Lowdermilk

Question 1

5. A 21 yearold client complains of severe pain immediately after the commencement of her menses. Which gynecologic condition is the most likely cause of this clients presenting complaint?
   a. Primary dysmenorrhea
   b. Secondary dysmenorrhea
   c. Dyspareunia
   d. Endometriosis

Answer 1

ANS: A
Primary dysmenorrhea, or pain during or shortly before menstruation, has a biochemical basis and arises from the release of prostaglandins with menses. Secondary dysmenorrhea develops after the age of 25 years and is usually associated with a pelvic pathologic condition. Dyspareunia, or painful intercourse, is commonly associated with endometriosis. Endometriosis is characterized by endometrial glands and stoma outside of the uterus.

Question 2

5. A 21yearold client complains of severe pain immediately after the commencement of her menses. Which gynecologic condition is the most likely cause of this clients presenting complaint?
   a. Primary dysmenorrhea
   b. Secondary dysmenorrhea
   c. Dyspareunia
   d. Endometriosis

Answer 2

ANS: A
Primary dysmenorrhea, or pain during or shortly before menstruation, has a biochemical basis and arises from the release of prostaglandins with menses. Secondary dysmenorrhea develops after the age of 25 years and is usually associated with a pelvic pathologic condition. Dyspareunia, or painful intercourse, is commonly associated with endometriosis. Endometriosis is characterized by endometrial glands and stoma outside of the uterus.

Question 3

17. Which nonpharmacologic contraceptive method has a failure rate of less than 25%?
    a. Standard days variation
    b. Periodic abstinence
    c. Postovulation
    d. Coitus interruptus

Answer 3

ANS: A
The standard days variation on the calendar method has a failure rate of 12% and is a variation of the calendar rhythm method with a fixed number of days for fertility in each cycle. The periodic abstinence method has a failure rate of 25% or higher. The postovulation method has a failure rate of 25% or higher. The coitus interruptus method has a failure rate of 27% or higher.

Question 4

25. Nurses, certified nurse-midwives, and other advanced practice nurses have the knowledge and expertise to assist women in making informed choices regarding contraception. A multidisciplinary approach should ensure that the womans social, cultural, and interpersonal needs are met. Which action should the nurse first take when meeting with a new client to discuss contraception?
    a. Obtain data about the frequency of coitus.
    b. Determine the womans level of knowledge concerning contraception and her commitment to any particular method.
    c. Assess the womans willingness to touch her genitals and cervical mucus.
    d. Evaluate the womans contraceptive life plan.

Answer 4

ANS: B
Determining the womans level of knowledge concerning contraception and her commitment to any particular method is the primary step of this nursing assessment and necessary before completing the process and moving on to a nursing diagnosis. Once the clients level of knowledge is determined, the nurse can interact with the woman to compare options, reliability, cost, comfort level, protection from STIs, and her partners willingness to participate. Although important, obtaining data about the frequency of coitus is not the first action that the nurse should undertake when completing an assessment. Data should include not only the frequency of coitus but also the number of sexual partners, level of contraceptive involvement, and the partners objections. Assessing the womans willingness to touch herself is a key factor for the nurse to discuss should the client express an interest in using one of the fertility awareness methods of contraception. The nurse must be aware of the clients plan regarding whether she is attempting to prevent conception, delay conception, or conceive.

Question 5

15. A client in late middle age who is certain she is not pregnant tells the nurse during an office visit that she has urinary problems, as well as sensations of bearing down and of something in her vagina. What condition would the nurse suspect based upon this report?
    a. Pelvic relaxation
    b. Cystoceles and/or rectoceles
    c. Uterine prolapse
    d. Genital fistulas

Answer 5

ANS: B
Uterine displacement can be caused by congenital or acquired weakness of the pelvic support structures and is known as pelvic relaxation. 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 produce a bearing-down sensation with urinary dysfunction. They occur more often in older women who have borne children. Uterine prolapse is a more serious type of displacement. In women with a complete prolapse, the cervix and body of the uterus protrude through the vagina. Genital fistulas are perforations between genital tract organs. Most occur between the bladder and the genital tract.

Question 6

2. Which presumptive sign or symptom of pregnancy would a client experience who is approximately 10 weeks of gestation?
   a. Amenorrhea
   b. Positive pregnancy test
   c. Chadwick sign
   d. Hegar sign

Answer 6

ANS : A
Amenorrhea is a presumptive sign of pregnancy. Presumptive signs of pregnancy are those felt by the woman. A positive pregnancy test and the presence of the Chadwick and Hegar signs are all probable signs of pregnancy.

Question 7

26. The pancreas forms in the foregut during the 5th to 8th week of gestation. A client with poorly controlled gestational diabetes asks the nurse what the effects of her condition will be on the fetus. What is the best response by the nurse? Poorly controlled maternal gestational diabetes will:
    a. produce fetal hypoglycemia.
    b. result in a macrocosmic fetus.
    c. result in a microcosmic fetus.
    d. enhance lung maturation.

Answer 7

ANS: B
Insulin is produced by week 20 of gestation. In the fetus of a mother with uncontrolled diabetes, maternal hypoglycemia produces fetal hypoglycemia and macrocosmia results. Hyperinsulinemia blocks lung maturation, placing the neonate at risk for respiratory distress.

Question 8

As the uterus grows, it may be palpated _____ sometime between the 12th and 14th weeks of pregnancy. At 14 weeks, the uterus is ______ The fundus is not palpable above the umbilicus until _____ weeks of gestation.

Answer 8

above the symphysis pubis

not yet at the level of the umbilicus.

22-24 weeks

Question 9

_____ medications may cause the false-positive test result.

Answer 9

Anticonvulsant

Question 10

16. What is the correct term used to describe the mucous plug that forms in the endocervical canal?
    a. Operculum
    b. Leukorrhea
    c. Funic souffle
    d. Ballottement

Answer 10

ANS: A
The operculum protects against bacterial invasion. Leukorrhea is the mucus that forms the endocervical plug (the operculum). The funic souffle is the sound of blood flowing through the umbilical vessels. Ballottement is a technique for palpating the fetus.

Question 11

Which renal system adaptation is an anticipated anatomic change of pregnancy?

a. Increased urinary output makes pregnant women less susceptible to urinary infections.
b. Increased bladder sensitivity and then compression of the bladder by the enlarging uterus result in the urge to urinate even when the bladder is almost empty.
c. Renal (kidney) function is more efficient when the woman assumes a supine position.
d. Using diuretic agents during pregnancy can help keep kidney function regular.

Answer 11

ANS: B
Bladder sensitivity and then compression of the bladder by the uterus result in the urge to urinate more often, even when the bladder is almost empty. A number of anatomic changes in pregnancy make a woman more susceptible to urinary tract infections. Renal function is more efficient when the woman lies in the lateral recumbent position and is less efficient when she is supine. Diuretic use during pregnancy can overstress the system and cause problems

Question 12

22. Pregnancy hormones prepare the vagina for stretching during labor and birth. Which change related to the pelvic viscera should the nurse share with the client?
    a. Because of a number of changes in the cervix, abnormal Papanicolaou (Pap) tests are easier to evaluate.
    b. Quickening is a technique of palpating the fetus to engage it in passive movement.
    c. The deepening color of the vaginal mucosa and cervix (Chadwick sign) usually appears in the second trimester or later as the vagina prepares to stretch during labor.
    d. Increased vascularity of the vagina increases sensitivity and may lead to a high degree of arousal, especially in the second trimester.

Answer 12

ANS: D
Increased sensitivity and an increased interest in sex sometimes go together and frequently occur during the second trimester. These cervical changes make evaluation of abnormal Pap tests more difficult. Quickening is the first recognition of fetal movements by the mother. Ballottement is a technique used to palpate the fetus. The Chadwick sign appears from the 6 to 8 weeks of gestation.

Question 13

25. To reassure and educate their pregnant clients regarding changes in their blood pressure, nurses should be cognizant of what?
    a. A blood pressure cuff that is too small produces a reading that is too low; a cuff that is too large produces a reading that is too high.
    b. Shifting the clients position and changing from arm to arm for different measurements produces the most accurate composite blood pressure reading at each visit.
    c. Systolic blood pressure slightly increases as the pregnancy advances; diastolic pressure remains constant.
    d. Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of a term pregnancy.

Answer 13

ANS: D
Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of a term pregnancy. This compression also leads to varicose veins in the legs and vulva. The tightness of a blood pressure cuff that is too small produces a reading that is too high; similarly, the looseness of a cuff that is too large results in a reading that is too low. Because maternal positioning affects readings, blood pressure measurements should be obtained in the same arm and with the woman in the same position. The systolic blood pressure generally remains constant but may decline slightly as the pregnancy advances. The diastolic blood pressure first decreases and then gradually increases.

Question 14

29. A patient in her first trimester complains of nausea and vomiting. She asks, Why does this happen? What is the nurses best response?
    a. Nausea and vomiting are due to an increase in gastric motility.
    b. Nausea and vomiting may be due to changes in hormones.
    c. Nausea and vomiting are related to an increase in glucose levels.
    d. Nausea and vomiting are caused by a decrease in gastric secretions.

Answer 14

ANS: B
Nausea and vomiting are believed to be caused by increased levels of hormones, decreased gastric motility, and hypoglycemia. Gastric motility decreases during pregnancy. Glucose levels decrease in the first trimester. Although gastric secretions decrease, these secretions are not the primary cause of the nausea and vomiting.

Question 15

29. A patient in her first trimester complains of nausea and vomiting. She asks, Why does this happen? What is the nurses best response?
    a. Nausea and vomiting are due to an increase in gastric motility.
    b. Nausea and vomiting may be due to changes in hormones.
    c. Nausea and vomiting are related to an increase in glucose levels.
    d. Nausea and vomiting are caused by a decrease in gastric secretions.

Answer 15

ANS: B
Nausea and vomiting are believed to be caused by increased levels of hormones, decreased gastric motility, and hypoglycemia. Gastric motility decreases during pregnancy. Glucose levels decrease in the first trimester. Although gastric secretions decrease, these secretions are not the primary cause of the nausea and vomiting.

Question 16

37. While assessing the vital signs of a pregnant woman in her third trimester, the client complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate?
    a. Have the patient stand up, and then retake her BP.
    b. Have the patient sit down, and then hold her arm in a dependent position.
    c. Have the patient lie supine for 5 minutes, and then recheck her BP on both arms.
    d. Have the patient turn to her left side, and then recheck her BP in 5 minutes.

Answer 16

ANS: D
BP is affected by maternal position during pregnancy. The supine position may cause occlusion of the vena cava and descending aorta. Turning the pregnant woman to a lateral recumbent position alleviates pressure on the blood vessels and quickly corrects supine hypotension. Pressures are significantly higher when the client is standing. This option causes an increase in systolic and diastolic pressures. The arm should be supported at the same level of the heart. The supine position may cause occlusion of the vena cava and descending aorta, creating hypotension.

Question 17

2. A pregnant womans diet consists almost entirely of whole grain breads and cereals, fruits, and vegetables. Which dietary requirement is the nurse most concerned about?
   a. Calcium
   b. Protein
   c. Vitamin B12
   d. Folic acid

Answer 17

ANS: C
A pregnant womans diet is consistent with that followed by a strict vegetarian (vegan). Vegans consume only plant products. Because vitamin B12 is found in foods of animal origin, this diet is deficient in vitamin B12. Depending on the womans food choices, a pregnant womans diet may be adequate in calcium. Protein needs can be sufficiently met by a vegetarian diet. The nurse should be more concerned with the womans intake of vitamin B12 attributable to her dietary restrictions. Folic acid needs can be met by enriched bread products.

Question 18

17. Which guidance might the nurse provide for a client with severe morning sickness?
    a. Trying lemonade and potato chips
    b. Drinking plenty of fluids early in the day
    c. Immediately brushing her teeth after eating
    d. Never snacking before bedtime

Answer 18

ANS: A
Interestingly, some women can tolerate tart or salty foods when they are nauseated. Lemonade and potato chips are an ideal combination. The woman should avoid drinking too much when nausea is most likely, but she should increase her fluid levels later in the day when she feels better. The woman should avoid brushing her teeth immediately after eating. A small snack of cereal and milk or yogurt before bedtime may help the stomach in the morning.

Question 19

24. The labor and delivery nurse is preparing a client who is severely obese (bariatric) for an elective cesarean birth. Which piece of specialized equipment will not likely be needed when providing care for this pregnant woman?
    a. Extra-long surgical instruments
    b. Wide surgical table
    c. Temporal thermometer
    d. Increased diameter blood pressure cuff

Answer 19

ANS: C
Obstetricians today are seeing an increasing number of morbidly obese pregnant women weighing 400, 500, and 600 pounds. To manage their conditions and to meet their logistical needs, a new medical subspecialty,bariatric obstetrics, has arisen. Extra-wide blood pressure cuffs, scales that can accommodate up to 880 pounds, and extra-wide surgical tables designed to hold the weight of these women are used. Special techniques for ultrasound examination and longer surgical instruments for cesarean birth are also required. A temporal thermometer can be used for a pregnant client of any size.

Question 20

4. Which statement by the client would lead the nurse to believe that labor has been established?
   a. I passed some thick, pink mucus when I urinated this morning.
   b. My bag of waters just broke.
   c. The contractions in my uterus are getting stronger and closer together.
   d. My baby dropped, and I have to urinate more frequently now

Answer 20

ANS: C
Regular, strong contractions with the presence of cervical change indicate that the woman is experiencing true labor. Although the loss of the mucous plug (operculum) often occurs during the first stage of labor or before the onset of labor, it is not the indicator of true labor. Spontaneous rupture of membranes often occurs during the first stage of labor; however, it is not an indicator of true labor. The presenting part of the fetus typically becomes engaged in the pelvis at the onset of labor but is not the indicator of true labor.

Question 21

19. Conscious relaxation is associated with which method of childbirth preparation?
    a. Grantly Dick-Read childbirth method
    b. Lamaze method
    c. Bradley method
    d. Psychoprophylactic method

Answer 21

ANS: A
With the Grantly Dick-Read method, women are taught to consciously and progressively relax different muscle groups throughout the body until a high degree of skill at relaxation is achieved. The Lamaze method combines controlled muscular relaxation with breathing techniques. The Bradley method advocates natural labor, without any form of anesthesia or analgesia, assisted by a husband-coach and using breathing techniques for labor. The psychoprophylactic method is another name for the Lamaze method.

Question 22

6. Which alteration in the FHR pattern would indicate the potential need for an amnioinfusion?
   a. Variable decelerations
   b. Late decelerations
   c. Fetal bradycardia
   d. Fetal tachycardia

Answer 22

ANS: A
Amnioinfusion is used during labor to either dilute meconium-stained amniotic fluid or supplement the amount of amniotic fluid to reduce the severity of variable FHR decelerations caused by cord compression. Late decelerations are unresponsive to amnioinfusion. Amnioinfusion is not appropriate for the treatment of fetal bradycardia and has no bearing on fetal tachycardia.

Question 23

11. The perinatal nurse realizes that an FHR that is tachycardic, bradycardic, has late decelerations, or loss of variability is nonreassuring and is associated with which condition?
    a. Hypotension
    b. Cord compression
    c. Maternal drug use
    d. Hypoxemia

Answer 23

ANS: D
Nonreassuring FHR patterns are associated with fetal hypoxemia. Fetal bradycardia may be associated with maternal hypotension. Variable FHR decelerations are associated with cord compression. Maternal drug use is associated with fetal tachycardia.

Question 24

6. When assessing a woman in the first stage of labor, which clinical finding will alert the nurse that uterine contractions are effective?
   a. Dilation of the cervix
   b. Descent of the fetus to 2 station
   c. Rupture of the amniotic membranes
   d. Increase in bloody show

Answer 24

ANS: A
The vaginal examination reveals whether the woman is in true labor. Cervical change, especially dilation, in the presence of adequate labor, indicates that the woman is in true labor. Engagement and descent of the fetus are not synonymous and may occur before labor. ROM may occur with or without the presence of labor. Bloody show may indicate a slow, progressive cervical change (e.g., effacement) in both true and false labor.

Question 25

MSC: Client Needs: Health Promotion and Maintenance

15. Which description of the phases of the first stage of labor is most accurate?
    a. Latent: mild, regular contractions; no dilation; bloody show
    b. Active: moderate, regular contractions; 4 to 7 cm dilation
    c. Lull: no contractions; dilation stable
    d. Transition: very strong but irregular contractions; 8 to 10 cm dilation

Answer 25

ANS: B
The active phase is characterized by moderate and regular contractions, 4 to 7 cm dilation, and duration of 3 to 6 hours. The latent phase is characterized by mild-to-moderate and irregular contractions, dilation up to 3 cm, brownish-to-pale pink mucus, and duration of 6 to 8 hours.

Question 26

18. Where is the point of maximal intensity (PMI) of the FHR located?
    a. Usually directly over the fetal abdomen
    b. In a vertex position, heard above the mothers umbilicus
    c. Heard lower and closer to the midline of the mothers abdomen as the fetus descends and internally rotates
    d. In a breech position, heard below the mothers umbilicus

Answer 26

ANS: C
Nurses should be prepared for the shift. The PMI of the FHR is usually directly over the fetal back. In a vertex position, the PMI of the FHR is heard below the mothers umbilicus. In a breech position, it is heard above the mothers umbilicus.

Question 27

20. Which technique is an adequate means of controlling the birth of the fetal head during delivery in a vertex presentation?
    a. Ritgen maneuver
    b. Fundal pressure
    c. Lithotomy position
    d. De Lee apparatus

Answer 27

ANS: A
The Ritgen maneuver extends the head during the actual birth and protects the perineum. Gentle, steady pressure against the fundus of the uterus facilitates vaginal birth. The lithotomy position has been commonly used in Western cultures, partly because it is convenient for the health care provider. The De Lee apparatus is used to suction fluid from the infants mouth.

Question 28

20. Which statement, related to the reconditioning of the urinary system after childbirth, should the nurse understand?
    a. Kidney function returns to normal a few days after birth.
    b. Diastasis recti abdominis is a common condition that alters the voiding reflex.
    c. Fluid loss through perspiration and increased urinary output accounts for a weight loss of more than 2 kg during the puerperium.
    d. With adequate emptying of the bladder, bladder tone is usually restored 2 to 3 weeks after childbirth.

Answer 28

ANS: C
Excess fluid loss through other means besides perspiration and increased urinary output occurs as well. Kidney function usually returns to normal in approximately 1 month. Diastasis recti abdominis is the separation of muscles in the abdominal wall and has no effect on the voiding reflex. Bladder tone is usually restored 5 to 7 days after childbirth.

Question 29

17. Women with severe and persistent mental illness are likely to be more vulnerable to being involved in controlling and/or violent relationships; however, many women develop mental health problems as a result of long-term abuse. Which condition is unlikely to be a psychologic consequence of continued abuse?
    a. Substance abuse
    b. Posttraumatic stress disorder (PTSD)
    c. Eating disorders
    d. Bipolar disorder

Answer 29

ANS: D
Bipolar disorder is a specific illness (also known as manic depressive disorder) not related to abuse. Substance abuse is a common method of coping with long-term abuse. The abuser is also more likely to use alcohol and other chemical substances. PTSD is the most prevalent mental health sequela of long-term abuse. The traumatic event is persistently re-experienced through distress recollection and dreams. Eating disorders, depression, psychologic-physiologic illness, and anxiety reactions are all mental health problems associated with repeated abuse.

Question 30

3. Which sexually transmitted infection (STI) is the most commonly reported in American women?
   a. Gonorrhea b. Syphilis
   c. Chlamydia d. Candidiasis

Answer 30

ANS: C
Chlamydia is the most common and fastest spreading STI among American women, with an estimated 3 million new cases each year. Infection rates are two and a half times that of men. Gonorrhea is probably the oldest communicable disease in the United States and second to Chlamydia in reported conditions. Syphilis is the earliest described STI. Candidiasis is a relatively common fungal infection.

Question 31

4. The Centers for Disease Control and Prevention (CDC) recommends which therapy for the treatment of the HPV?

Answer 31

ANS: B
Available treatments are imiquimod, podophyllin, and podofilox. Miconazole ointment is used to treat athletes foot. Penicillin IM is used to treat syphilis. Metronidazole is used to treat bacterial vaginosis.

Question 32

5. A client exhibits a thick, white, lumpy, cottage cheeselike discharge, along with white patches on her labia and in her vagina. She complains of intense pruritus. Which medication should the nurse practitioner order to treat this condition?
   a. Fluconazole b. Tetracycline c. Clindamycin d. Acyclovir

Answer 32

ANS: A
The client is experiencing a candidiasis infection. Fluconazole, metronidazole, and clotrimazole are the drugs of choice to treat this condition. Tetracycline is used to treat syphilis. Clindamycin is used to treat bacterial vaginosis. Acyclovir is used to treat genital herpes.

Question 33

11. The nurse should understand the process by which the HIV infection occurs. Once the virus has entered the body, what is the time frame for seroconversion to HIV positivity?
    a. 6 to 10 days
    b. 2 to 4 weeks
    c. 6 to 12 weeks
    d. 6 months

Answer 33

ANS: C
Seroconversion to HIV positivity usually occurs within 6 to 12 weeks after the virus has entered the body. Both 6 to 10 days and 2 to 4 weeks are too short for seroconversion to HIV positivity to occur, and 6 months is too long.

Question 34

15. A 21-year-old client exhibits a greenish, copious, and malodorous discharge with vulvar irritation. A speculum examination and wet smear are performed. Which condition is this client most likely experiencing?
    a. Bacterial vaginosis
    b. Candidiasis
    c. Yeast infection
    d. Trichomoniasis

Answer 34

ANS: D
Although uncomfortable, a speculum examination is always performed and a wet smear obtained if the client exhibits symptoms of trichomoniasis. The presence of many white blood cell protozoa is a positive finding for trichomoniasis.

Question 35

18. Clients treated for syphilis with penicillin may experience a Jarisch-Herxheimer reaction. Which clinical presentation would be unlikely if a client is experiencing this reaction?
    a. Vomiting and diarrhea
    b. Headache, myalgias, and arthralgia
    c. Preterm labor
    d. Jarisch-Herxheimer in the first 24 hours after treatment

Answer 35

ANS: A
The Jarisch-Herxheimer reaction is an acute febrile reaction that occurs within the first 24 hours of treatment and is accompanied by headache, myalgias, and arthralgia. Vomiting and diarrhea are not anticipated. If the client is pregnant, then she is at risk for preterm labor and birth.

Question 36

21. What is the drug of choice for the treatment of gonorrhea?
    a. Penicillin G
    b. Tetracycline
    c. Ceftriaxone
    d. Acyclovir

Answer 36

ANS: C
Ceftriaxone is effective for the treatment of all gonococcal infections. Penicillin is used to treat syphilis. Tetracycline is prescribed for chlamydial infections. Acyclovir is used to treat herpes genitalis.

Question 37

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

Answer 37

ANS: D
The major consequences of smoking tobacco during pregnancy are low-birth-weight infants, prematurity, and increased perinatal loss. Cigarettes will not normally cause genetic changes or extensive CNS damage. Addiction to tobacco is not a usual concern related to the neonate.

Question 38

36. The condition during which infants are at an increased risk for subgaleal hemorrhage is called what?
    a. Infection
    b. Jaundice
    c. Caput succedaneum
    d. Erythema toxicum neonatorum

Answer 38

ANS: B
Subgaleal hemorrhage is bleeding into the subgaleal compartment and is the result of the transition from a forceps or vacuum application. Because of the breakdown of the red blood cells within a hematoma, infants are at greater risk for jaundice. Subgaleal hemorrhage does not increase the risk for infections. Caput succedaneum is an edematous area on the head caused by pressure against the cervix. Erythema toxicum neonatorum is a benign rash of unknown cause that consists of blotchy red areas.

Question 39

14. Women with mild gestational hypertension and mild preeclampsia can be safely managed at home with frequent maternal and fetal evaluation. Complete or partial bed rest is still frequently ordered by some providers. Which complication is rarely the result of prolonged bed rest?
    a. Thrombophlebitis
    b. Psychologic stress
    c. Fluid retention
    d. Cardiovascular deconditioning

Answer 39

ANS: C
No evidence has been found that supports the practice of bed rest to improve pregnancy outcome. Fluid retention is not an adverse outcome of prolonged bed rest. The woman is more likely to experience diuresis with accompanying fluid and electrolyte imbalance and weight loss. Prolonged bed rest is known to increase the risk for thrombophlebitis. Psychologic stress is known to begin on the first day of bed rest and continue for the duration of the therapy. Therefore, restricted activity, rather than complete bed rest, is recommended. Cardiovascular deconditioning is a known complication of bed rest.

Question 40

15. Which neonatal complications are associated with hypertension in the mother?
    a. Intrauterine growth restriction (IUGR) and prematurity
    b. Seizures and cerebral hemorrhage
    c. Hepatic or renal dysfunction
    d. Placental abruption and DIC

Answer 40

ANS: A
Neonatal complications are related to placental insufficiency and include IUGR, prematurity, and necrotizing enterocolitis. Seizures and cerebral hemorrhage are maternal complications. Hepatic and renal dysfunction are maternal complications of hypertensive disorders in pregnancy. Placental abruption and DIC are conditions related to maternal morbidity and mortality.

Question 41

16. The nurse has evaluated a client with preeclampsia by assessing DTRs. The result is a grade of 3+. Which DTR response most accurately describes this score?
    a. Sluggish or diminished
    b. Brisk, hyperactive, with intermittent or transient clonus
    c. Active or expected response
    d. More brisk than expected, slightly hyperactive

Answer 41

ANS: D
DTRs reflect the balance between the cerebral cortex and the spinal cord. They are evaluated at baseline and to detect changes. A slightly hyperactive and brisk response indicates a grade 3+ response.

Question 42

19. What is the most common medical complication of pregnancy?
    a. Hypertension
    b. Hyperemesis gravidarum
    c. Hemorrhagic complications
    d. Infections

Answer 42

ANS: A
Preeclampsia and eclampsia are two noted deadly forms of hypertension. A large percentage of pregnant women will have nausea and vomiting, but a relatively few will have the severe form called hyperemesis gravidarum. Hemorrhagic complications are the second most common medical complication of pregnancy; hypertension is the most common. Infection is a risk factor for preeclampsia.

Question 43

6. A woman arrives for evaluation of signs and symptoms that include a missed period, adnexal fullness, tenderness, and dark red vaginal bleeding. On examination, the nurse notices an ecchymotic blueness around the womans umbilicus. What does this finding indicate?
   a. Normal integumentary changes associated with pregnancy
   b. Turner sign associated with appendicitis
   c. Cullen sign associated with a ruptured ectopic pregnancy
   d. Chadwick sign associated with early pregnancy

Answer 43

ANS: C
Cullen sign, the blue ecchymosis observed in the umbilical area, indicates hematoperitoneum associated with an undiagnosed ruptured intraabdominal ectopic pregnancy.

Question 44

10. The management of the pregnant client who has experienced a pregnancy loss depends on the type of miscarriage and the signs and symptoms. While planning care for a client who desires outpatient management after a first-trimester loss, what would the nurse expect the plan to include?
    a. Dilation and curettage (D&C)
    b. Dilation and evacuation (D&E)
    c. Misoprostol
    d. Ergot products

Answer 44

ANS: C
Outpatient management of a first-trimester loss is safely accomplished by the intravaginal use of misoprostol for up to 2 days. If the bleeding is uncontrollable, vital signs are unstable, or signs of infection are present, then a surgical evacuation should be performed. D&C is a surgical procedure that requires dilation of the cervix and scraping of the uterine walls to remove the contents of pregnancy. This procedure is commonly performed to treat inevitable or incomplete abortion and should be performed in a hospital. D&E is usually performed after 16 weeks of pregnancy. The cervix is widely dilated, followed by removal of the contents of the uterus. Ergot products such as Methergine or Hemabate may be administered for excessive bleeding after miscarriage.

Question 45

11. Which laboratory marker is indicative of DIC?
    a. Bleeding time of 10 minutes
    b. Presence of fibrin split products
    c. Thrombocytopenia
    d. Hypofibrinogenemia

Answer 45

ANS: B
Degradation of fibrin leads to the accumulation of multiple fibrin clots throughout the bodys vasculature. Bleeding time in DIC is normal. Low platelets may occur but are not indicative of DIC because they may be the result from other coagulopathies. Hypofibrinogenemia occurs with DIC.

Question 46

12. When is a prophylactic cerclage for an incompetent cervix usually placed (in weeks of gestation)?
    a. 12to14
    b. 6to8
    c. 23to24
    d. After 24

Answer 46

ANS: A
A prophylactic cerclage is usually placed at 12 to 14 weeks of gestation. The cerclage is electively removed when the woman reaches 37 weeks of gestation or when her labor begins. Six to 8 weeks of gestation is too early to place the cerclage. Cerclage placement is offered if the cervical length falls to less than 20 to 25 mm before 23 to 24 weeks. Although no consensus has been reached, 24 weeks is used as the upper gestational age limit for cerclage placement.

Question 47

24. A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Which information assists the nurse in developing the plan of care?
    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 performed to remove the products of conception.
    d. Hemorrhage is the primary concern.

Answer 47

ANS: D
Severe bleeding occurs if the fallopian tube ruptures. The recommended treatment is to remove the pregnancy before rupture to prevent hemorrhaging. If the tube must be removed, then the womans fertility will decrease; however, she will not be infertile. A D&C is performed on the inside of the uterine cavity. The ectopic pregnancy is located within the tubes.

Question 48

4. Which client is at greatest risk for early PPH?
   a. Primiparous woman (G 2, P 1-0-0-1) being prepared for an emergency cesarean birth for fetal distress
   b. Woman with severe preeclampsia on magnesium sulfate whose labor is being induced
   c. Multiparous woman (G 3, P 2-0-0-2) with an 8-hour labor
   d. Primigravida in spontaneous labor with preterm twins

Answer 48

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. A primiparous woman being prepared for an emergency cesarean birth for fetal distress, a multiparous woman with an 8-hour labor, and a primigravida in spontaneous labor with preterm twins do not indicate risk factors or causes of early PPH.

Question 49

14. If nonsurgical treatment for late PPH is ineffective, which surgical procedure would be appropriate to correct the cause of this condition?
    a. Hysterectomy
    b. Laparoscopy
    c. Laparotomy
    d. Dilation and curettage (D&C)

Answer 49

ANS: D
D&C allows the examination of the uterine contents and the removal of any retained placental fragments or blood clots. Hysterectomy is the removal of the uterus and is not the appropriate treatment for late PPH.

Question 50

6. Which clinical findings would alert the nurse that the neonate is expressing pain?
   a. Low-pitched crying; tachycardia; eyelids open wide
   b. Cry face; flaccid limbs; closed mouthc. High-pitched, shrill cry; withdrawal; change in heart rate d. Cry face; eyes squeezed; increase in blood pressure

Answer 50

ANS: D
Crying and an increased heart rate are manifestations indicative of pain in the neonate. Typically, infants tightly close their eyes when in pain, not open them wide. In addition, infants may display a rigid posture with the mouth open and may also withdraw limbs and become tachycardic with pain. A high-pitched, shrill cry is associated with genetic or neurologic anomalies.

Question 51

9. A pregnant woman was admitted for induction of labor at 43 weeks of gestation with sure dates. A nonstress test (NST) in the obstetricians office revealed a nonreactive tracing. On artificial rupture of membranes, thick meconium-stained fluid was noted. What should the nurse caring for the infant after birth anticipate?
   a. Meconium aspiration, hypoglycemia, and dry, cracked skin
   b. Excessive vernix caseosa covering the skin, lethargy, and RDS
   c. Golden yellow to green-stained skin and nails, absence of scalp hair, and an increased amount of subcutaneous fat
   d. Hyperglycemia, hyperthermia, and an alert, wide-eyed appearancev

Answer 51

ANS: A
Meconium aspiration, hypoglycemia, and dry, cracked skin are consistent with a postmature infant. Excessive vernix caseosa, lethargy, and RDS are consistent with a very premature infant. The skin may be meconium stained, but the infant will most likely have long hair and decreased amounts of subcutaneous fat. Postmaturity with a nonreactive NST is indicative of hypoxia. Signs and symptoms associated with fetal hypoxia are hypoglycemia, temperature instability, and lethargy.

Question 52

17. When providing an infant with a gavage feeding, which infant assessment should be documented each time?
    a. Abdominal circumference after the feeding
    b. Heart rate and respirations before feeding
    c. Suck and swallow coordination
    d. Response to the feeding

Answer 52

ANS: D
Documentation of a gavage feeding should include the size of the feeding tube, the amount and quality of the residual from the previous feeding, the type and quantity of the fluid instilled, and the infants response to the procedure. Abdominal circumference is not measured after a gavage feeding. Although vital signs may be obtained before feeding, the infants response to the feeding is more important. Similarly, some older infants may be learning to suck; the most important factor to document would still be the infants response to the feeding, including the attempts to suck.

Question 53

23. NEC is an acute inflammatory disease of the gastrointestinal mucosa that can progress to perforation of the bowel. Approximately 2% to 5% of premature infants succumb to this fatal disease. Care is supportive; however, known interventions may decrease the risk of NEC. Which intervention has the greatest effect on lowering the risk of NEC?
    a. Early enteral feedings
    b. Breastfeeding
    c. Exchange transfusion
    d. Prophylactic probiotics

Answer 53

ANS: B
A decrease in the incidence of NEC is directly correlated with exclusive breastfeeding. Breast milk enhances the maturation of the gastrointestinal tract and contains immune factors that contribute to a lower incidence or severity of NEC, Crohn disease, and celiac illness. The NICU nurse can be very supportive of the mother in terms of providing her with equipment to pump breast milk, ensuring privacy, and encouraging skin-to-skin contact with the infant. Early enteral feedings of formula or hyperosmolar feedings are a risk factor known to contribute to the development of NEC. The mother should be encouraged to pump or feed breast milk exclusively. Exchange transfusion may be necessary; however, it is a known risk factor for the development of NEC. Although still early, a study in 2005 found that the introduction of prophylactic probiotics appeared to enhance the normal flora of the bowel and therefore decrease the severity of NEC when it did occur. This treatment modality is not as widespread as encouraging breastfeeding; however, it is another strategy that the care providers of these extremely fragile infants may have at their disposal.

Question 54

3. What information regarding a fractured clavicle is most important for the nurse to take into consideration when planning the infants care?
   a. Prone positioning facilitates bone alignment.
   b. No special treatment is necessary.
   c. Parents should be taught range-of-motion exercises.
   d. The shoulder should be immobilized with a splint.

Answer 54

ANS: B
Fractures in newborns generally heal rapidly. Except for gentle handling, no accepted treatment for a fractured clavicle exists. Movement should be limited, and the infant should be gently handled. Performing range-of-motion exercises on the infant is not necessary. A fractured clavicle does not require immobilization with a splint.

Question 55

5. 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 (FHR) before birth is 180 beats per minute with limited variability. At birth the newborn has Apgar scores of 6 and 7 at 1 and 5 minutes and is noted to be pale and tachypneic. Based on the maternal history, what is the most likely cause of this newborns distress?
   a. Hypoglycemia
   b. Phrenic nerve injury
   c. Respiratory distress syndrome
   d. Sepsis

Answer 55

ANS: D
The prolonged rupture of membranes and the tachypnea (before and after birth) suggest sepsis. A differential diagnosis can be difficult because signs of sepsis are similar to noninfectious problems such as anemia and hypoglycemia. Phrenic nerve injury is usually the result of traction on the neck and arm during childbirth and is not applicable to this situation. The earliest signs of sepsis are characterized by lack of specificity (e.g., lethargy, poor feeding, irritability), not respiratory distress syndrome.

Question 56

14. The nurse is evaluating a neonate who was delivered 3 hours ago by vacuum-assisted delivery. The infant has developed a cephalhematoma. Which statement is most applicable to the care of this neonate?
    a. Intracranial hemorrhage (ICH) as a result of birth trauma is more likely to occur in the preterm, low-birth-weight infant.
    b. Subarachnoid hemorrhage (the most common form of ICH) occurs in term infants as a result of hypoxia.
    c. In many infants, signs of hemorrhage in a full-term infant are absent and diagnosed only through laboratory tests.
    d. Spinal cord injuries almost always result from vacuum-assisted deliveries

Answer 56

ANS: C
Abnormalities in lumbar punctures or red blood cell counts, for instance, or in visuals on computed tomographic (CT) scans might reveal a hemorrhage. ICH as a result of birth trauma is more likely to occur in the full-term, large infant. Subarachnoid hemorrhage in term infants is a result of trauma; in preterm infants, it is a result of hypoxia. Spinal cord injuries are almost always from breech births; however, spinal cord injuries are rare today because cesarean birth is used for breech presentation.

Question 57

17. 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. What is the first step in the provision of care for the infant?
    a. Pharmacologic treatment
    b. Reduction of environmental stimuli
    c. Neonatal abstinence syndrome (NAS) scoring
    d. Adequate nutrition and maintenance of fluid and electrolyte balance

Answer 57

ANS: C
NAS describes the cohort of symptoms associated with drug withdrawal in the neonate. The NAS system evaluates CNS, metabolic, vasomotor, respiratory, and gastrointestinal (GI) disturbances. This evaluation tool enables the health care team to develop an appropriate plan of care. The infant is scored throughout his or her length of stay, and the treatment plan is adjusted accordingly. Pharmacologic treatment is based on the severity of the withdrawal symptoms, which are determined by using a standard assessment tool. Medications of choice are morphine, phenobarbital, diazepam, or diluted tincture of opium. Swaddling, holding, and reducing environmental stimuli are essential in providing care to the infant who is experiencing withdrawal. These nursing interventions are appropriate for the infant who displays CNS disturbances. Poor feeding is one of the GI symptoms common to this client population. Fluid and electrolyte balance must be maintained, and adequate nutrition provided. These infants often have a poor suck reflex and may need to be fed via gavage.