Test Bank Questions - Exam #1 Maternal Newborn Questions with Answers 2024 Test, Exams of Nursing

Download Test Bank Questions - Exam #1 Maternal Newborn Questions with Answers 2024 Test and more Exams Nursing in PDF only on Docsity! Test Bank Questions - Exam #1 Maternal Newborn Questions with Answers 2024 Test chapter 1 A nurse wishes to improve their cultural sensitivity while working with patients. Which actionby the nurse would best indicate progress toward this goal? A. Demonstrate good knowledge of different cultural health beliefs B. Effectively respond to the needs of people of different cultures C. Interact respectfully with patients who have differing health beliefs D. Recognize that they will never be the expert in other cultures - Correct Answer C. Interact respectfully with patients who have differing health beliefs chapter 1 A nurse manager is evaluating staff members on their cultural competence. Which action best demonstrates this characteristic? A. Attends workshops on cultural diversity and health practices B. Participates in community health events with minority populations C. Plans care with the family members within their cultural beliefs D. Uses family members as interpreters to make them feel important - Correct Answer C. Plans care with the family members within their cultural beliefs chapter 1 A patient wishes to use complementary therapy when managing a chronic health condition. Which action by the nurse is most appropriate? A. Advise the patient that stopping medical treatment may cause it to worsen. B. Inform the patient that there are no complementary therapies for this condition. C. Investigate herbs that can be substituted for prescription drugs. D. Suggest the patient add massage therapy to the medical regimen. - Correct Answer D. Suggest the patient add massage therapy to the medical regimen. Complementary therapy is nontraditional medical treatment used together with conventional medical treatment. Adding massage to the medical regimen is an example of using complementary therapy. chapter 1 A nurse is working with a family that uses multiple complementary and alternative medicine (CAM) modalities. What action by the nurse is best? A. Allow the family to continue these practices as desired. B. Assess how these practices reflect religious beliefs. C. Inform the family that most of these practices do not work. D. Provide evidence-based information about the therapies. - Correct Answer D. Provide evidence-based information about the therapies. The nurse working with individuals or families who use CAM practices should respect the beliefs, values, and desires of the patient. The nurse should encourage families to make decisions regarding CAM practices based on evidence and research into their effects. The nurse can best assist in this by providing and discussing information Chapter 1 A nurse is caring for a patient from a culture with which the nurse is totally unfamiliar. What action by the nurse will best promote effective communication? A nurse works a great deal with refugees and is frustrated because, as a group, they don't seem to want to implement desired health behaviors. What action by the nurse would be most helpful? A. Conduct a health screening and educational event each month. B. Provide written information in the group's native language. C. Teach selected group representatives to be lay health educators. D. Try to establish relationships within the refugee community. - Correct Answer C. Teach selected group representatives to be lay health educators. According to family systems theory, each family system contains boundaries that affect how the outside world interacts with the family. Families that have recently immigrated to the United States might have closed boundaries and may only be re- ceptive to health information provided by extended family members or members of their community. Establishing a lay health educator program in which community members can be taught health information with the intent of delivering it to their communities would be a good way to work with these families while respecting their boundaries. chapter 1 A patient is dismissed from the hospital and is receiving nursing care at home to help in the recovery from a serious illness and operation. The visiting nurse notes that the family is in a state of disarray and members are disorganized and not communicating. The patient is trying to direct everyone's actions. The nurse calls a family meeting. What action by the nurse is best? A. Encourage family members to make "to do" lists and assign chores. B. Explain that changes in one person require changes in the others. C. Make a referral to a counselor or mental health nurse practitioner. D. Tell the family members that, for the patient to recover, they must assume the patient's role. - Correct Answer B. Explain that changes in one person require changes in the others. Family systems theory recognizes that changes in one member of a family affects every other member of the family. For the family to function effectively, all members need to adapt to the major changes in one of the members. chapter 1 A nurse is working with a blended family of 1 year with five children aged 3, 7, 13 (twins), and 19. The parents seem overly stressed and anxious and do not seem to work well as a unit. What can the nurse conclude about this family? A. Communication problems are the core of the parents' stress. B. Economic stressors are impacting the parental dyad. C. The family is in too many developmental stages to master any of them. D. There are too many children to give each one adequate attention. - Correct Answer C. The family is in too many developmental stages to master any of them. In family developmental theory, the age of the child determines the stage the family is in. If there is more than one child, the family is probably in multiple developmental stages at the same time. The family is probably in a combination of beginning families, preschool, school-aged and adolescent, and launching stages. The competing priorities of all these stages pave the way for chaos. chapter 1 A nurse is working with a patient who is newly married and pregnant and says she is distressed because she and her husband seem to be so different, and they argue over petty issues. What action by the nurse using group theory would be best? A. Ask the patient if she can remember why she and her husband fell in love. B. Caution her that this level of disagreement will cause stress to the unborn baby. C. Offer the patient a referral to a community counseling center for couples' therapy. D. Reassure her that this is normal and help her brainstorm ways to work cooperatively. - Correct Answer D. Reassure her that this is normal and help her brainstorm ways to work cooperatively. According to group theory, groups evolve through the distinct stages of forming, storming, norming, performing, and adjourning. Storming often occurs when a group that has recently formed notices differences in members, leading to chaos or confusion. This couple is in this stage. At this point, the nurse's best action is to reassure the patient and help her brainstorm ways of working together cooperatively, which might include forming rules or procedures that both parties agree to follow. chapter 1 A clinic nurse is using group theory to assess a family whose youngest child recently moved back home after graduating from college and is unable to find a job. Which statement by a parent would indicate to the nurse that goals for norming have been met? A. "I'm glad my son stays in his room in the basement all day, so he doesn't bother us." B. "It's hard to decide how much food to buy because we don't know where he's eating." C. "My son is gone a lot of the time, so we really don't notice that he moved back in." D. "We have agreed not to have a curfew as long as we know when he will be home." - Correct Answer D. "We have agreed not to have a curfew as long as we know when he will be home." A. "Are you willing to talk about your weight gain this year?" B. "Do you realize your weight puts you into an obese category?" C. "Do you participate in any activities or exercise?" D. "What do you think about your weight right now?" - Correct Answer D. "What do you think about your weight right now?" During adolescence, body weight has a dramatic effect on the development of self-image and self-esteem and can be a sensitive issue for discussion. An important strategy in discussions about weight and weight loss with adolescents is to begin the conversation with expressions of respect that are sensitive to cultural differences related to food choices and eating patterns. Regardless of whether the patient is ready to begin a weight control program, he may still benefit from talking openly about healthy eating and exercise. To open the conversation, the nurse can begin with a simple question to determine if the patient is willing to talk about the issue. chapter 1 A group of student nurses are reviewing the Nurse Practice Act. Which statements indicate that teaching has been effective? Select all that apply. A. "Nurse Practice Acts are the same across the United States." B. "Roles and responsibilities are specified by type of license." C. "Information for initial application." D. "Criteria for renewal of professional license." E. "Describes required elements for professional nursing programs." - Correct Answer B, C, D, E A. This is incorrect. Nurse Practice Acts vary from state to state based on legislative action. B. This is correct. This is a factual statement. C. This is correct. Nurse Practice Act specifies process for initial application for li- censure. D. This is correct. Nurse Practice Act provides information for the renewal of applica- tion for a professional license. E. This is correct. This is a factual statement. chapter 1 A nurse is reviewing research studies. Based on the concept of evidence-based practice, which type of research designs would be considered to be Level 1? Select all that apply. A. "Committee report." B. "Randomized clinical trial (RCT)." C. "Expert opinion." D. "Meta-analysis." E. "Case studies." - Correct Answer Answer: B, D A. This is incorrect. This would be an example of level VII. B. This is correct. An RCT is an example of the highest EBP level. C. This is incorrect. This would be an example of level VII. D. This is correct. A meta-analysis is an example of a systematic review that refers to the highest EBP level. E. This is incorrect. This would be an example of level IV. chapter 1 Which statements are accurate based on common mortality statistics? Select all that apply. A. "The birth rate is based on data collection obtained every 2 years." B. "Fetal and neonatal fatalities are included in the perinatal mortality rate." C. "Neonatal mortality rate includes deaths up to 1 year." D. "Infant mortality rate includes all deaths under age 1 year per 1,000 births." E. "Maternal mortality rates include only term gestations." - Correct Answer Answer: B, D A. This is incorrect. The birth rate is calculated each year based on the number of live births per 1,000 population. B. This is correct. The perinatal mortality rate includes fetal and neonatal deaths per 1,000 live births per year. C. This is incorrect. The neonatal mortality rate includes the number of infant deaths from time they were born until 28 days per 1,000 live births per year. D. This is correct. This is a factual statement. E. This is incorrect. The maternal mortality rate is based on the number of maternal deaths per 100,000 live births that occur during a pregnancy or up to 42-days postpartum chapter 2 A patient is having an infertility work-up and has been told she has scarring of her fallopiantubes. What action by the nurse is best? A. Ask the patient how many sexually transmitted infections she has had. B. Assess the patient for previous vaginal infections and their treatment. C. Gently tell the patient that nothing can be done about scarring of the tubes. D. Question the patient about genetic defects or family history of infertility. - Correct Answer B. Assess the patient for previous vaginal infections and their treatment. C. Instruct her to drink 10 glasses of water daily. D. Obtain consent for possible cesarean delivery. - Correct Answer D. Obtain consent for possible cesarean delivery. Pelvimetry measurements demonstrate the feasibility of a vaginal birth. The minimum measurement for the midpelvis (which is the narrowest lateral portion of the female pelvis) is 4.7 inches (12 cm). Pelvimetry measurements may not be accurate for several reasons, and despite findings, in most situations, the patient is allowed a trial of labor. As the joints of the pelvis soften and become more mobile, a vaginal delivery might still be possible. The nurse should obtain consent for a possible cesarean delivery. chapter 2 A 17-year-old female is brought to the family practice clinic by her mother, who is worried that her daughter has not yet developed secondary sex characteristics. Which action by the nurse is best? A. Assess a family pedigree for genetic influences. B. Explain that some girls don't develop until their 20s. C. Inform them that the daughter will be tested for estrogen deficiency. D. Obtain a urine sample for a pregnancy test. - Correct Answer C. Inform them that the daughter will be tested for estrogen deficiency. Estrogen is the primary female hormone and is responsible for the development of secondary sex characteristics. Physical changes associated with puberty usually begin between ages 11 and 13. A 17-year-old female who has not yet developed these features may have an estrogen deficiency. chapter 2 In providing anticipatory guidance to a 12-year-old female who has developed breast buds, what information should the nurse provide? A. Breast self-exam is now important. B. First period will occur in 6 months. C. Growth of pubic hair will occur next. D. Maximum height has been obtained. - Correct Answer C. Growth of pubic hair will occur next. chapter 2 A family practice nurse is providing anticipatory guidance to an 11-year-old boy. What information about puberty should the nurse plan to include? A. Boys start puberty about 2 years earlier than girls. B. Circulating estrogen may cause breast enlargement. C. Testosterone production is the last stage of puberty. D. The first sign of puberty is testicular enlargement. - Correct Answer D. The first sign of puberty is testicular enlargement. Testosterone secretion causes testicular enlargement, which is the first sign of pubertal changes in males. chapter 2 The nursing instructor explains to a class that important effects of estrogen in the proliferative phase of the uterine cycle include which of the following? A. Causes uterine spiral arteries to constrict, limiting blood flow B. Causes changes in cervical mucus to facilitate sperm penetration C. Leads to changes causing the uterus to be receptive to a fertilized ovum D. Results in rupture of endometrial blood vessels and the onset of menses - Correct Answer B. Causes changes in cervical mucus to facilitate sperm penetration During the proliferative phase of the uterine, or endometrial, cycle, increasing amounts of estrogen lead to changes in cervical mucus that facilitate sperm penetration at midcycle. chapter 2 A patient is in the family planning clinic to learn about her cycle and the best times to get pregnant. What information should the nurse plan to teach her? A. An ovum can be fertilized for 12 to 24 hours after ovulation. B. Pregnancy can only occur during the follicular phase. C. There are no physiological signs that demonstrate ovulation. D. You can't easily get pregnant if your cycles are irregular. - Correct Answer A. An ovum can be fertilized for 12 to 24 hours after ovulation. An ovum is capable of being fertilized by a sperm cell for approximately 12 to 24 hours after ovulation. chapter 2 A patient who is postmenopausal is in the clinic complaining of urinary incontinence and wants to know why this is occurring. Otherwise, she has no other complaints. What response by the nurse is best? A. "I'm not sure; let's ask the physician why this could occur." B. "Low estrogen levels after menopause cause the urinary tissues to atrophy." C. "Most older women experience some incontinence." D. "You won't need to worry about bras until at least age 14." - Correct Answer A. "Around age 10, girls may become interested in shaving their underarms." Adrenarche (the time when androgen secretion leads to axillary and pubic hair) oc- curs at an average age of 10, so girls around that time will start noticing this change and may think about shaving. chapter 2 A nurse is providing teaching relative to barrier methods of birth control to a group of patients attending a medical clinic. Which of the following statements indicates that teaching has been effective? Select all that apply. A. "There is no learning curve required for use of this method." B. "These methods do not provide protection against STDs." C. "This type of method requires a planned action." D. "Patients who have latex allergies will not be able to use this type of method." E. "Emergency contraception is not needed as the barrier method is 100% effective." - Correct Answer Answer: C, D A. This is incorrect. Correct application of barrier methods is critical to the method's success; thus, the patient must receive proper instruction and be able to demonstrate understanding. B. This is incorrect. Barrier methods provide effective protection against STDs. C. This is correct. This method requires preplanning before sexual relations occur. D. This is correct. Latex allergies can lead to anaphylaxis which can be life threatening. E. This is incorrect. The barrier method is not 100% effective and as such emergency contraception may be needed in case there was inadequate protection, or the patient is worried about the integrity of the barrier method. chapter 2 A teenager is seeking information from the clinic nurse about usage of a cervical cap for birth control. Which of the following are correct responses by the nurse? Select all that apply. A. "It must remain in place for up to 48 hours after sexual intercourse." B. "No spermicide is needed for application." C. "This type of method must be prescribed and fitted by the health-care provider." D. "The cap is held in place by suction." E. "It is easy to apply." - Correct Answer Answer: A, C, D A. This is correct. This is a factual statement related to the usage timeframe. B. This is incorrect. A spermicide is required to be used with a cervical cap to increase efficacy of the method. C. This is correct. The cervical cap is available by Rx only, must be fitted and receive instruction related to proper placement and evaluated in one week's time for proper placement by the health-care provider. D. This is correct. This is a factual statement. E. This is incorrect. The cervical cap is somewhat difficult to apply and must fit directly over the cervix to be effective. chapter 2 A nurse is reviewing medical records for patients who will be seen in the obstetrical clinic. Which pelvic types should the nurse anticipate may lead to a problem with a planned vaginal delivery? Select all that apply. A. "Gynecoid." B. "Anthropoid." C. "Platypelloid." D. "Android." E. "Retroverted." - Correct Answer Answer: C, D A. This is incorrect. Gynecoid pelvis is best suited for childbirth. B. This is incorrect. Anthropoid pelvis is similar to the gynecoid pelvis. C. This is correct. A platypelloid pelvis can impede fetal descent and thereby could impact a planned vaginal delivery. D. This is correct. An android pelvis can affect fetal descent and thereby could impact a planned vaginal delivery. E. This is incorrect. Retroverted does not refer to a pelvic type but rather can describe the position of the cervix or uterus and may impact the ability to get pregnant. chapter 2 An 18-year-old female patient has been diagnosed with amenorrhea. Which questions should the nurse ask to find out if the etiology is due to secondarya menorrhea? Select all that apply. A. "Just want to confirm that you have never started to menstruate?" B. "How long have you been running marathons?" C. "What type of birth control method are you using?" D. "Do you have breast implants?" E. "Are you experiencing any undue stress in your life?" - Correct Answer Answer: B, C, E A. This is incorrect. Primary amenorrhea is diagnosed in patients who have not started their menses by age 16. B. This is correct. Secondary amenorrhea can occur in response to intense exercise possible intellectual deficits and cardiac disorders. chapter 3 A nurse has completed a family pedigree on a patient with a known autosomal dominant inheritance disorder. No one else in the family has been affected by this disorder. How does the nurse explain this finding to the patient? A. Genetic variation occurred via a mutation. B. Information about the family is incorrect. C. The patient is not biologically related to the family. D. The patient's diagnosis must be incorrect. - Correct Answer A. Genetic variation occurred via a mutation Most autosomal dominant inheritance disorders are seen in families in which multiple members in different generations have been affected by the disorder. However, the variant allele may arise from a mutation, in which case the affected person will be the first known person in the family to be affected. chapter 3 A nurse is counseling a couple whose child has been diagnosed with cystic fibrosis. They understand that this is an inherited disease but don't know how the child got it, as neither of them is affected. What response by the nurse is best? A. "Are you certain that you (points to man) are the biological father?" B. "Maybe each of you has a mild case that hasn't been diagnosed yet." C. "Something in your environment must have altered one of the genes." D. "This is a recessive disorder, meaning that each of you is just a carrier." - Correct Answer D. "This is a recessive disorder, meaning that each of you is just a carrier." Cystic fibrosis is an example of an autosomal recessive inheritance problem. Both parents carry an altered gene for this condition (carriers), but both parents must pass this altered version on to their child for it to be expressed. chapter 3 A couple wishes to know the chances of passing on an X-linked dominant heritable disorder to their four sons. The father's family has the disorder. The sons appear healthy, but the couple wants to be prepared for possible future events related to the disease. What information does the nurse give them? A. "All of them will be affected." B. "Half of them will be affected." C. "None of your sons will be affected." D. "One of the four will be affected." - Correct Answer C. "None of your sons will be affected." An X-linked dominant inheritance disorder is the result of an alteration in a gene located on an X chromosome. None of this couple's sons can be affected because boys get a Y chromosome from the father, whereas all a man's daughters will have it. chapter 3 A nursing faculty member is explaining the process of fertilization to a class of students. One student asks the instructor to clarify the term "secondary oocyte." What description is best? A. An oocyte in the secondary position during transportation B. An oocyte in which the first meiotic division has occurred C. The second egg released by the ovary during ovulation D. The second egg to reach its place in the fallopian tube - Correct Answer B. An oocyte in which the first meiotic division has occurred The secondary oocyte is one in which the first meiotic division has occurred. This is the egg that is expelled from the ovary during ovulation. chapter 3 A student has read that hematopoiesis occurring in the wall of the yolk sac declines after the eighth week of gestation and asks the instructor for clarification. What statement by the faculty member is most accurate? A. "All of the blood needed is transported across the placenta." B. "Bone marrow production of blood begins in week 8." C. "The fetal liver takes over that function then." D. "You must have misread that information." - Correct Answer C. "The fetal liver takes over that function then." Formation and development of red blood cells (hematopoiesis) occurs in the wall of the yolk sac beginning in the third week. The function gradually declines after the eighth gestational week when the fetal liver begins to take over this process. chapter 3 The nurse discussing fetal development describes the hormone responsible for suppressing the maternal immunological response to the fetus, thereby facilitating physiological acceptance of the pregnancy. Which hormone is the nurse describing? A. Estrogen B. Human chorionic gonadotropin D. Tell the patient to substitute caffeinated beverages for the alcohol. - Correct Answer B. Explain that, during pregnancy, alcohol in any amount can harm the fetus. Alcohol is one of the most potent teratogens known, and a safe level of alcohol during pregnancy has not been established. Therefore, the nurse should advise the patient to stop drinking alcohol altogether while she is pregnant. chapter 3 A preterm infant is jittery and has an oxygen saturation of 88%. After stabilizing the newborn, what action by the nurse is most important? A. Assess the mother for caffeine use during pregnancy. B. Assess the mother for opioid use during pregnancy. C. Call Child Protective Services (CPS) to take the child away. D. Question the father about maternal drug abuse. - Correct Answer B. Assess the mother for opioid use during pregnancy. Maternal opioid use can lead to neonatal withdrawal syndrome, characterized by hyperirritability, gastrointestinal dysfunction, respiratory distress, and autonomic disturbances. After stabilizing the baby, the nurse should first assess the mother for opioid abuse during pregnancy. chapter 3 A neonate whose mother is a drug addict is listless and sweating. What action by the nurse takes priority? A. Check the baby's blood sugar. B. Have the mother hold the baby to her skin. C. Obtain an oxygen saturation. D. Place the baby on a cardiac monitor. - Correct Answer A. Check the baby's blood sugar. Babies born of mothers who have used amphetamines during pregnancy may exhibit hypoglycemia, sweating, poor visual tracking, lethargy, and difficulty feeding. The nurse would conclude that the baby may be at risk for hypoglycemia because he or she has other manifestations of this syndrome and should check the blood sugar. If low, the blood glucose can be treated quickly. chapter 3 A male baby is born with undescended testes. After caring for the newborn, what question bythe nurse is most important? A. "Did your other children have this problem?" B. "Do you have cats and litter boxes at home?" C. "Have you been exposed to measles?" D. "How old is the house in which you live?" - Correct Answer D. "How old is the house in which you live?" One risk factor for undescended testes is intrauterine lead exposure. In the U.S., the most common source of lead is from lead-based paint in older homes (built prior to 1978), lead-contaminated house dust and soil, and vinyl products. The nurse should assess for sources of lead exposure. chapter 3 The birthing center nurse caring for a 21-year-old laboring patient is given a report about the patient's cocaine use throughout pregnancy. This history prompts the labor nurse to assess for which condition? A. Abruptio placentae B. Cephalopelvic disproportion C. Hypotension D. Placenta previa - Correct Answer A. Abruptio placentae Cocaine and crack use during pregnancy causes vasoconstriction of the uterine vessels and adversely affects blood flow to the fetus. Cocaine use in pregnancy is associated with spontaneous abortion, abruptio placentae, stillbirth, intrauterine growth restriction (IUGR), fetal distress, meconium staining, and preterm birth. chapter 3 The perinatal nurse explains to a childbirth class that which of the following are the primary functions of the placenta? Select all that apply. A. "Creates blood vessels in the fetus." B. "Protects the fetus from pathogens." C. "Provides hormones that maintain the pregnancy." D. "Removes waste products from the fetus." E. "Transfers nutrients to the fetus." - Correct Answer Answer: B, C, D, E A. This is incorrect. The placenta does not create blood vessels in the fetus. B. This is correct. This is a factual statement and represents one of the functions of the placenta. C. This is correct. This is a factual statement as the placenta provides several hor- mones that help to maintain the pregnancy. D. This is correct. This is a factual statement and represents one of the functions of the placenta. A nurse is assessing a patient in the women's clinic for Chadwick's sign. How does the nurse perform this assessment? A. Auscultates the patient's abdomen for fetal heart tones B. Inspects the vulva and vagina for a bluish tint C. Palpates the patient's abdomen for a fluid wave D. Percusses the patient's abdomen for uterine margins - Correct Answer B. Inspects the vulva and vagina for a bluish tint Chadwick's sign is one of the earliest signs of pregnancy and consists of a bluish discoloration of the cervix, vulva, and vagina. The nurse would inspect the patient for this discoloration. chapter 4 A nurse is teaching a patient who is in her first trimester of pregnancy about physical changes she can expect. Which information should the nurse provide? A. Diminishing sexual interest occurs. B. Harmful agents can invade the uterus. C. Leukorrhea is an abnormal condition. D. Pregnant people are more susceptible to yeast infections. - Correct Answer D. Pregnant people are more susceptible to yeast infections. Glycogen levels are increased in vaginal cells during pregnancy, and this change creates an environment more hospitable to Candida albicans. Thus, pregnant people are more susceptible to yeast infections. chapter 4 A patient who gave birth 2 months ago calls the perinatal clinic crying because her hair is falling out in large amounts. What action by the nurse is most appropriate? A. Advise the patient to make an appointment with a dermatologist. B. Explain that this symptom will end once she stops breastfeeding. C. Reassure the patient that her hair will grow back within a year. D. Tell the patient it is extra hair that grew in pregnancy. - Correct Answer C. Reassure the patient that her hair will grow back within a year. New hair growth may be stimulated during pregnancy, but after birth, this process reverses and hair shedding occurs for 1-4 months. Virtually all hair will be replaced within 6-12 months. The nurse should educate the patient about this natural process. chapter 4 A pregnant patient in the perinatal clinic complains of a diffuse, reddish discoloration of her palms. What action by the nurse is most appropriate? A. Ask if she has been exposed to measles. B. Assess her for Raynaud's phenomenon. C. Explain that this is a normal finding. D. Take the patient's vital signs. - Correct Answer C. Explain that this is a normal finding. Palmar erythema is a reddish discoloration of the palms and occurs in about 60% of Caucasian women and in about 35% of African American women during pregnancy. chapter 4 A patient in her third trimester of pregnancy complains of a painful burning sensation in her hands and lower arms. Which action by the nurse is best? A. Advise the patient to elevate her hands at night. B. Document the finding and alert the provider. C. Encourage the patient to see a neurologist. D. Request a prescription for pregabalin (Lyrica). - Correct Answer A. Advise the patient to elevate her hands at night. Edema that occurs during pregnancy can lead to fluid collection in the wrist and puts pressure on the median nerve. This leads to carpal tunnel syndrome, characterized by burning pain and paresthesia in the (usually dominant) hand or hands up to the elbow. The nurse should advise the patient to elevate her hands at night. Carpal tunnel syndrome usually resolves after pregnancy, but if it persists, the patient may require surgical treatment. chapter 4 A pregnant patient in the perinatal clinic complains of occasional fainting. Which action by the nurse is best? A. Educate her that this is a frequent occurrence in pregnancy. B. Always encourage her to carry small snacks with her. C. Instruct her to take a series of short breaths when the warning signs occur. D. Tell her to lie down on her left side if she has warning signs. - Correct Answer D. Tell her to lie down on her left side if she has warning signs. Syncope, or fainting, is occasionally seen in pregnancy and is often preceded by warning signs such as lightheadedness, sweating, nausea, yawning, or sensations of warmth. The nurse should instruct the patient to sit or lie down when these warning Ptyalism is excessive production of saliva. The etiology is uncertain but chewing gum and using lozenges can offer limited relief. chapter 4 A pregnant patient is complaining of frequent heartburn. What statement by the patient indicates to the nurse that teaching has been effective? A. "Drinking less alcohol should prevent this." B. "Eating larger, less frequent meals will help." C. "I should take antacids before each meal." D. "I will not lie down for 1 hour after eating." - Correct Answer D. "I will not lie down for 1 hour after eating." Heartburn, or pyrosis, occurs due to changes in the function of the cardiac sphincter, which allows reflux of stomach contents into the esophagus. Self-care measures for this condition include eating small meals and remaining upright for at least an hour after meals. chapter 4 A pregnant patient calls the clinic to complain of sharp, right-sided lower abdominal pain. Which question by the nurse would elicit the most relevant information? A. "Do you have a fever, constipation, or any diarrhea?" B. "Have you fallen down or experienced any kind of injury in the last few days?" C. "Have you tried placing either a heating pad or an ice pack on your abdomen?" D. "Is the pain worse between your navel and hip bone or closer to the hip?" - Correct Answer A. "Do you have a fever, constipation, or any diarrhea?" Sharp pain in the lower abdomen is frequently due to round ligament pain. However, more serious conditions need to be ruled out first. Appendicitis must be considered. Because the appendix is pushed up and posterior by the uterus, the typical location of pain on the right side between the umbilicus and anterior iliac crest (McBurney's point) is not accurate. The nurse should ask about fever or changes in bowel habits. chapter 4 A man accompanies his partner to her OB clinic visit. The patient is near term. The man confides to the nurse that the patient is cranky, irritable, and yells at him for no reason. Which action by the nurse is best? A. Explain why the patient needs emotional support. B. Instruct the patient to get more rest during the day. C. Reassure the man that this behavior is normal in pregnancy. D. Teach the man assertive communication skills. - Correct Answer A. Explain why the patient needs emotional support. As they near term, pregnant people are tired and looking forward to the end of the discomforts of pregnancy. People at this stage need considerable emotional support from family and friends as they await childbirth. The nurse should explain these psychological changes in the patient and encourage the man to be as supportive as possible. chapter 4 A patient is in her second trimester of pregnancy. Which behaviors by the patient's family or friends would best indicate to the nurse that they are accepting the unborn child? A. An older sibling is talking about "my baby brother or sister." B. Close friends throw a baby shower for the expectant mother. C. Immediate family members express delight over the pregnancy. D. The parents state that no matter what the gender, they will love the baby. - Correct Answer A. An older sibling is talking about "my baby brother or sister." A. Accepting the unborn child is critical to adjusting successfully to the pregnancy. For this patient in her second trimester, having immediate family members begin relating to the unborn child is consistent with their place in the family. A sibling talking about being a big sister or big brother to the new baby is an example. chapter 4 A patient is in the first trimester of her first pregnancy and confides to the nurse that she is not sure if she is happy because so many things in her life will change. She is not sure she is willing to alter her current lifestyle. What action by the nurse is most appropriate? A. Ask the patient if she would like to see a counselor. B. Reassure the patient that ambivalence is normal now. C. Refer the patient to an expectant-mother support group. D. Tell the patient she needs to think of her unborn child. - Correct Answer B. Reassure the patient that ambivalence is normal now. B. An expectant mother must learn to give to her unborn child in the process of successfully negotiating the tasks of pregnancy. It is normal for a first-time mother to grieve for the impending loss of her lifestyle. The nurse should reassure the patient. chapter 4 C. This is correct. This is a factual statement because, based on the individual's skin tone and hormones, the linea nigra appears differently. This is a normal variation. D. This is correct. This is a factual statement because, based on the individual's body tone and weight gain, this will influence whether or not the individual develops stretch marks during pregnancy. E. This is incorrect. Some body image changes do not resolve after birth but may lessen in appearance such as chloasma, stretch marks, and/or linea nigra appearance. chapter 4 Which location should the nurse anticipate a fundal height measurement associated with 20 weeks of gestation? A. Below the xiphoid process B. 4 fingerbreadths below the umbilicus C. 2 centimeters below the xiphoid process D. At the level of the umbilicus - Correct Answer D. At the level of the umbilicus D. At 20 weeks' gestation, fundal height would be observed at the level of the umbilicus. chapter 4 A patient presents to the prenatal clinic and provides the nurse with a LMP of 3/2/21. Based on this information, the nurse would document the estimated date of delivery (EDD) as ____________. - Correct Answer Answer: 12/9/21 chapter 5 After questioning a pregnant patient about her fluid intake, the nurse discovers that the patient is drinking four glasses of diet cola per day. Which response by the nurse is best? A. "As long as you get enough fluid, soda is all right to drink." B. "Less than two cups of caffeine a day is probably OK." C. "The major worry with soda is the sugar content." D. "You really should switch to decaffeinated colas." - Correct Answer B. "Less than two cups of caffeine a day is probably OK." B. The primary sources of caffeine for pregnant people are coffee, tea, and soda. Research shows that small amounts of caffeine (less than two cups a day) are probably safe; however, higher amounts cause central nervous system stimulation and can increase the chance of spontaneous abortions, stress the fetus's metabolic system, and decrease blood flow to the placenta. chapter 5 The prenatal clinic nurse meets with a 30-year-old patient who is experiencing her first pregnancy. The patient's quadruple-marker screen result is positive at 17 weeks of gestation. Which action by the nurse is most important? A. Call the social worker for a consultation. B. Document the findings in the patient's chart. C. Facilitate a referral to a genetics counselor. D. Prepare the patient for intrauterine death. - Correct Answer C. Facilitate a referral to a genetics counselor. C. All pregnant people should be offered screening with maternal serum markers. The triple-marker screen and the quadruple-marker screen test for the presence of alpha-fetoprotein, estradiol, human chorionic gonadotropin, and other markers. These tests screen for potential neural tube defects, Down syndrome, and trisomy 18. If the screen is positive, the patient should be referred to a genetics specialist for counseling and further testing. chapter 5 A nurse is teaching a nonsmoking pregnant patient about the iron tablets she was just prescribed. What information is most important for the nurse to teach the patient? A. Call the doctor right away for dark, tarry stools. B. Drink at least one glass of orange juice a day. C. Stop the prenatal vitamins while taking iron. D. Take the medication between meals and with milk. - Correct Answer B. Drink at least one glass of orange juice a day. B. Vitamin C enhances the absorption of iron, and a nonsmoking patient should be able to get sufficient vitamin C from a glass of citrus juice daily. chapter 5 An 18-year-old patient at 18 weeks' gestation is being seen in the prenatal clinic. Her weight gain is 25 pounds over her prepregnant weight. Which is the perinatal nurse's best approach to care at this visit? A. Ask the patient to complete a 3-day dietary recall while she is in the clinic. B. Explain the possible concerns related to excessive weight gain in pregnancy. degree of trauma to the abdomen or those that include rigorous bouncing, arching of the back, or bending beyond a 45-degree angle; and maintaining an adequate fluid intake. Because yoga involves different positions, the nurse should assess whether the patient engages in positions that involve arching the back. chapter 5 The perinatal nurse recommends muscle-strengthening exercises to a patient who is pregnant for the first time. The patient states that she does not want to be "muscle- bound and masculine." What response by the nurse is best? A. "As long as you use lighter weights, you won't get muscle-bound." B. "OK, what do you think about swimming for exercise then?" C. "Strengthening muscles will decrease risks of ligament and joint injury." D. "Stronger muscles will make the labor process much easier on you." - Correct Answer C. "Strengthening muscles will decrease risks of ligament and joint injury." Muscle strengthening benefits the patient as she copes with the physical changes of pregnancy, which include weight gain and postural changes. Muscle-strengthening exercises also help to decrease the risk of ligament and joint injury. chapter 5 The prenatal nurse has reviewed a patient's 3-day diet recall and notes that the patient typically eats a deli meat sandwich or hot dog, chips, and an apple for lunch. Breakfast consists of cereal, milk, and juice; and dinner contains meat, a starch, vegetables, and a salad. What action by the nurse is most important? A. Advise the patient to obtain more calories from protein. B. Assess the patient's knowledge of proper food handling. C. Discuss adding fish such as tuna or swordfish to the diet. D. Weigh the patient and document her weight in the chart. - Correct Answer B. Assess the patient's knowledge of proper food handling. Pregnant patients should be taught proper food handling to prevent foodborne illnesses. Deli meats, hot dogs, and luncheon meats should be stored at 40° or less, heated before eating, and consumed within 4 days. Promoting safety is a priority. chapter 5 A patient in the prenatal clinic had a negative rubella titer. Which action by the nurse is most appropriate? A. Have the laboratory redraw rubella titers to verify the result. B. Instruct the patient to avoid anyone who may have the disease. C. Prepare to administer a rubella vaccination to the patient. D. Reassure the patient that rubella has few fetal consequences. - Correct Answer B. Instruct the patient to avoid anyone who may have the disease. Rubella (German measles) can cause fetal abnormalities if the pregnant patient contracts it during the first trimester, so all pregnant patients are screened for immunity. A positive test means the patient is immune to the disease, whereas a negative test indicates susceptibility to it. The patient needs to avoid people who may be ill with rubella and be immunized after her delivery. There is no need for a double check of the results. chapter 5 A nurse is reviewing the care plan for a patient in the third trimester of her first pregnancy. Which action by the patient best indicates positive adaptation to the pregnancy and impending motherhood? A. Attended three prenatal classes with her partner to learn about labor B. Continues to exercise, maintains a healthy diet, and quit smoking recently C. Educated about pregnancy, fetal growth and development, and motherhood D. Has prepared a well-stocked nursery complete with stimulating toys - Correct Answer C. Educated about pregnancy, fetal growth and development, and motherhood The best indicator of positive adaptation is when the patient can be described as well-educated on pregnancy, growth and development of the fetus, and motherhood. chapter 5 A perinatal clinic nurse educated a pregnant patient about basic prenatal exercises. On a return visit, which statement by the patient indicates that teaching goals have been met? A. "I have learned to isolate the right muscle for Kegel exercises." B. "It's hard to find 30 minutes a day for exercise, but I have done it." C. "Jumping rope is great exercise and keeps my weight in control." D. "When I get fatigued with these exercises, I just push through it." - Correct Answer A. "I have learned to isolate the right muscle for Kegel exercises." Kegel exercises are among the basic prenatal exercises taught to all pregnant patients. To do them correctly, the patient needs to learn to isolate the pubococcygeal (PC) muscle. chapter 5 chapter 5 A student nurse is working in the OB clinic as part of a preceptorship. The student has been assigned to a patient in her first trimester who complains of occasional headaches. Which action by the student warrants intervention by the student's preceptor? A. Asks questions to determine severity of headaches B. Takes vital signs C. Instructs the patient to use OTC headache pain medication as needed D. Tells the patient that headaches can be a common occurrence during pregnancy - Correct Answer C. Instructs the patient to use OTC headache pain medication as needed Headaches can be a minor complaint of pregnancy in addition to body aches; however, it is important to determine whether the presence of headaches is related to pathological processes such as hypertension. Instructing the patient to use OTC medication during pregnancy is overstepping the role of a nurse, and even though OTC headache pain medication such as Tylenol is considered to be safe during pregnancy, the health-care provider is responsible for prescribing/instructing a patient to take medication. chapter 5 A 22-year-old patient is experiencing her third pregnancy. Her obstetrical history includes one first-trimester elective abortion and one first-trimester spontaneous abortion. The patient is a semi-vegetarian who drinks milk and eats yogurt and fish as part of her daily intake. Which of the following should the nurse include in the patient's dietary teaching plan? Select all that apply. A. "Consuming red meat." B. "Eating food high in zinc." C. "Increasing calcium intake." D. "Restricting sodium." E. "Taking an iron supplement." - Correct Answer Answer: B, E A. This is incorrect. Semi-vegetarian diets include fish, poultry, eggs, and dairy prod- ucts but no beef or pork. Although red meat does contain iron, consuming meat goes against the patient's chosen lifestyle, and it would be disrespectful of the nurse to suggest this. B. This is correct. Semi-vegetarian diets include fish, poultry, eggs, and dairy prod- ucts but no beef or pork. Pregnant people who adhere to this diet may consume in- adequate amounts of iron and zinc. Most people cannot consume enough iron through their diets while pregnant, so an iron supplement should be suggested. The nurse can also educate the patient about foods high in zinc so that she can increase her intake. C. This is incorrect. Semi-vegetarian diets include fish, poultry, eggs, and dairy products but no beef or pork. Increasing calcium is not helpful advice in this situation. D. This is incorrect. Semi-vegetarian diets include fish, poultry, eggs, and dairy prod- ucts but no beef or pork. Restricting sodium intake is not helpful advice in this sit- uation. E. This is correct. Semi-vegetarian diets include fish, poultry, eggs, and dairy prod- ucts but no beef or pork. Pregnant people who adhere to this diet may consume in- adequate amounts of iron and zinc. Most people cannot consume enough iron through their diets while pregnant, so an iron supplement should be suggested. chapter 5 A nurse is educating a pregnant patient about calorie intake during pregnancy. Which information should the nurse include in the teaching plan? Select all that apply. A. "A minimum of 300 calories should be included in the diet regardless of the source." B. "There is no correlation between calorie intake and physical activity level during pregnancy." C. "Growth in the third trimester is focused on the fetus." D. "Average weight gain progresses during pregnancy." E. "Increasing intake from the major food groups will help to maintain caloric requirement." - Correct Answer Answer: C, D, E A. This is incorrect. Although a 300-calorie increase is recommended, it is important that the calories do not come from "empty calorie" sources and reflect healthy food choices. B. This is incorrect. Recommendations for weight gain are based on individual phys- ical attributes (height and weight) and level of physical activity. C. This is correct. This is a factual statement. Growth during the first and second trimester focuses on maternal stores whereas during the third trimester growth is focused on the fetal stores. D. This is correct. Recommendations for weight gain is increased sequentially during progression through pregnancy. In the first trimester, the average maternal weight gain is 1 to 2.5 kg, and thereafter the recommended weight gain for a patient of normal weight is approximately 0.4 kg per week. For overweight women, the recommended weekly weight gain during the second and third trimesters is 0.3 kg; for underweight women, it is 0.5 kg. E. This is correct. This is a factual statement and will help to prevent calorie intake chapter 6 The perinatal nurse is caring for a patient at 26 weeks' gestation who has a history of hypertension that has been well controlled. Today she presents with a blood pressure of 156/102 mm Hg, and she has 2+ protein on urine dipstick. Which initial action by the nurse is most appropriate? A. Arrange admission to the high-risk OB unit. B. Instruct the patient on strict bedrest. C. Obtain a clean-catch urine sample. D. Prepare to administer IV antihypertensives. - Correct Answer C. Obtain a clean- catch urine sample. Pre-eclampsia can occur in a pregnant person who has chronic hypertension. This patient has the characteristics of hypertension after a period of good control and proteinuria of at least 2+ on dipstick (100 mg/dL). The nurse needs to ensure protein levels are assessed in two samples at least 4 hours apart and ensure the patient has no signs of a urinary tract infection, as protein can occur in a sample of infected urine. The nurse should obtain a clean-catch urine sample to send to the laboratory for analysis. Asymptomatic UTI can occur in up to 11% of pregnant people, so assessing for signs and symptoms may not be accurate. chapter 6 A 22-year-old patient presents to the emergency department with abdominal pain and vaginal bleeding. Her blood pressure is 90/58 mm Hg, her pulse is 120 beats/minute, and she complains of dizziness. Which action by the nurse takes priority? A. Assess the patient for sexually transmitted infections. B. Collect a urine sample for pregnancy testing. C. Obtain informed consent for a salpingectomy. D. Start two large-bore IVs for fluid replacement. - Correct Answer D. Start two large- bore IVs for fluid replacement. This patient has both signs (hypotension, tachycardia) and symptoms (complaints of dizziness) of acute volume loss. The priority is starting large-bore IV lines for fluid resuscitation. chapter 6 A patient in her second trimester of pregnancy presents to the perinatal clinic with complaints of scant vaginal bleeding, abdominal pain, and shoulder pain. What action should the nurse perform first? A. Assess her for a history of preterm labor. B. Obtain a blood sample for a b-hCG test. C. Prepare the patient for a pelvic exam. D. Request an order for methotrexate (Rheumatrex). - Correct Answer B. Obtain a blood sample for a b-hCG test. This patient is displaying symptoms of a possible ruptured ectopic pregnancy (vaginal bleeding, abdominal pain, shoulder pain). Shoulder pain can occur from nerve irritation due to the presence of blood in the pelvic cavity. A b-hCG test finding will be lower than expected for the gestational age. To facilitate a rapid diagnosis, the nurse should first obtain and send a blood sample for b-hCG test. chapter 6 A nurse is caring for a patient who has been diagnosed with an incomplete molar pregnancy. Which action by the nurse is most appropriate? A. Advise the patient that she can try to get pregnant in 3 months. B. Arrange a consultation with a radiation oncology nurse. C. Facilitate screening for systemic lupus erythematosus (SLE). D. Give the patient information on perinatal loss support groups. - Correct Answer D. Give the patient information on perinatal loss support groups. Gestational trophoblastic disease (GTD) is a disease characterized by an abnormal placental development that results in the production of fluid-filled grapelike clusters (instead of normal placental tissue) and a vast proliferation of trophoblastic tissue. GTD includes the diagnosis of hydatidiform mole ("molar pregnancy"). Complete moles have a proliferation of trophoblastic tissue but no fetal parts. An incomplete mole is associated with a coexistent fetus that is genetically abnormal and usually only survives a few weeks before being spontaneously aborted. Support groups for grieving parents are an important community resource, and the nurse should ensure that the patient has information on local organizations. chapter 6 A nurse is reviewing the chart of a 52-year-old primigravida patient who was admitted with moderate dark-brown vaginal bleeding. On physical exam, her uterus is large for dates. Which documentation in the chart would be most significant? A. Folic acid level. B. Ultrasound report. C. Documented fetal kick count. D. Pelvic culture results. - Correct Answer B. Ultrasound report. The incidence of gestational trophoblastic disease (GTD), including hydatidiform vehicle crash. She has a severe laceration of her arm resulting in a large blood loss. Which assessment should the nurse perform first? A. Blood pressure B. Fetal heart tones C. Pulse D. Respiratory rate - Correct Answer C. Pulse Because a woman's blood volume can increase dramatically during pregnancy, blood pressure is an unreliable indicator of a volume deficit. Maternal pulse and fetal heart rate are much more accurate indicators. Because the priority in care of the pregnant trauma patient is care of the mother, the nurse should assess the mother's pulse first. chapter 6 A nurse is teaching a patient pregnant in the second trimester who has been diagnosed with a partial placenta previa. Which information is most important to document? A. Patient and partner show no anxiety or helplessness and were given educational support material. B. Patient instructed that bleeding may occur as placenta totally covers the cervical os. C. Patient instructed to tell all health-care providers that vaginal exams are prohibited. D. Patient received information about placenta previa and understood it well. - Correct Answer C. Patient instructed to tell all health-care providers that vaginal exams are prohibited. If the patient needs care from another health-care provider, she must tell them that, due to her placenta previa, all vaginal exams are prohibited. This is an important safety measure that must be taught and clearly documented. chapter 6 A nurse has admitted a patient pregnant in her third trimester with moderate vaginal bleeding and severe abdominal pain. After assessing maternal vital signs, obtaining the fetal heart rate, and starting an IV-line, which action should the nurse do next? A. Administer betamethasone (Celestone) just prior to delivery. B. Discuss pros and cons of continuous fetal monitoring. C. Facilitate laboratory work, including blood type and screen. D. Obtain informed consent for emergent delivery. - Correct Answer C. Facilitate laboratory work, including blood type and screen. Women who present with third-trimester vaginal bleeding should be examined carefully for placenta previa or abruptio placentae. Bleeding accompanied by abdominal pain is the classic sign of placental abruption. Care includes obtaining maternal vital signs, assessing fetal heart rate, and starting an IV for fluid resuscitation or transfusion if needed. Blood work should be obtained for CBC, type and screen, coagulation studies, and a Kleihauer Betke determination. chapter 6 A patient who is in her third trimester and is at risk for preterm birth calls the clinic to get the results of her fetal fibronectin test (fFN). The nurse sees the result is negative. Which advice to the patient is most appropriate? A. Come to the perinatal clinic for a screening ultrasound. B. Continue the current management plan as directed. C. Go to the hospital immediately for imminent delivery. D. Plan to continue taking betamethasone (Celestone) for 1 week. - Correct Answer B. Continue the current management plan as directed. A negative fFN test indicates that the chance of a patient giving birth in the next week is approximately 1%, so she should continue her management plan already in place. chapter 6 A patient who is 36 weeks pregnant presents to the perinatal clinic with complaints of backache, pelvic fullness, and uterine contractions. Which action by the nurse is most appropriate? A. Arrange admission to the hospital. B. Obtain a clean-catch, midstream urine sample. C. Obtain blood for a type and screen. D. Prepare to administer a tocolytic agent. - Correct Answer B. Obtain a clean-catch, midstream urine sample. Infection is a predisposing factor for preterm labor, so the nurse would be wise to collect a urine sample, which may be obtained via clean-catch or catheterized specimen. chapter 6 A patient at 32 weeks' gestation is admitted to the high-risk OB unit with a diagnosis of preterm labor. On assessment the nurse finds the following: blood pressure, 182/96 mm Hg; pulse, 106 beats/minute; respirations, 16 breaths/minute; regular uterine contractions of 5 in 10 minutes; and fetal heart rate of 145 beats/minute. The patient is dilated to 8 cm. Which action by the nurse is best? D. This is correct. Visual changes can indicate deteriorating CNS disturbances. This is a significant finding indicating worsening disease. E. This is correct. Adventitious lung sounds can correlate with pulmonary edema. This is a significant finding indicating worsening disease. chapter 6 A perinatal nurse is working with a patient who is diagnosed with hyperemesis gravidarum. The nurse should anticipate orders for which of the following treatments? Select all that apply. A. "Minimize protein intake to decrease nausea." B. "Crackers upon arising may alleviate nausea." C. "Ginger chews may be taken as a supplement." D. "Three main meals and avoid snacking." E. "Avoid foods that may act as sensory triggers." - Correct Answer Answer: B, C, E A. This is incorrect. High protein snacks are recommended as protein intake is critical during pregnancy. B. This is correct. This is a factual statement as crackers may help line the stomach and decrease stomach acid. C. This is correct. Ginger is a natural supplement which helps to decrease nausea. D. This is incorrect. Small frequent meals of dry, bland, high protein foods are rec- ommended. E. This is correct. Certain foods can act as sensory triggers either upon ingestion or via odor. The patient when aware of these foods should avoid them. chapter 6 What priority action should the nurse anticipate during labor for a patient who is 3 cm, 100% effaced, and 0 station with vaginal bleeding? A. Anticipate interventions for a prompt delivery. B. Type and screen for 2 units of blood. C. Prepare for labor augmentation with Pitocin. D. Monitor patient and repeat vaginal exam in 2 hours. - Correct Answer A. Anticipate interventions for a prompt delivery. This image indicates a moderate grade 2 placental abruption in which there is as much as 50% placental separation and bleeding. The patient is in early labor based on vaginal exam criteria, and therefore, the nurse should anticipate that the physician will want to ensure a prompt delivery to minimize potential complications due to hemorrhage. chapter 7 The perinatal nurse is assessing a woman at 36 weeks' gestation. Her fundal height measurement was last recorded at 34 cm. The patient's abdomen appears to be widest from side to side. Which type of fetal presentation does the nurse suspect? A. Breech B. Cephalic C. Face D. Shoulder - Correct Answer D. Shoulder Face is a type of cephalic presentation where the fetal head is fully extended and the face is the presenting part. As a cephalic presentation, the maternal abdomen would appear large up and down, not side to side. chapter 7 A nurse is measuring the frequency of a laboring woman's contractions. How does the nurse accomplish this correctly? A. Counts the number of contractions measured at the same intensity in 1 full minute B. Feels the fundus during the acme of the contraction and notes the fundal firmness C. Measures the beginning of one contraction to the beginning of the next contraction D. Measures the time from the beginning of one contraction to the end of the same contraction - Correct Answer C. Measures the beginning of one contraction to the beginning of the next contraction The frequency of contractions is measured from the beginning of one contraction to the beginning of the next contraction. A patient's cervix is 8 cm dilated and she is 100% effaced. What action by the nurse is most important currently? A. Allow the support person to be at the bedside. B. Encourage the woman to bear down. C. Have the woman avoid pushing. D. Instruct the woman to rest between contractions. - Correct Answer C. Have the woman avoid pushing. Pushing against a partially dilated cervix can lead to cervical edema and damage and can adversely affect the progress of the woman's labor. It is most important to protect the patient from injury by instructing the patient to avoid pushing at this time. A. Ask the woman about recent sexual intercourse. B. Assess the woman for urinary incontinence. C. Arrange for the woman to be admitted to the birthing unit. D. Inquire if the woman has symptoms of a vaginal infection. - Correct Answer B. Assess the woman for urinary incontinence. Amniotic fluid is alkaline with a pH between 6.5 and 7.5. When the alkaline amniotic fluid is exposed to Nitrazine tape, the tape turns blue-green, gray, or deep blue. Urine and vaginal secretions are usually acidic, which would leave the Nitrazine tape beige. Because the gush of fluid occurred after sneezing, the nurse should assess the woman for urinary incontinence (especially stress incontinence). chapter 7 A woman's birthing plan includes completing the latent phase of the first stage of labor at home. When should the nurse teach the woman to come into the birthing unit? A. After 10 hours of mild contractions B. When contractions are 3 to 5 minutes apart C. When contractions are experienced in the back D. When strong contractions occur 2 to 3 minutes apart - Correct Answer B. When contractions are 3 to 5 minutes apart During the latent phase of labor, contractions are typically 5 minutes apart, last 30 to 45 seconds, and are considered mild. When contractions become more frequent (every 3 to 5 minutes) and are of moderate to strong intensity, the woman has entered the active phase of labor; this is when the patient should come into the birthing unit. chapter 7 A nulliparous woman in labor is 3 cm dilated at 10:00 a.m. Based on knowledge of the average nulliparous woman's progression, when would the nurse expect her to be fully dilated? A. 12:00 p.m. B. 2:00 p.m. C. 5:00 p.m. D. 10:00 p.m. - Correct Answer C. 5:00 p.m. A nulliparous woman, on average, dilates 1 cm/hour of labor. The nurse would expect this woman to be fully dilated 7 hours from the initial assessment, or at 5:00 p.m. chapter 7 A woman is in the early latent phase of labor and is frustrated by the length of time this stage is taking. What action by the nurse is best? A. Administer 100% oxygen by face mask. B. Encourage frequent position changes or walking. C. Have the woman rest between contractions. D. Place the woman in a left side-lying position with side rails up. - Correct Answer B. Encourage frequent position changes or walking. Frequent position changes and walking are beneficial in helping to promote the descent of the fetus during labor. The nurse should encourage the woman to try several positions (squatting, leaning over a piece of furniture, hands and knees position) and walking to try to enhance the progression of her labor. chapter 7 A woman with a history of two stillbirths is in the active phase of the first stage of labor in the high-risk OB unit. How often should the nurse anticipate monitoring fetal heart tones (FHTs)? A. Continuously B. Every 5 minutes C. Every 15 minutes D. Every 30 minutes - Correct Answer A. Continuously Women with certain complications, including a history of stillbirth, a high-risk pregnancy (pre-eclampsia-eclampsia, placenta previa, abruptio placentae, multiple gestations, prolonged or premature rupture of the membranes), induction with oxytocin, or a problem with FHT, should have FHT monitored continuously A new nurse is assessing baseline fetal heart tones (FHTs) by auscultation and notes that theheart rate increased during a contraction from 140 to 158. What action by the nurse preceptor is best? A. Gather equipment for internal FHT monitoring. B. Have the nurse document FHT rate as 140/158 on the chart. C. Instruct the nurse to assess FHT between contractions. D. Tell the nurse to count only for 30 seconds. - Correct Answer C. Instruct the nurse to assess FHT between contractions. Baseline fetal heart tones can only be assessed during the absence of uterine activity. The preceptor should instruct the new nurse to listen for FHTs between contractions. chapter 7 Late decelerations are a sign of uteroplacental insufficiency and are often indicative of hypoxia and metabolic acidemia. Contractions that occur this frequently signify uterine hyperstimulation. Both circumstances indicate that the oxytocin should be stopped immediately. chapter 7 A nurse is caring for a new mother during the fourth stage of labor and assesses the following: patient has soaked two peri-pads in 45 minutes, pulse is 118 beats/minute, and blood pressure is 90/62 mm Hg. Which priority actions should the nurse take? Select all that apply. A. "Assess the firmness of the patient's uterus." B. "Review chart to see if Pitocin was administered post-delivery of the placenta." C. "Place ice on the perineum." D. "Encourage the new mother to attempt breastfeeding." E. "Escort the new mother to the bathroom to void." - Correct Answer Answer: A, B A. This is correct. Hypotension, tachycardia, excessive bleeding (more than one pe- ri-pad in the first hour) may indicate a noncontracting uterus that can be further correlated as danger signs of postpartum hemorrhage. Based on this woman's signs and symptoms, the nurse should assess her uterus and, if necessary, begin uterine massage. B. This is correct. The nurse should also check the MARS to see when Pitocin was given post-delivery and to find out if any other medications/actions were taken re- lated to increased blood loss during the delivery process. C. This is incorrect. Ice on the perineum is a comfort measure but is not indicated as a therapeutic intervention for postpartum hemorrhage. D. This is incorrect. Breastfeeding can stimulate uterine contractions but given the patient's emergent situation, different actions are required E. This is incorrect. A hypotensive woman should not be ambulated. chapter 7 A woman is admitted in labor. The perinatal nurse would demonstrate awareness of cultural values by assessing the patient for which of the following? Select all that apply. A. "Need for an interpreter." B. "Pain management and coping techniques." C. "Preference for food during labor." D. "Preferences for touch during labor." E. "Support person during labor." - Correct Answer Answer: A, B, D, E A. This is correct. Psychosocial influences (the last of the 5Ps) helps to share the woman's expectations with an ongoing preceptor of the birth experience. Cultural considerations include the potential need for an interpreter. B. This is correct. Psychosocial influences (the last of the 5Ps) helps to share the woman's expectations with an ongoing preceptor of the birth experience. Cultural considerations include assessing for strategies to assist with coping techniques and pain management. C. This is incorrect. Typically, food is not provided to a woman in labor, so even though it is part of one's cultural values, it is not a priority during this time. D. This is correct. Psychosocial influences (the last of the 5Ps) helps to share the woman's expectations with an ongoing preceptor of the birth experience. Cultural considerations include determining preferences for use of touch modalities during the labor experience to ease pain. E. This is correct. Psychosocial influences (the last of the 5Ps) helps to share the woman's expectations with an ongoing preceptor of the birth experience. Cultural considerations include the choice of a birth support person. chapter 7 Which statements are accurate regarding the administration of pain medications during labor? Select all that apply. A! "IVP medications should be administered during contractions." B! "Hydromorphone hydrochloride (Dilaudid) is associated with nausea." C! "Meperidine hydrochloride (Demerol) use can increase FHR variability." D! "The use of opioid antagonists is contraindicated in labor." E. "The use of opioid antagonists does not cause amnesia." - Correct Answer Answer: A, B, D, E A. This is correct. IVP medications should be administered during contractions to minimize effects on the fetus as uterine blood vessels are constricted. B. This is correct. Opioid agonists are associated with increased risk for nausea. C. This is incorrect. Opioid agonists lead to a decrease in FHR variability. D. This is incorrect. Opioid agonists can be used to treat pain in women in labor, but as with any medication, they must be administered correctly, and the patient mon- itored following administration. E. This is correct. This is a factual statement. chapter 7 A forceps-assisted birth is one in which a steel instrument with two curved blades is used to facilitate the birth of the infant's head. Perineal trauma is one of the major complications associated with the use of forceps. Because hemorrhage (bright red bleeding) may result from cervical lacerations and vaginal tearing, the woman requires close observation during the postpartum period. If this occurs, the care provider should be notified regarding a potential vaginal repair. chapter 8 The perinatal nurse is caring for a patient with pre-eclampsia. What intervention does the nurse include on this patient's care plan? A. Administer magnesium sulfate per agency policy. B. Assess the patient's blood pressure every 6 hours. C. Encourage the patient to rest on her back. D. Notify the physician of urine output greater than 30 mL/hr. - Correct Answer A. Administer magnesium sulfate per agency policy. The nurse is the manager of care for the woman with pre-eclampsia during the intrapartal period. Careful assessments are critical. The nurse administers medications as ordered and should adhere to hospital protocol for a magnesium sulfate infusion. chapter 8 The perinatal nurse providing care to a laboring woman recognizes a nonreassuring fetal heart rate tracing. Which of the following is the most appropriate initial action by the nurse? A. Assist the woman to a left lateral position. B. Decrease the rate of the intravenous solution. C. Document the fetal heart rate and variability. D. Request that the provider apply a fetal scalp electrode. - Correct Answer A. Assist the woman to a left lateral position. Because nonreassuring fetal heart rate patterns constitute a risk indicator for cesarean birth, the nurse and all members of the health-care team must always be ready for this outcome. The nurse should change the woman's position to her side to increase oxygen flow to the fetus. chapter 8 The perinatal nurse determines by vaginal examination that a patient's cervix is fully dilated, and the fetal presenting part is descending rapidly with the patient's pushing efforts. The most appropriate nursing intervention at this time would be to do which of the following? A. Assist the patient with breathing patterns to slow down her pushing. B. Document the patient's progress and coping abilities in labor. C. Notify the health-care provider to come now for the birth. D. Provide information to the patient's partner about her stage of labor. - Correct Answer A. Assist the patient with breathing patterns to slow down her pushing. This woman's labor is progressing precipitously. The nurse should instruct her to breathe through contractions to avoid pushing. chapter 8 The perinatal nurse is providing care to a 32-year-old G1 TPAL 0000 at 34 weeks' gestation. Her blood pressure is 170/100 mm Hg, reflexes are +3, urine is 2+ for protein, and the patient is complaining of a headache. An intravenous solution of magnesium sulfate is begun with an hourly dose of 2 g. Which laboratory value would be assessed most carefully by the nurse? A. Aspartate aminotransferase (AST) B. Gamma-glutamyl transpeptidase C. Hematocrit D. Neutrophil count - Correct Answer A. Aspartate aminotransferase (AST) Laboratory tests include a complete blood count with platelets, coagulation profile to assess for disseminated intravascular coagulation, metabolic studies for determination of liver enzymes (aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase), and electrolyte studies to establish renal functioning. The perinatal nurse is caring for a pre-eclamptic patient at 35 weeks' gestation. The patient's newest laboratory results include the following: platelet count 98,000/mm3 and RBC 3.1 million/μL. What action by the nurse is most appropriate? A. Administer betamethasone (Celestone). B. Increase the patient's IV fluids. C. Maintain the patient on bedrest. D. Notify the health-care provider immediately. - Correct Answer D. Notify the health- care provider immediately. This woman's laboratory values indicate the possible development of HELLP syn- drome (hemolysis, elevated liver enzymes, low platelets), which is a factor that may necessitate immediate interventions to facilitate birth. Notifying the provider is a priority. C. Onset of intrapartum hypertension D. Overly strong, painful contractions - Correct Answer A. Diminishing uterine contractions Diabetic women are at risk for having a macrosomic infant, which is a risk factor for hypotonic labor. For this patient, the nurse needs to be especially aware of this and assess for less frequent and less intense labor contractions. chapter 8 A woman had an amniotomy 1 hour ago. Now she is complaining of uterine tenderness. What action by the nurse is most appropriate? A. Increase the IV infusion rate. B. Notify the health-care provider. C. Perform a vaginal examination. D. Take the woman's temperature. - Correct Answer D. Take the woman's temperature. An amniotomy is an invasive procedure that carries the risk of infection. Maternal temperature should be assessed at least every 2 hours afterward. chapter 8 A nulliparous woman has been admitted to the labor and birth unit. Her Bishop score is 4. What medication does the nurse plan to administer? A. Betamethasone (Celestone) B. Hydromorphone (Dilaudid) C. Misoprostol (Cytotec) D. Oxytocin (Pitocin) - Correct Answer C. Misoprostol (Cytotec) The Bishop score is a rating system used to determine the level of cervical induci- bility. Labor induction is more likely to be successful with a higher score (9 or more for nulliparous women; 5 for multiparous women). This woman's cervix is not fa- vorable for induction, so a cervical ripening agent should be used. Misoprostol (Cytotec) is one such agent. chapter 8 A woman is receiving oxytocin (Pitocin) via infusion. The nurse assesses the following: uterine contractions lasting 100 seconds every 1.5 minutes, uterine resting tone 36 mm Hg, baseline fetal heart rate (FHR) 108 beats/minute with absent variability. What action by the nurse takes priority? A. Document the findings. B. Notify the provider. C. Reassess the FHR in 10 minutes. D. Stop the infusion. - Correct Answer D. Stop the infusion. Oxytocin can cause uterine tachysystole, and the nurse's assessments are consistent with this condition. The priority action by the nurse is to stop the infusion. chapter 8 The nurse manager of the perinatal services unit wants to improve outcomes associated with perinatal loss. What action by the manager would best help meet this goal? A. Develop a unit specifically for this population. B. Establish a multidisciplinary perinatal loss team. C. Identify key nurses to care for these patients. D. Provide debriefing services for the nursing staff. - Correct Answer B. Establish a multidisciplinary perinatal loss team. A team approach to perinatal loss and bereavement is best to provide a therapeutic and caring experience for families suffering perinatal loss. The families are best cared for by expert perinatal nurses. chapter 8 The nurse is caring for a woman who is being admitted for an induction with oxytocin (Pitocin). Which of the following findings would indicate a potential contraindication to the use of this medication in the laboring patient? Select all that apply. A. "The patient is a primipara at 38 weeks' gestation with a Bishop score of 2." B. "The patient has been having occasional irregular contractions." C. "Leopold maneuver indicates a transverse lie." D. "Blood pressure upon admission is 190/100." E. "Prior cesarean section for fetal distress." - Correct Answer Answer: A, C, D A. This is correct. The patient is not postterm, and the Bishop score indicates that the patient is a poor candidate for induction of labor. B. This is incorrect. Having occasional irregular contractions is not a significant find- ing and would not impact the use of oxytocin for induction. C. This is correct. Induction of labor is contraindicated when there is fetal transverse lie.