Maternity
Newborns whose mothers are substance abusers frequently have what behaviors? (Select all that apply.) a. Difficulty feeding b. Hyperactive Moro (startle) reflex c. Circumoral cyanosis d. Weak cry e. Decreased amounts of sleep
A, B, E
The student nurse learns that maternal complications of diabetes include which of the following? (Select all that apply.) a. Atherosclerosis b. Nephropathy c. Caudal regression syndrome d. IUFD e. Retinopathy
A, B, E
A nurse must continuously monitor a preterm infant's temperature and provide appropriate nursing care because of what characteristic of the preterm infant compared with the full-term infant. A. Cannot use shivering to produce heat B. Cannot break down glycogen to glucose C. Has a limited supply of brown fat available to provide heat D. Has a limited amount of pituitary hormones to control the internal heat
C Because neonates are unable to shiver, they use the breakdown of brown fat to supply body heat; the preterm infant has a limited supply of brown fat available for this breakdown.
Methotrexate is recommended as part of the treatment plan for which obstetric complication? a. Unruptured ectopic pregnancy b. Abruptio placentae c. Complete hydatidiform mole d. Missed abortion
A
An abortion in which the fetus dies but is retained in the uterus is called ________ abortion. a. incomplete b. threatened c. inevitable d. missed
D
Compared to the term infant, the preterm infant has a. few blood vessels visible though the skin. b. greater surface area in proportion to weight. c. well-developed flexor muscles. d. more subcutaneous fat.
B
A patient with pregnancy-induced hypertension is admitted complaining of pounding headache, visual changes, and epigastric pain. Nursing care is based on the knowledge that these signs indicate a. Gastrointestinal upset b. Effects of magnesium sulfate c. Worsening disease and impending seizure d. Anxiety due to hospitalization
C
Which is true about newborns classified as small for gestational age (SGA)? A. They weigh less than 2500 g B. They are born before 37 weeks gestation C. Placental malfunction is the only recognized cause of this condition D. They are below the 10th percentile on gestational growth charts
D SGA infants are defined as below the 10th percentile in growth when compared with other infants of the same gestational age. SGA is not defined by weight. Infants born before 38 weeks are defined as preterm. There are many causes of SGA babies.
What factor found in maternal history should alert the nurse to the potential for a prolapsed umbilical cord? a. Presenting part at station -3 b. Pregnancy at 38 weeks of gestation c. Oligohydramnios d. Meconium-stained amniotic fluid
A
A nurse suspects that a newborn is experiencing opioid withdrawal. Which assessment supports this suspicion? A. Lethargy and constipation B. Grunting and low-pitched cry C. Irritability and nasal congestion D. Watery eyes and rapid respirations
C Opioid withdrawal affects the CNS and respiratory systems
A student nurse is preparing to administer a dose of betamethasone. What action by the student warrants intervention by the registered nurse? a. Starts a separate IV line to infuse the medication b. Listens to the woman's lungs prior to administering the medication c. Prepares an IM injection choosing a mc017-1.jpg´ needle d. Tells the woman her blood glucose will be monitored more often
A
An NST in which two or more fetal heart rate (FHR) accelerations of 15 beats per minute (bpm) or more occur with fetal movement in a 20-minute period is termed a. reactive. b. negative. c. positive. d. nonreactive.
A
A macrosomic infant is born after a difficult, forceps-assisted delivery. After stabilization, the infant is weighed, and the birth weight is 4550 g (9 pounds, 6 ounces). What action by the nurse is most appropriate? a. Monitor blood glucose levels frequently. b. Take the infant immediately to the nursery. c. Leave the infant in the room with the mother. d. Perform a gestational age assessment.
A
A pregnant woman at 37 weeks of gestation has had ruptured membranes for 26 hours. A cesarean section is performed for failure to progress. The fetal heart rate before birth is 180 beats/min with limited variability. At birth, the newborn has Apgar scores of 6 and 7 at 1 and 5 minutes and is noted to be pale and tachypneic. Based on the maternal history, the cause of this newborn's distress is most likely a. sepsis. b. hypoglycemia. c. respiratory distress syndrome. d. phrenic nerve injury.
A
Preconception counseling is critical to the outcome of diabetic pregnancies because poor glycemic control before and during early pregnancy is associated with a. congenital anomalies in the fetus. b. polyhydramnios. c. frequent episodes of maternal hypoglycemia. d. hyperemesis gravidarum.
A
A couple are asking the nurse about in vitro fertilization. Which explanation by the nurse is best? A. IVF places the product of contraception from your sperm and her egg into the 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
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. There are no donors involved in this specific type of assisted reproductive technology although if the process does not work due to problems with either the man or the woman, donor products can be used. Telling the couple to not worry about the technical aspects of the treatment does not offer them any information and belittles their questions and concerns.
To reduce possible side effects from a cesarean section under general anesthesia, women are routinely given which of the following medications? A. Antacids B. Tranquilizers C. Antihypertensive D. Anticonvulsants
A Antacids are routinely administered presurgically to cesarean section patients.
A student nurse is preparing to administer a dose of betamethasone. What action by the student warrants intervention by the registered nurse? A. Starts a separate IV line to infuse the medication B. Tells the woman her blood glucose will be monitored more often C. Prepares an IM injection choosing a 1.5" needle D. Listens to the woman's lungs prior to administering the medication
A Betamethasone is given in two IM injections with the appropriate needle. When the student begins to insert a dedicated line for administering it, the nurse intervenes to stop this incorrect action. Since this drug is a steroid, blood glucose readings can rise, so diabetic patients will have more frequent blood sugars. Pulmonary edema is uncommon, but the astute nurse (or student) will listen to lung sounds prior to administration for a baseline.
A nursing faculty member explains to students that which patient status is an acceptable indication for serial oxytocin induction of labor? A. Past 42 weeks gestation B. Multiple fetuses C. Polyhydramnios D. History of long labors
A Continuing a pregnancy past the normal gestational period is likely to be detrimental to fetal health. Multiple fetuses and polyhydramnios over distend the uterus, making induction of labor high risk. History of rapid labors may be a reason for induction of labor because of the possibility that the baby would otherwise be born in uncontrolled circumstances.
An infant with severe meconium aspiration syndrome (MAS) is not responding to the conventional treatment. Which treatment may be necessary for this infant? A. ECMO - extracoporeal membrane oxygenation B. Respiratory support with ventilator C. Insertion of laryngoscope and suctioning of the trachea D. Insertion of an endotracheal tube
A Extracorpeal membrane oxygenation is a highly technical method that oxygenates the blood while bypassing the lungs, allowing the infant's lungs to rest and recover. The infant is most likely intubated and on a ventilator already. Laryngoscope insertion and tracheal suctioning are performed after birth before the infant takes the first breath.
Rh incompatibility can occur if the woman is Rh negative and her: A. Fetusis Rh positive B. Husbandis Rh positive C. Fetusis Rh negative D. Husband and fetus are both Rh negative
A For Rh incompatibility to occur, the mother must be Rh negative and her fetus Rh positive. The husband's Rh factor is a concern only as it relates to the possible Rh factor of the fetus. If the fetus is Rh negative, the blood types are compatible and no problems should occur. The husband's blood type does not enter into the problem.
Which data should alert the nurse that the neonate has postmaturity syndrome? A. Cracked, peeling skin B. Short chubby arms and legs C. Presence of vernix caseosa D. Presence of lanugo
A Loss of vernix caseosa, which protects the fetal skin in utero, may leave the skin macerated and appearing cracked and peeling. Postmature infants usually have long, thin arms and legs. Vernix caseosa decreases in the postmature infant. Absence of lanugo is common in postmature infants.
A woman has been prescribed metformin at the infertility clinic. She says "Why am I on this? I am not diabetic; my sister takes it for her diabetes." What response by the nurse is best? A. It is used to promote ovulation in polycystic ovary disease B. It will prevent your body from forming antibodies to sperm C. It helps prepare the uterine lining for eventual implantation D. I don't know but I will find out and let you know right away
A Metformin is used as an adjunctive therapy to promote ovulation in the woman with polycystic ovary disease. It does not prevent antibody formation or prepare the uterine lining. The nurse should know this information but if he or she does not know, finding out and telling the woman as soon as possible would be the correct response.
A woman at 38 weeks' gestation is admitted to the hospital. Her membranes ruptured 12 hours ago. There are no other signs of labor. Which medication does the nurse anticipate to be prescribed? A. Oxytocin B. Terbutaline C. Progesterone D. Estrogen
A Oxytocin is a medication that promotes powerful uterine contractions and thus is used to induce labor.
A physician prescribes clomiphene citrate (Clomid, Serophene) for a woman experiencing infertility. She is very concerned about the risk of multiple births. Which response by the nurse is most appropriate? 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. That has a very low chance of happening, so you don't need to worry too much
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. Women have had more than triplets on this medication. Ultrasound cannot prevent multiple gestation. Telling the woman not to worry is belittling her concerns.
On admission to the nursery, it is noted that the mother's membranes were ruptured for 48 hours before delivery and her temperatureis 102 degrees F. What information form the newborn's assessment should the nurse evaluate further? A. Temperature instability B. Irregular respiratory rate C. Jitteriness D. Excessive bruising of presenting part
A The newborn is at risk for sepsis caused by prolonged rupture of membranes and maternal fever. A primary sign of sepsis in the newborn is temperature instability, particularly hypothermia. An irregular respiratory pattern is normal. Jitteriness may be a sign of hypoglycemia. Excessive bruising is often related to a difficult delivery with an increased risk of hyperbilirubinemia.
A woman is going to have a vacuum extraction delivery. What nursing interventionis most important to prevent complications? A. Empty the woman's bladder B. Apply cold packs to the perineum C. Assess vital signs after the procedure D. Monitor the woman's temperature
A The nurse should empty the woman's bladder prior to vacuum extraction delivery. Ice packs can help with pain and prevent or limit the size of hematomas after delivery, but that is not the most important safety measure. Assessing vital signs will not prevent complications from occurring but will help identify them when they occur.
A nurse manager plans staffing for the Labor and Delivery unit. How does the available staff influence the selection of either continuous electronic or intermittent auscultation as the fetal monitoring method? A. There must be a 1:1 nurse-to-patient ratio B. Staffing patterns do not influence fetal monitor choices C. Use of intermittent auscultation requires a lower nurse-to -patient ratio D. More nurses are needed when electronic fetal monitoring is used
A The one-to-one ratios ratio is needed. Intermittent auscultation is more staff-intensive. Less nursing time is needed with electronic fetal monitoring, giving the nurse more time for teaching and supporting the laboring woman.
A student nurse is placing a tocotransducer on a woman for electronic fetal monitoring. What action by the student indicates to the registered nurse that the student understands the procedure? A. Places the tocotransducer over the uterine fundus B. Prepares sterile field for fetal scalp electrode placement C. Positions the tocotransducer on the woman's upper arm D. Attaches the tocotransducer to the woman's lower abdomen
A The tocotransducer monitors uterine activity and should be placed over the fundus, where the most intensive uterine contractions occur. No sterile field is needed. The tocotransducer is not placed on the upper arm or lower abdomen.
What order should the nurse expect for a patient admitted with a threatened abortion? A. Abstinence from sexual activity B. Pitocin IV C. NPO D. Narcotic analgesia every 3 hours PRN
A The woman may be counseled to avoid sexual activity with a threatened abortion. Activity restrictions wereonce recommended, but they have not shown effectiveness as treatment. Pitocin would be contraindicated. There is no reason for the woman to be NPO. In fact, hydration is important. Narcotic analgesia is not indicated.
A woman's membranes rupture while her labor is being augmented with an oxytocin infusion. A nurse observes variable decelerations in the fetal heart rate on the fetal monitor strip. What action should the nurse take next? A. Change the woman's position B. Take the woman's blood pressure C. Stop the oxytocin infusion D. Prepare the woman for an immediate birth
A Variable decelerations usually are seen as a result of cord compression; a change of position will relieve the pressure on the cord. Variable decelerations are not oxytocin related, and are not related to the mother's blood pressure. To prepare the client for an immediate birth is premature; other nursing interventions should be tried first.
The new nurse learns that which condition related to decreased variability is considered benign? A. A period fetal sleep state B. Extreme prematurity C. Fetal hypoxemia D. Preexisting neurologic injury
A When the fetus is temporarily in a sleep state there is minimal variability present. Periodic fetal sleep states last no longer than 30 minutes. The other conditions would be considered conducive to abnormal variability.
The causes of preterm labor are not fully understood although many factors have been associated with early labor. These include (Select all that apply.) a. History of cone biopsy b. Short cervical length c. Smoking d. Singleton pregnancy e. Higher level of education
A, B, C
The nurse who suspects that a patient has early signs of ectopic pregnancy should be observing her for which symptoms? (Select all that apply.) a. Vaginal spotting or light bleeding b. Pelvic pain c. Unanticipated heavy bleeding d. Missed period e. Abdominal pain
A, B, D, E
The primary reason for evaluating alpha-fetoprotein (AFP) levels in maternal serum is to determine if the fetus has a. sickle cell anemia. b. hemophilia. c. a normal lecithin/sphingomyelin (L/S) ratio. d. a neural tube defect.
D
Which statement is true about large for gestational age (LGA) infants? a. They are above the 80th percentile on gestational growth charts. b. They weigh more than 3500 g. c. They are prone to hypoglycemia, polycythemia, and birth injuries. d. Postmaturity syndrome and fractured clavicles are the most common complications.
C
A nurse is assessing a woman receiving magnesium sulfate. The nurse assesses her deep tendon reflexes at 0 and 1+. What action by the nurse is best? a. Assess the woman's temperature. b. Hold the magnesium sulfate. c. Take the woman's blood pressure. d. Ask the provider to order a 24-hour UA.
B
A nurse is assessing an SGA infant with asymmetric intrauterine growth restriction. What assessment finding correlates with this condition? a. All body parts appear proportionate. b. The head seems large compared with the rest of the body. c. One side of the body appears slightly smaller than the other. d. The extremities are disproportionate to the trunk.
B
Decreased surfactant production in the preterm lung is a problem because surfactant a. dilates the bronchioles, decreasing airway resistance. b. keeps the alveoli open during expiration. c. causes increased permeability of the alveoli. d. provides transportation for oxygen to enter the blood supply.
B
The pregnant woman who has had a previous cesarean birth asks about trial of labor after cesarean (TOLAC). Which of the following factors from her history is a contraindication for TOLAC? A. Previous cesarean was for breech presentation B. Patient had a classical uterine incision C. The abdominal incision was vertical rather than transverse D. An induction of labor is planned for this delivery
B A classical incision involves the upper uterine segment and is more likely to separate or rupture with subsequent uterine contractions. The reason for the previous cesarean delivery is not of concern, although the current presentation is of interest. The type of abdominal incision is not a concern, since it is not affected by uterine contractions. Induction is not a contraindication if managed judiciously.
The nurse identifies the following nursing diagnosis for a client undergoing an emergency cesarean section: Risk for ineffective individual coping related to emergency procedure. Which of the following nursing interventions would be appropriate in relation to this diagnosis? A. Apply antiembolic boots bilaterally B. Explain all procedures slowly and carefully C. Administer an antacid per MD orders D. Monitor the FHR and maternal vital signs
B Antiembolic stockings or SCD's are often applied during the cesarean section. Their application is unrelated to the nursing diagnosis. Antacid administration is warranted in thissituation and the fetal heart and maternal vital signs should be carefully monitored, but they are unrelated to the nursing diagnosis.
A nurse is admitting an infant of a diabetic mother. At 1 hour of age, the nurse notices that the newborn is jittery. Which action by the nurse is most appropriate? A. Begin oxygen by nasal cannula B. Assess the newborn's blood glucose C. Place the newborn under a radiant warmer D. Initiate use of cardiac/apnea monitor
B Infants of diabetic mothers are at risk for hypoglycemia after delivery. A primary sign of hypoglycemia is jitteriness. The newborn is not showing any signs of hypoxia, so oxygen would not be appropriate. Putting the newborn under a radiant warmer or on a monitor would not harm the infant, but they are not a priority intervention at this time.
At 38 weeks' gestation, a woman is admitted to the hospital in active labor, and an external fetal monitor is applied. Late fetal heart rate deceleration begin to appearwhen her cervixis dilated 6 cm, with contractions occurring every 4 minutes and lasting 45 seconds. What does the nurse conclude is the cause of these late decelerations? A. Imminent vaginal birth B. Uteroplacental insufficiency C. Pattern of nonprogessive labor D. Reassuring response to contractions
B Late decelerations are indicative of uteroplacental insufficiency and, if left uncorrected, lead to fetal hypoxia.
Prior to cesarean birth, the nurse places the indwelling catheter and tubing in which manner? A. Placed on the floor on a sterile drape B. Placed near the head of the table C. Clamped during the cesarean section D. Positioned at the foot of the bed
B The anesthesiologist must monitor urine output during the surgery so the catheter and tubing are placed near the head of the table. They are not placed on the floor, even on a sterile drape. The catheter is not clamped because urinary output must be monitored continuously. An early sign of hypovolemia is decreasing urinary output.
What nursing action would take priority when caring for a woman with suspected ectopic pregnancy? A. Administer oxygen B. Monitor vital signs C. Obtain surgical consent D. Provide emotional support
B The woman with a suspected ectopic pregnancy may be at risk for the development of hypovolemic shock. Assessment is the first step of the nursing process and airway, breathing, and circulation are the priorities. Administering oxygen and providing emotional support are possible later interventions and obtaining surgical consent is the physician's responsibility.
A newborn is admitted with a diagnosis of transient tachypnea of the newborn (TTN). When planning nursing care for this baby, what nursing goal should the nurse formulate? A. Promote adequate quantity of surfactant B. Promote absorption of fetal lung fluid C. Assist in removal of meconium from airway D. Stimulate respirations
B Transient tachypnea of the newborn (TTN) is caused by delayed absorption of fetal lung fluid. Nursing care is focused on supporting oxygenation needs to allow the newborn's body to reabsorb the fluid. Inadequate surfactant is related to prematurity and respiratory distress syndrome. Meconium in the airways results in meconium aspiration syndrome. TTN causes tachypnea so stimulating respirations is not appropriate.
While working with the pregnant woman in her first trimester, the nurse is aware that chorionic villus sampling (CVS) can be performed during pregnancy as early as _____ weeks. a. 8 b. 12 c. 10 d. 4
C
Before the physician performs an external version, the nurse should expect an order for a: A. Indwelling catheter B. Local anesthetic C. Tocolytic drug D. Cervical ripening agent
C A tocolytic drug will relax the uterus before and during version, making manipulation easier. An indwelling catheter, a local anesthetic, and cervical ripening agent are not needed.
The causes of preterm labor are not fully understood, although many factors have been associated with early labor. These include: (Select all that apply) A. Singleton pregnancy B. History of cone biopsy C. Smoking D. Short cervical length E. Higher level of education
B, C, D A history of cone biopsies, smoking, and a short cervical length are all associated with early labor. Singleton pregnancy and higher level of education are not.
The nurse teaches women to recognize signs of complication when using contraceptives using the acronym ACHES. What does this acronym stand for? (Select all that apply): A. Aching all over B. Chest pain, dyspnea, hemoptysis, cough C. Severe headache, weakness or numbness of extremities, and hypertension D. Eye problems E. Severe swollen areas all over the body
B, C, D ACHES stands for abdominal pain (severe), Chest pain, dyspnea, hemoptysis, cough, severe Headache, severe weakness or numbness of extremities, hypertension, Eye problems, and sever pain or Swelling, heat, or redness of calf or thigh. It does not include aching all over.
Which assessment findings indicate to the nurses that a woman's preeclampsia should now be considered severe? Select all that apply. A. Urine output 40 mL/hour for the past 2 hours B. Serum creatinine 3.1 mg/dL C. Seeing "sparkly" thins in the visual field D. Crackles in both lungs E. Soft, non-tender abdomen
B, C, D Signs of severe preeclampsia include elevated creatinine, seeing sparkles or visual disturbances, and pulmonary edema (manifested by crackles). The urine output is above the minimum requirements, and a soft non-tender abdomen is a reassuring sign.
Newborns whose mothers are substance abusers frequently have what behaviors? (Select all that apply). A. Circumoral cyanosis B. Decreased amounts of sleep C. Hyperactive Moro (startle) reflex D. Difficulty feeding E. Weak cry
B, C, D The infant exposed to drugs in utero often has poor sleeping patterns, hyperactive reflexes, and uncoordinated sucking and swallowing behavior. They do not have circumoral cyanosis and will have a high-pitched cry.
A patient is at 6 weeks' gestation and is having a transvaginal ultrasound. While preparing the patient for this procedure, she expresses concerns over the necessity for this test. The nurse explains that this diagnostic test may be necessary to determine which of the following? (Select all that apply.) a. Amniotic fluid volume b. Bicornuate uterus c. Presence and location of pregnancy (intrauterine or elsewhere) d. Presence of ovarian cysts e. Multifetal gestation
B, C, D, 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: Amniotic fluid volume is assessed during the second and third trimester. Conventional ultrasound would be used.
The nurse is admitting a neonate two hours after delivery. Which assessment data should the nurse be concerned about? Select all that apply. A. Hands and feet blue with otherwise pink color B. Bilateral nasal flaring C. Minimal response to verbal stimulation D. Apical heart rate 140-156 E. Chest retractions
B, E Nasal flaring and chest retractions could be signs of respiratory distress and require immediate intervention. Blue hands and feet, a minimal response to verbal stimulation and apical heart rate of 140-156 are normal findings for a neonate at 2 hours.
The nurse learns that which is the most common cause of spontaneous abortion? a. Immunologic factors b. Infections c. Chromosomal abnormalities d. Endocrine imbalance
C
The primary symptom present in abruptio placentae that distinguishes it from placenta previa is a. changes in maternal vital signs. b. rupture of membranes. c. presence of abdominal pain. d. vaginal bleeding.
C
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
C Advantages of DMPA include a contraceptive effectiveness comparable to that of combined oral contraceptives with the requirement of only four injections a year. Disadvantages of injectable progestins are menstrual irregularities. Use of injectable progestin carries an increased risk of venous thrombosis and thromboembolism. To be effective, DMPA injections must be administered every 11 to 13 weeks. Access to health care is necessary to prevent pregnancy or potential complications.
The nurse-midwife is concerned that a woman's uterine activity is too intense and that her obesity is preventing accurate assessment of the intrauterinepressure. On the basis of this information, the nurse should obtaina(n): A. Tocotransducer B. Scalp electrode C. Intrauterine pressure catheter D. Doppler transducer
C An intrauterine pressure catheter can measure actual intrauterine pressure. The toco transducer measures the uterine pressure externally; this may not be accurate with obesity. A scalp electrode measures the fetal heart rate (FHR). A doppler auscultates the FHR.
Which factor found in maternal history should alert the nurse to the potential for a prolapsed cord? A. Oligohydramnios B. Pregnancy at 38 week C. Presenting part at -3 station D. Meconium stained amniotic fluid
C Because the fetal presenting part is positioned high in the pelvis and is not well applied to the cervix, a prolapsed core could occur if the membranes rupture. Hydramnios puts the woman at high risk for a prolapsed umbilical cord. A very small fetus, normally preterm, puts the woman at risk for a prolapsed cord. Meconium-stained fluid shows that the fetus has already been compromised, but it does not increase the chance of a prolapsed cord.
The nurse has explained to the client that the results of her hysterosalpingogram revealed bilateral tubal blockage. The nurse realizes that further education about the results of the hysterosalpingogramis needed when the client asks which question. A. Will the surgery to unblock my tubes be done in the hospital or the surgery center? B. Will the acupuncture treatments I am getting interfere with the surgical procedure? C. Will this plug in my fallopian tubes go away forever after I become pregnant? D. Will long-distance running and a low percentage of body fact affect the success of the surgery?
C Bilateral tubal blockage requires surgical intervention. The client will not become pregnant until the tubes are cleared surgically; a pregnancy cannot occur and "unblock" the tube. This statement indicates that the client does not understand her situation and requires further education. The other options contain statements that indicate understanding of the need for surgical treatment.
A woman is to receive Dinoprostone for cervical ripening. The nurse should be prepared to administer the medication via which of the following routes? A. Intravenously B. Orally C. Endocervically D. Intrathecally
C Dinoprostone (Cervidil) is administered endocervically in the posterior fornix of the vagina.
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. There are no known side effects
C Douching within 6 hours of intercourse removes the spermicide and increases the risk of pregnancy. Foams or gels should be inserted just before intercourse and are effective for about 1 hour. Each application is effective for about 1 hours. Effectiveness is about 74% when used alone. Vaginal irritation may occur with spermicide use.
What is the most common complication for which a nurse must monitor preterm infants? A. Hemorrhage B. Brain damage C. Respiratory distress D. Aspiration of mucus
C Immaturity of the respiratory tract in preterm infants is evidenced by a lack of functional alveoli, smaller lumina with increased possibility of collapse of the respiratory passages, weakness of respiratory musculature, and insufficient calcification of the boy thorax, leading to respiratory distress.
A nurse is assessing an SGA infant with asymmetric intrauterine growth restriction. What assessment finding correlates with this condition? A. One side of the body appears slightly smaller than the other B. All body parts appear proportionate C. The head seems large compared with the rest of the body D. The extremities are disproportionate to the trunk
C In asymmetric intrauterine growth restriction, the head is normal in size but appears large because the infant's body is long and thin due to lack of subcutaneous fat. The left and right side growth should be symmetric. With asymmetric intrauterine growth restriction, the body appears smaller than normal compared to the head. The body parts are out of proportion, with the body looking smaller than expected due to the lack of subcutaneous fat. The body, arms, and legs have lost subcutaneous fat so they look small compared to the head.
Nursing intervention for the pregnant diabetic is based on the knowledge that the need for insulin: A. Increases throughout pregnancy and the postpartum period B. Decreases throughout pregnancy and the postpartum period C. Varies depending on the stage of gestation D. Should not change because the fetus produces its own insulin
C Insulin needs decrease during the first trimester, when nausea, vomiting, and anorexia are a factor. Insulin needs increase during the second and third trimesters, when the hormones of pregnancy create insulin resistance in maternal cells.
A woman in the prenatal clinic asks the nurse how her asthma will affect her pregnancy and fetus. What response by the nurse is best? A. Asthma medications cannot be used during pregnancy B. The only problem is that you will not be able to breastfeed C. Medications for asthma do not appear to harm the fetus D. Pregnancy tends to make asthma worse
C Medications for asthma seem to be well tolerated during pregnancy. Breastfeeding is safe for the newborn. The course of asthma is variable in pregnancy.
A nurse is providing information about contraceptives to a couple. Which contraceptive method provides protection against sexually transmitted diseases? A. Oral contraceptives B. Tubal ligation C. Male or female condoms D. Intrauterine device (IUD)
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. Oral contraceptives, tubal ligations, or IUDs do not provide protection against STDs.
A female client is considering invitro fertilization and gamete intrafallopian transfer (GIFT). Which statement indicates the client needs additional information? A. I will give myself injections of medications to cause ovaries to ripen more than one egg B. My husband will need to produce a sample of his sperm the day my eggs are retrieved C. I will be in the hospital overnight for this procedure D. I can expect to have some discomfort after the procedure
C Ova retrieval and GIFT are outpatient procedures. The client will not be hospitalized overnight. The other statements are correct and do not require any follow-up by the nurse.
Which contraceptive method is contraindicated in women with a history of toxic shock syndrome? A. Condom B. Spermicide C. Cervical cap D. Norplant
C The cervical cap may increase the risk of toxic shock syndrome because it may be left in the vagina for a prolonged period. Condoms, spermicides and Norplant are not contraindicated in women who have had toxic shock syndrome.
Immediately prior to an amniotomy, the external fetal heart monitor tracing shows 145 bpm with early decelerations. Immediately following the procedure, the tracing shows a prolonged deceleration. A moderate amount of clear, amniotic fluid is seen on the bed linens. The nurse concludes that which of the following has occurred? A. Placental abruption B. Uterine perforation C. Prolapsed cord D. Head compression
C The drop in fetal hart rate indicates that the cord has likely prolapsed. There are no signs of placental abruption. Uterine perforation is a risk factor for IUPC placement. Head compression mirrors the contraction, resulting in early decelerations.
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
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 testicular biopsy would be indicated only in cases of azoospermia (no sperm cells) or severe oligospermia (low number of sperm cells). Antisperm antibodies are produced by a man against his own sperm. This is unlikely to the case here, because the husband has already produced children. Examination of testicular infection should be done before semen analysis. Furthermore, infection affects spermatogenesis. However, the woman's hormone levels would likely be tested first.
A woman is being discharged from the hospital after evacuation of a molar pregnancy. The nurse recognizes that additional discharge teaching is required when the woman makes which statement? A. I'm so sad about this pregnancy B. I may need chemotherapy after this C. I will need to see the doctor yearly for follow-up D. I will use contraception for the next year
C The woman is requires frequent monitoring to rule out development of malignancy after experiencing trophoblastic gestational disease. Weekly hCG measurements are done until normal levels are recorded for three weeks. Expressions of sadness are appropriate for any pregnancy loss, even if no fetus developed. Needing chemotherapy is a possibility for this woman. The woman should use contraception for at least one year during thefollow-up care.
Near the end of the first week of life, an infant who has not been treated for any infection develops a copper-colored, maculopapular rash on the palms and around the mouth and anus. The newborn is showing signs of: A. Gonorrhea B. Herpes simplex viral infection C. Congenital syphilis D. HIV
C This rash is indicative of congenital syphilis. The lesions may extend over the trunk and extremities. This is not characteristic of gonorrhea, herpes, or HIV
Providing care for the neonate born to a mother who abuses substances can present a challenge for the health care team. Nursing care for this infant requires a multisystem approach. The first step in the provision of this care is: A. Pharmacologic treatment B. Reduction of environmental stimuli C. Neonatal abstinence syndrome scoring D. Adequate nutrition and maintenance of fluid and electrolyte balance
C Various scoring systems exist to determine the number, frequency, and severity of behaviors that indicate neonatal abstinence syndrome. The score is helpful in determining the necessity of drug therapy to alleviate withdrawal. Pharmacologic treatment is based on the severity of withdrawal symptoms. Swaddling, holding, and reducing environmental stimuli is based on the severity of withdrawal symptoms. Swaddling, holding, and reducing environmental stimuli are essential in providing care to the infant who is experiencing withdrawal. However, the scoring helps provide definitive care. Fluid and electrolyte balance are appropriate for any infant.
A woman who had two previous cesarean births is in active labor, when she suddenly complains of pain between her scapulae. The nurse's priority action is to a. decrease the rate of nonadditive intravenous fluid. b. reposition the woman with her hips slightly elevated. c. observe for abnormally high uterine resting tone. d. notify the provider promptly and prepare the woman for surgery.
D
The nurse caring for a woman hospitalized for hyperemesis gravidarum should expect that initial treatment involves a. an antiemetic, such as pyridoxine, to control nausea and vomiting. b. enteral nutrition to correct nutritional deficits. c. corticosteroids to reduce inflammation. d. IV therapy to correct fluid and electrolyte imbalances.
D
The perinatal nurse is giving discharge instructions to a woman, status post suction and curettage secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next 12 months. The best response from the nurse is a. "Oral contraceptives are the only form of birth control that will prevent a recurrence of a molar pregnancy." b. "If you get pregnant within 1 year, the chance of a successful pregnancy is very small. Therefore, if you desire a future pregnancy, it would be better for you to use the most reliable method of contraception available." c. "If you can avoid a pregnancy for the next year, the chance of developing a second molar pregnancy is rare. Therefore, to improve your chance of a successful pregnancy, it is better not to get pregnant at this time." d. "The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produces during pregnancy. If you were to get pregnant, it would make the diagnosis of this cancer more difficult."
D
Which statement regarding various biochemical assessments used during pregnancy is correct? a. Screening for maternal serum alpha-fetoprotein (MSAFP) levels is recommended between 10 and 12 weeks of gestation in order to give parents time to consider options. b. Percutaneous umbilical blood sampling (PUBS) is one of the multiple marker screen tests for Down syndrome. c. Chorionic villus sampling (CVS) is becoming more popular because it provides early diagnosis. d. MSAFP is a screening tool only; it identifies candidates for more definitive procedures.
D
With regard to hemolytic disease of the newborn, nurses should be aware that: A. Rh incompatibility matters only when an Rh-negative offspring is born to an Rh-positive mother B. ABO incompatibility is more likely than Rh incompatibility to precipitate significant anemia C. Exchange transfusions frequently are required in the treatment of hemolytic disorders D. The indirect Coombs test is performed on the mother before birth; the direct Coombstest is performed on the cord blood after birth
D An indirect Coombs test may be performed on the mother a few times during pregnancy. ABO incompatibility is more common than Rh incompatibility but causes less severe problems. Significant anemia, for instance, is rare with ABO. Exchange transfusions are needed infrequently because of the decrease in incidence of severe hemolytic disease in newborns from Rh incompatibility.
The infant of a mother with diabetes is hypoglycemic. What type of feeding should be instituted first? A. Glucose water in a bottle B. D5W intravenously C. Formula via nasogastric tube D. Breast milk
D Breastmilk is metabolized more slowly and provides longer and normal glucose levels. Breast milk is best for nearly all babies. High levels of dextrose correct the hypoglycemia but will stimulate the production of more insulin. Oral feedings are tried first, intravenous lines should be a later choice if the hypoglycemia continues. Formula does provide longer normal glucose levels but would be administered via bottle, not by tube feeding unless the baby is unable to take oral feedings.
A mother with diabetes has done some reading about the effects of the condition on her newborn. Which statement shows a misunderstanding that should be clarified by the nurse? A. Although my baby is large, some women with diabetes have very small babies because the blood flow through the placenta may not be as good as it should be B. My baby will be watched closely for signs of low blood sugar, especially during the early days after birth C. Thered appearance of my baby's skin is due to an excessive number of red blood cells D. My baby's pancreas may not produce enough insulin because the cells become smaller than normal during my pregnancy
D Infants of diabetic mothers may have hypertrophy of the islets of Langerhans, which may cause them to produce more insulin than they need. The other statements are correct and show good understanding
In assessing the knowledge of a pregestational woman with type 1 diabetes concerning changing insulin needs during pregnancy, the nurse recognizes that further teaching is warranted when the patient states a. "Episodes of hypoglycemia are more likely to occur during the first 3 months." b. "Insulin needs should return to normal within 7 to 10 days after birth if I am bottle feeding." c. "Insulin dosage will likely need to be increased during the second and third trimesters." d. "I will need to increase my insulin dosage during the first 3 months of pregnancy."
D Insulin needs are reduced in the first trimester because of increased insulin production by the pancreas and increased peripheral sensitivity to insulin. "Insulin dosage will likely need to be increased during the second and third trimesters," "Episodes of hypoglycemia are more likely to occur during the first 3 months," and "Insulin needs should return to normal within 7 to 10 days after birth if I am bottle-feeding" are accurate statements and signify that the woman has understood the teachings regarding control of her diabetes during pregnancy.
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
D It is important for couples to be aware of potential side effects sothey can make an informed decision about the use of contraceptives. The only contraceptive method that may require hospitalization is sterilization. The only surgical procedure used would be for permanent sterilization. Some have more effective rates, and this should be included in the teaching.
A woman arrives at the hospital in preterm labor, and terbutaline is prescribed. For what therapeutic effect should the nurse monitor? A. Increased blood pressure and pulse B. Reduction of pain in the perineal area C. Gradual cervical dilation as labor progresses D. Decreased frequency and duration of contractions
D Terbutaline sulfate is a beta-mimetic that acts on the smooth muscle of the uterus to reduce contractility, which in turn, inhibits dilation and the frequency and duration of contractions. Although terbutaline may increase blood pressure and pulse, this is a side, not a therapeutic effect requiring frequent assessments. Terbutaline is not an analgesic and terbutaline should stop cervical dilation, rather than increase it.
A woman with group Oblood whose husband has group AB blood, has just given birth. The major sign of ABO incompatibility in the neonate is which complication or test result? A. Negative Coombs test B. Bleeding from the nose and ear C. Jaundice after the first 24 hours of life D. Jaundice within the first 24 hours of life
D The neonate with ABO blood incompatibility with its mother will have jaundice (pathologic within the first 24 hours of life. The neonate would have a positive Coombs test result.
A pregnant woman, G3 P 2002, had her two other children by cesarean section. Which of the following situations would mandate that this delivery also be by cesarean section? A. The woman refuses to have a regional anesthesia B. The woman is postdates with intact membranes C. The baby is in the occiput posterior position D. The previous uterine incisions were vertical
D The presence of vertical incisions in the uterine wall is an absolute indication for a cesarean delivery. A vaginal delivery can be performed with no anesthesia. A postdates pregnancy is not an absolute indication for a cesarean delivery. An occiput posterior position is not an absolute indication for a cesarean delivery.
A macrosonic infant is born after a difficult, forceps-assisted delivery. After stabilization, the infant is weighed, and the birth weightis 4550 g (9lbs, 6oz). What action by the nurse is most appropriate? A. Leave the infant in the room with the mother B. Take the infant immediately to the nursery C. Perform a gestational age assessment D. Monitor blood glucose levels frequently
D This infant is macrosomic (over 4000 g) and is at high-risk for hypoglycemia. Blood glucose levels should be monitored frequently, and the infant should be observed closely for signs of hypoglycemia. The infant can stay with the mother, but this is not the best answer since it does not include the close monitoring needed. Regardless of gestational age, this infant is macrosomic.
The most common cause of neonatal sepsis seen within 24 hours after birth are caused by which organism? A. Candida albicans B. Chlamydia trachomatis C. Escherichia coli D. Group B beta-hemolytic streptococci
D Transmission of Group B beta -hemolytic streptococci to the fetus results inrespiratory distress that can rapidly lead to septic shock.
