OB Exam 1 Practice 384 Questions with Verified Answers,100% CORRECT, Exams of Nursing

Download OB Exam 1 Practice 384 Questions with Verified Answers,100% CORRECT and more Exams Nursing in PDF only on Docsity! OB Exam 1 Practice 384 Questions with Verified Answers A client with a history of bipolar disorder is called by the postpartum support nurse for follow-up. Which symptoms would reassure the nurse that the client is not experiencing a manic episode? a.Psychomotor agitation and lack of sleep b.Increased appetite and lack of interest in activities c.Hyperactivity and distractibility d.Pressured speech and grandiosity - CORRECT ANSWER ANS: B An increased appetite and a lack of interest would reassure the nurse that the client is not experiencing an episode of mania. Clinical manifestations of a manic episode include at least three of the following: grandiosity, decreased need for sleep, pressured speech, flight of ideas, distractibility, psychomotor agitation, and excessive involvement in pleasurable activities. The pregnant woman exhibiting symptoms of a manic episode will likely have a decreased interest in eating and an increased level of interest in pleasurable activities without regard for negative consequences. Psychomotor agitation and a lack of sleep, hyperactivity and distractibility, and pressured speech and grandiosity are all clinical manifestations of a manic episode. When a woman is diagnosed with postpartum depression (PPD) with psychotic features, what is the nurse's primary concern in planning the client's care? a.Displaying outbursts of anger b.Neglecting her hygiene c.Harming her infant d.Losing interest in her husband - CORRECT ANSWER ANS: C Thoughts of harm to herself or to the infant are among the most serious symptoms of PPD and require immediate assessment and intervention. Although outbursts of anger and neglecting personal hygiene are symptoms attributable to PPD, the major concern remains the potential of harm to herself or her infant. Although this client is likely to lose interest in her spouse, it is not the nurse's primary concern. During an inpatient psychiatric hospitalization, what is the most important nursing intervention? a.Contacting the client's significant other b.Supervising and guiding visits with her infant c.Allowing no contact with anyone who annoys her d.Having the infant with the mother at all times - CORRECT ANSWER ANS: B In the hospital setting, the reintroduction of the infant to the mother can and should occur at the mother's own pace. A schedule is set that increases the number of hours the mother cares for her infant over several days, culminating in the infant staying overnight in the mother's room. These supervised and guided visits allow the mother to experience meeting the infant's needs and giving up sleep for the infant. Reintroducing the mother to her infant while in a supervised setting is essential. Another important task for a mother under psychiatric care is to reestablish positive interactions with others. PPD is characterized by an intense pervasive sadness along with labile mood swings and is more persistent than postpartum baby blues. PPD, even without psychotic features, is more serious and persistent than postpartum baby blues. PPD is more common among younger mothers and African-American mothers. Most women need professional help to get through PPD, including pharmacologic intervention. While providing care to the maternity client, the nurse should be aware that one of these anxiety disorders is likely to be triggered by the process of labor and birth. Which disorder fits this criterion? a.Phobias b.Panic disorder c.Posttraumatic stress disorder (PTSD) d.Obsessive-compulsive disorder (OCD) - CORRECT ANSWER ANS: C PTSD can occur as the result of a past trauma such as rape. Symptoms of PTSD include re-experiencing the event, numbing, irritability, angry outbursts, and exaggerated startle reflex. With the increased bodily touch and vaginal examinations that occur during labor, the client may have memories of the original trauma. The process of giving birth may result in her feeling out of control. The nurse should verbalize an understanding and reassure the client as necessary. Phobias are irrational fears that may lead a person to avoid certain events or situations. Panic disorders may occur in as many as 3% to 5% of women in the postpartum period and are described as episodes of intense apprehension, fear, and terror. Symptoms of a panic disorder may include palpitations, chest pain, choking, or smothering. OCD symptoms include recurrent, persistent, and intrusive thoughts. The mother may repeatedly check and recheck her infant once he or she is born, although she realizes that this behavior is irrational. OCD is optimally treated with medications. Which substance used during pregnancy causes vasoconstriction and decreased placental perfusion, resulting in maternal and neonatal complications? a.Alcohol b.Caffeine c.Tobacco d.Chocolate - CORRECT ANSWER ANS: C Smoking in pregnancy is known to cause a decrease in placental perfusion and is the cause of low-birth-weight infants. Prenatal alcohol exposure is the single greatest preventable cause of mental retardation. Alcohol use during pregnancy can cause high blood pressure, miscarriage, premature birth, stillbirth, and anemia. Caffeine may interfere with certain medications and worsen arrhythmias. Chocolate, particularly dark chocolate, contains caffeine that may interfere with certain medications. As part of the discharge teaching, the nurse can prepare the mother for her upcoming adjustment to her new role by instructing her regarding self-care activities to help prevent PPD. Which statement regarding this condition ismost helpful for the client? a.Stay home, and avoid outside activities to ensure adequate rest. b.Be certain that you are the only caregiver for your baby to facilitate infant attachment. c.Keep your feelings of sadness and adjustment to your new role to yourself. d.Realize that PPD is a common occurrence that affects many women. - CORRECT ANSWER ANS: D Should the new mother experience symptoms of the baby blues, it is important that she be aware that these symptoms are nothing to be ashamed of. As many as 10% to 15% of new mothers experience similar symptoms. Although obtaining enough rest is important for the mother, she should not distance herself from her family and friends. Her spouse or partner can communicate the best visiting times to enable the new mother to obtain adequate rest. It is also important that she not isolate herself at home by herself during this time of role adjustment. Even if breastfeeding, other family members can participate in the infant's care. If depression occurs, then the symptoms will often interfere with mothering functions; therefore, family support is essential. The new mother should share her feelings with someone else and avoid overcommitting herself or feel as though she has to besuperwoman. A telephone call to the hospital "warm line" may provide reassurance with lactation issues and other infant care questions. Should symptoms continue, a referral to a professional therapist may be necessary. A woman at 24 weeks of gestation states that she has a glass of wine with dinner every evening. Why would the nurse counsel the client to eliminate all alcohol? a.Daily consumption of alcohol indicates a risk for alcoholism. b.She will be at risk for abusing other substances as well. c.The fetus is placed at risk for altered brain growth. d.The fetus is at risk for multiple organ anomalies - CORRECT ANSWER ANS: C No period exists when consuming alcohol during pregnancy is safe. The documented effects of alcohol consumption during pregnancy include mental retardation, learning disabilities, high activity level, and short attention span. The brain grows most rapidly in the third trimester and is vulnerable to alcohol exposure during this time. Abuse of other substances has not been linked to alcohol use. during pregnancy. Opioid replacement therapy has been shown to decrease opioid and other drug use, reduce criminal activity, improve individual functioning, and decrease the rates of infections such as hepatitis B and C, human immunodeficiency virus (HIV), and other STIs. Detoxification is the treatment used for alcohol addiction. Pregnant women requiring withdrawal from alcohol should be admitted for inpatient management. Women are more likely to stop smoking during pregnancy than at any other time in their lives. A smoking cessation program can assist in achieving this goal. The 4 Ps Plus is a screening tool specifically designed to identify pregnant women who need in-depth assessment related to substance abuse. Reports have linked third trimester use of selective serotonin uptake inhibitors (SSRIs) with a constellation of neonatal signs. The nurse is about to perform an assessment on the infant of a mother with a history of a mood disorder. Which signs and symptoms in the neonate may be the result of maternal SSRI use? (Select all that apply.) a.Hypotonia b.Hyperglycemia c.Shivering d.Fever e.Irritability - CORRECT ANSWER ANS: C, D, E Neonatal signs of maternal SSRI use include continuous crying, irritability, jitteriness, shivering, fever, hypertonia, respiratory distress, feeding difficulty, hypoglycemia, and seizures. The onset of signs and symptoms ranges from several hours to several days after birth, but the signs generally resolve within 2 weeks. Screening questions for alcohol and drug abuse should be included in the overall assessment during the first prenatal visit for all women. The 4 Ps Plus is a screening tool specifically designed to identify the need for a more in-depth assessment. Which are the correct components of the 4 Ps Plus? (Select all that apply.) a.Parents b.Partner c.Present d.Past e.Pregnancy - CORRECT ANSWER ANS: A, B, D, E The nurse who is screening the client using the 4 Ps Plus would use the following format: Parents: "Did either of your parents have a problem with alcohol or drugs?" Partner: "Does your partner have a problem with alcohol or drugs?" Past: "Have you ever had any beer, wine, or liquor?" Pregnancy: "In the month before you knew you were pregnant, how many cigarettes did you smoke? How much beer, wine, or liquor did you drink?" Present: Is not a component of the 4 Ps Plus. Preconception counseling is critical in the safe management of diabetic pregnancies. Which complication is commonly associated with poor glycemic control before and during early pregnancy? a. Frequent episodes of maternal hypoglycemia b. Congenital anomalies in the fetus c. Hydramnios d. Hyperemesis gravidarum - CORRECT ANSWER ANS: B Preconception counseling is particularly important since strict metabolic control before conception and in the early weeks of gestation is instrumental in decreasing the risk of congenital anomalies. Frequent episodes of maternal hypoglycemia may occur during the first trimester (not before conception) as a result of hormonal changes and the effects on insulin production and use. Hydramnios occurs approximately 10 times more often in diabetic pregnancies than in nondiabetic pregnancies. Typically, it is observed in the third trimester of pregnancy. Hyperemesis gravidarum may exacerbate hypoglycemic events because the decreased food intake by the mother and glucose transfer to the fetus contribute to hypoglycemia. 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." - CORRECT ANSWER ANS: 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. 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 - CORRECT ANSWER ANS: 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 c. During the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus. d. Maternal insulin requirements steadily decline during pregnancy. - CORRECT ANSWER ANS: C Pregnant women develop increased insulin resistance during the second and third trimesters. Insulin never crosses the placenta; the fetus starts making its own around the 10th week. As a result of normal metabolic changes during pregnancy, insulin-dependent women are prone to hypoglycemia (low levels). Maternal insulin requirements may double or quadruple by the end of pregnancy. 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. - CORRECT ANSWER ANS: 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 statement regarding the laboratory test for glycosylated hemoglobin Alc is correct? a. The laboratory test for glycosylated hemoglobin Alc is performed for all pregnant women, not only those with or likely to have diabetes. b. This laboratory test is a snapshot of glucose control at the moment. c. This laboratory test measures the levels of hemoglobin Alc, which should remain at less than 7%. d. This laboratory test is performed on the woman's urine, not her blood. - CORRECT ANSWER ANS: C Hemoglobin Alc levels greater than 7% indicate an elevated glucose level during the previous 4 to 6 weeks. This extra laboratory test is for diabetic women and defines glycemic control over the previous 4 to 6 weeks. Glycosylated hemoglobin level tests are performed on the blood. A new mother with a thyroid disorder has come for a lactation follow-up appointment. Which thyroid disorder is a contraindication for breastfeeding? a. Hyperthyroidism b. PKU c. Hypothyroidism d. Thyroid storm - CORRECT ANSWER ANS: B PKU is a cause of mental retardation in infants; mothers with PKU pass on phenylalanine and therefore should elect not to breastfeed. A woman with either hyperthyroidism or hypothyroidism would have no particular reason not to breastfeed. A thyroid storm is a complication of hyperthyroidism and is not a contraindication to breastfeeding. An 18-year-old client who has reached 16 weeks of gestation was recently diagnosed with pregestational diabetes. She attends her centering appointment accompanied by one of her girlfriends. This young woman appears more concerned about how her pregnancy will affect her social life than her recent diagnosis of diabetes. A number of nursing diagnoses are applicable to assist in planning adequate care. What is the most appropriate diagnosis at this time? a. Risk for injury, to the fetus related to birth trauma b. Deficient knowledge, related to diabetic pregnancy management c. Deficient knowledge, related to insulin administration d. Risk for injury, to the mother related to hypoglycemia or hyperglycemia - CORRECT ANSWER ANS: B Before a treatment plan is developed or goals for the outcome of care are outlined, this client must come to an understanding of diabetes and the potential effects on her pregnancy. She appears more concerned about changes to her social life than adopting a new self-care regimen. Risk for injury to the fetus related to either placental insufficiency or birth trauma may come later in the pregnancy. At this time, the client is having difficulty acknowledging the adjustments that she needs to make to her lifestyle to care for herself during pregnancy. The client may not yet be on insulin. Insulin requirements increase with gestation. The importance of glycemic control must be part of health teaching for this client. However, she has not yet acknowledged that changes to her lifestyle need to be made and may not participate in the plan of care until understanding takes place A woman with gestational diabetes has had little or no experience reading and interpreting glucose levels. The client shows the nurse her readings for the past few days. Which reading signals the nurse that the client may require an adjustment of insulin or carbohydrates? a. 75 mg/dl before lunch. This is low; better eat now. b. 115 mg/dl 1 hour after lunch. This is a little high; maybe eat a little less next time. c. 115 mg/dl 2 hours after lunch. This is too high; it is time for insulin. d. 50 mg/dl just after waking up from a nap. This is too low; maybe eat a snack before going to sleep. - CORRECT ANSWER ANS: D 50 mg/dl after waking from a nap is too low. During hours of sleep, glucose levels should not be less than 60 mg/dl. Snacks before sleeping can be helpful. The premeal acceptable range is 60 to 99 mg/dl. The readings 1 hour after a meal should be less than 129 mg/dl. Two hours after eating, the readings should be less than 120 mg/dl. Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother? a. Hypoglycemia b. Hypercalcemia c. Hypobilirubinemia d. Hypoinsulinemia - CORRECT ANSWER ANS: A The neonate is at highest risk for hypoglycemia because fetal insulin production is accelerated during pregnancy to metabolize excessive glucose from the mother. At birth, the maternal glucose supply stops and the neonatal insulin exceeds the available glucose, thus leading to hypoglycemia. Hypocalcemia is associated with preterm birth, birth trauma, and asphyxia, all common problems of the infant of a diabetic mother. Excess erythrocytes are broken down after birth, and large amounts of bilirubin are released into the neonate's circulation, with resulting hyperbilirubinemia. Because fetal insulin production is accelerated during pregnancy, hyperinsulinemia develops in the neonate. Which preexisting factor is known to increase the risk of GDM? a. Underweight before pregnancy pregnancy. If you were to get pregnant, then it would make the diagnosis of this cancer more difficult." c."If you can avoid a pregnancy for the next year, the chance of developing a second molar pregnancy is rare. Therefore, to improve your chance of a successful pregnancy, not getting pregnant - CORRECT ANSWER ANS: B Beta-human chorionic gonadotropin (beta-hCG) hormone levels are drawn for 1 year to ensure that the mole is completely gone. The chance of developing choriocarcinoma after the development of a hydatidiform mole is increased. Therefore, the goal is to achieve a zero human chorionic gonadotropin (hCG) level. If the woman were to become pregnant, then it may obscure the presence of the potentially carcinogenic cells. Women should be instructed to use birth control for 1 year after treatment for a hydatidiform mole. The rationale for avoiding pregnancy for 1 year is to ensure that carcinogenic cells are not present. Any contraceptive method except an intrauterine device (IUD) is acceptable. The nurse is preparing to administer methotrexate to the client. This hazardous drug is most often used for which obstetric complication? a.Complete hydatidiform mole b.Missed abortion c.Unruptured ectopic pregnancy d.Abruptio placentae - CORRECT ANSWER ANS: C Methotrexate is an effective nonsurgical treatment option for a hemodynamically stable woman whose ectopic pregnancy is unruptured and measures less than 4 cm in diameter. Methotrexate is not indicated or recommended as a treatment option for a complete hydatidiform mole, for a missed abortion, or for abruptio placentae. A 26-year-old pregnant woman, gravida 2, para 1-0-0-1, is 28 weeks pregnant when she experiences bright red, painless vaginal bleeding. On her arrival at the hospital, which diagnostic procedure will the client most likely have performed? a.Amniocentesis for fetal lung maturity b.Transvaginal ultrasound for placental location c.Contraction stress test (CST) d.Internal fetal monitoring - CORRECT ANSWER ANS: B The presence of painless bleeding should always alert the health care team to the possibility of placenta previa, which can be confirmed through ultrasonography. Amniocentesis is not performed on a woman who is experiencing bleeding. In the event of an imminent delivery, the fetus is presumed to have immature lungs at this gestational age, and the mother is given corticosteroids to aid in fetal lung maturity. A CST is not performed at a preterm gestational age. Furthermore, bleeding is a contraindication to a CST. Internal fetal monitoring is also contraindicated in the presence of bleeding. A laboring woman with no known risk factors suddenly experiences spontaneous ROM. The fluid consists of bright red blood. Her contractions are consistent with her current stage of labor. No change in uterine resting tone has occurred. The fetal heart rate (FHR) begins to decline rapidly after the ROM. The nurse should suspect the possibility of what condition? a.Placenta previa b.Vasa previa c.Severe abruptio placentae d.Disseminated intravascular coagulation (DIC) - CORRECT ANSWER ANS: B Vasa previa is the result of a velamentous insertion of the umbilical cord. The umbilical vessels are not surrounded by Wharton jelly and have no supportive tissue. The umbilical blood vessels thus are at risk for laceration at any time, but laceration occurs most frequently during ROM. The sudden appearance of bright red blood at the time of ROM and a sudden change in the FHR without other known risk factors should immediately alert the nurse to the possibility of vasa previa. The presence of placenta previa most likely would be ascertained before labor and is considered a risk factor for this pregnancy. In addition, if the woman had a placenta previa, it is unlikely that she would be allowed to pursue labor and a vaginal birth. With the presence of severe abruptio placentae, the uterine tonicity typically is tetanus (i.e., a boardlike uterus). DIC is a pathologic form of diffuse clotting that consumes large amounts of clotting factors, causing widespread external bleeding, internal bleeding, or both. DIC is always a secondary diagnosis, often associated with obstetric risk factors such as the hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome. This woman did not have any prior risk factors. A woman arrives for evaluation of signs and symptoms that include a missed period, adnexal fullness, tenderness, and dark red vaginal bleeding. On examination, the nurse notices an ecchymotic blueness around the woman's umbilicus. What does this finding indicate? a.Normal integumentary changes associated with pregnancy b.Turner sign associated with appendicitis c.Cullen sign associated with a ruptured ectopic pregnancy d.Chadwick sign associated with early pregnancy - CORRECT ANSWER ANS: C Cullen sign, the blue ecchymosis observed in the umbilical area, indicates hematoperitoneum associated with an undiagnosed ruptured intraabdominal ectopic pregnancy. Linea nigra on the abdomen is the normal integumentary The management of the pregnant client who has experienced a pregnancy loss depends on the type of miscarriage and the signs and symptoms. While planning care for a client who desires outpatient management after a first-trimester loss, what would the nurse expect the plan to include? a.Dilation and curettage (D&C) b.Dilation and evacuation (D&E) c.Misoprostol d.Ergot products - CORRECT ANSWER ANS: C Outpatient management of a first-trimester loss is safely accomplished by the intravaginal use of misoprostol for up to 2 days. If the bleeding is uncontrollable, vital signs are unstable, or signs of infection are present, then a surgical evacuation should be performed. D&C is a surgical procedure that requires dilation of the cervix and scraping of the uterine walls to remove the contents of pregnancy. This procedure is commonly performed to treat inevitable or incomplete abortion and should be performed in a hospital. D&E is usually performed after 16 weeks of pregnancy. The cervix is widely dilated, followed by removal of the contents of the uterus. Ergot products such as Methergine or Hemabate may be administered for excessive bleeding after miscarriage. Which laboratory marker is indicative of DIC? a.Bleeding time of 10 minutes b.Presence of fibrin split products c.Thrombocytopenia d.Hypofibrinogenemia - CORRECT ANSWER ANS: B Degradation of fibrin leads to the accumulation of multiple fibrin clots throughout the body's vasculature. Bleeding time in DIC is normal. Low platelets may occur but are not indicative of DIC because they may be the result from other coagulopathies. Hypofibrinogenemia occurs with DIC. When is a prophylactic cerclage for an incompetent cervix usually placed (in weeks of gestation)? a.12 to 14 b.6 to 8 c.23 to 24 d.After 24 - CORRECT ANSWER ANS: A A prophylactic cerclage is usually placed at 12 to 14 weeks of gestation. The cerclage is electively removed when the woman reaches 37 weeks of gestation or when her labor begins. Six to 8 weeks of gestation is too early to place the cerclage. Cerclage placement is offered if the cervical length falls to less than 20 to 25 mm before 23 to 24 weeks. Although no consensus has been reached, 24 weeks is used as the upper gestational age limit for cerclage placement In caring for an immediate postpartum client, the nurse notes petechiae and oozing from her intravenous (IV) site. The client would be closely monitored for which clotting disorder? a.DIC b.Amniotic fluid embolism (AFE) c.Hemorrhage d.HELLP syndrome - CORRECT ANSWER ANS: A The diagnosis of DIC is made according to clinical findings and laboratory markers. A physical examination reveals unusual bleeding. Petechiae may appear around a blood pressure cuff on the woman's arm. Excessive bleeding may occur from the site of slight trauma such as venipuncture sites. These symptoms are not associated with AFE, nor is AFE a bleeding disorder. Hemorrhage occurs for a variety of reasons in the postpartum client. These symptoms are associated with DIC. Hemorrhage would be a finding associated with DIC and is not a clotting disorder in and of itself. HELLP syndrome is not a clotting disorder, but it may contribute to the clotting disorder DIC. In caring for the woman with DIC, which order should the nurse anticipate? a.Administration of blood b.Preparation of the client for invasive hemodynamic monitoring c.Restriction of intravascular fluids d.Administration of steroids - CORRECT ANSWER ANS: A Primary medical management in all cases of DIC involves a correction of the underlying cause, volume replacement, blood component therapy, optimization of oxygenation and perfusion status, and continued reassessment of laboratory parameters. Central monitoring would not be initially ordered in a client with DIC because it could contribute to more areas of bleeding. Management of DIC would include volume replacement, not volume restriction. Steroids are not indicated for the management of DIC. 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 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 - CORRECT ANSWER 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. What condition indicates concealed hemorrhage when the client experiences abruptio placentae? a.Decrease in abdominal pain b.Bradycardia c.Hard, boardlike abdomen d.Decrease in fundal height - CORRECT ANSWER ANS: C Concealed hemorrhage occurs when the edges of the placenta do not separate. The formation of a hematoma behind the placenta and subsequent infiltration of the blood into the uterine muscle results in a very firm, boardlike abdomen. Abdominal pain may increase. The client will have shock symptoms that include tachycardia. As bleeding occurs, the fundal height increases. What is the highest priority nursing intervention when admitting a pregnant woman who has experienced a bleeding episode in late pregnancy? a.Assessing FHR and maternal vital signs b.Performing a venipuncture for hemoglobin and hematocrit levels c.Placing clean disposable pads to collect any drainage d.Monitoring uterine contractions - CORRECT ANSWER ANS: A Assessment of the FHR and maternal vital signs will assist the nurse in determining the degree of the blood loss and its effect on the mother and fetus. The most important assessment is to check the well-being of both the mother and the fetus. The blood levels can be obtained later. Assessing future bleeding is important; however, the top priority remains mother/fetal well-being. Monitoring uterine contractions is important but not a top priority. Which order should the nurse expect for a client admitted with a threatened abortion? a.Bed rest b.Administration of ritodrine IV c.Nothing by mouth (nil per os [NPO]) d.Narcotic analgesia every 3 hours, as needed - CORRECT ANSWER ANS: A Decreasing the woman's activity level may alleviate the bleeding and allow the pregnancy to continue. Ritodrine is not the first drug of choice for tocolytic medications. Having the woman placed on NPO is unnecessary. At times, dehydration may produce contractions; therefore, hydration is important. Narcotic analgesia will not decrease the contractions and may mask the severity of the contractions. 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 - CORRECT ANSWER ANS: C 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. A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Which information assists the nurse in developing the plan of care? a.Bed rest and analgesics are the recommended treatment. b.She will be unable to conceive in the future. c.A D&C will be performed to remove the products of conception. b.Abdominal pain c.Unanticipated heavy bleeding d.Vaginal spotting or light bleeding e.Missed period - CORRECT ANSWER ANS: A, B, D, E A missed period or spotting can be easily mistaken by the client as an early sign of pregnancy. More subtle signs depend on exactly where the implantation occurs. The nurse must be thorough in her assessment because pain is not a normal symptom of early pregnancy. As the fallopian tube tears open and the embryo is expelled, the client often exhibits severe pain accompanied by intraabdominal hemorrhage, which may progress to hypovolemic shock with minimal or even no external bleeding. In approximately one half of women, shoulder and neck pain results from irritation of the diaphragm from the hemorrhage. A primigravida is being monitored at the prenatal clinic for preeclampsia. Which finding is of greatest concern to the nurse? a.Blood pressure (BP) increase to 138/86 mm Hg b.Weight gain of 0.5 kg during the past 2 weeks c.Dipstick value of 3+ for protein in her urine d.Pitting pedal edema at the end of the day - CORRECT ANSWER ANS: C Proteinuria is defined as a concentration of 1+ or greater via dipstick measurement. A dipstick value of 3+ alerts the nurse that additional testing or assessment should be performed. A 24-hour urine collection is preferred over dipstick testing attributable to accuracy. Generally, hypertension is defined as a BP of 140/90 mm Hg or an increase in systolic pressure of 30 mm Hg or diastolic pressure of 15 mm Hg. Preeclampsia may be demonstrated as a rapid weight gain of more than 2 kg in 1 week. Edema occurs in many normal pregnancies, as well as in women with preeclampsia. Therefore, the presence of edema is no longer considered diagnostic of preeclampsia. The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the oxytocin (Pitocin) infusion, the nurse reviews the woman's latest laboratory test findings, which reveal a platelet count of 90,000 mm3, an elevated aspartate aminotransaminase (AST) level, and a falling hematocrit. The laboratory results are indicative of which condition? a.Eclampsia b.Disseminated intravascular coagulation (DIC) syndrome c.Hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome d.Idiopathic thrombocytopenia - CORRECT ANSWER ANS: C HELLP syndrome is a laboratory diagnosis for a variant of severe preeclampsia that involves hepatic dysfunction characterized by hemolysis (H), elevated liver (EL) enzymes, and low platelets (LP). Eclampsia is determined by the presence of seizures. DIC is a potential complication associated with HELLP syndrome. Idiopathic thrombocytopenia is the presence of low platelets of unknown cause and is not associated with preeclampsia. A woman with preeclampsia has a seizure. What is the nurse's highest priority during a seizure? a.To insert an oral airway b.To suction the mouth to prevent aspiration c.To administer oxygen by mask d.To stay with the client and call for help - CORRECT ANSWER ANS: D If a client becomes eclamptic, then the nurse should stay with the client and call for help. Nursing actions during a convulsion are directed toward ensuring a patent airway and client safety. Insertion of an oral airway during seizure activity is no longer the standard of care. The nurse should attempt to keep the airway patent by turning the client's head to the side to prevent aspiration. Once the seizure has ended, it may be necessary to suction the client's mouth. Oxygen is administered after the convulsion has ended. A pregnant woman has been receiving a magnesium sulfate infusion for treatment of severe preeclampsia for 24 hours. On assessment, the nurse finds the following vital signs: temperature 37.3° C, pulse rate 88 beats per minute, respiratory rate 10 breaths per minute, BP 148/90 mm Hg, absent deep tendon reflexes (DTRs), and no ankle clonus. The client complains, "I'm so thirsty and warm." What is the nurse's immediate action? a.To call for an immediate magnesium sulfate level b.To administer oxygen c.To discontinue the magnesium sulfate infusion d.To prepare to administer hydralazine - CORRECT ANSWER ANS: C Regardless of the magnesium level, the client is displaying the clinical signs and symptoms of magnesium toxicity. The first action by the nurse should be to discontinue the infusion of magnesium sulfate. In addition, calcium gluconate, the antidote for magnesium, may be administered. Hydralazine is an antihypertensive drug commonly used to treat hypertension in severe preeclampsia. Typically, likely have a heavy flow attributable to the relaxation of the uterine wall caused by magnesium administration. 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."The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor." b."I don't know why it is taking so long." c."The length of labor varies for different women." d."Your baby is just being stubborn." - CORRECT ANSWER ANS: A Because magnesium sulfate is a tocolytic agent, its use may increase the duration of labor. The amount of oxytocin needed to stimulate labor may be more than that needed for the woman who is not receiving magnesium sulfate. The nurse should explain to the client the effects of magnesium sulfate on the duration of labor. Although the length of labor varies for different women, the most likely reason this woman's labor is protracted is the tocolytic effects of magnesium sulfate. The behavior of the fetus has no bearing on the length of labor. What nursing diagnosis is the most appropriate for a woman experiencing severe preeclampsia? a.Risk for injury to mother and fetus, related to central nervous system (CNS) irritability b.Risk for altered gas exchange c.Risk for deficient fluid volume, related to increased sodium retention secondary to the administration of magnesium sulfate d.Risk for increased cardiac output, related to the use of antihypertensive drugs - CORRECT ANSWER ANS: A Risk for injury is the most appropriate nursing diagnosis for this client scenario. Gas exchange is more likely to become impaired, attributable to pulmonary edema. A risk for excess, not deficient, fluid volume, related to increased sodium retention, is increased, and a risk for decreased, not increased, cardiac output, related to the use of antihypertensive drugs, also is increased. Which statement best describes chronic hypertension? a.Chronic hypertension is defined as hypertension that begins during pregnancy and lasts for the duration of the pregnancy. b.Chronic hypertension is considered severe when the systolic BP is higher than 140 mm Hg or the diastolic BP is higher than 90 mm Hg. c.Chronic hypertension is general hypertension plus proteinuria. d.Chronic hypertension can occur independently of or simultaneously with preeclampsia. - CORRECT ANSWER ANS: D Women with chronic hypertension may develop superimposed preeclampsia, which increases the morbidity for both the mother and the fetus. Chronic hypertension is present before pregnancy or diagnosed before the 20 weeks of gestation and persists longer than 6 weeks postpartum. Chronic hypertension becomes severe with a diastolic BP of 110 mm Hg or higher. Proteinuria is an excessive concentration of protein in the urine and is a complication of hypertension, not a defining characteristic. Which intervention is most important when planning care for a client with severe gestational hypertension? a.Induction of labor is likely, as near term as possible. b.If at home, the woman should be confined to her bed, even with mild gestational hypertension. c.Special diet low in protein and salt should be initiated. d.Vaginal birth is still an option, even in severe cases. - CORRECT ANSWER ANS: A By 34 weeks of gestation, the risk of continuing the pregnancy may be considered greater than the risks of a preterm birth. Strict bed rest is controversial for mild cases; some women in the hospital are even allowed to move around. Diet and fluid recommendations are essentially the same as for healthy pregnant women, although some authorities have suggested a diet high in protein. Women with severe gestational hypertension should expect a cesarean delivery. What is the primary purpose for magnesium sulfate administration for clients with preeclampsia and eclampsia? a.To improve patellar reflexes and increase respiratory efficiency b.To shorten the duration of labor c.To prevent convulsions d.To prevent a boggy uterus and lessen lochial flow - CORRECT ANSWER ANS: C Magnesium sulfate is the drug of choice used to prevent convulsions, although it can generate other problems. Loss of patellar reflexes and respiratory depression are signs of magnesium toxicity. Magnesium sulfate can also increase the duration complications of hypertensive disorders in pregnancy. Placental abruption and DIC are conditions related to maternal morbidity and mortality. The nurse has evaluated a client with preeclampsia by assessing DTRs. The result is a grade of 3+. Which DTR response most accurately describes this score? a.Sluggish or diminished b.Brisk, hyperactive, with intermittent or transient clonus c.Active or expected response d.More brisk than expected, slightly hyperactive - CORRECT ANSWER ANS: D DTRs reflect the balance between the cerebral cortex and the spinal cord. They are evaluated at baseline and to detect changes. A slightly hyperactive and brisk response indicates a grade 3+ response. A woman with severe preeclampsia has been receiving magnesium sulfate by intravenous infusion for 8 hours. The nurse assesses the client and documents the following findings: temperature of 37.1° C, pulse rate of 96 beats per minute, respiratory rate of 24 breaths per minute, BP of 155/112 mm Hg, 3+ DTRs, and no ankle clonus. The nurse calls the provider with an update. The nurse should anticipate an order for which medication? a.Hydralazine b.Magnesium sulfate bolus c.Diazepam d.Calcium gluconate - CORRECT ANSWER ANS: A Hydralazine is an antihypertensive medication commonly used to treat hypertension in severe preeclampsia. Typically, it is administered for a systolic BP higher than 160 mm Hg or a diastolic BP higher than 110 mm Hg. An additional bolus of magnesium sulfate may be ordered for increasing signs of CNS irritability related to severe preeclampsia (e.g., clonus) or if eclampsia develops. Diazepam is sometimes used to stop or shorten eclamptic seizures. Calcium gluconate is used as the antidote for magnesium sulfate toxicity. The client is not currently displaying any signs or symptoms of magnesium toxicity. The client being cared for has severe preeclampsia and is receiving a magnesium sulfate infusion. Which new finding would give the nurse cause for concern? a.Sleepy, sedated affect b.Respiratory rate of 10 breaths per minute c.DTRs of 2 d.Absent ankle clonus - CORRECT ANSWER ANS: B A respiratory rate of 10 breaths per minute indicates the client is experiencing respiratory depression from magnesium toxicity. Because magnesium sulfate is a CNS depressant, the client will most likely become sedated when the infusion is initiated. DTRs of 2 and absent ankle clonus are normal findings. What is the most common medical complication of pregnancy? a.Hypertension b.Hyperemesis gravidarum c.Hemorrhagic complications d.Infections - CORRECT ANSWER ANS: A Preeclampsia and eclampsia are two noted deadly forms of hypertension. A large percentage of pregnant women will have nausea and vomiting, but a relatively few will have the severe form called hyperemesis gravidarum. Hemorrhagic complications are the second most common medical complication of pregnancy; hypertension is the most common. Infection is a risk factor for preeclampsia. Which statement most accurately describes the HELLP syndrome? a.Mild form of preeclampsia b.Diagnosed by a nurse alert to its symptoms c.Characterized by hemolysis, elevated liver enzymes, and low platelets d.Associated with preterm labor but not perinatal mortality - CORRECT ANSWER ANS: C The acronym HELLP stands for hemolysis (H), elevated liver (EL) enzymes, and low platelets (LP). The HELLP syndrome is a variant of severe preeclampsia and is difficult to identify because the symptoms are not often obvious. The HELLP syndrome must be diagnosed in the laboratory. Preterm labor is greatly increased; therefore, so is perinatal mortality. Which adverse prenatal outcomes are associated with the HELLP syndrome? (Select all that apply.) a.Placental abruption b.Placenta previa Which information should the nurse take into consideration when planning care for a postpartum client with cardiac disease? a. The plan of care for a postpartum client is the same as the plan for any pregnant woman. b. The plan of care includes rest, stool softeners, and monitoring of the effect of activity. c. The plan of care includes frequent ambulating, alternating with active range-of- motion exercises. d. The plan of care includes limiting visits with the infant to once per day. - CORRECT ANSWER ANS: B Bed rest may be ordered, with or without bathroom privileges. Bowel movements without stress or strain for the woman are promoted with stool softeners, diet, and fluids. Care of the woman with cardiac disease in the postpartum period is tailored to the woman's functional capacity. The woman will be on bed rest to conserve energy and to reduce the strain on the heart. Although the woman may need help caring for the infant, breastfeeding and infant visits are not contraindicated. A woman has experienced iron deficiency anemia during her pregnancy. She had been taking iron for 3 months before the birth. The client gave birth by cesarean 2 days earlier and has been having problems with constipation. After assisting her back to bed from the bathroom, the nurse notes that the woman's stools are dark (greenish-black). What should the nurse's initial action be? a. Perform a guaiac test, and record the results. b. Recognize the finding as abnormal, and report it to the primary health care provider. c. Recognize the finding as a normal result of iron therapy. d. Check the woman's next stool to validate the observation. - CORRECT ANSWER ANS: C The nurse should recognize that dark stools are a common side effect in clients who are taking iron replacement therapy. A guaiac test would be indicated if gastrointestinal (GI) bleeding was suspected. GI irritation, including dark stools, is also a common side effect of iron therapy. Observation of stool formation is a normal nursing activity. A woman with asthma is experiencing a postpartum hemorrhage. Which drug should be avoided when treating postpartum bleeding to avoid exacerbating asthma? a. Oxytocin (Pitocin) b. Nonsteroidal antiinflammatory drugs (NSAIDs) c. Hemabate d. Fentanyl - CORRECT ANSWER ANS: C Prostaglandin derivatives should not be used to treat women with asthma, because they may exacerbate symptoms. Oxytocin is the drug of choice to treat this woman's bleeding; it will not exacerbate her asthma. NSAIDs are not used to treat bleeding. Fentanyl is used to treat pain, not bleeding. Which important component of nutritional counseling should the nurse include in health teaching for a pregnant woman who is experiencing cholecystitis? a. Assess the woman's dietary history for adequate calories and proteins. b. Teach the woman that the bulk of calories should come from proteins. c. Instruct the woman to eat a low-fat diet and to avoid fried foods. d. Instruct the woman to eat a low-cholesterol, low-salt diet. - CORRECT ANSWER ANS: C Eating a low-fat diet and avoiding fried foods is appropriate nutritional counseling for this client. Caloric and protein intake do not predispose a woman to the development of cholecystitis. The woman should be instructed to limit protein intake and choose foods that are high in carbohydrates. A low-cholesterol diet may be the result of limiting fats. However, a low-salt diet is not indicated. Postoperative care of the pregnant woman who requires abdominal surgery for appendicitis includes which additional assessment? a. Intake and output (I&O) and intravenous (IV) site b. Signs and symptoms of infection c. Vital signs and incision d. Fetal heart rate (FHR) and uterine activity - CORRECT ANSWER ANS: D Care of a pregnant woman undergoing surgery for appendicitis differs from that for a nonpregnant woman in one significant aspect: the presence of the fetus. Continuous fetal and uterine monitoring should take place. An assessment of I&O levels, along with an assessment of the IV site, are normal postoperative care procedures. Evaluating the client for signs and symptoms of infection is also part of routine postoperative care. Routine vital signs and evaluation of the incision site are expected components of postoperative care. Since the gene for cystic fibrosis was identified in 1989, data can be collected for the purposes of genetic counseling for couples regarding carrier status. According to the most recent statistics, how often does cystic fibrosis occur in Caucasian live births? a. 1 in 100 b. 1 in 1000 c. 1 in 2000 d. 1 in 3200 - CORRECT ANSWER ANS: D Cystic fibrosis occurs in approximately 1 in 3200 Caucasian live births. 1 in 100, 1 in 1000, and 1 in 2000 occurrences of cystic fibrosis in live births are all too frequent rates. Which information regarding the care of antepartum women with cardiac conditions is most important for the nurse to understand? a. Stress on the heart is greatest in the first trimester and the last 2 weeks before labor. b. Women with class II cardiac disease should avoid heavy exertion and any activity that causes even minor symptoms. c. Women with class III cardiac disease should get 8 to 10 hours of sleep every day and limit housework, shopping, and exercise. d. Women with class I cardiac disease need bed rest through most of the pregnancy and face the possibility of hospitalization near term. - CORRECT ANSWER ANS: B Class II cardiac disease is symptomatic with ordinary activity. Women in this category need to avoid heavy exertion and limit regular activities as symptoms dictate. Stress is greatest between weeks 28 and 32 of gestation, when hemodynamic changes reach their maximum. Class III cardiac disease is symptomatic with less-than-ordinary activity. These women need bed rest most of the day and face the possibility of hospitalization near term. Class I cardiac disease is asymptomatic at normal levels of activity. These women can perform c. Monitoring her for 24 hours d. Using continuous EFM for a minimum of 4 hours - CORRECT ANSWER ANS: D Monitoring the external FHR and contractions is recommended after blunt trauma in a viable gestation for a minimum of 4 hours, regardless of injury severity. Fetal monitoring should be initiated as soon as the woman is stable. In this scenario, no clinical findings indicate the possibility of a ruptured spleen. If the maternal and fetal findings are normal, then EFM should continue for a minimum of 4 hours after a minor trauma or a minor automobile accident. Once the monitoring has been completed and the health care provider is reassured of fetal well-being, the client may be discharged home. Monitoring for 24 hours is unnecessary unless the ERM strip is abnormal or nonreassuring. Bell palsy is an acute idiopathic facial paralysis, the cause for which remains unknown. Which statement regarding this condition is correct? a. Bell palsy is the sudden development of bilateral facial weakness. b. Women with Bell palsy have an increased risk for hypertension. c. Pregnant women are affected twice as often as nonpregnant women. d. Bell palsy occurs most frequently in the first trimester. - CORRECT ANSWER ANS: B The clinical manifestations of Bell palsy include the development of unilateral facial weakness, pain surrounding the ears, difficulty closing the eye, and hyperacusis. The cause is unknown; however, Bell palsy may be related to a viral infection. Pregnant women are affected at a rate of three to five times that of nonpregnant women. The incidence rate peaks during the third trimester and puerperium. Women who develop Bell palsy in pregnancy have an increased risk for hypertension. A pregnant woman at term is transported to the emergency department (ED) after a severe vehicular accident. The obstetric nurse responds and rushes to the ED with a fetal monitor. Cardiopulmonary arrest occurs as the obstetric nurse arrives. What is the highest priority for the trauma team? a. Obtaining IV access, and starting aggressive fluid resuscitation b. Quickly applying the fetal monitor to determine whether the fetus viability c. Starting cardiopulmonary resuscitation (CPR) d. Transferring the woman to the surgical unit for an emergency cesarean delivery in case the fetus is still alive - CORRECT ANSWER ANS: C In a situation of severe maternal trauma, the systematic evaluation begins with a primary survey and the initial ABCs (airway, breathing, and circulation) of resuscitation. CPR is initiated first, followed by intravenous (IV) replacement fluid. After immediate resuscitation and successful stabilization measures, a more detailed secondary survey of the mother and fetus should be accomplished. Attempts at maternal resuscitation are made, followed by a secondary survey of the fetus. In the presence of multisystem trauma, a cesarean delivery may be indicated to increase the chance for maternal survival. Another common pregnancy-specific condition is pruritic urticarial papules and plaques of pregnancy (PUPPP). A client asks the nurse why she has developed this condition and what can be done. What is the nurse's best response? a. PUPPP is associated with decreased maternal weight gain. b. The rate of hypertension decreases with PUPPP. c. This common pregnancy-specific condition is associated with a poor fetal outcome. d. The goal of therapy is to relieve discomfort. - CORRECT ANSWER ANS: D PUPPP is associated with increased maternal weight gain, increased rate of twin gestation, and hypertension. It is not, however, associated with poor maternal or fetal outcomes. The goal of therapy is simply to relieve discomfort. Antipruritic topical medications, topical steroids, and antihistamines usually provide relief. PUPPP usually resolves before childbirth or shortly thereafter. It is extremely rare for a woman to die in childbirth; however, it can happen. In the United States, the annual occurrence of maternal death is 12 per 100,000 cases of live birth. What are the leading causes of maternal death? a. Embolism and preeclampsia b. Trauma and motor vehicle accidents (MVAs) c. Hemorrhage and infection d. Underlying chronic conditions - CORRECT ANSWER ANS: B Trauma is the leading cause of obstetric death in women of childbearing age. Most maternal injuries are the result of MVAs and falls. Although preeclampsia and embolism are significant contributors to perinatal morbidity, these are not the leading cause of maternal mortality. Maternal death caused by trauma may occur as the result of hemorrhagic shock or abruptio placentae. In these cases, the hemorrhage is the result of trauma, not childbirth. The wish to become a parent is not eliminated by a chronic health problem, and many women each year risk their lives to have a baby. Because of advanced pediatric care, many women are surviving childhood illnesses and reaching adulthood with chronic health problems such as cystic fibrosis, diabetes, and pulmonary disorders. Which congenital anomalies can occur as a result of the use of antiepileptic drugs (AEDs) in pregnancy? (Select all that apply.) a. Cleft lip b. Congenital heart disease c. Neural tube defects d. Gastroschisis e. Diaphragmatic hernia - CORRECT ANSWER ANS: A, B, C Congenital anomalies that can occur with AEDs include cleft lip or palate, congenital heart disease, urogenital defects, and neural tube defects. Carbamazepine and valproate should be avoided if all possible; they may cause neural tube defects. Congenital anomalies of gastroschisis and diaphragmatic hernia are not associated with the use of AEDs. A lupus flare-up during pregnancy or early postpartum occurs in 15% to 60% of women with this disorder. Which conditions associated with systemic lupus erythematosus (SLE) are maternal risks? (Select all that apply.) a. Miscarriage b. Intrauterine growth restriction (IUGR) c. Nephritis d. Preeclampsia e. Cesarean birth - CORRECT ANSWER ANS: A, C, D, E Maternal risks associated with SLE include miscarriage, nephritis, preeclampsia, and cesarean birth. IUGR is a fetal risk related to SLE. Other fetal risks include stillbirth and prematurity. the chance of fetal well-being. Trauma may affect a number of systems within the body, and being aware of normal system alterations in the pregnant woman is important for the nurse who is caring for this client. Care should be adapted according to the body system that has been injured. The effects of trauma on pregnancy are also influenced by the length of gestation, type and severity of the injuries, and the degree of disruption of uterine and fetal physiologic features. 3. ANS: D DIF: Cognitive Level: Apply REF: p. 732 TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity NOT: Immediate priorities for the stabilizat A woman arrives at the clinic seeking confirmation that she is pregnant. The following information is obtained: She is 24 years old with a body mass index (BMI) of 17.5. She admits to having used cocaine "several times" during the past year and occasionally drinks alcohol. Her blood pressure is 108/70 mm Hg. The family history is positive for diabetes mellitus and cancer. Her sister recently gave birth to an infant with a neural tube defect (NTD). Which characteristics places this client in a high-risk category? a. Blood pressure, age, BMI b. Drug and alcohol use, age, family history c. Family history, blood pressure (BP), BMI d. Family history, BMI, drug and alcohol abuse - CORRECT ANSWER ANS: D The woman's family history of an NTD, her low BMI, and her drug and alcohol use abuse are high risk factors of pregnancy. The woman's BP is normal, and her age does not put her at risk. Her BMI is low and may indicate poor nutritional status, which is a high risk. A 39-year-old primigravida woman believes that she is approximately 8 weeks pregnant, although she has had irregular menstrual periods all her life. She has a history of smoking approximately one pack of cigarettes a day; however, she tells the nurse that she is trying to cut down. Her laboratory data are within normal limits. What diagnostic technique would be useful at this time? a. Ultrasound examination b. Maternal serum alpha-fetoprotein (MSAFP) screening c. Amniocentesis d. Nonstress test (NST) - CORRECT ANSWER ANS: A An ultrasound examination could be performed to confirm the pregnancy and to determine the gestational age of the fetus. An MSAFP screening is performed at 16 to 18 weeks of gestation; therefore, it is too early in the woman's pregnancy to perform this diagnostic test. An amniocentesis is performed if the MSAFP levels are abnormal or if fetal or maternal anomalies are detected. An NST is performed to assess fetal well-being in the third trimester. The nurse sees a woman for the first time when she is 30 weeks pregnant. The client has smoked throughout the pregnancy, and fundal height measurements now are suggestive of intrauterine growth restriction (IUGR) in the fetus. In addition to ultrasound to measure fetal size, what is another tool useful in confirming the diagnosis? a. Doppler blood flow analysis b. Contraction stress test (CST) c. Amniocentesis d. Daily fetal movement counts - CORRECT ANSWER ANS: A Doppler blood flow analysis allows the examiner to study the blood flow noninvasively in the fetus and the placenta. It is a helpful tool in the management of high-risk pregnancies because of IUGR, diabetes mellitus, multiple fetuses, or preterm labor. Because of the potential risk of inducing labor and causing fetal distress, a CST is not performed on a woman whose fetus is preterm. Indications for an amniocentesis include diagnosis of genetic disorders or congenital anomalies, assessment of pulmonary maturity, and the diagnosis of fetal hemolytic disease, not IUGR. Fetal kick count monitoring is performed to monitor the fetus in pregnancies complicated by conditions that may affect fetal oxygenation. Although this may be a useful tool at some point later in this woman's pregnancy, it is not used to diagnose IUGR. A 41-week pregnant multigravida arrives at the labor and delivery unit after a NST indicated that her fetus could be experiencing some difficulties in utero. Which diagnostic tool yields more detailed information about the condition of the fetus? a. Ultrasound for fetal anomalies b. Biophysical profile (BPP) c. MSAFP screening d. Percutaneous umbilical blood sampling (PUBS) - CORRECT ANSWER ANS: B Real-time ultrasound permits a detailed assessment of the physical and physiologic characteristics of the developing fetus and a cataloging of normal and abnormal biophysical responses to stimuli. The BPP is a noninvasive, dynamic assessment of a fetus that is based on acute and chronic markers of fetal disease. An ultrasound for fetal anomalies would most likely have occurred earlier in the pregnancy. It is too late in the pregnancy to perform an MSAFP. Furthermore, it does not provide information related to fetal well-being. Indications for PUBS include prenatal diagnosis or inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection, determination of the acid-base status of the fetus with IUGR, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus. At 35 weeks of pregnancy, a woman experiences preterm labor. Although tocolytic medications are administered and she is placed on bed rest, she continues to experience regular uterine contractions and her cervix is beginning to dilate and efface. What is an important test for fetal well-being at this time? a. PUBS b. Ultrasound for fetal size c. Amniocentesis for fetal lung maturity d. NST - CORRECT ANSWER ANS: C Amniocentesis is performed to assess fetal lung maturity in the event of a preterm birth. The fluid is examined to determine the lecithin to sphingomyelin (L/S) ratio. Indications for PUBS include prenatal diagnosis or inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection, determination of the acid-base status of the fetus with IUGR, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus. Determination of fetal size by ultrasound is typically performed during the second trimester and is not indicated in this scenario. An NST measures the fetal response to fetal movement in a noncontracting mother. A 30-year-old gravida 3, para 2-0-0-2 is at 18 weeks of gestation. Which screening test should the nurse recommend be ordered for this client? a. BPP b. Chorionic villi sampling consistent, causal relation has been established between maternal smoking and reduced birth weight. Childbearing triggers profound and complex physiologic and psychologic changes on the mother. Evidence suggests a relationship between emotional distress and birth complications. Which information should nurses provide to expectant mothers when teaching them how to evaluate daily fetal movement counts (DFMCs)? a. Alcohol or cigarette smoke can irritate the fetus into greater activity. b. Kick counts should be taken every hour and averaged every 6 hours, with every other 6-hour stretch off. c. The fetal alarm signal should go off when fetal movements stop entirely for 12 hours. d. A count of less than four fetal movements in 1 hour warrants future evaluation. - CORRECT ANSWER ANS: C No movement in a 12-hour period is cause for investigation and possibly intervention. Alcohol and cigarette smoke temporarily reduce fetal movement. The mother should count fetal activity (kick counts) two or three times daily for 60 minutes each time. A count of less than 3 in 1 hour warrants further evaluation by a NST. In comparing the abdominal and transvaginal methods of ultrasound examination, which information should the nurse provide to the client? a. Both require the woman to have a full bladder. b. The abdominal examination is more useful in the first trimester. c. Initially, the transvaginal examination can be painful. d. The transvaginal examination allows pelvic anatomy to be evaluated in greater detail. - CORRECT ANSWER ANS: D The transvaginal examination allows pelvic anatomy to be evaluated in greater detail than the abdominal method and also allows intrauterine pregnancies to be diagnosed earlier. The abdominal examination requires a full bladder; the transvaginal examination requires an empty one. The transvaginal examination is more useful in the first trimester; the abdominal examination works better after the first trimester. Neither the abdominal nor the transvaginal method of ultrasound examination should be painful, although the woman will feel pressure as the probe is moved during the transvaginal examination. Which clinical finding is a major use of ultrasonography in the first trimester? a. Amniotic fluid volume b. Presence of maternal abnormalities c. Placental location and maturity d. Cervical length - CORRECT ANSWER ANS: B Ultrasonography can detect certain uterine abnormalities such as bicornuate uterus, fibroids, and ovarian cysts. Amniotic fluid volume, placental location and maturity, and cervical length are not available via ultrasonography until the second or third trimester. Which information is the highest priority for the nurse to comprehend regarding the BPP? a. BPP is an accurate indicator of impending fetal well-being. b. BPP is a compilation of health risk factors of the mother during the later stages of pregnancy. c. BPP consists of a Doppler blood flow analysis and an amniotic fluid index (AFI). d. BPP involves an invasive form of an ultrasonic examination. - CORRECT ANSWER ANS: A An abnormal BPP score is one indication that labor should be induced. The BPP evaluates the health of the fetus, requires many different measures, and is a noninvasive procedure. A client in the third trimester has just undergone an amniocentesis to determine fetal lung maturity. Which statement regarding this testing is important for the nurse in formulating a care plan? a. Because of new imaging techniques, an amniocentesis should have been performed in the first trimester. b. Despite the use of ultrasonography, complications still occur in the mother or infant in 5% to 10% of cases. c. Administration of Rho(D) immunoglobulin may be necessary. d. The presence of meconium in the amniotic fluid is always a cause for concern. - CORRECT ANSWER ANS: C As a result of the possibility of fetomaternal hemorrhage, administration of Rho(D) immunoglobulin is the standard of practice after amniocentesis for women who are Rh negative. Amniocentesis is possible after the 14th week of pregnancy when the uterus becomes an abdominal organ. Complications occur in less than 1% of cases; many have been minimized or eliminated through the use of ultrasonography. Meconium in the amniotic fluid before the beginning of labor is not usually a problem. Which information is an important consideration when comparing the CST with the NST? a. The NST has no known contraindications. b. The CST has fewer false-positive results when compared with the NST. c. The CST is more sensitive in detecting fetal compromise, as opposed to the NST. d. The CST is slightly more expensive than the NST. - CORRECT ANSWER ANS: A The CST has several contraindications. The NST has a high rate of false-positive results and is less sensitive than the CST but relatively inexpensive. The nurse is planning the care for a laboring client with diabetes mellitus. This client is at greater risk for which clinical finding? a. Oligohydramnios b. Polyhydramnios c. Postterm pregnancy d. Chromosomal abnormalities - CORRECT ANSWER ANS: B Polyhydramnios or amniotic fluid in excess of 2000 ml is 10 times more likely to occur in the client with diabetes mellitus rather than in nondiabetic pregnancies. This complication places the mother at risk for premature rupture of membranes, premature labor, and postpartum hemorrhage. Prolonged rupture of membranes, IUGR, intrauterine fetal death, and renal agenesis (Potter syndrome) place the client at risk for developing oligohydramnios. Anencephaly, placental insufficiency, and perinatal hypoxia contribute to the risk for postterm pregnancy. Maternal age older than 35 years and balanced translocation (maternal and paternal) are risk factors for chromosomal abnormalities. a. 4 b. 8 c. 10 d. 14 - CORRECT ANSWER ANS: C CVS can be performed in the first or second trimester, ideally between 10 and 13 weeks of gestation. During this procedure, a small piece of tissue is removed from the fetal portion of the placenta. If performed after 9 completed weeks of gestation, then the risk of limb reduction is no greater than in the general population. Which nursing intervention is necessary before a first-trimester transabdominal ultrasound? a. Place the woman on nothing by mouth (nil per os [NPO]) for 12 hours. b. Instruct the woman to drink 1 to 2 quarts of water. c. Administer an enema. d. Perform an abdominal preparation. - CORRECT ANSWER ANS: B When the uterus is still in the pelvis, visualization may be difficult. Performing a first-trimester transabdominal ultrasound requires the woman to have a full bladder, which will elevate the uterus upward and provide a better visualization of the fetus; therefore, being NPO is not appropriate. Neither an enema nor an abdominal preparation is necessary for this procedure. How does the nurse document a NST during which two or more FHR accelerations of 15 beats per minute or more occur with fetal movement in a 20-minute period? a. Nonreactive b. Positive c. Negative d. Reactive - CORRECT ANSWER ANS: D The NST is reactive (normal) when two or more FHR accelerations of at least 15 beats per minute (each with a duration of at least 15 seconds) occur in a 20- minute period. A nonreactive result means that the heart rate did not accelerate during fetal movement. A positive result is not used with NST. CST uses positive as a result term. A negative result is not used with NST. CST uses negative as a result term. The indirect Coombs' test is a screening tool for Rh incompatibility. If the titer is greater than ______, amniocentesis may be a necessary next step. a. 1:2 b. 1:4 c. 1:8 d. 1:12 - CORRECT ANSWER ANS: C If the maternal titer for Rh antibodies is greater 1:8, then an amniocentesis is indicated to determine the level of bilirubin in the amniotic fluid. This testing will determine the severity of fetal hemolytic anemia. IUGR is associated with which 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 - CORRECT ANSWER ANS: A, B, C, E Poor nutrition, maternal collagen disease, gestational hypertension, and smoking are risk factors associated with the occurrence of IUGR. Premature rupture of membranes is associated with preterm labor, not IUGR. Which assessments are included in the fetal BPP? (Select all that apply.) a. Fetal movement b. Fetal tone c. Fetal heart rate d. AFI e. Placental grade - CORRECT ANSWER ANS: A, B, C, D Fetal movement, tone, heart rate, and AFI are all assessed in a BPP. The placental grade is determined by ultrasound and is not included in the criteria of assessment factors for a BPP. Transvaginal ultrasonography is often performed during the first trimester. While preparing a 6-week gestational client for this procedure, she expresses concerns over the necessity for this test. The nurse should explain that this diagnostic test may be indicated for which situations? (Select all that apply.) a. Multifetal gestation b. Obesity c. Fetal abnormalities d. Amniotic fluid volume e. Ectopic pregnancy - CORRECT ANSWER ANS: A, B, C, E Transvaginal ultrasound is useful in women who are obese whose thick abdominal layers cannot be penetrated with traditional abdominal ultrasound. This procedure is also used to identify multifetal gestation, ectopic pregnancy, estimating gestational age, confirming fetal viability, and identifying fetal abnormalities. Amniotic fluid volume is assessed during the second and third trimester; conventional ultrasound would be used. Cell-free deoxyribonucleic acid (DNA) screening is a new method of noninvasive prenatal testing (NIPT) that has recently become available in the clinical setting. This technology can provide a definitive diagnosis of which findings? (Select all that apply a. Fetal Rh status b. Fetal gender c. Maternally transmitted gene disorder d. Paternally transmitted gene disorder e. Trisomy 21 - CORRECT ANSWER ANS: A, B, D, E The NIPT cannot actually distinguish fetal from maternal DNA. It can determine fetal Rh status, gender, trisomies 13, 18, and 21, as well as paternally transmitted gene disorders. The test can be performed any time after 10 weeks of gestation and is recommended for women who have previously given birth to a child with chromosomal abnormalities. Biophysical risks include factors that originate with either the mother or the fetus and affect the functioning of either one or both. The nurse who provides prenatal care should have an understanding of these risk factors. Match the specific pregnancy problem with the related risk factor. a. Polyhydramnios 6. A woman has come to the clinic for preconception counseling because she wants to start trying to get pregnant. Which guidance should she expect to receive? a. Discontinue all contraception now. b. Lose weight so that you can gain more during pregnancy. c. You may take any medications you have been regularly taking. d. Make sure you include adequate folic acid in your diet. - CORRECT ANSWER D 7. To prevent gastrointestinal (GI) upset, when should a pregnant client be instructed to take the recommended iron supplements? a. On a full stomach b. At bedtime c. After eating a meal d. With milk - CORRECT ANSWER B 8. After the nurse completes nutritional counseling for a pregnant woman, she asks the client to repeat the instructions to assess the clients understanding. Which statement indicates that the client understands the role of protein in her pregnancy? a. Protein will help my baby grow. b. Eating protein will prevent me from becoming anemic. c. Eating protein will make my baby have strong teeth after he is born. d. Eating protein will prevent me from being diabetic. - CORRECT ANSWER A 9. Pregnant adolescents are at greater risk for decreased BMI and fad dieting with which condition? a. Obesity b. Gestational diabetes c. Low-birth-weight babies d. High-birth-weight babies - CORRECT ANSWER C 10. Maternal nutritional status is an especially significant factor of the many that influence the outcome of pregnancy. Why is this the case? a. Maternal nutritional status is extremely difficult to adjust because of an individuals ingrained eating habits. b. Adequate nutrition is an important preventive measure for a variety of problems. c. Women love obsessing about their weight and diets. d. A womans preconception weight becomes irrelevant. - CORRECT ANSWER B 11. With regard to weight gain during pregnancy, the nurse should be aware of which important information? a. In pregnancy, the womans height is not a factor in determining her target weight. b. Obese women may have their health concerns, but their risk of giving birth to a child with major congenital defects is the same as with women of normal weight. c. Women with inadequate weight gain have an increased risk of delivering a preterm infant with intrauterine growth restriction (IUGR). d. Greater than expected weight gain during pregnancy is almost always attributable to old-fashioned overeating. - CORRECT ANSWER C 12. Which nutritional recommendation regarding fluids is accurate? a. A womans daily intake should be six to eight glasses of water, milk, and/or juice. b. Coffee should be limited to no more than 2 cups, but tea and cocoa can be consumed without worry. c. Of the artificial sweeteners, only aspartame has not been associated with any maternity health concerns. d. Water with fluoride is especially encouraged because it reduces the childs risk of tooth decay. - CORRECT ANSWER A 13. Which minerals and vitamins are usually recommended as a supplement in a pregnant clients diet? a. Fat-soluble vitamins A and D b. Water-soluble vitamins C and B6 c. Iron and folate d. Calcium and zinc - CORRECT ANSWER C 14. Which vitamins or minerals may lead to congenital malformations of the fetus if taken in excess by the mother? a. Zinc b. Vitamin D c. Folic acid d. Vitamin A - CORRECT ANSWER D 15. While obtaining a diet history, the nurse might be told that the expectant mother has cravings for ice chips, cornstarch, and baking soda. Which nutritional problem does this behavior indicate? a. Preeclampsia b. Pyrosis c. Pica d. Purging - CORRECT ANSWER C 16. Assessment of a womans nutritional status includes a diet history, medication regimen, physical examination, and relevant laboratory tests. Which finding might require consultation to a higher level of care? a. Oral contraceptive use may interfere with the absorption of iron b. Illnesses that have created nutritional deficits, such as PKU, may require nutritional care before conception. c. The womans socioeconomic status and educational level are not relevant to her examination; they are the province of the social worker. d. Testing for diabetes is the only nutrition-related laboratory test most pregnant women need. - CORRECT ANSWER B 17. Which guidance might the nurse provide for a client with severe morning sickness? a. Trying lemonade and potato chips b. Drinking plenty of fluids early in the day c. Immediately brushing her teeth after eating d. Never snacking before bedtime - CORRECT ANSWER A 18. Many clients are concerned about the increased levels of mercury in fish and may be reluctant to include this source of nutrients in their diet. What is the best advice for the nurse to provide? a. Canned white tuna is a preferred choice. b. Shark, swordfish, and mackerel should be avoided. c. Fish caught in local waterways is the safest. d. Salmon and shrimp contain high levels of mercury. - CORRECT ANSWER B 19. Nutrition is an alterable and important preventive measure for a variety of potential problems such as low birth weight and prematurity. While completing a. 5 b. 10 c. 25 d. 30 - CORRECT ANSWER C 29. Which action is the first priority for the nurse who is assessing the influence of culture on a clients diet? a. Evaluate the clients weight gain during pregnancy. b. Assess the socioeconomic status of the client. c. Discuss the four food groups with the client. d. Identify the food preferences and methods of food preparation common to the clients culture. - CORRECT ANSWER D 30. The nurse has formulated a diagnosis of Imbalanced nutrition: Less than body requirements for the client. Which goal is most appropriate for this client to obtain? a. Gain a total of 30 pounds. b. Consistently take daily supplements. c. Decrease her intake of snack foods. d. Increase her intake of complex carbohydrates. - CORRECT ANSWER A 31. Which action is the highest priority for the nurse when educating a pregnant adolescent? a. Emphasize the need to eliminate common teenage snack foods because they are high in fat and sodium. b. Determine the weight gain needed to meet adolescent growth, and add 35 pounds. c. Suggest that she not eat at fast-food restaurants to avoid foods of poor nutritional value. d. Realize that most adolescents are unwilling to make dietary changes during pregnancy. - CORRECT ANSWER B 1. Most women with uncomplicated pregnancies can use the nurse as their primary source for nutritional information. However, the nurse or midwife may need to refer a client to a registered dietitian for in-depth nutritional counseling. Which conditions would require such a consultation? (Select all that apply.) a. Preexisting or gestational illness such as diabetes b. Ethnic or cultural food patterns c. Obesity d. Vegetarian diets e. Multifetal pregnancy - CORRECT ANSWER A, B, C, D 2. Foodborne illnesses can cause adverse effects for both mother and fetus. The nurse is in an ideal position to evaluate the clients knowledge regarding steps to prevent a foodborne illness. The nurse asks the client to teach back the fours simple steps of food preparation. What are they? (Select all that apply.) a. Purchase b. Clean c. Separate d. Cook e. Chill - CORRECT ANSWER B, C, D, E Ideally, when should prenatal care begin? a. Before the first missed menstrual period b. After the first missed menstrual period c. After the second missed menstrual period d. After the third missed menstrual period - CORRECT ANSWER ANS: B Prenatal care should begin soon after the first missed menstrual period. This offers the greatest opportunities to ensure the health of the expectant mother and her infant. Prenatal care before missing the first menstrual period is too early. It is unlikely the woman is even aware of the pregnancy. Ideally, prenatal visits should begin soon after the first period is missed. Beginning prenatal care after the third missed menstrual period is too late. The woman will have completed the first trimester by that time. A woman arrives at the clinic for a pregnancy test. Her last menstrual period (LMP) was February 14, 2015. What is the client's expected date of birth (EDB)? a. September 17, 2015 b. November 7, 2015 c. November 21, 2015 d. December 17, 2015 - CORRECT ANSWER ANS: C Using the Nägele's rule, the EDB is calculated by subtracting 3 months from the month of the LMP and adding 7 days + 1 year to the day of the LMP. Therefore, with an LMP of February 14, 2015, her due date is November 21, 2015. September 17, 2015, is too short a period to complete a normal pregnancy. Using the Nägele's rule, an EDB of November 7, 2015, is 2 weeks early. December 17, 2015, is almost a month past the correct EDB. Which women should undergo prenatal testing for the human immunodeficiency virus (HIV)? a. All women, regardless of risk factors b. Women who have had more than one sexual partner c. Women who have had a sexually transmitted infection (STI) d. Woman who are monogamous with one partner - CORRECT ANSWER ANS: A An HIV test is recommended for all women, regardless of risk factors. The incidence of perinatal transmission from an HIV-positive mother to her fetus ranges from 25% to 35%. Women who test positive for HIV can then be treated. Which sign or symptom is considered a first-trimester warning sign and should be immediately reported by the pregnant woman to her health care provider? a. Nausea with occasional vomiting b. Fatigue c. Urinary frequency d. Vaginal bleeding - CORRECT ANSWER ANS: D Signs and symptoms that must be reported include severe vomiting, fever and chills, burning on urination, diarrhea, abdominal cramping, and vaginal bleeding. These symptoms may be signs of complications of the pregnancy. Nausea with occasional vomiting is a normal first-trimester complaint. Although it may be worrisome or annoying to the mother, it is not usually an indication of a problem with the pregnancy. Fatigue is common during the first trimester. Because of physiologic changes that happen during pregnancy, clients should be taught that urinary frequency is normal. Which client might be well advised to continue condom use during intercourse throughout her pregnancy? encourage the client to keep all appointments; however, this is not the most important role during the pregnancy. During the first trimester, which of the following changes regarding her sexual drive should a client be taught to expect? a. Increased sexual drive, because of enlarging breasts b. Decreased sexual drive, because of nausea and fatigue c. No change in her sexual drive d. Increased sexual drive, because of increased levels of female hormones - CORRECT ANSWER ANS: B A pregnant woman usually experiences a decrease, not an increase, in libido during the first trimester. Maternal physiologic changes, such as breast enlargement, nausea, fatigue, abdominal changes, perineal enlargement, leukorrhea, pelvic vasocongestion, and orgasmic responses, may affect sexuality and sexual expression. Libido may be depressed in the first trimester but often increases during the second and third trimesters. During pregnancy, the breasts may become enlarged and tender, which tends to interfere with coitus, thereby decreasing the desire to engage in sexual activity. A 3-year-old girl's mother is 6 months pregnant. What concern is this child most likely to verbalize? a. How the baby will get out? b. How will the baby eat? c. Will you die having the baby? d. What color eyes will the baby have? - CORRECT ANSWER ANS: B By age 3 or 4 years, children like to be told the story of their own beginning and accept it being compared with the present pregnancy. They like to listen to the fetal heartbeat and feel the baby move. Sometimes they worry about how the baby is being fed and what it will wear. School-age children take a more clinical interest in their mother's pregnancy and may want to know "How did the baby get in there?" and "How will it get out?" Whether the child's mother will die does not tend to be the focus of her questions about the impending birth of a sibling. The baby's eye color does not tend to be the focus of children's questions about the impending birth of a sibling. In her work with pregnant women of different cultures, a nurse practitioner has observed various practices that seemed unfamiliar. The nurse practitioner has learned that cultural rituals and practices during pregnancy seem to have one purpose in common. Which statement best describes that purpose? a. To promote family unity b. To ward off the "evil eye" c. To appease the gods of fertility d. To protect the mother and fetus during pregnancy - CORRECT ANSWER ANS: D Although many cultures consider pregnancy normal, certain practices are expected of women of all cultures to ensure a good outcome. Cultural prescriptions tell women what to do, and cultural proscriptions establish taboos. The purposes of these practices are to prevent maternal illness resulting from a pregnancy-induced imbalanced state and to protect the vulnerable fetus. Promoting family unity is important, although not usually the premise for cultural rituals and practices. Warding off the "evil eye" may be specific to one particular culture; however, it is not the primary purpose of these practices. Appeasing the gods of fertility is not the impetus behind cultural rituals. A client has arrived for her first prenatal appointment. She asked the nurse to explain exactly how long the pregnancy will be. What is the nurse's best response? a. Normal pregnancy is 10 lunar months. b. Pregnancy is made up of four trimesters. c. Pregnancy is considered term at 36 weeks. d. Estimated date of delivery (EDD) is 40 completed weeks. - CORRECT ANSWER ANS: A Pregnancy spans 9 calendar months; but, health care providers prefer to use the lunar month of 28 days or 4 weeks. Pregnancy consists of three trimesters, each approximately 13 weeks long. A pregnancy is considered term at 37 completed weeks; however, EDD is based upon 40 weeks of gestation. What should the nurse be cognizant of concerning the client's reordering of personal relationships during pregnancy? a. Because of the special motherhood bond, a woman's relationship with her mother is even more important than with the father of the child. b. Nurses need not get involved in any sexual issues the couple has during pregnancy, particularly if they have trouble communicating them to each other. c. Women usually express two major relationship needs during pregnancy: feeling loved and valued and having the child accepted by the father. d. The woman's sexual desire is likely to be highest in the first trimester because of the excitement and because intercourse is physically easier. - CORRECT ANSWER ANS: C Love and support help a woman feel better about her pregnancy. The most important person to the pregnant woman is usually the father of the child. Nurses can facilitate communication between partners about sexual matters if, as is common, they are nervous about expressing their worries and feelings to one another. The second trimester is the time when a woman's sense of well-being, along with certain physical changes, increases her desire for sex. Sexual desire is down in the first and third trimesters. What represents a typical progression through the phases of a woman's establishing a relationship with the fetus? a. Accepts the fetus as distinct from herself—accepts the biologic fact of pregnancy—has feelings of caring and responsibility. b. Fantasizes about the child's gender and personality—views the child as part of herself—becomes introspective. c. Views the child as part of herself—has feelings of well-being—accepts the biologic fact of the pregnancy. d. "I am pregnant"—"I am going to have a baby"—"I am going to be a mother." - CORRECT ANSWER ANS: D The woman first centers on herself as pregnant, then on the baby as an entity separate from herself, and then on her responsibilities as a mother. The expressions "I am pregnant," "I am going to have a baby," and "I am going to be a mother" sum up the progression through the three phases. In phase one, the woman views the child as part of herself and not as a separate being. This is only the first step of the progression through phases of attachment. Accepting the fetus as distinct from herself occurs during the second phase of emotional attachment. Fantasizing about the child's sex and personality based on fetal activity occurs during the third phase of attachment. d. The size of the uterus is discounted in the initial examination because it will be increasing in size during the second trimester. - CORRECT ANSWER ANS: B The nurse should instruct the client to empty her bladder. An empty bladder facilitates the examination and also provides an opportunity to obtain a urine sample for a number of tests. All women should be assessed for a history of physical abuse, particularly because the likelihood of abuse increases during pregnancy. Noting body hair is important because body hair reflects nutritional status, endocrine function, and hygiene. Particular attention is paid to the size of the uterus because it is an indication of the duration of gestation. A woman who is 16 weeks pregnant has come in for a follow-up visit with her significant other. To reassure the client regarding fetal well-being, which is the highest priority action for the nurse to perform? a. Assess the fetal heart tones with a Doppler stethoscope. b. Measure the girth of the woman's abdomen. c. Complete an ultrasound examination (sonogram). d. Offer the woman and her family the opportunity to listen to the fetal heart tones. - CORRECT ANSWER ANS: D To provide the parents with the greatest sense of reassurance, the nurse should offer to have the client and her significant other the chance to listen to their baby's heartbeat. A fetoscope can detect the fetal heart rate around 20 weeks of gestation. Doppler can detect the fetal heart rate between 10 and 12 weeks and should be performed as part of routine fetal assessment. Abdominal girth is not a valid measure for determining fetal well-being. Fundal height is an important measure that should be determined with precision, with the same technique and positioning of the client consistently used at every prenatal visit. Routine ultrasound examinations are recommended in early pregnancy; they date the pregnancy and provide useful information about the health of the fetus. However, they are not necessary at each prenatal visit. What is the primary role of the doula during labor? a. Helps the woman perform Lamaze breathing techniques and to provide support to the woman and her partner b. Checks the fetal monitor tracing for effects of the labor process on the fetal heart rate c. Takes the place of the father as a coach and support provider d. Administers pain medications as needed by the woman - CORRECT ANSWER ANS: A A doula is professionally trained to provide labor support, including physical, emotional, and informational support, to both the woman and her partner during labor and the birth. The doula does not become involved with clinical tasks. A client at 34 weeks of gestation seeks guidance from the nurse regarding personal hygiene. Which information should the nurse provide? a. Tub bathing is permitted even in late pregnancy unless membranes have ruptured. b. The perineum should be wiped from back to front. c. Bubble bath and bath oils are permissible because they add an extra soothing and cleansing action to the bath. d. Expectant mothers should use specially treated soap to cleanse the nipples. - CORRECT ANSWER ANS: A The primary danger from taking baths is falling in the tub. The perineum should be wiped from front to back. Bubble baths and bath oils should be avoided because they may irritate the urethra. Soap, alcohol, ointments, and tinctures should not be used to cleanse the nipples because they remove protective oils. Warm water is sufficient. The client is instructed to place her thumb and forefinger on the areola and gently press inward. What is the purpose of this exercise? a. To check the sensitivity of the nipples b. To determine whether the nipple is everted or inverted c. To calculate the adipose buildup in the abdomen d. To see whether the fetus has become inactive - CORRECT ANSWER ANS: B Sometimes known as the pinch test, this exercise is used to determine whether the nipple is everted or inverted. Nipples must be everted to allow breastfeeding. The pinch does not determine the level of sensitivity of the nipples, nor is it not used to determine the level of adipose tissue in the abdomen. Fetal activity is not determined by using the pinch test. Dental care during pregnancy is an important component of good prenatal care. Which instruction regarding dental health should the nurse provide? a. Regular brushing and flossing may not be necessary during early pregnancy because it may stimulate the woman who is already nauseated to vomit. A cleaning is all that is necessary. b. Dental surgery, in particular, is contraindicated during pregnancy and should be delayed until after delivery. c. If dental treatment is necessary, then the woman will be most comfortable with it in the second trimester. d. If a woman has dental anxiety, then dental care may interfere with the expectant mother's need to practice conscious relaxation and to prepare for labor. - CORRECT ANSWER ANS: C The second trimester is the best time for dental treatment because the woman will be able to sit most comfortably in the dental chair. Dental care, such as brushing with a fluoride toothpaste, is especially important during pregnancy. Periodontal disease has been linked to both preterm labor and low-birth-weight (LBW) infants. Emergency dental surgery is permissible; however, the mother must clearly understand the risks and benefits. Conscious relaxation is useful and may even help the woman get through any dental appointments, but it is not a reason to avoid them. Many pregnant women have questions regarding work and travel during pregnancy. Which education is a priority for the nurse to provide? a. Women should sit for as long as possible and cross their legs at the knees from time to time for exercise. b. Women should avoid seat belts and shoulder restraints in the car because they press on the fetus. c. Metal detectors at airport security checkpoints can harm the fetus if the woman passes through them a number of times. d. While working or traveling in a car or on an airplane, women should arrange to walk around at least every hour or so. - CORRECT ANSWER ANS: D Periodic walking helps prevent thrombophlebitis. Pregnant women should avoid sitting or standing for long periods and crossing the legs at the knees. Pregnant women must wear lap belts and shoulder restraints. The most common injury to a. She keeps all prenatal appointments. b. She "eats for two." c. She slowly drives her car. d. She wears only low-heeled shoes. - CORRECT ANSWER ANS: A The goal of prenatal care is to foster a safe birth for the infant and mother. Although properly eating, carefully driving, and using proper body mechanics all are healthy measures that a mother can take, obtaining prenatal care is the optimal method for providing safety for both herself and her baby. What type of cultural concern is the most likely deterrent to many women seeking prenatal care? a. Religion b. Modesty c. Ignorance d. Belief that physicians are evil - CORRECT ANSWER ANS: B A concern for modesty is a deterrent to many women seeking prenatal care. For some women, exposing body parts, especially to a man, is considered a major violation of their modesty. Many cultural variations are found in prenatal care. Even if the prenatal care described is familiar to a woman, some practices may conflict with the beliefs and practices of a subculture group to which she belongs. The nurse working with pregnant clients must seek to gain understanding of the process whereby women accept their pregnancy. Which statement regarding this process is most accurate? a. Nonacceptance of the pregnancy very often equates to a rejection of the child. b. Mood swings are most likely the result of worries about finances and a changed lifestyle, as well as profound hormonal changes. c. Ambivalent feelings during pregnancy are usually only expressed in emotionally immature or very young mothers. d. Conflicts such as not wanting to be pregnant or childrearing and career-related decisions need not be addressed during pregnancy because they will naturally resolve themselves after birth. - CORRECT ANSWER ANS: B Mood swings are natural and are likely to affect every woman to some degree. A woman may dislike being pregnant, refuse to accept it, and still love and accept the child. Ambivalent feelings about pregnancy are normal for the mature or immature woman and for the younger or older woman. Conflicts such as not wanting to be pregnant or childrearing and career-related decisions need to be resolved. The baby ends the pregnancy but not all the issues. What is important for the nurse to recognize regarding the new father and his acceptance of the pregnancy and preparation for childbirth? a. The father goes through three phases of acceptance of his own. b. The father's attachment to the fetus cannot be as strong as that of the mother because it does not start until after the birth. c. In the last 2 months of pregnancy, most expectant fathers suddenly get very protective of their established lifestyle and resist making changes to the home. d. Typically, men remain ambivalent about fatherhood right up to the birth of their child. - CORRECT ANSWER ANS: A A father typically goes through three phases of development to reach acceptance of fatherhood: the announcement phase, the moratorium phase, and the focusing phase. The father-child attachment can be as strong as the mother-child relationship and can also begin during pregnancy. During the last 2 months of the pregnancy, many expectant fathers work hard to improve the environment of the home for the child. Typically, the expectant father's ambivalence ends by the first trimester, and he progresses to adjusting to the reality of the situation and then to focusing on his role. Which consideration is essential for the nurse to understand regarding follow-up prenatal care visits? a. The interview portions become more intensive as the visits become more frequent over the course of the pregnancy. b. Monthly visits are scheduled for the first trimester, every 2 weeks for the second trimester, and weekly for the third trimester. c. During the abdominal examination, the nurse should be alert for supine hypotension. d. For pregnant women, a systolic BP of 130 mm Hg and a diastolic BP of 80 mm Hg is sufficient to be considered hypertensive. - CORRECT ANSWER ANS: C The woman lies on her back during the abdominal examination, possibly compressing the vena cava and aorta, which can cause a decrease in BP and a feeling of faintness. The interview portion of the follow-up examinations is less extensive than in the initial prenatal visits, during which so much new information must be gathered. Monthly visits are routinely scheduled for the first and second trimesters; visits increase to every 2 weeks at week 28 and to once a week at week 36. For pregnant women, hypertension is defined as a systolic BP of 140 mm Hg or higher and a diastolic BP of 90 mm Hg or higher. With regard to medications, herbs, boosters, and other substances normally encountered by pregnant women, what is important for the nurse to be aware of? a. Both 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 observed in the final trimester. c. Killed-virus vaccines (e.g., tetanus) should not be administered 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. - CORRECT ANSWER ANS: A Both prescription and OTC drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus. 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, during which 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. Which statement regarding multifetal pregnancy is incorrect? a. The expectant mother often develops anemia because the fetuses have a greater demand for iron. b. Twin pregnancies come to term with the same frequency as single pregnancies. c. The mother should be counseled to increase her nutritional intake and gain more weight. d. Backache and varicose veins often are more pronounced with a multifetal pregnancy. - CORRECT ANSWER ANS: B