NUR 353 Exam 1: Reproductive Questions

Which of the following fetal positions is most favorable for birth? A. Vertex presentation B. Transverse lie C. Frank breech presentation D. Posterior position of the fetal head

A (Vertex presentation (flexion of the fetal head) is the optimal presentation for passage through the birth canal. Transverse lie is an unacceptable fetal position for vaginal birth and requires a C-section. Frank breech presentation, in which the buttocks present first, can be a difficult vaginal delivery. Posterior positioning of the fetal head can make it difficult for the fetal head to pass under the maternal symphysis pubis)

A woman who has completed one pregnancy with a fetus (or fetuses) reaching the stage of fetal viability is called a: a. primipara. b. primigravida. c. multipara. d. nulligravida.

A (A primipara is a woman who has completed one pregnancy with a viable fetus. To remember terms, keep in mind that gravida is a pregnant woman; para comes from parity, meaning a viable fetus; primi means first; multi means many; and null means none. A primigravida is a woman pregnant for the first time. A multipara is a woman who has completed two or more pregnancies with a viable fetus. A nulligravida is a woman who has never been pregnant.)

A nurse is caring for a client who is in the second stage of labor. The client's labor has been progressing, and she is expected to deliver vaginally in 20 minutes. The provider is preparing to administer lidocaine for pain relief and perform an episiotomy. The nurse should know that which of the following types of regional anesthetic block is to be administered? a. Pudendal b. Epidural c. Spinal d. Paracervical

A (A pudendal block is a transvaginal infection of local anesthetic that anesthetizes the perineal area for the episiotomy and repair, and the expulsion of the fetus.)

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

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

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

A (At approximately 6 weeks of gestation, softening and compressibility of the lower uterine segment occur; this is called the Hegar sign. The McDonald sign indicates a fast-food restaurant. The Chadwick sign is a blue-violet cervix caused by increased vascularity; this occurs around the fourth week of gestation. Softening of the cervical tip is called the Goodell sign, which may be observed around the sixth week of pregnancy.)

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

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

The breathing technique that the mother should be instructed to use as the fetus' head is crowning is: A. Blowing B. Slow chest C. Shallow D. Accelerated-decelerated

A (Blowing forcefully through the mouth controls the strong urge to push and allows for a more controlled birth of the head.)

A nursing instructor is conducting lecture and is reviewing the functions of the female reproductive system. She asks Mark to describe the follicle-stimulating hormone (FSH) and the luteinizing hormone (LH). Mark accurately responds by stating that: a. FSH and LH are released from the anterior pituitary gland. b. FSH and LH are secreted by the corpus luteum of the ovary c. FSH and LH are secreted by the adrenal glands d. FSH and LH stimulate the formation of milk during pregnancy.

A (FSH and LH, when stimulated by gonadotropin-releasing hormone from the hypothalamus, are released from the anterior pituitary gland to stimulate follicular growth and development, growth of the graafian follicle, and production of progesterone.)

A nurse is reviewing the record of a client who has just been told that a pregnancy test is positive. The physician has documented the presence of a Goodell's sign. The nurse determines this sign indicates: A. softening of the cervix B. A soft blowing sound that corresponds to the maternal pulse during auscultation of the uterus. C. The presence of hCG in the urine D. The presence of fetal movement

A (In the early weeks of pregnancy the cervix becomes softer as a result of increased vascularity and hyperplasia, which causes the Goodell's sign.)

A pregnant client calls the clinic and tells a nurse that she is experiencing leg cramps and is awakened by the cramps at night. To provide relief from the leg cramps, the nurse tells the client to: A. Dorsiflex the foot while extending the knee when the cramps occur B. Dorsiflex the foot while flexing the knee when the cramps occur C. Plantar flex the foot while flexing the knee when the cramps occur D. Plantar flex the foot while extending the knee when the cramps occur.

A (Legs cramps occur when the pregnant woman stretches the leg and plantar flexes the foot. Dorsiflexion of the foot while extending the knee stretches the affected muscle, prevents the muscle from contracting, and stops the cramping.)

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

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

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

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

The nurse should tell a primigravida that the definitive sign indicating that labor has begun would be: a. progressive uterine contractions with cervical change. b. lightening. c. rupture of membranes. d. passage of the mucous plug (operculum).

A (Regular, progressive uterine contractions that increase in intensity and frequency are the definitive sign of true labor along with cervical change. Lightening is a premonitory sign indicating that the onset of labor is getting closer. Rupture of membranes usually occurs during labor itself. Passage of the mucous plug is a premonitory sign indicating that the onset of labor is getting closer)

Nurses should be aware of the difference experience can make in labor pain, such as: a. sensory pain for nulliparous women often is greater than for multiparous women during early labor. b. affective pain for nulliparous women usually is less than for multiparous women throughout the first stage of labor. c. women with a history of substance abuse experience more pain during labor. d. multiparous women have more fatigue from labor and therefore experience more pain.

A (Sensory pain is greater for nulliparous women because their reproductive tract structures are less supple. Affective pain is greater for nulliparous women during the first stage but decreases for both nulliparous and multiparous during the second stage. Women with a history of substance abuse experience the same amount of pain as those without such a history. Nulliparous women have longer labors and therefore experience more fatigue.)

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

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

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

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

During a prenatal examination, the nurse draws blood from a young Rh negative client and explain that an indirect Coombs test will be performed to predict whether the fetus is at risk for: A. Acute hemolytic disease B. Respiratory distress syndrome C. Protein metabolic deficiency D. Physiologic hyperbilirubinemia

A (When an Rh negative mother carries an Rh positive fetus there is a risk for maternal antibodies against Rh positive blood; antibodies cross the placenta and destroy the fetal RBC's.)

A nurse in the labor room is performing a vaginal assessment on a pregnant client in labor. The nurse notes the presence of the umbilical cord protruding from the vagina. Which of the following would be the initial nursing action? A. Place the client in Trendelenburg's position B. Call the delivery room to notify the staff that the client will be transported immediately C. Gently push the cord into the vagina D. Find the closest telephone and stat page the physician

A (When cord prolapse occurs, prompt actions are taken to relieve cord compression and increase fetal oxygenation. The mother should be positioned with the hips higher than the head to shift the fetal presenting part toward the diaphragm. The nurse should push the call light to summon help, and other staff members should call the physician and notify the delivery room. No attempt should be made to replace the cord. The examiner, however, may place a gloved hand into the vagina and hold the presenting part off of the umbilical cord. Oxygen at 8 to 10 L/min by face mask is delivered to the mother to increase fetal oxygenation)

Nurses can advise their patients that which of these signs precede labor? (Select all that apply.) a. A return of urinary frequency as a result of increased bladder pressure b. Persistent low backache from relaxed pelvic joints c. Stronger and more frequent uterine (Braxton Hicks) contractions d. A decline in energy, as the body stores up for labor e. Uterus sinks downward and forward in first-time pregnancies.

A B C (After lightening a return of the frequent need to urinate occurs as the fetal position causes increased pressure on the bladder. In the run-up to labor, women often experience persistent low backache and sacroiliac distress as a result of relaxation of the pelvic joints. Before the onset of labor, it is common for Braxton Hicks contractions to increase in both frequency and strength. Bloody show may be passed. A surge of energy is a phenomenon that is common in the days preceding labor. In first-time pregnancies, the uterus sinks downward and forward about 2 weeks before term.)

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

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

A nurse is caring for a client who is at 40 weeks gestation and experiencing contractions every 3 to 5 minutes and becoming stronger. A vaginal exam reveals that the client's cervix is 3 cm dilated, 80% effaced and -1 station. The client asks for pain medication. Which of the following actions should the nurse take? (Select all that apply.) a. Encourage use of patterned breathing techniques. b. Insert an indwelling catheter. c. Administer opioid analgesic medication. d. Suggest application of cold. e. Provide ice chips.

A C D (The use of patterned breathing techniques can assist with pain management at this time. There is no indication for the insertion of an indwelling urinary catheter at this time. An opioid analgesic can be safely administered at this time. The use of a non pharmacological approach, such as the application of cold, is an appropriate intervention at this time. Providing ice chips does not address the client's request for assistance with pain management.)

A nurse is caring for a client in the third stage of labor. Which of the following findings indicate placental separation? (Select all that apply.) a. Lengthening of the umbilical cord b. Swift gush of clear amniotic fluid c. Softening of the lower uterine segment d. Appearance of dark blood from the vagina e. Fundus firm upon palpation

A D E

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

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

A nurse is assisting in performing an assessment on a client who suspects that she is pregnant and is checking the client for probable signs of pregnancy. Select all probable signs of pregnancy. A. Uterine enlargement B. Fetal heart rate detected by nonelectric device C. Outline of the fetus via radiography or ultrasound D. Chadwick's sign E. Braxton Hicks contractions F. Ballottement

A D E F (The probable signs of pregnancy include: >Uterine Enlargement >Hegar's sign or softening and thinning of the uterine segment that occurs at week 6. >Goodell's sign or softening of the cervix that occurs at the beginning of the 2nd month >Chadwick's sign or bluish coloration of the mucous membranes of the cervix, vagina and vulva. Occurs at week 6. >Ballottement or rebounding of the fetus against the examiner's fingers of palpation >Braxton-Hicks contractions Positive pregnancy test measuring for hCG. >Positive signs of pregnancy include: >Fetal Heart Rate detected by electronic device (doppler) at 10-12 weeks >Fetal Heart rate detected by nonelectronic device (fetoscope) at 20 weeks AOG >Active fetal movement palpable by the examiners >Outline of the fetus via radiography or ultrasound)

The maternity nurse should notify the health care provider about which assessment findings during labor? (Select all that apply.) a. Positive urine drug screen b. Blood glucose level of 78 mg/dL c. Increased systolic blood pressure during first stage d. Elevated white blood cell count e. Oral temperature of 99.8° F f. Respiratory rate of 10 breaths/min

A F (The health care provider should be alerted to a positive urine drug screen, because certain drugs will have an effect on pain medications that can be safely administered. The respiratory rate usually increases during labor. A rate of 10 is low and needs to be reported. Decreased blood glucose levels (due to exertion and glucose consumption for energy), and increased systolic blood pressure, elevated white blood cell count (due to stress response), and a slightly elevated temperature (up to 100.4° F) are expected findings during labor.)

A nurse is describing the process of fetal circulation to a client during a prenatal visit. The nurse accurately tells the client that fetal circulation consists of: A. Two umbilical veins and one umbilical artery B. Two umbilical arteries and one umbilical vein C. Arteries carrying oxygenated blood to the fetus D. Veins carrying deoxygenated blood to the fetus

B (Blood pumped by the embryo's heart leaves the embryo through two umbilical arteries. Once oxygenated, the blood then is returned by one umbilical vein. Arteries carry deoxygenated blood and waste products from the fetus, and veins carry oxygenated blood and provide oxygen and nutrients to the fetus.)

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

B (A positive pregnancy test is a probable sign of pregnancy. Positive signs of pregnancy are those that are attributed to the presence of a fetus, such as hearing the fetal heartbeat or palpating fetal movement. Braxton Hicks contractions are a probable sign of pregnancy. Quickening is a presumptive sign of pregnancy.)

Concerning the third stage of labor, nurses should be aware that: a. the placenta eventually detaches itself from a flaccid uterus b. the duration of the third stage may be as short as 3 to 5 minutes c. it is important that the dark, roughened maternal surface of the placenta appear before the shiny fetal surface d. the major risk for women during the third stage is a rapid heart rate

B (A. The placenta cannot detach itself from a flaccid (relaxed) uterus. B. The third stage of labor lasts from birth of the fetus until the placenta is delivered. The duration may be as short as 3 to 5 minutes, although up to 1 hour is considered within normal limits. C. Which surface of the placenta comes out first is not clinically important. D. The major risk for women during the third stage of labor is postpartum hemorrhage. The risk of hemorrhage increases as the length of the third stage increases.)

At a prenatal visit at 36 weeks' gestation, a client complains of discomfort with irregularly occurring contractions. The nurse instructs the client to: A. Lie down until they stop B. Walk around until they subside C. Time contraction for 30 minutes D. Take 10 grains of aspirin for the discomfort

B (Ambulation relieves Braxton Hicks.)

Which presumptive signs (felt by the woman) or probable sign (observed by the examiner) of pregnancy is not matched with another possible cause? a. Amenorrhea: stress, endocrine problems b. Quickening: gas, peristalsis c. Goodell sign: cervical polyps d. Chadwick sign: pelvic congestion

C (Amenorrhea sometimes can be caused by stress, vigorous exercise, early menopause, or endocrine problems. Quickening can be gas or peristalsis. Goodell sign might be the result of pelvic congestion, not polyps. Chadwick sign might be the result of pelvic congestion.)

A nurse explains the purpose of effleurage to a client in early labor. The nurse tells the client that effleurage is: A. A form of biofeedback to enhance bearing down efforts during delivery B. Light stroking of the abdomen to facilitate relaxation during labor and provide tactile stimulation to the fetus C. The application of pressure to the sacrum to relieve a backache D. Performed to stimulate uterine activity by contracting a specific muscle group while other parts of the body rest

B (Effleurage is a specific type of cutaneous stimulation involving light stroking of the abdomen and is used before transition to promote relaxation and relieve mild to moderate pain. Effleurage provides tactile stimulation to the fetus.)

A nurse is caring for a client who is in active labor. The client reports lower-back pain. The nurse suspects that this pain is related to a persistent occiput posterior fetal position. Which of the following non pharmacological nursing interventions should the nurse recommend to the client? a. Abdominal effleurage b. Sacral counterpressure c. Showering if not contraindicated c. Back rub ad massage

B (Sacral counterperssure to the lower back relieves the pressure exerted on the pelvis and spinal nerves by the fetus. Abdominal effleurage is an appropriate pain management technique but does not address the pressure on the pelvis due to the fetal position. A shower is an appropriate pain management strategy but does not address the pressure on the pelvis due to the fetal position. A back rub with massage is an appropriate pain management strategy but does not address the pressure on the pelvis due to the fetal position.)

With regard to systemic analgesics administered during labor, nurses should be aware that: a. systemic analgesics cross the maternal blood-brain barrier as easily as they do the fetal blood-brain barrier. b. effects on the fetus and newborn can include decreased alertness and delayed sucking. c. IM administration is preferred over IV administration. d. IV patient-controlled analgesia (PCA) results in increased use of an analgesic.

B (Systemic analgesics cross the fetal blood-brain barrier more readily than the maternal blood-brain barrier. Effects depend on the specific drug given, the dosage, and the timing. IV administration is preferred over IM administration because the drug acts faster and more predictably. PCAs result in decreased use of an analgesic.)

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

B (The expected FHR is 120 to 160 beats/min. The nurse may have inadvertently counted the uterine souffle, the beatlike sound of blood flowing through the uterine blood vessels, which corresponds to the mother's heartbeat. The physician should be notified if the FHR is confirmed to be 82 beats/min. Allow the woman to hear the heart beat as soon as a full assessment is made.)

A client experiences a large gush of fluid from her vagina while walking in the hallway of the birthing unit. Which of the following actions should the nurse take first? a. Check the amniotic fluid for meconium. b. Monitor FHR for distress. c. Dry the client and make her comfortable. d. Monitor uterine contractions.

B (The greatest risk to the client and fetus is umbilical cord prolapse, leading to fetal distress following rupture of membranes. The first action by the nurse is to monitor the FHR for clinical findings of distress. A is something the nurse should assess for, but this is not the first action the nurse should take. The nurse should provide comfort by drying the client following rupture of the membranes, but this is not the first action the nurse should take. The nurse monitors the client's uterine contraction pattern after rupture of the membranes, but this is not the first action the nurse should take.)

When involved in prenatal teaching, the nurse should advise the clients that an increase in vaginal secretions during pregnancy is called leukorrhea and is caused by increased: A. Metabolic rates B. Production of estrogen C. Functioning of the Bartholin glands D. Supply of sodium chloride to the cells of the vagina

B (The increase of estrogen during pregnancy causes hyperplasia of the vaginal mucosa, which leads to increased production of mucus by the endocervical glands. The mucus contains exfoliated epithelial cells.)

Nurses can help their clients by keeping them informed about the distinctive stages of labor. What description of the phases of the first stage of labor is accurate? a. Latent: mild, regular contractions; no dilation; bloody show; duration of 2 to 4 hours b. Active: moderate, regular contractions; 4 to 7 cm dilation; duration of 3 to 6 hours c. Lull: no contractions; dilation stable; duration of 20 to 60 minutes d. Transition: very strong but irregular contractions; 8 to 10 cm dilation; duration of 1 to 2 hours

B (The latent phase is characterized by mild to moderate, irregular contractions; dilation up to 3 cm; brownish to pale pink mucus; and a duration of 6 to 8 hours. The active phase is characterized by moderate, regular contractions; 4 to 7 cm dilation; and a duration of 3 to 6 hours. No official "lull" phase exists in the first stage. The transition phase is characterized by strong to very strong, regular contractions; 8 to 10 cm dilation; and a duration of 20 to 40 minutes.)

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

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

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

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

A 26-year old multigravida is 14 weeks' pregnant and is scheduled for an alpha-fetoprotein test. She asks the nurse, "What does the alpha-fetoprotein test indicate?" The nurse bases a response on the knowledge that this test can detect: A. Kidney defects B. Cardiac defects C. Neural tube defects D. Urinary tract defects

C

A client arrives at a prenatal clinic for the first prenatal assessment. The client tells a nurse that the first day of her last menstrual period was September 19th, 2013. Using Naegele's rule, the nurse determines the estimated date of confinement as: A. July 26, 2013 B. June 12, 2014 C. June 26, 2014 D. July 12, 2014

C

A pregnant client is making her first Antepartum visit. She has a two year old son born at 40 weeks, a 5 year old daughter born at 38 weeks, and 7 year old twin daughters born at 35 weeks. She had a spontaneous abortion 3 years ago at 10 weeks. Using the GTPAL format, the nurse should identify that the client is: A. G4 T3 P2 A1 L4 B. G5 T2 P2 A1 L4 C. G5 T2 P1 A1 L4 D. G4 T3 P1 A1 L4

C (5 pregnancies; 2 term births; twins count as 1; one abortion; 4 living children.)

A client who is gravida 1, para 0 is admitted in labor. Her cervix is 100% effaced, and she is dilated to 3 cm. Her fetus is at +1 station. The nurse is aware that the fetus' head is: A. Not yet engaged B. Entering the pelvic inlet C. Below the ischial spines D. Visible at the vaginal opening

C (A station of +1 indicates that the fetal head is 1 cm below the ischial spines.)

Which position would the nurse suggest for second-stage labor if the pelvic outlet needs to be increased? a. Semirecumbent b. Sitting c. Squatting d. Side-lying

C (A. A semirecumbent position does not assist in increasing the size of the pelvic outlet. B. Although sitting may assist with fetal descent, this position does not increase the size of the pelvic outlet. C. Kneeling or squatting moves the uterus forward and aligns the fetus with the pelvic inlet; this can facilitate the second stage of labor by increasing the pelvic outlet. D. A side-lying position is unlikely to assist in increasing the size of the pelvic outlet.)

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

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

A woman is in the second stage of labor and has a spinal block in place for pain management. The nurse obtains the woman's blood pressure and notes that it is 20% lower than the baseline level. Which action should the nurse take? a. Encourage her to empty her bladder. b. Decrease her intravenous (IV) rate to a keep vein-open rate. c. Turn the woman to the left lateral position or place a pillow under her hip. d. No action is necessary since a decrease in the woman's blood pressure is expected.

C (Encouraging the woman to empty her bladder will not help the hypotensive state and may cause her to faint if she ambulates to the bathroom. The IV rate should be kept at the current rate or increased to maintain the appropriate perfusion. Turning the woman to her left side is the best action to take in this situation since this will increase placental perfusion to the infant while waiting for the doctor's or nurse midwife's instruction. Hypotension indicated by a 20% drop from preblock level is an emergency situation and action must be taken.)

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

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

With regard to what might be called the tactile approaches to comfort management, nurses should be aware that: a. either hot or cold applications may provide relief, but they should never be used together in the same treatment. b. acupuncture can be performed by a skilled nurse with just a little training. c. hand and foot massage may be especially relaxing in advanced labor when a woman's tolerance for touch is limited. d. therapeutic touch (TT) uses handheld electronic stimulators that produce sympathetic vibrations.

C (Heat and cold may be applied in an alternating fashion for greater effect. Unlike acupressure, acupuncture, which involves the insertion of thin needles, should be done only by a certified therapist. The woman and her partner should experiment with massage before labor to see what might work best. Therapeutic touch is a laying-on of hands technique that claims to redirect energy fields in the body.)

A nurse is caring for a client following the administration of an epidural block and is preparing to administer an IV fluid bolus. The client's partner asks about the purpose of the IV fluids. Which of the following is an appropriate response for the nurse to make? a. "It is needed to promote increase urine output." b. "It is needed to counteract respiratory depression." c. "It is needed to counteract hypotension." d. "It is needed to prevent oligohydramnios."

C (Maternal hypotension can occur following an epidural block and can be offset by administering an IV fluid bolus. O2 is administered to counteract respiratory depression that can occur following an epidural block. )

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

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

The chief function of progesterone is the: A. Development of the female reproductive system B. Stimulation of the follicles for ovulation to occur C. Preparation of the uterus to receive a fertilized egg D. Establishment of secondary male sex characteristics

C (Progesterone stimulates differentiation of the endometrium into a secretory type of tissue.)

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

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

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

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

The nurse knows that the second stage of labor, the descent phase, has begun when: a. the amniotic membranes rupture. b. the cervix cannot be felt during a vaginal examination. c. the woman experiences a strong urge to bear down. d. the presenting part is below the ischial spines.

C (Rupture of membranes has no significance in determining the stage of labor. The second stage of labor begins with full cervical dilation. During the descent phase of the second stage of labor, the woman may experience an increase in the urge to bear down. Many women may have an urge to bear down when the presenting part is below the level of the ischial spines. This can occur during the first stage of labor, as early as 5 cm of dilation.)

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

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

The nurse recognizes that an expected change in the hematologic system that occurs during the 2nd trimester of pregnancy is: A. A decrease in WBC's B. In increase in hematocrit C. An increase in blood volume D. A decrease in sedimentation rate

C (The blood volume increases by approximately 40-50% during pregnancy. The peak blood volume occurs between 30 and 34 weeks of gestation. The hematocrit decreases as a result of the increased blood volume.)

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

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

The nurse is aware than an adaptation of pregnancy is an increased blood supply to the pelvic region that results in a purplish discoloration of the vaginal mucosa, which is known as: A. Ladin's sign B. Hegar's sign C. Goodell's sign D. Chadwick's sign

D (A purplish color results from the increased vascularity and blood vessel engorgement of the vagina.)

A nurse midwife is performing an assessment of a pregnant client and is assessing the client for the presence of ballottement. Which of the following would the nurse implement to test for the presence of ballottement? A. Auscultating for fetal heart sounds B. Palpating the abdomen for fetal movement C. Assessing the cervix for thinning D. Initiating a gentle upward tap on the cervix

D (Ballottement is a technique of palpating a floating structure by bouncing it gently and feeling it rebound. In the technique used to palpate the fetus, the examiner places a finger in the vagina and taps gently upward, causing the fetus to rise. The fetus then sinks, and the examiner feels a gentle tap on the finger.)

In order to accurately assess the health of the mother accurately during labor, the nurse should be aware that: a. the woman's blood pressure increases during contractions and falls back to prelabor normal between contractions. b. use of the Valsalva maneuver is encouraged during the second stage of labor to relieve fetal hypoxia. c. having the woman point her toes reduces leg cramps. d. the endogenous endorphins released during labor raise the woman's pain threshold and produce sedation.

D (Blood pressure increases during contractions but remains somewhat elevated between them. Use of the Valsalva maneuver is discouraged during second stage labor because of a number of potentially unhealthy outcomes, including fetal hypoxia. Pointing the toes can cause leg cramps, as can the process of labor itself. D. In addition, physiologic anesthesia of the perineal tissues, caused by the pressure of the presenting part, decreases the mother's perception of pain.)

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

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

If exhibited by a pregnant woman, what represents a positive sign of pregnancy? a. Morning sickness b. Quickening c. Positive pregnancy test d. Fetal heartbeat auscultated with Doppler/fetoscope

D (Morning sickness and quickening, along with amenorrhea and breast tenderness, are presumptive signs of pregnancy; subjective findings are suggestive but not diagnostic of pregnancy. Other probable signs include changes in integument, enlargement of the uterus, and Chadwick sign. A positive pregnancy test is still considered to be a probable sign of pregnancy (objective findings are more suggestive but not yet diagnostic of pregnancy) since error can occur in performing the test or in rare cases human chorionic gonadotropin (hCG) may be detected in the urine of nonpregnant women. Chances of error are less likely to occur today since pregnancy tests used are easy to perform and are very sensitive to the presence of the hCG associated with pregnancy. Detection of a fetal heartbeat, palpation of fetal movements and parts by an examiner, and detection of an embryo/fetus with sonographic examination would be positive signs diagnostic of pregnancy.)

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

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

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

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

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

D (Remember that the primary spermatocyte contains two sex chromosomes, one X chromosome and one Y chromosome, and the primary oocyte contains two sex chromosomes, both X chromosomes. During the first reduction division, two secondary spermatocytes are produced, one X and one Y, establishing X and Y cell lines. The X-bearing cell line is established during oogenesis. Female gametes will all be X bearing and male gametes will be either X or Y bearing. A female develops through the fertilization of the ovum by an X-bearing sperm producing an XX zygote; a male is produced through the fertilization of a Y-bearing sperm producing an XY zygote. Therefore, at fertilization, chromosomal sex is established. Chromosomal sex is not established at ovulation, ejaculation, or climax, so these choices are erroneous.)

A nurse in the delivery room is assisting with the delivery of a newborn infant. After the delivery of the newborn, the nurse assists in delivering the placenta. Which observation would indicate that the placenta has separated from the uterine wall and is ready for delivery? A. The umbilical cord shortens in length and changes in color B. A soft and boggy uterus C. Maternal complaints of severe uterine cramping D. Changes in the shape of the uterus

D (Signs of placental separation include lengthening of the umbilical cord, a sudden gush of dark blood from the introitus (vagina), a firmly contracted uterus, and the uterus changing from a discoid (like a disk) to a globular (like a globe) shape. The client may experience vaginal fullness, but not severe uterine cramping.)

A woman is 6 weeks pregnant. She has had a previous spontaneous abortion at 14 weeks of gestation and a pregnancy that ended at 38 weeks with the birth of a stillborn girl. What is her gravidity and parity using the GTPAL system? _____.

G 3 P1 0 1 0 (Using the GPTAL system, this woman's gravidity and parity information is calculated as follows: G: Total number of times the woman has been pregnant (she is pregnant for the third time) T: Number of pregnancies carried to term (she has one stillborn) P: Number of pregnancies that resulted in a preterm birth (she has none) A: Abortions or miscarriages before the period of viability (she has had one) L: Number of children born who are currently living (she has no living children))

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

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

A nurse is caring for a client who is using patterned breathing during labor. The client reports numbness and tingling of the fingers. Which of the following actions should the nurse take? a. Administer O2 via nasal cannula at 2 L/min. b. Apply a warm blanket c. Assist the client to a side-lying position d. Place an oxygen mask over the client's nose and mouth.

D (The client is experiencing hyperventilation caused by low serum levels of PCO2. Placing an oxygen mask over the client's nose and mouth or having the client breathe into a paper bag will reduce the intake of oxygen, allowing the PCO2 to rise and alleviate the numbness and tingling.)

A nurse is caring for a client in labor and prepares to auscultate the fetal heart rate by using a Doppler ultrasound device. The nurse most accurately determines that the fetal heart sounds are heard by: A. Noting if the heart rate is greater than 140 BPM B. Placing the diaphragm of the Doppler on the mother abdomen C. Performing Leopold's maneuvers first to determine the location of the fetal heart D. Palpating the maternal radial pulse while listening to the fetal heart rate

D (The nurse simultaneously should palpate the maternal radial or carotid pulse and auscultate the fetal heart rate to differentiate the two. If the fetal and maternal heart rates are similar, the nurse may mistake the maternal heart rate for the fetal heart rate. Leopold's maneuvers may help the examiner locate the position of the fetus but will not ensure a distinction between the two rates.)

A nurse is providing instructions to a client in the first trimester of pregnancy regarding measures to assist in reducing breast tenderness. The nurse tells the client to: A. Avoid wearing a bra B. Wash the nipples and areola area daily with soap, and massage the breasts with lotion. C. Wear tight-fitting blouses or dresses to provide support D. Wash the breasts with warm water and keep them dry

D (The pregnant woman should be instructed to wash the breasts with warm water and keep them dry. The woman should be instructed to avoid using soap on the nipples and areola area to prevent the drying of tissues. Wearing a supportive bra with wide adjustable straps can decrease breast tenderness. Tight-fitting blouses or dresses will cause discomfort.)

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

D (The tightness of a cuff that is too small produces a reading that is too high; similarly, the looseness of a cuff that is too large results in a reading that is too low. Because maternal positioning affects readings, blood pressure measurements should be obtained in the same arm and with the woman in the same position. The systolic blood pressure generally remains constant but may decline slightly as pregnancy advances. The diastolic blood pressure first drops and then gradually increases. This compression also leads to varicose veins in the legs and vulva.)

An expected cardiopulmonary adaptation experienced by most pregnant women is: A. Tachycardia. B. Dyspnea at rest C. Progression of dependent edema D. Shortness of breath on exertion

D (This is an expected cardiopulmonary adaptation during pregnancy; it is caused by an increased ventricular rate and elevated diaphragm.)

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

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

A primigravida asks the nurse about signs she can look for that would indicate that the onset of labor is getting closer. The nurse should describe: a. weight gain of 1 to 3lbs. b. quickening. c. fatigue and lethargy. d. bloody show.

D (Women usually experience a weight loss of 1 to 3 lbs. Quickening is the perception of fetal movement by the mother, which occurs at 16 to 20 weeks of gestation. Women usually experience a burst of energy or the nesting instinct. Passage of the mucous plug (operculum) also termed pink/bloody show occurs as the cervix ripens.)

A pregnant woman is the mother of two children. Her first pregnancy ended in a still birth at 32 weeks of gestation, her second pregnancy with the birth of her daughter at 36 weeks, and her third pregnancy with the birth of her son at 41 weeks. Using the 5-digit system to describe this woman's current obstetric history, the nurse would record ____________________________.

G4 P1 2 0 2 (Gravida (the first number) is 4 since this woman is now pregnant and was pregnant 3 times before. Para (the next 4 numbers) represents the outcomes of the pregnancies and would be described as: 4T: 1 = Term birth at 41 weeks of gestation (son) 4P: 2 = Preterm birth at 32 weeks of gestation (stillbirth) and 36 weeks of gestation (daughter) 4A: 0 = Abortion: none occurred 4L: 2 = Living children: her son and her daughter)

True or false: With spinal anesthesia, maternal BP, pulse, and RR and FHR do not have to be checked and documented every 5 to 10 minutes.

False

True or False: Opioids decrease maternal heart and respiratory rate and blood pressure, which affects fetal oxygenation. Therefore maternal vital signs and FHR and pattern must be assessed and documented before and after administration of opioids for pain relief.

True

True or false: With epidural anesthesia, blood pressure must be monitored.

True