Test Bank For Introductory Maternity & Pediatric Nursing 5th edition Nancy Hatfield, Exams of Nursing

Download Test Bank For Introductory Maternity & Pediatric Nursing 5th edition Nancy Hatfield and more Exams Nursing in PDF only on Docsity! Chapter 1: The Nurse's Role in a Changing Maternal–Child Health Care Environment Hatfield: Introductory Maternity and Pediatric Nursing, 5th Edition 1. The opening up of hospital visiting policies for children and families likely resulted from the work of which individual? A. Joseph Brennaman B. John Bowlby C. Marshal Klaus D. John Kennell Answer: B Rationale: In 1951, John Bowlby received worldwide attention with his study that revealed the negative results of the separation of child and mother because of hospitalization. His work led to a re-evaluation and liberalization of hospital visiting policies for children. Joseph Brennaman suggested that a lack of stimulation for infants contributed to high infant mortality rates at the time. In the 1970s and 1980s, physicians Marshall Klaus and John Kennell carried out important studies on the effect of the separation of newborns and parents. They established that early separation may have long-term effects on family relationships and that offering the new family an opportunity to be together at birth and for a significant period after birth may provide benefits that last well into early childhood. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Remember Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 4 2. An expectant mother states that she read that more black mothers die in childbirth than do white mothers. When responding to her questions about the reasons for this, the nurse accurately states that which is the major reason for the high maternal mortality rate? A. Having formal education. B. Being unmarried. C. Income. D. Lack of prenatal care. Answer: D Rationale: Research shows that maternal mortality rate is directly related to lack of prenatal care secondary to lack of access to services or insurance. Income as well as educational level may play a role in the availability of health care, but they are not directly responsible. Being unmarried has no bearing on infant mortality. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Understand Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 9 3. Which statement correctly defines the term "infant death rate"? A. number of deaths in utero of fetuses 500 g or more per 1,000 live births B. number of deaths occurring in the first 28 days of life per 1,000 live births C. number of deaths occurring at birth or in the first 12 months of life per 1,000 live births D. death of a live-born child before his or her first birthday. Answer: D Rationale: The term infant death refers to the death of a live-born child before he or she reaches age 1 year. It also includes neonatal mortality rate. Neonatal mortality rate is the number of infant deaths during the first 28 days of life for every 1,000 live births. Infant mortality rate is the number of deaths during the first 12 months of life per 1,000 live births. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Remember Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 9 4. The nursing instructor is preparing to teach a group of students about the history of maternity care. What major development will the instructor emphasize as greatly influencing the practice of maternity care in the United States over the past century? A. technologic advances and the use of forceps by primary care providers B. development of anesthesia and acceptance of the germ theory C. advent of birthing centers and the development of family-centered care D. development of pediatric specialty and replacement of midwives as primary birth attendants Answer: B Rationale: The emphasis should be placed on anesthesia and the germ theory. The development of anesthesia allowed women a choice for pain management in birth; the germ theory advanced the progress of general health care and decreased infections in laboring women. Pediatrics as a specialty is an important step forward but is not the greatest development, and midwives are still in practice. Maternity care continues to evolve, and birthing centers are still under development. Forceps are not considered an advance in maternity care. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance Reference: p. 5 9. A group of nursing students are examining the data of the local hospitals to determine the potential maternal needs of the community. Which factor will be the best statistical indicator of the adequacy of prenatal care? A. Number of prenatal visits B. Maternal mortality rate C. Infant mortality rate D. Infant measurements at birth Answer: B Rationale: Maternal mortality rate is the best indicator of a country's level of prenatal care. Increases in prenatal care result in a decrease in maternal mortality. Infant mortality is a reflection of postnatal care. Infant mortality includes all infant deaths from birth to 12 months and can be the result of congenital anomalies, genetic anomalies, or other problems. The number of prenatal visits and measurements of the infant at birth are not the best indicators as they do not accurately reflect the health of the mother. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 9 10. The nurse is teaching a client about lifestyle changes that could help the client reach a higher level of wellness. The nurse is engaged in which aspect of care? A. Infection prevention B. Cost containment C. Health promotion D. Illness treatment Answer: C Rationale: By encouraging healthy lifestyle changes, the nurse is engaging in health promotion activities. Health promotion involves helping people make lifestyle changes to move them to higher levels of wellness. Health promotion includes all aspects of health: physical, mental, emotional, social, and spiritual. Although health promotion can help to contain costs over a longer span, this is not what the nurseis doing. Healthy lifestyle changes are not part of infection prevention or illness treatment. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 7 11. A young female client is pregnant for the first time and is uncertain who to seek prenatal care from. The nurse should point out which health care provider as the likely choice? A. Perinatologist B. Neonatologist C. Family practitioner D. Obstetrician Answer: D Rationale: The obstetrician is the common choice for prenatal care through labor and delivery. Perinatologists may care for women who have a high-risk pregnancy, and neonatologists provide care to infants. Family practitioner physicians may provide care but are less likely to attend in labor and delivery. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Understand Client Needs: Health Promotion and Maintenance Integrated Process: Caring Reference: p. 3 12. While preparing to teach a group of nursing students the history of maternity care, which factor will the instructor include to explain as the etiology of most infections in females after birthing in the 1700s? A. Reproductive tract infection B. Breast infection C. Kidney infection D. Urinary tract infection Answer: A Rationale: Prior to the germ theory, women most often died of puerperal fever, an illness marked by high fever caused by infection of the reproductive tract after delivering infants. Women who delivered in hospitals were more likely to develop this infection than women who delivered at home. Breast infections occurred during breast feeding but were not usually fatal. There was no greater incidence of kidney or urinary tract infections. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Safety and Infection Control Integrated Process: Teaching/Learning Reference: p. 3-4 13. A group of nursing students are comparing the various changes in maternity care over the course of history and discover that the development of what medical treatment was most influential in moving birth from the home into the hospital setting? A. Infection control and germ theory B. Planned cesarean birth C. Instruments to assist in birth of infants D. Anesthesia and analgesic therapy Answer: D Rationale: Movement from the home to the hospital for the birth of infants began with the use of medications to control pain during labor. This trend started with the wealthy and followed to include more of society. Cesarean births are a more recent development than the advent of anesthesia. Infection control could be maintained at home, so it was not a driving force. The use of instruments developed along with cesarean technology. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Apply Client Needs: Physiological Integrity: Basic Care and Comfort Integrated Process: Teaching/Learning Reference: p. 3 14. The nursing instructor is teaching a group of students about the history of maternity and family care. The instructor determines the session is successful when the students correctly choose which major change resulting from research by Klaus and Kennell? A. Limited family visits for children in the hospital B. Family-centered care of today C. Rooming-in for maternity patients D. Isolation of children with infections Answer: B Rationale: Klaus and Kennell conducted studies and determined the optimal outcomes for children occurred when parents had more contact and interaction with the child in the hospital. Limiting visits has detrimental effects on infant development. Rooming-in was not as well received, as patients were not comfortable with the loss of privacy. Isolation of children with infections is still a proper precaution. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 4 15. A client with a history of type 1 diabetes mellitus is confirmed to be pregnant. The nurse determines this client will be best cared for under which practice model? Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 14 20. The nurse is organizing health information to teach a client basic principles that will help maintain wellness in the family. Which actions should the nurse prioritize in this teaching? A. encouraging yearly checkups for all clients. B. teaching insulin injection techniques C. medication administration D. assisting in understanding a treatment Answer: A Rationale: The current movement in health care is to focus on health promotion and thereby prevent future illness and diseases. Encouraging yearly checkups would assist with finding problems before they become serious. Prevention, treatment, and rehabilitation are all processes of care. Teaching a client how to give injections, administer medication, or understand a treatment would occur after a specific health issue but not prevent these issues from occurring. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 14 21. Which nursing intervention would best demonstrate evidence-based practice in maternal– child health care? A. Family-centered pediatric care B. Minimizing parental interaction with preterm infants C. Placing adults and children with similar diseases on the same unit D. Decentralizing care to allow clients to be closer to home Answer: A Rationale: Evidence-based practice has become the standard that nurses are to strive for in caring for their clients. By involving the family in caring for ill children, the child and the family are better served and have improved outcomes. Parental interaction is encouraged for preterm infants to foster bonding. Children and adults need to be separated on inpatient units to ensure that the caregivers have a clear understanding of each client's needs, since children are not small adults. Centralized care has proved to be most beneficial to client outcomes by providing resources and specialists in one location. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 5 22. What societal issues greatly influence delivery of maternal and pediatrichealth care? Select all that apply. A. Cost of health care B. Increase in surrogacy and adoption C. Low income of families D. Increased cultural and ethnic diversity of clients E. Increased number of children born in the U.S. Answer: A, C, D Rationale: Demographic trends such as a decreased number children being born, combined with an increase in a multicultural society seeking health care, are affecting the delivery of maternal–child health care. Poverty and the cost of health care also play a major role in influencing health care delivery for both women and children. Question format: Multiple Select Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 7 23. The United States lags behind other industrialized countries regardinginfant mortality. The main factor that contributes to this is: A. lack of available facilities for caring for the infants. B. older mothers having babies. C. the large number of preterm births in the U.S. D. more congenital anomalies in children born in the U.S. Answer: C Rationale: Two factors that contribute to the fact that the United States lags behind other industrialized countries are the large number of preterm births and the differences in reporting live births in various countries. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 9 24. The nurse reviews the client's plan of care (above). Which nursing action(s) does the nurse identify as independent? Select all that apply. A. assisting out of bed B. administering ibuprofen C. giving IV normal saline D. reinforcing breathing exercises E. offering oral fluids Answer: A, E Rationale: Independent nursing actions are actions that may be performed based on the nurse's own clinical judgment, for example, getting the client out of bed and offering oral fluids. Dependent nursing actions, such as administering medications or IV fluids, are actions that the nurse performs as a result of a health care provider's prescription. Interdependent nursing actions are actions that the nurse must accomplish in conjunction with other health team members, such as reinforcing breathing exercises with the respiratory therapist. Question format: Multiple Select Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 14 25. A nurse manager is orienting a group of new nurses to the maternity unit. During the orientation, the nurse manager emphasizes the need for accurate and complete documentation based on which reason? A. The facility could lose its standing in the community. B. The facility might not keep its accreditation. C. The records could be used in a legal action in the future. D. The records act as the main source of communication among team members. Answer: C Rationale: One of the most important parts of nursing care is recording information about the client on the permanent record. This record, the client's chart, is a legal document and must be accurate and complete. In maternity and pediatric settings, documentation is extremely important because records can be used in legal situations many years after the fact. Although documentation is a form of communication among team members, it is not the main source for doing so. Incomplete or inaccurate documentation can affect a facility's accreditation and or status in the community, but this is not the main reason for accurate and thorough documentation. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Communication and Documentation Reference: p. 14 Integrated Process: Caring Reference: p. 28 30. A nurse working at a child health clinic is involved in primary and secondary prevention activities. Which activity(ies) reflects secondary prevention? Select all that apply. A. vision screening at all well-child visits B. safety education for bicycles and skateboards C. administration of immunizations D. instructions for treatment of head lice E. drug education program Answer: A, D Rationale: Secondary prevention involves health screening activities that aid in early diagnosis and encourage prompt treatment before long-term negative effects arise. Therefore, vision screening and instructions for head lice treatment wouldbe appropriate. Safety education, immunizations, and drug education are examples of primary prevention activities, which are health-promoting activities to prevent the development of illness or injury. Question format: Multiple Select Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 23 Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing 1. A young couple are asking the nurse for suggestions on the best way to help their newborn develop properly. Which is the best response by the nurse? A. Provide nutritional supplements. B. Start reading to the child on first birthday. C. Minimize distractions in the nursery. D. Provide a variety of brightly colored toys. Answer: D Rationale: Children, from an early age, need stimulation and interaction to develop the five senses optimally. Many parents buy brightly colored toys to facilitate stimulation. You should encourage proper nutrition through diet rather than supplementation. Reading should begin immediately, not on first birthday. Question format: Multiple Choice Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 19 2. Which situation may occur in immediate families at a greater level than insome other types of families? A. financial difficulties B. problems with allocation of resources C. formation of a poor parent–child relationship D. lack of support people in a crisis Answer: D Rationale: People in an immediate family may all be so involved in a crisis that there is no objective support person. Financial difficulties, resource allocation problems, and poor relationships may be formed in any family situation. Question format: Multiple Choice Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing Cognitive Level: Understand Client Needs: Health Promotion and Maintenance Integrated Process: Caring Reference: p. 21-22 3. Which of the following may be a strength of the single-parent type of family? A. financial security B. readily available support in a crisis C. development of a special parent-child relationship D. child wishing for no other siblings Answer: C Rationale: Because there is no competition for time from a spouse, single-parent families can promote special parent-child relationships. Financial security, support in a crisis, and the desire for no siblings can occur in any family situation. Question format: Multiple Choice Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing Cognitive Level: Apply Client Needs: Psychosocial Integrity Integrated Process: Nursing Process Reference: p. 21-22 4. The nurse is preparing to teach a drug education class at a local elementary school. The nurse is focused on providing which type of care to the community? A. Primary prevention B. Secondary prevention C. Tertiary prevention D. Preventive care Answer: A Rationale: Primary prevention is promotion of healthy activities and includes education concerning safety, diet, rest, exercise, and disease prevention. Secondary prevention focuses on health screening activities that aid in early diagnosis and encourage prompt treatment. Tertiary prevention focuses on rehabilitation and instruction on ways to prevent further injury or illness. "Preventive care" is not considered a specific category but is a general function that encompasses all three levels. Question format: Multiple Choice Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 23 5. The primary health care provider has recommended a client consult a nutritionist for specialized care. The nurse, by providing a list of referrals to the client, is providing which service? A. Client advocacy B. Community-based nursing C. Primary care D. Secondary prevention Answer: A Rationale: Client advocacy is speaking or acting on behalf of clients to help them gain greater independence and to make the health care delivery system more Cognitive Level: Understand Client Needs: Psychosocial Integrity Integrated Process: Nursing Process Reference: p. 20 10. The nurse at a family planning clinic is meeting with a young couple who have decided not to have any children after they marry since they are both bringing children into the relationship. The nurse will document this as which type of family structure? A. Blended family B. Immediate family C. Extended family D. Communal family Answer: A Rationale: The blended family consists of each parent bringing their own children into the family when they marry. It may also consist of additional children if the couple decide to have more. The immediate family is composed of a man, a woman, and their children (either biological or adopted), who share a common household. Members of a communal family share responsibility for homemaking and child rearing; all children are the collective responsibility of adult members. An extended family consists of one or more nuclear families plus other relatives, often crossing generations to include grandparents, aunts, uncles, and cousins. Question format: Multiple Choice Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing Cognitive Level: Apply Client Needs: Psychosocial Integrity Integrated Process: Nursing Process Reference: p. 21 11. The nurse is assessing a child of a different cultural background. Which nursing action should the nurse prioritize when providing nursing care? A. Use personal cultural experiences with the family. B. Use a standard nursing care plan for the family. C. Expect the family to adopt the cultural beliefs of that facility. D. Ask the family for input into their care based on their cultural beliefs. Answer: D Rationale: Cultural beliefs vary; care should be based on the individual beliefs of each family. The imposition of personal or institutional beliefs, as well as the beliefs of others, should never be placed on a client. Question format: Multiple Choice Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing Cognitive Level: Apply Client Needs: Psychosocial Integrity Integrated Process: Nursing Process Reference: p. 22 12. The nurse is explaining the differences of language development in children. Which example would be appropriate for the nurse to include in the explanation? A. Firstborn children are slower to develop language skills than their siblings. B. Second-born children are quicker to develop language skills than their siblings. C. Boys raised with older sisters are slower to develop language skills than their siblings. D. Girls raised with older brothers are quicker to develop language skills thantheir siblings. Answer: C Rationale: Birth order has an impact on the development of children. Firstborn children command a great deal of attention and tend to be higher achievers than siblings; thus language skills develop sooner in the firstborn child. With second and subsequent children, parents tend to be more relaxed and permissive. These children are likely to be more relaxed and are slower to develop language skills. Question format: Multiple Choice Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 21 13. A nursing instructor is teaching the class about community-based nursing. The instructor determines the session is successful when the students correctly choose which activity as an example of tertiary prevention? A. Caring for new mothers and infants in a maternity clinic B. Identifying a child with pediculosis in an elementary school C. Ensuring the client attends physical therapy after orthopedic surgery D. Reviewing dietary habits with parents of a slightly anemic child Answer: C Rationale: Tertiary prevention focuses on rehabilitation activities and would be the focus of a nurse in an orthopedic clinic, aligning with the needs of the clients in that clinic. Orthopedic clients are typically recovering from injury or surgery and are in need of rehabilitation such as physical therapy. Secondary prevention includes health screening activities that aid in early diagnosis and encourage prompt treatment, such as screening for head lice in schools and reviewing dietary habits in individuals who are experiencing anemia. Primary prevention includes health promoting activities to prevent the development of illness or injury, such as new mothers bringing their infants to the clinic for follow-up well-child appointments. Question format: Multiple Choice Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 23 14. The nurse is preparing to discuss birthing options with a 25-year-old female who is in a low-risk pregnancy with one older child. Which option will be best for the nurse to recommend for this client? A. Home setting B. Birthing center C. Hospital D. Any birthing settings Answer: D Rationale: When a woman is low-risk and has no known medical needs, birth location is the choice of the mother. Home births attended with certified nurse midwives are less likely to have complications and require interventions. Birthing centers are an option for an alternative birth setting, and hospitals are required birth locations for women with potential needs or complications. The nurse should present the advantages and disadvantages of each option and allow the client to make the decision. Question format: Multiple Choice Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 24 15. Which action by the nurse in a community clinic would best meet a family's need of physical sustenance? A. Enrolling the pregnant mother in a WIC program B. Offering parenting classes to teenage mothers C. Holding monthly educational sessions on nutrition D. Providing weekly exercise classes for the neighborhood families Answer: A Rationale: Physical sustenance deals with meeting the basic needs of food, clothing, shelter and protection from harm of each family member. By enrolling the pregnant mother in WIC, her physical needs of nutrition are addressed. Parenting classes, nutrition classes, and exercise classes are all good ideas but do not directly address physical sustenance. Question format: Multiple Choice Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Teaching/Learning Reference: p. 19 20. A nursing instructor is teaching a group of nursing students about the various options available to provide nursing care in a community. The instructordetermines the session is successful when the students correctly choose which action as the primary focus of home care nursing? A. Provide care based on insurance coverage. B. Teach and supervise caregivers. C. Provide direct client care. D. Act as a liaison between health care provider and family. Answer: C Rationale: The primary focus of home care nursing is to provide direct care. Teaching and supervising caregivers and acting as a liaison between the health care provider and family are additional functions of the home care nurse that support the direct care. The nurse should be aware of potential insurance restrictions so that other options may be explored if insurance will not cover specific treatments or medications that the health care provider has determined essential to the client. In these instances, the nurse can then act as the advocate to help find the necessary resources the client may need. Question format: Multiple Choice Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing Cognitive Level: Remember Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 24 Chapter 3: Structure and Function of the Reproductive System 1. A client who is trying not to get pregnant calls the nurse on Saturday at 11 a.m. reporting that she had unprotected sex on Thursday at 10 p.m. She believes she has just ovulated and wants to verify that she has no risk of pregnancy. What can the nurse tell her? A. Because she did not ovulate before the unprotected sex, she will not get pregnant. B. If she ovulated on Saturday around 11 a.m., the egg could be fertilized any time before about 11 a.m. on Sunday. C. If she ovulated on Saturday around 11 a.m., the egg could be fertilized any time before about 10 p.m. on Sunday. D. If she ovulated on Saturday around 11 a.m., the egg could be fertilized any time before about 11 a.m. on Monday. Answer: B Rationale: A single ovum is released from the ovary 14 days before the next menstrual period. It lives approximately 24 hours. The client's fertile period would be from Saturday at 11 a.m. to Monday at 11 a.m. During any other time frame, it would be unlikely that she would become pregnant. Question format: Multiple Choice Chapter 3: Structure and Function of the Reproductive System Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 43 2. Male and female reproductive systems are complementary; for example, male testes and female ovaries; male scrotum and female labia majora; and maleglans penis and female clitoris. What part of the female system is homologous to the spermatic cord in the male? A. cardinal ligaments B. round ligaments C. uterosacral ligaments D. broad ligament Answer: B Rationale: Round ligaments and spermatic cord are both fibromuscular bands that assist in holding specific reproductive structures in place in the male and female. Cardinal ligaments anchor the walls of the cervix and vagina to the lateral pelvic walls. The uterosacral ligaments anchor the lower posterior portion of the uterus to the sacrum. The broad ligament is a sheet of peritoneum that attaches the lower sides of the uterus to the sidewalls of the pelvis. Question format: Multiple Choice Chapter 3: Structure and Function of the Reproductive System Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 39 3. When reviewing normal menstruation with an early adolescent, the nurse would teach that during the second half of a typical menstrual cycle, the endometrium of the uterus becomes: A. thin and transparent, due to progesterone stimulation. B. thin and transparent, due to follicle-stimulating hormone. C. thick and purple-hued, due to estrogen stimulation. D. thick and purple-hued, due to progesterone stimulation. Answer: D Rationale: Progesterone is released following ovulation and thus is the dominating hormone of the second half of the menstrual cycle; its effect is to increase endometrium growth. Progesterone stimulates a growth of tissue, not a thinning of it. FSH and estrogen are found in the earlier stages of menstruation, not in the second half. Question format: Multiple Choice Chapter 3: Structure and Function of the Reproductive System Cognitive Level: Understand Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 44 4. A woman tells the nurse that both she and her husband like to continue sexual relations during her menstrual period. They have a monogamous relationship. She asks if this will harm her. Which would be the best response? A. "Avoid sexual relations because orgasm may be painful during your menses." B. "The risk of infection is too great for sexual relations during this time." C. "You will not be able to achieve orgasm during your menses." D. "If this is satisfying for you and your partner, then there is no harm in it." Answer: D Rationale: Sexual relations may be continued through a menstrual flow if this is satisfying for both partners. There is no danger to either party, and it is possible to achieve orgasm. Question format: Multiple Choice Chapter 3: Structure and Function of the Reproductive System Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Communication and Documentation Reference: p. 42 Answer: A Rationale: During the excitement phase, the physiologic response of both male and females results in an increase in heart rate, blood pressure, and respirations. During the plateau phase, the physiologic changes that occurred during excitement are maintained. In the female, the clitoris retracts and the uterus is fully elevated. In the male, the penis engorges further and the testes remain elevated. Orgasm is marked by muscular contractions. During resolution, the muscles relax and blood pressure, heart rate, and breathing return to normal. Question format: Multiple Choice Chapter 3: Structure and Function of the Reproductive System Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 44- 45 10. The nurse is answering questions from a newborn's parents concerning a circumcision. Which structure will the nurse point out is removed during the procedure? A. tunica albuginea B. corpus spongiosum C. rugae D. prepuce Answer: D Rationale: The foreskin or prepuce is a fold of skin which covers the glans of the penis. This fold of skin is removed in a circumcision. The tunica albuginea is connective tissue found inside the penile shaft. The corpus spongiosum is erectile tissue that runs the full length of the penis. Rugae are folds that allow for stretching during an erection. Question format: Multiple Choice Chapter 3: Structure and Function of the Reproductive System Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Teaching/Learning Reference: p. 35 11. The nurse at a health fair is teaching about the various changes of puberty. Which sequence of events will be best for the nurse to present when illustrating pubertal changes in females? A. menarche, breast budding, appearance of pubic hair B. Appearance of pubic hair, menarche, breast budding C. breast budding, appearance of pubic hair, menarche D. appearance of pubic hair, breast budding, menarche Answer: C Rationale: Secondary sexual characteristics develop in an orderly sequence with variance in the timing for individuals. Breast budding in the female is usually the first physical sign noted, and occurs between the ages of 10 and 12 years on average. Appearance of pubic hair usually occurs just before menarche, the first menstrual period. From the onset to the start of menarche is typically 2 years. Question format: Multiple Choice Chapter 3: Structure and Function of the Reproductive System Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 42 12. The nurse is assessing a 16-year-old female on a routine well-child visit. Which assessment finding will the nurse predict this healthy female will report concerning her menstrual cycles? A. Flow usually lasts 4 to 6 days. B. The usual cycle is 36 days. C. There's abundant clear mucus at the beginning D. Menstruation began at age 15. Answer: A Rationale: The average menstrual flow is 4 to 6 days in length. The cycle usually lasts 28 days. There should be no mucus during the menstrual cycle, with clear mucus being noted at the time of ovulation or approximately day 14. Menstruation usually begins at the age of 12 to 14 years. Question format: Multiple Choice Chapter 3: Structure and Function of the Reproductive System Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 42 13. The nurse is teaching a family planning class at a health fair. Which physiologic change during the plateau stage of sexual response will the nurse point out? A. lengthening of the vagina B. labia minor lightens in color C. retraction of the clitoris D. scrotal elevation Answer: C Rationale: Retraction of the clitoris occurs during the plateau stage prior to orgasm. Lengthening of the vagina and scrotal elevation occur during excitement. The labia minora deepens in color. Question format: Multiple Choice Chapter 3: Structure and Function of the Reproductive System Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 44- 45 14. The nursing instructor is teaching a group of nursing students about the menstrual cycle. The instructor determines the session is successful when the students correctly choose which action as responsible for the increased thickness of the endometrium? A. the level of the FSH B. the decreasing level of the progesterone C. the dropping level of LH D. the increasing level of estrogen Answer: D Rationale: Estrogen levels increase after menstruation. These levels promote a thickening of the endometrial tissue. FSH and LH are responsible for ovarian changes. Progesterone will be increasing not decreasing, and works with estrogen in influencing the menstrual cycle. Question format: Multiple Choice Chapter 3: Structure and Function of the Reproductive System Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 44 15. The nurse is teaching a couple trying to conceive about the changes in the cervical mucus near the time of ovulation. The nurse determines the session is successful when the couple correctly choose mucus in which form as indicating ovulation has occurred? A. Thin and copious B. Thick and tacky C. Scant amount D. Mucus is not visible at ovulation Answer: A Rationale: During ovulation, the mucus will be distensible and stretchable. After ovulation, the mucus will be scant, thick and opaque in nature. During the proliferative phase before ovulation, it is tacky, crumbly, and yellow or white in color. During the menses, there will be no mucus noted. Question format: Multiple Choice Chapter 3: Structure and Function of the Reproductive System Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 44 Rationale: Alkaline seminal fluids serve several purposes, including nourishing the sperm by providing fructose, protecting the sperm from acidic vaginal fluids, and enhancing motility. The alkaline fluids do not help in sperm maturation or cooling the sperm, which would be ill advised. Question format: Multiple Select Chapter 3: Structure and Function of the Reproductive System Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 38 21. The nurse is assessing a female client who is having difficulty experiencing an orgasm. Which action should the nurse point out as often being necessary for an orgasm in females? A. penile penetration B. clitoral stimulation C. uterine stimulation D. sensory deprivation Answer: B Rationale: The clitoris is highly sensitive and allows the woman to experience pleasure during sexual stimulation. It is thought to be the main stimulus for initiating orgasm in women. Penetration may be pleasurable, but alone it is not enough to stimulate orgasm. Uterine stimulation does not affect orgasm. Sensory arousal also plays a major role in attaining female orgasm. Question format: Multiple Choice Chapter 3: Structure and Function of the Reproductive System Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 39 22. The school nurse is preparing a teaching session for a group of adolescent girls explaining the menstrual cycle. The nurse determines the session is successful when the young students correctly choose which fact? A. The average menstrual flow lasts 4 to 6 days. B. The average age for menarche is 11 to 13 years. C. Menarche is the start of puberty. D. Total blood loss each month averages 45 to 80 ml of blood. Answer: A Rationale: The average flow lasts 4 to 6 days and is caused by casting away of blood, tissue, and debris from the uterus. The average age for menarche is from 12 to 14 years. Menarche is the end of puberty, which follows breast budding and the appearance of pubic hair. The total blood loss each month is 25 to 60 ml. Question format: Multiple Choice Chapter 3: Structure and Function of the Reproductive System Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 42 23. The nurse is teaching an adolescent client about fertility and the various phases of the menstrual cycle. The client has a 28-day menstrual cycle. Which statement is a priority for the nurse to include in the teaching? A. "Days 1 through 5 are the days you will typically experience menstrual flow." B. "Day 10 is part of the proliferative phase of your menstrual cycle." C. "Day 14 of your menstrual cycle is normally when you will ovulate." D. "Days 27 and 28 are when you have declining hormonal secretions." Answer: C Rationale: It is a priority for the nurse to teach the client when ovulation will occur to assist in pregnancy prevention at this age. While the other statements are all true, not knowing the specific information for those days does not hold the same consideration or life-altering potential as when pregnancy can occur. The menstrual cycle is based on an average of 28 days and divided into four phases based on the hormones secreted and their actions. Days 1 through 5 are the menstruation phase. Days 6 through 14 are the proliferative phase, ending with ovulation on the 14th day. Days 15 through 26 are the secretory phase. Days 27 and 28 are the ischemic phase when hormonal secretions decline. Question format: Multiple Choice Chapter 3: Structure and Function of the Reproductive System Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 43 24. A nurse is conducting a sexual health education class about the structures of the female reproductive system. Which structure will the class identify as responsible for contractions during labor if the teaching has been successful? A. endometrium B. myometrium C. broad ligament D. corpus Answer: B Rationale: The corpus is the main body of the uterus, and the fundus is the top- most section resembling a dome. The walls of the corpus and fundus have three layers. The perimetrium is the tough outer layer of connective tissue that supports the uterus. The middle layer is the myometrium, a muscular layer that is responsible for the contractions of labor. The muscle fibers of the myometrium wrap around the uterus in three directions: obliquely, laterally, and longitudinally. This muscle configuration allows for the strong contractions and expulsion of the fetus during labor and birth. The endometrium is the vascular mucosal inner layer. This layer changes under hormonal influence every month in preparation for possible conception and pregnancy. Four ligaments provide support and hold the uterus in position. These ligaments anchor the uterus at the base (cervical region), leaving the upper portion (corpus) free in the pelvic cavity. The broad ligament attaches the lower sides of the uterus to the sidewalls of the pelvis. Question format: Multiple Choice Chapter 3: Structure and Function of the Reproductive System Cognitive Level: Understand Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 40 25. A nurse is conducting a sexual health education class about the structures and events of semen production. Which component will the students identify as responsible for semen production if the teaching has been successful? A. accessory gland alkaline fluids B. sperm C. testes D. vas deferens E. seminiferous tubules Answer: A, B Rationale: The alkaline fluids from the accessory glands and sperm combine to form a thick, whitish secretion termed semen or seminal fluid. The testes and seminiferous tubules within the testes are where sperm are produced. The vas deferens is the muscular tube in which sperm begin their journey out of the man's body. It connects the epididymis with the ejaculatory duct. Question format: Multiple Select Chapter 3: Structure and Function of the Reproductive System Cognitive Level: Understand Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: A. barrier B. hormonal C. rhythm D. transdermal Answer: A Rationale: The nurse should emphasize a barrier method of birth control such as a condom. The condom will help not only with birth control but with the spread of STIs, which is common in this age group. The other methods, such as hormonal, rhythm, and transdermal, will only prevent pregnancy and are more commonly utilized in long-term monogamous relationships. Question format: Multiple Choice Chapter 4: Special Issues of Women's Health Care and Reproduction Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 64- 65 6. The nurse is preparing a teaching session for a client considering tubal ligation. Which factor should the nurse prioritize in this session? A. Wait several months after birth, and schedule the surgery as an outpatient. B. The procedure is easy to perform and will be painless. C. This is a permanent and irreversible procedure for birth control. D. She must have signed consent from her partner. Answer: C Rationale: The procedure is considered permanent and irreversible. This is a procedure not for routine birth control but for permanent birth control. If the women elects for this procedure, it can be done immediately following the birth of the child, lessening the inconvenience or hospitalization of the client. The procedure is not painless, nor easy. A consent form from the partner is not always required. Question format: Multiple Choice Chapter 4: Special Issues of Women's Health Care and Reproduction Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 70 7. The nurse is conducting a well-visit physical assessment on a 29-year-old female. The nurse determines the client is probably ovulating based on which condition of the cervical mucus? A. Thin, slippery, and stretchy B. Cloudy, thick, and watery C. Clear and of large quantity D. Thin and red-tinged Answer: A Rationale: The mucus at the time of ovulation is thin, slippery, and stretchy to allow for the passage of sperm into the uterus. This is called spinnbarkeit fiber. If the mucus is too thick, it will inhibit fertilization. Before ovulation, the mucus is thick and does not stretch easily. Question format: Multiple Choice Chapter 4: Special Issues of Women's Health Care and Reproduction Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 62 8. A community health nurse is preparing a presentation for a health fair on the topics of planning for a pregnancy. Which major goal has the nurse determined should be accomplished with this presentation? A. Ensure women are using the correct contraceptive method. B. Ensure couples understand genetic risks. C. Provide one-on-one counseling. D. Decrease the number of unwanted pregnancies. Answer: D Rationale: Preconception counseling with general health care is a health promotion activity to help prevent unwanted pregnancies. The nurse will be responsible for presenting the basic information to everyone. In this environment it would not be appropriate for the nurse to provide one-on-one counseling due to privacy concerns. The nurse could present various risks but it would be beyond the scope of this event to ensure every participant understands each point. Question format: Multiple Choice Chapter 4: Special Issues of Women's Health Care and Reproduction Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 58- 59 9. A young couple are disappointed that they are not yet pregnant and are seeking assistance at the health clinic. After assessing their medical history, the nurse discovers the female has a history of several episodes of PID. The nurse predicts this may be a source of the infertility related to which factor? A. It causes anovulation due to interference with secretion of pituitary hormones. B. It causes changes in cervical mucus that make it less receptive to penetration by sperm. C. It causes sperm-agglutinating antibodies to be produced in the vagina. D. It interferes with the transport of ova due to tubal scarring. Answer: D Rationale: Pelvic inflammatory disease results in scarring and adhesions of the tubes, leading to poor transport of ova. PID does not affect hormone metabolism, nor does it affect the production of cervical mucus. Antibodies are present only in a few cases and are unrelated to PID. Question format: Multiple Choice Chapter 4: Special Issues of Women's Health Care and Reproduction Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process Reference: p. 55-56 10. The nurse is preparing to meet with a couple who have requested counseling concerning family planning. The nurse will prioritize which topics fordiscussion? A. Ensuring the couple is legally married B. Ensuring the correct time frame is followed C. Possible genetic abnormalities D. Preventing STIs Answer: C Rationale: Family planning consists of two complementary components: planning pregnancy and preventing pregnancy. The nurse may be involved with teaching the families how to avoid unwanted pregnancies, bring about wanted births, and control the intervals between births. Discussing potential genetic anomalies would be involved as the family prepares for children. It would not be proper for the nurse to ignore this couple based on their marriage status. The time frame would be determined by the couple and is flexible. Preventing STIs would also not be a focus of this session. Question format: Multiple Choice Chapter 4: Special Issues of Women's Health Care and Reproduction Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 58- 60 11. A client is requesting information on the various available contraceptives. When explaining a vaginal spermicide, which information should the nurse prioritize? A. Wash with clean water and soap after intercourse. B. Insert the product by applicator in the vagina prior to intercourse. C. Apply the spermicide directly to the glans penis to kill the sperm when theyexit the penis. D. Leave the product in place for 24 hours after intercourse. Answer: B Rationale: Vaginal spermicides provide a physical barrier that prevents sperm penetration and a chemical barrier that kills sperm. It is designed to be inserted vaginally immediately before or within a few hours before sexual intercourse. Question format: Multiple Choice Chapter 4: Special Issues of Women's Health Care and Reproduction Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 61 16. A client prescribed a combined oral contraceptive (COC) has presented for a routine visit. Which finding if reported by the client upon assessment should the nurse prioritize? A. abdominal pain B. small amount of breakthrough bleeding C. light menstrual flow D. cramping during menses Answer: A Rationale: The warning signs to report for a client on combined oral contraceptives are severe abdominal or chest pain, dyspnea, headache, weakness, numbness, blurred or double vision, speech disturbances, or severe leg pain and edema. Light bleeding, light flow, and cramping are all normal. Question format: Multiple Choice Chapter 4: Special Issues of Women's Health Care and Reproduction Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 68 17. The nurse has assessed several clients who have arrived for routine appointments. The nurse predicts the health care provider will prioritize a bone density scan for which client? A. a 40-year-old black client, 5 ft 4 in (1.62 m) tall, 172 lbs (78 kg), inactive lifestyle B. a 25-year-old Asian client, 5 ft 7 in (1.7 m) tall, 129 lbs (58.5 kg), with two children C. a 55-year-old white client who smokes and has family history of osteoporosis D. a 45-year-old Hispanic client with a vitamin D deficiency Answer: C Rationale: Risk factors for osteoporosis include female gender, white or Asian ethnicity, slender build, advanced age, estrogen deficiency because of menopause, low bone mass density, family history of osteoporosis, personal history of fracture as an adult, smoking, excessive alcohol intake, low dietary intake of calcium, vitamin D deficiency, inactive lifestyle, and use of glucocorticoids and anticonvulsants. The more of these risk factors an individual has, the higher therisk for osteoporosis. The 55-year-old white smoker with a family history of osteoporosis should be referred for bone scan or density testing. The other individuals have fewer overall risk factors. Question format: Multiple Choice Chapter 4: Special Issues of Women's Health Care and Reproduction Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 78 18. The nurse is assessing a young couple who desire to get pregnant. The 38- year-old husband and 29-year-old wife report they had used oral contraceptive pills (OCPs); however, they have now been trying unsuccessfully to conceive over the past 4 months. What is the best response for the nurse to make? A. Return in 9 months for further assessment if not pregnant. B. Should seek fertility counseling from a specialist. C. Increase intercourse frequency to four times a week around the time of ovulation. D. Should undergo comprehensive diagnostic testing. Answer: C Rationale: The most fertile time is the ovulation period of the woman's ovarian cycle. Increasing the frequency of intercourse around ovulation will increase the chance of conception. Individuals are not considered infertile until they have tried for at least 1 year to get pregnant. If this couple is still not pregnant after 8 months, then they can be referred for a fertility workup. Question format: Multiple Choice Chapter 4: Special Issues of Women's Health Care and Reproduction Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 74-75 19. The nurse is assessing a 52-year-old perimenopausal female who is concerned about the changes occurring in her body. When questioned about the most serious changes, which effect should the nurse point out? A. pelvic support muscles lose tone B. dense breast tissue is replaced with adipose tissue C. the uterus and ovaries decrease in size D. bone mineral density decreases Answer: D Rationale: As women age, the decrease in hormone levels place women at increased risk for osteoporosis. This is a potential concern that can impact life, and bone mineral density should be monitored. There is no evidence of atrophy in the pelvic muscles, nor in the uterus or ovaries as related to menopause. Breast tissue changes at the same rate that all other tissue changes. Question format: Multiple Choice Chapter 4: Special Issues of Women's Health Care and Reproduction Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process Reference: p. 78 20. The nurse is preparing to teach a client how to conduct the basal body temperature method to determine her fertile window. Which instruction should the nurse prioritize? A. It depends on the average temperature taken each morning. B. Temperature should be taken prior to any activity every morning. C. Avoid intercourse only on the days the temperature drops. D. It is the best method for predicting ovulation. Answer: B Rationale: BBT is the basal body temperature method and requires the woman to take her temperature and record it every morning. This should be the first activity of the day before exiting the bed or doing other activities. To prevent conception, avoid unprotected intercourse from the day the BBT drops through the fourth day of temperature elevation. The BBT alone is not a reliable method for predicting ovulation. Use BBT along with calendar or cervical mucus methods to increase effectiveness. Question format: Multiple Choice Chapter 4: Special Issues of Women's Health Care and Reproduction Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 62 21. The nurse was teaching a college student how to properly take the prescribed combination oral contraceptive (COC). The nurse determines the session is successful when the client correctly chooses which instruction to follow when taking the OCP? A. empty stomach, full glass of water B. same time of day, each day C. take with a meal D. same day of the week, once a week Answer: B Rationale: OCPs are to be taken daily at the same time of day every day. Absorption is not affected by the stomach contents. Oral contraceptive pills must be taken every day to be effective. Question format: Multiple Choice Chapter 4: Special Issues of Women's Health Care and Reproduction Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 53 Chapter 5: Fetal Development 1. In caring for a fully immunized pregnant woman who is a nurse in a familyhealth practice, the obstetric nurse should remind the client that she must not come in contact with clients who have symptoms that could indicate which infection? A. measles B. Chicken pox C. smallpox D. diphtheria Answer: B Rationale: Chicken pox can be teratogenic to the fetus and exposure may have a significant impact on the fetus and may cause defects. The fetus receives passive immunity from the mother for measles, diphtheria, and smallpox. Question format: Multiple Choice Chapter 5: Fetal Development Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 92 2. Assessment for surfactant level via lecithin/sphingomyelin (L/S) ratio in the amniotic fluid is a primary estimation of fetal maturity. The purpose of surfactant is to: A. prevent alveoli from collapsing on expiration. B. increase lung resistance on inspiration. C. encourage immunologic competence of lung tissue. D. promote maturation of lung alveoli. Answer: A Rationale: Surfactant is a phospholipid that reduces surface tension; it prevents alveoli from collapsing on expiration. Resistance to airflow is an effect of tissue elasticity and airway size. Immunologic competence is provided by antibodies in the mucus layer. Fully matured alveoli contain squamous cells as well as type II surfactant cells. Question format: Multiple Choice Chapter 5: Fetal Development Cognitive Level: Remember Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 90 3. A 38-year-old client presents to the clinic desiring to get pregnant. She reports she had a tubal ligation in her early 20s after two babies and a divorce. After learning that the client recently underwent a reversal of the tubal ligation, the nurse will warn the client of which potential risk? A. ectopic pregnancy B. Down syndrome C. twins D. exposure to teratogens Answer: A Rationale: Tubal ligation reversal is a difficult procedure and can place the woman at higher risk for ectopic pregnancy. She needs to be aware of the possibility. Down syndrome, multiple births, and exposure to teratogens are all issues that have nothing to do with reversal of tubal ligation. These are issues that any pregnant female should be made aware. Question format: Multiple Choice Chapter 5: Fetal Development Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 98 4. A client and partner are excited to discover they are expecting twins. The nurse is prepared to monitor the twins for which potential situation after noting they share an amniotic sac? A. increased teratogenic effects B. conjoined twins C. twin-to-twin transfusion syndrome D. cord entanglement Answer: D Rationale: The greatest risk for monoamniotic monochorionic twins is cord entanglement as they share the same amnio and chorion and are contained in the amniotic fluid together. Conjoined is a possibility but not the greatest risk. Twin-to- twin transfusion syndrome is also a possibility but is a greater risk for diamniotic monochorionic as they share either placenta or vessels. Fraternal (dizygotic) twins with two placentas, two amnions, and two chorions are diamniotic dichorionic and would not be at risk for the cord entanglement. Question format: Multiple Choice Chapter 5: Fetal Development Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Reference: p. 98 5. The nurse is assessing a 38-year-old Black client who has just discovered she is pregnant. On assessment, the nurse documents the client is 5 ft 10 in (1.77 m) tall 9. The nurse is preparing a presentation for a health fair which will illustrate the development of a baby. The nurse should point out the fertilized egg is implanted in the endometrium by which day? A. 4 B. 6 C. 8 D. 10 Answer: D Rationale: By day 10 after fertilization, the blastocyst has completely buried itself in the endometrial lining. Prior to day 10, the attachment is much looser. Question format: Multiple Choice Chapter 5: Fetal Development Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 88 10. The nurse is meeting with a young couple who desire to get pregnant to teach them how to determine the best times for intercourse. During which time frame should the nurse encourage them to engage in intercourse to increase their chances of getting pregnant? A. 2 days before to 1 day after ovulation B. 1 day before ovulation to 2 days after ovulation C. 3 days before or the day of ovulation D. 3 days before to 2 days after ovulation Answer: D Rationale: Sperm are able to live for up to 72 hours after ejaculation and the ovum remains fertile for a maximum of 48 hours after ovulation. The window of opportunity for conception is 3 days before to 2 days after ovulation. Question format: Multiple Choice Chapter 5: Fetal Development Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 86 11. A group of nursing students are analyzing the fetal circulation. After the session, the students correctly point out which fetal structure contains the highest concentration of oxygen? A. umbilical artery B. umbilical vein C. ductus arteriosus D. pulmonary vein Answer: B Rationale: The umbilical vein carries oxygenated blood from the placenta to the fetus; the umbilical artery carries deoxygenated blood from the fetus to the placenta. The ductus arteriosus shunts blood from the right atrium to the left atrium in order to bypass the deflated lungs. The pulmonary vein drains the deflated lungs. Question format: Multiple Choice Chapter 5: Fetal Development Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 94 12. The nurse is assessing a young female who just found out she is pregnant. She is now reporting vague abdominal discomfort. After noting the client has a history of PID, the nurse predicts the health care provider will give priority to ruling out which situation? A. Ectopic pregnancy B. Repeat PID C. UTI D. Endometriosis Answer: A Rationale: An ectopic pregnancy or tubal pregnancy can result when there is blockage or scarring of the fallopian tubes due to infection (PID) or trauma (tubal ligation reversal). Ectopic pregnancy may present with vague signs and symptoms but is the leading cause of maternal death in the first trimester and should be given priority when determining the cause of abdominal complaints. The other choices would be ruled out after the ectopic pregnancy is ruled out. Question format: Multiple Choice Chapter 5: Fetal Development Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Reference: p. 98 13. The nurse is conducting a prenatal class for a group of first-time parents in the first trimester. The nurse should point out that the mother should feel the baby move by the end of which week of gestation? A. 16 weeks B. 18 weeks C. 20 weeks D. 22 weeks Answer: C Rationale: On average, the first time a mother can feel the fetus move is by the end of 20 weeks' gestation. Question format: Multiple Choice Chapter 5: Fetal Development Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 91 14. The nursing instructor is illustrating the circulatory flow between the mother and fetus. The instructor determines the session is successful when the class correctly chooses which structure with which route? A. The one umbilical artery carries oxygen-rich blood to the fetus from theplacenta. B. The two umbilical arteries carry waste products from the placenta to the fetus. C. The one umbilical vein carries oxygen-rich blood to the fetus from theplacenta. D. The two umbilical veins carry waste products from the fetus to the placenta. Answer: C Rationale: There are two umbilical arteries and one umbilical vein. The arteries carry waste from the fetus to the placenta; the vein carries oxygenated blood to the fetus from the placenta. Question format: Multiple Choice Chapter 5: Fetal Development Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 95 15. A group of nursing students are preparing a presentation for a health fair illustrating the structures found during a pregnancy. Which structures should the students point out form a protective barrier around the developing fetus? A. ectoderm and amnion B. amnion and mesoderm C. chorion and amnion D. chorion and endoderm Answer: C Rationale: The chorion and amnion are the two fetal membranes. The ectoderm, mesoderm, and endoderm are layers in the developing blastocyst. Question format: Multiple Choice Chapter 5: Fetal Development Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 90 20. A student nurse is preparing an illustration for a health fair depicting the various types of twins. Which format will the student use to depict identicaltwins? A. two separate eggs and different sperm B. two separate eggs and one sperm C. one egg and two different sperm D. one egg and one sperm Answer: D Rationale: Identical twins develop from the fertilization of one egg by one sperm, and this divides into two zygotes shortly after fertilization, resulting in two babies who share identical genetic material and are termed identical twins. With two separate eggs and two separate sperm, the twins would be fraternal dizygotic. One sperm cannot fertilize two eggs, and two sperm cannot fertilize one egg. Question format: Multiple Choice Chapter 5: Fetal Development Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 98 21. A client calls the nurse in a panic after a home pregnancy test indicates she is pregnant. She reports that that she consumed a lot of alcohol on the night that she thinks the pregnancy occurred. The next day she had taken several acetaminophen. For the past 3 weeks, she has had her usual nightly glass of wine with dinner but no other alcohol. What is an appropriate response for the nurse to make when the client questions if she has caused irreversible damage to the fetus? A. "Why did you have unprotected sex if you had been drinking? Exposure to alcohol can cause facial deformities, low birth weight, and underdeveloped brains." B. "The fetus is not exposed to the mother's blood until after it implants about 6 days after fertilization, so the first night is not an issue. But it is best to avoid alcohol while you are pregnant." C. "The wedding night is not an issue because the fetus is not exposed to the mother's blood at first, but I hope this last week of drinking has not caused any problems." D. "Alcohol is very damaging to the growing fetus, so you had better be sure to stop drinking. Do you need any support for that?" Answer: B Rationale: The fetus was not developing during the initial night of drinking. The embryo would be exposed to the mother's blood following the sixth day after implantation, at which time the alcohol will be circulating in the embryo's circulation. Alcohol use should be stopped now that the client knows she is pregnant, but the nurse should reassure her that the limited amounts she has consumed will most likely not have an adverse effect on the fetus. A practitioner should not question the client's choice of drinking and having unprotected sex. There is no indication of alcohol use disorder, so support may not be warranted. The nurse should maintain a professional and calm attitude and not criticize or condemn the client. Question format: Multiple Choice Chapter 5: Fetal Development Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Caring Reference: p. 95 22. The nursing instructor is teaching a class on the structures vital to the development of the fetus. The instructor determines the class is successful when the class correctly chooses which facts concerning amniotic fluid? A. Produced by fetal brain B. Amniotic fluid is 90% water C. Production stops in the eighth month D. Helps the fetus regulate body temperature Answer: D Rationale: Amniotic fluid is formed by the fetal membranes, the amnion and chorion, on a constant basis until birth. It is 98% to 99% water, with the remaining 1% to 2% composed of electrolytes, creatinine, urea, glucose, hormones, fetal cells, lanugo, and vernix. It serves four main functions: physical protection, temperature regulation, provision of unrestricted movement, and symmetrical growth. The fetus is unable to regulate its own body temperature so the amniotic fluid provides this function. Question format: Multiple Choice Chapter 5: Fetal Development Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 90 23. A young couple, 8 weeks' pregnant with their first child, are being assessed at their first prenatal visit. They ask about scheduling an ultrasound to find out the gender of the fetus. For when should the nurse recommend this ultrasound be scheduled? A. for today (8 weeks' gestation) B. for 12 weeks' gestation C. for 16 weeks' gestation D. for 20 weeks' gestation Answer: C Rationale: The sex organs can be distinguished at 12 weeks' gestation but are difficult to see on routine ultrasound. The gender of the fetus can be determined at the end of 16 weeks' gestation on ultrasound. Question format: Multiple Choice Chapter 5: Fetal Development Cognitive Level: Understand Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 91 24. The nurse is conducting an obstetrics assessment on a client at 20 weeks' gestation who is questioning the nurse about the development of the fetus. Which new occurring developments can the nurse point out to this client? A. Eyelids are open. B. Lungs are fully shaped. C. Eyebrows and scalp hair are present. D. A developed startle reflex is evident. Answer: C Rationale: At 20 weeks, the fetus is still developing. All structures are present, but not in full size. The fetus will have limited amounts of eyebrows and scalp hair. At 20 weeks, the eyelids are not present; the lungs are present, but not developed. The startle reflex will not be evident until after birth. Question format: Multiple Choice Chapter 5: Fetal Development Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 91 25. The nurse is preparing a pregnant client with severe hypertension for an emergent amniocentesis for possible early delivery of the fetus. The nurse will explain to the client that the health care provider is evaluating which parameter? A. fetal renal output B. fetal alimentary output C. maternal blood makeup D. level of fetal surfactants Answer: D Rationale: Amniocentesis is done to check the lung surfactant ratio of the fetus, which will determine if the lungs are matured enough for delivery. Amniocentesis can be used to determine fetal renal and alimentary output, but these factors are not critical to birth. Maternal blood work will reveal information about the mother and not the lung maturity of the fetus. Question format: Multiple Choice Chapter 5: Fetal Development Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Reference: p. 92 Integrated Process: Nursing Process Reference: p. 111 3. The nurse is assessing a 37-year-old woman, pregnant with twins in her second trimester, and notes the following over the past 3 visits: blood pressure 128/88, 134/90, and 130/86. Which nutritional supplement should the nurse suggest the client take? A. vitamin A B. iron C. calcium D. lactase Answer: C Rationale: The elevated blood pressures indicate the client is possibly developing gestational hypertension. This increases the risk of developing preeclampsia. Current research has demonstrated that calcium supplementation during pregnancy may reduce the risk of preeclampsia. Excessive levels of vitamin A may cause birth defects. Iron supplementation is used to fortify blood cell formation and decrease anemia. Lactase supplementation aids in the digestion of dairy. Question format: Multiple Choice Chapter 6: Maternal Adaptation during Pregnancy Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 113 4. A pregnant client in her second trimester reports feeling tired all the time. The nurse notes pale skin and low normal hemoglobin on assessment. Which recommendation should the nurse prioritize for this client? A. An iron supplement B. A calcium supplement C. More meat in her diet D. More seafood and organ meats in her diet Answer: A Rationale: Iron is necessary for the formation of hemoglobin; therefore, it is essential to the oxygen-carrying capacity of the blood. Women who have normal hemoglobin may need increased iron to carry more oxygen. Calcium supplementation is essential for normal fetal development. The use of measured supplements would ensure a steady amount, whereas the use of meat and seafood would not allow this. Question format: Multiple Choice Chapter 6: Maternal Adaptation during Pregnancy Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 113 5. A pregnant vegan reports eating lots of dark green leafy vegetables, legumes, citrus fruits, and berries. To ensure that her infant's nervous system will develop properly, what foods should the nurse recommend that she add to her diet? A. Milk and cheese B. Carrots, sweet potatoes, and mangoes C. Nuts, seeds, and chocolate D. Fortified cereals Answer: D Rationale: The best source to recommend are the fortified cereals to meet the amino acid needs necessary for the development of her infant's nervous system during pregnancy. She should be encouraged to include fortified cereals to meet these needs. The carrots, sweet potatoes, mangoes, nuts, and seeds will add other nutrients to her diet. A vegan will not eat milk and cheese, as they are animal products. Question format: Multiple Choice Chapter 6: Maternal Adaptation during Pregnancy Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 116 6. The nurse is assessing a pregnant client at her 20-week visit. Which breast assessment should the nurse anticipate documenting? A. Slack, soft breast tissue B. Deeply fissured nipples C. Enlarged lymph nodes D. Darkened breast areolae Answer: D Rationale: As part of the pigment changes that occur with pregnancy, breast areolae become darker. The breast tissue should not be softer or slacker than before. There should not yet be any lymph enlargement, and the nipples should not have fissures. Question format: Multiple Choice Chapter 6: Maternal Adaptation during Pregnancy Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 105 7. A client calls to cancel an appointment for the first prenatal visit after reporting a home pregnancy test is negative. Which instruction should the nurse prioritize? A. Use a diluted urine specimen. B. Wait until after two missed menstrual periods. C. Keep the appointment. D. Refrain from eating for 4 hours before testing. Answer: C Rationale: Although home pregnancy tests are accurate 95% of the time, they may still have false positives or false negatives, and the client needs to seek prenatal care and confirmation from her health care provider. Diluting the urine, waiting to miss a second period, or eating before the test would have no effect. The tests look for hCG, which is not affected. Question format: Multiple Choice Chapter 6: Maternal Adaptation during Pregnancy Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 104 8. A client in her first trimester reports frequent urination and asks the nurse for suggestions. The nurse should teach the client that the urination is most likely related to which cause? A. Pressure on the bladder from the uterus B. Increased concentration of urine C. Addition of fetal urine to maternal urine D. Decreased glomerular selectivity Answer: A Rationale: Early in pregnancy, the expanding uterus presses on the bladder. During the second trimester there is some relief when the uterus lifts, but the pressure returns again as the fetus continues to grow. Urine concentration does not affect frequency. Fetal urine does not enter the mother's renal system, except through increases in circulatory volume. The glomeruli should not be affected by pregnancy. Question format: Multiple Choice Chapter 6: Maternal Adaptation during Pregnancy Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 109 9. A pregnant client in her third trimester, lying supine on the examination table, suddenly grows very short of breath and dizzy. Concerned, she asks the nurse what is happening. Which response should the nurse prioritize? A. Cerebral arteries are growing congested with blood. B. The uterus requires more blood in a supine position. C. Blood is trapped in the vena cava in a supine position. D. Sympathetic nerve responses cause dyspnea when a woman lies supine. Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 107 14. The community nurse is preparing a presentation for a health fair illustrating successful pregnancies. Which component should the nurse prioritize as the most critical to ensure a positive psychological experience with the pregnancy by the mother? A. Early prenatal care B. Age at the time of pregnancy C. Having a planned pregnancy D. Social support Answer: D Rationale: All options are correct and play a role pregnancy, but the most critical for a positive psychological experience is for the woman to have a social support system. Early care, maternal age, and planned pregnancy all affect fetal and maternal health, but are not necessarily linked to positive psychological experiences. Question format: Multiple Choice Chapter 6: Maternal Adaptation during Pregnancy Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 110 15. The nursing instructor is teaching a class on the nutritional needs of the pregnant client. The instructor determines the session is successful when the students correctly choose which supplement as being known to prevent up to 70% of CNS birth defects? A. iodine B. zinc C. folic acid D. vitamin A Answer: C Rationale: Folic acid is noted to help prevent up to 70% of CNS birth defects; however, the folic acid needs to be in the body prior to the pregnancy to be most effective. Iodine affects thyroid development. Zinc is required for enzyme formation and gene expression. Vitamin A helps develop vision. Question format: Multiple Choice Chapter 6: Maternal Adaptation during Pregnancy Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 114 16. A client in her third trimester reports sleeping poorly: sleeping on her back results in lightheadedness and dizziness and lying on her side results in no sleep. Which suggestion for sleeping should the nurse prioritize for this client? A. without a pillow B. with a pillow under her shoulders C. with a pillow under her right hip D. with a pillow under both hips Answer: C Rationale: Pregnancy places strain on the cardiovascular system with increased fluid in the lungs and heart. The use of one pillow under the right hip will help displace the uterus and fetus off the major blood vessels, allowing the circulation to flow appropriately and provide relief to the client. When the woman lies flat on her back the uterus and contents can compress the vena cava and aorta and reduce blood flow, resulting in the light-headedness and dizzy spells. Removal of the pillow would not alter the effects on the vena cava. A pillow under the shoulders would hurt the neck, and a pillow under both hips would exacerbate the light-headedness. Question format: Multiple Choice Chapter 6: Maternal Adaptation during Pregnancy Cognitive Level: Apply Client Needs: Physiological Integrity: Basic Care and Comfort Integrated Process: Teaching/Learning Reference: p. 107 17. A client at 39 weeks' gestation calls the OB triage and questions the nurse concerning a bloody mucus discharge noted in the toilet after an OB office visit several hours earlier. What is the best response from the triage nurse? A. "It might be nothing. If it happens again call your provider who is on-call." B. "If the provider did an exam, it might be just normal vaginal secretions, so don't worry about it." C. "A one time discharge of bloody mucus in the toilet might have been your mucus plug." D. "Bloody mucus is a sign you are in labor. Please come to thehospital." Answer: C Rationale: Bloody mucus can either be a mucus plug or bloody show. The one-time occurrence would be more likely to be the mucus plug. A bloody show would continue if her cervix was changing, but this usually does not occur until after contractions start. It is a sign that something is happening and should be reported to the health care provider. The bloody mucus is not a sign of labor, but it can be an early sign that labor is coming soon. Question format: Multiple Choice Chapter 6: Maternal Adaptation during Pregnancy Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 106 18. The nurse is assessing a pregnant client at 20 weeks' gestation and obtains a hemoglobin level. Which result would be a cause for concern? A. 12.8 g/dL B. 11.9 g/dL C. 11.2 g/dL D. 10.6 g/dL Answer: D Rationale: The average hemoglobin level at term is 12.5 g/dl. The hemoglobin level is considered normal until it falls below 11 g/dl. Question format: Multiple Choice Chapter 6: Maternal Adaptation during Pregnancy Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Reference: p. 107 19. A client at 40 weeks' gestation informs the nurse that she is tired of being pregnant. What is the best response from the nurse? A. "Do you need to speak with someone about your feelings?" B. "That is a very normal feeling, especially at this point in pregnancy." C. "Most woman would have asked to be induced by this point. Is that what you want?" D. "Are you getting enough rest? If you don't take time for rest, that is why you might be tired." Answer: B Rationale: During the third trimester, the client is preparing for parenthood and is often tired and ready for a break. The woman may feel large and unable to do any normal activities, and may feel ready to have the baby in her arms rather than in her uterus. This is not an abnormal statement, and the provider should not overreact. Deciding to induce labor is something that should be done in consultation with the health care provider and only when it is necessary for the health/safety of the mother or baby. Question format: Multiple Choice Chapter 6: Maternal Adaptation during Pregnancy Cognitive Level: Analyze Client Needs: Psychosocial Integrity Integrated Process: Caring Reference: p. 112 C. Hegar sign D. Chadwick sign Answer: B Rationale: The positive signs of pregnancy are fetal image on a sonogram, hearing a fetal heart rate, and examiner feeling fetal movement. A pregnancy test has 95% accuracy; however, it may come back as a false positive. Hegar sign is a softening of the uterine isthmus. Chadwick sign may have other causes besides pregnancy. Question format: Multiple Choice Chapter 6: Maternal Adaptation during Pregnancy Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 104 25. A client in her first trimester is concerned about how weight gain will affect her appearance and questions the nurse concerning dietary restrictions. How much weight gain should the nurse point out will be safe for this client with a low BMI? A. 25 to 35 pounds (11 to 16 kilograms) B. 28 to 40 pounds (13 to 18 kilograms) C. 15 to 25 pounds (7 to 11 kilograms) D. 16 to 30 pounds (7.25 to 14 kilograms) Answer: B Rationale: The recommendation for average weight gain is 25 to 35 lbs (11 to 16 kilograms). The woman who is underweight with a low BMI should gain 28 to 40 pounds (13 to 18 kilograms). Less than 28 pounds (13 kilograms) may hinder fetal development, and weight gain over 40 pounds (18 kilograms) may be dangerous to the mother. Individuals with a high BMI should gain 15 to 25 pounds (7 to 11 kilograms). A weight gain of less than 16 pounds (7.25 kilograms) may result in a low-birth-weight infant and gains over 30 pounds (14 kilograms) may necessitate a cesarean section. Question format: Multiple Choice Chapter 6: Maternal Adaptation during Pregnancy Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 113 Chapter 7: Prenatal Care 1. Charlene McCoy, who has several children already, reports for a first prenatal visit. She seems preoccupied and withdrawn, and she makes consistently negative remarks about the pregnancy. Reviewing her records, you note that she is receiving a serotonin reuptake inhibitor. What should you do? A. Reassure her that ambivalence is normal. B. Refer her for drug and alcohol counseling. C. Give her printed material to read at home. D. Alert the RN or health care provider. Answer: D Rationale: A client on an SSRI or SRI (serotonin reuptake inhibitor) might be in current treatment for a psychiatric disorder. The medication may also be one that is not safe during pregnancy. The RN and the health care provider need to be alerted to seek more information from the client. Reassurance is good practice, but not enough in this case. You do not have enough information to refer her for drug and alcohol counseling. She is under the care of another provider for her mental disorder, so do not confuse her with more material to read. Question format: Multiple Choice Chapter 7: Prenatal Care Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 122 2. As part of the first prenatal visit, the nurse is assessing a pregnant woman's obstetrical history, which includes an 18-month-old daughter, born 2 days after her estimated date of birth; a 3-year-old son born at 35 weeks' gestation; and two lost pregnancies, one at 12 weeks and one at 21 weeks. How should the nurse document this history? A. G5 T1 P2 A1 L2 B. G4 T1 P1 A2 L2 C. G5 T2 P2 A1 L1 D. G4 T1 P2 A2 L2 Answer: A Rationale: The G represents the total number of pregnancies, which is 5. The T represents term deliveries that ended at or beyond 38 weeks' gestation, which is 1. The P refers to preterm deliveries (ended after 20 weeks and before end of 37 weeks), which is 2. The A refers to abortions or the number of pregnancies that ended before 20 weeks' gestation, which is 1. The L refers to living children, which is 2. Thus the nurse will document G5 T1 P2 A1 L2 for this client. Question format: Multiple Choice Chapter 7: Prenatal Care Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Communication and Documentation Reference: p. 122 3. A client who is uncertain when her LMP occurred is given an EDD of April 23 after the first ultrasound. Based on this information, the nurse determines the client's LMP was probably which day? A. July 13 B. July 16 C. July 19 D. July 21 Answer: B Rationale: According to Naegele rule, the last menstrual period was July 16th. Take the LMP and add 7 days and subtract 3 months; if finding the LMP from the EDD, subtract 7 days and add 3 months. Question format: Multiple Choice Chapter 7: Prenatal Care Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 123 4. The nurse has just received the results of a pregnant client's MSAFP screening and notes the levels are elevated. The nurse should prioritize which discussion with the client? A. risk for Down syndrome B. risk for neural tube defects C. test needs to be repeated D. further testing is required Answer: D Rationale: The maternal serum alpha-fetoprotein (MSAFP) measures the levels of alpha- fetoprotein, which is a protein manufactured by the fetus. The woman's blood contains small amounts of this protein during pregnancy. The blood test is run between 16 and 20 weeks' gestation; an abnormal level indicates a need for further testing to determine the risks her fetus may face. Higher levels can indicate multiple fetuses, death of the fetus, the presence of neural tube defects, and possibly Down syndrome; however, further testing such as ultrasound or amniocentesis is required to determine the exact cause of the elevation. Question format: Multiple Choice Chapter 7: Prenatal Care Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential 9. The nurse advises a pregnant client to keep a small high-carbohydrate, low-fat snack at the bedside. The nurse should point out this will assist with which condition? A. heartburn B. faintness C. slowed GI transit time D. nausea and vomiting Answer: D Rationale: Women will commonly experience nausea and vomiting upon awakening first thing in the morning. Clients who experience this should be encouraged to have small snacks at their bedside for eating prior to moving from the bed. Heartburn is a result of pressure and hormone action. Faintness is due to pressure on the vena cava, not blood sugar. GI transit time is not affected. Question format: Multiple Choice Chapter 7: Prenatal Care Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 131 10. The nurse is teaching a pregnant client some nonpharmacologic ways to handle common situations encountered during pregnancy. The nurse determines the session is successful when the client correctly chooses which condition that can be minimized if she avoids drinking fluids with her meals? A. nosebleeds B. heartburn C. blood clots D. constipation Answer: B Rationale: Filling the stomach with heavy food and fluid can cause overfill and place pressure on the stomach, increasing gastric reflux. Avoid excess fluids with meals and eat small frequent meals to avoid heartburn. Nosebleeds result from increased estrogen. Blood clots can result from sitting still for too long. Constipation can result from increased progesterone. Question format: Multiple Choice Chapter 7: Prenatal Care Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 131 11. The nurse is meeting with a client at 28 weeks' gestation. To prepare her for the final trimester, which factor should the nurse prioritize in the teaching session? A. preventing anemia B. decreasing shortness of breath C. decreasing bleeding gums D. preventing varicosities Answer: B Rationale: As the fetus grows inside the mother, there is more pressure on the diaphragm, more difficulty breathing, and episodes of dyspnea may occur. This tends to decrease with "lightening," when the fetus drops. Preventing anemia, decreasing bleeding gums, and preventing varicosities are situations that should be addressed throughout the entire pregnancy. Question format: Multiple Choice Chapter 7: Prenatal Care Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 131 12. A pregnant client reports difficulty sleeping well. Which suggestion for sleeping should the nurse prioritize to assist this client? A. on her stomach with a pillow under her breasts B. on her side with the weight of the uterus on the bed C. on her back with a pillow under her knees and hips D. on her back with a pillow under her head Answer: B Rationale: Resting on the side prevents pressure from the uterus against the vena cava and therefore allows blood to return to the uterus. Other positions may be more uncomfortable or may exacerbate the problems associated with pressure on the vena cava. Question format: Multiple Choice Chapter 7: Prenatal Care Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 131 13. A pregnant client is planning a vacation to a different state and questions the nurse concerning precautions. Which suggestion should the nurse prioritize for this client who will be traveling by automobile? A. Travel no more than 120 miles daily. B. Sit in the back seat with feet elevated. C. Stop and walk every 2 hours. D. Limit trips away from home, greater than 200 miles. Answer: C Rationale: Walking increases venous return and reduces the possibility of thrombophlebitis, a risk for pregnant women who sit for extended periods of time. Limiting mileage, sitting in the back with the feet elevated, and limiting trips may help, but they are not enough to prevent phlebitis. Question format: Multiple Choice Chapter 7: Prenatal Care Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 137 14. The nurse is assessing a client at 30 weeks' gestation who reports increased constipation. Which suggestion should the nurse prioritize for this client? A. taking mineral oil B. increasing fluid intake C. reducing iron supplement D. increasing intake of meat Answer: B Rationale: Increasing fluid content by drinking at least 8 glasses of noncaffeinated beverages helps relieve constipation in both pregnant and nonpregnant women. Reducing an iron supplement could lead to anemia; mineral oil can reduce absorption of fat- soluble vitamins. The client should add foods rich in fiber, which would include grains, vegetables, and fruits (instead of meat). Question format: Multiple Choice Chapter 7: Prenatal Care Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 132 15. The nurse is assessing a client at 12 weeks' gestation who reports enjoying her usual slow, long daily walk. The nurse should point out which recommendation to this client? A. Reduce walking to half a block daily. B. Continue this as long as she enjoys it. C. Stop and rest every block. D. Engage in aerobics for greater benefits. Answer: B Rationale: Walking is an excellent exercise during pregnancy because it is low impact and increases venous circulation. Exercise should be maintained as long as it is comfortable, but intensity should not increase over what is normally performed. Question format: Multiple Choice Chapter 7: Prenatal Care 20. The nurse is preparing to administer a prescribed medication to the pregnant client. Which order should the nurse question? A. penicillin B. rubella C. acetaminophen D. folic acid Answer: B Rationale: Most vaccines are contraindicated during pregnancy and are considered teratogenic, such as rubella. Penicillin and acetaminophen may be taken under provider supervision. Folic acid supplementation should be encouraged. Question format: Multiple Choice Chapter 7: Prenatal Care Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 123 21. The nurse is assessing a client at her first prenatal visit and reports her LMP started December 1. Which date will the nurse predict for the EDD? A. October 7 B. September 8 C. July 7 D. August 8 Answer: B Rationale: According to Naegele rule, the estimated date of birth is September 8. Add 7 days and subtract 3 months to the LMP to determine the estimated date of birth. Question format: Multiple Choice Chapter 7: Prenatal Care Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 123 22. A young couple are very excited to discover they are pregnant and ask the nurse when to expect the baby. Based on a July 20 LMP, which day will the nurse predict for delivery? A. April 27 B. March 13 C. April 13 D. May 20 Answer: A Rationale: Naegele rule is to subtract 3 months and add 7 days from the first day of the last menstrual period to determine an expected due date, making the client's due date April 27. Question format: Multiple Choice Chapter 7: Prenatal Care Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 123 23. The nurse will be assisting a client during an amniocentesis. Which nursing intervention should the nurse prioritize? A. Caution about the opioid premedication. B. Be certain she is aware of potential complications. C. Ensure she understands the need for 2 days of bed rest. D. Expect test results within 1 week. Answer: B Rationale: The client should be aware of the potential complications and risks, and should sign an informed consent. Opioids are contraindicated for pregnant woman due to side effects. She should maintain bed rest for the remainder of the day, with light housework the following day and a return to normal activities on the third day. It may take 2 or 3 weeks before the test results come back from the laboratory. Question format: Multiple Choice Chapter 7: Prenatal Care Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Reference: p. 128 24. The nurse is assessing a client at her first prenatal visit and notes the fundal height is palpable at the level of the umbilicus. The nurse predicts the client is at which gestational age? A. 18 weeks B. 20 weeks C. 24 weeks D. 22 weeks Answer: B Rationale: Some clients will not seek early prenatal care, especially if it is not their first pregnancy. The uterus expands to reach the height of the umbilicus by week 20. Before week 20 it is too low to be palpated, and after week 20 it maybe beyond the umbilicus. Question format: Multiple Choice Chapter 7: Prenatal Care Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 121 25. A pregnant client arrives for her first prenatal appointment. She reports her previous pregnancy ended at 19 weeks, and she has 3-year-old twins born at 30 weeks' gestation. How will the nurse document this in her records? A. G2 T2 P1 A0 L2 B. G2 T1 P1 A1 L1 C. G3 T0 P1 A1 L2 D. G3 T2 P2 A0 L1 Answer: C Rationale: G indicates the total number of pregnancies (2 prior, now pregnant = 3); T indicates term deliveries at or beyond 38 weeks' gestation (none = 0); P is for preterm deliveries (at 20 to 37 weeks = 1; multiple fetus delivery are scored as 1); A is for abortions or pregnancies ending before 20 weeks' gestation (1); and L refers to living children which is 2. Thus, G3 T0 P1 A1 L2 is what the nurse should note in the client's record. Question format: Multiple Choice Chapter 7: Prenatal Care Cognitive Level: Analyze Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Communication and Documentation Reference: p. 122 26. The nurse takes a call from a worried client who was seen several hours earlier for her 35- weeks' gestation visit, which included a pelvic examination. Which instruction should the nurse prioritize if the client is reporting a small amount of vaginal spotting? A. Return right away. B. Watch it and report if heavy increase in bleeding. C. The bleeding, called Chadwick sign, is a normal part of pregnancy. D. The cervical mucus plug may have been expelled. Answer: B Rationale: During the third trimester, if the provider completes a vaginal exam it can be normal to have a small amount of spotting. If the bleeding becomes active or increases, the client needs to be seen immediately. Chadwick sign is a change of color in the vaginal area. The loss of the mucus plug would lead to a much greater amount of blood. Question format: Multiple Choice Chapter 7: Prenatal Care Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Teaching/Learning Reference: p. 161-162 3. The 29-year-old client presents at 5:30 a.m. with labor pains. Her history reveals G4, three previous vaginal births, and gynecoid pelvis. At 9 a.m. her assessment reveals 80% effaced and dilated at 3 cm. What nourishment can the nurse provide if the client mentions she hasn't eaten since 5 p.m. yesterday and is hungry? A. solid food and fluids B. nothing except for intravenous fluids C. clear liquids but no solid food D. cannot assess with the information given Answer: C Rationale: The nurse should offer clear liquids but no solid foods. She is moving closer to active labor nearing the end of the latent phase. It would not be advisable to offer her solid foods, but she needs to continue her nourishment with fluids to her thirst. Solid foods may lead to nausea and vomiting. Intravenous fluids are too extreme as long as she is able to drink. Question format: Multiple Choice Chapter 8: The Labor Process Cognitive Level: Apply Client Needs: Physiological Integrity: Basic Care and Comfort Integrated Process: Nursing Process Reference: p. 161-162 4. The nurse is preparing to teach a group of soon-to-be new parents about the labor process. When detailing the differences between the various presentations, which one should the nurse point out seldom happens? A. Breech B. Shoulder C. Oblique lie D. Transverse lie Answer: B Rationale: Shoulder presentations are the least likely to occur. They occur in less than 0.3% of all births. Approximately 97% of fetuses are in a cephalic presentation at the end of pregnancy. A longitudinal lie, in which the long axis of the fetus is parallel to the long axis of the mother, is the most common. When the fetus is in a transverse lie, the long axis of the fetus is perpendicular to the long axis of the woman. An oblique lie is in between the two. Question format: Multiple Choice Chapter 8: The Labor Process Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 153 5. A 33-year-old client has been progressing slowly through an unusually long labor. The nurse assesses the fetal scalp pH and determines it is 7.26. How should the nurse explain this result to the client when asked what it means? A. Reassuring; it is associated with normal acid-base balance. B. Worrisome; it may be associated with metabolic acidosis. C. Critical; it represents metabolic acidosis. D. Damaging; it is frequently associated with fetal neurological damage. Answer: A Rationale: The fetal pH slowly decreases during labor as a result of the normal stress of labor. Although 7.26 is low for an adult, it is not problematic during labor for an emerging fetus. Question format: Multiple Choice Chapter 8: The Labor Process Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Reference: p. 162 6. A 24-year-old primigravida client at 39 weeks' gestation presents to the OB unit concerned she is in labor. Which assessment findings will lead the nurse to determine the client is in true labor? A. The contraction pains are 2 minutes apart and 1 minute in duration. B. The client reports back pain, and the cervix is effacing and dilating. C. The contraction pains have been present for 5 hours, and the patterns are regular. D. After walking for an hour, the contractions have not fully subsided. Answer: B Rationale: True labor is indicated when the cervix is changing. Contractions occur for weeks before true labor, and may occur close together. Contractions may also occur for a long time before true labor begins. Question format: Multiple Choice Chapter 8: The Labor Process Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 158 7. The nurse is monitoring a client who is in active labor. The nurse will carefully monitor which phase of the involuntary uterine contraction to ensure the fetus is progressing adequately? A. Increment B. Acme C. Decrement D. Relaxation Answer: D Rationale: The relaxation phase of uterine contractions is the time in which the fetus has a break. This time needs to be observed, and it is beneficial for the fetus to have a break. The three phases of a uterine contraction are the increment (building up in intensity), acme (peak intensity), and decrement (decreasing intensity). These phases are followed by a relaxation phase. Question format: Multiple Choice Chapter 8: The Labor Process Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 162 8. A primigravida client at 39 weeks' gestation calls the OB unit questioning the nurse about being in labor. Which response should the nurse prioritize? A. Tell the woman to stay home until her membranes rupture. B. Emphasize that food and fluid should stop or be light. C. Ask the woman to describe why she believes that she is in labor. D. Arrange for the woman to come to the hospital for labor evaluation. Answer: C Rationale: The nurse needs further information to assist in determining if the woman is in true or false labor. The nurse will need to ask the client questions to seek further assessment and triage information. Having the client wait until membranes rupture may be dangerous, as she may give birth before reaching the hospital. The client should continue fluid intake until it is determined whether or not she is in labor. The client may be in false labor, and more information should be obtained before she is brought to the hospital. Question format: Multiple Choice Chapter 8: The Labor Process Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Reference: p. 157 9. A pregnant client arrives to the clinic for a prenatal visit appearing uncomfortable. During the assessment, the nurse determines the client is experiencing fairly strong contractions at 12:05 p.m., 12:10 p.m., 12:15 p.m., and 12:20 p.m. What can the nurse conclude from these findings? A. The client is in active labor. B. The duration of the contractions is every 5 minutes. C. The frequency of the contractions is every 5 minutes. D. The client can be sent home. Answer: C not of concern. Communicate to the parents that it is similar to a bruise or a blister. This sign is not indicative of the use of forceps. Question format: Multiple Choice Chapter 8: The Labor Process Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process Reference: p. 162 14. The nurse determines a client is 7 cm dilated. What is the best response when asked by the client's partner how long will she be in labor? A. "She is in active labor; she is progressing at this point and we will keep you posted." B. "She is in the transition phase of labor, and it will be within 2 to 3 hours, though it might be sooner." C. "She is still in early latent labor and has much too long to go to tell when she will give birth." D. "She is doing well and is in the second stage; it could be anytime now." Answer: A Rationale: At 7 cm dilated, she is considered in the active phase of labor. There is no science that can predict the length of labor. She is progressing in labor, and it is best not to give the family a specific time frame. Question format: Multiple Choice Chapter 8: The Labor Process Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Communication and Documentation Reference: p. 161 15. When documenting the fetus is at "zero station", the nurse knows this is where in relation to the pelvic structure? A. Pelvic inlet B. Pelvic outlet C. Ischial spines D. Pelvic crest Answer: C Rationale: Zero station is the engagement of the fetus at the level of the ischial spines of the pelvis. The ischial spines are a landmark that is used mark the passage of the fetus. The pelvic crest is a landmark location on the pelvis for documenting fetal station. The pelvic inlet must be shaped accordingly to allow for passage of the fetus. The pelvic outlet is associated with internal rotation of the fetal head. Question format: Multiple Choice Chapter 8: The Labor Process Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Communication and Documentation Reference: p. 154 16. A 37-year-old primigravida client at 40 weeks' gestation is seen in the clinic for a scheduled prenatal visit. What report by the client would lead the nurse to predict the woman is close to labor? A. Nesting B. Dilation C. Effacement D. Ripening of the cervix Answer: A Rationale: Nesting is the activity or burst of energy women often experience prior to the onset of labor. The client could express feeling energetic or through a report of her activities at home. Dilation, effacement, and cervical ripening are all observed by the provider during assessment. Question format: Multiple Choice Chapter 8: The Labor Process Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 156-157 17. The community health nurse is conducting a presentation on labor and delivery. When illustrating the birth process, the nurse should point out "0 station" refers to which sign? A. "This is just a way of determining your progress in labor." B. "This indicates that you start labor within the next 24 hours." C. "This means +1 and the baby is entering the true pelvis." D. "The presenting part is at the true pelvis and is engaged." Answer: D Rationale: 0 station is when the fetus is engaged in the pelvis, or has dropped. This is an encouraging sign for the client. This sign is indicative that labor may be beginning, but there is no set time frame regarding when it will start. Labor has not started yet, and the fetus has not begun to move out of the uterus. Question format: Multiple Choice Chapter 8: The Labor Process Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 154 18. The nurse has been monitoring a multipara client for several hours. She cries out that her contractions are getting harder and that she cannot do this. The nurse notes the client is very irritable, nauseated, annoyed, and doesn't want to be left alone. Based on the assessment the nurse predicts the cervix to be dilated how many centimeters? A. 0 to 2 B. 5 to 7 C. 3 to 4 D. 8 to 10 Answer: D Rationale: The reaction of the client is indicative of entering or being in the transition phase of labor, stage 1. The dilation (dilatation) would be 8 cm to 10 cm. Before that, when dilation is 0 to 7 cm, the client has an easier time using positive coping skills. Question format: Multiple Choice Chapter 8: The Labor Process Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 160 19. A group of nursing students are preparing a presentation that will illustrate various components of the birthing process. When discussing the pelvis, the students should point out that the pelvis is often referred to as which term? A. passenger B. passageway C. powers D. psyche Answer: B Rationale: The passageway is one of the 4 Ps and involves the pelvis, both bony pelvis and the soft tissues, cervix, and vagina. The passenger refers to the fetus. The primary powers are the involuntary contractions of the uterus, whereas the secondary powers come from the maternal abdominal muscles. The psyche refers to the mother's mental state. Question format: Multiple Choice Chapter 8: The Labor Process Cognitive Level: Understand Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 151 20. A nulliparous client at 37 weeks' gestation calls the labor and delivery unit stating she thinks she is in labor. The nurse predicts she is in true labor based on which answer to her assessment questions?