Maternity Final Exam

The most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is: -Bleeding. -Intense abdominal pain. -Uterine activity. -Cramping.

-Intense abdominal pain. Pain is absent with placenta previa and may be agonizing with abruptio placentae. Bleeding, uterine activity, and cramping may be present in varying degrees for both placental conditions.

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

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

The nurse is caring for a postpartum client with preeclampsia. Which statement would the nurse include in discharge teaching?

"Return to the hospital if you have epigastric pain."

Post abortion teaching

- 38 degree temp, chills, fever, foul smelling discharge, increase bleeding, abdominal tenderness etc.

A nurse is examining a patient who has been admitted for possible ectopic pregnancy who is approximately 8 weeks pregnant. Which finding would be a priority concern? -No FHT heard via Doppler -Scant vaginal bleeding noted on peri pad -Ecchymosis noted around umbilicus -Blood pressure 100/80

-Ecchymosis noted around umbilicus (cullens sign) Because this patient is most likely in the early stages of pregnancy, FHT would not be able to be auscultated at this time. Scant vaginal bleeding would not be a priority concern but should still be monitored by the nurse. Ecchymosis around the umbilicus indicates Cullen sign, which indicates hematoperitoneum, and may also develop in an undiagnosed, ruptured intraabdominal ectopic pregnancy.

A woman diagnosed with marginal placenta previa gave birth vaginally 15 minutes ago. At present she is at the greatest risk for: -Hemorrhage. -Infection. -Urinary retention. -Thrombophlebitis.

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

What is the drug of choice for the treatment of gonorrhea? a.Penicillin G b.Tetracycline c.Ceftriaxone d.Acyclovir

ANS: C Ceftriaxone is effective for the treatment of all gonococcal infections. Penicillin is used to treat syphilis. Tetracycline is prescribed for chlamydial infections. Acyclovir is used to treat herpes genitalis.

Which assessment is not included in the fetal biophysical profile (BPP)? a. Fetal movement b. Fetal tone c. Fetal heart rate d. Amniotic fluid index e. Placental grade

ANS: E Fetal movement, tone, heart rate, and amniotic fluid index are all assessed in a BPP. The placental grade is determined by ultrasound (as is a BPP), but it is not included in the criteria of assessment factors for a BPP.

A postmenopausal woman has been diagnosed with two leiomyomas (fibroids). Which clinical finding is most commonly associated with the presence of leiomyomas?

Abnormal uterine bleeding

A breastfeeding woman develops engorged breasts at 3 days postpartum. What action will help this client achieve her goal of reducing the engorgement? a.Skip feedings to enable her sore breasts to rest. b.Avoid using a breast pump. c.Breastfeed her infant every 2 hours. d.Reduce her fluid intake for 24 hours.

C (The mother should be instructed to attempt feeding her infant every 2 hours while massaging the breasts as the infant is feeding. Skipping feedings may cause further swelling and discomfort. If the infant does not adequately feed and empty the breast, then the mother may pump to extract the milk and relieve some of the discomfort. Dehydration further irritates swollen breast tissue.)

When a nurse is counseling a woman for primary dysmenorrhea, which nonpharmacologic intervention might be recommended? a. Increasing the intake of red meat and simple carbohydrates b. Reducing the intake of diuretic foods such as peaches and asparagus c. Temporarily substituting physical activity for a sedentary lifestyle d. Using a heating pad on the abdomen to relieve cramping

d. Using a heating pad on the abdomen to relieve cramping

Abdominal trauma

if pregnant women unresponsive starting CPR is highest priority -if responsive and no bleeding -> monitor FHTs for at least 4 hours even if no bleeding to assess for placental abruption

While evaluating the reflexes of a newborn, the nurse notes that with a loud noise the newborn symmetrically abducts and extends his arms, his fingers fan out and form a C with the thumb and forefinger, and he has a slight tremor. The nurse would document this finding as a positive _____ reflex. a. tonic neck b. glabellar (Myerson) c. Babinski d. Moro

D. Moro (Startle reflex)

When caring for a pregnant woman with cardiac problems, the nurse must be alert for the signs and symptoms of cardiac decompensation. Which critical findings would the nurse find on assessment of the client experiencing this condition? a. Regular heart rate and hypertension b. Increased urinary output, tachycardia, and dry cough c. Shortness of breath, bradycardia, and hypertension d. Dyspnea, crackles, and an irregular, weak pulse, cyanosis, edema

: D Signs of cardiac decompensation include dyspnea; crackles; an irregular, weak, and rapid pulse; rapid respirations; a moist and frequent cough; generalized edema; increasing fatigue; and cyanosis of the lips and nailbeds. A regular heart rate and hypertension are not generally associated with cardiac decompensation. Of the symptoms of increased urinary output, tachycardia, and dry cough, only tachycardia is indicative of cardiac decompensation. Of the symptoms of shortness of breath, bradycardia, and hypertension, only dyspnea is indicative of cardiac decompensation.

Because a full bladder prevents the uterus from contracting normally, nurses intervene to help the woman spontaneously empty her bladder as soon as possible. If all else fails, what tactic might the nurse use? a. Inserting a sterile catheter b. Pouring water from a squeeze bottle over the woman's perineum c. Placing oil of peppermint in a bedpan under the woman d. Asking the physician to prescribe analgesic agents

A If all else fails, the woman will be straight cathed to relieve bladder distension.

A woman in preterm labor at 30 weeks of gestation receives two 12-mg intramuscular (IM) doses of betamethasone. What is the purpose of this pharmacologic intervention? a. To stimulate fetal surfactant production b. To suppress uterine contractions c. To maintain adequate maternal respiratory effort and ventilation during magnesium sulfate therapy d. To reduce maternal and fetal tachycardia associated with ritodrine administration

A Important as baby may deliver preterm.

Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the client mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. This fetus is at the greatest risk for which condition? a. Macrosomia b. Congenital anomalies of the central nervous system c. Preterm birth d. Low birth weight

A Poor glycemic control later in pregnancy increases the rate of fetal macrosomia. Poor glycemic control during the preconception time frame and into the early weeks of the pregnancy is associated with congenital anomalies. Preterm labor or birth is more likely to occur with severe diabetes and is the greatest risk in women with pregestational diabetes. Increased weight, or macrosomia, is the greatest risk factor for this fetus.

Which statement concerning the complication of maternal diabetes is the most accurate? a. Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy. b. Hydramnios occurs approximately twice as often in diabetic pregnancies than in nondiabetic pregnancies. c. Infections occur about as often and are considered about as serious in both diabetic and nondiabetic pregnancies. d. Even mild-to-moderate hypoglycemic episodes can have significant effects on fetal well-being.

A Prompt treatment of DKA is necessary to save the fetus and the mother. Hydramnios occurs 10 times more often in diabetic pregnancies. Infections are more common and more serious in pregnant women with diabetes. Mild-to-moderate hypoglycemic episodes do not appear to have significant effects on fetal well-being.

Which client is at greatest risk for early PPH? a. Woman with severe preeclampsia on magnesium sulfate whose labor is being induced b. Primigravida in spontaneous labor with preterm twins c. Multiparous woman (G 3, P 2-0-0-2) with an 8-hour labor d. Primiparous woman (G 2, P 1-0-0-1) being prepared for an emergency cesarean birth for fetal distress

A The effects of magnesium sulfate puts this patient at greater risk for PPH than the other scenarios.

Parents have been asked by the neonatologist to provide breast milk for their newborn son, who was born prematurely at 32 weeks of gestation. The nurse who instructs them regarding pumping, storing, and transporting the milk needs to assess their knowledge of lactation. Which statement is valid? a.Premature infants more easily digest breast milk than formula. b.A glass of wine just before pumping will help reduce stress and anxiety. c.The mother should only pump as much milk as the infant can drink. d.The mother should pump every 2 to 3 hours, including during the night.

A (Human milk is the ideal food for preterm infants, with benefits that are unique, in addition to those benefits received by full-term, healthy infants. Greater physiologic stability occurs with breastfeeding, compared with formula feeding. Consumption of alcohol during lactation is approached with caution. Excessive amounts can have serious effects on the infant and can adversely affect the mothers milk ejection reflex. To establish an optimal milk supply, the most appropriate instruction for the mother should be to pump 8 to 10 times a day for 10 to 15 minutes on each breast.)

Intrauterine growth restriction (IUGR) is associated with numerous pregnancy-related risk factors (Select all that apply). a. Poor nutrition b. Maternal collagen disease c. Gestational hypertension d. Premature rupture of membranes e. Smoking

A, B, C, E

There is little consensus on the management of premenstrual dysphoric disorder (PMDD). However, nurses can advise women on several self-help modalities that often improve symptoms. The nurse knows that health teaching has been effective when the client reports that she has adopted a number of lifestyle changes, including (Select all that apply): a. Regular exercise. b. Improved nutrition. c. A daily glass of wine. d. Smoking cessation. e. Oil of evening primrose.

A, B, D, E

Cleft lip or palate is a common congenital midline fissure, or opening, in the lip or palate resulting from failure of the primary palate to fuse. Multiple genetic and, to a lesser extent, environmental factors may lead to the development of a cleft lip or palate. Such factors include (choose all that apply): A. Alcohol consumption B. Female gender C. Use of some antiepileptics D. Maternal cigarette smoking E. Antibiotic use in pregnancy

A, C, D Factors that are associated with the potential development of cleft lip or palate are maternal infections, radiation exposure, corticosteroids, anticonvulsants, male gender, Native American or Asian descent, and smoking during pregnancy. Cleft lip is more common in male infants. Antibiotic use in pregnancy is not associated with the development of cleft lip or palate.

Which congenital anomalies can occur as a result of the use of antiepileptic drugs (AEDs) in pregnancy? (Select all that apply.) a. Neural tube defects b. Gastroschisis c. Congenital heart disease d. Cleft lip e. Diaphragmatic hernia

A,C,D

A new mother states that her infant must be cold because the baby's hands and feet are blue. This common and temporary condition is called what? a. Acrocyanosis b. Erythema toxicum neonatorum c. Harlequin sign d. Vernix caseosa

A. Acrocyanosis

Prior to the patient undergoing amniocentesis, the most appropriate nursing intervention is to: A. Administer RhoD immunoglobulin. B. Administer anticoagulant. C. Send the patient for a computed tomography (CT) scan before the procedure. D. Assure the mother that short-term radiation exposure is not harmful to the fetus.

A. Administer RhoD immunoglobulin. Because of the possibility of fetomaternal hemorrhage, administering RhoD immunoglobulin to the woman who is Rh negative is standard practice after an amniocentesis. Anticoagulants are not administered before amniocentesis as this would increase the risk of bleeding when the needle is inserted transabdominally. A CT is not required before amniocentesis, because the procedure is ultrasound guided. The mother is not exposed to radiation during amniocentesis.

Which newborn reflex is elicited by stroking the lateral sole of the infant's foot from the heel to the ball of the foot? a. Babinski b. Tonic neck c. Stepping d. Plantar grasp

A. Babinski

A nurse caring for pregnant women must be aware that the most common medical complication of pregnancy is: A. Hypertension. B. Hyperemesis gravidarum. C. Hemorrhagic complications. D. Infections.

A. Hypertension

Warning signs to teach patients starting or taking COCs

A: Abdominal pain may indicate a problem with the liver or gallbladder. C: Chest pain or shortness of breath may indicate possible clot problem within the lungs or heart. H: Headaches (sudden or persistent) may be caused by cardiovascular accident or hypertension. E: Eye problems may indicate vascular accident or hypertension. S: Severe leg pain may indicate a thromboembolic process. (can be bc of DVT) (ACHES)

Which statement regarding emergency contraception is correct? a.Emergency contraception requires that the first dose be taken within 72 hours of unprotected intercourse. b.Emergency contraception may be taken right after ovulation. c.Emergency contraception has an effectiveness rate in preventing pregnancy of approximately 50%. d.Emergency contraception is commonly associated with the side effect of menorrhagia.

ANS: A Emergency contraception should be taken as soon as possible or within 72 hours of unprotected intercourse to prevent pregnancy. If taken before ovulation, follicular development is inhibited, which prevents ovulation. The risk of pregnancy is reduced by as much as 75%. The most common side effect of postcoital contraception is nausea.

Which statement regarding emergency contraception is correct? a. Emergency contraception requires that the first dose be taken within 120 hours of unprotected intercourse. b. Emergency contraception may be taken right after ovulation. c. Emergency contraception has an effectiveness rate in preventing pregnancy of approximately 50%. d. Emergency contraception is commonly associated with the side effect of menorrhagia.

ANS: A Emergency contraception should be taken as soon as possible or within 72 hours of unprotected intercourse to prevent pregnancy. If taken before ovulation, follicular development is inhibited, which prevents ovulation. The risk of pregnancy is reduced by as much as 75%. The most common side effect of postcoital contraception is nausea.

A pregnant woman was admitted for induction of labor at 43 weeks of gestation with sure dates. A nonstress test (NST) in the obstetrician's office revealed a nonreactive tracing. On artificial rupture of membranes, thick meconium-stained fluid was noted. What should the nurse caring for the infant after birth anticipate? a.Meconium aspiration, hypoglycemia, and dry, cracked skin b.Excessive vernix caseosa covering the skin, lethargy, and RDS c.Golden yellow to green-stained skin and nails, absence of scalp hair, and an increased amount of subcutaneous fat d.Hyperglycemia, hyperthermia, and an alert, wide-eyed appearance

ANS: A Meconium aspiration, hypoglycemia, and dry, cracked skin are consistent with a postmature infant. Excessive vernix caseosa, lethargy, and RDS are consistent with a very premature infant. The skin may be meconium stained, but the infant will most likely have long hair and decreased amounts of subcutaneous fat. Postmaturity with a nonreactive NST is indicative of hypoxia. Signs and symptoms associated with fetal hypoxia are hypoglycemia, temperature instability, and lethargy.

On vaginal examination of a 30-year-old woman, the nurse documents the following findings: profuse, thin, grayish-white vaginal discharge with a "fishy" odor and complaints of pruritus. Based upon these findings, which condition would the nurse suspect? a.Bacterial vaginosis b.Candidiasis c.Trichomoniasis d.Gonorrhea

ANS: A Most women with bacterial vaginosis complain of a characteristic "fishy" odor. The discharge is usually profuse, thin, and has a white, gray, or milky color. Some women may also experience mild irritation or pruritus. The discharge associated with candidiasis is thick, white, and lumpy and resembles cottage cheese. Trichomoniasis may be asymptomatic, but women commonly have a characteristic yellow-to-green, frothy, mucopurulent, copious, and malodorous discharge. Women with gonorrhea are often asymptomatic. Although they may have a purulent endocervical discharge, the discharge is usually minimal or absent.

A client exhibits a thick, white, lumpy, cottage cheese-like discharge, along with white patches on her labia and in her vagina. She complains of intense pruritus. Which medication should the nurse practitioner order to treat this condition? a.Fluconazole b.Tetracycline c.Clindamycin d.Acyclovir

ANS: A The client is experiencing a candidiasis infection. Fluconazole, metronidazole, and clotrimazole are the drugs of choice to treat this condition. Tetracycline is used to treat syphilis. Clindamycin is used to treat bacterial vaginosis. Acyclovir is used to treat genital herpes.

What is the correct term for the cheeselike, white substance that fuses with the epidermis and serves as a protective coating? a.Vernix caseosa b.Surfactant c.Caput succedaneum d.Acrocyanosis

ANS: A The protection provided by vernix caseosa is needed because the infant's skin is so thin. Surfactant is a protein that lines the alveoli of the infant's lungs. Caput succedaneum is the swelling of the tissue over the presenting part of the fetal head. Acrocyanosis is cyanosis of the hands and feet, resulting in a blue coloring.

A pregnant woman's amniotic membranes have ruptured. A prolapsed umbilical cord is suspected. What intervention would be the nurse's highest priority? a. Placing the woman in the knee-chest position b. Covering the cord in sterile gauze soaked in saline c. Preparing the woman for a cesarean birth d. Starting oxygen by face mask

ANS: A The woman is assisted into a modified Sims position, Trendelenburg position, or the knee-chest position in which gravity keeps the pressure of the presenting part off the cord. Although covering the cord in sterile gauze soaked saline, preparing the woman for a cesarean, and starting oxygen by face mark are appropriate nursing interventions in the event of a prolapsed cord, the intervention of top priority would be positioning the mother to relieve cord compression.

Despite warnings, prenatal exposure to alcohol continues to far exceed exposure to illicit drugs. Which condition is rarely associated with fetal alcohol syndrome (FAS)? a. Respiratory conditions b. Intellectual impairment c. Neural development disorder d. Alcohol-related birth defects (ARBDs)

ANS: A Respiratory difficulties are not attributed to exposure to alcohol in utero. Other abnormalities related to FAS include mental retardation, neurodevelopment disorders, and ARBDs.

Which sexual behaviors are associated with exposure to an STI? (Select all that apply.) a.Fellatio b.Unprotected anal intercourse c.Multiple sex partners d.Dry kissing e.Abstinence

ANS: A, B, C Engaging in fellatio, unprotected anal intercourse, or having multiple sex partners increases the exposure risk and the possibility of acquiring an STI. Dry kissing and abstinence are considered safe sexual practices.

A woman who has undergone an induced abortion be instructed to return to the emergency department when what situation exists? (Select all that apply.) a. Fever higher than 38° C b. Chills c. Foul-smelling vaginal discharge d. Bleeding greater than 2 pads in 2 hours e. Abdominal tenderness and or pain

ANS: A, B, C, D, E The client should report to a health care facility for any of the following symptoms: fever higher than 38° C, chills, bleeding more than two saturated pads in 2 hours or heavy bleeding lasting for days, foul-smelling discharge, abdominal tenderness or pain, and cramping or backache.

Intrauterine growth restriction (IUGR) is associated with numerous pregnancy-related risk factors (Select all that apply). a. Poor nutrition b. Maternal collagen disease c. Gestational hypertension d. Premature rupture of membranes e. Smoking

ANS: A, B, C, E Poor nutrition, maternal collagen disease, gestational hypertension, and smoking all are risk factors associated with IUGR. Premature rupture of membranes is associated with preterm labor, not IUGR.

The nurse, responsible for providing health teaching regarding the side effects of combined oral contraceptives (COCs), should discuss what issues? (Select all that apply.) a. Gallbladder disease b. Myocardial infarction c. Hypotension d. Breast tenderness e. Dry skin and scalp

ANS: A, B, D Serious side effects include stroke, myocardial infarction, hypertension, gallbladder disease, and liver tumors. More common side effects include nausea, breast tenderness, fluid retention, increased appetite, and oily skin and scalp

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

ANS: B Because the liver metabolizes oral contraceptives, their effectiveness is reduced when they are simultaneously taken with anticonvulsants. Stating that the pill is an effective birth control method with side effects is a true statement, but this response is not the most appropriate. The anticonvulsant reduces the effectiveness of the pill, not the other way around. Stating that the pill is a good choice for a woman of her age and personal history does not teach the client that the effectiveness of the pill may be reduced because of her anticonvulsant therapy.

In 1979, Lenore Walker pioneered the cause of women as victims of violence when she published her book The Battered Woman. While Walker conducted her research she found a similar pattern of abuse among many of the women. This concept is now referred to as the Cycle of Violence. Which phase does not belong in this three-cycle pattern of violence? a. Tension-building state b. Frustration followed by violence c. Acute battering incident d. Kindness and contrite, loving behavior

ANS: B Frustration followed by violence is not part of the Cycle of Violence. Tension-building state is also known as phase I of the cycle. The batterer expresses dissatisfaction and hostility with violent outbursts. The woman senses anger and anxiously tries to placate him. Acute battering incident is phase II of the cycle. It results in the man's uncontrollable discharge of tension toward the woman. Outbursts can last from several hours to several days and may involve kicking, punching, slapping, choking, burns, broken bones, and the use of weapons. Sometimes referred to as the honeymoon, kindness and contrite, loving behavior is the third phase of the cycle. The batterer feels remorseful and apologizes profusely. He tries to help the woman and often showers her with gifts.

Nurses must remember that pregnancy is a time of risk for all women. Which condition is likely the biggest risk for the pregnant client? a. Preeclampsia b. Intimate partner violence (IPV) c. Diabetes d. Abnormal Pap test

ANS: B The prevalence of IPV during pregnancy is estimated at 4% to 8% of all pregnant women. The risk for IPV and even IPV-related homicide is more common than all of the other pregnancy-related conditions.Although preeclampsia poses a risk to the health of the pregnant client, it is less common than IPV.Gestational diabetes continues to be a complication of pregnancy; however, it is less common than IPV during pregnancy.Some women are at risk for an abnormal Pap screening during pregnancy. This finding is not as common as IPV.

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

ANS: B The client may have multiple injuries in various stages of healing that indicates a pattern of violence. An argument is not always an indication of battering. A fractured arm and fresh bruises could be caused by the reported fall and do not necessarily indicate IPV. It may be normal for the woman to be reticent and have a dull affect.

Importantly, the nurse must be aware of which information related to the use of IUDs? 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 STIs 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. The return to fertility is immediate after the removal of the IUD. IUDs offer no protection against STIs. A consent form is required for insertion, as is a negative pregnancy test.

With regard to infants who are SGA (small for gestational age) and intrauterine growth restriction (IUGR), the nurse should be aware of which information? a.In the first trimester, diseases or abnormalities result in asymmetric IUGR. b.Infants with asymmetric IUGR have the potential for normal growth and development. c.In asymmetric IUGR, weight is slightly larger than SGA, whereas length and head circumference are somewhat less than SGA. d.Symmetric IUGR occurs in the later stages of pregnancy.

ANS: B IUGR is either symmetric or asymmetric. The symmetric form occurs in the first trimester; infants who are SGA have reduced brain capacity. The asymmetric form occurs in the later stages of pregnancy. Weight is less than the 10th percentile; head circumference is greater than the 10th percentile. Infants with asymmetric IUGR have the potential for normal growth and development.

Which maternal condition always necessitates delivery by cesarean birth? a. Marginal placenta previa b. Complete placenta previa c. Ectopic pregnancy d. Eclampsia

ANS: B In complete placenta previa, the placenta completely covers the cervical os. A cesarean birth is the acceptable method of delivery. The risk of fetal death occurring is due to preterm birth. If the previa is marginal (i.e., 2 cm or greater away from the cervical os), then labor can be attempted. A cesarean birth is not indicated for an ectopic pregnancy. Labor can be safely induced if the eclampsia is under control.

The nurse caring for a woman hospitalized for hyperemesis gravidarum should expect that initial treatment to involve: a. Corticosteroids to reduce inflammation. b. IV therapy to correct fluid and electrolyte imbalances. c. An antiemetic, such as pyridoxine, to control nausea and vomiting. d. Enteral nutrition to correct nutritional deficits.

ANS: B Initially, the woman who is unable to keep down clear liquids by mouth requires IV therapy for correction of fluid and electrolyte imbalances. Corticosteroids have been used successfully to treat refractory hyperemesis gravidarum; however, they are not the expected initial treatment for this disorder. Pyridoxine is vitamin B6, not an antiemetic. Promethazine, a common antiemetic, may be prescribed. In severe cases of hyperemesis gravidarum, enteral nutrition via a feeding tube may be necessary to correct maternal nutritional deprivation. This is not an initial treatment for this patient.

What is the correct terminology for an abortion in which the fetus dies but is retained within the uterus? a. Inevitable abortion b. Missed abortion c. Incomplete abortion d. Threatened abortion

ANS: B Missed abortion refers to the retention of a dead fetus in the uterus. An inevitable abortion means that the cervix is dilating with the contractions. An incomplete abortion means that not all of the products of conception were expelled. With a threatened abortion, the woman has cramping and bleeding but no cervical dilation.

Necrotizing enterocolitis (NEC) is an inflammatory disease of the gastrointestinal mucosa. The signs of NEC are nonspecific. What are generalized signs and symptoms of this condition? a.Hypertonia, tachycardia, and metabolic alkalosis b.Abdominal distention, temperature instability, and grossly bloody stools c.Hypertension, absence of apnea, and ruddy skin color d.Scaphoid abdomen, no residual with feedings, and increased urinary output

ANS: B Some generalized signs of NEC include decreased activity, hypotonia, pallor, recurrent apnea and bradycardia, decreased oxygen saturation values, respiratory distress, metabolic acidosis, oliguria, hypotension, decreased perfusion, temperature instability, cyanosis, abdominal distention, residual gastric aspirates, vomiting, grossly bloody stools, abdominal tenderness, and erythema of the abdominal wall. The infant may display hypotonia, bradycardia, and metabolic acidosis.

Which nursing intervention is paramount when providing care to a client with preterm labor who has received terbutaline? a. Assess deep tendon reflexes (DTRs). b. Assess for dyspnea and crackles. c. Assess for bradycardia. d. Assess for hypoglycemia.

ANS: B Terbutaline is a beta2-adrenergic agonist that affects the mother's cardiopulmonary and metabolic systems. Signs of cardiopulmonary decompensation include adventitious breath sounds and dyspnea. An assessment for dyspnea and crackles is important for the nurse to perform if the woman is taking magnesium sulfate. Assessing DTRs does not address the possible respiratory side effects of using terbutaline. Since terbutaline is a beta2-adrenergic agonist, it can lead to hyperglycemia, not hypoglycemia. Beta2-adrenergic agonist drugs cause tachycardia, not bradycardia.

Which trait is least likely to be displayed by a woman experiencing intimate partner violence (IPV)? a.Socially isolated b.Assertive personality c.Struggling with depression d.Dependent partner in a relationship

ANS: B Every segment of society is represented among women who are suffering abuse. However, traits of assertiveness, independence, and willingness to take a stand have been documented as more characteristic of women who are in nonviolent relationships. Women who are financially more dependent have fewer resources and support systems, exhibit symptoms of depression, and are more often seen as victims.

Postabortion instructions may differ among providers regarding tampon use and the resumption of intercourse. However, education should be provided regarding serious complications. When should the woman who has undergone an induced abortion be instructed to return to the emergency department? (Select all that apply.) a.Fever higher than 39° C b.Chills c.Foul-smelling vaginal discharge d.Bleeding greater than four pads in 2 hours e.Severe abdominal pain

ANS: B, C, E The client should report to a health care facility for any of the following symptoms: fever higher than 38° C, chills, bleeding more than two saturated pads in 2 hours or heavy bleeding lasting for days, foul-smelling discharge, abdominal tenderness or pain, and cramping or backache.

Which client would be an ideal candidate for injectable progestins such as Depo-Provera (DMPA) as a contraceptive choice? a.The ideal candidate for DMPA wants menstrual regularity and predictability. b.The client has a history of thrombotic problems or breast cancer. c.The ideal candidate has difficulty remembering to take oral contraceptives daily. d.The client is homeless or mobile and rarely receives health care.

ANS: C Advantages of DMPA include its contraceptive effectiveness, compared with the effectiveness of combined oral contraceptives, and the requirement of only four injections a year. The disadvantages of injectable progestins are prolonged amenorrhea and uterine bleeding. The 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.

Which client would be an ideal candidate for injectable progestins such as medroxyprogesterone acetate as a contraceptive choice? a. The ideal candidate wants menstrual regularity and predictability. b. The client has a history of thrombotic problems or breast cancer. c. The ideal candidate has difficulty remembering to take oral contraceptives daily. d. The client is homeless or mobile and rarely receives health care.

ANS: C Advantages of medroxyprogesterone acetate includes its contraceptive effectiveness, compared with the effectiveness of combined oral contraceptives, and the requirement of only four injections a year. The disadvantages of injectable progestins are prolonged amenorrhea and uterine bleeding. The use of injectable progestin carries an increased risk of venous thrombosis and thromboembolism. To be effective, injections must be administered every 11 to 13 weeks. Access to health care is necessary to prevent pregnancy or potential complications.

Which sexually transmitted infection (STI) is the most commonly reported in American women? a.Gonorrhea b.Syphilis c.Chlamydia d.Candidiasis

ANS: C Chlamydia is the most common and fastest spreading STI among American women, with an estimated 3 million new cases each year. Infection rates are two and a half times that of men. Gonorrhea is probably the oldest communicable disease in the United States and second to Chlamydia in reported conditions. Syphilis is the earliest described STI. Candidiasis is a relatively common fungal infection.

With regard to violence against women, intimate partner violence (IPV) nurses should be aware that: a. Relationship violence usually consists of a single episode that the couple can put behind them b. Violence often declines or ends with pregnancy c. Economic coercion is considered part of IPV d. Battered women generally are poorly educated and come from a deprived social background

ANS: C Economic coercion accompanies physical assault and psychologic attacks.IPV almost always follows an escalating pattern. It rarely ends with a single episode of violence.IPV often begins with and escalates during pregnancy. It may include both psychologic attacks and economic coercion.Race, religion, social background, age, and education level are not significant factors in differentiating women at risk.

Which condition is the most life-threatening virus to the fetus and neonate? a.Hepatitis A virus (HAV) b.Herpes simplex virus (HSV) c.Hepatitis B virus (HBV) d.Cytomegalovirus (CMV)

ANS: C HBV is the most life-threatening viral condition to the fetus and neonate. HAV is not the most threatening to the fetus nor is HSV the most threatening to the neonate. Although serious, CMV is not the most life-threatening viral condition to the fetus.

The nurse should understand the process by which the HIV infection occurs. Once the virus has entered the body, what is the time frame for seroconversion to HIV positivity? a.6 to 10 days b.2 to 4 weeks c.6 to 12 weeks d.6 months

ANS: C Seroconversion to HIV positivity usually occurs within 6 to 12 weeks after the virus has entered the body. Both 6 to 10 days and 2 to 4 weeks are too short for seroconversion to HIV positivity to occur, and 6 months is too long.

The primary theme of the feminist perspective on violence against women recognizes the: a. Role of testosterone as the underlying cause of men's violent behavior b. Basic human instinctual drive toward aggression c. Dominance and coercive control over women by men d. Cultural norm of violence in Western society

ANS: C The contemporary social view of violence is derived from the feminist theory. With the primary theme of male dominance and coercive control, this view enhances our understanding of all forms of violence against women, including wife battering, stranger and acquaintance rape, incest, and sexual harassment in the workplace. The role of testosterone as an underlying cause of men's violent behavior is not associated with the feminist perspective of violence against women.The basic human instinctual drive toward aggression is not associated with the feminist perspective.The cultural norm of violence in Western society is not associated with the feminist perspective regarding violence against women.

A woman arrives at the emergency department with complaints of bleeding and cramping. The initial nursing history is significant for a last menstrual period 6 weeks ago. On sterile speculum examination, the primary care provider finds that the cervix is closed. The anticipated plan of care for this woman would be based on a probable diagnosis of which type of spontaneous abortion? a. Incomplete b. Inevitable c. Threatened d. Septic

ANS: C A woman with a threatened abortion has spotting, mild cramps, and no cervical dilation. A woman with an incomplete abortion would have heavy bleeding, mild-to-severe cramping, and cervical dilation. An inevitable abortion demonstrates the same symptoms as an incomplete abortion: heavy bleeding, mild-to-severe cramping, and cervical dilation. A woman with a septic abortion has malodorous bleeding and typically a dilated cervix.

1. In planning for home care of a woman with preterm labor, which concern should the nurse need to address? a. Nursing assessments are different from those performed in the hospital setting. b. Restricted activity and medications are necessary to prevent a recurrence of preterm labor. c. Prolonged bed rest may cause negative physiologic effects. d. Home health care providers are necessary.

ANS: C Prolonged bed rest may cause adverse effects such as weight loss, loss of appetite, muscle wasting, weakness, bone demineralization, decreased cardiac output, risk for thrombophlebitis, alteration in bowel functions, sleep disturbance, and prolonged postpartum recovery. Nursing assessments differ somewhat from those performed in the acute care setting, but this concern does not need to be addressed. Restricted activity and medications may prevent preterm labor but not in all women. In addition, the plan of care is individualized to meet the needs of each client. Many women receive home health nurse visits, but care is individualized for each woman.

In the 1970s, the rape-trauma syndrome (RTS) was identified as a cluster of symptoms and related behaviors observed in the weeks and months after an episode of rape. Researchers identified three phases related to this condition. Which phase is not displayed in a client with RTS? a.Acute Phase: Disorganization b.Outward Adjustment Phase c.Shock/Disbelief: Disorientation Phase d.Long-Term Process: Reorganization Phase

ANS: C Shock, disbelief, or disorientation is a component of the Acute Phase. The rape survivor feels embarrassed, degraded, fearful, and angry. She may feel unclean and want to bathe and douche repeatedly, even though doing so may destroy evidence. The victim relives the scene over and over in her mind, thinking of things she "should have done." During the Outward Adjustment Phase, the victim may appear to have resolved her crisis and return to activities of daily living and work. Other women may move, leave their job, and buy a weapon to protect themselves. Disorientation is a reaction during which the victim may feel disoriented, have difficulty concentrating, or have poor recall. The Long-Term Process is the reorganization phase. This recovery phase may take years and may be difficult and painful.

Which finding on a prenatal visit at 10 weeks of gestation might suggest a hydatidiform mole? a. Complaint of frequent mild nausea b. Blood pressure of 120/80 mm Hg c. Fundal height measurement of 18 cm d. History of bright red spotting for 1 day, weeks ago

ANS: C - gestation size appears larger The uterus in a hydatidiform molar pregnancy is often larger than would be expected on the basis of the duration of the pregnancy. Nausea increases in a molar pregnancy because of the increased production of hCG. A woman with a molar pregnancy may have early-onset pregnancy-induced hypertension. In the client's history, bleeding is normally described as brownish.

Common characteristics of a potential batterer include (choose all that apply): a. High level of self-esteem b. High frustration tolerance c. Substance abuse problems d. Excellent verbal skills e. Personality disorders

ANS: C, E Substance abuse and personality disorders are often seen in batterers. Typically the batterer has low self-esteem. Batterers usually have a low frustration level (i.e., they lose their temper easily). Batterers characteristically have poor verbal skills and especially can have difficulty expressing their feelings.

A 21-year-old client exhibits a greenish, copious, and malodorous discharge with vulvar irritation. A speculum examination and wet smear are performed. Which condition is this client most likely experiencing? a.Bacterial vaginosis b.Candidiasis c.Yeast infection d.Trichomoniasis

ANS: D Although uncomfortable, a speculum examination is always performed and a wet smear obtained if the client exhibits symptoms of trichomoniasis. The presence of many white blood cell protozoa is a positive finding for trichomoniasis. A normal saline test is used to test for bacterial vaginosis. A potassium hydroxide preparation is used to test for candidiasis. Yeast infection is the common name for candidiasis, for which the test is a potassium hydroxide preparation.

A client currently uses a diaphragm and spermicide for contraception. She asks the nurse to explain the major differences between the cervical cap and the diaphragm. What is the most appropriate response by the nurse? 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 be safely 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. Spermicide should be used inside the cap as an additional chemical barrier. The cervical cap should remain in place for 6 hours after the last act of intercourse. Repeated intercourse with the cervical cap is more convenient because no additional spermicide is needed.

The nurse providing care in a women's health care setting must be knowledgeable about STIs. Which STIs can be successfully treated? a.HSV b.AIDS c.Venereal warts d.Chlamydia

ANS: D The usual treatment for Chlamydia bacterial infection is doxycycline or azithromycin. Concurrent treatment of all sexual partners is needed to prevent recurrence. No known cure is available for HSV; therefore, the treatment focuses on pain relief and preventing secondary infections. Because no cure is known for AIDS, prevention and early detection are the primary focus of care management. HPV causes condylomata acuminata (venereal warts); no available treatment eradicates the virus.

___, or the appearance of slightly cyanotic hands and feet, is caused by vasomotor instability, capillary stasis, and a high hemoglobin level. It is normal and intermittently appears over the first 7 to 10 days after childbirth.

Acrocyanosis

In evaluating the effectiveness of magnesium sulfate for the treatment of preterm labor, which finding alerts the nurse to possible side effects? a. Urine output of 160 ml in 4 hours b. DTRs 2+ and no clonus c. Respiratory rate (RR) of 16 breaths per minute d. Serum magnesium level of 10 mg/dl

ANS: D The therapeutic range for magnesium sulfate management is 4 to 7.5 mg/dl. A serum magnesium level of 10 mg/dl could lead to signs and symptoms of magnesium toxicity, including oliguria and respiratory distress. Urine output of 160 ml in 4 hours, DTRs of 2+, and a RR of 16 breaths per minute are all normal findings.

On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. What is the nurse's highest priority at this time? a. Assessing the woman's vital signs b. Massaging the woman's fundus c. Calling the woman's primary health care provider d. Beginning an intravenous (IV) infusion of Ringer's lactate solution

B The initial intervention in management of excessive postpartum bleeding due to uterine atony is firm massage of the uterine fundus. Expression of any clots in the uterus, elimination of bladder distention, and continuous IV infusion of 10 to 40 units of oxytocin added to 1000ml of lactated ringers or normal saline solution also are primary interventions.

A woman who has recently given birth complains of pain and tenderness in her leg. On physical examination, the nurse notices warmth and redness over an enlarged, hardened area. Which condition should the nurse suspect, and how will it be confirmed? a. von Willebrand disease (vWD); noting whether bleeding times have been extended b. Thrombophlebitis; using real-time and color Doppler ultrasound c. Idiopathic or immune thrombocytopenic purpura (ITP); drawing blood for laboratory analysis d. Disseminated intravascular coagulation (DIC); asking for laboratory tests

B

Which instruction should the nurse provide to reduce the risk of nipple trauma? a.Limit the feeding time to less than 5 minutes. b.Position the infant so the nipple is far back in the mouth. c.Assess the nipples before each feeding. d.Wash the nipples daily with mild soap and water.

B (If the infants mouth does not cover as much of the areola as possible, the pressure during sucking will be applied to the nipple, thus causing trauma to the area. Stimulating the breast for less than 5 minutes will not produce the extra milk the infant may need and will also limit access to the higher-fat hindmilk. Assessing the nipples for trauma is important; however, this action alone will not prevent sore nipples. Soap can be drying to the nipples and should be avoided during breastfeeding.)

A woman gave birth vaginally to a 9-pound, 12-ounce girl yesterday. Her primary health care provider has written orders for perineal ice packs, use of a sitz bath three times daily, and a stool softener. Which information regarding the client's condition is most closely correlated with these orders? a. Woman is a gravida 2, para 2. b. Woman had a vacuum-assisted birth. c. Woman received epidural anesthesia. d. Woman has an episiotomy.

B - Woman has an episiotomy

What are the various modes of heat loss in the newborn? (Select all that apply.) a. Perspiration b. Convection c. Radiation d. Conduction e. Urination

B,C,D

A new father wants to know what medication was put into his infants eyes and why it is needed. How does the nurse explain the purpose of the erythromycin (Ilotycin) ophthalmic ointment? a. Erythromycin (Ilotycin) ophthalmic ointment destroys an infectious exudate caused by Staphylococcus that could make the infant blind. b. This ophthalmic ointment prevents gonorrheal and chlamydial infection of the infants eyes, potentially acquired from the birth canal. c. Erythromycin (Ilotycin) prevents potentially harmful exudate from invading the tear ducts of the infants eyes, leading to dry eyes. d. This ointment prevents the infants eyelids from sticking together and helps the infant see.

B. (The nurse should explain that prophylactic erythromycin ophthalmic ointment is instilled in the eyes of all neonates to prevent gonorrheal and chlamydial infection that potentially could have been acquired from the birth canal. This prophylactic ophthalmic ointment is not instilled to prevent dry eyes and has no bearing on vision other than to protect against infection that may lead to vision problems.)

A woman gave birth to a healthy 7-pound, 13-ounce infant girl. The nurse suggests that the client place the infant to her breast within 15 minutes after birth. The nurse is aware that the initiation of breastfeeding is most effective during the first 30 minutes after birth. What is the correct term for this phase of alertness? a. Transition period b. First period of reactivity c. Organizational stage d. Second period of reactivity

B. First period of reactivity

The nurse is caring for a pregnant client at 30 weeks of gestation in preterm labor. Which medication would be administered to the client to enhance fetal lung maturation?

Betamethasone

The prevalence of urinary incontinence (UI) increases as women age, with more than one third of the women in the United States suffering from some form of this disorder. The symptoms of mild-to-moderate UI can be successfully decreased by a number of strategies. Which of these should the nurse instruct the client to use first?

Bladder training and pelvic muscle exercises

The prevalence of urinary incontinence (UI) increases as women age, with more than one third of the women in the United States suffering from some form of this disorder. The symptoms of mild-to-moderate UI can be successfully decreased by a number of strategies. Which of these should the nurse instruct the client to use first?

Bladder training and pelvic muscle exercises Pelvic muscle exercises, known as Kegel exercises, along with bladder training can significantly decrease or entirely relieve stress incontinence in many women. Pelvic floor support devices, also known as pessaries, come in a variety of shapes and sizes. Pessaries may not be effective for all women and require scrupulous cleaning to prevent infection. Anterior and posterior repairs and even a hysterectomy may be performed. If surgical repair is performed, then the nurse must focus her care on preventing infection and helping the woman avoid putting stress on the surgical site. Pharmacologic therapy includes selective serotonin-norepinephrine reuptake inhibitors or vaginal estrogen therapy. However, pharmacologic therapy is not the first action a nurse should recommend.

While working with the pregnant woman in her first trimester, the nurse is aware that chorionic villus sampling (CVS) can be performed during pregnancy at: a. 4 weeks b. 8 weeks c. 10 weeks d. 14 weeks

C. 10 weeks

A mother expresses fear about changing her infants diaper after he is circumcised. What does the client need to be taught to care for her newborn son? a.Cleanse the penis with prepackaged diaper wipes every 3 to 4 hours. b.Apply constant, firm pressure by squeezing the penis with the fingers for at least 5 minutes if bleeding occurs. c.Gently cleanse the penis with water and apply petroleum jelly around the glans after each diaper change. - they will be ready for discharge after they are urinating - have a wet diaper d.Wash off the yellow exudate that forms on the glans at least once every day to prevent infection.

C (Gently cleansing the penis with water and applying petroleum jelly around the glans after each diaper change are appropriate techniques when caring for an infant who has had a circumcision. With each diaper change, the penis should be washed with warm water to remove any urine or feces. If bleeding occurs, then the mother should apply gentle pressure to the site of the bleeding with a sterile gauze square. Yellow exudates are part of normal healing and cover the glans penis 24 hours after the circumcision; yellow exudates are not an infective process and should not be removed.)

If the newborn has excess secretions, the mouth and nasal passages can be easily cleared with a bulb syringe. How should the nurse instruct the parents on the use of this instrument? a. Avoid suctioning the nares. b. Insert the compressed bulb into the center of the mouth. c. Suction the mouth first. d. Remove the bulb syringe from the crib when finished.

C (The mouth should always be suctioned first to prevent the infant from inhaling pharyngeal secretions by gasping as the nares are suctioned. After compressing the bulb, the syringe should be inserted into one side of the mouth. If it is inserted into the center of the mouth, then the gag reflex is likely to be initiated. When the infants cry no longer sounds as though it is through mucus or a bubble, suctioning can be stopped. The nasal passages should be suctioned one nostril at a time. The bulb syringe should remain in the crib so that it is easily accessible if needed again.)

Which preexisting factor is known to increase the risk of GDM? a. Underweight before pregnancy b. Maternal age younger than 25 years c. Previous birth of large infant d. Previous diagnosis of type 2 diabetes mellitus

C A previous birth of a large infant suggests GDM. Obesity (body mass index [BMI] of 30 or greater) creates a higher risk for gestational diabetes. A woman younger than 25 years is not generally at risk for GDM. The person with type 2 diabetes mellitus already has diabetes and thus will continue to have it after pregnancy. Insulin may be required during pregnancy because oral hypoglycemia drugs are contraindicated during pregnancy.

During a prenatal visit, the nurse is explaining dietary management to a woman with pregestational diabetes. Which statement by the client reassures the nurse that teaching has been effective? a. I will need to eat 600 more calories per day because I am pregnant. b. I can continue with the same diet as before pregnancy as long as it is well balanced. c. Diet and insulin needs change during pregnancy. d. I will plan my diet based on the results of urine glucose testing.

C Diet and insulin needs change during the pregnancy in direct correlation to hormonal changes and energy needs. In the third trimester, insulin needs may double or even quadruple. The diet is individualized to allow for increased fetal and metabolic requirements, with consideration of such factors as prepregnancy weight and dietary habits, overall health, ethnic background, lifestyle, stage of pregnancy, knowledge of nutrition, and insulin therapy. Energy needs are usually calculated on the basis of 30 to 35 calories per kilogram of ideal body weight. Dietary management during a diabetic pregnancy must be based on blood, not urine, glucose changes.

To manage her diabetes appropriately and to ensure a good fetal outcome, how would the pregnant woman with diabetes alter her diet? a. Eat six small equal meals per day. b. Reduce the carbohydrates in her diet. c. Eat her meals and snacks on a fixed schedule. d. Increase her consumption of protein.

C Having a fixed meal schedule will provide the woman and the fetus with a steady blood sugar level, provide a good balance with insulin administration, and help prevent complications. Having a fixed meal schedule is more important than the equal division of food intake. Approximately 45% of the food eaten should be in the form of carbohydrates.

The nurse is assessing a full term, quiet, and alert newborn. What is the average expected apical pulse range (in beats per minute)? a. 80 to 100 b. 100 to 120 c. 120 to 160 d. 150 to 180

C. 120-160

A nurse hears a primiparous women talking.to her son and telling him that his chin is just like his dad's. This statement is most descriptive of which process? A.Mutuality. B. Synchrony. C. Claiming D. Reciprocity

C. Claiming

While examining a newborn, the nurse notes uneven skinfolds on the buttocks and a clunk when performing the Ortolani maneuver. These findings are likely indicative of what? a. Polydactyly b. Clubfoot c. Hip dysplasia d. Webbing

C. Hip dysplasia

In assisting the breastfeeding mother to position the baby, which information regarding positioning is important for the nurse to keep in mind? a.The cradle position is usually preferred by mothers who had a cesarean birth. b.Women with perineal pain and swelling prefer the modified cradle position. c.Whatever the position used, the infant is belly to belly with the mother. d.While supporting the head, the mother should push gently on the occiput.

C (The infant naturally faces the mother, belly to belly. The football position is usually preferred after a cesarean birth. Women with perineal pain and swelling prefer the side-lying position because they can rest while breastfeeding. The mother should never push on the back of the head. It may cause the baby to bite, hyperextend the neck, or develop an aversion to being brought near the breast.)

6A newborn is jaundiced and is receiving phototherapy via ultraviolet bank lights. What is the most appropriate nursing intervention when caring for an infant with hyperbilirubinemia and receiving phototherapy? a. Applying an oil-based lotion to the newborns skin to prevent dying and cracking b. Limiting the newborns intake of milk to prevent nausea, vomiting, and diarrhea c. Placing eye shields over the newborns closed eyes d. Changing the newborns position every 4 hours

C (The infants eyes must be protected by an opaque mask to prevent overexposure to the light. Eye shields should completely cover the eyes but not occlude the nares. Lotions and ointments should not be applied to the infant because they absorb heat and can cause burns. The lights increase insensible water loss, placing the infant at risk for fluid loss and dehydration. Therefore, adequate hydration is important for the infant. The infant should be turned every 2 hours to expose all body surfaces to the light.)

During a phone follow-up conversation with a woman who is 4 days postpartum, the woman tells the nurse, "I don't know what's wrong. I love my son, but I feel so let down. I seem to cry for no reason!" The nurse would recognize that the woman is experiencing: A. Taking-in B. Postpartum depression (PPD) C. Postpartum blues D. Attachment difficulty

C. Postpartum blues "baby blues" A. Incorrect: The taking-in phase is the period after birth when the mother focuses on her own psychologic needs. Typically, this period lasts 24 hours. B. Incorrect: PPD is an intense, pervasive sadness marked by severe, labile mood swings; it is more serious and persistent than the PP blues. C. Correct: During the PP blues, women are emotionally labile, often crying easily and for no apparent reason. This lability seems to peak around the fifth PP day. D. Incorrect: Crying is not a maladaptive attachment response; it indicates PP blues.

The nurse observes several interactions between a postpartum woman and her new son. What behavior, if exhibited by this woman, would the nurse identify as a possible maladaptive behavior regarding parent-infant attachment? A.The postpartum woman talks and coos to her son. B.She seldom makes eye contact with her son. C.The mother cuddles her son close to her. D.She tells visitors how well her son is feeding.

C. She seldom makes eye contact with her son.

A client in late middle age who is certain she is not pregnant tells the nurse during an office visit that she has urinary problems, as well as sensations of bearing down and of something in her vagina. What condition would the nurse suspect based upon this report?

Cystoceles and/or rectoceles Uterine displacement can be caused by congenital or acquired weakness of the pelvic support structures and is known as pelvic relaxation. Cystoceles are protrusions of the bladder downward into the vagina; rectoceles are herniations of the anterior rectal wall through a relaxed or ruptured vaginal fascia. Both can produce a bearing-down sensation with urinary dysfunction. They occur more often in older women who have borne children. Uterine prolapse is a more serious type of displacement. In women with a complete prolapse, the cervix and body of the uterus protrude through the vagina. Genital fistulas are perforations between genital tract organs. Most occur between the bladder and the genital tract. Which woman has the highest risk for endometrial cancer?

The client is being induced in response to worsening preeclampsia. She is also receiving magnesium sulfate. It appears that her labor has not become active, despite several hours of oxytocin administration. She asks the nurse, "Why is this taking so long?" What is the nurse's most appropriate response? a. "I don't know why it is taking so long." b. "Your baby is just being stubborn." c. "The length of labor varies for different women." d. "The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor."

D

Which physiologic alteration of pregnancy most significantly affects glucose metabolism? a. Pancreatic function in the islets of Langerhans is affected by pregnancy. b. Pregnant women use glucose at a more rapid rate than nonpregnant women. c. Pregnant women significantly increase their dietary intake. d. Placental hormones are antagonistic to insulin, thus resulting in insulin resistance.

D Placental hormones, estrogen, progesterone, and human placental lactogen (HPL) create insulin resistance. Insulin is also broken down more quickly by the enzyme placental insulinase. Pancreatic functioning is not affected by pregnancy. The glucose requirements differ because of the growing fetus. The pregnant woman should increase her intake by 200 calories a day.

A primiparous woman is delighted with her newborn son and wants to begin breastfeeding as soon as possible. How should the client be instructed to position the infant to facilitate correct latch-on? a.The infant should be positioned with his or her arms folded together over the chest. b.The infant should be curled up in a fetal position. c.The woman should cup the infants head in her hand. d.The infants head and body should be in alignment with the mother.

D (The infants head and body should be in correct alignment with the mother and the breast during latch-on and feeding. The infant should be facing the mother with his arms hugging the breast. The babys body should be held in correct alignment (i.e., ears, shoulder, and hips in a straight line) during feedings. The mother should support the babys neck and shoulders with her hand and not push on the occiput.)

As part of their teaching function at discharge, nurses should educate parents regarding safe sleep. Based on the most recent evidence, which information is incorrect and should be discussed with parents? a. Prevent exposure to people with upper respiratory tract infections. b. Keep the infant away from secondhand smoke. c. Avoid loose bedding, water beds, and beanbag chairs. d. Place the infant on his or her abdomen to sleep.

D. (The infant should be laid down to sleep on his or her back for better breathing and to prevent sudden infant death syndrome (SIDS). Grandmothers may encourage the new parents to place the infant on the abdomen; however, evidence shows back to sleep reduces SIDS. Infants are vulnerable to respiratory infections; therefore, infected people must be kept away. Secondhand smoke can damage lungs. Infants can suffocate in loose bedding and in furniture that can trap them. Per AAP guidelines, infants should always be placed back to sleep and allowed tummy time to play to prevent plagiocephaly.)

An African-American woman noticed some bruises on her newborn daughter's buttocks. The client asks the nurse what causes these. How would the nurse best explain this integumentary finding to the client? a. Lanugo b. Vascular nevus c. Nevus flammeus d. Mongolian spot

D. Mongolian Spot

The nurse notes a patient had a reactive nonstress test (NST). How should the nurse interpret this test result? A. There were two or more fetal heart rate decelerations within a 15-minute period. B. There was a fetal heart rate deceleration that lasted for at least 1 minute. C. There was a fetal heart rate acceleration that lasted for 4 minutes. D. There were two or more fetal heart rate accelerations within a 20-minute period.

D. There were two or more fetal heart rate accelerations within a 20-minute period. A reactive NST is defined as having two or more fetal heart rate accelerations within a 20-minute period. This is a normal finding. A deceleration, whether over 15 minutes or 1 minute, is when the fetal heart rate decreases; this is not a reactive NST. A 4-minute fetal heart rate acceleration is not a reactive NST; it is too long.

Which ovarian neoplasm is described as a growth that contains hair, teeth, and sebaceous secretions?

Dermoid cyst

Which ovarian neoplasm is described as a growth that contains hair, teeth, and sebaceous secretions?

Dermoid cyst Dermoid cysts are germ cell tumors, usually occurring in childhood, that may contain teeth, hair, bones, and sebaceous secretions and may unilaterally or bilaterally develop. Treatment is most often surgical removal. An ovarian fibroma is a solid ovarian neoplasm that develops from connective tissue, usually after menopause. A uterine polyp is a tumor that grows on the uterine wall on a stalk or pedicle. A follicular cyst develops within the ovaries of young women in response to follicle rupture and should resolve within one or two menstrual cycles.

Which condition is the most common malignancy of the reproductive system?

Endometrial cancer

What is indicative of infection in postpartum patient?

Fever of 38° C (100.4° F) or higher for 2 consecutive days during the first 10 days of the postpartum period:indicative of a postpartum infection and requires further investigation.

Maternal hypertension at risk for -

IUGR

A woman with severe preeclampsia is being treated with an intravenous infusion of magnesium sulfate. When is this treatment considered successful?

If seizures dont occur

A ___ ___ is a bluish-black area of pigmentation that may appear over any part of the exterior surface of the infant's body and is more commonly noted on the back and buttocks and most frequently observed on infants whose ethnic origins are Mediterranean, Latin American, Asian, or African.

Mongolian Spot

Which actions would the nurse take when a pregnant client has convulsions? Select all that apply.

Obtain a prescription for magnesium sulfate. Assess the client's airway, breathing, and pulse. Lower the bed and turn the client onto one side. Raise the side rails of the bed and pads with pillows.

The nurse is preparing to administer intravenous magnesium sulfate to a client with preeclampsia. Meanwhile, the student nurse positions the client in the supine position, monitors the fetal heart rate (FHR), checks for baseline variability, and monitors for the absence of late decelerations. Which action by the student nurse indicates the need for further teaching?

Placing the client in a supine position

Which woman has the highest risk for endometrial cancer?

Postmenopausal woman with hypertension

Which woman has the highest risk for endometrial cancer?

Postmenopausal woman with hypertension Endometrial cancer is most often seen in postmenopausal women between the ages of 50 and 65 years. Hypertension is a risk factor associated with the development of this malignancy. The use of an IUD does not increase a womans risk for endometrial cancer. A client who has been on birth control for 15 years is not at increased risk for endometrial cancer; the birth control contraceptives might actually offer some protection. The development of a cystocele will not increase a womans risk for endometrial cancer.

The nurse is caring for a client with preeclampsia who is receiving an intravenous (IV) magnesium sulfate infusion. In assessing the client every 20 minutes, which maternal findings would require immediate intervention by the nurse?

Respiratory rate of 9 breaths/min

Which condition in a pregnant client with severe preeclampsia is an indication for administering magnesium sulfate?

Seizure activity

A client currently uses a diaphragm and spermicide for contraception. She asks the nurse to explain the major differences between the cervical cap and the diaphragm. What is the most appropriate response by the nurse?

The cervical cap can be safely used for repeated acts of intercourse without adding more spermicide later. The cervical cap can be inserted hours before sexual intercourse without the need for additional spermicide later. Spermicide should be used inside the cap as an additional chemical barrier. The cervical cap should remain in place for 6 hours after the last act of intercourse. Repeated intercourse with the cervical cap is more convenient because no additional spermicide is needed.

The nurse should be aware that a pessary is most effective in the treatment of which disorder?

Uterine prolapse A fitted pessary may be inserted into the vagina to support the uterus and hold it in the correct position. Usually a pessary is used for only a short time and is not used for the client with a cystocele. A rectocele cannot be corrected by the use of a pessary. A pessary is not likely the most effective treatment for stress incontinence.

A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks the nurse about the pill as a contraceptive choice. What is the nurses best response?

Your current medications will reduce the effectiveness of the pill. Because the liver metabolizes oral contraceptives, their effectiveness is reduced when they are simultaneously taken with anticonvulsants. Stating that the pill is an effective birth control method with side effects is a true statement, but this response is not the most appropriate. The anticonvulsant reduces the effectiveness of the pill, not the other way around. Stating that the pill is a good choice for a woman of her age and personal history does not teach the client that the effectiveness of the pill may be reduced because of her anticonvulsant therapy.

A woman complains of severe abdominal and pelvic pain around the time of menstruation that has gotten worse over the last 5 years. She also complains of pain during intercourse and has tried unsuccessfully to get pregnant for the past 18 months. These symptoms are most likely related to: a. Endometriosis. b. PMS. c. Primary dysmenorrhea. d. Secondary dysmenorrhea.

a. Endometriosis.

As relates to dysfunctional uterine bleeding (DUB), the nurse should be aware that: a. It is most commonly caused by anovulation. b. It most often occurs in middle age. c. The diagnosis of DUB should be the first considered for abnormal menstrual bleeding. d. The most effective medical treatment is steroids.

a. It is most commonly caused by anovulation.

Rho immune globulin will be ordered postpartum if which situation occurs? a. Mother Rh, baby Rh+ b. Mother Rh, baby Rh c. Mother Rh+, baby Rh+ d. Mother Rh+, baby Rh

a. Mother Rh, baby Rh+ An Rh mother delivering an Rh+ baby may develop antibodies to fetal cells that entered her bloodstream when the placenta separated. The Rho immune globulin works to destroy the fetal cells in the maternal circulation before sensitization occurs. If mother and baby are both Rh+ or Rh the blood types are alike, so no antibody formation would be anticipated. If the Rh+ blood of the mother comes in contact with the Rh blood of the infant, no antibodies would develop because the antigens are in the mothers blood, not in the infants.

A 41-week pregnant multigravida presents in the labor and delivery unit after a nonstress test indicated that her fetus could be experiencing some difficulties in utero. Which diagnostic tool would yield more detailed information about the fetus? a. Ultrasound for fetal anomalies b. Biophysical profile (BPP) c. Maternal serum alpha-fetoprotein (MSAFP) screening d. Percutaneous umbilical blood sampling (PUBS)

b. Biophysical profile (BPP)

A patient has undergone an amniocentesis for evaluation of fetal well-being. Which intervention would be included in the nurse's plan of care after the procedure? (Select all that apply.) a. Perform ultrasound to determine fetal positioning. b. Observe the patient for possible uterine contractions. c. Administer RhoGAM to the patient if she is Rh negative. d. Perform a minicatheterization to obtain a urine specimen to assess for bleeding.

b. Observe the patient for possible uterine contractions. c. Administer RhoGAM to the patient if she is Rh negative. Rationale: Ultrasound is used prior to the procedure as a visualization aid to assist with insertion of transabdominal needle. There is no need to assess the urine for bleeding as this is not considered to be a typical presentation or complication.

Risk factors tend to be interrelated and cumulative in their effect. While planning the care for a laboring client with diabetes mellitus, the nurse is aware that she is at a greater risk for: a. Oligohydramnios. b. Polyhydramnios. c. Postterm pregnancy. d. Chromosomal abnormalities.

b. Polyhydramnios.

What information should the nurse understand fully regarding rubella and Rh status? a. Breastfeeding mothers cannot be vaccinated with the live attenuated rubella virus. b. Women should be warned that the rubella vaccination is teratogenic and that they must avoid pregnancy for at least 1 month after vaccination. c. Rh immunoglobulin is safely administered intravenously because it cannot harm a nursing infant. d. Rh immunoglobulin boosts the immune system and thereby enhances the effectiveness of vaccinations.

b. Women should be warned that the rubella vaccination is teratogenic and that they must avoid pregnancy for at least 1 month after vaccination. Women should understand that they must practice contraception for at least 1 month after being vaccinated. Because the live attenuated rubella virus is not communicable in breast milk, breastfeeding mothers can be vaccinated. Rh immunoglobulin is administered intramuscular (IM); it should never be administered to an infant. Rh immunoglobulin suppresses the immune system and therefore might thwart the rubella vaccination.

During her gynecologic checkup, a 17-year-old girl states that recently she has been experiencing cramping and pain during her menstrual periods. The nurse would document this complaint as: a. Amenorrhea. b. Dysmenorrhea. c. Dyspareunia. d. Premenstrual syndrome (PMS).

b. dysmenorrhea

When assessing a patient for amenorrhea, the nurse should be aware that this is unlikely to be caused by: a. Anatomic abnormalities. b. Type 1 diabetes mellitus. c. Lack of exercise. d. Hysterectomy.

c. Lack of exercise

Because a full bladder prevents the uterus from contracting normally, nurses intervene to help the woman spontaneously empty her bladder as soon as possible. If all else fails, what tactic might the nurse use? a. Pouring water from a squeeze bottle over the womans perineum b. Placing oil of peppermint in a bedpan under the woman c. Asking the physician to prescribe analgesic agents d. Inserting a sterile catheter

d. Inserting a sterile catheter Invasive procedures are usually the last to be tried, especially with so many other simple and easy methods available (e.g., water, peppermint vapors, pain pills). Pouring water over the perineum may stimulate voiding. It is easy, noninvasive, and should be tried first. The oil of peppermint releases vapors that may relax the necessary muscles. It, too, is easy, noninvasive, and should be tried early on. If the woman is anticipating pain from voiding, then pain medications may be helpful. Other nonmedical means should be tried first, but medications still come before the insertion of a catheter.

On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. What is the nurses highest priority at this time? a. Beginning an intravenous (IV) infusion of Ringers lactate solution b. Assessing the womans vital signs c. Calling the womans primary health care provider d. Massaging the womans fundus

d. Massaging the womans fundus The nurse should first assess the uterus for atony by massaging the womans fundus. Uterine tone must be established to prevent excessive blood loss. The nurse may begin an IV infusion to restore circulatory volume, but this would not be the first action. Blood pressure is not a reliable indicator of impending shock from impending hemorrhage; assessing vital signs should not be the nurses first action. The physician would be notified after the nurse completes the assessment of the woman.

The nurse recognizes that a nonstress test (NST) in which two or more fetal heart rate (FHR) accelerations of 15 beats/min or more occur with fetal movement in a 20-minute period is: a. Nonreactive b. Positive c. Negative d. Reactive

d. Reactive