Exam 3

Question 1

1.-4. What are the 4 goals of the CDC’d preconception care for women?

Answer 1

1. Improve knowledge/attitude/behavior related to preconception health
2. Assure all childbearing women receive preconception health
3. Reduce risk of adverse pregnancy outcomes through interconception interventions
4. Reduce disparities in adverse pregnancy outcomes

Question 2

1. What are 2 actions that show pregnancy from the healthy/natural perspective?
2. What are actions that show pregnancy from an illness perspective:

Answer 2

1. ◦ Active participant in social circle/career
   ◦ Choose provider with similar view
2. ◦ Withdraw from work/social obligations
   ◦ Make unhealthy pregnancy choices, deny pregnancy

Question 3

1. What might affect a pregnant woman’s pre-pregnancy nutrition?
2. When is the best moment to educate on nutritional needs in pregnancy?
3. What is the rough percentage of anemia in pregnancy?
4. Name 5 dietary recommendations for pregnancy:

Answer 3

1. Her financial status and culture.
2. before pregnancy
3. 50% globally
4. well-balanced diet, 8-10 glasses of water daily, Increase protein (70g), Increase vitamins and minerals (Iron 30mg, folic acid 400mcg), adjust fats/carbs for energy

Question 4

1. What is recommended weight gain for underweight BMI?
2. What is recommended weight gain for normal BMI?
3. Overweight?
4. Obese?
5. How many extra calories should be consumed in 2nd and 3rd trimesters?
6. Basal metabolic rate (BMR) increases ..% to ..% by end of pregnancy
7. Mother uses …….. for fuel, and fetus uses ……… .
8. What happens if there is inadequate weight gain?

Answer 4

1. 28-40lbs
2. 25-35 lbs.
3. 15-25lbs
4. 11-20lbs
5. 340/day, and 452/day
6. 15% - 20%
7. fat, glucose
8. low birth weight, and baby small for gestational age

Question 5

1. How does fetus eliminate wastes? What are these wastes?
2. Name a few common discomforts of pregnancy.
3. What do UTI’s possibly indicate?
4. What is anticipatory guidance?

Answer 5

1. through placenta. CO2 water and urea
2. Urinary frequency, constipation, hemorrhoids, and UTI’s
3. UTIs associated with preterm labor
4. preventing complications and coping with changes

Question 6

1. Early pregnancy: spontaneous fetal movements are ………… .
2. The quickening happens when? What can be done after this point to monitor fetal activity?
3. How much activity do pregnant women need? Ex:
4. What are two benefits of exercise on pregnant women?

Answer 6

1. reflexive
2. 16 weeks. kick counts
3. 30 min/day of swimming/walking
4. uterine tone and lower diabetes risk

Question 7

1. Which senses are functioning in the fetus? Which is first, and when?
2. What types of emotional changes do pregnant women experience?
3. Give an example of the mother ensuring safe passage:
4. Give an example of the mother ensuring acceptance of the child:
5. The complex process of integrating fetus as part of self but also as separate being (fantasies/nesting) is an example of ………..
6. When a mother
   examines the meaning of giving, gifts for herself/baby she is ………… .

Answer 7

1. vision, hearing, taste, smell, touch, proprioception, vestibular. Vestibular is first at 25 weeks.
2. Progesterone affects mood → focus on child, Increased sensitivity and analysis of experiences, mood swings, Transitioning process to motherhood
3. Decides prenatal care options; more protective of self/fetus
4. Feeling the receptivity of partner, others
5. Binding with her unknown child
6. Learning to give of herself

Question 8

1. • 2. The self-perception and self-concept pattern address which 2 things?
2. In which 2 ways can nurses intervene in these issues?

Answer 8

1. accepting of pregnant body image (can be ambivalent, accepting, or yearning for pre-pregnant state).
2. Influences in assumming the maternal role. Includes internal (self & maturity level) and external (family & society) influences
3. By addressing thinking/self-image issues, and encouraging discussion between woman and partner

Question 9

1. How does pregnancy affect the following people: Partner, children, extended family/Grandparents:

Answer 9

1. Partner: Possible resentment, financial stress, potential for abuse, concerns about role

Children: Less attention from parents,
Changed relationship with mother

Extended Family: Reminded of own aging, Feeling of resentment vs new closeness

Question 10

1. What are 2 sexual concerns of pregnant women?
2. In what 2 ways can nurses help this?
3. At which stage(s) of pregnancy do women have the greatest anxiety, and how might this be of danger to the fetus?
4. How might a pregnant woman demonstrate her anxiety?

Answer 10

1. Concerns about effect of intercourse on pregnancy, and Potential for sexual dissatisfaction
2. Provide accurate information to facilitate intimacy needs during pregnancy, Provide support
3. 1st and 3rd trimester. Decreased blood flow to uterus/fetus.
4. ◦ Psychosomatic complaints/behaviors, Dreams/fantasies, Smoking/substance abuse

Question 11

1. In what 4 aspects of life do values/beliefs change when pregnant?

Answer 11

1. fulfillment vs losing oneself, shifting in friendships, shifting values between woman and partner, and changes in spiritual values

Question 12

1. What does Zika cause?
2. Which drugs are unsafe in pregnancy?
3. What type of vaccines are not safe for pregnancy?
4. Name a few biological risks to pregnancy in the following categories: infections, diseases, and substances:

Answer 12

1. microencephaly.
2. environmental agents that cause spontaneous abortions or congenital defects, ex thalidomide
3. Unsafe (live viruses): measles, mumps, rubella, polio
4. Infections from toxoplasmosis, rubella, herpes, zika, hep b, strep.

Diseases: HIV, substance abuse, RH incompatibility, seizures

Substances: alcohol, nicotine, and caffeine

Question 13

1. Name a few mechanical forces for fetal risk:
2. Molds fetus is higher risk for ……………. ……….. . What does it cause?
3. What should be taken in to account for safe/welcoming workplace environment for pregnant women?

Answer 13

1. abdominal trauma, car accidents, incorrect seat belt use, molds fetus, birthing process, radiation effect on fetus
2. Multiple pregnancies. Congenital hip dislocation.
3. family-friendly policies, avoid hazardous substances.

Question 14

1. • 3. What are the 3 levels of culture that impact health care delivery?
2. What do economics influence?

Answer 14

1. primary - rules known and obeyed by all
2. secondary - rules not relayed to outsiders (taboos, rituals)
3. visible to outsider (dress, foods, religion)
4. prenatal care, employment choices, nutrition, financial stress

Question 15

1. What is the Family Medical Leave Act?
2. What types of experiences and perceptions influence the type of care (OBGYN or midwife etc) that women seek?
3. T or F, pregnant women are at a higher risk for abuse?

Answer 15

1. provides new parents time off work during the early months of parenthood
2. cultural, financial, and geographical
3. T

Question 16

1. What was the Primary mode of infant feeding around the world before the 1900’s
2. Currently, ….% of U.S. women initiate breastfeeding at hospital discharge; only ….% still breastfeed by 6 months postpartum
3. how long breast feeding is recommended?
4. Which countries accept breastfeeding?
5. ……….. contain milk-producing glands?
6. Where is milk stored in the breast?

Answer 16

1. breast feeding
2. 80%, 22%
3. at least 6 mo. Ideal is 1 year
4. Chinese, India, South Africa, and others
5. alveoli
6. lactiferous sinuses which empty into the pores of the nipple

Question 17

1. what causes alveoli and lobules to increase in number and size
2. what stimulates proliferation of ductal system
3. ………. is responsible for milk synthesis
4. …………. is responsible for milk ejection from the breast (let-down reflex)
5. ………….. is the first milk produced; provides antibodies and nutrients

Answer 17

1. progesterone
2. estrogen
3. prolactin
4. oxytocin
5. colostrum

Question 18

1. how much energy is needed for lactation daily? Protein?
2. How much fluid is lost in lactation?
3. Name 3 contraindications to breastfeeding:

Answer 18

1. 500-800 cal. 71g protein/day
2. 750-1000mL
3. meds/drugs, HIV/AIDS, Hep C.

Question 19

1. Erikson’s Theory of Psychosocial Development is based on ….. critical stages.
2. Each stage requires a …………… ………….. between two opposing forces
3. • 10. Name each stage of development
4. T or F? Each stage depends on preceding stages; must be successfully accomplished to proceed

Answer 19

1. 8
2. resolution of conflict
3. Infancy - trust v. mistrust
4. toddler- autonomy v. shame and doubt
5. Preschool- initiative v. guilt
6. school-age- industry v. inferiority
7. adolescent- identity v. role confusion
8. young adult- intimacy v. isolation
9. middle adults- generativity v. stagnation
10. older adults- ego integrity v. despair
11. T

Question 20

1. What does Piaget help us understand?
2. What word does he use to describe a pattern of action or thought
3. How are schemes used?
4. Individuals strive to maintain balance between ……….. and ………….

Answer 20

1. the cognitive development of children (birth to 15 yrs old)
2. scheme
3. used to assimilate (take in) or accommodate (modify) new experiences
4. assimilation and accommodation

Question 21

1. In Piaget’s theory, what is the sensorimotor scheme?
2. Preoperational:
3. concrete operations:
4. Formal Operations

Answer 21

1. 0-2yrs. Begins with reflex movements that change to voluntary. Infant physically manipulates body and objects.
2. 2-7yrs Egocentric, magical thinking. Thought is dominated by the senses. No cause and effect. Advancing language.
3. 7-11 yrs Uses logic to solve concrete problems. Knows cause/effect. Considers other’s points of view.
4. 11-15 yrs. True logical thought. Abstract thinking. Morality established.

Question 22

1. What is Kohlberg’s theory about?
2. What are the 3 stages of moral development?
3. Which theory is Kohlberg’s based upon and what does it emphasize?

Answer 22

1. focuses on stages of moral development during school-age, adolescent, and young adult years
2. pre-conventional, conventional, and post-conventional
3. Piaget’s theory. Emphasizes an ethic of justice and human rights

Question 23

Name the landmarks of each month of infancy (1, 2, 5, 6-7, 7-9, 8-9, 10, 11-12, 12-15 and how parents can facilitate development:

Answer 23

1 mo: Lifts head when prone Place infant in prone position & show parent’s face or toy

2 mo: Has social smile. Talk to infant to stimulate senses

5 mo: Rolls from back to front Place infant in protected area and encourage infant to move by placing toy out of reach

6-7 mo: Sits alone, leaning on hands. Place pillow behind back; practice sitting

7-9 mo: Crawls Confine infant to safe area; childproof house

8-9 mo. Use pincer grasp to feed self. Make finger foods available

10 mo: Pulls self to standing position. Place chair or appropriate object within reach

11-12 mo: Initiates vocalization Talk to infant frequently; read books; include in family gatherings

12-15 mo. Walks Provide clutter free walkways. Praise and encourage infant for attempts

Question 24

1. How much water do (supplied by breast milk) do babies need in the 1st 6month? Second 6months?
2. what percentage of protein do infants need?
3. What percentage of breast milk is fat?
4. What vitamins do babies need?
5. when are solids introduced and when is optimal for less allergy risk?
6. what milestones indicate infant can be weaned?
7. why is bottle propping dangerous?

Answer 24

1. 125-150 mL/kg/day first 6 months
   125-135 mL/kg/day second 6 months
2. ◦ Protein: not to exceed 20%—kidney is immature
3. 50%
4. Vitamin D supplementation (if breastfed) and Iron fortification by 6 months
5. 4-6 months. 6 month optimal
6. no more extrusion reflex, able to sit mostly independently, can turn head to refuse food
7. can aspirate, and dental carries

Question 25

1. Average newborn weighs 2. Newborns lose ........... of birth weight in first week 3. Most infants ....... their birth weight by 4-5 months 4. Most infants ........... their birth weight by 1 year old 5. What should we plot on a growth chart?

Answer 25

1. 7.5 lb at birth 2. 5 – 10% 3. double 4. triple 5. length, weight & head circumference

Question 26

1. leading cause of death (after congenital)? 2. at what age do infant's eye moves coordinate? When do they mature? 3. when is sense of smell fully developed? 4. taste? 5. when do babies start cooing? Babbling? Single words?

Answer 26

1. falls, burns, choking 2. 3 months. 6 months 3. 2 weeks 4. present at birth. salivation at 3 months 5. 2 months, 6 months, 12 months

Question 27

1. What are 3 concepts of psychosocial development in infants? 2. What are 2 concepts of cognitive development in infants? 3. Male babies are .......... than females, but ............ are more physiologically mature than .............. . 4. How can we promote health in babies?

Answer 27

1. Trust vs. Mistrust (Erikson), gratification over frustration, attachment & separation anxiety 2. Sensory and motor development. 3. bigger, females, males 4. Build parental competence in caring for infant, recognizing family's perceptions of good and bad health practices, and teach characteristics that influence health.

Question 28

1. when can infants differentiate self from others in mirror? 2. name a few ways that infants learn to separate self from non-self 3. When are children most commonly abused? Who abuses more frequently? Who abuses more severely or sexually? Why does this happen?

Answer 28

1. 4 months 2. Developed through feedback ◦ Effect of crying/smiling on others ◦ Ability to use body to influence others ◦ Messages infant receives from body 3. under 3yo. Mothers, fathers. Parenting isn't instinctive and it is an inadequate response to parental coping

Question 29

1. what is the diff between a developmental crisis and situational crisis? 2. what are the 3 stages that infants go thru upon separation? 3. How can a nurse intervene

Answer 29

1. developmental is necessary to growth. Learning new skills. Situational is not anticipated like being separated from caregiver 2. ◦ Protest: infant cries loudly; screams for mother ◦ Despair: stops crying; withdrawn, apathetic ◦ Withdrawal: ignores mother on her return

Question 30

1. how long should infants be rear-facing in car seat? 2. What is the max weight od a sheild-type of "infant only" seat? 3. At which months of infant's life are routing immunizations? 4. Active immunizations are: 5. Passive immunizations are:

Answer 30

1. up to 20lbs. 2. 30lbs. 3. birth, 1, 2, 4, 6, and 12 months. 4. Live, killed, or attenuated organisms that stimulate immune system to build immunity. 5. Naturally occurs in newborns from maternal antibodies

Question 31

1. How can nurses help parents in childcare needs? 2. Ideally, mother and infant should be together for ........ to ...... months before starting childcare. 3. In what 2 ways does poverty influence infants?

Answer 31

1. ◦Counseling parents on types/screening day care, and ◦Helping parents understand separation and expected behaviors 2. 4-6 3. ◦ Higher disease rates ◦ Delayed development

Question 32

1. In the toddler years, what is the average increase in height and weight per year? 2. Due to their small airways, what types of infections are toddlers susceptible to? What is the leading cause of hearing loss in toddlers? 3. How many teeth will have erupted by the end of toddler years? 4. By the time a toddler reaches 2.5 years old, how much weight have they gained since birth? 5. Excessive ........ leads to iron-deficiency anemia

Answer 32

1. 2-4 inches height/year; 4-6 lb weight/year 2. respiratory infections and otits media. Otitis media causes hearing loss. 3. 20 4. birth weight quadruples 5. milk

Question 33

1. What is the earliest we can toilet train? 2. How can a nurse provide anticipatory guidance to parents regarding potty training (2)? 3. How many hours of sleep per day do toddlers need?

Answer 33

1. 18 mos. 2. teach parents about developmental readiness of child, and recognize parental attitudes and beliefs on the subject 3. 12 hours

Question 34

1. In toddlerhood, what stages (in Piaget's theory) is the toddler transitioning between? 2. Do toddlers express egocentrism? What does that mean? 3. Knowing that an object exists even when out of view is called? 4. In toddlerhood, what stage in Erikson's theory are they? 5. What are toddlers prone to at this age (behavior) 6. How can parents guide toddlers? 7. Is this age a target for abuse?

Answer 34

1. sensorimotor to preoperational 2. yes. it's the inability to put self in other's shoes. 3. object permanence 4. autonomy vs doubt/shame 5. Tantrums and "NO!" 6. make safe environment, promote their autonomy, avoid tantrum trigger situations 7. YES!

Question 35

1. at 12 months how many words? 2. at 18 months, how many words? 3. at 24 months, how many words? 4. at 30 months, how many words? 5. at 36 months, how many words?

Answer 35

1. few words (mama) undestands more than can speak 2. up to 20 words includes jargon and echolalia. Names familiar objects. Understands up to 50 words. 3. up to 270 words; talks in words, phrases; averages 2-word sentences. Understands up to 1200 words. 4. Says up to 425 words; average sentence length is 2.5 words. Understands up to 2400 words. 5. Says up to 900 words in simple sentences; 3-4 words per sentence. Understands up to 3600 words.

Question 36

1. what is Amblyopia and what causes it? 2. What is Strabismus and what causes it? 3. What affects parent-child interactions and gives a foundation for coping skills? 4. between 1 and ...... years is the greatest risk of drowning. 5. At what age is poisoning a great risk/

Answer 36

1. Amblyopia (lazy eye; diminished or loss of vision in one eye) Cause: brain favors normal eye 2. Strabismus (cross-eyed; deviation in line of vision. Cause: extraocular muscle weakness 3. temperament 4. 3. 5. 1-2 years

Question 37

1. In what 4 ways can we find suitable daycare, and make it a good experience? 2. In what 3 ways can legislation help keep toddlers healthy? 3. What must be routinely assessed in toddlers to ensure their health?

Answer 37

1. o Interview and observe setting o Check references o Decision based on specific criteria o Get and stay involved 2. Safety and injury prevention, Abuse and neglect protection, Assistance for handicapped children 0-3 years 3. Growth/development, Immunizations, Discussion of developmental concerns, Anticipatory guidance

Question 38

1. In what ways can a nurse be involved with families to promote the best health of toddlers (5)?

Answer 38

1. o Provide education focused on the physical and developmental changes for toddler o Teach health-promotion activities to toddlers o Engage in screening activities o Promote routine health examinations and childhood immunization schedule o Educate parents about resources available in the community—many free or low cost