OB/Peds E2

1. Which piece of the usual equipment setup for a pelvic examination is omitted with a Pap test?
a. Gloves and eye protectors
b. Speculum
c. Fixative agent
d. Lubricant

ANS: D
Lubricants interfere with the accuracy of the cytology report. Gloves and eye protectors, speculum, and a fixative agent are all used during the exam.
PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 692 OBJ: Nursing Process: Implementati

2. The microscopic examination of scrapings from the cervix, endocervix, or other mucous membranes to detect premalignant or malignant cells is called
a. bimanual palpation.
b. rectovaginal palpation.
c. a Papanicolaou test.
d. DNA testing.

ANS: C
The Pap test is a microscopic examination for cancer that should be performed regularly, depending on the patient's age. Bimanual palpation is a physical examination of the vagina,. rectovaginal palpation is a physical examination performed through

3. The nurse providing care in a women's health care setting must be aware that which sexually transmitted disease (STD) can be cured?
a. Herpes
b. Acquired immunodeficiency syndrome (AIDS)
c. Venereal warts
d. Chlamydia

ANS: D
The usual treatment for chlamydia bacterial infection is doxycycline or azithromycin. Concurrent treatment of all sexual partners is needed to prevent recurrence. Because no cure is known for herpes, treatment focuses on pain relief and preventing

4. Which statement by a woman diagnosed with premenstrual syndrome indicates that further health teaching is needed?
a. "I may have to try some antidepressants."
b. "I need to limit my intake of caffeine."
c. "I might try taking some vitamin E."
d. "Salty

ANS: D
Eating salty foods contributes to edema and fluid retention and should be avoided as much as possible. This statement indicates a lack of understanding. The other statements are all accurate.
PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating
REF:

5. Which statement by the patient indicates that she understands breast self-examination?
a. "I will examine both breasts in two different positions."
b. "I will perform breast self-examination 1 week after my menstrual period starts."
c. "I will examine

ANS: B
The woman should examine her breasts when hormonal influences are at a low level, typically the week after her menses. Women who don't menstruate should pick a date and perform SBE on that date every month. She should use four positions: standing w

6. A benign breast condition that includes dilation and inflammation of the collecting ducts is called
a. ductal ectasia.
b. intraductal papilloma.
c. chronic cystic disease.
d. fibroadenoma.

ANS: A
Generally occurring in women approaching menopause, ductal ectasia results in a firm irregular mass in the breast, enlarged axillary nodes, and nipple discharge. Intraductal papillomas develop in the epithelium of the ducts of the breasts; as the m

7. Which patient is most at risk for fibroadenoma of the breast?
a. A 38-year-old woman
b. A 50-year-old woman
c. A 16-year-old woman
d. A 27-year-old woman

ANS: C
Although it may occur at any age, fibroadenoma is most common in the teenage years.
PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 693 OBJ: Nursing Process: Assessment
MSC: Client Needs: Physiologic Integrity

8. Adjuvant treatment with tamoxifen may be recommended for patients with breast cancer if the tumor is
a. smaller than 5 cm.
b. located in the upper outer quadrant only.
c. contained only in the breast.
d. estrogen receptive.

ANS: D
Tamoxifen is antiestrogen therapy for tumors stimulated by estrogen. Tamoxifen is used depending on age, stage, and hormone receptor status, not size. Location of the cancer does not determine the usefulness of tamoxifen. Stage of the cancer is a c

9. Which statement is true about primary dysmenorrhea?
a. It occurs in young multiparous women.
b. It is experienced by all women.
c. It may be due to excessive endometrial prostaglandin.
d. It is unaffected by oral contraceptives.

ANS: C
Some women produce excessive endometrial prostaglandin during the luteal phase of the menstrual cycle. Prostaglandin diffuses into endometrial tissue and causes uterine cramping. It usually occurs in young nulliparous women. It is not experienced b

10. In helping a patient manage PMS, the nurse should
a. recommend a diet with more red meat and sugar.
b. suggest herbal therapies and massage.
c. tell the patient to ask for medications as soon as symptoms occur.
d. suggest the use of diuretics.

ANS: B
Herbal therapies, conscious relaxation and massage have all been reported to have a beneficial effect on PMS. Carbohydrates may decrease cravings. Medications can be tried if lifestyle changes do not help or if there are depressive symptoms. Diuret

11. With regard to endometriosis, nurses should be aware that
a. it is characterized by the presence and growth of endometrial tissue inside the uterus.
b. it affects 25% of all women.
c. it may worsen with repeated cycles or remain asymptomatic and disap

ANS: C
Symptoms vary among women, ranging from nonexistent to incapacitating. Endometriosis affects 10% of all women and is found equally in Caucasian and African-American women. With endometriosis, the endometrial tissue is outside the uterus. Symptoms v

12. A 49-year-old patient confides to the nurse that she has started experiencing pain with intercourse and asks, "Is there anything I can do about this?" What is the best response by the nurse?
a. "You need to be evaluated for a sexually transmitted dise

ANS: B
Loss of lubrication with resulting discomfort in intercourse is a symptom of estrogen deficiency. This is a normal occurrence with the aging process and does not indicate STDs. It is part of the aging process, but the use of lubrication will help r

13. A 70-year-old woman should be taught to report what condition to her health care provider?
a. Vaginal bleeding
b. Pain with intercourse
c. Breasts become smaller
d. Skin becomes thinner

ANS: A
Vaginal bleeding after menopause should always be investigated. It is highly suggestive of endometrial cancer. The other conditions are related to aging.
PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 711 OBJ: Integrated Process: Teachi

14. Which woman is most likely to have osteoporosis?
a. A 50-year-old woman receiving estrogen therapy
b. A 60-year-old woman who takes supplemental calcium
c. A 55-year-old woman with a sedentary lifestyle
d. A 65-year-old woman who walks 2 miles each da

ANS: C
Risk factors for the development of osteoporosis include smoking, alcohol consumption, sedentary lifestyle, family history of the disease, and a high-fat diet. Hormone therapy may prevent bone loss. Supplemental calcium will help prevent bone loss,

15. A woman with a history of a cystocele should contact the physician right away if she experiences
a. involuntary loss of urine when she coughs.
b. constipation.
c. backache.
d. urinary frequency and burning.

ANS: D
Urinary frequency and burning are symptoms of cystitis, a common problem associated with cystocele. Involuntary loss of urine during coughing is stress incontinence and is not an emergency. Constipation may be a problem with rectoceles. Back pain i

16. To assist the woman in regaining control of the urinary sphincter, the nurse should teach her to
a. practice Kegel exercises.
b. void every hour while awake.
c. allow the bladder to become full before voiding.
d. restrict fluids to limit incontinent e

ANS: A
Kegel exercises, tightening and relaxing the pubococcygeal muscle, will improve control of the urinary sphincter. Voiding every hour is too frequent and not realistic. Overdistention of the bladder will contribute to incontinence. Restricting fluid

17. The physician diagnoses a 3-cm ovarian cyst in a 28-year-old woman. The nurse expects the initial treatment to include
a. beginning hormone therapy.
b. examining the woman after her next menstrual period.
c. scheduling a laparoscopy as soon as possibl

ANS: B
If the woman is in her childbearing years, when the risk of ovarian cancer is less, the physician may wait until after the next menstrual cycle and examine the woman again. Cysts in women of childbearing age may decrease within one cycle, so treatm

18. The drug of choice to treat gonorrhea is
a. penicillin G.
b. tetracycline.
c. ceftriaxone.
d. acyclovir.

ANS: C
Penicillin is the drug of choice used to treat syphilis.
PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 712 OBJ: Nursing Process: Planning
MSC: Client Needs: Physiologic Integrity

19. When a nurse is counseling a woman for primary dysmenorrhea, which nonpharmacologic intervention might be recommended?
a. Increasing the intake of red meat and simple carbohydrates
b. Reducing the intake of diuretic foods, such as peaches and asparagu

ANS: D
Heat minimizes cramping by increasing vasodilation and muscle relaxation and minimizing uterine ischemia. Dietary changes are not needed. Physical activity is beneficial for everyone but is not a treatment for this condition.
PTS: 1 DIF: Cognitive

20. Nafarelin (Synarel) is currently used as a treatment for mild to severe endometriosis. The nurse should tell the woman taking this medication that the drug
a. stimulates the secretion of gonadotropin-releasing hormone (GnRH).
b. may produce masculiniz

ANS: D
Nafarelin is a GnRH agonist, and its side effects are similar to those of menopause. The hypoestrogenism effect results in hot flashes and vaginal dryness. Danazole, another mediction to treat endometriosis causes masculinizing effects. Nararelin i

21. The nurse who is teaching a group of women about breast cancer should tell the women that
a. risk factors identify almost all women who will develop breast cancer.
b. African-American women have a higher rate of breast cancer.
c. 1 in 10 women in the

ANS: D
The exact cause of breast cancer in unknown. Risk factors help identify women who may get breast cancer and for whom increased surveillance is recommended; however, breast cancer can occur without risk factors. Caucasian women have a higher inciden

22. The nurse providing education regarding breast care should explain to the woman that fibrocystic changes in breasts are
a. a disease of the milk ducts and glands in the breasts.
b. a pre-malignant disorder characterized by lumps found in the breast ti

ANS: C
Fibrocystic changes are palpable thickenings in the breast usually associated with pain and tenderness. The pain and tenderness fluctuate with the menstrual cycle. Fibrocystic changes are palpable thickenings in the breast. Fibrocystic changes are

23. Which diagnostic test is used to confirm a suspected diagnosis of breast cancer?
a. Mammogram
b. Ultrasound
c. Core needle biopsy
d. MRI

ANS: C
When a suspicious mammogram is noted or a lump is detected, diagnosis is confirmed by either a core needle biopsy or one of the other types of biopsies. A mammogram screens for breast cancer. An ultrasound may be used with or before biopsy. An MRI

24. A 36-year-old woman has been diagnosed as having uterine fibroids. When planning care for this patient, the nurse should know that
a. fibroids are malignant tumors of the uterus.
b. fibroids will increase in size during the perimenopausal period.
c. a

ANS: C
The major symptoms associated with fibroids are menorrhagia and the physical effects produced by large leimyomas. Excessive menstrual bleeding is one possible symptom of fibroids. They are benign. They atrophy during menopause. A hysterectomy may b

25. When assessing a woman for menopausal discomforts, the nurse expects the woman to describe the most frequently reported discomfort, which is
a. headaches.
b. hot flashes.
c. mood swings.
d. vaginal dryness with dyspareunia.

ANS: B
Vasomotor instability, in the form of hat flashes or flushing, is a result of fluctuating estrogen levels and is the most common disturbance of the perimenopausal woman. Headaches are not a commonly reported symptom. Mood swings and vaginal dryness

26. While evaluating a patient for osteoporosis, the nurse should be aware of what risk factor?
a. African-American race
b. Low protein intake
c. Obesity
d. Cigarette smoking

ANS: D
Smoking is associated with earlier and greater bone loss and decreased estrogen production. Women at risk for osteoporosis are likely to be Caucasian or Asian. Inadequate calcium intake is a risk factor for osteoporosis. Women at risk for osteoporo

27. When discussing estrogen replacement therapy (ERT) with a perimenopausal woman, the nurse should include the risks of
a. breast cancer.
b. vaginal and urinary tract atrophy.
c. osteoporosis.
d. arteriosclerosis.

ANS: A
Women with a high risk of breast cancer should be counseled against using ERT. Estrogen prevents atrophy of vaginal and urinary tract tissue and protects against the development of osteoporosis. Estrogen has a favorable effect on circulating lipids

28. During her annual gynecologic checkup, a woman states that recently she has been experiencing cramping and pain during her menstrual periods. The nurse should document this complaint as
a. amenorrhea.
b. dysmenorrhea.
c. dyspareunia.
d. PMS.

ANS: B
Dysmenorrhea is pain during or shortly before menstruation. Pain is described as sharp and cramping or sometimes as a dull ache. It may radiate to the lower back or upper thighs. Amenorrhea is the absence of menstrual flow. Dyspareunia is pain duri

29. Management of primary dysmenorrhea often requires a multifaceted approach. The nurse who provides care for a patient with this condition should be aware that the optimal pharmacologic therapy for pain relief is
a. acetaminophen.
b. oral contraceptives

ANS: C
Nonsteroidal anti-inflammatory medications are the first-line drug for primary dysmenorrhea. Preparations containing acetaminophen are less effective for dysmenorrhea because they lack the antiprostaglandin properties of NSAIDs. OCPs are a reasonab

30. A woman is 6 weeks pregnant and has elected to terminate her pregnancy. The nurse knows that the most common technique used for medical termination of a pregnancy in the first trimester is
a. administration of prostaglandins.
b. dilation and evacuatio

ANS: A
The most common technique for medical termination of a pregnancy within the first 7 weeks of pregnancy is administration of prostaglandins. D&C is the most common method of surgical abortion used if medical abortion fails. Pitocin would not be used

31. The nurse should be aware that a pessary is most effective in the treatment of what disorder?
a. Cystocele
b. Uterine prolapse
c. Rectocele
d. Stress urinary incontinence

ANS: B
A fitted pessary may be inserted into the vagina to support the uterus and hold it in the correct position. It is not used for cystocele, rectocele, or incontinence.
PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 708 OBJ: Nursing Proces

32. A postmenopausal woman who is 54 years old has been diagnosed with two leiomyomas. What assessment finding is most commonly associated with the presence of leiomyomas?
a. Abnormal uterine bleeding
b. Diarrhea
c. Weight loss
d. Acute abdominal pain

ANS: A
Most women are asymptomatic. Abnormal uterine bleeding is the most common symptom of leiomyomas, or fibroids. Diarrhea, weight loss, and acute abdominal pain are not characteristic of fibroids.
PTS: 1 DIF: Cognitive Level: Comprehension/Understandi

33. A woman calls the triage nurse at the family medicine clinic and reports a raised area on her vulva. What response by the nurse is best?
a. Ask her when her next annual physical is due.
b. Make an appointment for the next day or two.
c. Send her direc

ANS: B
A raised or discolored lesion of the vulva needs to be examined as soon as possible. The nurse should schedule the woman for the soonest available appointment. This could be a cancerous lesion and so should not wait until the next annual physical,

MULTIPLE RESPONSE
1. Women are often reluctant to have annual mammograms for many reasons. These reasons include which of the following? (Select all that apply.)
a. Reluctance to hear bad news
b. Fear of x-ray exposure
c. Belief that lack of family histor

ANS: A, B, D, E
Common reasons women give for postponing or avoiding mammography include reluctance to hear bad news, fears of x-ray exposure, and fear of pain. Some women may believe their family history makes it unnecessary, but this is not a common sta

2. Which medications can be taken by postmenopausal women to treat and/or prevent osteoporosis? (Select all that apply.)
a. Calcium
b. Evista
c. Fosamax
d. Actonel
e. Vitamin C

ANS: A, B, C, D
Calcium, Evista, Fosamax, and Actonel are all used to prevent or treat osteoporosis. Vitamin C is not.
PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: pp. 706-707 OBJ: Nursing Process: Planning
MSC: Client Needs: Physiologic Integr

3. The exact cause of breast cancer remains undetermined. Researchers have found that there are a number of common risk factors that increase a woman's chance of developing a malignancy. It is essential for the nurse who provides care to women of any age

ANS: A, D, E
Family history, race, and nulliparity or first pregnancy after age 30 are all risk factors for breast cancer. Early menarche (not late) and late (not early) menopause are also risk factors.
PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
R

4. A nurse is teaching a community group of women about ways to decrease their risk of cardiovascular disease. What actions does the nurse recommend? (Select all that apply.)
a. Stop smoking
b. Drink 8 to 10 glasses of water daily
c. Exercise on most days

ANS: A, C, D, E
Risk factors for coronary artery disease include smoking, sedentary lifestyle, hypertension, and a high-fat diet. Drinking water is healthy but not specifically related to cardiovascular disease.
PTS: 1 DIF: Cognitive Level: Comprehension/

1. A pregnant woman who abuses cocaine admits to exchanging sex for her drug habit. This behavior puts her at a greater risk for which of the following?
a. Depression of the central nervous system
b. Hypotension and vasodilation
c. Sexually transmitted di

ANS: C
Sex acts exchanged for drugs place the woman at increased risk for sexually transmitted diseases because of multiple partners and lack of protection. Cocaine is a central nervous system stimulant. Cocaine causes hypertension and vasoconstriction. P

2. During which phase of the cycle of violence does the batterer become contrite and remorseful?
a. Battering phase
b. Honeymoon phase
c. Tension-building phase
d. Increased drug-taking phase

ANS: B
During the honeymoon phase, the battered person wants to believe that the battering will never happen again, and the batterer will promise anything to get back into the home. During the battering phase violence actually occurs, and the victim feels

3. What is a major barrier to health care for teen mothers?
a. The hospital/clinic is within walking distance of the girl's home.
b. The institution is open days, evenings, and Saturdays by special arrangement.
c. The teen must be prepared to see a differ

ANS: C
Whenever possible, the teen should be scheduled to see the same nurses and practitioners for continuity of care. If the hospital/clinic were within walking distance of the girl's home, it would prevent the teen from missing appointments because of

4. Of adolescents who become pregnant, what percentage have had a previous birth?
a. 10%
b. 15%
c. 17%
d. 35%

ANS: C
Seventeen percent of pregnant adolescents have had one or more previous births.
PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 500 OBJ: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance

5. In counseling a patient who has decided to relinquish her baby for adoption, the nurse should do which of the following?
a. Affirm her decision while acknowledging her maturity in making it.
b. Question her about her feelings regarding adoption.
c. Tel

ANS: A
A supportive, affirming approach by the nurse will strengthen the patient's resolve and help her to appreciate the significance of the event. The teen needs help in coping with her feelings about this decision. It is important for the nurse to supp

6. A woman who is older than 35 years may have difficulty achieving pregnancy, because
a. personal risk behaviors influence fertility.
b. she has used contraceptives for an extended time.
c. her ovaries may be affected by the aging process.
d. prepregnanc

ANS: C
Once the mature woman decides to conceive, a delay in becoming pregnant may occur because of the normal aging of the ovaries. The older adult participates in fewer risk behaviors than the younger adult. The problem is the age of the ovaries, not th

7. What is most likely to be a concern for the older mother?
a. The importance of having enough rest and sleep
b. Information about effective contraceptive methods
c. Nutrition and diet planning
d. Information about exercise and fitness

ANS: A
The woman who delays childbearing may have unique concerns, one of which is having less energy than younger mothers. The older mother usually has more financial means to search out effective contraceptive methods. The older mother often is better o

8. What is the most dangerous effect on the fetus of a mother who smokes cigarettes while pregnant?
a. Genetic changes and anomalies
b. Extensive central nervous system damage
c. Fetal addiction to the substance inhaled
d. Intrauterine growth restriction

ANS: D
The major consequences of smoking tobacco during pregnancy are low-birth-weight infants, prematurity, and increased perinatal loss. Cigarettes normally will not cause genetic changes or extensive central nervous system damage. Addiction is not a no

9. A patient at 24 weeks of gestation says she has a glass of wine with dinner every evening. The nurse will counsel her to eliminate all alcohol intake. What is the best rationale provided by the nurse?
a. A daily consumption of alcohol indicates a risk

ANS: C
The brain grows most rapidly in the third trimester and is most vulnerable to alcohol exposure during this time. A risk for alcoholism is not the major risk for the infant. Multiple organ anomalies are not a major concern.
PTS: 1 DIF: Cognitive Lev

10. Which of these substances can lead to miscarriage, preterm labor, placental separation (abruption), and stillbirth?
a. Heroin
b. Alcohol
c. PCP
d. Cocaine

ANS: D
Cocaine is a powerful CNS stimulant. Effects on pregnancy associated with cocaine use include abruptio placentae, preterm labor, precipitous birth, and stillbirth. Heroin is an opiate. Its use in pregnancy is associated with preeclampsia, intrauter

11. When helping the mother, father, and other family members actualize the loss of the infant, nurses should
a. use the words lost or gone rather than dead or died.
b. make sure the family understands that it is important to name the baby.
c. if the pare

ANS: C
Presenting the baby in a nice way stimulates the parents' senses and provides pleasant memories of their baby. Nurses must use dead and died to assist the bereaved in accepting reality. Although naming the baby can be helpful, it is important not t

12. A woman has delivered twins. The first twin was stillborn, and the second is in the intensive care nursery and is recovering quickly from respiratory distress. The woman is crying softly and says, "I wish my baby could have lived." What is the most th

ANS: D
The nurse should recognize the woman's grief and its significance and allow her to express her feelings. The other three responses belittle the woman's feelings.
PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 514 OBJ: Integrated Process:

13. Which of the following is an appropriate nursing measure when a baby has an unexpected anomaly?
a. Remove the baby from the delivery area immediately.
b. Tell the parents that the baby has to go to the nursery immediately.
c. Inform the parents immedi

ANS: D
Parents experience less anxiety when they are told about the defect as early as possible and are allowed to touch and hold the baby. The parents should be both informed and able to touch and hold the baby as soon as possible.
PTS: 1 DIF: Cognitive

14. A woman who is 6 months pregnant has sought medical attention saying she fell down the stairs. What scenario would cause an emergency department nurse to suspect that the woman has been battered?
a. The woman and her partner are having an argument tha

ANS: B
The battered woman often has multiple injuries in various stages of healing. Arguing may or may not be sign of battering; many times the batterer will be attentive and refuse to leave the woman's side. A battered woman often has a flat affect or av

15. Which of the following items are inconsistent with the nurse's knowledge of symptoms of fetal alcohol syndrome?
a. Respiratory conditions
b. Impaired growth
c. CNS abnormality
d. Facial abnormalities

ANS: A
Respiratory difficulties are not a category of conditions that are related to FAS. Abnormalities related to FAS include impaired growth (intrauterine growth restriction), CNS abnormalities, and a constellation of typical facial features.
PTS: 1 DIF

16. When the nurse is alone with a battered patient, the patient seems extremely anxious and says, "It was all my fault. The house was so messy when he got home and I know he hates that." The best response by the nurse is
a. "No one deserves to be hurt. I

ANS: A
The nurse should stress that the patient is not at fault and offer to help. Asking what else the woman does to make the partner angry or reminding her that he is frustrated is placing blame on the woman. Telling her "don't worry" is giving false re

17. In helping bereaved parents cope and move on, nurses should keep in mind that
a. a perinatal or parental grief support group is more likely to be helpful if the needs of the parents are matched with the focus of the group.
b. when pictures of the infa

ANS: A
The nurse should try when possible to match the recommended support resources to the parents. For example, a religious-based group may not work for nonreligious parents. Close-up pictures of the baby must be taken as the infant was, congenital anom

18. A common effect of both smoking and cocaine use on the pregnant woman is
a. vasoconstriction.
b. increased appetite.
c. inactivates fetal hemoglobin.
d. euphoria.

ANS: A
Both smoking and cocaine use cause vasoconstriction, which results in impaired placental blood flow to the fetus. Both smoking and cocaine use decrease the appetite. Smoking inactivates fetal hemoglobin. Euphoria can be seen with cocaine use.
PTS:

19. What information about caffeine in pregnancy does the nurse provide the prenatal class with?
a. It stays in your body twice as long as when you are not pregnant.
b. It causes vasoconstriction, which could keep the fetus from growing.
c. Caffeine depre

ANS: B
Caffeine is a vasoconstrictor. Its half-life is 3 times as long in the pregnant woman. It stimulates cardiac function. It does cause mild but not severe diuresis.
PTS: 1 DIF: Cognitive Level: Comprehension/Understanding
REF: p. 507 | Table 24.1 OBJ

20. The student nurse learns that the most important reason marijuana should not be used during pregnancy is which of the following?
a. Unknown effects, more research is needed
b. Causes a higher rate of spontaneous abortions
c. Leads to multiple organ dy

ANS: A
Marijuana's effects on the fetus are largely unknown. More research is needed in this area.
PTS: 1 DIF: Cognitive Level: Comprehension/Understanding
REF: p. 507 | Table 24.1 OBJ: Integrated Process: Teaching-Learning
MSC: Client Needs: Health Promo

21. A nurse is interviewing a pregnant woman in the clinic. She seems hostile and answers many questions with "Whatever" and "I don't really know." At her last appointment she was late and disheveled. What action by the nurse is best?
a. Ask the woman if

ANS: C
This woman is displaying some signs of substance abuse. In a non-judgmental manner, the nurse should ask about all drugs and medications she is using. The questions will appear less confrontative if the nurse begins by asking about over-the-counter

1. Many teens wait until the second or even third trimester to seek prenatal care. The nurse should understand that the reasons behind this delay include which of the following?
(Select all that apply.)
a. Lack of realization that they are pregnant
b. Unc

ANS: A, B, C, E
Not realizing they are pregnant, uncertainty over where to get care, denial, and wanting to hide the pregnancy are all reasons some teens delay prenatal care. Wanting to gain control over the situation does not lead to delaying care.
PTS:

2. Approximately 82% of teen pregnancies are unintended. Seventy percent of teens have had sex by their 19th birthday. Factors that contribute to an increased risk for teen pregnancy include which of the following? (Select all that apply.)
a. High self-es

ANS: B, C, E
Peer pressure to begin sexual activity is a contributing factor toward teen pregnancy. Limited access to contraceptive devices and lack of accurate information about how to use these devices are also factors. Lack of appropriate role models,

1. Childbirth preparation can be considered successful if the outcome is described as follows:
a. Labor and delivery were pain-free.
b. The woman's partner participated eagerly.
c. The woman rehearsed labor and practiced skills to master pain.
d. Only non

ANS: C
Preparation allows the woman to rehearse for labor and to learn new skills to cope with the pain of labor and the expected behavioral changes. Childbirth preparation does not guarantee a pain-free labor. A woman should be prepared for pain and anes

2. In order to help patients manage discomfort and pain during labor, nurses should be aware that
a. the predominant pain of the first stage of labor is the visceral pain located in the lower portion of the abdomen.
b. somatic pain is the extreme discomfo

ANS: A
This pain comes from cervical changes, distention of the lower uterine segment, and uterine ischemia. Somatic pain is a faster, sharp pain. Somatic pain is most prominent during late first-stage labor and during second-stage labor as the descending

3. The nurse caring for women in labor understands that childbirth pain is different from other types of pain in that it is
a. more responsive to pharmacologic management.
b. associated with a physiologic process.
c. designed to make one withdraw from the

ANS: B
Childbirth pain is part of a normal process, whereas other types of pain usually signify an injury or illness. Childbirth pain is not more or less responsive to medication. The pain with childbirth is a normal process; it is not caused by the type

4. Excessive anxiety in labor heightens the woman's sensitivity to pain by increasing
a. muscle tension.
b. blood flow to the uterus.
c. the pain threshold.
d. rest time between contractions.

ANS: A
Anxiety and fear increase muscle tension, diverting oxygenated blood to the woman's brain and skeletal muscles. Prolonged tension results in general fatigue, increased pain perception, and reduced ability to use coping skills. It can also decrease

5. When providing labor support, the nurse knows that which fetal position might cause the laboring woman more back discomfort?
a. Right occiput anterior
b. Left occiput anterior
c. Right occiput transverse
d. Left occiput posterior

ANS: D
In the left occiput posterior position, each contraction pushes the fetal head against the mother's sacrum, which results in intense back discomfort. The other fetal positions do not cause more back discomfort.
PTS: 1 DIF: Cognitive Level: Knowledg

6. The nurse working with a pregnant woman explains that a major advantage of nonpharmacologic pain management is that
a. more complete pain relief is possible.
b. no side effects or risks to the fetus are involved.
c. the woman remains fully alert at all

ANS: B
Because nonpharmacologic pain management does not include analgesics, adjunct drugs, or anesthesia, it is harmless to the mother and the fetus. There is less pain relief with nonpharmacologic pain management during childbirth. The woman's alertness

7. The best time to teach nonpharmacologic pain control methods to an unprepared laboring woman is during which phase?
a. Latent phase
b. Active phase
c. Transition phase
d. Second stage

ANS: A
The latent phase of labor is the best time for intrapartum teaching, because the woman is usually anxious enough to be attentive, yet comfortable enough to understand the teaching. During the active phase, the woman is focused internally and unable

8. The nurse providing newborn stabilization must be aware that the primary side effect of maternal narcotic analgesia in the newborn is
a. respiratory depression.
b. bradycardia.
c. acrocyanosis.
d. tachypnea.

ANS: A
An infant delivered within 5 hours of maternal analgesic administration (timing depends on drug used) is at risk for respiratory depression from the sedative effects of the opioid. Bradycardia, acrocyanosis, and tachypnea are not anticipated side e

9. A woman received 50 mcg of fentanyl intravenously 1 hour before delivery. What drug should the nurse have readily available?
a. Promethazine (Phenergan)
b. Nalbuphine (Nubain)
c. Butorphanol (Stadol)
d. Naloxone (Narcan)

ANS: D
Naloxone reverses narcotic-induced respiratory depression, which may occur with administration of narcotic analgesia. Phenergan is normally given for nausea. Nubain and Stadol are analgesics that can be given to women in labor.
PTS: 1 DIF: Cognitiv

10. The nerve block used in labor that provides anesthesia to the lower vagina and perineum is called a(n)
a. epidural.
b. pudendal.
c. local.
d. spinal block.

ANS: B
A pudendal block anesthetizes the lower vagina and perineum to provide anesthesia for an episiotomy and use of low forceps if needed. An epidural provides anesthesia for the uterus, perineum, and legs. A local provides anesthesia for the perineum a

11. A laboring woman has been given an injection of epidural anesthesia. Which assessment by the nurse takes priority?
a. Urinary output
b. Contraction pattern
c. Maternal blood pressure
d. Intravenous infusion rate

ANS: C
Epidural anesthesia may produce maternal hypotension due to vasodilation so the priority assessment by the nurse is maternal blood pressure. The other assessments are important for this woman but are not directly related to the anesthetic injection

12. Which statement is true about the physiologic effects of pain in labor?
a. It usually results in a more rapid labor.
b. It is considered to be a normal occurrence.
c. It may result in decreased placental perfusion.
d. It has no effect on the outcome o

ANS: C
When experiencing excessive pain, the woman may react with a stress response that diverts blood flow from the uterus and the fetus. Excessive pain may prolong the labor due to increased anxiety in the woman. Pain is considered normal for labor, how

13. Which woman will most likely have increased anxiety and tension during her labor?
a. Gravida 1 who did not attend prepared childbirth classes
b. Gravida 2 who refused any medication
c. Gravida 2 who delivered a stillborn baby last year
d. Gravida 3 wh

ANS: C
If a previous pregnancy had a poor outcome, the woman will probably be more anxious during labor and delivery. The woman is not prepared for labor and will have increased anxiety during labor. However, the woman with a poor previous outcome is more

14. Which method of pain management does the nurse plan for a gravida 3 para 2 admitted at 8-cm cervical dilation?
a. Epidural anesthesia
b. Narcotics
c. Spinal block
d. Breathing and relaxation techniques

ANS: D
Nonpharmacologic methods of pain management may be the best option for a woman in advanced labor. There is probably not enough remaining time to administer epidural anesthesia or spinal anesthesia. A narcotic given at this time may reach its peak a

15. The laboring woman who imagines her body opening to let the baby out is using a mental technique called
a. dissociation.
b. effleurage.
c. imagery.
d. distraction.

ANS: C
Imagery is a technique of visualizing images that will assist the woman in coping with labor. Dissociation helps the woman learn to relax all muscles except those that are working. Effleurage is self-massage. Distraction can be used in the early la

16. The registered nurse explains to the student that when giving a narcotic to a laboring woman, the nurse should inject the medication at the beginning of a contraction so that
a. full benefit of the medication is received during that contraction.
b. le

ANS: B
Injecting at the beginning of a contraction, when blood flow to the placenta is normally reduced, limits transfer to the fetus. The full benefit will be received by the woman; however, it will decrease the amount reaching the fetus. It will not inc

17. The method of anesthesia in labor considered the safest for the fetus is the
a. pudendal block.
b. epidural block.
c. spinal (subarachnoid) block.
d. local infiltration.

ANS: D
Local infiltration of the perineum rarely has any adverse effects on either the mother or the fetus. The fetus can be affected by maternal side effects of the other types of anesthesia.
PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 362

18. A woman received an epidural anesthetic and now her blood pressure is 88/64 mm Hg. What action by the nurse takes priority?
a. Turn the woman to the left side.
b. Place a wedge under the woman's right hip.
c. Call the provider or nurse-anesthetist imm

ANS: B
If hypotension occurs after administration of an epidural, turn the patient to the left lateral side-lying position, and infuse intravenous crystalloids. These actions will improve placental blood flow. Oxygen administration is also recommended, bu

19. The priority nursing intervention for the patient who has received an epidural narcotic is
a. monitoring respiratory rate hourly.
b. administering analgesics as needed.
c. monitoring blood pressure every 4 hours.
d. assessing the level of anesthesia.

ANS: A
The possibility of respiratory depression exists for up to 24 hours after administration of an epidural narcotic. The nurse should monitor the woman's respiratory rate hourly during this time frame. Epidural narcotic should be enough pain relief th

20. One of the greatest risks to the mother during administration of general anesthesia is
a. respiratory depression.
b. uterine relaxation.
c. inadequate muscle relaxation.
d. aspiration of stomach contents.

ANS: D
Aspiration of acidic gastric contents and possible airway obstruction is a potentially fatal complication of general anesthesia. Respirations can be altered during general anesthesia, and the anesthesiologist will take precautions to maintain prope

21. The student nurse is working with a laboring woman. What action by the student requires the registered nurse to intervene?
a. Placing the woman in a supine position
b. Assisting the woman to a sitting position
c. Turning the woman to a side-lying posi

ANS: A
The supine position allows the heavy uterus to compress the inferior vena cava and can reduce placental blood flow, compromising fetal oxygen supply. The nurse should intervene to position the woman in any of the other positions, which are all appr

22. A woman had spinal anesthesia for delivery. Now she complains of a pounding headache rated 7/10. What action by the nurse is most appropriate?
a. Prepare to assist with a blood patch procedure.
b. Give the woman IV opioid pain medications.
c. Increase

ANS: A
The subarachnoid block may cause a postspinal headache due to loss of cerebrospinal fluid from the puncture in the dura. When blood is injected into the epidural space in the area of the dural puncture ("blood patch"), it forms a seal over the hole

23. The nurse teaching a childbirth preparation class teaches the participants that the first type of breathing technique used in labor is called
a. slow-paced.
b. modified-paced.
c. patterned-paced.
d. pant-blow.

ANS: A
Breathing for the first stage of labor consists of a cleansing breath and various breathing techniques known as paced breathing. The first type used in labor is the slow-paced. Modified-paced breathing is used when the slow-paced breathing is no lo

24. When instructing the woman in early labor, the nurse teaches her that an important aspect of proper breathing technique is
a. breathing no more than three times the normal rate.
b. beginning and ending with a cleansing breath.
c. holding the breath no

ANS: B
The cleansing breath helps the woman clear her mind to focus on relaxing and signals the coach that the contraction is beginning or ending. It is important to prevent hyperventilation; however, the cleansing breaths are the most important aspect of

25. Which patient is most likely to experience pain during labor?
a. Gravida 2 who has not attended childbirth preparation classes
b. Gravida 2 who is anxious because her last labor was difficult
c. Gravida 1 whose fetus is in a breech presentation
d. Gra

ANS: B
Anxiety affects a woman's perception of pain. Tension during labor causes tightening of abdominal muscles, impeding contractions and increasing pain by stimulation of nerve endings. The gravida 2 has previous experience, and this will decrease anxi

26. Which type of cutaneous stimulation involves massage of the abdomen?
a. Thermal stimulation
b. Imagery
c. Mental stimulation
d. Effleurage

ANS: D
Effleurage is massage usually performed on the abdomen during contractions. Thermal stimulation is the use of warmth to provide comfort, such as showers and baths. Imagery involves the woman creating a relaxing mental scene and dissociating herself

27. A woman is experiencing most of her labor pain in her back. What action by the nurse is best?
a. Positioning the woman lying supine with head slightly elevated
b. Showing the support person how to apply firm pressure to the sacrum
c. Assisting the wom

ANS: B
Firm pressure against the sacrum may be helpful in relieving the discomfort associated with back labor. The nurse can provide this action, but including the support person (if desired) is beneficial. The woman should not lie on her back. Sitting up

28. Which technique could the support person use when the laboring woman appears to be losing control?
a. Have the nurse take over the role of support.
b. Tell the woman that she is causing stress to her baby and herself.
c. Wait for the contraction to en

ANS: D
Making eye contact and breathing along with the laboring woman to help pace her breathing will assist her in remaining calm. The woman already has a trusting relationship with the support person so they should stay in that position if possible. Tel

29. A nurse admits a woman to the labor and delivery unit who has a history of IV drug abuse. In planning care for this patient, the nurse explains to the student that which pain control plan is contraindicated for this woman?
a. Epidural anesthesia
b. Bo

ANS: B
Women who are opiate-dependent should not receive analgesics having mixed agonist and antagonist actions (butorphanol and nalbuphine). Epidural anesthesia not using these drugs is appropriate as are promethazine and naloxone if needed.
PTS: 1 DIF:

30. A woman has received an epidural block. What action by the nurse takes priority?
a. Instruct her to call for help when getting out of bed.
b. Assess the woman for a post-procedure headache.
c. Determine type and time of last oral intake.
d. Administer

ANS: A
Due to variable leg strength and sensation with an epidural block, the woman who is able to get out of bed needs to call for assistance for safety. Post-procedure headaches are associated with subarachnoid blocks. Oral intake and pro-motility agent

31. What statement by the woman after a childbirth education class demonstrates that she needs more information?
a. "I'm having a pudendal block so control my labor pain."
b. "I may get a headache after a subarachnoid block."
c. "I don't want IV opioids a

ANS: A
A pudendal block numbs the lower vagina and perineum for vaginal birth. There is no relief of labor pain because it is done just before birth. This woman needs further education. The other statements are all accurate.
PTS: 1 DIF: Cognitive Level: E

32. A woman had an epidural place an hour ago and is now complaining of severe itching. What action by the nurse is most appropriate?
a. Discontinue the epidural infusion at once.
b. Notify the anesthesia provider.
c. Prepare to administer diphenhydramine

ANS: C
Pruritis (itching) is a common side effect of epidural medications. The nurse should be prepared to administer diphenhydramine. There is no need to discontinue the epidural infusion or notify the anesthesia provider. Promethazine is used for nausea

MULTIPLE RESPONSE
1. While developing an intrapartum care plan for the patient in early labor, it is important that the nurse recognize that psychosocial factors may influence a woman's experience of pain. These include (Select all that apply.)
a. culture

ANS: A, B, C, E
Culture: a woman's sociocultural roots influence how she perceives, interprets, and responds to pain during childbirth. Some cultures encourage loud and vigorous expressions of pain, whereas others value self-control. The nurse should avoi

2. The nurse is caring for a laboring patient who develops a fever after she has had her epidural initiated. What actions by the nurse are appropriate? (Select all that apply.)
a. Palpate the woman's bladder distention.
b. Assess the woman's blood pressur

ANS: C, D
Heat dissipation is reduced as a result of decreased hyperventilation, sweating, and activity after the onset of pain relief. Vasodilation redistributes heat from the core to the periphery of the body, where it is lost to the environment. Assess

COMPLETION
1. A newborn infant weighing 8 lb needs naloxone (Narcan). This infant should receive approximately _____ mg.

ANS:
0.36
The dose of naloxone is 0.1 mg/kg. This baby weighs 3.6 kg, so 0.1 x 3.6 = 0.36 mg.
PTS: 1 DIF: Cognitive Level: Application/Applying
REF: Table 18.1 OBJ: Nursing Process: Implementation
MSC: Client Needs: Physiologic Integrity

1. The infant of a mother with diabetes is hypoglycemic. What type of feeding should be instituted first?
a. Glucose water in a bottle
b. D5W intravenously
c. Formula via nasogastric tube
d. Breast milk

ANS: D
Breast milk is metabolized more slowly and provides longer normal glucose levels. Breast milk is best for nearly all babies. High levels of dextrose correct the hypoglycemia but will stimulate the production of more insulin. Oral feedings are tried

2. The nurse learns that the most common cause of pathologic hyperbilirubinemia is which of the following?
a. Hepatic disease
b. Hemolytic disorders in the newborn
c. Postmaturity
d. Congenital heart defect

ANS: B
Hemolytic disorders in the newborn are the most common cause of pathologic jaundice. Hepatic damage and prematurity may be causes of pathologic hyperbilirubinemia, but they are not the most common cause. Congenital heart defect is not a common caus

3. An infant with severe meconium aspiration syndrome (MAS) is not responding to conventional treatment. Which treatment may be necessary for this infant?
a. Extracorporeal membrane oxygenation
b. Respiratory support with ventilator
c. Insertion of laryng

ANS: A
Extracorporeal membrane oxygenation is a highly technical method that oxygenates the blood while bypassing the lungs, allowing the infant's lungs to rest and recover. The infant is most likely intubated and on a ventilator already. Laryngoscope ins

4. Four hours after delivery of a healthy neonate of an insulin-dependent diabetic woman, the baby appears jittery, irritable, and has a high-pitched cry. Which nursing action has top priority?
a. Start an intravenous line with D5W.
b. Notify the clinicia

ANS: D
These are signs of hypoglycemia in the newborn. The nurse should test the infant's blood glucose level and then feed the infant if it is low. It is not common practice to give intravenous glucose to a newborn prior to feeding. Feeding the infant is

5. A nurse is participating in a neonatal resuscitation. What action by the nurse takes priority?
a. Suction the mouth and nose.
b. Stimulate the infant by rubbing the back.
c. Perform the Apgar test.
d. Place the infant in a preheated warmer.

ANS: D
In a resuscitation situation, the nurse places the newborn in a preheated warmer immediately to reduce cold stress. Next position the infant in a "sniffing" position. Suctioning is the third step. Drying the infant is fourth, although if more than

6. A neonate has white patches in her mouth that bled when the mother tried wiping them away. What action by the nurse is best?
a. Tell the mother to leave the patches alone.
b. Assess the mother for a perineal rash.
c. Give the infant medicated pacifiers

ANS: B
These patches are characteristic of maternal infection with candidiasis or yeast. The nurse assesses the mother's perineal area for a rash. Telling the mother to leave the rash alone may be appropriate information but does not get to the bottom of

7. Transient tachypnea of the newborn (TTN) is thought to occur as a result of
a. a lack of surfactant.
b. hypoinflation of the lungs.
c. delayed absorption of fetal lung fluid.
d. a slow vaginal delivery associated with meconium-stained fluid.

ANS: C
Delayed absorption of fetal lung fluid is thought to be the reason for TTN. Lack of surfactant and hypoinflation of the lungs are not related to TTN. A slow vaginal delivery will help prevent TTN.
PTS: 1 DIF: Cognitive Level: Knowledge/Remembering

8. A newborn has meconium aspiration at birth. The nurse notes increasing respiratory distress. What action takes priority?
a. Obtain an oxygen saturation.
b. Notify the provider at once.
c. Stimulate the baby to increase respirations.
d. Prepare to initi

ANS: A
This baby has a risk for, and signs of, persistent pulmonary hypertension. The nurse first checks an oxygen saturation then notifies the provider, or alternatively, gets the reading (and other assessments) while another nurse does the notification.

9. The nurse present at the delivery is reporting to the nurse who will be caring for the neonate after birth. What information might be included for an infant who had thick meconium in the amniotic fluid?
a. The infant had Apgar scores of 6 and 8.
b. An

ANS: C
A laryngoscope is inserted to examine the vocal cords. If no meconium is below the cords, probably no meconium is present in the lower air passages, and the infant will not develop meconium aspiration syndrome. Apgar scores are important but not di

10. The nurse is teaching the parents of a newborn who is going to receive phototherapy. What other measure does the nurse teach to help reduce the bilirubin?
a. Increase the frequency of feedings.
b. Increase oral intake of water between feedings.
c. How

ANS: A
Frequent feedings prevent hypoglycemia, provide protein to maintain albumin levels in the blood and promote gastrointestinal motility and removal of bilirubin in the stools. More frequent breastfeeding should be encouraged. Avoid offering water bet

11. A mother with diabetes has done some reading about the effects of the condition on her newborn. Which statement shows a misunderstanding that should be clarified by the nurse?
a. "Although my baby is large, some women with diabetes have very small bab

ANS: D
Infants of diabetic mothers may have hypertrophy of the islets of Langerhans, which may cause them to produce more insulin than they need. The other statements are correct and show good understanding.
PTS: 1 DIF: Cognitive Level: Evaluation/Evaluat

12. Nursing care of the infant with neonatal abstinence syndrome should include
a. Positioning the infant's crib in a quiet corner of the nursery
b. Feeding the infant on a 2-hour schedule
c. Placing stuffed animals and mobiles in the crib to provide visu

ANS: A
Placing the crib in a quiet corner helps avoid excessive stimulation of the infant. These infants have an increase calorie needs but poor suck and swallow coordination. Feeding should occur to meet these needs. Stimulation should be kept to a minim

13. The difference between physiologic and nonphysiologic jaundice is that nonphysiologic jaundice
a. usually results in kernicterus.
b. appears during the first 24 hours of life.
c. results from breakdown of excessive erythrocytes not needed after birth.

ANS: B
Nonphysiologic jaundice appears during the first 24 hours of life, whereas physiologic jaundice appears after the first 24 hours of life. Pathologic jaundice may lead to kernicterus, but it needs to be stopped before that occurs. Both jaundices are

14. The goal of treatment of the infant with phenylketonuria (PKU) is to
a. cure cognitive delays.
b. prevent central nervous system (CNS) damage.
c. prevent gastrointestinal symptoms.
d. prevent the renal system damage.

ANS: B
CNS damage can occur as a result of toxic levels of phenylalanine. No cure exists for cognitive delays should they occur. Digestive problems are a clinical manifestation of PKU, but it is more important to prevent the CNS damage. PKU does not invol

15. Parents of a newborn with phenylketonuria are anxious to learn about the appropriate treatment for their infant. What topic does the nurse include in the teaching plan?
a. Fluid and sodium restrictions
b. A phenylalanine-free diet
c. Progressive mobil

ANS: B
Phenylketonuria is treated with a special diet that restricts phenylalanine intake. Fluid and sodium restrictions are not included in this plan. Mobility and splinting are not included in the plan. A protein-rich diet is not in the plan.
PTS: 1 DIF

16. The nurse is caring for a neonate undergoing phototherapy. What action does the nurse include on the infant's care plan?
a. Keep the infant's eyes covered under the light.
b. Keep the infant supine at all times.
c. Restrict parenteral and oral fluids.

ANS: A
Retinal damage from phototherapy should be prevented by using eye shields on the infant under the light. To ensure total skin exposure, the infant's position is changed frequently. Special attention to increasing fluid intake ensures that the infan

17. An infant with hypocalcemia is receiving an intravenous bolus of calcium. The infant's heart rate changes from 144 beats/minute to 62 beats/minute. What action by the nurse is best?
a. Call for a stat EGG.
b. Stop the infusion.
c. Stimulate the infant

ANS: B
IV calcium can lead to bradycardia. When this infant's heart rate drops to 60 beats/minute, the nurse stops the infusion. A stat ECG is not necessary unless policy requires it or the bradycardia does not resolve. Stimulating the infant will not inc

18. A macrosomic infant is born after a difficult, forceps-assisted delivery. After stabilization, the infant is weighed, and the birth weight is 4550 g (9 pounds, 6 ounces). What action by the nurse is most appropriate?
a. Leave the infant in the room wi

ANS: D
This infant is macrosomic (over 4000 g) and is at high risk for hypoglycemia. Blood glucose levels should be monitored frequently, and the infant should be observed closely for signs of hypoglycemia. The infant can stay with the mother, but this is

19. A pregnant woman at 37 weeks of gestation has had ruptured membranes for 26 hours. A cesarean section is performed for failure to progress. The fetal heart rate before birth is 180 beats/min with limited variability. At birth, the newborn has Apgar sc

ANS: D
The prolonged rupture of membranes and the tachypnea (before and after birth) both suggest sepsis. There is no evidence of phrenic nerve damage or respiratory distress syndrome. Early signs of sepsis may be difficult to distinguish from other probl

20. What action by the nurse is the most important action in preventing neonatal infection?
a. Good hand hygiene
b. Isolation of infected infants
c. Separate gown technique
d. Standard Precautions

ANS: A
Virtually all controlled clinical trials have demonstrated that effective handwashing is responsible for the prevention of nosocomial infection in nursery units. The other actions do reduce risk but not nearly to the degree that good hand hygiene d

21. What action does the nurse add to the plan of care for an infant experiencing symptoms of drug withdrawal?
a. Keeping the newborn sedated
b. Feeding every 4 to 6 hours to allow extra rest
c. Swaddling the infant snugly
d. Playing soft music during fee

ANS: C
The infant should be wrapped snugly to reduce self-stimulation behaviors and protect the skin from abrasions. The baby is not kept sedated. The infant should be fed in small, frequent amounts and burped well to diminish aspiration and maintain hydr

22. The nursing student learns that transmission of HIV from mother to baby occurs in which fashion?
a. From the maternal circulation only in the third trimester
b. From the use of unsterile instruments
c. Only through the ingestion of amniotic fluid
d. T

ANS: D
Postnatal transmission of HIV through breastfeeding may occur. Transplacental transmission can occur at any time during pregnancy. Unsterile instruments are possible sources of transmission but highly unlikely. Transmission of HIV may also occur du

23. A primigravida has just delivered a healthy infant girl. The nurse is about to administer erythromycin ointment in the infant's eyes when the mother asks, "What is that medicine for?" The nurse responds
a. "It is an eye ointment to help your baby see

ANS: C
With the prophylactic use of erythromycin, the incidence of gonococcal conjunctivitis has declined to less than 0.5%. Eye prophylaxis is administered at or shortly after birth to prevent ophthalmia neonatorum. Erythromycin has no bearing on enhanci

24. Near the end of the first week of life, an infant who has not been treated for any infection develops a copper-colored, maculopapular rash on the palms and around the mouth and anus. The newborn is showing signs of
a. gonorrhea.
b. herpes simplex viru

ANS: C
This rash is indicative of congenital syphilis. The lesions may extend over the trunk and extremities. This is not characteristic of gonorrhea, herpes, or HIV.
PTS: 1 DIF: Cognitive Level: Knowledge
REF: p. 650 | Table 30.1 | p. 654 OBJ: Nursing Pr

25. Providing care for the neonate born to a mother who abuses substances can present a challenge for the health care team. Nursing care for this infant requires a multisystem approach. The first step in the provision of this care is
a. pharmacologic trea

ANS: C
Various scoring systems exist to determine the number, frequency, and severity of behaviors that indicate neonatal abstinence syndrome. The score is helpful in determining the necessity of drug therapy to alleviate withdrawal. Pharmacologic treatme

26. A woman who has had no prenatal care enters the labor and delivery unit in advanced labor. She has chickenpox. What action by the nurse is best?
a. Place the woman in isolation.
b. Give the woman immune globulin before delivery.
c. Treat the woman wit

ANS: A
Women with varicella infections (chickenpox or shingles) need to be in isolation (airborne and contact per the CDC). There might not be enough time to administer immune globulin to the mother before delivery, but it could be given to the baby. Acyc

27. A woman who has a history of frequent substance abuse is close to delivering. What action by the nurse is best?
a. Notify social services of the situation prior to the birth.
b. Draw up and label a syringe of naloxone.
c. Administer naloxone if the ba

ANS: B
When anticipating the delivery of a baby whose mother is addicted to opioids, the nurse prepares to give the newborn naloxone for respiratory depression. To administer the drug in the fastest way possible, the nurse prepares a syringe with the medi

1. Some infants develop hypoxic-ischemic encephalopathy after asphyxia. Therapeutic hypothermia has been used to improve neurologic outcomes for these infants. Criteria for the use of this modality include (Select all that apply.)
a. The infant must be 28

ANS: B, C, D
The infant must be at least 36 weeks of gestation to meet the criteria for therapeutic hypothermia. Treatment should be initiated within the first 6 hours of life, ideally at a tertiary care center. The infant must have evidence of perinatal

2. Newborns whose mothers are substance abusers frequently have what behaviors? (Select all that apply.)
a. Circumoral cyanosis
b. Decreased amounts of sleep
c. Hyperactive Moro (startle) reflex
d. Difficulty feeding
e. Weak cry

ANS: B, C, D
The infant exposed to drugs in utero often has poor sleeping patterns, hyperactive reflexes, and uncoordinated sucking and swallowing behavior. They do not have circumoral cyanosis and will have a high-pitched cry.
PTS: 1 DIF: Cognitive Level

COMPLETION
1. The nurse is preparing a dose of naloxone for a newborn who weighs 6.9 pounds. How much naloxone does the nurse administer? ______ mg

ANS:
0.31 mg
The dose is 0.1 mg/kg for this 3.1-kg baby.
PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 642 | Drug Guide OBJ: Nursing Process: Implementation
MSC: Client Needs: Physiologic Integrity

1. What is most helpful in preventing premature birth?
a. High socioeconomic status
b. Adequate prenatal care
c. Transitional Assistance to Needy Families
d. Women, Infants, and Children nutritional program

ANS: B
Prenatal care is vital in identifying possible problems. Women from higher economic status are more likely to seek adequate prenatal care, but it is the care that is most helpful. Government programs help with specific needs of the pregnant woman,

2. Compared to the term infant, the preterm infant has
a. few blood vessels visible though the skin.
b. more subcutaneous fat.
c. well-developed flexor muscles.
d. greater surface area in proportion to weight.

ANS: D
Preterm infants have greater surface area in proportion to their weight. They often have visible blood vessels because their skin is thin and they have less fat. More fat and well- developed flexor muscles are characteristic of a more mature infant

3. Decreased surfactant production in the preterm lung is a problem because surfactant
a. causes increased permeability of the alveoli.
b. provides transportation for oxygen to enter the blood supply.
c. keeps the alveoli open during expiration.
d. dilate

ANS: C
Surfactant prevents the alveoli from collapsing each time the infant exhales, thus reducing the work of breathing. It does not cause increased permeability, provide transportation of oxygen or dilate the bronchioles.
PTS: 1 DIF: Cognitive Level: Kn

4. A preterm infant is on a respirator with intravenous lines and much equipment around her when her parents come to visit for the first time. What action by the nurse is most important?
a. Suggest that the parents visit for only a short time to reduce th

ANS: C
Physical contact with the infant is important to establish early bonding. The nurse as the support person and teacher is responsible for shaping the environment and making the care giving responsive to the needs of both the parents and the infant.

5. A nurse is caring for a late preterm infant. What action by the nurse is inconsistent with best practice to prevent cold stress?
a. Wean the infant directly to an open crib.
b. Check temperature every 3 to 4 hours.
c. Encourage kangaroo care.
d. Place

ANS: A
Weaning to an open crib takes many steps and is not done directly because of the risk of cold stress. The other actions help prevent cold stress.
PTS: 1 DIF: Cognitive Level: Application/Applying
REF: pp. 622-623 OBJ: Nursing Process: Implementatio

6. Which preterm infant should receive gavage feedings instead of a bottle?
a. Sometimes gags when a feeding tube is inserted
b. Is unable to coordinate sucking and swallowing
c. Sucks on a pacifier during gavage feedings
d. Has an axillary temperature of

ANS: B
An infant who cannot coordinate sucking, swallowing, and breathing should receive gavage feedings. The other infants are ready for bottle feedings.
PTS: 1 DIF: Cognitive Level: Comprehension/Understanding
REF: p. 627 OBJ: Nursing Process: Assessmen

7. Overstimulation may cause increased oxygen use in a preterm infant. Which nursing intervention helps to avoid this problem?
a. Group all care activities together to provide long periods of rest.
b. While giving your report to the next nurse, stand in f

ANS: C
Parents should be taught these signs of overstimulation so they will learn to adapt their care to the needs of their infant. This may understimulate the infant during those long periods and overtire the infant during the procedures. Talking in fron

8. A premature infant never seems to sleep longer than an hour at a time. Each time a light is turned on, an incubator closes, or people talk near her crib, she wakes up and cries inconsolably until held. The correct nursing diagnosis is ineffective copin

ANS: B
This nursing diagnosis is the most appropriate for this infant. Light and sound are known adverse stimuli that add to an already stressed premature infant. The nurse must monitor the environment closely for sources of overstimulation. The other dia

9. In caring for the preterm infant, what complication is thought to be a result of high arterial blood oxygen level?
a. Necrotizing enterocolitis (NEC)
b. Retinopathy of prematurity (ROP)
c. Bronchopulmonary dysplasia (BPD)
d. Intraventricular hemorrhage

ANS: B
ROP is thought to occur as a result of high levels of oxygen in the blood. NEC is due to the interference of blood supply to the intestinal mucosa. Necrotic lesions occur at that site. BPD is caused by the use of positive pressure ventilation again

10. With regard to eventual discharge of the high-risk newborn or transfer to a different facility, nurses and families should be aware that
a. infants will stay in the NICU until they are ready to go home.
b. once discharged to home, the high-risk infant

ANS: C
High-risk infants can cause profound parental stress and emotional turmoil. Parents need support, special teaching, and quick access to various resources available to help them care for their baby. Parents and their high-risk infant should get to s

11. Which combination of expressing pain could be demonstrated in a neonate?
a. Low-pitched crying, tachycardia, eyelids open wide
b. Cry face, flaccid limbs, closed mouth
c. High-pitched, shrill cry, withdrawal, change in heart rate
d. Cry face, eye sque

ANS: D
Cry face, eye squeeze, and an increase in blood pressure indicate pain. The other manifestations are not those of pain in the neonate.
PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 624 OBJ: Nursing Process: Assessment
MSC: Client Needs

12. Which is true about newborns classified as small for gestational age (SGA)?
a. They weigh less than 2500 g.
b. They are born before 38 weeks of gestation.
c. Placental malfunction is the only recognized cause of this condition.
d. They are below the 1

ANS: D
SGA infants are defined as below the 10th percentile in growth when compared with other infants of the same gestational age. SGA is not defined by weight. Infants born before 38 weeks are defined as preterm. There are many causes of SGA babies.
PTS

13. A nurse is caring for an SGA newborn. What nursing action is most important?
a. Observe for respiratory distress syndrome.
b. Observe for and prevent dehydration.
c. Promote bonding.
d. Prevent hypoglycemia by early and frequent feedings.

ANS: D
The SGA infant has poor glycogen stores and is subject to hypoglycemia. Respiratory distress syndrome is seen in preterm infants. Dehydration is a concern for all infants and is not specific for SGA infants. Promoting bonding is a concern for all i

14. A nurse is assessing an SGA infant with asymmetric intrauterine growth restriction. What assessment finding correlates with this condition?
a. One side of the body appears slightly smaller than the other.
b. All body parts appear proportionate.
c. The

ANS: C
In asymmetric intrauterine growth restriction, the head is normal in size but appears large because the infant's body is long and thin due to lack of subcutaneous fat. The left and right side growth should be symmetric. With asymmetric intrauterine

15. Which statement is true about large for gestational age (LGA) infants?
a. They weigh more than 3500 g.
b. They are above the 80th percentile on gestational growth charts.
c. They are prone to hypoglycemia, polycythemia, and birth injuries.
d. Postmatu

ANS: C
Hypoglycemia, polycythemia, and birth injuries are common in LGA infants. LGA infants are determined by their weight compared to their age. They are above the 90th percentile on the gestational growth charts. Birth injuries are a problem, but postm

16. Of all the signs seen in infants with respiratory distress syndrome, which sign is especially indicative of the syndrome?
a. Pulse more than 160 beats/min
b. Circumoral cyanosis
c. Grunting
d. Substernal retractions

ANS: C
Grunting increases the pressure inside the alveoli to keep them open when surfactant is insufficient. This is a characteristic and often early sign of RDS. The other assessments are not specific to RDS.
PTS: 1 DIF: Cognitive Level: Knowledge/Rememb

17. While caring for the postterm infant, the nurse recognizes that the fetus may have passed meconium prior to birth as a result of
a. hypoxia in utero.
b. NEC.
c. placental insufficiency.
d. rapid use of glycogen stores.

ANS: A
When labor begins, poor oxygen reserves may cause fetal compromise. The fetus may pass meconium as a result of hypoxia before or during labor, increasing the risk of meconium aspiration. Meconium is not passed as a result of NEC, placental insuffic

18. Which data should alert the nurse that the neonate is postmature?
a. Cracked, peeling skin
b. Short, chubby arms and legs
c. Presence of vernix caseosa
d. Presence of lanugo

ANS: A
Loss of vernix caseosa, which protects the fetal skin in utero, may leave the skin macerated and appearing cracked and peeling. Postmature infants usually have long, thin arms and legs. Vernix caseosa decreases in the postmature infant. Absence of

19. Because of the premature infant's decreased immune functioning, what nursing diagnosis should the nurse include in a plan of care for a premature infant?
a. Delayed growth and development
b. Ineffective thermoregulation
c. Ineffective infant feeding p

ANS: D
The nurse needs to know that decreased immune functioning increases the risk for infection. The other diagnoses are appropriate for the premature infant but not related directly to immune function.
PTS: 1 DIF: Cognitive Level: Comprehension/Underst

20. To maintain optimal thermoregulation for the premature infant, what action by the nurse is most appropriate?
a. Bathe the infant once a day.
b. Put an undershirt on the infant in the incubator.
c. Assess the infant's hydration status.
d. Lightly cloth

ANS: B
Air currents around an unclothed infant will result in heat loss. Bathing causes evaporative heat loss. Assessing hydration will not maintain thermoregulation. Clothing is not worn when the infant is under a radiant warmer.
PTS: 1 DIF: Cognitive Le

21. A nurse is caring for a preterm baby who weighs 4.8 pounds. What assessment finding indicates the baby is dehydrated?
a. Urine output of 3.3 mL/hour
b. Urine specific gravity of 1.001
c. Low serum sodium
d. Weight gain of 43 g in one day

ANS: A
This baby weighs 2.18 kg. Dehydration is noted with a urine output of <2 mL/kg/hour. A urine output of 3.3 mL is 1.5 mL/kg/hour and so indicates dehydration. The dilute urine specific gravity indicates overhydration as does the low serum sodium. Th

22. The nurse is observing a parent holding a preterm infant. The infant is sneezing, yawning, and extending the arms and legs. What action by the nurse is best?
a. Cover the infant with a warmed blanket.
b. Encourage the parent to do kangaroo care.
c. En

ANS: C
These are signs that the preterm infant is overstimulated. The parent should place the infant back in her warmer, and the nurse can turn down the lights and limit noise. The other suggestions will not help decrease stimulation.
PTS: 1 DIF: Cognitiv

23. A nurse is caring for a preterm infant who has a weak cry and is irritable. What action by the nurse is best?
a. Assess the infant for pain.
b. Take the infant's temperature.
c. Obtain a bedside glucose reading.
d. Reduce stimulation in the environmen

ANS: B
These are signs of inadequate thermoregulation. The nurse should assess the infant's temperature first. The other actions do not address thermoregulation.
PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 622 | Safety Alert Box OBJ: Nursing

MULTIPLE RESPONSE
1. The nurse tells the nursing student that late preterm infants are at increased risk for which of the following problems? (Select all that apply.)
a. Problems with thermoregulation
b. Cardiac distress
c. Hyperbilirubinemia
d. Sepsis
e.

ANS: A, C, D
Problems with thermoregulation, hyperbilirubinemia, and sepsis are common with late preterm infants. They typically have respiratory distress and hypoglycemia.
PTS: 1 DIF: Cognitive Level: Comprehension/Understanding
REF: p. 619 OBJ: Integrat

2. An important nursing factor during the care of the infant in the NICU is assessment for signs of adequate parental attachment. The nurse must observe for signs that bonding is NOT occurring as expected. These include
(Select all that apply.)
a. using p

ANS: B, D, E
Bonding is not progressing as expected when parents show interest in other babies equal to that of their own, decreasing the number and length of visits, and refusing to hold and help care for the infant. Using positive terms to describe the

1. Preconception counseling is critical to the outcome of diabetic pregnancies because poor glycemic control before and during early pregnancy is associated with
a. frequent episodes of maternal hypoglycemia.
b. congenital anomalies in the fetus.
c. polyh

ANS: B
Preconception counseling is particularly important because strict metabolic control before conception and in the early weeks of gestation is instrumental in decreasing the risks of congenital anomalies. Frequent episodes of maternal hypoglycemia ma

2. In assessing the knowledge of a pregestational woman with type 1 diabetes concerning changing insulin needs during pregnancy, the nurse recognizes that further teaching is warranted when the patient states
a. "I will need to increase my insulin dosage

ANS: A
Insulin needs are reduced in the first trimester due to increased insulin production by the pancreas and increased peripheral sensitivity to insulin. Also the woman may be experiencing nausea, vomiting, and anorexia that would decrease her insulin

3. Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the woman mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. The nu

ANS: A
Poor glycemic control later in pregnancy increases the rate of fetal macrosomia. Poor glycemic control during the preconception time frame and into the early weeks of the pregnancy is associated with congenital anomalies. Preterm labor or birth is

4. In terms of the incidence and classification of diabetes, maternity nurses should know that
a. type 1 diabetes is most common.
b. type 2 diabetes often goes undiagnosed.
c. there is only one type of gestational diabetes.
d. type 1 diabetes may become t

ANS: B
Type 2 often goes undiagnosed, because hyperglycemia develops gradually and often is not severe. Type 2, previously called adult onset diabetes, is the most common. There are 2 subgroups of gestational diabetes. Type GDM A1 is diet-controlled where

5. A nurse in labor and delivery learns about metabolic changes that occur throughout pregnancy in diabetes. What information does the nurse know?
a. Insulin crosses the placenta to the fetus only in the first trimester, after which the fetus secretes its

ANS: C
Pregnant women develop increased insulin resistance during the second and third trimesters. Insulin never crosses the placenta; the fetus starts making its own around the tenth week. As a result of normal metabolic changes during pregnancy, insulin

6. Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother?
a. Hypoglycemia
b. Hypercalcemia
c. Hypobilirubinemia
d. Hypoinsulinemia

ANS: A
The neonate is at highest risk for hypoglycemia because fetal insulin production is accelerated during pregnancy to metabolize excessive glucose from the mother. At birth, the maternal glucose supply stops and the neonatal insulin exceeds the avail

7. Which factor is known to increase the risk of gestational diabetes mellitus?
a. Underweight before pregnancy
b. Maternal age younger than 25 years
c. Previous birth of large infant
d. Previous diagnosis of type 2 diabetes mellitus

ANS: C
Previous birth of a large infant suggests gestational diabetes mellitus. Obesity (BMI of 30 or greater) creates a higher risk for gestational diabetes. A woman younger than 25 generally is not at risk for gestational diabetes mellitus. The person w

8. Glucose metabolism is profoundly affected during pregnancy because
a. pancreatic function in the islets of Langerhans is affected by pregnancy.
b. the pregnant woman uses glucose at a more rapid rate than the nonpregnant woman.
c. the pregnant woman in

ANS: D
Placental hormones, estrogen, progesterone, and human placental lactogen (HPL) create insulin resistance. Insulin also is broken down more quickly by the enzyme placental insulinase. Pancreatic functioning is not affected by pregnancy. The glucose

9. To manage her diabetes appropriately and ensure a good fetal outcome, the pregnant woman with diabetes will need to alter her diet by doing which of the following?
a. Eating six small equal meals per day
b. Reducing carbohydrates in her diet
c. Eating

ANS: C
Having a fixed meal schedule will provide the woman and the fetus with a steadier blood sugar level, provide better balance with insulin administration, and help prevent complications. It is more important to have a fixed meal schedule than equal d

10. A pregnant diabetic woman is in the hospital and her blood glucose reading is 42 mg/dL. What action by the nurse is best?
a. Provide her with 15 grams of oral carbohydrate if she can swallow.
b. Administer a bolus of rapid-acting insulin.
c. Order the

ANS: A
This woman has hypoglycemia and needs to injest 15 grams of carbohydrate if she is able to swallow. Insulin would make the problem worse. The meal tray is a good idea but not as the first response as it will take too long. The provider should be no

11. Nursing intervention for the pregnant diabetic is based on the knowledge that the need for insulin
a. increases throughout pregnancy and the postpartum period.
b. decreases throughout pregnancy and the postpartum period.
c. varies depending on the sta

ANS: C
Insulin needs decrease during the first trimester, when nausea, vomiting, and anorexia are a factor. They increase during the second and third trimesters, when the hormones of pregnancy create insulin resistance in maternal cells.
PTS: 1 DIF: Cogni

12. With regard to the association of maternal diabetes and other risk situations affecting mother and fetus, nurses should be aware that
a. Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy.
b. Hydramnios rarely occurs in d

ANS: A
Prompt treatment of DKA is necessary to save the fetus and the mother. Hydramnios is a potential complication for the diabetic pregnancy. Infections are more common and more serious in pregnant women with diabetes. Women who were treated with an in

13. What form of heart disease in women of childbearing years usually has a benign effect on pregnancy?
a. Cardiomyopathy
b. Rheumatic heart disease
c. Congenital heart disease
d. Mitral valve prolapse

ANS: D
Mitral valve prolapse is a benign condition that is usually asymptomatic. Cardiomyopathy produces congestive heart failure during pregnancy. Rheumatic heart disease can lead to heart failure during pregnancy. Some congenital heart diseases will pro

14. When teaching the pregnant woman with class II heart disease, what information should the nurse provide?
a. Advise her to gain at least 30 lb.
b. Explain the importance of a diet high in calcium.
c. Instruct her to avoid strenuous activity.
d. Inform

ANS: C
Activity may need to be limited so that cardiac demand does not exceed cardiac capacity. Weight gain should be kept at a minimum with heart disease. Iron and folic acid intake is important to prevent anemia. Fluid intake should not be limited durin

15. Prophylaxis of subacute bacterial endocarditis (SBE) is given before and after birth when a pregnant woman has
a. valvular disease.
b. congestive heart disease.
c. dysrhythmias.
d. postmyocardial infarction.

ANS: A
Prophylaxis for intrapartum endocarditis and pulmonary infection may be provided for women who have mitral valve prolapse. It is not indicated for congestive heart failure, dysrhythmias, or myocardial infarctions.
PTS: 1 DIF: Cognitive Level: Knowl

16. The nurse understands that postpartum care of the woman with cardiac disease
a. is the same as that for any pregnant woman.
b. includes rest and monitoring of the effect of activity.
c. includes ambulating frequently, alternating with active range of

ANS: B
After delivery, the woman with cardiac disease should rest, and the nurse monitors her for the effect activity has on her cardiovascular status. Care of the woman with cardiac disease in the postpartum period is tailored to the woman's functional c

17. In caring for a pregnant woman with sickle cell anemia the nurse is aware that signs and symptoms of sickle cell crisis include
a. anemia.
b. endometritis.
c. fever and pain.
d. urinary tract infection.

ANS: C
Women with sickle cell anemia have recurrent attacks (crisis) of fever and pain, most often in the abdomen, joints, and extremities. These attacks are attributed to vascular occlusion when RBCs assume the characteristic sickled shape. Crises are us

18. With regard to anemia, nurses should be aware that
a. it is the most common medical disorder of pregnancy.
b. it can trigger reflex brachycardia.
c. the most common form of anemia is caused by folate deficiency.
d. thalassemia is a European version of

ANS: A
Iron deficiency anemia causes 75% of anemias in pregnancy. It is difficult to meet the pregnancy needs for iron through diet alone. It does not cause bradycardia. Thalassemia is a distinct disease from sickle cell anemia.
PTS: 1 DIF: Cognitive Leve

19. For which of the infectious diseases can a woman be immunized?
a. Toxoplasmosis
b. Rubella
c. Cytomegalovirus
d. Herpesvirus type 2

ANS: B
Rubella is the only infectious disease listed for which a vaccine is available.
PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 566 OBJ: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance

20. A woman who delivered her third child yesterday has just learned that her two school-age children have contracted chickenpox. What action by the nurse is best?
a. Assess if the woman has had chickenpox or been vaccinated.
b. Tell her that the baby has

ANS: A
The first thing the nurse should do is to determine the woman's susceptibility to this infection. If she is non-immune, she will get her first vaccination prior to discharge. The nurse does not know the baby's immune status without knowing the moth

21. A woman has a history of drug use and is screened for hepatitis B during the first trimester. What is an appropriate action?
a. Provide a low-protein diet.
b. Offer the vaccine.
c. Discuss the recommendation to bottle-feed her baby.
d. Practice respir

ANS: B
A person who has a history of high-risk behaviors should be offered the hepatitis B vaccine. A low-protein diet will not prevent the infection. The first trimester is too early to discuss feeding methods. Respiratory isolation is not needed for thi

22. A woman has tested human immunodeficiency virus (HIV)-positive and has now discovered that she is pregnant. Which statement indicates that she understands the risks of this diagnosis?
a. "Even though my test is positive, my baby might not be affected.

ANS: A
The rate of perinatal transmission of HIV has decreased with the use of antiretroviral medications during pregnancy. There is no need to have an abortion. The mother may or may not go on to develop AIDS.
PTS: 1 DIF: Cognitive Level: Evaluation/Eval

23. A nurse has taught a pregnant woman about toxoplasmosis. What statement by the patients indicates a need for further instruction?
a. "I will be certain to empty the litter boxes regularly."
b. "I won't eat raw eggs."
c. "I had better wash all of my fr

ANS: A
The patient should avoid contact with materials that are possibly contaminated with cat feces while pregnant. This includes cat litter boxes, sand boxes, and garden soil. She should wash her hands thoroughly after working with soil or handling anim

24. A woman who had no prenatal care has just delivered after a brief labor. The baby has rough, dry skin; is large for gestational age; and has an umbilical hernia. What action by the nurse is most appropriate?
a. Question the mother about substance abus

ANS: C
These signs in the newborn are indicative of hypothyroidism. The mother will have thyroid levels checked. Asking about substance abuse, reassessing gestational age, and obtaining a blood glucose reading are all unnecessary.
PTS: 1 DIF: Cognitive Le

25. A woman in the perinatal clinic asks the nurse how her asthma will affect her pregnancy and fetus. What response by the nurse is best?
a. Asthma medications cannot be used during pregnancy.
b. The only problem is that you will not be able to breastfee

ANS: C
Medications for asthma seem to be well tolerated during pregnancy. Breastfeeding is safe for the newborn. The course of asthma is variable in pregnancy.
PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 570 | Table 26.3 OBJ: Integrated Proc

26. A woman has been admitted to the labor and delivery unit who is HIV positive. She is in active labor. What action by the nurse is most appropriate?
a. Prepare to administer IV zidovudine.
b. Place the mother on contact precautions.
c. Administer oxyge

ANS: A
During labor, an IV infusion of zidovudine is administered. The woman does not need contact precautions; standard precautions suffice. The woman does not need oxygen because of her HIV status. There is no reason to notify social services.
PTS: 1 DI

MULTIPLE RESPONSE
1. The student nurse learns that maternal complications of diabetes include which of the following? (Select all that apply.)
a. Atherosclerosis
b. Retinopathy
c. IUFD
d. Nephropathy
e. Caudal regression syndrome

ANS: A, B, D
Maternal complications of diabetes include heart disease, retinopathy, nephropathy, and neuropathy. Stillbirth and caudal regression syndrome are fetal complications.
PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 550 OBJ: Integra

2. Congenital anomalies can occur with the use of antiepileptic drugs, including (Select all that apply.)
a. Craniofacial abnormalities
b. Congenital heart disease
c. Neural tube defects
d. Gastroschisis
e. Diaphragmatic hernia

ANS: A, B, C
Congenital anomalies that can occur with antiepileptic drugs include craniofacial abnormalities, congenital heart disease, and neural tube defects. They are not known to cause gastroschisis or diaphragmatic hernias.
PTS: 1 DIF: Cognitive Leve

3. The student nurse learns that maternal risks of systemic lupus erythematosus include
(Select all that apply.)
a. Premature rupture of membranes (PROM)
b. Fetal death resulting in stillbirth
c. Hypertension
d. Preeclampsia
e. Renal complications

ANS: A, C, D, E
PROM, hypertension, preeclampsia, and renal complications are all maternal risks associated with SLE. Stillbirth and prematurity are fetal risks of SLE.
PTS: 1 DIF: Cognitive Level: Comprehension/Understanding
REF: p. 563 OBJ: Integrated P

4. When caring for a pregnant woman with suspected cardiomyopathy, the nurse must be alert for signs and symptoms of cardiac decompensation, which include (Select all that apply.)
a. A regular heart rate
b. Hypertension
c. Shortness of breath
d. Weakness

ANS: C, D, E
Some symptoms of cardiomyopathy include shortness of breath, weakness, and crackles in the lung bases. A regular heart rate may or may not be present. Hypertension is not a typical finding.
PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
R

Which statement by a postpartum woman indicates that teaching about thrombus formation has been effective?
a. "I'll stay in bed for the first 3 days after my baby is born."
b. "I'll keep my legs elevated with pillows."
c. "I'll sit in my rocking chair mos

ANS: D
Venous congestion begins as soon as the woman stands up. The stockings should be applied before she rises from the bed in the morning. As soon as possible, the woman should ambulate frequently. The mother should avoid knee pillows because they incr

The perinatal nurse is caring for a woman in the immediate postbirth period. Assessment reveals that the woman is experiencing profuse bleeding. The most likely etiology for the bleeding is
a. uterine atony.
b. uterine inversion.
c. vaginal hematoma.
d. v

ANS: A
Uterine atony is marked hypotonia of the uterus. It is the leading cause of postpartum hemorrhage. The other situations can cause bleeding but are not the most common cause.
PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 599 OBJ: Nursin

The nurse knows that a measure for preventing late postpartum hemorrhage is to
a. administer broad-spectrum antibiotics.
b. inspect the placenta after delivery.
c. manually remove the placenta.
d. pull on the umbilical cord to hasten the delivery of the p

ANS: B
If a portion of the placenta is missing, the clinician can explore the uterus, locate the missing fragments, and remove the potential cause of late postpartum hemorrhage. Broad-spectrum antibiotics will be given if postpartum infection is suspected

A multiparous woman is admitted to the postpartum unit after a rapid labor and birth of a 4000-g infant. Her fundus is boggy, lochia is heavy, and vital signs are unchanged. The nurse has the woman void and massages her fundus, but her fundus remains diff

ANS: B
After taking these corrective actions, the nurse should contact the provider and anticipate collaborative care measures. Another nurse can assess vital signs. Since the woman just voided, an indwelling catheter is not needed.
PTS: 1 DIF: Cognitive

Early postpartum hemorrhage is defined as signs and symptoms of hypovolemia with which of the following descriptions of blood loss?
a. Cumulative blood loss >1000 mL in the first 24 hours after the birth process.
b. 750 mL in the first 24 hours after vagi

ANS: A
The newest definition of early postpoartum hemorrhage is cumulative blood loss >1000 mL with signs of hypovolemia within the first 24 hours after the birth process. Hemorrhage after 24 hours is considered late postpartum hemorrhage.
PTS: 1 DIF: Cog

A woman delivered a 9-lb, 10-oz baby 1 hour ago. When you arrive to perform her 15-minute assessment, she tells you that she "feels all wet underneath." You discover that both pads are completely saturated and that she is lying in a 6-inch-diameter puddle

ANS: B
Firmness of the uterus is necessary to control bleeding from the placental site. The nurse should first assess for firmness and massage the fundus as indicated. Calling for help is not needed unless corrective action does not improve the situation.

A steady trickle of bright red blood from the vagina in the presence of a firm fundus suggests
a. uterine atony.
b. lacerations of the genital tract.
c. perineal hematoma.
d. infection of the uterus.

ANS: B
Undetected lacerations will bleed slowly and continuously. Bleeding from lacerations is uncontrolled by uterine contraction. The fundus is not firm with uterine atony. A hematoma would be internal. Swelling and discoloration would be noticed, but b

A postpartum patient is at increased risk for postpartum hemorrhage if she delivers a(n)
a. 5-lb, 2-oz infant with outlet forceps.
b. 6.5-lb infant after a 2-hour labor.
c. 7-lb infant after an 8-hour labor.
d. 8-lb infant after a 12-hour labor.

ANS: B
A rapid (precipitous) labor and delivery may cause exhaustion of the uterine muscle and prevent contraction. The use of forceps may cause lacerations that could lead to bleeding, but that is not as common as hemorrhage after a precipitous labor whe

What instructions should be included in the discharge teaching plan to assist the patient in recognizing early signs of complications?
a. Palpate the fundus daily to ensure that it is soft.
b. Notify the physician of a return to bright red bleeding.
c. Re

ANS: B
An increase in lochia or a return to bright red bleeding after the lochia has become pink indicates a complication. The fundus should stay firm. Large clots after discharge are a sign of complications and should be reported.
PTS: 1 DIF: Cognitive L

Which woman is at greatest risk for early postpartum hemorrhage?
a. A primiparous woman being prepared for an emergency cesarean birth for fetal distress
b. A woman with severe preeclampsia on magnesium sulfate whose labor is being induced
c. A multiparou

ANS: B
Magnesium sulfate administration during labor poses a risk for PPH. Magnesium acts as a smooth muscle relaxant, thereby contributing to uterine relaxation and atony. The other situations do not post risk factors or causes of early PPH.
PTS: 1 DIF:

When caring for a postpartum woman experiencing hypovolemic shock, the nurse recognizes that the most objective and least invasive assessment of adequate organ perfusion and oxygenation is
a. absence of cyanosis in the buccal mucosa.
b. cool, dry skin.
c.

ANS: D
Hemorrhage may result in hypovolemic shock. Shock is an emergency situation in which the perfusion of body organs may become severely compromised, and death may occur. The presence of adequate urinary output indicates adequate tissue perfusion. The

The nurse should expect medical intervention for subinvolution to include
a. oral methylergonovine maleate (Methergine) for 48 hours.
b. oxytocin intravenous infusion for 8 hours.
c. oral fluids to 3000 mL/day.
d. intravenous fluid and blood replacement.

ANS: A
Methergine provides long-sustained contraction of the uterus and is the usual treatment. Oxytocin and oral fluids are not used for this condition. There is no indication that blood loss has occurred in this situation; if it does blood replacement m

If nonsurgical treatment for late postpartum hemorrhage is ineffective, which surgical procedure is appropriate to correct the cause of this condition?
a. Hysterectomy
b. Laparoscopy
c. Laparotomy
d. D&C

ANS: D
D&C allows examination of the uterine contents and removal of any retained placental fragments or blood clots. Hysterectomy, laparoscopy, and laparotomy are not indicated.
PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: pp. 602-603 OBJ: Nur

The mother-baby nurse must be able to recognize what sign of thrombophlebitis?
a. Visible varicose veins
b. Positive Homans sign
c. Local tenderness, heat, and swelling
d. Pedal edema in the affected leg

ANS: C
Tenderness, heat, and swelling are classic signs of thrombophlebitis that appear at the site of the inflammation. Varicose veins may predispose the woman to thrombophlebitis but are not a sign. A positive Homans sign may be caused by a strained mus

Which nursing measure is appropriate to prevent thrombophlebitis in the recovery period after a cesarean birth?
a. Roll a bath blanket and place it firmly behind the knees.
b. Limit oral intake of fluids for the first 24 hours.
c. Assist the patient in pe

ANS: C
Leg exercises and passive range of motion promote venous blood flow and prevent venous stasis while the patient is still on bed rest. The blanket behind the knees will cause pressure and decrease venous blood flow. Limiting oral intake will produce

One of the first symptoms of puerperal infection to assess for in the postpartum woman is
a. fatigue continuing for longer than 1 week.
b. pain with voiding.
c. profuse vaginal bleeding with ambulation.
d. temperature of 38� C (100.4� F) or higher after 2

ANS: D
Postpartum or puerperal infection is any clinical infection after childbirth. The definition used in the United States continues to be the presence of a fever of 38� C (100.4� F) or higher on 2 successive days of the first 10 postpartum days, start

The perinatal nurse caring for the postpartum woman understands that late postpartum hemorrhage is most likely caused by
a. subinvolution of the uterus.
b. defective vascularity of the decidua.
c. cervical lacerations.
d. coagulation disorders.

ANS: A
The most common causes of late postpartum hemorrhage are subinvolution and retained placental fragments.
PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 602 OBJ: Nursing Process: Planning
MSC: Client Needs: Physiologic Integrity

The patient who is being treated for endometritis is placed in Fowler's position because it
a. promotes comfort and rest.
b. facilitates drainage of lochia.
c. prevents spread of infection to the urinary tract.
d. decreases tension on the reproductive org

ANS: B
Lochia and infectious material are eliminated by gravity drainage when the woman is placed in the Fowler's position.
PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 610 OBJ: Nursing Process: Implementation
MSC: Client Needs: Physiologic

Nursing measures that help prevent postpartum urinary tract infection include which of the following?
a. Promoting bed rest for 12 hours after delivery
b. Discouraging voiding until the sensation of a full bladder is present
c. Forcing fluids to at least

ANS: C
Adequate fluid intake of 2500 to 3000 mL/day prevents urinary stasis, dilutes urine, and flushes out waste products. The woman should be encouraged to ambulate early. With pain medications, trauma to the area, and anesthesia, the sensation of a ful

Which measure may prevent mastitis in the breastfeeding mother?
a. Initiating early and frequent feedings
b. Nursing the infant for 5 minutes on each breast
c. Wearing a tight-fitting bra
d. Applying ice packs before feeding

ANS: A
Early and frequent feedings prevent stasis of milk, which contributes to engorgement and mastitis. Five minutes does not adequately empty the breast. This will produce stasis of the milk. A firm-fitting bra will support the breast but not prevent m

A mother with mastitis is concerned about breastfeeding while she has an active infection. The nurse should explain that
a. the infant is protected from infection by immunoglobulins in the breast milk.
b. the infant is not susceptible to the organisms tha

ANS: C
The organisms are localized in the breast tissue and are not excreted in the breast milk. The mother is just producing the immunoglobulin from this infection, so it is not available for the infant. Because of an immature immune system, infants are

If the nurse suspects a uterine infection in the postpartum patient, she should assess the
a. pulse and blood pressure.
b. odor of the lochia.
c. episiotomy site.
d. abdomen for distention.

ANS: B
An abnormal odor of the lochia indicates infection in the uterus. The pulse may be altered with an infection, but the odor of the lochia will be an earlier sign and more specific. The infection may move to the episiotomy site if proper hygiene is n

Which condition is a transient, self-limiting mood disorder that affects new mothers after childbirth?
a. Postpartum depression
b. Postpartum psychosis
c. Postpartum bipolar disorder
d. Postpartum blues

ANS: D
Postpartum blues, or "baby blues," is a transient self-limiting disease that is believed to be related to hormonal fluctuations after childbirth. Postpartum depression is not the normal worries (blues) that many new mothers experience. Many caregiv

When a woman is diagnosed with postpartum psychosis, one of the main concerns is that she may
a. have outbursts of anger.
b. neglect her hygiene.
c. harm her infant.
d. lose interest in her husband.

ANS: C
Thoughts of harm to one's self or the infant are among the most serious symptoms of PPD and require immediate assessment and intervention. The other problems can be attributed to postpartum psychosis, but the major concern is harm to the infant.
PT

What risk factor for peripartum depression (PPD) is likely to have the greatest effect on the woman's condition?
a. Personal history of depression
b. Single-mother status
c. Low socioeconomic status
d. Unplanned or unwanted pregnancy

ANS: A
A personal history of depression is a known risk factor for peripartum depression. Being single, from a low socioeconomic status, or having an unplanned or unwanted pregnancy may contribute to depression for some women but are not strong predictors

The maternity nurse knows that which disorder can be triggered by a birth the woman views as traumatic?
a. A phobia
b. Panic disorder
c. Posttraumatic stress disorder (PTSD)
d. Obsessive-compulsive disorder (OCD)

ANS: C
In PTSD, women perceive childbirth as a traumatic event. They have nightmares and flashbacks about the event, anxiety, and avoidance of reminders of the traumatic event. This will not lead to phobias, panic disorder, or OCD.
PTS: 1 DIF: Cognitive L

To provide adequate postpartum care, the nurse should be aware that peripartum depression (PPD)
a. is the "baby blues," plus the woman has a visit with a counselor or psychologist.
b. does not affect the father who can then care for the baby.
c. is distin

ANS: C
PPD is characterized by a persistent depressed state. The woman is unable to feel pleasure or love although she is able to care for her infant. She often experiences generalized fatigue, irritability, little interest in food and sleep disorders. PP

What teaching does the nurse provide to help new mothers prevent postpartum depression?
a. Stay home and avoid outside activities to ensure adequate rest.
b. Be the only caregiver for your baby to facilitate infant attachment.
c. Keep feelings of sadness

ANS: D
The new mother should understand that postpartum depression is common. Rest is important, but she does not need to confine herself to the house. Others need to help care for the baby so the mother can rest. Women need to be open and discuss their f

A provider left an order for a woman to have Methylergonovine 0.2 mg IM. The nurse assesses the woman and finds her vital signs to be: temperature 37.9� C (100.2� F), pulse 90 beats/minute, respirations 18 breaths/minute, and blood pressure 152/90 mm Hg.

ANS: B
Methylergonovine is contraindicated in women with hypertension. The nurse should check the agency's policy to see at what blood pressure reading this medication should be held. After checking the policy, the nurse can consult the provider if it can

Medications used to manage postpartum hemorrhage include which of the following? (Select all that apply.)
a. Oxytocin
b. Methergine
c. Terbutaline
d. Hemabate
e. Magnesium sulfate

ANS: A, B, D
Pitocin, Methergine, and Hemabate are all used to manage PPH. Terbutaline and magnesium sulfate are tocolytics; relaxation of the uterus causes or worsens PPH.
PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 600 OBJ: Nursing Proces

What actions can the labor and delivery nurse take to decrease a woman's chance of contracting a puerperal infection? (Select all that apply.)
a. Avoid straight catheterizing the woman unless she cannot void.
b. Keep vaginal examinations to a minimum.
c.

ANS: A, B, C, E
Risk for infection increases with catheterization, vaginal examinations, exposure to wet linens and pads, and poor hand hygiene. Remaining on bedrest does not reduce the chance for infection.
PTS: 1 DIF: Cognitive Level: Comprehension/Unde

The nurse explain to the student that which of the following factors increase a woman's risk for thrombosis? (Select all that apply.)
a. Use of stirrups for a prolonged period of time
b. Prolonged bedrest during or after labor and delivery
c. Adherence to

ANS: A, B, D, E
Use of stirrups for a prolonged period of time, bedrest, excessive sweating (leading to dehydration) all increase the risk of thrombosis. Vegetarian diets are not related. Maternal age >35 increases the risk.
PTS: 1 DIF: Cognitive Level: C

A woman just received an injection of carboprost, 2500 mcg IM. What actions by the nurse take priority? (Select all that apply.)
a. Assess for nausea and vomiting
b. Assess fetal well-being.
c. Administer acetaminophen for headache.
d. Monitor urine outpu

ANS: B, E
The usual dose of carboprost is 250 mcg, so this excessive dose could lead to uterine rupture. The nurse monitors the woman for signs of this and continually monitors the fetus for well-being. The provider would be notified and agency policy fol

A home health care nurse is checking on a new mother with signs of obsessive-compulsive disorder. What assessment findings correlate with this condition? (Select all that apply.)
a. Frequently checking on the baby
b. Fear of being alone with the baby
c. W

ANS: A, B
Postpartum OCD often manifests with women performing obsessive behaviors and voicing fear of being left alone with their baby. Feeling worthless is a sign of depression. A spending spree might be a sign of the manic phase of bipolar disease. Vie

1. Which actions by the nurse may prevent infections in the labor and delivery area?
a. Vaginal examinations every hour while the woman is in active labor
b. Use of clean techniques for all procedures
c. Cleaning secretions from the vaginal area by using

ANS: D
Bacterial growth prefers a moist, warm environment. Vaginal examinations should be limited to decrease transmission of vaginal organisms into the uterine cavity. Use an aseptic technique if membranes are not ruptured; use a sterile technique if mem

2. A woman in labor at 34 weeks of gestation is hospitalized and treated with intravenous magnesium sulfate for 18 to 20 hours. When the magnesium sulfate is discontinued, which oral drug will probably be prescribed for continuation of the tocolytic effec

ANS: B
The woman receiving decreasing doses of magnesium sulfate is often switched to oral terbutaline to maintain tocolysis for 48 hours. The terbutaline will probably be discontinued prior to discharge. Ritodrine is the only drug approved by the FDA for

3. Which technique is least effective for the woman with persistent occiput posterior position?
a. Lie supine and relax.
b. Sit or kneel, leaning forward with support.
c. Rock the pelvis back and forth while on hands and knees.
d. Squat.

ANS: A
Lying supine increases the discomfort of "back labor." A sitting or kneeling position may help the fetal head to rotate to occiput anterior. Rocking the pelvis encourages rotation from occiput posterior to occiput anterior. Squatting aids both rota

4. Birth for the nulliparous woman with a fetus in a breech presentation is usually by
a. cesarean delivery.
b. vaginal delivery.
c. forceps-assisted delivery.
d. vacuum extraction.

ANS: A
Delivery for the nulliparous woman with a fetus in breech presentation is almost always cesarean section. The greatest fetal risk in the vaginal delivery of breech presentation is that the head (largest part of the fetus) is the last to be delivere

5. Which patient situation presents the greatest risk for the occurrence of hypotonic dysfunction during labor?
a. A primigravida who is 17 years old
b. A 22-year-old multiparous woman with ruptured membranes
c. A multiparous woman at 39 weeks of gestatio

ANS: C
Overdistention of the uterus in a multiple pregnancy is associated with hypotonic dysfunction because the stretched uterine muscle contracts poorly. A young primigravida usually will have good muscle tone in the uterus. This prevents hypotonic dysf

6. A primigravida at 40 weeks of gestation is having uterine contractions every 1.5 to 2 minutes and says that they are very painful. Her cervix is dilated 2 cm and has not changed in 3 hours. The woman is crying and wants an epidural. What is the likely

ANS: C
Women who experience hypertonic uterine dysfunction, or primary dysfunctional labor, often are anxious first-time mothers who are having painful and frequent contractions that are ineffective at causing cervical dilation or effacement to progress.

7. A woman is having her first child. She has been in labor for 15 hours. Two hours ago, her vaginal examination revealed the cervix to be dilated to 5 cm and 100% effaced, and the presenting part was at station 0. Five minutes ago, her vaginal examinatio

ANS: C
With a secondary arrest of the active phase, the progress of labor has stopped. This patient has not had any anticipated cervical change, indicating an arrest of labor. Dilation at 5 cm is past the latent phase. This does not describe a "protracted

8. Which factor is most likely to result in fetal hypoxia during a dysfunctional labor?
a. Incomplete uterine relaxation
b. Maternal fatigue and exhaustion
c. Maternal sedation with narcotics
d. Administration of tocolytic drugs

ANS: A
A high uterine resting tone, with inadequate relaxation between contractions, reduces maternal blood flow to the placenta and decreases fetal oxygen supply. Maternal fatigue or sedation does not decrease uterine blood flow. Tocolytic drugs decrease

9. After a birth complicated by a shoulder dystocia, what action by the nurse is most appropriate?
a. Give supplemental oxygen with a small face mask.
b. Encourage the parents to hold the infant.
c. Palpate the infant's clavicles.
d. Perform a complete ne

ANS: C
Because of the shoulder dystocia, the infant's clavicles may have been fractured. Palpation is a simple assessment to identify crepitus or deformity that requires follow-up. There is no indication for oxygen. The infant needs to be assessed for cla

10. A laboring patient in the latent phase is experiencing uncoordinated, irregular contractions of low intensity. How should the nurse respond to complaints of constant cramping pain?
a. "You are only 2 cm dilated, so you should rest and save your energy

ANS: D
Intervention is needed to manage the dysfunctional pattern. Offering support and comfort is important to help the patient cope with the situation. Telling the woman to rest is belittling her complaints. Breathing will not reduce the pain. Fetal mon

11. Why is adequate hydration important when uterine activity occurs before pregnancy is at term?
a. Fluid and electrolyte imbalance can interfere with the activity of the uterine pacemakers.
b. Dehydration may contribute to uterine irritability for some

ANS: B
Dehydration can contribute to uterine irritability for some women, especially if the woman has an infection. Fluid and electrolyte imbalances are not associated with preterm labor. The woman has an increased blood volume during pregnancy. Fluid nee

12. In planning for home care of a woman with preterm labor, the nurse needs to address which concern?
a. Nursing assessments will be different from those done in the hospital setting.
b. Restricted activity and medications will be necessary to prevent re

ANS: C
Prolonged bed rest may cause adverse effects such as weight loss, loss of appetite, muscle wasting, weakness, bone demineralization, decreased cardiac output, risk for thrombophlebitis, alteration in bowel functions, sleep disturbance, and prolonge

13. A woman in preterm labor at 30 weeks of gestation receives two 12-mg doses of betamethasone intramuscularly. The purpose of this pharmacologic treatment is to
a. stimulate fetal surfactant production.
b. reduce maternal and fetal tachycardia associate

ANS: A
Antenatal glucocorticoids given as intramuscular injections to the mother accelerate fetal lung maturity. Inderal would be given to reduce the effects of ritodrine administration. Betamethasone has no effect on uterine contractions. Calcium glucona

14. With regard to the care management of preterm labor, nurses should be aware that
a. teaching pregnant women the symptoms probably causes more harm through false alarms.
b. Braxton Hicks contractions often signal the onset of preterm labor.
c. because

ANS: D
Gestational age of 20 to 37 weeks, uterine contractions, and a thinning cervix are all indications of preterm labor. It is essential that nurses teach women how to detect the early symptoms of preterm labor. Braxton Hicks contractions resemble pret

15. Which nursing action must be initiated first when evidence of prolapsed cord is found?
a. Notify the provider.
b. Apply a scalp electrode.
c. Prepare the mother for an emergency cesarean delivery.
d. Reposition the mother with her hips higher than her

ANS: D
The priority is to relieve pressure on the cord. Changing the maternal position will shift the position of the fetus so that the cord is not compressed. The provider needs to be notified but not until the nurse has taken some corrective action. Try

16. A woman who had two previous cesarean births is in active labor, when she suddenly complains of pain between her scapulae. The nurse's priority action is to
a. reposition the woman with her hips slightly elevated.
b. observe for abnormally high uterin

ANS: D
Pain between the scapulae may occur when the uterus ruptures, because blood accumulates under the diaphragm. This is an emergency that requires surgical intervention so the nurse notifies the provider and prepares the woman for surgery. Repositioni

17. Which action should be initiated to limit hypovolemic shock when uterine inversion occurs?
a. Administer oxygen at 31 L/min by nasal cannula.
b. Administer an oxytocin by intravenous push.
c. Monitor fetal heart rate every 5 minutes.
d. Increase the i

ANS: D
Intravenous fluids are necessary to replace the lost blood volume that occurs in uterine inversion. The woman may need blood products as well. Administering oxygen will not prevent hypovolemic shock. Oxytocin should not be given until the uterus is

18. What factor found in maternal history should alert the nurse to the potential for a prolapsed umbilical cord?
a. Oligohydramnios
b. Pregnancy at 38 weeks of gestation
c. Presenting part at station -3
d. Meconium-stained amniotic fluid

ANS: C
Because the fetal presenting part is positioned high in the pelvis and is not well applied to the cervix, a prolapsed cord could occur if the membranes rupture. Hydramnios puts the woman at high risk for a prolapsed umbilical cord. A very small fet

19. The fetus in a breech presentation is often born by cesarean delivery because
a. the buttocks are much larger than the head.
b. postpartum hemorrhage is more likely if the woman delivers vaginally.
c. internal rotation cannot occur if the fetus is bre

ANS: D
After the fetal legs and trunk emerge from the woman's vagina, the umbilical cord can be compressed between the maternal pelvis and the fetal head if a delay occurs in the birth of the head. The head is the largest part of a fetus. There is no rela

20. An important independent nursing action to promote normal progress in labor is
a. assessing the fetus.
b. encouraging urination about every 1 to 2 hours.
c. allowing the woman to stay in her preferred position.
d. regulating intravenous fluids.

ANS: B
The bladder can reduce room in the woman's pelvis that is needed for fetal descent and can increase her discomfort. Assessment of the fetus is an important task, but will not promote normal progression of labor. Position changes help labor progress

21. A woman who is 32 weeks pregnant telephones the nurse at her obstetrician's office and complains of constant backache. She asks what pain reliever is safe for her to take. The best nursing response is
a. "Back pain is common at this time during pregna

ANS: C
A prolonged backache is one of the subtle symptoms of preterm labor. Early intervention may prevent preterm birth. The woman should be assessed before trying any home care measures.
PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 583 OBJ:

22. The nurse should suspect uterine rupture if
a. fetal tachycardia occurs.
b. the woman becomes dyspneic.
c. contractions abruptly stop during labor.
d. labor progresses unusually quickly.

ANS: C
A large rupture of the uterus will disrupt its ability to contract. Fetal tachycardia is a sign of hypoxia. Dyspnea and unusually quick labor are not signs of rupture.
PTS: 1 DIF: Cognitive Level: Comprehension/Understanding
REF: p. 595 OBJ: Nursin

23. A student nurse is preparing to administer a dose of betamethasone. What action by the student warrants intervention by the registered nurse?
a. Starts a separate IV line to infuse the medication
b. Tells the woman her blood glucose will be monitored

ANS: A
Betamethasone is given in two IM injections with the appropriate needle. When the student begins to insert a dedicated line for administering it, the nurse intervenes to stop this incorrect action. Since this drug is a steroid, blood glucose readin

24. An hour after her membranes ruptured, a laboring woman has a temperature of 38.2� C (100.7� F). What action does the nurse perform first?
a. Provide cool, wet washcloths for the woman's forehead.
b. Assess and document the fetal heart rate.
c. Adminis

ANS: B
Fetal tachycardia is associated with maternal fever. While all options are reasonable, the nurse needs to assess fetal well-being first.
PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 580 | Safety Alert Box OBJ: Nursing Process: Assessme

25. The nursing student observes a laboring woman doing lunges to the left side and asks for an explanation of this activity. What response by the nurse is best?
a. It decreases the pain associated with back labor.
b. It promotes rotation of the fetal occ

ANS: B
This action encourages rotation of the fetal head to the anterior position. It does relieve back labor, but this response does not explain why. It does not relieve cramping or open the pelvic inlet.
PTS: 1 DIF: Cognitive Level: Comprehension/Unders

1. The causes of preterm labor are not fully understood although many factors have been associated with early labor. These include (Select all that apply.)
a. Singleton pregnancy
b. History of cone biopsy
c. Smoking
d. Short cervical length
e. Higher leve

ANS: B, C, D
A history of cone biopsies, smoking, and a short cervical length are all associated with early labor. Singleton pregnancy and higher level of education are not.
PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 583 | Table 27.2 OBJ:

2. What are the priority nursing assessments for a woman receiving tocolytic therapy with terbutaline?
(Select all that apply.)
a. Fetal heart rate
b. Maternal heart rate
c. Intake and output
d. Maternal blood glucose
e. Maternal blood pressure
f. Odor of

ANS: A, B, E
All assessments are important, but those most relevant to the medication include the fetal heart rate and maternal pulse, which tend to increase, and the maternal blood pressure, which tends to exhibit a wide pulse pressure. The other assessm

3. A woman reports a sudden gush of fluid from her vagina and is worried about premature rupture of her membranes. What other causes of this does the nurse assess for? (Select all that apply.)
a. Urinary incontinence
b. Leaking of amniotic fluid
c. Loss o

ANS: A, C, D, E
Urinary incontinence, loss of the mucous plug (leading to bloody show), and increased vaginal discharge can all be mistaken for PROM. Leaking amniotic fluid is an indication of PROM.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 581 OBJ: Nursing Process: Assessment
MSC: Client Needs: Physiologic Integrity

...

4. The nursing faculty explains to students on the labor and delivery unit that late preterm and term births are very different. What distinguishes the late preterm birth from a term birth? (Select all that apply.)
a. Late preterm births are between 34 an

ANS: A, C, E
Late preterm and term deliveries are very different, with late preterm occurring between 34 and 36 completed weeks of gestation. Mortality for late preterm babies is three times higher than for term babies. Because infant appearance can be de

1. The provider orders an infusion of magnesium sulfate to run at 4 g/hour. The pharmacy delivers a bag of 4 g magnesium sulfate in 250 mL. At what rate does the nurse set the pump? ___________________

ANS:
250 mL/hour
4 g/250 mL = 0.16 mg/mL
4/0.016 - 250 mL/hour
PTS: 1 DIF: Cognitive Level: Application/Applying
REF: Table 27.3 OBJ: Nursing Process: Implementation
MSC: Client Needs: Physiologic Integrity

1. The perinatal nurse is giving discharge instructions to a woman, status post suction and curettage secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next 12 months. The best response from the nurse is
a. "If

ANS: B
Beta-hCG levels will be drawn for 1 year to ensure that the mole is completely gone. There is an increased chance of developing choriocarcinoma after the development of a hydatidiform mole. The goal is to achieve a "zero" hCG level. If the woman we

2. Which maternal condition always necessitates delivery by cesarean section?
a. Partial abruptio placentae
b. Total placenta previa
c. Ectopic pregnancy
d. Eclampsia

ANS: B
In total placenta previa, the placenta completely covers the cervical os. The fetus would die if a vaginal delivery occurred. In a partial abruptio placentae, if the mother has stable vital signs and the fetus is alive, a vaginal delivery can be at

3. The nursing student learns that spontaneous termination of a pregnancy is considered to be an abortion if
a. the pregnancy is less than 20 weeks.
b. the fetus weighs less than 1000 g.
c. the products of conception are passed intact.
d. no evidence exis

ANS: A
An abortion is the termination of pregnancy before the age of viability (20 weeks). The weight of a fetus is not considered because some fetuses of an older age may have a low birth weight. A spontaneous abortion may be complete or incomplete. A sp

4. An abortion in which the fetus dies but is retained in the uterus is called ________ abortion.
a. inevitable
b. missed
c. incomplete
d. threatened

ANS: B
Missed abortion refers to a dead fetus being retained in the uterus. An inevitable abortion means that the cervix is dilating with the contractions. An incomplete abortion means that not all of the products of conception were expelled. With a threa

5. A placenta previa in which the placental edge just reaches the internal os is called
a. total.
b. partial.
c. complete.
d. marginal.

ANS: D
A placenta previa that does not cover any part of the cervix is termed marginal. With a total placenta previa the placenta completely covers the os. With a partial previa the lower border of the placenta is within 3 cm of the internal cervical os b

6. The student nurse is assessing a woman with abruptio placentae. The student reports to the registered nurse "I can't really palpate her abdomen, it's as hard as a board." What action by the nurse is the priority?
a. Tell the student to document the fin

ANS: C
A hard, board-like abdomen in this setting is characteristic of concealed hemorrhage. The nurse assesses the woman's fundal height (which will rise with bleeding) and vital signs to detect shock. Documentation occurs after interventions are complet

7. The priority nursing intervention when admitting a pregnant woman who has experienced a bleeding episode in late pregnancy is to
a. assess fetal heart rate (FHR) and maternal vital signs.
b. perform a venipuncture for hemoglobin and hematocrit levels.

ANS: A
Assessment of the FHR and maternal vital signs will assist the nurse in determining the degree of the blood loss and its effect on the mother and fetus. The blood levels can be obtained later. It is important to assess future bleeding and provide f

8. A pregnant woman has been diagnosed with gestational hypertension and is crying. She asks the nurse if this means she has to take blood pressure medicine for the rest of her life. What answer by the nurse is best?
a. "Yes, you will have hypertension fo

ANS: C
Gestational hypertension can last after delivery. If it has not resolved by postpartum week 6, it is considered chronic, and the woman will probably have to take medication. It may or may not resolve, but the nurse should not provide false reassura

9. A woman with severe preeclampsia is being treated with bed rest and intravenous magnesium sulfate. The drug classification of this medication is
a. tocolytic.
b. anticonvulsant.
c. antihypertensive.
d. diuretic.

ANS: B
Anticonvulsant drugs act by blocking neuromuscular tr... ANSmission and depress the central nervous system to control seizure activity. A tocolytic drug does slow the frequency and intensity of uterine contractions, but it is not used for that purp

10. What is the only known cure for preeclampsia?
a. Magnesium sulfate
b. Antihypertensive medications
c. Delivery of the fetus
d. Administration of acetylsalicylic acid (ASA) every day of the pregnancy

ANS: C
If the fetus is viable and near term, delivery is the only known definitive treatment for preeclampsia. Magnesium sulfate is one of the medications used to treat but not to cure preeclampsia. Antihypertensive medications are used to lower the dange

11. Which clinical sign is not included in the symptoms of preeclampsia?
a. Hypertension
b. Edema
c. Proteinuria
d. Glycosuria

ANS: D
Spilling glucose into the urine is not one of the three classic symptoms of preeclampsia. Hypertension is usually the first sign noted. Edema occurs but is considered a non-specific sign. Edema can lead to rapid weight gain. Proteinuria should be a

12. A nurse is assessing a woman receiving magnesium sulfate. The nurse assesses her deep tendon reflexes at 0 and 1+. What action by the nurse is best?
a. Hold the magnesium sulfate.
b. Ask the provider to order a 24-hour UA.
c. Assess the woman's temper

ANS: A
Absent or hypoactive deep tendon reflexes are indicative of magnesium sulfate toxicity. The nurse should hold the magnesium and notify the provider. There is no need for a 24- hour UA at this point. Temperature changes are not related to magnesium.

13. The labor of a pregnant woman with preeclampsia is going to be induced. The nurse reviews the woman's latest laboratory test findings, which reveal a low platelet count, an elevated aspartate transaminase (AST) level, and a falling hematocrit. What ac

ANS: C
This woman has HELLP syndrome, with is characterized by low platelet counts and hepatic dysfunction. She is at risk for bleeding, so the nurse instructs her to call for assistance in getting in and out of bed. The nurse does not palpate the abdomen

14. The nurse is explaining how to assess edema to the nursing students working on the antepartum unit. Which score indicates edema of lower extremities, face, hands, and sacral area?
a. +1 edema
b. +2 edema
c. +3 edema
d. +4 edema

ANS: C
Edema of the extremities, face, and sacral area is classified as +3 edema. Edema classified as +1 indicates minimal edema of the lower extremities. Marked edema of the lower extremities is termed +2 edema. Generalized massive edema (+4) includes ac

15. The prenatal clinic nurse monitored women for preeclampsia. If all four women were in the clinic at the same time, which one should the nurse see first?
a. Blood pressure increase to 138/86 mm Hg
b. Weight gain of 0.5 kg during the past 2 weeks
c. A d

ANS: C
Proteinuria is defined as a concentration of 1+ or greater via dipstick measurement. A dipstick value of 3+ is indicative of severe preeclampsia and should alert the nurse that additional testing or assessment should be made. Generally, hypertensio

16. A patient with pregnancy-induced hypertension is admitted complaining of pounding headache, visual changes, and epigastric pain. Nursing care is based on the knowledge that these signs indicate
a. Anxiety due to hospitalization
b. Worsening disease an

ANS: B
Headache and visual disturbances are due to increased cerebral edema. Epigastric pain indicates distention of the hepatic capsules and often warns that a seizure is imminent. These sign are not due to anxiety or magnesium sulfate or related to gast

17. Rh incompatibility can occur if the woman is Rh negative and her
a. fetus is Rh positive.
b. husband is Rh positive.
c. fetus is Rh negative.
d. husband and fetus are both Rh negative.

ANS: A
For Rh incompatibility to occur, the mother must be Rh negative and her fetus Rh positive. The husband's Rh factor is a concern only as it relates to the possible Rh factor of the fetus. If the fetus is Rh negative, the blood types are compatible a

18. In which situation is a dilation and curettage (D&C) indicated?
a. Complete abortion at 8 weeks
b. Incomplete abortion at 16 weeks
c. Threatened abortion at 6 weeks
d. Incomplete abortion at 10 weeks

ANS: D
D&C is used to remove the products of conception from the uterus and can be used safely until week 14 of gestation. After that there is a greater risk of excessive bleeding, and this procedure may not be used. If all the products of conception have

19. What order should the nurse expect for a patient admitted with a threatened abortion?
a. Abstinence from sexual activity
b. Pitocin IV
c. NPO
d. Narcotic analgesia every 3 hours, prn

ANS: A
The woman may be counseled to avoid sexual activity with a threatened abortion. Activity restrictions were once recommended, but they have not shown effectiveness as treatment. Pitocin would be contraindicated. There is no reason for the woman to b

20. What data on a patient's health history places her at risk for an ectopic pregnancy?
a. Use of oral contraceptives for 5 years
b. Recurrent pelvic infections
c. Ovarian cyst 2 years ago
d. Heavy menstrual flow of 4 days' duration

ANS: B
Infection and subsequent scarring of the fallopian tubes prevents normal movement of the fertilized ovum into the uterus for implantation. Oral contraceptives, ovarian cysts, and heavy menstrual flows do not increase risk.
PTS: 1 DIF: Cognitive Lev

21. What finding on a prenatal visit at 10 weeks might suggest a hydatidiform mole?
a. Complaint of frequent mild nausea
b. Blood pressure of 120/80 mm Hg
c. Fundal height measurement of 18 cm
d. History of bright red spotting for 1 day, weeks ago

ANS: C
The uterus in a hydatidiform molar pregnancy is often larger than would be expected on the basis of the duration of the pregnancy. Many women have nausea in the first trimester. A woman with a molar pregnancy may have early-onset pregnancy-induced

22. What routine nursing assessment is contraindicated in the patient admitted with suspected placenta previa?
a. Monitoring FHR and maternal vital signs
b. Observing vaginal bleeding or leakage of amniotic fluid
c. Determining frequency, duration, and in

ANS: D
Vaginal examination of the cervix may result in perforation of the placenta and subsequent hemorrhage and is therefore contraindicated. Monitoring FHR and maternal vital signs is a necessary part of the assessment for this woman. Monitoring for ble

23. The primary symptom present in abruptio placentae that distinguishes it from placenta previa is
a. vaginal bleeding.
b. rupture of membranes.
c. presence of abdominal pain.
d. changes in maternal vital signs.

ANS: C
Pain in abruptio placentae occurs in response to increased pressure behind the placenta and within the uterus. Placenta previa manifests with painless vaginal bleeding, but both may have vaginal bleeding. Rupture of membranes may occur with both co

24. Which laboratory marker is indicative of disseminated intravascular coagulation (DIC)?
a. Positive KB test
b. Presence of fibrin split products
c. Thrombocytopenia
d. Positive drug screen

ANS: B
Degradation of fibrin leads to the accumulation of multiple fibrin clots throughout the body's vasculature. The other lab tests are not indicative of DIC.
PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 525 OBJ: Nursing Process: Assessme

25. A woman taking magnesium sulfate has respiratory rate of 10 breaths/min. In addition to discontinuing the medication, the nurse should
a. vigorously stimulate the woman.
b. instruct her to take deep breaths.
c. administer calcium gluconate.
d. increas

ANS: C
Calcium gluconate reverses the effects of magnesium sulfate. Stimulation, instruction on taking deep breaths, and increasing her fluid rate will not increase the respirations.
PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 539 | Drug Gui

26. A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Nursing care is based on the knowledge that
a. bed rest and analgesics are the recommended treatment.
b. she will be unable to conceive in the future.
c. a D&C will be perfo

ANS: D
Severe bleeding occurs if the fallopian tube ruptures. The recommended treatment is to remove the pregnancy before hemorrhaging. If the tube must be removed, her fertility will decrease but she will not be infertile. A D&C is done on the inside of

27. The nurse learns that which is the most common cause of spontaneous abortion?
a. Chromosomal abnormalities
b. Infections
c. Endocrine imbalance
d. Immunologic factors

ANS: A
Around 60% of pregnancy losses from spontaneous abortion in the first trimester result from chromosomal abnormalities that are incompatible with life. Maternal infection, endocrine imbalances, and immunologic factors may also be causes of early mis

28. Methotrexate is recommended as part of the treatment plan for which obstetric complication?
a. Complete hydatidiform mole
b. Missed abortion
c. Unruptured ectopic pregnancy
d. Abruptio placentae

ANS: C
Methotrexate is an effective, nonsurgical treatment option for a hemodynamically stable woman whose ectopic pregnancy is unruptured and less than 3.5 cm in diameter. Methotrexate is not indicated or recommended as a treatment option for a complete

29. The nurse caring for a woman hospitalized for hyperemesis gravidarum should expect that initial treatment involves
a. corticosteroids to reduce inflammation.
b. IV therapy to correct fluid and electrolyte imbalances.
c. an antiemetic, such as pyridoxi

ANS: B
Initially, the woman who is unable to down clear liquids by mouth requires IV therapy for correction of fluid and electrolyte imbalances. Corticosteroids are not the expected treatment for this disorder. Pyridoxine is vitamin B6, not an antiemetic.

30. A woman with preeclampsia has a seizure. What action by the nurse takes priority?
a. Insert an oral airway.
b. Suction the mouth to prevent aspiration.
c. Administer oxygen by mask.
d. Stay with the patient and call for help.

ANS: D
If a patient seizes, the nurse should stay with her and call for help. Nursing actions during a seizure are directed toward ensuring a patent airway and patient safety. Insertion of an oral airway during seizure activity is no longer the standard o

31. A woman is in the emergency department with severe abdominal pain. When her pregnancy test comes back positive, she yells "I can't be pregnant! I had a tubal ligation two months ago!" What action by the nurse is the priority?
a. Provide emotional supp

ANS: B
A failed tubal ligation is a risk factor for ectopic pregnancy. After a blood pregnancy test, a trans-vaginal ultrasound is needed to look for a gestational sac within the uterus. Of course the nurse provides emotional support, but that is not the

32. A woman who is 8 months pregnant is brought to the emergency department after a serious motor vehicle crash. Although she has no apparent injuries, she is admitted to the hospital. Her partner is upset and wants to know why she just can't come home. W

ANS: B
After serious trauma, a woman may be admitted and observed because an abruptio placentae may take up to 24 hours to become apparent. Not all motor vehicle crash patients will need to be admitted. The baby may or may not need to be delivered at any

MULTIPLE RESPONSE
1. The nurse who suspects that a patient has early signs of ectopic pregnancy should be observing her for which symptoms? (Select all that apply.)
a. Pelvic pain
b. Abdominal pain
c. Unanticipated heavy bleeding
d. Vaginal spotting or li

ANS: A, B, D, E
Early signs of ectopic pregnancy include pelvic pain, abdominal pain, spotting or light bleeding, and a woman's report of a "missed period." Heavy bleeding is a later sign and occurs after the tube has ruptured.
PTS: 1 DIF: Cognitive Level

2. What assessment findings indicate to the nurses that a woman's preeclampsia should now be considered severe? (Select all that apply.)
a. Urine output 40 mL/hour for the past 2 hours
b. Serum creatinine 3.1 mg/dL
c. Seeing "sparkly" things in the visual

ANS: B, C, D
Signs of severe preeclampsia include elevated creatinine, seeing sparkles, and pulmonary edema (manifested by crackles). The urine output is above the minimum requirements, and a soft non-tender abdomen is a reassuring sign.
PTS: 1 DIF: Cogni

3. A woman has several relatives who had gestational hypertension and wants to decrease her risk for it. What information does the nurse provide this woman? (Select all that apply.)
a. There is no way to reduce risk factors for gestational hypertension.
b

ANS: B, C
There are many risk factors for gestational hypertension, including obesity and anemia. The woman can take action to address these factors prior to becoming pregnant. The father's risks include the first baby and having fathered other preeclampt