Maternity final exam

To teach patients about the process of labor adequately, the nurse knows that which event is the best indicator of true labor?

Cervical dilation and effacement

The baseline fetal heart rate (FHR) is the average rate during a 10-minute segment. Changes in FHR are categorized as periodic or episodic. These patterns include both accelerations and decelerations. The labor nurse is evaluating the patient's most recent 10-minute segment on the monitor strip and notes a late deceleration. This is likely to be caused by which physiologic alteration? (Select all that apply.)

Compression of the fetal head Cord around the baby's neck

A nurse is planning care for a hospitalized toddler in the preoperational thinking stage. Which characteristics should the nurse expect in this stage? (Select all that apply.)

Concrete thinking Egocentrism Animism

A child with cystic fibrosis (CF) receives aerosolized bronchodilator medication. When should this medication be administered?

Before chest physiotherapy (CPT

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?

Biophysical profile (BPP)

An adolescent boy is brought to the ER after a motorcycle accident. His respirations are deep, periodic, and gasping. There are extreme fluctuations in blood pressure. Pupils are dilated and fixed. What type of head injury should the nurse suspect?

Brainstem

The breastfeeding mother should be taught a safe method to remove the breast from the baby's mouth. Which suggestion by the nurse is most appropriate?

Break the suction by inserting your finger into the corner of the infant's mouth

In girls, what is the initial indication of puberty?

Breast development

The nurse observes some children in the playroom. Which play situation exhibits the characteristics of parallel play?

Brian playing with his truck next to Kristina playing with her truck

Which clinical manifestations would suggest hydrocephalus in a neonate?

Bulging fontanel and dilated scalp veins

Which symptom described by a patient is characteristic of premenstrual syndrome (PMS)?

"I feel irritable and moody a week before my period is supposed to start."

A 5 year old sustained a concussion when falling out of a tree. In preparation for discharge, the nurse is discussing home care with the mother. Which statement made by the mother indicates a correct understanding of the teaching?

"I should expect my child to have some difficulty concentrating for a while."

Proximodistal

"Near to far"

You (the nurse) are reviewing the educational packet provided to a patient about tubal ligation. What is an important fact you should point out? (Select all that apply.)

"Sterilization offers no protection against STIs." "It is highly unlikely that you will become pregnant after the procedure."

An unmarried young woman describes her sex life as "active" and involving "many" partners. She wants a contraceptive method that is reliable and does not interfere with sex. She requests an intrauterine device (IUD). The nurse's most appropriate response is:

"The risk of pelvic inflammatory disease (PID) will be higher for you."

Which statement would indicate that the patient requires additional instruction about breast self-examination?

"Yellow discharge from my nipple is normal if I am having my period."

How much folic acid is recommended for women of childbearing age?

0.4 mg

The exact cause of breast cancer remains undetermined. Researchers have found that there are many common risk factors that increase a woman's chance of developing a malignancy. It is essential for the nurse who provides care to women of any age to be aware of which of the following risk factors? (Select all that apply.)

1) Family history 2) Race 3) Nulliparity of first pregnancy after age 30

Signs and symptoms that a woman should report immediately to her health care provider include: (Select all that apply.)

1) heartburn accompanied by severe headache 2) rupture of membranes 3) vaginal bleeding

Along with gas exchange and nutrient transfer, the placenta produces many hormones necessary for normal pregnancy. These include: (Select all that apply.)

1) progesterone 2) human chorionic gonadotropin (hCG) 3) estrogen

Generally what is the earliest age at which puberty begins?

10 years in girls, 12 years in boys.

The nurse should expect the anterior fontanel to close at age:

12-18 months

A woman's obstetric history indicates that she is pregnant for the fourth time and all of her children from previous pregnancies are living. One was born at 39 weeks of gestation, twins were born at 34 weeks of gestation, and another child was born at 35 weeks of gestation. What is her gravidity and parity using the GTPAL system?

4-1-2-0-4

When is the best age for solid food to be introduced into the infant's diet?

4-6 months

Which maternal condition always necessitates delivery by cesarean section?

Total placenta previa

VEAL CHOP

Variable decelerations. Cord compression Early deceleration Head compression Accelerations. Okay Late deceleration Placental insufficiency

Which is the preferred site for intramuscular injections in infants?

Vastus lateralis

Which vitamin supplements are necessary for children with cystic fibrosis?

Vitamins A, D, E, and K

Which term is used to describe breath sounds that are produced as air passes through narrowed passageways?

Wheezes

A nurse is conducting dietary teaching on high-fiber foods for parents of a child with constipation. Which foods should the nurse include as being high in fiber? (Select all that apply.)

Whole grain breads Bran pancakes Raw carrots

As relates to rubella and Rh issues, nurses should be aware that:

Women should be warned that the rubella vaccination is teratogenic, and that they must avoid pregnancy for 1 month after vaccination.

With regard to spinal and epidural (block) anesthesia, the nurse should know that:

a high incidence of after birth headache is seen with spinal blocks

Human chorionic gonadotropin (hCG) is an important biochemical marker for pregnancy and the basis for many tests. A maternity nurse should be aware that:

a higher than normal level of hCG may indicate an ectopic pregnancy or Down syndrome.

The term used to describe legal and professional responsibility for practice for maternity nurses is:

accountability

The process by which people retain some of their own culture while adopting the practices of the dominant society is known as:

acculturation

What type of shock is characterized by a hypersensitivity reaction causing massive vasodilation and capillary leaks, which may occur with drug or latex allergy?

anaphylactic shock

Constipation has recently become a problem for a school-age child who is being treated for seasonal allergies. The nurse should focus the assessment on what possibly related factor?

antihistamines

To prevent gastrointestinal upset, patients should be instructed to take iron supplements:

at bedtime

The head-to-tail direction of growth is referred to as

cephalocaudal

While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the fetal heart rate (FHR) for five sequential contractions begins to decelerate late in the contraction, with the nadir of the decelerations occurring after the peak of the contraction. The nurse's first priority is to

change the woman's position

When providing care for a pregnant woman, the nurse should be aware that one of the most frequently reported maternal medical risk factors is:

diabetes mellitus

When assessing a woman in the first stage of labor, the nurse recognizes that the most conclusive sign that uterine contractions are effective would be:

dilation of the cervix

With regard to systemic analgesics administered during labor, nurses should be aware that:

effects on the fetus and newborn can include decreased alertness and delayed sucking

A child is brought to the emergency department experiencing an anaphylactic reaction to a bee sting. While an airway is being established, what medication should the nurse prepare for immediate administration?

epinephrine

During a health history interview, a woman states that she thinks that she has "bumps" on her labia. She also states that she is not sure how to check herself. The correct response would be to:

explain the process of vulvar self-examination to the woman and reassure her that she should become familiar with normal and abnormal findings during the examination.

The nurse teaches a pregnant woman about the presumptive, probable, and positive signs of pregnancy. The woman demonstrates understanding of the nurse's instructions if she states that a positive sign of pregnancy is:

fetal movement palpated by the nurse mid-wife

Women with hyperemesis gravidarum:

have vomiting severe and persistent enough to cause weight loss, dehydration, and electrolyte imbalance.

When providing care to the prenatal patient, the nurse understands that pica is defined as:

ingestion of nonfood substances

When planning care for a laboring woman whose membranes have ruptured, the nurse recognizes that the woman's risk for ______________________ has increased.

intrauterine infection

On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. The nurse's first action is to:

massage the woman's fundus

What are the earliest recognizable clinical manifestations of cystic fibrosis (CF)?

meconium ileus

Which drug is usually the best choice for patient-controlled analgesia (PCA) for a child in the immediate postoperative period?

morphine

The nurse is doing a routine assessment on a 14-month-old infant and notes that the anterior fontanel is closed. This should be interpreted as:

normal finding

A woman has chosen the calendar method of conception control. During the assessment process, it is most important that the nurse:

obtain a history of menstrual cycle lengths for the past 6 months.

Where is the best place to observe for the presence of petechiae in dark-skinned individuals?

oral mucosa

Play serves many purposes. In teaching parents about appropriate activities, the nurse should inform them that play serves the following function: (Select all that apply.)

physical development; self-awareness

When evaluating a patient whose primary complaint is amenorrhea, the nurse must be aware that lack of menstruation is most often the result of:

pregnancy

The hormone responsible for maturation of mammary gland tissue is:

progesterone

A new mother asks the nurse about the "white substance" covering her infant. The nurse explains that the purpose of vernix caseosa is to:

protect the fetal skin from amniotic fluid.

The nerve block used in labor that provides anesthesia to the lower vagina and perineum is Called:

pudendal

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:

reactive

Anaphylaxis

results in distributive shock from extreme allergy or hypersensitivity to a foreign substance.

Post birth uterine/vaginal discharge, called lochia:

should smell like normal menstrual flow unless an infection is present.

What term is used to identify the condition in which the normal adult hemoglobin is partly or completely replaced by abnormal hemoglobin?

sickle cell anemia

The nurse caring for a pregnant patient knows that her health teaching regarding fetal circulation has been effective when the patient reports that she has been sleeping:

side lying position

The nurse expects to administer an oxytocic (e.g. Pitocin, Methergine) to a woman after expulsion of her placenta to:

stimulate uterine contraction

The patient's family is important to the maternity nurse because:

the family culture and structure will influence nursing care and decisions

The nurse is talking with the parents of a child who died 6 months ago. They sometimes still "hear" the child's voice and have trouble sleeping. They describe feeling "empty" and depressed. The nurse should recognize that:

these are normal grief responses.

The nurse understands that hypospadias refers to what urinary anomaly?

urethral opening along ventral surface of penis

The nurse caring for a woman in labor should understand that maternal hypotension can result in:

uteroplacental insufficiency

In providing nourishment for a child with cystic fibrosis (CF), what diet consideration should be stressed to both the child and caregivers?

Diet should be high in carbohydrates and protein.

A newborn assessment shows separated sagittal suture, oblique palpebral fissures, depressed nasal bridge, protruding tongue, and transverse palmar creases. These findings are most suggestive of:

Down syndrome

Clinical manifestations of increased intracranial pressure (ICP) in infants are: select all that apply

Drowsiness Irritability Distended scalp veins

The nurse is teaching the parents of a 7 year old child who has just had a cast applied for a fractured arm with the wrist and elbow immobilized. Which instructions should be included in the teaching?

Elevate casted arm when resting and when sitting up.

The nurse is caring for a 10-month-old infant diagnosed with respiratory syncytial virus (RSV) bronchiolitis. Which interventions should be included in the child's care? (Select all that apply.)

Encourage infant to drink 8 ounces of formula every 4 hours Institute cluster care to encourage adequate rest Place on noninvasive oxygen monitoring

At the time of a child's death, the nurse tells his mother, "We will miss him so much." What does this statement indicate about the nurse?

Expressing personal feelings of loss.

A 2-year-old child has been returned to the nursing unit after an inguinal hernia repair. Which pain assessment tool should the nurse use to assess this child for the presence of pain?

FLACC tool

A current recommendation to prevent neural tube defects is the administration of what supplement?

Folic acid for all women of childbearing age

Which information should the nurse stress to workers at a day care center about respiratory syncytial virus (RSV)?

Frequent hand washing can decrease the spread of the virus.

When a woman is diagnosed with postpartum depression (PPD) with psychotic features, one of the main concerns is that she may:

Harm her infant

A woman with asthma is experiencing a after birth hemorrhage. Which drug would not be used to treat her bleeding because it may exacerbate her asthma?

Hemabate

A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Nursing care is based on the knowledge that:

Hemorrhage is the major concern.

Which statement expresses accurately the genetic implications of cystic fibrosis (CF)?

If it is present in a child, both parents are carriers of this defective gene.

Which statement most accurately describes the pathologic changes of sickle cell anemia?

Increased red blood cell destruction occurs.

An Apgar score of 10 at 1 minute after birth would indicate a(n):

Infant having no difficulty adjusting to extrauterine life but who should be assessed again at 5 minutes after birth.

Iron dextran is ordered for a young child with severe iron deficiency anemia. What nursing consideration should be considered?

Injecting deeply into a large muscle

What is the initial method of treating osteomyelitis?

Intravenous antibiotic therapy

What intervention should the nurse share with parents on how to prevent iron deficiency anemia in a healthy, term, breastfed infant?

Iron-fortified infant cereal can be introduced at approximately 6 months of age.

A first-time mother at 18 weeks of gestation comes for her regularly scheduled prenatal visit. The patient tells the nurse that she is afraid that she is going into premature labor because she is beginning to have regular contractions. The nurse explains that this is the Braxton Hicks sign and teaches the patient that this type of contraction:

Is painless.

What distinguishing manifestation of spasmodic croup should parents be taught to identify?

It has a harsh, barky cough

Which statement is most descriptive of a concussion?

It is a transient, reversible neuronal dysfunction.

Which fetal heart rate (FHR) finding would concern the nurse during labor?

Late decelerations

A woman gave birth to a healthy infant boy 5 days ago. What type of lochia would the nurse expect to find when assessing this woman?

Lochia serosa

Which drug would be used to treat a child who has increased intracranial pressure (ICP) resulting from cerebral edema?

Mannitol

A child diagnosed with cystic fibrosis is prescribed recombinant human deoxyribonuclease (rhDNase). What information should be included in the medication education provided the child and family?

May cause minor voice alterations

The nurse is performing an assessment on a child and notes the presence of Koplik's spots. In which communicable disease are Koplik's spots present?

Measles (rubeola)

Which statement best explains why iron deficiency anemia is common during toddlerhood?

Milk is a poor source of iron.

A woman in labor has just received an epidural block. The most important nursing intervention is to:

Monitor the maternal blood pressure for possible hypotension

Rh immune globulin will be ordered after birth if which situation occurs?

Mother Rh-, baby Rh+

A laboring woman received an opioid agonist (meperidine) intravenously 90 minutes before she gave birth. Which medication should be available to reduce the postnatal effects of Demerol on the neonate?

Naloxone (Narcan)

The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic analgesics causing addiction. The nurse should provide what explanation in response to the parent's concern?

Narcotics rarely cause addiction when they are medically indicated.

An infant diagnosed with hydrocephalus is hospitalized for surgical placement of a ventriculoperitoneal shunt. Which interventions should be included in the child's postoperative care? (Select all that apply.)

Observe closely for signs of infection Maintain an accurate record of intake and output Monitor for abdominal distention

The nurse knows that proper placement of the tocotransducer for electronic fetal monitoring is located:

Over the uterine fundus

The two primary functions of the ovaries are:

Ovulation and hormone production.

Which clinical manifestation should the nurse expect when a child diagnosed with sickle cell anemia experiences an acute vaso-occlusive crisis?

Painful swelling of hands and feet, painful joints

Pancreatic enzymes are administered to the child with cystic fibrosis. What information should be included in patient education concerning the administration of these enzymes?

Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal.

Medications used to manage postpartum hemorrhage (PPH) include: (select all that apply)

Pitocin Terbutaline

Which assessment is least likely to be associated with a breech presentation?

Post-term gestation

Which statement best describes Tanner staging?

Predictable stages of puberty that are based on primary and secondary sexual characteristics

The goal of treatment of the infant with phenylketonuria (PKU) is to:

Prevent central nervous system (CNS) damage, which leads to mental retardation.

Which factor is known to increase the risk of gestational diabetes mellitus?

Previous birth of large infant

A 2-year-old child comes to the emergency department demonstrating signs of dehydration and hypovolemic shock. Which best explains why an intraosseous infusion is started?

Rapid venous access is not possible.

Which common childhood communicable disease may cause severe defects in the fetus when it occurs in its congenital form?

Rubella

Induction of labor is considered an acceptable obstetric procedure if it is in the best interest to deliver the fetus. The charge nurse in the labor and delivery unit is often asked to schedule patients for this procedure and therefore must be cognizant of the specific conditions appropriate for labor induction. These include: (Select all that apply.)

Rupture of membranes at or near term. Chorioamnionitis inflammation of the amniotic sac Post-term pregnancy. Fetal death.

The nurse is caring for a preschool child with a cast applied recently for a fractured tibia. Which assessment findings indicate possible compartment syndrome? (Select all that apply.)

Severe pain not relieved by analgesics Tingling of extremity Inability to move extremity

Which type of croup is always considered a medical emergency?

Spasmodic croup

When caring for a child with probable appendicitis, the nurse should be alert to recognize what sign of perforation?

Sudden relief from pain

Pain should be assessed regularly in all newborn infants. If the infant is displaying physiologic or behavioral cues indicating pain, measures should be taken to manage the pain. Examples of nonpharmacologic pain management techniques include: (Select all that apply.)

Swaddling nonnutritive sucking skin-to-skin contact with the mother

Cystic fibrosis (CF) is suspected in a toddler. Which test is essential in establishing this diagnosis?

Sweat chloride test

What finding indicates that preterm labor is occurring?

The cervix is effacing and dilated to 2 cm

The best reason for recommending formula over breastfeeding is that:

The mother has a medical condition or is taking drugs that could be passed along to the infant via breast milk.

Which factor is most important in predisposing toddlers to frequent infections such as otitis media, tonsillitis, and upper respiratory tract infections?

The presence of short, straight internal ear/throat structures and large tonsil/adenoid lymph tissue.

Which nursing assessment indicates that a woman who is in second-stage labor is almost ready to give birth?

The vulva bulges and encircles the fetal head.

The nurse knows that the second stage of labor, the descent phase, has begun when:

The woman experiences a strong urge to bear down.

The mother of a school-age child tells the school nurse that she and her spouse are going through a divorce. The child has not been doing well in school and sometimes has trouble sleeping. The nurse should recognize this as:

A common reaction to divorce

During labor a fetus with an average heart rate of 135 beats/min over a 10-minute period would be considered to have:

A normal baseline heart rate.

Which best describes how preschoolers react to the death of a loved one?

A preschooler is likely to feel guilty and responsible for the death.

An infant boy was born just a few minutes ago. The nurse is conducting the initial assessment. Part of the assessment includes the Apgar score. The Apgar assessment is performed:

At least twice, 1 minute and 5 minutes after birth

Which clinical manifestation would most suggest acute appendicitis?

Abdominal pain that is most intense at McBurney's point

The nurse is caring for a child receiving intravenous (IV) morphine for severe postoperative pain. The nurse observes a slower respiratory rate, and the child cannot be aroused. The most appropriate management of this child is for the nurse to:

Administer naloxone (Narcan).

The nurse is monitoring an infant for signs of increased intracranial pressure (ICP). Which are late signs of increased ICP in an infant? Select all that apply

Alteration in pupil size and reactivity Extension or flexion posturing Cheyne-Stokes respirations

A young child has just injured an ankle at school. In addition to calling the child's parents, what is the most appropriate immediate action by the school nurse?

Apply ice

Which interaction is part of the discharge plan for a school-age child with osteomyelitis who is receiving home antibiotic therapy?

Arrangements for tutoring and schoolwork

When infants are seen for fractures, which nursing intervention is a priority?

Assess for child abuse. Fractures in infants are often nonaccidental.

The nurse is admitting a school-age child with suspected Guillain-Barré syndrome (GBS). Which nursing intervention is a priority in the care for this child?

Assessing respiratory efforts