Evolve Chaps 20, 3, 23, 24

Question 1

The nurse is caring for a woman with mitral stenosis who is in the active stage of labor. Which action should the nurse take to promote cardiac function?

a. Maintain the woman in a side-lying position with the head and shoulders elevated to facilitate hemodynamics
b. Prepare the woman for delivery by cesarean section because this is the recommended delivery method to sustain hemodynamics
c. Encourage the woman to avoid the use of narcotics or epidural regional analgesia because this alters cardiac function
d. Promote the use of the Valsalva maneuver during pushing in the second stage to improve diastolic ventricular filling

Answer 1

a. Maintain the woman in a side-lying position with the head and shoulders elevated to facilitate hemodynamics

Question 2

In planning for the care of a 30-year-old woman with pregestational diabetes, the nurse recognizes that the most important factor affecting pregnancy outcome is the:

a. Mother’s age.
b. Number of years since diabetes was diagnosed.
c. Amount of insulin required prenatally.
d. Degree of glycemic control during pregnancy.

Answer 2

d. Degree of glycemic control during pregnancy.

Question 3

Diabetes in pregnancy puts the fetus at risk in several ways. Nurses should be aware that:

a. With good control of maternal glucose levels, sudden and unexplained stillbirth is no longer a major concern.
b. The most important cause of perinatal loss in diabetic pregnancy is congenital malformations.
c. Infants of mothers with diabetes have the same risks for respiratory distress syndrome because of the careful monitoring.
d. At birth the neonate of a diabetic mother is no longer in any risk.

Answer 3

b. The most important cause of perinatal loss in diabetic pregnancy is congenital malformations.
- Congenital malformations account for 30% to 50% of perinatal deaths.

Question 4

A new mother with which of these thyroid disorders would be strongly discouraged from breastfeeding?

a. Hyperthyroidism
b. Phenylketonuria (PKU)
c. Hypothyroidism
d. Thyroid storm

Answer 4

b. Phenylketonuria (PKU)
- A woman with hyperthyroidism would have no particular reason not to breastfeed.
- PKU is a cause of mental retardation in infants; mothers with PKU pass on phenylalanine through breast milk.
- A woman with hypothyroidism would have no particular reason not to breastfeed.
- A thyroid storm is a complication of hyperthyroidism.

Question 5

While providing care in an obstetric setting, the nurse should understand that postpartum care of the woman with cardiac disease:

a. Is the same as that for any pregnant woman.
b. Includes rest, stool softeners, and monitoring of the effect of activity.
c. Includes ambulating frequently, alternating with active range of motion.
d. Includes limiting visits with the infant to once per day.

Answer 5

b. Includes rest, stool softeners, and monitoring of the effect of activity.

Question 6

A woman with gestational diabetes has had little or no experience reading and interpreting glucose levels. She shows the nurse her readings for the past few days. Which one should the nurse tell her indicates a need for adjustment (insulin or sugar)?

a. 75 mg/dl before lunch; this is low, better eat now
b. 115 mg/dl 1 hour after lunch; this is a little high, maybe eat a little less next time
c, 115 mg/dl 2 hours after lunch; this is too high, time for insulin
d. 60 mg/dl just after waking up from a nap; this is too low, maybe eat a snack before going to sleep

Answer 6

d. 60 mg/dl just after waking up from a nap; this is too low, maybe eat a snack before going to sleep

• The premeal acceptable range is 65 to 95 mg/dl.
• The readings 1 hour after a meal should be less than 130 mg/dl.
• Two hours after eating, the readings should be under 120 mg/dl.
• A reading of 60 mg/dl is too low. During hours of sleep glucose levels should not be under 60 mg/dl. Snacks before sleeping can be helpful.

Question 7

A woman with asthma is experiencing a postpartum hemorrhage. Which drug would NOT be used to treat her bleeding because it may exacerbate her asthma?

a. Pitocin
b. Nonsteroidal antiinflammatory drugs (NSAIDs)
c. Hemabate
d. Fentanyl

Answer 7

c. Hemabate

• Prostaglandin derivatives should not be used to treat women with asthma, because they may exacerbate symptoms. Oxytocin is the recommended medication for uterine bleeding.
• Pitocin would be the drug of choice to treat this woman’s bleeding because it would not exacerbate her asthma.
• NSAIDs are not used to treat bleeding.
• Fentanyl is used to treat pain, not bleeding.

Question 8

During a physical assessment of an at-risk patient, the nurse notes generalized edema, crackles at the base of the lungs, and some pulse irregularity. These are most likely signs of:

a. Euglycemia.
b. Rheumatic fever.
c. Pneumonia.
d. Cardiac decompensation.

Answer 8

d. Cardiac decompensation.

Question 9

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 sickle cell anemia.

Answer 9

a. It is the most common medical disorder of pregnancy.

Question 10

The most common neurologic disorder accompanying pregnancy is:

a. Eclampsia.
b. Bell’s palsy.
c. Epilepsy.
d. Multiple sclerosis.

Answer 10

c. Epilepsy.

• Eclampsia sometimes may be confused with epilepsy, which is the most common neurologic disorder accompanying pregnancy.
• Bell’s palsy is a form of facial paralysis. Epilepsy is the most common neurologic disorder accompanying pregnancy.
• Epilepsy is the most common neurologic disorder accompanying pregnancy. The effects of pregnancy on epilepsy are unpredictable.
• Multiple sclerosis is a patchy demyelinization of the spinal cord that does not affect the normal course of pregnancy or birth. However, epilepsy is the most common neurologic disorder accompanying pregnancy.

Question 11

Less than 10% of women who are substance abusers receive treatment for their addiction during pregnancy.

a. True
b. False

Answer 11

a. True

Question 12

An effective relief measure for primary dysmenorrhea would be to:

a. Reduce physical activity level until menstruation ceases.
b. Begin taking prostaglandin synthesis inhibitors on the first day of the menstrual flow.
c. Decrease intake of salt and refined sugar about 1 week before menstruation is about to occur.
d. Use barrier methods rather than the oral contraceptive pill (OCP) for birth control.

Answer 12

c. Decrease intake of salt and refined sugar about 1 week before menstruation is about to occur.

Question 13

Self-care instructions for a woman following a modified radical mastectomy would include that she should:

a. Wear clothing with snug sleeves to support her affected arm.
b. Use depilatory creams instead of shaving the axilla of her affected arm.
c. Expect a decrease in sensation or tingling in her affected arm as her body heals.
d. Empty surgical drains once a day or every other day.

Answer 13

c. Expect a decrease in sensation or tingling in her affected arm as her body heals.

• Loose clothing should be worn because tight clothing could impede circulation in the affected arm.
• The axilla of the affected arm should not be shaved nor should depilatory creams or strong deodorants be used after this surgery.
• A decrease in sensation and tingling in the affected arm and in the incision are expected for weeks to months after the surgery.
• Drains should be emptied at least twice a day and more often if necessary.

Question 14

When providing care to a young single woman just diagnosed with acute pelvic inflammatory disease, the nurse should:

a. Point out that inappropriate sexual behavior caused the infection.
b. Position the woman in a semi-Fowler position.
c. Explain to the woman that infertility is a likely outcome of this type of infection.
d. Tell her that antibiotics need to be taken until pelvic pain is relieved.

Answer 14

b. Position the woman in a semi-Fowler position.

• Although sexual behavior may have contributed to the infection, the nurse must discuss these practices in a nonjudgmental manner and provide information about prevention measures.
• The position of comfort is the semi-Fowler position. In addition, the foot of the bed could be elevated to keep the uterus in a dependent position and thus reduce discomfort.
• Until treatment is complete and healing has occurred, the outcome is unknown and should not be suggested.
• The nurse should emphasize that medication must be continued until follow-up assessment indicates that the infection has been treated successfully.

Question 15

The CDC-recommended medication for the treatment of chlamydia is:

a. Doxycycline.
b. Podofilox.
c. Acyclovir.
d. Penicillin.

Answer 15

a. Doxycycline.

• Doxycycline is effective for treating chlamydia, but it should be avoided if the woman is pregnant.
• Podofilox is a recommended treatment for nonpregnant women diagnosed with human papilloma virus infection.
• Acyclovir is recommended for genital herpes simplex virus infection.
• Penicillin is not a CDC-recommended medication for chlamydia; it is the preferred medication for syphilis.

Question 16

The nurse should refer the patient for further testing if she noted which finding on inspection of the breasts of a 55-year-old woman?

a. Left breast slightly smaller than right breast
b. Eversion (elevation) of both nipples
c. Bilateral symmetry of venous network, which is faintly visible
d. Small dimple located in the upper outer quadrant of the right breast

Answer 16

d. Small dimple located in the upper outer quadrant of the right breast

Question 17

When evaluating a woman whose primary complaint is amenorrhea, the nurse must be aware that lack of menstruation is most often the result of:

a. Stress.
b. Excessive exercise.
c. Pregnancy.
d. Eating disorders.

Answer 17

c. Pregnancy.

Question 18

The viral sexually transmitted infection (STI) that affects most people in the United States today is:

a. Herpes simplex virus type 2 (HSV-2).
b. Human papillomavirus (HPV).
c. Human immunodeficiency virus (HIV).
d. Cytomegalovirus (CMV).

Answer 18

b. Human papillomavirus (HPV).

Question 19

The recommended treatment for the prevention of human immunodeficiency virus (HIV) transmission to the fetus during pregnancy is:

a. Acyclovir.
b. Ofloxacin.
c. Podophyllin.
d. Zidovudine.

Answer 19

d. Zidovudine.

• Acyclovir is an antiviral treatment for HSV.
• Ofloxacin is an antibacterial treatment for gonorrhea.
• Podophyllin is a solution used in the treatment of human papillomavirus.
• Perinatal transmission of HIV has decreased significantly in the past decade as a result of prophylactic administration of the antiretroviral drug zidovudine to pregnant women in the prenatal and perinatal periods.

Question 20

Fibrocystic changes in the breast most often appear in women in their 20s and 30s. The etiology is not known, but it may be an imbalance of estrogen and progesterone. The nurse who cares for this patient should be aware that treatment modalities are conservative. One proven modality that may provide relief is:

a. Diuretic administration.
b. Including caffeine daily in the diet.
c. Increased vitamin C supplementation.
d. Application of cold packs to the breast as necessary.

Answer 20

a. Diuretic administration.

• Diuretic administration plus a decrease in sodium and fluid intake are recommended.
• Although not supported by research, some advocate eliminating dimethylxanthines (caffeine) from the diet. Smoking should also be avoided, and alcohol consumption should be reduced.
• Vitamin E supplements are recommended; however, the patient should avoid megadoses because this is a fat-soluble vitamin.
• Pain relief measures include applying heat to the breast, wearing a supportive bra, and taking nonsteroidal antiinflammatory drugs.

Question 21

A patient has been prescribed adjuvant tamoxifen therapy. What common side effects might she experience?\

a. Nausea, hot flashes, and vaginal bleeding
b. Vomiting, weight loss, and hair loss
c. Nausea, vomiting, and diarrhea
d. Hot flashes, weight gain, and headaches

Answer 21

a. Nausea, hot flashes, and vaginal bleeding

• Common side effects of tamoxifen therapy include hot flashes, nausea, vomiting, vaginal bleeding, menstrual irregularities, and rash.
• Weight loss and hair loss are not common side effects of tamoxifen.
• Diarrhea is not a common side effect of tamoxifen.
• Weight gain and headaches are not common side effects of tamoxifen.

Question 22

Examples of sexual risk behaviors associated with exposure to a sexually transmitted infection (STI) include (choose all that apply):

a. Fellatio.
b. Unprotected anal intercourse.
c. Multiple sex partners.
d. Dry kissing.
e. Abstinence.

Answer 22

a. Fellatio.
b. Unprotected anal intercourse.
c. Multiple sex partners.

Question 23

Two hours after giving birth, a primiparous woman becomes anxious and complains of intense perineal pain with a strong urge to have a bowel movement. Her fundus is firm, at the umbilicus, and midline. Her lochia is moderate rubra with no clots. The nurse would suspect:

a. Bladder distention.
b. Uterine atony.
c. Constipation.
d. Hematoma formation.

Answer 23

d. Hematoma formation.

• Bladder distension would result in an elevation of the fundus above the umbilicus and deviation to the right or left of midline.
• Uterine atony would result in a boggy fundus.
• Constipation is unlikely at this time.
• Increasing perineal pressure along with a firm fundus and moderate lochial flow are characteristic of hematoma formation.

Question 24

Postpartum women experience an increased risk for urinary tract infection. A prevention measure the nurse could teach the postpartum woman would be to:

a. Acidify the urine by drinking 3 glasses of orange juice each day.
b. Maintain a fluid intake of 1 to 2 L/day.
c. Empty bladder every 4 hours throughout the day.
d. Perform perineal care on a regular basis.

Answer 24

d. Perform perineal care on a regular basis.

• Urine is acidified with cranberry juice.
• The woman should drink at least 3 L of fluid each day.
• The woman should empty her bladder every 2 hours to prevent stasis of urine.
• Keeping the perineum clean will help prevent a urinary tract infection.

Question 25

Which woman is at greatest risk for early postpartum hemorrhage (PPH)?

a. A primiparous woman (G 2 P 1 0 0 1) 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 multiparous woman (G 3 P 2 0 0 2) with an 8-hour labor
d. A primigravida in spontaneous labor with preterm twins

Answer 25

b. A woman with severe preeclampsia on magnesium sulfate whose labor is being induced

• Although many causes and risk factors are associated with PPH, a primiparous woman (G 2 P 1 0 0 1) being prepared for an emergency cesarean birth for fetal distress does not pose risk factors or causes of early PPH.
• Magnesium sulfate administration during labor poses a risk for PPH. Magnesium acts as a smooth muscle relaxant, thereby contributing to uterine relaxation and atony.
• Although many causes and risk factors are associated with PPH, a multiparous woman (G 3 P 2 0 0 2) with an 8-hour labor does not pose risk factors or causes of early PPH.
• Although many causes and risk factors are associated with PPH, a primigravida in spontaneous labor with preterm twins does not pose risk factors or causes of early PPH.

Question 26

The first and most important nursing intervention when a nurse observes profuse postpartum bleeding is to:

a. Call the woman’s primary health care provider.
b. Administer the standing order for an oxytocic.
c. Palpate the uterus and massage it if it is boggy.
d. Assess maternal blood pressure and pulse for signs of hypovolemic shock.

Answer 26

c. Palpate the uterus and massage it if it is boggy

• Calling the woman’s primary care provider is appropriate. However, the primary intervention should be to assess the uterus. Uterine atony is the leading cause of postpartum hemorrhage (PPH).
• Administering a standing order for an oxytocic is appropriate. However, the primary intervention should be to assess the uterus. Uterine atony is the leading cause of PPH.
• The initial management of excessive postpartum bleeding is firm massage of the uterine fundus.
• Assessing maternal blood pressure and pulse is appropriate. However, the primary intervention should be to assess the uterus. Uterine atony is the leading cause of PPH.

Question 27

What PPH conditions are considered medical emergencies that require immediate treatment?

a. Inversion of the uterus and hypovolemic shock
b. Hypotonic uterus and coagulopathies
c. Subinvolution of the uterus and idiopathic thrombocytopenic purpura (ITP)
d. Uterine atony and disseminated intravascular coagulation (DIC)

Answer 27

a. Inversion of the uterus and hypovolemic shock

• Inversion of the uterus and hypovolemic shock are considered medical emergencies.
• Although a hypotonic uterus and coagulopathies are serious conditions, they do not necessarily constitute a medical emergency that requires immediate treatment.
• Although subinvolution and ITP are serious conditions, they do not necessarily constitute a medical emergency that requires immediate treatment.
• Although uterine atony and DIC are serious conditions, they do not necessarily constitute a medical emergency that requires immediate treatment.

Question 28

What infection is contracted mostly by first-time mothers who are breastfeeding?

a. Endometritis
b. Wound infections
c. Mastitis
d. Urinary tract infections

Answer 28

c. Mastitis

• Endometritis is an infection of the uterus and is not confined to first-time mothers.
• Wound infections are most likely to occur after a cesarean birth and are not seen more often in first-time mothers.
• Mastitis is infection in a breast, usually confined to a milk duct. Most women who suffer this are first-timers who are breastfeeding.
• UTI can occur both during pregnancy and postpartum. Breastfeeding or being a first-time mother are not contributing factors.

Question 29

A mother in late middle age who is certain she is not pregnant tells the nurse during an office visit that she has urinary problems and sensations of bearing down and of something in her vagina. The nurse would realize that the woman most likely is suffering from:

a. Pelvic relaxation.
b. Cystoceles and/or rectoceles.
c. Uterine displacement.
d. Genital fistulas.

Answer 29

b. Cystoceles and/or rectoceles.
- Cystoceles are protrusions of the bladder downward into the vagina; rectoceles are herniations of the anterior rectal wall through a relaxed or ruptured vaginal fascia. Both can present as a bearing down sensation with urinary dysfunction. They occur more often in older women who have borne children.

Question 30

To provide adequate postpartum care, the nurse should be aware that postpartum depression (PPD) with psychotic features:

a. Is more likely to occur in women with more than two children.
b. Is rarely delusional and then usually about someone trying to harm her (the mother).
c. Although serious, is not likely to need psychiatric hospitalization.
d. May include bipolar disorder (formerly called “manic depression”).

Answer 30

d. May include bipolar disorder (formerly called “manic depression”).

• PPD is more likely to occur in first-time mothers.
• Delusions may be present in 50% of women with PPD, usually involving something being wrong with the infant.
• PPD with psychosis is a psychiatric emergency that requires hospitalization.
• Manic mood swings are possible.

Question 31

Possible alternative and complementary therapies for postpartum depression (PPD) for breastfeeding mothers include (choose all that apply):

a. Acupressure.
b. Aromatherapy.
c. St. John’s wort.
d. Wine consumption.
e. Yoga.

Answer 31

a. Acupressure.
b. Aromatherapy.
e. Yoga.

-Possible alternative/complementary therapies for postpartum depression include acupuncture, acupressure, aromatherapy, therapeutic touch, massage, relaxation techniques, reflexology, and yoga.

Question 32

An infant was born 2 hours ago at 37 weeks of gestation, weighing 4.1 kg. The infant appears chubby with a flushed complexion and is very tremulous. The tremors are most likely the result of:

a. Birth injury.
b. Hypocalcemia.
c. Hypoglycemia.
d. Seizures.

Answer 32

c. Hypoglycemia.

• This infant is macrosomic and at risk for hypoglycemia. The description is indicative of a macrocosmic infant. The tremors are jitteriness that is associated with hypoglycemia.
• This infant is macrosomic and at risk for hypoglycemia. The description is indicative of a macrocosmic infant. The tremors are jitteriness that is associated with hypoglycemia.
• Hypoglycemia is common in the macrosomic infant. Signs of hypoglycemia include jitteriness, apnea, tachypnea, and cyanosis.
• This infant is macrosomic and at risk for hypoglycemia. The description is indicative of a macrocosmic infant. The tremors are jitteriness that is associated with hypoglycemia.

Question 33

The abuse of which of the following substances during pregnancy is the leading cause of cognitive impairment in the United States?

a. Alcohol
b. Tobacco
c. Marijuana
d. Heroin

Answer 33

a. Alcohol

Question 34

A newborn was admitted to the neonatal intensive care unit after being delivered at 29 weeks of gestation to a 28-year-old multiparous, married, Caucasian female whose pregnancy was uncomplicated until premature rupture of membranes and preterm birth. The newborn’s parents arrive for their first visit after the birth. The parents walk toward the bedside but remain approximately 5 feet away from the bed. The nurse’s most appropriate action would be to:

a. Wait quietly at the newborn’s bedside until the parents come closer.
b. Go to the parents, introduce himself or herself, and gently encourage them to come meet their infant; explain the equipment first, and then focus on the newborn.
c. Leave the parents at the bedside while they are visiting so they can have some privacy.
d. Tell the parents only about the newborn’s physical condition and caution them to avoid touching their baby.

Answer 34

b. Go to the parents, introduce himself or herself, and gently encourage them to come meet their infant; explain the equipment first, and then focus on the newborn. Correct

Question 35

With regard to injuries to the infant’s plexus during labor and birth, nurses should be aware that:

a. If the nerves are stretched with no avulsion, they should recover completely in 3 to 6 months.
b. Erb palsy is damage to the lower plexus.
c. Parents of children with brachial palsy are taught to pick up the child from under the axillae.
d. Breastfeeding is not recommended for infants with facial nerve paralysis until the condition resolves.

Answer 35

a. If the nerves are stretched with no avulsion, they should recover completely in 3 to 6 months.

Question 36

In appraising the growth and development potential of a preterm infant, nurses should:

a. Tell parents their child won’t catch up until about age 10 (girls) to 12 (boys).
b. Correct for milestones such as motor competencies and vocalizations until the child is approximately 3 years of age.
c. Know that the greatest catch-up period is between 9 and 15 months postconceptual age.
d. Know that the length and breadth of the trunk is the first part of the infant to experience catch-up growth.

Answer 36

b. Correct for milestones such as motor competencies and vocalizations until the child is approximately 3 years of age.

Question 37

During the initial acute distress phase of grieving, parents still must make unexpected and unwanted decisions about funeral arrangements and even naming the baby. The nurse’s role should be to:

a. Take over as much as possible to relieve the pressure.
b. Encourage grandparents to take over.
c. Make sure the parents themselves approve the final decisions.
d. Let them alone to work things out.

Answer 37

c. Make sure the parents themselves approve the final decisions.

Question 38

For clinical purposes, preterm and postterm infants are defined as:

a. Preterm before 34 weeks if appropriate for gestational age (AGA); before 37 weeks if small for gestational age (SGA).
b. Postterm after 40 weeks if large for gestational age (LGA); beyond 42 weeks if AGA.
c. Preterm before 37 weeks, postterm beyond 42 weeks, no matter the size for gestational age at birth.
d. Preterm, SGA before 38 to 40 weeks; postterm, LGA beyond 40 to 42 weeks.

Answer 38

c. Preterm before 37 weeks, postterm beyond 42 weeks, no matter the size for gestational age at birth.

Question 39

A plan of care for an infant experiencing symptoms of drug withdrawal should include:

a. Administering chloral hydrate for sedation.
b. Feeding every 4 to 6 hours to allow extra rest.
c. Swaddling the infant snugly and holding the baby tightly.
d. Playing soft music during feeding.

Answer 39

c. Swaddling the infant snugly and holding the baby tightly.

Question 40

With regard to the classification of neonatal bacterial infection, nurses should be aware that:

a. Congenital infection progresses slower than nosocomial infection.
b. Nosocomial infection can be prevented by effective handwashing; early-onset infections cannot.
c. Infections occur with about the same frequency in boy and girl infants, although female mortality is higher.
d. The clinical sign of a rapid, high fever makes infection easier to diagnose.

Answer 40

b. Nosocomial infection can be prevented by effective handwashing; early-onset infections cannot.

Question 41

Which infant would be more likely to have Rh incompatibility?

a. Infant of an Rh-negative mother and a father who is Rh positive and homozygous for the Rh factor
b. Infant who is Rh negative and whose mother is Rh negative
c. Infant of an Rh-negative mother and a father who is Rh positive and heterozygous for the Rh factor
d. Infant who is Rh positive and whose mother is Rh positive

Answer 41

a. Infant of an Rh-negative mother and a father who is Rh positive and homozygous for the Rh factor

Question 42

As a result of large body surface in relation to weight, the preterm infant is at high risk for heat loss and cold stress. By understanding the four mechanisms of heat transfer (convection, conduction, radiation, and evaporation), the nurse can create an environment for the infant that prevents temperature instability. While evaluating the plan that has been implemented, the nurse knows that the infant is experiencing cold stress when he or she exhibits:

a. Decreased respiratory rate.
b. Bradycardia followed by an increased heart rate.
c. Mottled skin with acrocyanosis.
d. Increased physical activity.

Answer 42

c. Mottled skin with acrocyanosis.

Question 43

The nurse is caring for an infant born at 28 weeks of gestation. Which complication could the nurse expect to observe during the course of the neonate’s hospitalization? Select all that apply.

a. Polycythemia
b. Respiratory distress syndrome
c. Meconium aspiration syndrome
d. Periventricular hemorrhage
e. Persistent pulmonary hypertension
f. Patent ductus arteriosus

Answer 43

b. Respiratory distress syndrome
d. Periventricular hemorrhage
f. Patent ductus arteriosus