.

A nurse observes that parents discuss rules with their children when the children do not agree with the rules. Which style of parenting is being displayed? a. Authoritarian b. Authoritative c. Permissive d. Disciplinarian

ANS: B A A parent who expects children to follow rules without questioning is using an authoritarian parenting style. B A parent who discusses the rules with which children do not agree is using an authoritative parenting style. C A parent who does not consistently enforce rules and allows the child to decide whether he or she wishes to follow rules is using a permissive parenting style. D A disciplinarian style would be similar to the authoritarian style.

Which family will most likely have the most difficulty coping with an ill child? a. A single-parent mother who has the support of her parents and siblings b. Parents who have just moved to the area and are living in an apartment while they look for a house c. The family of a child who has had multiple hospitalizations related to asthma and has adequate relationships with the nursing staff d. A family in which there is a young child and four older married children who live in the area

ANS: B A Although only one parent is available, she has the support of her extended family, which will assist her in adjusting to the crisis. B Parents in a new environment will have increased stress related to their lack of a support system. They have no previous experiences in the setting from which to draw confidence. C Because this family has had positive experiences in the past, family members can draw from those experiences and feel confident about the setting. D This family has an extensive support system that will assist the parents in adjusting to the crisis.

What characteristic would most likely be found in a Mexican-American family? a. Stoicism b. Close extended family c. Considering docile children weak d. Very interested in health-promoting lifestyles

ANS: B A Although stoicism may be present in any family, Mexican-American families tend to be more expressive. B Most Mexican-American families are very close, and it is not unusual for children to be surrounded by parents, siblings, grandparents, and godparents. It is important to respect this cultural characteristic and to see it as a strength, not a weakness. C Considering docile children weak is a characteristic of Native Americans. D Although everyone tends now to embrace more health-promoting lifestyles, they are more prominent in Anglo-Americans.

More than 100 different ethno-cultural groups reside within the United States, and numerous traditional health beliefs are observed among these groups. Traditional beliefs related to the maintenance of health are likely to include a. Avoidance of natural events such as a solar eclipse b. Practicing silence, meditation, and prayer c. Protection of the soul by avoiding envy or jealousy d. Understanding that a hex, spell, or the evil eye may cause illness or injury

ANS: B A Illness can be prevented by avoiding natural events such as a solar eclipse along with environmental factors such as bad air. B Mental and spiritual health is maintained by activities such as silence, meditation, and prayer. Many people view illness as punishment for breaking their religious code and adhere strictly to morals and religious practices to maintain health. C Phenomena such as accidental provocation of envy, jealousy, or hate of a friend or acquaintance may cause illness. D Agent such as hexes, spells, and the evil eye may strike a person (often a child) and causes injury, illness, or misfortunate.

The results of a nonstress test shows three fetal heart rate accelerations with fetal movement that peak at 15 beats per minute above baseline and last 15 seconds. The nurses next action should be to A. Apply acoustic stimulation for one second for further testing B. This is a reassuring sign and no other testing is necessary at this time C. Continue to test for 40 additional minutes D. Prepare the woman for a contraction stress test

ANS: B A. Acoustic stimulation can be used if the fetus is not active. The results given in the base of the question are reassuring, and no other testing is necessary. B. A reactive sign is at least two fetal heart rate accelerations with or without fetal movement, occurring within a 20-minute period, peaking at least 15 beats per minute about the baseline, and lasting 15 seconds. This is reassuring, and no further testing is necessary. C. The test results are reassuring, and there is no need to continue the test. D. The test results are reassuring, and no further testing is necessary at this time.

The purpose of initiating contractions in a contraction stress test is to A. Determine the degree of fetal activity B. Apply a stressful stimulus to the fetus C. Identify fetal acceleration patterns D. Increase placental blood flow

ANS: B A. The contraction stress test involves recording the response of the fetal heart rate to stress induced by uterine contractions. B. The contraction stress test involves recording the response of the fetal heart rate to stress induced by uterine contractions. C. The contraction stress test involves recording the response of the fetal heart rate to stress induced by uterine contractions. D. The contraction stress test involves recording the response of the fetal heart rate to stress induced by uterine contractions.

A woman who is 6 weeks' pregnant is scheduled for an ultrasound. She asks the nurse what can be seen at this stage of the pregnant. The nurse would be correct if she responded: A. The sex of the baby B. The baby's heartbeat C. Characteristics of the baby's face D. Fetal presentation

ANS: B A. The sex of the baby cannot be determined until about 12 weeks. B. The heartbeat is visible when the embryo is 5 mm in length. Fetal sex and details about the baby cannot be seen until later in the pregnancy. C. Characteristics of the baby's face can be seen on a three-dimensional sonogram later in the pregnancy. D. Fetal presentation is determined during the second and third trimester

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

ANS: B An open neural tube allows a high level of AFP to seep into the amniotic fluid and enter the maternal serum. Hemophilia is a genetic defect and is best detected with chromosomal studies such as chorionic villus sampling or amniocentesis. Sickle cell anemia is a genetic defect and is best detected with chromosomal studies such as chorionic villus sampling or amniocentesis. L/S ratios are determined with an amniocentesis and is usually done in the third trimester.

A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks the nurse about the pill as a contraceptive choice. The nurse's most appropriate response is a. "This is a highly effective method, but it has some side effects." b. "Your current medications will reduce the effectiveness of the pill." c. "The pill will reduce the effectiveness of your seizure medication." d. "This is a good choice for a woman of your age and personal history."

ANS: B Because the liver metabolizes oral contraceptives, their effectiveness is reduced when they are taken simultaneously with anticonvulsants

An unmarried young woman describes her sex life as "active" and involving "many" partners. She wants a contraceptive method that is reliable and does not interfere with sex. She requests an intrauterine device (IUD). The nurse's most appropriate response is a. "The IUD does not interfere with sex." b. "The risk of pelvic inflammatory disease will be higher for you." c. "The IUD will protect you from sexually transmitted diseases." d. "Pregnancy rates are high with the IUDs."

ANS: B Disadvantages of IUDs include an increased risk of pelvic inflammatory disease (PID) in the first 20 days after insertion, as well as the risks of bacterial vaginosis and uterine perforation. The IUD offers no protection against sexually transmitted diseases (STDs) or the human immunodeficiency virus (HIV). Because this woman has multiple sex partners, she is at higher risk of developing an STD. The IUD does not protect against infection, as does a barrier method.

A married couple is discussing alternatives for pregnancy prevention and has asked about fertility awareness methods (FAMs). The nurse's most appropriate reply is a. "They're not very effective, and it's very likely you'll get pregnant." b. "They can be effective for many couples, but they require motivation." c. "These methods have a few advantages and several health risks." d. "You would be much safer going on the pill and not having to worry."

ANS: B FAMs are effective with proper vigilance about ovulatory changes in the body and with adherence to coitus intervals.

28. During her annual gynecologic checkup, a 17-year-old woman states that recently she has been experiencing cramping and pain during her menstrual periods. The nurse should document this complaint as a. Amenorrhea b. Dysmenorrhea c. Dyspareunia d. PMS

ANS: B Feedback A Amenorrhea is the absence of menstrual flow. B Dysmenorrhea is pain during or shortly before menstruation. Pain is described as sharp and cramping or sometimes as a dull ache. It may radiate to the lower back or upper thighs. C Dyspareunia is pain during intercourse. D PMS is a cluster of physical, psychologic, and behavioral symptoms that begin in the luteal phase of the menstrual cycle and resolve within a couple of days of the onset of menses.

7. A woman is 16 weeks pregnant with her first baby. She asks how long it will be before she feels the baby move. The best answer is a. "You should have felt the baby move by now." b. "Within the next month, you should start to feel fluttering sensations." c. "The baby is moving, but you can't feel it yet." d. "Some babies are quiet, and you don't feel them move."

ANS: B Feedback A Because this is her first pregnancy, movement is felt toward the later part of the 17 to 20 weeks. This statement may be alarming to the woman. B Maternal perception of fetal movement usually begins 17 to 20 weeks after conception. C This is a true statement. The fetus's movements are not strong enough to be felt until 17 to 20 weeks; however, this statement does not answer the concern of the woman. D Fetal movement should be felt by 17 to 20 weeks. If movement is not felt by the end of that time, further assessment will be necessary.

25. When assessing a woman for menopausal discomforts, the nurse expects the woman to describe the most frequently reported discomfort, which is a. Headaches b. Hot flashes c. Mood swings d. Vaginal dryness with dyspareunia

ANS: B Feedback A Headaches may be associated with a decline in hormone levels; however, it is not the most frequently reported discomfort for menopausal women. B Vasomotor instability, in the form of hat flashes or flushing, is a result of fluctuating estrogen levels and is the most common disturbance of the perimenopausal woman. C Mood swings may be associated with a decline in hormone levels; however, it is not the most frequently reported discomfort for menopausal women. D Vaginal dryness and dyspareunia may be associated with a decline in hormone levels; however, it is not the most frequently reported discomfort for menopausal women.

5. The upper uterus is the best place for the fertilized ovum to implant because it is here that the a. Placenta attaches most firmly b. Developing baby is best nourished c. Uterine endometrium is softer d. Maternal blood flow is lower

ANS: B Feedback A If the placenta attaches too deeply, it does not easily detach after birth. B The uterine fundus is richly supplied with blood and has the thickest endometrium, both of which promote optimal nourishment of the fetus. C Softness is not a concern with implantation; attachment and nourishment are the major concerns. D The blood supply is rich in the fundus, which allows for optimal nourishment of the fetus.

12. A patient is sent from the physician's office for assessment because of too little amniotic fluid. The nurse is aware that oligohydramnios can result in a. Excessive fetal urine secretion b. Newborn respiratory distress c. Central nervous system abnormality d. Gastrointestinal blockage

ANS: B Feedback A Oligohydramnios may be caused by a decreased in urine secretion. B Because an abnormally small amount of amniotic fluid restricts normal lung development, the infant may have inadequate respiratory function after birth, when the placenta no longer performs respiratory function. C Excessive amniotic fluid production may occur when the fetus has a central nervous system abnormality. D Excessive amniotic fluid production may occur when the gastrointestinal tract prevents normal ingestion of amniotic fluid.

14. Oogenesis, the process of egg formation, begins during fetal life in the female. Which statement related to ovum formation is correct? a. Two million primary oocytes will mature. b. At birth, all ova are contained in the female's ovaries. c. The oocytes complete their division during fetal life. d. Monthly, at least two oocytes mature.

ANS: B Feedback A Only 400 to 500 ova will mature during the approximately 35 years of a woman's reproductive life. B All of the cells that may undergo meiosis in a woman's lifetime are contained in the ovaries at birth. C The primary oocytes begin their first meiotic division during fetal life but remain suspended until puberty. D Every month, one primary oocyte matures and completes meiotic division yielding two unequal cells.

19. With regard to the structure and function of the placenta, the maternity nurse should be aware that a. As the placenta widens, it gradually thins to allow easier passage of air and nutrients. b. As one of its early functions, the placenta acts as an endocrine gland. c. The placenta is able to keep out most potentially toxic substances, such as cigarette smoke, to which the mother is exposed. d. Optimal blood circulation is achieved through the placenta when the woman is lying on her back or standing.

ANS: B Feedback A The placenta widens until week 20 and continues to grow thicker. B The placenta produces four hormones necessary to maintain the pregnancy. C Toxic substances such as nicotine and carbon monoxide readily cross the placenta into the fetus. D Optimal circulation occurs when the woman is lying on her side.

10. A woman who is 16 weeks pregnant asks the nurse, "Is it possible to tell by ultrasound if the baby is a boy or girl yet?" The best answer is a. "A baby's sex is determined as soon as conception occurs." b. "The baby has developed enough that we can determine the sex by examining the genitals through ultrasound." c. "Boys and girls look alike until approximately 20 weeks after conception, and then they begin to look different." d. "It might be possible to determine your baby's sex, but the external organs look very similar right now."

ANS: B Feedback A This is a true statement, but the external genitalia are similar in appearance until approximately the 12th week. B Although gender is determined at conception, the external genitalia of males and females look similar through the 9th week. By the 12th week, the external genitalia are distinguishable as male or female. C The external genitalia are similar in appearance until approximately 12 weeks, not 20 weeks. D The external genitalia are different at approximately week 12.

With regard to the assessment of female, male, and couple infertility, nurses should be aware that a. The couple's religious, cultural, and ethnic backgrounds provide emotional clutter that does not affect the clinical scientific diagnosis. b. The investigation is lengthy and can be very costly. c. The woman is assessed first; if she is not the problem, the male partner is analyzed. d. Semen analysis is for men; the postcoital test is for women.

ANS: B Fertility assessment and diagnosis take time, money, and commitment from the couple.

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

ANS: B Maternal infection is a risk with this procedure, and it is contraindicated if the client has an active infection in the cervix, vagina, or pelvic area. The procedure can still be performed; however, Rh sensitization may occur if the mother is Rh-negative. Rho(D) immune globulin can be administered following the procedure. This procedure is usually done for women over age 35; however, if the woman is at high risk for fetal anomalies, her age is not a contraindication. This procedure is done between 10 and 12 weeks.

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

ANS: B The contraction stress test (CST) involves recording the response of the fetal heart rate to stress induced by uterine contractions. The NST and biophysical profiles look at fetal movements. The NST looks at fetal heart accelerations with fetal movements. The CST records the fetal response to stress. It does not increase placental blood flow.

The role of the nurse in family planning is to a. Advise couples on which contraceptive to use. b. Educate couples on the various methods of contraception. c. Decide on the best method of contraception for the couple. d. Refer the couple to a reliable physician.

ANS: B The nurse's role is to provide information to the couple so that they can make an informed decision about family planning.

With regard to the use of intrauterine devices (IUDs), nurses should be aware that a. Return to fertility can take several weeks after the device is removed. b. IUDs containing copper can provide an emergency contraception option if inserted within a few days of unprotected intercourse. c. IUDs offer the same protection against sexually transmitted diseases as the diaphragm. d. Consent forms are not needed for IUD insertion

ANS: B The woman has up to 5 days to insert the IUD after unprotected sex.

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

ANS: B When the uterus is still in the pelvis, visualization may be difficult. It is necessary to perform the test when the woman has a full bladder, which provides a "window" through which the uterus and its contents can be viewed. The client needs a full bladder in order to elevate the uterus; therefore, being NPO would not be appropriate. A soap suds enema is not necessary for this procedure. An abdominal prep is not necessary for this procedure.

44. The nurse is teaching a client taking prenatal vitamins how to avoid constipation. Which should the nurse plan to include in the teaching session? (Select all that apply.) a. Advise taking a daily laxative for constipation. b. Recommend a diet high in fruits and vegetables. c. Encourage an increase in fluid consumption during the day. d. Increase the intake of whole grains and whole grain products. e. Suggest increasing the intake of dairy products, especially cheeses.

ANS: B, C, D Common sources of dietary fiber include fruits and vegetables (with skins when possible—apples, strawberries, pears, carrots, corn, potatoes with skins, and broccoli), whole grains, and whole grain products—whole wheat bread, bran muffins, bran cereals, oatmeal, brown rice, and whole wheat pasta. Increased intake of fluids can help prevent constipation. A pregnant client should not take a daily laxative unless prescribed by her health care provider. Increased intake of dairy products, especially cheese, can increase constipation. PTS: 1 DIF: Cognitive Level: Application REF: 162

The consequences technique will assist children to learn the direct result of their behavior. This technique can be used with children from toddler age to adolescence. If children learn to understand consequences, they are less likely to repeat the offending behavior. Consequences fall into which categories? Select all that apply. a. Corporal b. Natural c. Logical d. Unrelated e. Behavioral

ANS: B, C, D Natural consequences are those that occur spontaneously. For example, a child leaves a toy outside and it is lost. Logical consequences are those that are directly related to the misbehavior. If two children are fighting over a toy, the toy is removed and neither child has it. Unrelated consequences are purposely imposed; for example, the child is late for dinner so he or she is not allowed to watch television. Corporal punishment is not part of this behavioral approach and usually takes the approach of spanking the child. Corporal punishment is highly controversial and is strongly discouraged by the American Academy of Pediatrics. Behavior modification is another disciplinary technique that rewards positive behavior and ignores negative behavior.

26. Which congenital defects in a newborn are associated with long-term parenting problems? (Select all that apply.) a. Polydactyl b. Cleft lip and palate c. Ventral septal defect d. Ambiguous genitalia

ANS: B, D Although any defect in a newborn produces extreme concern and anxiety, certain defects are associated with long-term parenting problems. Accepting an infant with facial or genital anomalies is particularly difficult for the family and community. Polydactyl and ventral septal defects are reparable, with good outcomes. PTS: 1 DIF: Cognitive Level: Analysis REF: 492

20. The nurse is formulating a nursing care plan for a postpartum client. Which actions by the nurse indicate use of critical thinking skills when formulating the care plan? (Select all that apply). a. Using a standardized postpartum care plan b. Determining priorities for each diagnosis written c. Writing interventions from a nursing diagnosis book d. Reflecting and suspending judgment when writing the care plan e. Clustering data during the assessment process according to normal versus abnormal

ANS: B, D, E Critical thinking focuses on appraisal of the way the individual thinks, and it emphasizes reflective skepticism. Determining priorities, reflecting and suspending judgment, and clustering data are actions that indicate the use of critical thinking. Using a standardized care plan and writing interventions from a nursing diagnosis book do not show that reflection about the client's individual care is being done. PTS: 1 DIF: Cognitive Level: Application REF: 27

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

ANS: C Feedback A Because she is currently pregnant, she is classified as a gravida 4; the pregnancy that was terminated at 8 weeks is classified as an abortion. B Gravida 4 is correct, but she is a para 2. The pregnancy that was terminated at 8 weeks is classified as an abortion. C She has had four pregnancies, including the current one (gravida 4). She had two pregnancies that terminated after 20 weeks (para 2). The pregnancy that terminated at 8 weeks is classified as an abortion. D Since she is currently pregnant, she is classified as a gravida 4, not a 3. The para is correct.

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

ANS: C Feedback A By continuing to touch her, the nurse is showing disrespect for her cultural beliefs. B A Muslim's response to touch does not reflect like or dislike. C Touching is an important component of communication in various cultures, but if the patient appears to find it offensive, the nurse should respect her cultural beliefs and limit touching her. D This reaction may be offensive to the patient.

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

ANS: C Feedback A Career responsibilities may have demands that make the grandparents not as accessible, but it is not a major factor in determining the woman's response to becoming a grandmother. B Being divorced is not a major factor that determines adaptation of grandparents. C Age is a major factor in determining the emotional response of prospective grandparents. Young grandparents may not be happy with the stereotype of grandparents as being old. D The age of the daughter is not a major factor that determines adaptation of grandparents. The age of the grandparent is a major factor.

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

ANS: C Feedback A Chloasma is a facial melasma also known as the "mask of pregnancy." This condition is manifested by a blotchy, hyperpigmentation of the skin over the cheeks, nose and forehead especially in dark complexioned women. B Linea nigra is a pigmented line extending from the symphysis pubis to the top of the fundus in the midline. C Striae gravidarum or stretch marks appear in 50% to 90% of pregnant women during the second half of pregnancy. They most often occur on the breasts and abdomen. This integumentary alteration is the result of separation within the underlying connective (collagen) tissue. D Angiomas and other changes also may appear.

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

ANS: C Feedback A Developing a trusting relationship should be established during these visits, but that is not the primary reason. B Most women do not have questions concerning labor until the last trimester of the pregnancy. C This routine allows monitoring of maternal health and fetal growth and ensures that problems will be identified early. D All problems cannot be eliminated because of prenatal visits, but they can be identified.

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

ANS: C Feedback A Elastic stockings should be applied before lowering the legs in the morning. B Elevating the legs at night may cause pressure on the diaphragm and increase breathing problems. C Elevating the feet and legs improves venous return and prevents venous stasis. D Sitting with the legs crossed will decrease circulation in the legs and increase venous stasis.

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

ANS: C Feedback A Group sessions begin at 12 to 16 weeks of gestation and end with an early postpartum visit. Prior to group sessions, the patient has an individual assessment, physical examination, and history. B At the beginning of each group meeting, patients measure their own BP, weight, and urine dips and enter these in their record. Fetal heart rate assessment and fundal height are obtained by the nurse. C Gestational age cohorts comprise the groups, with approximately 8 to 12 women in each group. This group remains intact throughout the pregnancy. Individual follow-up visits are scheduled as needed. D Results evaluating this approach have been very promising. In a recent study of adolescent patients, there was a decrease in LBW infants and an increase in breastfeeding rates.

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

ANS: C Feedback A Instruct the woman to eat five to six small meals rather than three full meals per day. Nausea is more intense when the stomach is empty. B Fluids should be taken separately from meals. Fluids overstretch the stomach and may precipitate vomiting. C This will assist with the symptoms of morning sickness. It is also important for the woman to arise slowly. D Coffee and orange juice stimulate acid formation in the stomach. It is best to suggest eating dry carbohydrates when rising in the morning.

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

ANS: C Feedback A It is normal for a child to regress when a new sibling is introduced into the home. B The toddler may have feelings of jealousy and resentment toward the new baby taking the attention from him. Frequent reassurance of parental love and affection are important. C It is important for a mother to seek time alone with her toddler to reassure him that he is loved. D Changes in sleeping arrangements should be made several weeks before the birth so that the child does not feel displaced by the new baby.

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

ANS: C Feedback A Since she is prone to blood clots in the legs, massaging the affected leg muscle is contraindicated. B Pointing the toes will contract the muscle and not relieve the pain. C Dorsiflexion of the foot stretches the leg muscle and relieves the painful muscle contraction. D Warm packs can be used to relax the muscle, but more immediate relief is necessary, such as dorsiflexion of the foot.

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

ANS: C Feedback A This statement is belittling the patient's concerns. B This statement is belittling the patient's concerns by telling her she should not worry. C Encouraging the client to discuss her feelings is the best approach. Women during their third trimester need reassurance that such fears are not unusual in pregnancy. D This statement disregards the patient's feelings and treats them as unimportant.

16. Which environment can assist a pregnant teen to achieve the task of establishing a stable identity? a. Home schooling b. Alternative education program c. School-based mothers' program d. Continuing mainstream high school classes

ANS: C A school-based mothers' program that provides peer support is important. Home schooling, alternative education, and continuing mainstream high school classes would not provide as much peer support. PTS: 1 DIF: Cognitive Level: Analysis REF: 478

5. Which should the nurse do when counseling a teenage client who has decided to relinquish her baby for adoption? a. Question her about her feelings regarding adoption. b. Tell her she can always change her mind about adoption. c. Affirm her decision while acknowledging her maturity in making it. d. Ask her if anyone is coercing her into the decision to relinquish her baby.

ANS: C A supportive affirming approach by the nurse will strengthen the client's resolve and help her appreciate the significance of the event. It is important for the nurse to support and affirm the decision the client has made. This will strengthen the client's resolve to follow through. Later the client should be given an opportunity to express her feelings. Telling her that she can always change her mind about adoption should not be an option after the baby is born and placed with the adoptive parents. It is important that the teenager be treated as an adult, with the assumption that she is capable of making an important decision on her own. PTS: 1 DIF: Cognitive Level: Application REF: 496

20. A pregnant client tells you during a clinic visit that she is concerned about her significant other's change in behavior during the course of the pregnancy. She relates feelings of being afraid but emphatically denies any physical or verbal threats. She confides in you that she has been using her mobile phone to find out more information about this subject. What is the most appropriate nursing response? a. Tell her that all relationships change during pregnancy and give herself and her significant other some time to adapt to this situation by spending quality time with one another. b. Tell the client that you are concerned for her and the baby; provide her with a phone number for a safe house just in case she needs to act quickly and leave the home situation. c. Explore in more detail the client's feelings but tell her that you are concerned about searching information on the Internet as a stimulus trigger for potential abuse. d. Do not let the client leave the clinic office and call the domestic abuse hotline number to report the incident.

ANS: C All health care providers should take comments of potential abuse seriously. Because there is no confirmation of abuse by the client's admission, additional investigation is warranted. Based on the facts presented, the nurse should be concerned that the client's significant other might be alerted to a potential trigger of violent behavior. PTS: 1 DIF: Cognitive Level: Application REF: 499

21. The nurse is seeing a 17-year-old female in the clinic for complaints of acne. The nurse plans on taking advantage of this teachable moment with the teen. What topics will the nurse include in the teen's teaching plan? a. Smoking habits, folic acid intake, and heart disease b. Hyperlipidemia, distracted driving, and menstrual history c. Sexual activity, contraception, and screening for violence d. Optimum weight, hypothyroidism, and sexually transmitted diseases

ANS: C All the topics mentioned are worthy of discussion. However, sexual activity, contraception, and screening for violence have priority related to the age and gender of the patient. Because adolescents are often seen by a health care provider for various reasons before they become pregnant, counseling to improve health for a future pregnancy should be offered to them during any health care visit. Smoking cessation, attaining optimum weight, folic acid intake, and screening for violence are topics that should be discussed with all young women so that any future pregnancy has the most positive outcome. PTS: 1 DIF: Cognitive Level: Analysis REF: 477

25. A nurse is developing information to give to a group of pregnant women who are interested in nutritional management of their pregnancy with regard to expected weight gain. The nurse bases the amount of weight gain for pregnant women on calculation of their: a. EDC (expected date of confinement). b. prepregnancy weight. c. BMI (body mass index). d. basal energy expenditure (BEE).

ANS: C BMI takes into account height, weight, and body frame characteristics. Weight gain is not based on the EDC. Although the prepregnancy weight is important, it must be looked at in correlation to a calculated BMI. The calculation of BEE is used for clients who are at nutritional risk and are receiving enteral and/or parenteral nutrition therapies. PTS: 1 DIF: Cognitive Level: Application REF: 143

38. For the pregnant client who is a vegan, what combination of foods will the nurse advise to meet the nutritional needs for all essential amino acids? a. Eggs and beans b. Fruits and vegetables c. Grains and legumes d. Vitamin and mineral supplements

ANS: C Combining incomplete plant proteins with other plant foods that have complementary amino acids allows intake of all essential amino acids. Dishes that contain grains (e.g., wheat, rice, corn) and legumes (e.g., garbanzo, navy, kidney, or pinto beans, peas, peanuts) are combinations that provide complete proteins. Eggs are not eaten by vegans. Fruits and vegetables alone will not provide the essential amino acids. Vitamin and mineral supplements do not provide amino acids. PTS: 1 DIF: Cognitive Level: Application REF: 153

28. Which food selections would lead to enhanced iron absorption during pregnancy? a. Eating additional fiber and grains in the diet b. Drinking coffee with meals c. Drinking orange juice d. Including spinach in the diet two to three times a week

ANS: C Drinking orange juice, which contains ascorbic acid, acts to enhance iron absorption. Foods that are high in fiber and grains contain phytates, which can decrease iron absorption. Coffee intake can affect iron binding and therefore decrease absorption. Spinach contains oxalates, which can interfere with iron absorption. PTS: 1 DIF: Cognitive Level: Application REF: 150

43. A patient at 8 weeks' gestation complains to the nurse, "I feel sick almost every morning. And I throw up at least two or three times a week." What is the nurse's best advice to the patient? a. "Do you like cheese?" b. "Try eating four meals a day instead of three meals a day." c. "Try eating peanut butter on whole wheat bread right before going to bed." d. "If you can eat enough throughout the day, you don't have to worry about being sick."

ANS: C Eating a bedtime protein snack helps maintain glucose levels throughout the night. Cheese is high in fat and can aggravate nausea. Small and frequent meals is the recommendation; four meals a day is not frequent enough. Consumption is not the patient's stated concern—it is the nausea and vomiting. PTS: 1 DIF: Cognitive Level: Analysis REF: 154

41. The health care provider has recommended an iron supplement for the patient who is 20 weeks pregnant. The nurse is reviewing the recommendation with the patient. What fluid is best for the nurse to recommend when taking an iron supplement? a. 8 ounces of milk b. 8 ounces of water c. 4 ounces of orange juice d. 4 ounces of apple juice

ANS: C Iron absorption is enhanced when taken with a source of vitamin C. Calcium can block the absorption of vitamin C. Water and apple juice to not facilitate or block the absorption of iron. PTS: 1 DIF: Cognitive Level: Application REF: 149

26. A pregnant client comes to the OB clinic and informs you that she is very concerned about the amount of weight gain associated with pregnancy. She then tells you that she wants to switch to a low-fat diet during pregnancy. BMI measurements indicate a BMI of 22.7. What would be the best nursing response to this client's stated plan? a. Tell the client that as long as she maintains a varied diet with regard to the other nutrients, there should be no problems. b. Refer the client to a dietician for assistance in planning the low-fat diet. c. Advise the client that it is important to maintain the intake of essential fatty acids during pregnancy. d. Schedule the client for more frequent visits during the next few months to evaluate her weight pattern.

ANS: C It is important to teach the client that essential fatty acids are needed in the diet to assist fetal development (visual and cognitive). Dieting during pregnancy is not advised. Clients should maintain a regular diet that has a varied intake of nutrient sources. There is no need for referral at this time because dieting is not recommended during pregnancy. The client's BMI indicates that she is within the normal weight range. There is no need to add additional appointments at this time. PTS: 1 DIF: Cognitive Level: Application REF: 145

12. Regarding advanced roles of nursing, which statement is true with regard to clinical practice? a. Family nurse practitioners (FNPs) can assist with childbirth care in the hospital setting. b. Clinical nurse specialists provide primary care to obstetric clients. c. Neonatal nurse practitioners provide emergency care in the postbirth setting to high-risk infants. d. A certified nurse midwife (CNM) is not considered to be an advanced practice nurse.

ANS: C Neonatal NPs provide care for the high-risk neonate in the birth room and in the neonatal intensive care unit, as needed. FNPs do not participate in childbirth care but can take care of uncomplicated pregnancies and postbirth care outside of the hospital setting. CNSs work in hospital settings but do not provide primary care services to clients. A CNM is an advanced practice nurse who receives additional certification in the specific area of midwifery. PTS: 1 DIF: Cognitive Level: Application REF: 17

2. Which nursing intervention is an independent function of the nurse? a. Administering oral analgesics b. Requesting diagnostic studies c. Teaching the client perineal care d. Providing wound care to a surgical incision

ANS: C Nurses are now responsible for various independent functions, including teaching, counseling, and intervening in nonmedical problems. Interventions initiated by the physician and carried out by the nurse are called dependent functions. Administrating oral analgesics is a dependent function; it is initiated by a physician and carried out by a nurse. Requesting diagnostic studies is a dependent function. Providing wound care is a dependent function; it is usually initiated by the physician through direct orders or protocol. PTS: 1 DIF: Cognitive Level: Understanding REF: 24

22. A patient has just acknowledged that she is 20 weeks pregnant and confides to the nurse that she has a daily heroin habit. The nurse discusses treatment options for the patient. Which patient statement requires follow-up? a. "My plan is to visit the outpatient clinic daily for treatment." b. "I will see my health care provider at least every 2 weeks." c. "My baby will not have to go through withdrawal when I take methadone." d. "With oral methadone, my baby and I are at decreased risk of infection."

ANS: C Pregnant women who use heroin are often prescribed an alternative drug such as methadone, a synthetic opiate. Methadone can be taken orally once daily and is long- acting, providing consistent blood levels to decrease the adverse fetal effects of wide swings in blood levels found with heroin use. Methadone also reduces the risk of infections from contaminated needles and drug-seeking behavior, such as prostitution. At therapeutic levels, it does not produce the euphoria or sedation of heroin and allows the woman to have a relatively normal lifestyle. The woman who receives a daily dose of methadone in a drug treatment program is more likely to receive prenatal care. However, the newborn must withdraw from methadone after birth. PTS: 1 DIF: Cognitive Level: Application REF: 488

31. When explaining the recommended weight gain to your client, the nurse's teaching should include which statement? a. "All pregnant women need to gain a minimum of 25 to 35 pounds." b. "The fetus, amniotic fluid, and placenta require 15 pounds of weight gain." c. "Weigh gain in pregnancy is based on the client's prepregnant body mass index." d. "More weight should be gained in the first and second trimesters and less in the third."

ANS: C Recommendations for weight gain in pregnancy are based on the woman's prepregnancy weight for her height (body mass index). Depending on the prepregnant weight, recommendation for weight gain may be more or less than 25 to 35 pounds. The combination of the fetus, amniotic fluid, and placenta averages about 11 pounds in the client who has a normal BMI. Less weight should be gained in the first trimester, when the fetus needs fewer nutrients for growth, and more in the third trimester, when fetal growth is accelerated. PTS: 1 DIF: Cognitive Level: Application REF: 143

14. A client who is 6 months pregnant has sought medical attention, saying she fell down the stairs. Which scenario would cause an emergency department nurse to suspect that the woman has been battered? a. She avoids making eye contact and is hesitant to answer questions. b. The woman and her partner are having an argument that is loud and hostile. c. The woman has injuries on various parts of her body that are in different stages of healing. d. Examination reveals a fractured arm and fresh bruises. Her husband asks her about her pain.

ANS: C The battered woman often has multiple injuries in various stages of healing. It is more normal for the woman to have a flat affect. A loud and hostile argument is not always an indication of battering. Often the batterer will be attentive and refuse to leave the woman's bedside. PTS: 1 DIF: Cognitive Level: Analysis REF: 500

33. Which client has correctly increased her caloric intake from her recommended pregnancy intake to the amount necessary to sustain breastfeeding in the first 6 postpartum months? a. From 1800 to 2200 calories per day b. From 2000 to 2500 calories per day c. From 2200 to 2530 calories per day d. From 2500 to 2730 calories per day

ANS: C The increased calories necessary for breastfeeding are 500, with 330 calories coming from increased caloric intake and 170 calories from maternal stores. An increase of 230 calories is insufficient for breastfeeding. An increase of 400 and 500 calories is above the recommended amount. PTS: 1 DIF: Cognitive Level: Analysis REF: 145

9. A nurse is conducting a prenatal nutritional education class for a group of nursing students. Which should the nurse include as the definition of pica? a. Iron deficiency anemia b. Intolerance to milk products c. Ingestion of nonfood substances d. Episodes of anorexia and vomiting

ANS: C The practice of eating substances not normally thought of as food is called pica. Clay, dirt, and solid laundry starch are the substances most commonly ingested. Pica may produce iron deficiency anemia if proper nutrition is decreased. Intolerance to milk products is termed lactose intolerance. Pica is not related to anorexia and vomiting. PTS: 1 DIF: Cognitive Level: Application REF: 155

3. Which most therapeutic response to the client's statement, "I'm afraid to have a cesarean birth" should be made by the nurse? a. "Everything will be OK." b. "Don't worry about it. It will be over soon." c. "What concerns you most about a cesarean birth?" d. "The physician will be in later and you can talk to him."

ANS: C The response, "What concerns you most about a cesarean birth" focuses on what the client is saying and asks for clarification, which is the most therapeutic response. The response, "Everything will be ok" is belittling the client's feelings. The response, "Don't worry about it. It will be over soon" will indicate that the client's feelings are not important. The response, "The physician will be in later and you can talk to him" does not allow the client to verbalize her feelings when she wishes to do that. PTS: 1 DIF: Cognitive Level: Application REF: 18

7. What is most likely to be a concern for an older mother? a. Nutrition and diet planning b. Exercise and fitness c. Having enough rest and sleep d. Effective contraceptive methods

ANS: C The woman who delays childbearing may have unique concerns, one of which is having less energy than younger mothers. The older mother is better off financially and can afford better nutrition. Information about exercise and fitness is readily available. The older mother usually has more financial means to search out effective contraceptive methods. PTS: 1 DIF: Cognitive Level: Understanding REF: 484, 485

3. Which is a major barrier to health care for teen mothers? a. Health care workers have a positive attitude. b. The hospital or clinic is within walking distance of the girl's home. c. Seeing a different nurse and/or health care provider at every visit. d. The institution is open days, evenings, and Saturday by special arrangement.

ANS: C Whenever possible, the teen should be scheduled to see the same nurses and practitioners for continuity of care. A positive attitude of the health care providers is important in teen pregnancy care. If the hospital or clinic were within walking distance of the girl's home, it would prevent the teen from missing appointments because of transportation problems. If the institution were open days, evenings, and Saturday by special arrangement, this would be helpful for teens who work, go to school, or have other time of day restrictions. Scheduling conflicts are a major barrier to health care. PTS: 1 DIF: Cognitive Level: Understanding REF: 480, 482

In general, healthy families are able to adapt to changes within the family unit; however, some factors add to the usual stress experienced by any family. The nurse is in a unique position to assess the child for symptoms of neglect. Which high-risk family situation places the child at the greatest risk for being neglected? a. Marital conflict and divorce b. Adolescent parenting c. Substance abuse d. A child with special needs

ANS: C A Although divorce is traumatic to children, research has shown that living in a home filled with conflict is also detrimental. In this situation conflict may arise and young children may be unable to verbalize their distress; however, the child is not likely to be neglected. B Teenage parenting often has a negative effect on the health and social outcomes of the entire family. Adolescent girls are at risk for a number of pregnancy complications, are unlikely to attain a high level of education, and are more likely to be poor. C Parents who abuse drugs or alcohol may neglect their children because obtaining and using the substance(s) may have a stronger pull on the parents than the care of their children. D When a child is born with a birth defect or has an illness that requires special care, the family is under additional stress. These families often suffer financial hardship as health insurance benefits quickly reach their maximum.

While reviewing the dietary-intake documentation of a 7-year-old Asian boy with a fractured femur, the nurse notes that he consistently refuses to eat the food on his tray. What assumption is most likely accurate? a. He is a picky eater. b. He needs less food because he is on bed rest. c. He may have culturally related food preferences. d. He is probably eating between meals and spoiling his appetite.

ANS: C A Although the child may be a picky eater, the key point is that he is from a different culture. The foods he is being served may seem strange to him. B Nutrition plays an important role in healing. Although the energy the child expends has decreased while on bed rest, he has increased needs for good nutrition. C When cultural differences are noted, food preferences should always be obtained. A child will often refuse to eat unfamiliar foods. D Although the nurse should determine whether the child is eating food the family has brought from home, the more important point is to determine whether he has food preferences.

The parent of a child who has had numerous hospitalizations asks the nurse for advice because her child has been having behavior problems at home and in school. In discussing effective discipline, what is an essential component? a. All children display some degree of acting out and this behavior is normal. b. The child is manipulative and should have firmer limits set on her behavior. c. Positive reinforcement and encouragement should be used to promote cooperation and the desired behaviors. d. Underlying reasons for rules should be given and the child should be allowed to decide which rules should be followed.

ANS: C A Behavior problems should not be disregarded as normal. B It would be incorrect to assume the child is being manipulative and should have firmer limits set on her behaviors. C Using positive reinforcement and encouragement to promote cooperation and desired behaviors is one of the three essential components of effective discipline. D Providing the underlying reasons for rules and giving the child a choice concerning which rules to follow constitute a component of permissive parenting and are not considered an essential component of effective discipline.

A nurse is caring for a child with the religion of Christian Science. What intervention should the nurse include in the care plan for this child? a. Offer iced tea to the child who is experiencing deficient fluid volume. b. Inform the spiritual care department that the child has been admitted to the hospital. c. Allow parents to sign a form opting out of routine immunizations. d. Ask parents whether the child has been baptized.

ANS: C A Coffee and tea are declined as a drink. B When a Christian Science believer is hospitalized, a parent or patient may request that a Christian Science practitioner be notified as opposed to the hospital-assigned clergy. C Christian Science believers seek exemption from immunizations but obey legal requirements. D Baptism is not a ceremony for the Christian Science religion.

A traditional family structure in which male and female partners and their children live as an independent unit is known as a(n) _____ family. a. Extended b. Binuclear c. Nuclear d. Blended

ANS: C A Extended families include other blood relatives in addition to the parents. B A binuclear family involves two households. C Approximately two thirds of U.S. households meet the definition of a nuclear family. This is also known as the traditional family. D A blended family is reconstructed after divorce and involves the merger of two families.

Families who deal effectively with stress exhibit which behavior pattern? a. Focus on family problems b. Feel weakened by stress c. Expect that some stress is normal d. Feel guilty when stress exists

ANS: C A Healthy families focus on family strengths rather than on the problems and know that stress is temporary and may be positive. B If families are dealing effectively with stress, then weakening of the family unit should not occur. C Healthy families recognize that some stress is normal in all families. D Because some stress is normal in all families, feeling guilty is not reasonable. Guilt only immobilizes the family and does not lead to resolution of the stress.

To resolve family conflict, it is necessary to have open communication, accurate perception of the problem, and a(n) a. Intact family structure b. Arbitrator c. Willingness to consider the view of others d. Balance in personality types

ANS: C A The structure of a family may affect family dynamics, but it is still possible to resolve conflict without an intact family structure if all of the ingredients of conflict resolution are present. B Conflicts can be resolved without the assistance of an arbitrator. C Without the willingness of the members of a group to consider the views of others, conflict resolution cannot take place. D Most families have diverse personality types among their members. This diversity may make conflict resolution more difficult but should not impede it as long as the ingredients of conflict resolution are present.

Injectable progestins (DMPA, Depo-Provera) are a good contraceptive choice for women who a. Want menstrual regularity and predictability b. Have a history of thrombotic problems or breast cancer c. Have difficulty remembering to take oral contraceptives daily d. Are homeless or mobile and rarely receive health care

ANS: C Advantages of DMPA include a contraceptive effectiveness comparable to that of combined oral contraceptives with the requirement of only four injections a year.

What is important in instructing a patient in the use of spermicidal foams or gels? a. Insert 1 to 2 hours before intercourse. b. One application is effective for several hours. c. Avoid douching for at least 6 hours. d. Effectiveness is about 85%.

ANS: C Douching within 6 hours of intercourse removes the spermicide and increases the risk of pregnancy

The purpose of amniocentesis for a client hospitalized at 34 weeks of gestation with pregnancy-induced hypertension is to: a. Identify abnormal fetal cells. b. Detect metabolic disorders. c. Determine fetal lung maturity. d. Identify the sex of the fetus.

ANS: C During the third trimester, amniocentesis is most often performed to determine fetal lung maturity. In cases of pregnancy-induced hypertension, preterm delivery may be necessary due to changes in placental perfusion. Identification of abnormal cells is done during the early portion of the pregnancy. The test is done in the early portion of the pregnancy if the metabolic disorder is genetic. Amniocentesis is done early in the pregnancy to do genetic studies and determine the sex.

8. During a centering pregnancy group meeting, the nurse teaches patients that the fetal period is best described as one of a. Development of basic organ systems 4/14 b. Resistance of organs to damage from external agents c. Maturation of organ systems d. Development of placental oxygen-carbon dioxide exchange

ANS: C Feedback A Basic organ systems are developed during the embryonic period. B The organs are always at risk for damage from external sources; however, the older the fetus, the more resistant the organs will be. The greatest risk is when the organs are developing. C During the fetal period, the body systems grow in size and mature in function to allow independent existence after birth. D The placental system is complete by week 12, but that is not the best description of the fetal period.

2. The microscopic examination of scrapings from the cervix, endocervix, or other mucous membranes to detect premalignant or malignant cells is called a. Bimanual palpation b. Rectovaginal palpation c. A Papanicolaou test d. DNA testing

ANS: C Feedback A Bimanual palpation is a physical examination of the vagina; the Pap test is a microscopic examination for cancer. B Rectovaginal palpation is a physical examination performed through the rectum; the Pap test is a microscopic examination for cancer. C The Pap test is a microscopic examination for cancer that should be performed regularly, depending on the patient's age. D DNA testing for the various types of HPV that cause cervical cancer is now available. Samples are collected in the same way as a Pap test.

24. A 36-year-old woman has been diagnosed as having uterine fibroids. When planning care for this patient, the nurse should know that a. Fibroids are malignant tumors of the uterus that require radiation or chemotherapy. b. Fibroids will increase in size during the perimenopausal period. c. Abnormal uterine bleeding is a common finding. d. Hysterectomy should be performed.

ANS: C Feedback A Fibroids are benign tumors of the smooth muscle of the uterus, and their etiology is unknown. B Fibroids are estrogen-sensitive and shrink as levels of estrogen decline. C The major symptoms associated with fibroids are menorrhagia and the physical effects produced by large leimyomas. D A hysterectomy may be performed if the woman does not want more children and other therapies are not successful.

23. Which diagnostic test is used to confirm a suspected diagnosis of breast cancer? a. Mammogram b. Ultrasound c. Core needle biopsy d. CA 15-3

ANS: C Feedback A Mammography is a clinical screening tool that may aid early detection of breast cancers. B Transillumination, thermography, and ultrasound breast imaging are being explored as methods of detecting early breast carcinoma. C When a suspicious mammogram is noted or a lump is detected, diagnosis is confirmed by either a core needle biopsy or needle localization biopsy. D CA-15 is a serum tumor marker that is used to test for the presence of breast cancer.

3. The purpose of the ovum's zona pellucida is to a. Make a pathway for more than one sperm to reach the ovum. b. Allow the 46 chromosomes from each gamete to merge. c. Prevent multiple sperm from fertilizing the ovum. d. Stimulate the ovum to begin mitotic cell division.

ANS: C Feedback A Once one sperm has entered the ovum, the zona pellucida changes to prevent other sperm from entering. B Each gamete (sperm and ovum) has only 23 chromosomes. There will be 46 chromosomes when they merge. C Fertilization causes the zona pellucida to change its chemical composition so that multiple sperm cannot fertilize the ovum. D Mitotic cell division begins when the nuclei of the sperm and ovum unite.

18. The drug of choice to treat gonorrhea is a. Penicillin G b. Tetracycline c. Ceftriaxone d. Acyclovir

ANS: C Feedback A Penicillin is used to treat syphilis. B Tetracycline is used to treat chlamydial infections. C Ceftriaxone is effective for treatment of all gonococcal infections. D Acyclovir is used to treat herpes genitalis.

17. Sally comes in for her first prenatal examination. This is her first child. She asks you (the nurse), "How does my baby get air inside my uterus?" The correct response is a. "The baby's lungs work in utero to exchange oxygen and carbon dioxide." b. "The baby absorbs oxygen from your blood system." c. "The placenta provides oxygen to the baby and excretes carbon dioxide into your bloodstream." d. "The placenta delivers oxygen-rich blood through the umbilical artery to the baby's abdomen."

ANS: C Feedback A The fetal lungs do not function for respiratory gas exchange in utero. B The baby does not simply absorb oxygen from a woman's blood system. Blood and gas transport occur through the placenta. C The placenta functions by supplying oxygen and excreting carbon dioxide to the maternal bloodstream. D The placenta delivers oxygen-rich blood through the umbilical vein, not artery.

16. At approximately _____ weeks of gestation, lecithin is forming on the alveolar surfaces, the eyelids open, and the fetus measures approximately 27 cm crown to rump and weighs approximately 1110 g. a. 20 b. 24 c. 28 d. 30

ANS: C Feedback A These milestones would not be completed by 20 weeks of gestation. B These milestones in human development will not be completed at 24 weeks of gestation. C These are all milestones that occur at 28 weeks. D These specific milestones will be reached as early as 28 weeks, not 30 weeks of gestation.

Chorionic villus sampling can be performed during pregnancy as early as _____ weeks. a. 4 b. 8 c. 10 d. 12

ANS: C Fetal villus tissue can be obtained as early as 10 weeks of gestation and can be analyzed directly for chromosomal or genetic abnormalities. It is too early to perform at 4 weeks. It is too early to be performed at 8 weeks. The test should be performed at 12 weeks, but it can be done as early as 10 weeks.

A score of 9 on a biophysical profile is considered: a. Abnormal. b. Equivocal. c. Normal. d. None of the above.

ANS: C Five parameters of fetal activity (fetal heart rate, fetal breathing movements, gross fetal movements, fetal tone, and amniotic fluid volume) are used to determine the biophysical profile. The maximum score is 2 points for each parameter. A score falling between 8 and 10 is considered normal. A score of 4 or less is considered abnormal. A score of 9 is considered reassuring. A score of 8 to 10 is considered reassuring.

While instructing a couple regarding birth control, the nurse should be aware that the method called natural family planning a. Is the same as coitus interrupts, or "pulling out" b. Uses the calendar method to align the woman's cycle with the natural phases of the moon c. Is the only contraceptive practice acceptable to the Roman Catholic Church d. Relies on barrier methods during fertility phases

ANS: C Natural family planning is the only contraceptive practice acceptable to the Roman Catholic Church.

Which contraceptive method provides protection against sexually transmitted diseases? a. Oral contraceptives b. Tubal ligation c. Male or female condoms d. Intrauterine device (IUD)

ANS: C Only the barrier methods provide some protection from sexually transmitted diseases. Because latex condoms provide the best protection available, they should be used during any potential exposure to a sexually transmitted disease.

Which contraceptive method is contraindicated in a woman with a history of toxic shock syndrome? a. Condom b. Spermicide c. Cervical cap d. Norplant

ANS: C The cervical cap may increase the risk of toxic shock syndrome, because it may be left in the vagina for a prolonged period.

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

ANS: C The nurse should clarify the statement and assist the client in exploring her feelings about the test. This is false reassurance and does not deal with the concerns expressed by the woman. The woman may not by able to answer "why" questions. It may also make her defensive. This is a closed statement and does not encourage the woman to express her feelings.

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

ANS: C The nurse should provide the couple with all necessary information about a procedure so that the couple can make an informed decision. The nurse's role is to inform, not to advise. Decision making should always lie with the couple involved. The nurse should provide information so that couple can make an informed decision. Ensuring fetal safety is not possible with all of the diagnostic testing. To offer this is to give false reassurance to the parents. The nurse can inform the couple about potential problems so they can make an informed decision.

A couple comes in for an infertility workup, having attempted to get pregnant for 2 years. The woman, 37, has always had irregular menstrual cycles but is otherwise healthy. The man has fathered two children from a previous marriage and had a vasectomy reversal 2 years ago. The man has had two normal semen analyses, but the sperm seem to be clumped together. What additional test is needed? a. Testicular biopsy b. Antisperm antibodies c. FSH level d. Examination for testicular infection

ANS: C The woman has irregular menstrual cycles. The scenario does not indicate that she has had any testing related to this irregularity. Hormone analysis is performed to assess endocrine function of the hypothalamic-pituitary-ovarian axis when menstrual cycles are absent or irregular. Determination of blood levels of prolactin, FSH, luteinizing hormone (LH), estradiol, progesterone, and thyroid hormones may be necessary to diagnose the cause of irregular menstrual cycles.

A woman will be taking oral contraceptives using a 28-day pack. The nurse should advise this woman to protect against pregnancy by a. Limiting sexual contact for one cycle after starting the pill b. Using condoms and foam instead of the pill for as long as she takes an antibiotic c. Taking one pill at the same time every day d. Throwing away the pack and using a backup method if she misses two pills during week 1 of her cycle

ANS: C To maintain adequate hormone levels for contraception and to enhance compliance, patients should take oral contraceptives at the same time each day.

A couple is trying to cope with an infertility problem. They want to know what they can do to preserve their emotional equilibrium. The nurse's most appropriate response is a. "Tell your friends and family so that they can help you." b. "Talk only to other friends who are infertile, because only they can help." c. "Get involved with a support group. I'll give you some names." d. "Start adoption proceedings immediately, because obtaining an infant is very difficult."

ANS: C Venting negative feelings may unburden the couple. A support group may provide a safe haven for the couple to share their experiences and gain insight from others' experiences.

25. Which characteristics of fetal alcohol syndrome (FAS) should the nurse expect to assess in affected neonates? (Select all that apply.) a. Hydrocephaly b. Low activity c. Epicanthal folds d. Short palpebral fissures e. Flat midface, with a low nasal bridge

ANS: C, D, E Common facial anomalies associated with FAS include microcephaly, short palpebral fissures (the openings between the eyelids), epicanthal folds, flat midface with a low nasal bridge, indistinct philtrum (groove between the nose and upper lip), and a thin upper lip. Microcephaly is present, not hydrocephaly. Central nervous system impairment includes a high activity level, not a low one. PTS: 1 DIF: Cognitive Level: Understanding REF: 487

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

ANS: D Feedback A Fetal movement is a presumptive sign of pregnancy. B Amenorrhea is a presumptive sign of pregnancy. C Breast changes are a presumptive sign of pregnancy. D The only positive signs of pregnancy are auscultation of fetal heart tones, visualization of the fetus by ultrasound, and fetal movement felt by the examiner.

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

ANS: D Feedback A Pressures are significantly higher when the patient is standing. This option causes an increase in systolic and diastolic pressures. B The arm should be supported at the same level of the heart. C The supine position may cause occlusion of the vena cava and descending aorta, creating hypotension. D Blood pressure is affected by positions during pregnancy. The supine position may cause occlusion of the vena cava and descending aorta. Turning the pregnant woman to a lateral recumbent position alleviates pressure on the blood vessels and quickly corrects supine hypotension.

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

ANS: D Feedback A The patient should be reassured that these symptoms are within normal limits. No referral is needed at this time. B Progesterone is responsible for the heightened awareness of the need to breathe in pregnancy. Progesterone levels increase during pregnancy. C Progesterone affects relaxation of the smooth muscles in the respiratory tract. D As capillaries become engorged, the upper respiratory tract is affected by the subsequent edema and hyperemia, which causes these conditions, seen commonly during pregnancy.

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

ANS: D Feedback A This is a task that ends with delivery. During this task the woman seeks health care and cultural practices. B This process continues throughout pregnancy as the woman reworks relationships. C This task occurs during pregnancy as the woman allows her body to give space to the fetus. She continues with giving to others in the form of food or presents. D Developing attachment (strong ties of affection) to the unborn baby begins in early pregnancy when the woman accepts that she is pregnant. By the second trimester, the baby becomes real and feelings of love and attachment surge.

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

ANS: D Feedback A This is an acceptable request for a laboring woman. B Using breathing techniques to alleviate pain is a realistic part of a birth plan. C Not all fathers are able to be present during the birth; however, this couple has made a realistic plan that works for their specific situation. D Since monitoring is essential to assess fetal well-being, it is not a factor that can be determined by the couple. The nurse should fully explain its importance. The option for intermittent electronic monitoring could be explored if this is a low risk pregnancy and as long as labor is progressing normally. The birth plan is a tool with which parents can explore their childbirth options; however, the plan must be viewed as tentative.

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

ANS: D Feedback A This is when the woman observes the behaviors of mothers and compares them with her own expectations. B Roleplaying involves searching for opportunities to provide care for infants in the presence of another person. C Fantasies allow the woman to try on a variety of behaviors. This usually deals with how the child will look and the characteristics of the child. D The woman experiences sadness as she realizes that she must give up certain aspects of her previous self and that she can never go back.

22. Which client would require additional calories and nutrients? a. A 36-year-old female gravida 2, para 1, in her first trimester of pregnancy b. An 18-year-old female who delivered a 7-lb baby and is bottle feeding c. A 23-year-old female who had a cesarean section birth and is bottle feeding d. A 20-year-old female who had a vaginal birth 5 months ago and is breastfeeding

ANS: D A client who is breastfeeding will require more calories and nutrients than individuals who are pregnant, delivered regardless of the type of birth, and whether they are bottle feeding. PTS: 1 DIF: Cognitive Level: Application REF: 145

5. A nurse is reviewing teaching and learning principles. Which situation is most conducive to learning? a. An auditorium is being used as a classroom for 300 students. b. A teacher who speaks very little Spanish is teaching a class of Hispanic students. c. A class is composed of students of various ages and educational backgrounds. d. An Asian nurse provides nutritional information to a group of pregnant Asian women.

ANS: D A client's culture influences the learning process; thus, a situation that is most conducive to learning is one in which the teacher has knowledge and understanding of the client's cultural beliefs. A large class is not conducive to learning. It does not allow questions, and the teacher cannot see nonverbal cues from the students to ensure understanding. The ability to understand the language in which teaching is done determines how much the client learns. Clients for whom English is not their primary language may not understand idioms, nuances, slang terms, informed usage of words, or medical terms. The teacher should be fluent in the language of the student. Developmental levels and educational levels influence how a person learns best. For the teacher to present the information in the best way, the class should be at the same level. PTS: 1 DIF: Cognitive Level: Application REF: 20

3. To increase the absorption of iron in a pregnant client, with what should an iron preparation be given? a. Tea b. Milk c. Coffee d. Orange juice

ANS: D A vitamin C source may increase the absorption of iron. Tannin in the tea reduces the absorption of iron. The calcium and phosphorus in milk decrease iron absorption. Decreased intake of caffeine is recommended during pregnancy. PTS: 1 DIF: Cognitive Level: Application REF: 149

5. What is the recommended weight gain during pregnancy for a client who begins pregnancy at a normal weight? a. 10 to 15 lb b. 15 to 20 lb c. 20 to 25 lb d. 25 to 35 lb

ANS: D A weight gain of 25 to 35 lb is believed to reduce intrauterine growth restriction that may result from inadequate nutrition, and also allows for variations in individual needs. There is no precise weight gain appropriate for all women. A 10-lb weight gain is not sufficient to meet the needs of the pregnancy. A 15- to 20-lb weight gain is recommended for women who are overweight before the pregnancy. A 20- to 25-lb weight gain is recommended for women who are overweight before the pregnancy. PTS: 1 DIF: Cognitive Level: Understanding REF: 161

17. A client who is in week 28 of gestation is concerned about her weight gain of 17 lb. Which is the nurse's best response? a. "You should not gain any more weight until you reach the third trimester." b. "You should try to decrease your amount of weight gain for the next 12 weeks." c. "You have not gained enough weight for the number of weeks of your pregnancy." d. "You have gained an appropriate amount for the number of weeks of your pregnancy."

ANS: D A woman in her 28th week of gestation should have gained between 17 and 20 lb. The normal pattern of weight gain is about 3.5 lb total in the first trimester (by 13 weeks) and 1 lb per week after that. The client has gained the appropriate amount of weight. It would be inappropriate to have her decrease her weight gain. She has gained an appropriate amount of weight and should not increase the weight gain. Weight gain needs to be consistent during the last part of the pregnancy and should not be suppressed. PTS: 1 DIF: Cognitive Level: Application REF: 162

10. Which is an example of healthy grieving? a. The mother exhibits an absence of crying or expression of feelings. b. The parents do not mention the baby in conversation with family members. c. The mother asks that the baby be taken away from the delivery area quickly. d. While holding the baby, the mother says to her husband, "He has your eyes and nose."

ANS: D Attachment behaviors are necessary for healthy grieving. Absence of crying and not mentioning the baby may be signs of denial. By not seeing the baby, attachment and therefore healthy grieving will not occur. PTS: 1 DIF: Cognitive Level: Understanding REF: 482

2. A nurse is teaching a nutrition class to a group of pregnant clients. The nurse should include that the major source of nutrients in the diet of a pregnant woman should be composed of which? a. Fats b. Fiber c. Simple sugars d. Complex carbohydrates

ANS: D Complex carbohydrates supply the pregnant woman with vitamins, minerals, and fiber. Fats provide 9 calories in each gram, in contrast to carbohydrates and proteins, which provide only 4 calories in each gram. Fiber is supplied mainly by the complex carbohydrates. The most common simple carbohydrate is table sugar, which is a source of energy but does not provide any nutrients. PTS: 1 DIF: Cognitive Level: Application REF: 145

13. You are taking care of a couple postbirth who are very eager to learn about bathing techniques that they can use for their newborn. Which teaching technique could the nurse use to facilitate parents learning about giving a bath to their newborn infant? a. Provide direct, step-by-step demonstration to each parent separately to foster individual retention and comprehension. b. Present information to parents prior to discharge so that the information will be current. c. Have each parent bathe the newborn each time the infant comes to the room and provide commentary after the skill repetition. d. Demonstrate bathing techniques on the newborn infant with parents in attendance.

ANS: D Demonstration of bathing techniques is a form of role modeling that would enhance teaching and learning outcomes. Presenting the information at the time of discharge will not allow for identification of concerns and/or evaluation of whether the skill has been acquired. Although it may be advantageous to have each parent bathe their newborn, this action would not be advised in terms of time management and safety related to maintenance of core temperature. PTS: 1 DIF: Cognitive Level: Application REF: 21

12. Which is the most important reason for evaluating the pattern of weight gain in pregnancy? a. Prevents excessive adipose tissue deposits b. Determines cultural influences on the woman's diet c. Assesses the need to limit caloric intake in obese women d. Identifies potential nutritional problems or complications of pregnancy

ANS: D Deviations from the recommended pattern of weight gain may indicate nutritional problems or developing complications. Excessive adipose tissue may occur with excess weight gain but is not the reason for monitoring the weight gain pattern. The pattern of weight gain is not affected by cultural influences. It is important to monitor the pattern of weight gain for the developing complications. PTS: 1 DIF: Cognitive Level: Understanding REF: 160

7. Which goal is most appropriate for the collaborative problem of wound infection? a. The client will not exhibit further signs of infection. b. Maintain the client's fluid intake at 1000 mL/8 hr. c. The client will have a temperature of 98.6° F within 2 days. d. Monitor the client to detect therapeutic response to antibiotic therapy.

ANS: D In a collaborative problem, the goal should be nurse-oriented and reflect the nursing interventions of monitoring or observing. Monitoring for complications such as further signs of infection is an independent nursing role. Intake and output is an independent nursing role. Monitoring a client's temperature is an independent nursing role. PTS: 1 DIF: Cognitive Level: Application REF: 18

24. Which of the following is associated with inadequate maternal weight gain during pregnancy? a. Prolonged labor b. Preeclampsia c. Gestational diabetes d. Low-birth-weight infant

ANS: D Inadequate maternal weight gain during pregnancy can manifest in the birth of a low- birth-weight infant. Prolonged labor and gestational diabetes are associated with excess weight gain during pregnancy. Preeclampsia is based on maternal hypertension, proteinuria, and edema states. PTS: 1 DIF: Cognitive Level: Application REF: 161

8. Which nursing intervention is correctly written? a. Force fluids as necessary. b. Observe interaction with the infant. c. Encourage turning, coughing, and deep breathing. d. Assist to ambulate for 10 minutes at 8 AM, 2 PM, and 6 PM.

ANS: D Interventions might not be carried out if they are not detailed and specific. "Force fluids" is not specific; it does not state how much. Encouraging the client to turn, cough, and breathe deeply is not detailed and specific. Observing interaction with the infant does not state how often this procedure should be done. PTS: 1 DIF: Cognitive Level: Application REF: 25

36. The pregnant client with significant iron deficiency anemia is prescribed iron supplements. The client confides to the nurse that she can't take iron because it makes her nauseous. What is the best response by the nurse? a. "Iron will be absorbed more readily if taken with orange juice." b. "It is important to take this drug regardless of this side effect." c. "Taking the drug with milk may decrease your symptoms." d. "Try taking the iron at bedtime on an empty stomach."

ANS: D Iron taken at bedtime may be easier to tolerate. All the answers are true statements; however, only the option that states that iron taken at bedtime may be easier to tolerate addresses both optimal absorption of iron and alleviation of nausea, which will not be noticeable during sleep. It is true that taking iron with milk will decrease the symptoms, but it will also decrease absorption. PTS: 1 DIF: Cognitive Level: Application REF: 149

19. Women who become pregnant after the age of 35 are more likely to: a. have multiple births because of increased fertility rates. b. be hypotensive during the pregnancy. c. have fewer obstetric complications due to stronger pelvic structure. d. have a child who has a trisomy 21 abnormality.

ANS: D Mature woman who become pregnant often have issues with conception and can experience infertility. There is no causal relationship between maternal age and hypotension during pregnancy. Women older than 35 are more likely to have obstetric complications for a variety of reasons. Women older than 35 are more likely to develop chromosomal abnormalities, specifically Down syndrome, which is trisomy 21. PTS: 1 DIF: Cognitive Level: Application REF: 484

6. A client who is older than 35 years may have difficulty achieving pregnancy because: a. prepregnancy medical attention is lacking. b. personal risk behaviors influence fertility. c. she has used contraceptives for an extended time. d. her ovaries may be affected by the aging process.

ANS: D Once the mature woman decides to conceive, a delay in becoming pregnant may occur because of the normal aging of the ovaries. Prepregnancy medical care is available and encouraged. The older adult participates in fewer risk behaviors than the younger adult. The problem is the age of the ovaries, not the past use of contraceptives. PTS: 1 DIF: Cognitive Level: Understanding REF: 484

12. Which is an appropriate nursing measure when a baby has an unexpected defect? a. Remove the baby from the delivery area immediately. b. Inform the parents immediately that something is wrong. c. Tell the parents that the baby has to go to the nursery immediately. d. Explain the defect and show the baby to the parents as soon as possible.

ANS: D Parents experience less anxiety when they are told about the defect as early as possible and are allowed to touch and hold the baby. The parents should be able to touch and hold the baby as soon as possible. The nurse should not take the baby away; this would raise anxiety levels of the parents. They should be told about the defect and allowed to see the baby. PTS: 1 DIF: Cognitive Level: Application REF: 492

42. The nurse is reviewing a list of foods high in folic acid with a patient who is considering becoming pregnant. The nurse determines that the patient understands the teaching when the patient states she will include which list of foods in her diet? a. Peaches, yogurt, and tofu b. Strawberries, milk, and tuna c. Asparagus, lemonade, and chicken breast d. Spinach, orange juice, and fortified bran flakes

ANS: D Prepregnant, the recommendation for folic acid is 800 mcg. Foods high in folic acid are dark green leafy vegetables, legumes (beans, peanuts), orange juice, asparagus, spinach, and fortified cereal and pasta. In the United States, folic acid is added to orange juice and wheat-based products. PTS: 1 DIF: Cognitive Level: Application REF: 146

7. A pregnant client's diet may not meet her need for folate. What is a good source of this nutrient? a. Chicken b. Cheese c. Potatoes d. Green leafy vegetables

ANS: D Sources of folate include green leafy vegetables, whole grains, fruits, liver, dried peas, and beans. Chicken is a good source of protein, but poor in folate. Cheese is an excellent source of calcium, but poor in folate. Potatoes contain carbohydrates and vitamins but are poor in folate. PTS: 1 DIF: Cognitive Level: Understanding REF: 147, 148

4. Which action should the nurse take to evaluate the client's learning about performing infant care? a. Demonstrate infant care procedures. b. Allow the client to verbalize the procedure. c. Routinely assess the infant for cleanliness. d. Observe the client as she performs the procedure.

ANS: D The client's correct performance of the procedure under the nurse's supervision is the best proof of her ability. Demonstration is an excellent teaching method, but not an evaluation method. During verbalization of the procedure, the nurse may not pick up on techniques that are incorrect. It is not the best tool for evaluation. Routinely assessing the infant for cleanliness will not ensure that the proper procedure is carried out. The nurse may miss seeing that unsafe techniques being used. PTS: 1 DIF: Cognitive Level: Application REF: 21

17. A 16-year-old primipara has just completed her first prenatal visit with the health care provider. The nurse is preparing to teach her about nutrition during pregnancy. What must the nurse include in the patient's teaching plan? a. Provide her with pictures of dairy products. b.Ask her, "Are you ready to hear this information now?" c. Read directly from the pamphlet prepared for teen mothers. d. Provide a comfortable and warm setting after she has put on her street clothes.

ANS: D The nurse must structure teaching for teens in a way that suits them best. For teaching to be most effective, the physical environment must be comfortable and distractions to learning must be kept at a minimum. Pictures, videos, and computer-based materials are more effective teaching tools for younger clients. Patients must have an attitude of readiness and openness for the teaching to be effective. However, if the environment is not conducive to learning, efforts for effective teaching will be minimized. PTS: 1 DIF: Cognitive Level: Application REF: 18

11. Which nursing diagnosis should the nurse set as a priority for a laboring client? a. Risk for anxiety related to upcoming birth b. Risk for imbalanced nutrition related to NPO status c. Risk for altered family processes related to new addition to the family d. Risk for injury (maternal) related to altered sensations and positional or physical changes

ANS: D The nurse should determine which problem needs immediate attention. Risk for injury is the problem that has the priority at this time because it is a safety problem. Risk for anxiety, imbalanced nutrition, and altered family processes are not the priorities at this time. PTS: 1 DIF: Cognitive Level: Application REF: 24, 25

11. A client has delivered twins. The first twin was stillborn, and the second is in the intensive care nursery, recovering quickly from respiratory distress. The client is crying softly and says, "I wish my baby could have lived." Which is the most therapeutic response? a. "How soon do you plan to have another baby?" b. "Don't be sad. At least you have one healthy baby." c. "I have a friend who lost a twin and she's doing just fine now." d. "I am so sorry about your loss. Would you like to talk about it?"

ANS: D The nurse should recognize the woman's grief and its significance. Asking her about plans for another baby is denying the loss of the other infant. Pointing out the health of another baby is belittling her feelings. Stating that the nurse has a friend who lost a twin is denying the loss of the infant and her grief and belittling her feelings. PTS: 1 DIF: Cognitive Level: Application REF: 492

10. The nurse is writing an expected outcome for the nursing diagnosis—acute pain related to trauma of tissue, secondary to vaginal birth, as evidenced by client stating pain of 8 on a scale of 10. Which is a correctly stated expected outcome for this problem? a. Client will state that pain is a 2 on a scale of 10. b. Client will have a reduction in pain after administration of the prescribed analgesic. c. Client will state an absence of pain 1 hour after administration of the prescribed analgesic. d. Client will state that pain is a 2 on a scale of 10, 1 hour after the administration of the prescribed analgesic.

ANS: D The outcome should be client-centered, measurable, realistic, and attainable and have a time frame. Client stating that pain is now 2 on a scale of 10 lacks a time frame. Client having a reduction in pain after administration of the prescribed analgesic lacks a measurement. Client stating an absence of pain 1 hour after the administration of prescribed analgesic is unrealistic.

14. To determine cultural influences on a client's diet, what should the nurse do first? a. Evaluate the client's weight gain during pregnancy. b. Assess the socioeconomic status of the client. c. Discuss the four food groups with the client. d. Identify the food preferences and methods of food preparation common to the client's culture.

ANS: D Understanding the client's food preferences and how she prepares food will assist the nurse in determining whether the client's culture is adversely affecting her nutritional intake. Evaluating a client's weight gain during pregnancy should be included for all clients, not just for those who are culturally different. The socioeconomic status of the clients may alter the nutritional intake, but not the cultural influence. Teaching the food groups to the client should come after assessing food preferences. PTS: 1 DIF: Cognitive Level: Application REF: 160

4. When should iron supplementation during a normal pregnancy begin? a. Before pregnancy b. In the first trimester c. In the third trimester d. In the second trimester

ANS: D Vitamin supplements should be prescribed in the second trimester, when the need for iron is increased. Healthy young women do not usually need iron supplementation for their diets. Morning sickness in the first trimester increases the routine side effects of iron supplements. The iron supplements may continue to be prescribed in the third trimester and during the postpartum period. PTS: 1 DIF: Cognitive Level: Understanding REF: 155

6. Some of the embryo's intestines remain within the umbilical cord during the embryonic period because the a. Umbilical cord is much larger at this time than it will be at the end of pregnancy. b. Intestines begin their development within the umbilical cord. c. Nutrient content of the blood is higher in this location. d. Abdomen is too small to contain all the organs while they are developing.

ANS: D 3/14 Feedback A The intestines remain within the umbilical cord only until approximately week 10. B Intestines begin their development within the umbilical cord, but only because the liver and kidneys occupy most of the abdominal cavity. All the intestines are within the abdominal cavity around week 10. C Blood supply is adequate in all areas. Intestines stay in the umbilical cord for approximately 10 weeks because they are growing faster than the abdomen. D The abdominal contents grow more rapidly than the abdominal cavity, so part of their development takes place in the umbilical cord. By 10 weeks, the abdomen is large enough to contain them.

The nurse observes that when an 8-year-old boy enters the playroom, he often causes disruption by taking toys from other children. The nurse's best approach for this behavior is to a. Ban the child from the playroom. b. Explain to the children in the playroom that he is very ill and should be allowed to have the toys. c. Approach the child in his room and ask, "Would you like it if the other children took your toys from you?" d. Approach the child in his room and state, "I am concerned that you are taking the other children's toys. It upsets them and me."

ANS: D A Banning the child from the playroom will not solve the problem. The problem is his behavior, not the place where he exhibits it. B Illness is not a reason for a child to be undisciplined. When the child recovers, the parents will have to deal with a child who is undisciplined and unruly. C Children should not be made to feel guilty and to have their self-esteem attacked. D By the nurse's using "I" rather than the "you" message, the child can focus on the behavior. The child and the nurse can begin to explore why the behavior occurs.

What should the nurse expect to be problematic for a family whose religious affiliation is Jehovah's Witness? a. Immunizations b. Autopsy c. Organ donation d. Blood transfusion

ANS: D A Christian Science believers may seek exemption from immunizations. B Believers in Islam are opposed to organ donation. C Jehovah's Witness believers can make individual decisions about autopsy. D Jehovah's Witness believers are opposed to blood transfusions. They may accept alternatives to transfusions, such as non-blood plasma expanders.

Which statement is true about the characteristics of a healthy family? a. The parents and children have rigid assignments for all the family tasks. b. Young families assume the total responsibility for the parenting tasks, refusing any assistance. c. The family is overwhelmed by the significant changes that occur as a result of childbirth. d. Adults agree on the majority of basic parenting principles.

ANS: D A Healthy families remain flexible in their role assignments. B Members of a healthy family accept assistance without feeling guilty. C Healthy families can tolerate irregular sleep and meal schedules, which are common during the months after childbirth. D Adults in a healthy family communicate with each other so that minimal discord occurs in areas such as discipline and sleep schedules.

According to Friedman's classifications, providing such physical necessities as food, clothing, and shelter is the _____ family function. a. Economic b. Socialization c. Reproductive d. Health care

ANS: D A The economic function provides resources but is not concerned with health care and other basic necessities. B The socialization function teaches the child cultural values. C The reproductive function is concerned with ensuring family continuity. D Physical necessities such as food, clothing, and shelter are considered part of health care.

A woman had a chorionic villus sampling procedure. Prior to discharge the nurse should teach her to report what symptom that may be an indication of a complication? A. Lack of fetal movement B. Frequent urination C. Nausea and vomiting D. Vaginal bleeding or passage of amniotic fluid

ANS: D A. Chorionic villus sampling is done between 10 and 12 weeks of gestation. Fetal movement is not felt until about 16 weeks. B. Frequent urination is a common symptom of pregnancy during the first trimester. It is not an indication of procedural complications. C. Nausea and vomiting are a common symptom of pregnancy during the first trimester and not an indication of procedural complications. D. Vaginal bleeding or passage of amniotic fluid suggests possible miscarriage and should be reported.

4. While teaching an early pregnancy class, the nurse explains that the morula is a a. Fertilized ovum before mitosis begins b. Flattened disc-shaped layer of cells within a fluid-filled sphere c. Double layer of cells that becomes the placenta d. Solid ball composed of the first cells formed after fertilization

ANS: D Feedback A The fertilized ovum is called the zygote. B This is the embryonic disc. It will develop into the baby. C The placenta is formed from two layers of cells: the trophoblast, which is the other portion of the fertilized ovum, and the deciduas, which is the portion of the uterus where implantation occurs. D The morula is so named because it resembles a mulberry. It is a solid ball of 12 to 16 cells that develops after fertilization.

13. When explaining twin conception, the nurse points out that dizygotic twins develop from a. A single fertilized ovum and are always of the same sex b. A single fertilized ovum and may be the same sex or different sexes c. Two fertilized ova and are the same sex d. Two fertilized ova and may be the same sex or different sexes

ANS: D Feedback A A single fertilized ovum that produces twins is called monozygotic. B Monozygotic twins are always the same sex. C Dizygotic twins are from two fertilized ova and may or may not be the same sex. D Dizygotic twins are two different zygotes, each conceived from a single ovum and a single sperm. They may be both male, both female, or one male and one female.

3. The nurse providing care in a women's health care setting must be aware that which sexually transmitted disease (STD) can be cured? a. Herpes b. Acquired immunodeficiency syndrome (AIDS) c. Venereal warts d. Chlamydia

ANS: D Feedback A Because no cure is known for herpes, treatment focuses on pain relief and preventing secondary infections. B Because no cure is known for AIDS, prevention and early detection are the main focus. C Condylomata acuminata is caused by the human papillomavirus. No treatment eradicates the virus. D The usual treatment for chlamydia bacterial infection is doxycycline or azithromycin. Concurrent treatment of all sexual partners is needed to prevent recurrence.

4. Which statement by a woman diagnosed with premenstrual syndrome indicates that further health teaching is needed? a. "I will not eat chips or pickles." b. "Coffee and chocolate can make me more irritable and nervous." c. "Drinking alcohol makes me more depressed." d. "I'll eat only three meals per day."

ANS: D Feedback A Less intake of salty foods helps decrease fluid retention. B Caffeine consumption increases irritability, insomnia, anxiety, and nervousness. C Alcohol consumption aggravates depression. D The woman should be encouraged to eat six small meals a day to decrease risk of hypoglycemia.

18. The most basic information a maternity nurse should have concerning conception is a. Ova are considered fertile 48 to 72 hours after ovulation. b. Sperm remain viable in the woman's reproductive system for an average of 12 to 24 hours. c. Conception is achieved when a sperm successfully penetrates the membrane surrounding the ovum. d. Implantation in the endometrium occurs 6 to 10 days after conception.

ANS: D Feedback A Ova are considered fertile for approximately 24 hours after ovulation. B Sperm remain viable in the woman's reproductive system for an average of 2 to 3 days. C Penetration of the ovum by the sperm is called fertilization. Conception occurs when the zygote, the first cell of the new individual, is formed. D After implantation, the endometrium is called the decidua.

21. The nurse who is teaching a group of women about breast cancer should tell the women that a. Risk factors identify almost all women who will develop breast cancer. b. African-American women have a higher rate of breast cancer. c. One in 10 women in the United States will develop breast cancer in her lifetime. d. The exact cause of breast cancer is unknown.

ANS: D Feedback A Risk factors help identify a small percentage of women in whom breast cancer eventually will develop. B Caucasian women have a higher incidence of breast cancer; however, AfricanAmerican women have a higher rate of dying of breast cancer after they are diagnosed. C One in eight women in the United States will develop breast cancer in her lifetime. D The exact cause of breast cancer in unknown.

15. Between 6 and 10 days after conception, the trophoblast secretes enzymes that enable it to burrow into the endometrium until the entire blastocyst is covered. This is termed implantation. Tiny projections then develop out of the trophoblast and extend into the endometrium. These projections are referred to as a. Decidua basalis b. Decidua capsularis c. Decidua vera d. Chorionic villi

ANS: D Feedback A The deciduas basalis is the portion of the endometrium where the chorionic villi tap into the maternal blood vessels. B The deciduas capsularis is the portion of the endometrium that covers the blastocyst. C The portion of the endometrium that lines the rest of the uterus is called deciduas vera. D These villi are vascular processes that obtain oxygen and nutrients from the maternal bloodstream and dispose of carbon dioxide and waste products into the maternal blood.

1. Which piece of the usual equipment setup for a pelvic examination is omitted with a Pap test? a. Gloves and eye protectors b. Speculum c. Fixative agent d. Lubricant

ANS: D Feedback A The examiner should always use Standard Precautions. B A speculum is needed to see the cervix. C A fixative agent is applied to the slide to prevent drying or disruption of the specimen. D Lubricants interfere with the accuracy of the cytology report.

Which woman is a safe candidate for the use of oral contraceptives? a. 39-year-old with a history of thrombophlebitis b. 16-year-old with a benign liver tumor c. 20-year-old who suspects she may be pregnant d. 43-year-old who does not smoke cigarettes

ANS: D Heavy cigarette smoking is a contraindication.

Informed consent concerning contraceptive use is important because some of the methods a. Are invasive procedures that require hospitalization b. Require a surgical procedure to insert c. May not be reliable d. Have potentially dangerous side effects

ANS: D It is important for couples to be aware of potential side effects so they can make an informed decision about the use of contraceptives.

The major advantage of chorionic villus sampling over amniocentesis is that it: a. Is not an invasive procedure. b. Does not require hospitalization. c. Has less risk of spontaneous abortion. d. Requires less time to obtain results.

ANS: D Results from chorionic villus sampling can be known within 24 to 48 hours, whereas results from amniocentesis require 2 to 4 weeks. It is an invasive procedure. The woman does have to be in a hospital setting for the fetus and her to be properly assessed during and after the procedure. The risk of an abortion is at the same level for both procedures.

A woman currently uses a diaphragm and spermicide for contraception. She asks the nurse what the major differences are between the cervical cap and diaphragm. The nurse's most appropriate response is a. "No spermicide is used with the cervical cap, so it's less messy." b. "The diaphragm can be left in place longer after intercourse." c. "Repeated intercourse with the diaphragm is more convenient." d. "The cervical cap can safely be used for repeated acts of intercourse without adding more spermicide later."

ANS: D The cervical cap can be inserted hours before sexual intercourse without the need for additional spermicide later. No additional spermicide is required for repeated acts of intercourse

A non-stress test in which there are two or more fetal heart rate accelerations of 15 or more beats/min with fetal movement in a 20-minute period is termed: a. Nonreactive. b. Positive. c. Negative. d. Reactive.

ANS: D The non-stress test (NST) is reactive (normal) when there are two or more fetal heart rate accelerations of at least 15 beats/min (each with a duration of at least 15 seconds) in a 20-minute period. A nonreactive result means that the heart rate did not accelerate during fetal movement. A positive result is not used with an NST. The CST uses positive as a result term. A negative result is not used with an NST. The CST uses negative as a result term.

Parents of children with special needs often require specialized care and experience frequent hospitalizations. When caring for these families, the nurse should be aware that they may experience financial hardship due to their child's condition and require assistance in obtaining referrals to resources. Is this statement true or false?

ANS: T These families often suffer financial hardship, which can lead to issues related to coping and other strains on the family. Health insurance benefits may quickly reach their maximum. Even if the child is on special assistance for health care, one parent may have to remain home with the child rather than work outside of the home. Social work and financial or prescription assistance may all be necessary and appropriate sources of support.

1. The nurse understands that further health teaching is necessary when her young patient who has just had an abortion states, "I guess I'll have to wear a tampon for the next week." Is this statement true or false?

ANS: T Bleeding and cramping are normal after the procedure and will last for 1 to 2 weeks. Sanitary pads should be used rather than a tampon for the first week after an abortion to prevent infection. Other necessary health teaching that should be done includes the following: no intercourse for the first week; no douching for the first week, or perhaps not at all; temperature evaluation twice per day to identify infection; follow-up appointment in 2 weeks; and no strenuous work for a few days.

2. Women in the U.S. are now more likely to die of cardiac disease than all cancers combined. Is this statement true or false?

ANS: T Heart disease is now the leading cause of death for women in the United States, killing 26% of women who died in 2006. Almost twice as many American women die of heart disease or stroke than any form of cancer including breast cancer.

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

ANS: T Increased vascularity, edema, and connective tissue changes during pregnancy make the tissues of the vulva and perineum more pliable. This can lead to an increased interest in sexual activity and ease of orgasm.

Conception in the first cycle of treatment for infertility has a success rate of 15% to 25%, falling as subsequent attempts are made. Is this statement true or false?

ANS: T Only 3% of couples conceive in the 12th cycle of treatment. Couples are often in a hurry for definitive therapy; however, a thorough assessment of the problem is essential for effective and financially sound treatment.

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

ANS: T This is because of an increase in factors that favor coagulation and a decrease in factors that inhibit coagulation. Fibrinogen increases by 50% and factors VII, VIII, IX, and X also rise.

A woman who is 8 months' pregnant had a biophysical profile test done. The results give a score of 4/10. The nurse can anticipate that the next plan of action may be to ______________.

ANS: consider delivery A score of 4 out of 10 (4/10) is nonreassuring. Delivery may be considered as an option, because the fetus is at risk.

A woman who is 8 months pregnant has been advised to have an amniocentesis. She asked the nurse the reason for the procedure. The usual reason for an amniocentesis during this period of pregnancy is to determine _________________________.

ANS: fetal lung maturity The usual reason for amniocentesis during the third trimester is to determine fetal lung maturity.

Fertilization of the ovum takes place in which part of the fallopian tube? A. Interstitial portion B. Ampulla C. Isthmus D. Infundibulum

B. Ampulla * The ampulla is the wider middle part of the tube lateral to the isthmus and is where fertilization occurs

The nurse has been assigned to care for a patient during the night shift. The patient's medication to prevent seizures was due at 6 AM. At that time the nurse was involved with another patient and did not administer the medication. At 10 AM, the patient ambulated to the bathroom, had a seizure, fell, and later developed brain damage as a result of the fall. The nurse can be sued for... A. Abandonment B. Malpractice C. A civil tort D. Nothing, the nurse is immune because she was assisting another patient

B. Malpractice (Rationale: Abandonment would have occurred if the nurse had not provided any care for the patient, or if the nurse had walked away from his or her job. Malpractice has 4 elements that must be proved: a duty [the nurse was assigned to care for the patient], breach of duty [the nurse did not render care by neglecting the medication]; damage [the patient suffered brain damage]; proximate cause [brain damage was due to the fall during the seizure]. A civil tort is a civil wrong or injury. Malpractice is a type of tort. This answer is incorrect, because malpractice is more specific to the root of the question. The nurse is not immune if she neglects one patient for another.)

A 27-year-old woman newly diagnosed with diabetes is admitted to an agency to regulate her medication and receive patient teaching on diabetes. She is assigned a case manager on her first day. To best explain this role to the woman, the nurse states that a case manager will... A. Decide which patient teaching is necessary for the woman B. Manage and collaborate the woman's care to ensure optimal outcomes C. Be responsible for reviewing the woman's chart for errors D. Decide which method of treatment is most cost affective for the agency

B. Manage and collaborate the woman's care to ensure optimal outcomes (Rationale: This may be a part of the duties of the case manager. The case manager will coordinate the patient teaching. Also, she will coordinate all services needed by the woman. A case manager will focus on both quality and cost outcomes. They will coordinate services needed and manage the care collaboratively to ensure optimal outcomes. Part of the duty of the quality assurance team is the responsibility of reviewing the woman's chart for errors. The case manager is concerned about cost effectiveness, but the main focus is to ensure quality outcomes.)

The nurse is reviewing the lab reports on a 17-year-old new patient. The gonadotropin-releasing hormone levels are extremely low. The nurse can anticipate that the patient will: A. Look older than her years B. Not have primary or secondary sexual characteristics C. Have primary, but not secondary, sexual characteristics D. Have adequate levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) Incorrect

B. Not have primary or secondary sexual characteristics * Gonadotropin-releasing hormone is responsible for initiating the beginning of puberty

When teaching a group of mothers of preteen girls, the nurse explains that the earliest outward sign of puberty starting is ____________.

Breast changes *Breast changes such as nipple enlargement and protrusion, are the earliest outward changes of puberty

A 27-year-old pregnant woman is seeing a nurse-midwife for prenatal care. Her first baby was born by cesarean because the baby was too large to fit through the woman's pelvis. She has also developed gestational diabetes during this pregnancy. When discussing with the woman her options for places of birth, what is the best choice for her?... A. Home birth B. Birth center C. LDRP in a hospital setting D. It does not matter

C. LDRP in a hospital setting (Rationale: Because of her complications, the woman is not a candidate for home birth or a birth center. Home births and freestanding birthing centers should be used for patients with very low risk for complications. The woman's past history and present complication with this pregnancy place her in a high-risk category. Therefore, due to her complications, the woman needs to be in a setting where emergency care is quickly available.)

The most overwhelming adverse influence on health is... A. Race B. Customs C. Socioeconomic status D. Genetic constitution

C. Socioeconomic status (Rationale: Although children of different racial groups have differing health issues, socioeconomic status is a key predictor. On a population basis, customs is not an overwhelming adverse influence. A higher percentage of lower-class individuals have some health problem at any one time than other individuals in different classes. There is a high correlation between poverty and poor nutrition. On a population basis, genetic constitution is not an overwhelming adverse influence.)

A woman who is 6 weeks' pregnant is in for her prenatal appointment and asks the nurse when the sex of the baby can be determined by ultrasound. The nurse bases her answer on the knowledge that: A. The sex cannot be determined by ultrasound; an amniocentesis must be done B. The sex of the baby can be determined now by ultrasound C. The external genitalia look similar in both males and females until about 9 weeks of gestation D. The external genitalia will look different at 6 weeks, so an ultrasound can be done at that time

C. The external genitalia look similar in both males and females until about 9 weeks of gestation

A woman brings her two sons, ages 2 and 4, to the health clinic. She tells the nurse that they have been in the United States for only 1 year and are homeless. Because of this history, the nurse will assess the children for infections and... A. Congenital defects B. Allergies C. Accelerated growth patterns D. Malnutrition

D. Malnutrition (Rationale: Congenital defects and allergies would not be a result of homelessness. Most homeless children will have decelerated growth and development patterns due to malnutrition and decrease in stimuli. Homeless women and children are at high risk for poor nutrition and exposure to various infections.)

The role of the pediatric nurse is influenced by trends in health care. What is the greatest trend in health care?... A. Primary focus on treatment of disease or disability B. National health care planning on a distributive or an episodic basis C. Accountability to professional codes and international standards D. Shift of focus to health promotion and disease prevention.

D. Shift of focus to health promotion and disease prevention. (Rationale: Primary focus on treatment of disease or disability is traditionally the role of the physician. National health care planning on a distributive or an episodic basis is not a major trend. Accountability to professional codes and international standards is an established responsibility, not a trend. Shifting focus to health promotion and disease prevention is the current focus of health care in which nursing plays a major role. )

During a childbirth class a woman asks the nurse, "I'm just weeks pregnant. I know the placenta is not fully developed yet, so what is producing all the hormones I need?" The nurse will development her answer on the knowledge that A. The placenta is big enough at this point to produce the hormones necessary B. Extra hormones are not necessary for this stage of the pregnancy C. The pituitary is working to secrete the extra hormones that are necessary until the placenta develops D. The corpus luteum secretes the extra hormones necessary until the placenta develops

D. The corpus luteum secretes the extra hormones necessary until the placenta develops * LH causes the follicle to persist as a corpus luteum for about 12 days after ovulation. If conception occurs, the fertilized ovum secretes human chorionic gonadotropin that causes the corpus luteum to persist. The corpus luteum produces the extra estrogen and progesterone necessary to support the pregnancy

___________ refers to the view that one's own culture's way of doing things is always the best.

Ethnocentrism Rationale: Although the United States is a culturally diverse nation, the prevailing practice of health care is based on the beliefs held by members of the dominant culture, primarily Caucasians of European descent. Cultural relativism is the opposite of ethnocentrism. It refers to learning about and applying the standards of another's culture.

What is the nurse's role in teaching and learning?

Nurses need to apply principles that help the nurse become effective teachers. Including: -Looking at the readiness of the individual or the family to learn with relevance to the content. -Encourage active participation (it increases learning) when ever possible. *Avoid passive listening and viewing!* Discussion formats can help with participation and stimulation rather then a straight lecture. -Repetition of a skill increases retention and feeling of competence! Parents are more likely to if they can actively bathe, feed, and diaper an infant more than once. -Use praise and positive feed back for motivation! These can especially be helpful in frustrating tasks like breastfeeding. -Use of role modeling is an effective way to demonstrate behavior. Just be cautious that behaviors may be scrutinized at all times and may be repeated by the parent later. -Conflicts and frustration obviously impede learning. Recognize these problems and help them become resolved quickly. Have them verbalize any feelings about breast feeding for example. Expressing feelings about the issue must be dealt with before teaching can be done. -Structure the material from simple to complex tasks. -Be aware of their learning style and provide many different teaching methods to maintain interest. -Retention is great when the material is presented in small segments over time. *So follow up care is especially important!*

A 23-year-old postpartum woman is having trouble breastfeeding. Upon assessment, the nurse discovers that the woman does not have a let-down reflex. One reason for this may be that she is lacking the horomone ___________________.

Oxytocin *One purpose of oxytocin is to stimulate contractions in the breast muscles that will push the breast milk down towards the tipple. This is called the let down reflex.

A 16-year-old is being seen for the first time by the nurse practitioner. The young woman states that she has not had the onset of menstruation yet. Her breasts are developing and her pelvis has widened. The term used to describe this list of signs and symptoms is ___________.

Primary amenorrhea * This is when a girl has not started menstruation by the time she is 16 year old

A _________ family is one formed when single, divorced, or widowed parents bring children from a previous union into the new relationship.

blended These families must overcome differences in parenting styles and values to form a cohesive blended family. Often they wish to have children with each other in the new relationship. Differing expectations of the children's development and beliefs regarding discipline may lead to conflict. Older children often resent the introduction of a stepmother or stepfather.