Neneh Sheriff Flashcards
Master test 1 material
1
Q
During a prenatal visit, a client expresses interest in accessing community-based care and services. Which response allows the registered nurse to best describe services that are offered by way of community-based care?
A. “Most healthcare services provided to childbearing women and their families take place in a hospital setting.”
B. “Community-based care can provide a client with certain primary care services.”
C. “Nurses are the sole providers of services related to home care.”
D. “Due to lack of support from third-party payers, community-based care has decreased.”
A
B.
2
Q
The labor and delivery nurse and a novice nurse are admitting a client who is in labor. The client is making groaning guttural sounds during contractions and answers questions with one-word answers. The labor and delivery nurse is quickly setting up the instruments and sterile field for this delivery while asking admission questions between contractions. The labor and delivery nurse has not completed a pelvic exam. The novice nurse understands that this is an example of:
A. An expert nurse assessing advanced labor and imminent delivery in the client.
B. The correct order of steps when admitting a who is in labor.
C. Inconsistencies in an individual nurse’s approach to client care.
D. Advanced nurse practice.
A
A.
3
Q
Currently, one-third of children under 20 years old come from families of minority populations. The new nurse is observing her preceptor assess the client’s communication pattern, religious beliefs, level of education, and support system. The new nurse understands that the best reason for her preceptor to assess these areas is to increase the:
A. Client’s cooperation with the plan of care.
B. Hospitals compliance with the Joint Commission on Accreditation of Healthcare Organizations JCAHO standards.
C. Nurse’s knowledge of cultural beliefs.
D. Client’s satisfaction with her care.
A
A.
4
Q
The client at 30 weeks’ gestation expresses a desire for the registered nurse to independently manage her perinatal care and the birth of her baby. When the nurse explains she is not credentialed to independently manage the client’s perinatal care and delivery, the nurse is recognizing principles related to:
A. Standards of care.
B. Scope of practice.
C. Right to privacy.
D. Informed consent.
A
B.
5
Q
The certified nurse-midwife (CNM) role includes which of the following? Select all that apply.
A. Prepared to independently the care of women that are at low risk for complications during pregnancy and birth
B. Provides primary care for high-risk patients who are in hospital settings
C. Provides primary care for healthy newborns
D. Obtains a physician consultation for any technical procedures at delivery
E. Formal educated in two disciplines of nursing
A
A, C, C
6
Q
The new graduate is learning about advanced practice nursing. Which of the following situations best illustrates an advanced practice nursing role? Select all that apply.
A. An experienced registered nurse who is the manager of a large obstetrical unit
B. A registered nurse who is the circulating nurse at surgical (cesarean) deliveries
C. A clinical nurse specialist who is the staff nurse on a mother—baby unit
D. A nurse practitioner consults with a physician in the newborn nursery
E. A nurse-midwife who attends vaginal deliveries of uncomplicated pregnancies
A
D, E
7
Q
The major focus of the nurse practitioner (NP) is on:
A. Leadership.
B. Physical and psychosocial clinical assessment.
C. Independent care of a patient with a high-risk pregnancy.
D. Tertiary prevention.
A
B
8
Q
The nurse is reviewing charts for quality improvement. A client experienced a complication during labor. The nurse is uncertain if the labor nurse took the appropriate action during the situation. What is the best method for the quality improvement nurse to determine if the action by the labor and delivery nurse was justified?
A. Call the nurse manager of the labor and delivery unit and ask what the nurse should be doing.
B. Ask the departmental chair of the obstetrical physicians what the best nursing action should be.
C. Examine other charts to find cases of the same complication, and determine how it was handled in those situations.
D. Look in the policy and procedure book. Examine the practice guidelines published by a professional nursing organization.
A
D
9
Q
According to the 1973 United States Supreme Court decision in Roe v. Wade, abortion is legal if induced:
A. At a federally funded clinic.
B. Before the period of viability.
C. To provide tissue for therapeutic research.
D. At a military hospital overseas.
A
B
10
Q
The nurse is caring for a client who has delivered her first child. The client states, “My mother said that I have to have a bowel movement before I can go home, but my girlfriend said that isn’t true anymore. What caused this change?” Which response by the nurse is best?
A. “Doctors just want clients to go home sooner these days.”
B. “It really doesn’t matter. Don’t worry about it.”
C. “Research indicates that it is normal for bowel function to be slow for a few days.”
D. “We used to give all clients laxatives, but now they cost too much.”
A
C
11
Q
Which of the following practices characterize the basic competencies related to evidence-based practice? Select all that apply.
A. Clinical practice supported by good evidence
B. Clinical practice supported by intuitive evidence
C. Clinical practice supported by data
D. Clinical practice that promotes quality
E. Clinical practice that provides a useful approach to problem solving
A
A, C, D, E
12
Q
The nurse is preparing a report on the number of births by three service providers at the facility (certified nurse—midwives, family practitioners, and obstetricians). This would be an example of:
A. Inferential statistics.
B. Descriptive statistics.
C. Evidence-based practice is the use of conclusions of research to improve nursing care.
D. Secondary use of data.
A
B
13
Q
An example of descriptive statistics is:
A. A positive correlation between breastfeeding and infant weight gain.
B. The infant mortality rate in the state of Oklahoma.
C. A causal relationship between the number of sexual partners and sexually transmitted diseases.
D. The total number of spontaneous abortions in women who abuse drugs compared to women who do not abuse drugs.
A
B
14
Q
The 2011 estimated infant mortality rate in the United States exceeds the infant mortality rate of several other developed countries, including Sweden, Japan, France, Germany, and Canada. Which research question most effectively explores variables that may potentially influence these statistics?
A. What is the average age of healthcare providers in each country?
B. What is the level of racial diversity in each country?
C. What is the average age of children in each country?
D. What is the level of awareness related to contraception in each country?
A
B.
15
Q
The nurse knows the birth rate by age group in the state. Which research question could be developed for further study from this data?
A. What is the average number of children per family in the United States?
B. How does educational level affect the incidence of unplanned pregnancy?
C. What is the overall nutritional status of adolescents?
D. Which high schools provide day care for student parents?
A
B
16
Q
The major focus of the clinical nurse specialist (CNS) involves:
A. Conducting physical and psychosocial assessments, including history, physical examination, and certain diagnostic tests and procedures.
B. Independently managing the care of women at low risk for complications during pregnancy and birth and the care of healthy newborns.
C. Generating new research relevant to topics such as health care and administrative issues.
D. Demonstrating leadership within his or her specialty and working to improve inpatient care both directly and indirectly.
A
D
17
Q
A couple has been attempting pregnancy for the last three years and is looking for assistance from the fertility specialist. The nurse assesses the client’s emotional response to infertility. Which responses could the nurse expect? Select all that apply.
A. Love, no matter what, they have each other
B. Failure, they cannot conceive a child
C. Anger, other people have children
D. Fear, they may never experience parenthood
E. Sadness, they may never have a child
A
B, C, D, E
18
Q
The student is reading an article that states the pregnancy-related mortality rate in the United States in the year 2011 was 17.8. Which statement(s) by the student could be an accurate explanation? Select all that apply.
A. In 2011, there were 17.8 maternal deaths per 100,000 women of childbearing age in the United States.
B. In 2011, there were 17.8 maternal deaths per 100,000 live births in the United States.
C. In 2011, there were 17.8 maternal deaths per 100,000 women in the country in the United States.
D. In 2011, there were 17.8 maternal deaths per 100,000 pregnancies in the United States.
E. In 2011, there were 17.8 deaths of women from the United States as a result of the childbearing period per 100,000 live births.
A
D, E
19
Q
While conducting a family assessment, the nurse determines that a particular family’s structure is binuclear. Some potential challenges inherently faced by binuclear families include:
A. Challenges related to coparenting and joint custody, including negotiation and compromise between the parents about childrearing decisions.
B. Issues related to both parents being employed, including child care, household chores, and spending time together.
C. Challenges related to children interacting with peers and when revealing their parents sexual orientation.
D. Issues related to single parenting, including lack of social and emotional support, need for assistance with childrearing, and financial strain.
A
A
20
Q
The nurse is preparing a community presentation on family development. Which of the following statements should the nurse include?
A. The youngest child’s age determines the family’s current stage.
B. A family does not experience overlapping of stages.
C. Family development ends when the youngest child leaves home.
D. The stages describe the family’s progression over time.
A
D
21
Q
The nurse is preparing to assess the development of a family new to the clinic. The nurse understands that the primary use of a family assessment tool is to:
A. Obtain a comprehensive medical history of family members.
B. Determine which clinic the client should be referred to.
C. Predict how a family will likely change with the addition of children.
D. Understand the physical, emotional, and spiritual needs of members.
A
D
22
Q
A nurse is caring for a Muslim client who is pregnant. She is anticipating delivery within the next few days. The nurse asks if she and her husband have chosen a name for their baby. The patient quietly shakes her head, “no.” Based upon the patient’s response, the nurse understands that:
A. The client is not happily anticipating the arrival of her baby.
B. Cultural beliefs may require the couple to choose the baby’s name following the birth.
C. The client does not speak English.
D. Cultural beliefs may require that the baby’s name be kept secret until after the delivery.
A
B
23
Q
A woman of Korean descent has just given birth to a son. Her partner wishes to give her sips of hot broth from a thermos that he brought from home. The client has refused your offer of ice chips or other cold drinks. The nurse should:
A. Explain to the client that she can have the broth if she will also drink cold water or juice.
B. Encourage the partner to feed the client sips of broth. Ask if the client would like you to bring her some warm water to drink as well.
C. Explain to the couple that food cant be brought from home but that the nurse will make hot broth for the client.
D. Encourage the client to have the broth after the nurse takes it to the kitchen and boils it first.
A
B
24
Q
The nurse works in a facility that cares for clients from a broad range of racial, ethnic, cultural, and religious backgrounds. Which statement should the nurse include in a presentation for nurses new to the facility on the client population of the facility?
A. “Our clients come from a broad range of backgrounds, but we have a good interpreter service.”
B. “Many of our clients come from backgrounds different from your own, but it doesn’t cause problems for the nurses.”
C. “Because most of the doctors are bilingual, we don’t have to deal with the differences in cultural backgrounds of our clients.”
D. “Understanding the common values and health practices of our diverse clients will facilitate better care and health outcomes.”
A
D
25
The nurse manager in a hospital with a large immigrant population is planning an in-service. The nurse manager is aware of how ethnocentrism affects nursing care. Which statement should the nurse manager include? "The belief that ones own values and beliefs are the only or the best values:
A. "Strangers to the United States should adopt U.S. norms and values."
B. "Can create barriers to communication through misunderstanding."
C. "Leads to an expectation that patients will exhibit pain the same way."
D. "Improves the quality of care provided to culturally diverse patient bases."
B
26
When preparing to teach a culturally diverse group of childbearing families about hospital birthing options, in order to be culturally competent, the nurse should:
A. Understand that the families have the same values as the nurse.
B. Teach the families how childbearing takes place in the United States.
C. Insist that the clients answer questions instead of their husbands.
D. Learn about the cultural groups that are likely to attend the class.
D
27
A nurse is admitting a Mexican woman scheduled for a cholecystectomy. The nurse uses a cultural assessment tool during the admission. Which question would be most important for the nurse to ask?
A. "What other treatments have you used for your abdominal pain?"
B. "What is your country of origin; where were you were born?"
C. "When you talk to family members, how close do you stand?"
D. "How would you describe your role within your family?"
A
28
The labor and delivery nurse is caring for a laboring client who has asked for a priest to visit her during labor. The client's mother died during childbirth, and although there are no complications during the client's pregnancy, she is fearful of her own death during labor. What is the best response of the nurse?
A. "Nothing is going to happen to you. Well take very good care of you during your birth."
B. "Would you like to have an epidural so that you wont feel the pain of the contractions?"
C. "The priest wont be able to prevent complications and might get in the way of your providers."
D. "Would you like me to contact your parish or our hospital chaplain to come see you?"
D
29
A pregnant client reports experiencing occasional gastroesophageal reflux. She explains that she relieves her symptoms through acupressure treatments, as well as by taking an over-the-counter medication recommended by her obstetrician. The nurse recognizes acupressure to be a form of:
A. Homeopathy.
B. Alternative therapy.
C. Biofeedback.
D. Complementary therapy.
D
30
A client reports using "homeopathic remedies" to ease her back pain. In order to more fully explore the client's use of complementary and alternative medicine (CAM), the nurse should ask:
A. "Will you tell me more about the homeopathic remedies you're using?"
B. "Are you aware that some complementary and alternative therapies can be dangerous?"
C. "Does your physician approve of your use of homeopathic remedies?"
D. "Have you prioritized your need for comfort above your concern for your baby's health?"
A
31
The client pregnant with her first child reports that her husband wants her to visit a homeopath for help with her nausea and vomiting. The client asks what the nurse's opinion of homeopathy is. The best response by the nurse is:
A. "Homeopathy is unproven and potentially dangerous. Avoid using homeopathic remedies."
B. "The FDA has approved homeopathic remedies, and practitioners undergo education and certification."
C. "I cant give you advice about what alternatives to try. Go online and do some research to get information."
D. "Homeopathy is the same as herbal remedies. Some are safe during pregnancy and some are not."
B
32
Complementary and alternative therapies have many benefits for the childbearing family and others. However, many of these remedies have associated risks. Which of the following situations would be considered risks? Select all that apply.
A. Getting a massage from a licensed massage therapist for back pain, prescribed by the primary caregiver
B. Sampling a homeopathic medicine from a friend to reduce swelling in the legs
C. Getting a chiropractic treatment for low back pain due to discomforts of pregnancy without telling the primary health care provider
D. Taking an herbal preparation suggested by a health food store worker for treatment of leg pain
E. Joining a group that practices tai chi weekly to help with physical fitness and movement
B, C, D
33
The labor and delivery unit nurse manager is incorporating complementary and alternative therapies into the units policies and procedures. Which statement should the nurse manager include during an in-service educational presentation for the nursing staff?
A. "Policies have been developed for using massage and aromatherapy."
B. "When clients ask questions you don't know, tell them to look online."
C. "Because herbs are dangerous during pregnancy, we will not use them."
D. "Be sure to ask clients what alternative therapies they have used."
A
34
A nurse is discussing the 8 stages of the family cycle with the parents of a 12-year-old child. Which stages should the nurse discuss first? Select all that apply.
A. Readjustment of the marital relationship, parent/child establishment of separate identities outside of family
B. Facilitating peer relationships while maintaining family dynamics
C. Marriage between partners, identification as part of family, establishment of goals for future, interaction and building relationship
D. Increase in child's independence, parents concentrate on shift to aging parent careers and marital relationship
E. Established family network, socialization of child, reinforce independence in child when apart from parents
B, D
35
The nurse is discussing culture with the Japanese family and practices to which they subscribe. Which examples clearly define acculturation?
Select all that apply.
A. A first generation Italian lives in an Italian community in the United States and follows Italian traditions and values, continues to speak Italian.
B. A 65-year-old was born and raised in Pennsylvania, moved to Georgia at the age of 40, has a change in pronunciation and customs.
C. A Native American from the reservation goes to Phoenix to live and go to school. The Native American goes home on the weekends to help the family with chores, when sick goes home for traditional healing.
D. The granddaughter of a Chinese immigrant has lived in the United States all of her life including college. She spends most of her time with American friends, dresses as they do and appreciates their values and interests.
E. A young couple were raised and grew up in Mexico, decided to move to the United States. They attend school, acquire professional jobs and eventually start a family. They learn English and speak English when speaking to their children, and follow the holidays of the United States.
B, D, E
36
A nurse is teaching a classroom of teenage girls about the female reproductive system. After teaching, the nurse asks the students to describe the release of an ovum during ovulation. Which of the following is a correct student response?
A. "During ovulation, an egg is released from the ovary and enters the fallopian tube."
B. "Around the middle of the menstrual cycle, one of the fallopian tubes releases an egg."
C. "Ovulation is when the uterus releases an unfertilized egg or ovum."
D. "The endometrium is where the eggs are formed and released into the fallopian tube."
A
37
The clinic nurse is caring for a young woman seeking contraception. Recently, she married and became sexually active. The woman states, "The opening of my husbands penis isn't at the tip; its around the corner below the tip. He tells me that he was born that way. Will that cause problems if we want to have children?" What is the best response for the nurse to give?
A. "The variation is called epispadias. It is not likely to impact his fertility."
B. "The variation is called epispadias. It will likely cause him to be infertile."
C. "The variation is called hypospadias. It is not likely to impact his fertility."
D. "The variation is called hypospadias. It will likely cause him to be infertile."
C
38
A prenatal patient states, "The doctor said he might have to cut my cervix so the baby can get out during delivery." Based upon this statement, the nurse should provide teaching related to episiotomy, which includes defining:
A. The perineal body.
B. The labia majora.
C. The mons pubis.
D. The vaginal vestibule.
A
39
A pregnant patient asks, "What's the difference between the true pelvis and the false pelvis?" The nurse's best response is:
A. "The true pelvis doesn't affect fetal passage during labor and childbirth."
B. "The false pelvis consists of the inlet, the pelvic cavity, and the outlet."
C. "The true pelvis helps direct the presenting fetal part into the false pelvis."
D. "The false pelvis helps support the weight of the pregnant uterus."
A
40
A pregnant adolescent asks the nurse, "Why does the physician call measuring my uterus a fundal height?" The nurse's answer is based on the fact that the fundus of the uterus is located:
A. In the elongated portion where the fallopian tubes enter.
B. In the lower third area.
C. At the uppermost (dome-shaped top) portion.
D. Between the internal cervical os and the endometrial cavity.
C
41
A nurse teaches newly pregnant patients that if an ovum is fertilized and implants in the endometrium, the hormone the fertilized egg begins to secrete is:
A. Estrogen.
B. Human chorionic gonadotropin (hCG).
C. Progesterone.
D. Luteinizing hormone.
B
42
A school nurse is teaching a health class to middle school children. The nurse explains that follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are secreted by the:
A. Hypothalamus.
B. Ovaries and testes.
C. Posterior pituitary.
D. Anterior pituitary.
A
43
The nurse is presenting a community education session on female hormones. Which statement from a participant indicates the need for further information?
A. "Estrogen is what causes females to look female."
B. "The presence of some hormones causes other to be secreted."
C. "Progesterone is present at the end of the menstrual cycle."
D. "Prostaglandin is responsible for achieving conception."
A
44
A woman has been unable to complete a full-term pregnancy because the fertilized ovum failed to implant in the uterus. This is most likely due to a lack of which hormone?
A. Estrogen
B. Progesterone
C. Follicle-stimulating hormone (FSH)
D. Luteinizing hormone (LH)
B
45
The nurse is explaining the menstrual cycle to a group of women. The teaching on phases of the menstrual cycle should include the fact that the corpus luteum begins to degenerate, estrogen and progesterone levels fall, and the blood supply to the endometrium is reduced in which phase?
A. Menstrual phase
B. Proliferative phase
C. Secretory phase
D. Ischemic phase
A
46
Which statement best indicates that the patient understands the differences in the follicular and luteal phases of the ovarian cycle?
A. "My period will be every 28 days."
B. "The first part of my period might vary in length, but not the second."
C. "The follicular phase is the second half of my cycle."
D. "The follicular phase is when the egg is fertilized."
B
47
The nurse is preparing a handout on the ovarian cycle to a group of middle school girls. Which information should the nurse include?
A. There are two phases of the ovarian cycle: luteal and follicular.
B. Irregular menstrual cycles have varying lengths of the follicular phase.
C. The ovum travels from the ovary to the tube during the luteal phase.
D. The human chorionic gonadotropin (hCG) hormone stimulates ovulation.
A
48
The nurse is preparing a presentation on the menstrual cycle for a group of high school students. Which statement should the nurse include in this presentation?
A. "The menstrual cycle has five distinct phases that occur during the month."
B. "One hormone controls the phases of the menstrual cycle."
C. "The secretory phase occurs when a woman is most fertile."
D. "Menstrual cycle phases vary in order from one woman to another."
C
49
```
In preparation for teaching a women's community center class about physiologic changes during menopause, the nurse is preparing a handout for students. Which information should the nurse include in her teaching?
A. The ovaries remain small after puberty, but they increase in size following menopause.
B. Ovarian secretion of estrogen decreases between age 45 to 55, after which point ovulatory activity ceases.
C. Due to changes in estrogen levels, the labia minora increase in size after menopause.
D. After menopause, the endometrium continues to undergo monthly degeneration and renewal.
```
B
50
A woman is experiencing mittelschmerz and increased vaginal discharge. Her temperature has increased by 0.6°C (1.0°F) for the past 36 hours. This most likely indicates that:
A. Menstruation is about to begin.
B. Ovulation will occur soon.
C. Ovulation has occurred.
D. She is pregnant and will not menstruate.
C
51
The nurse is preparing to teach a client about the functions of the pelvis during childbearing. Which information should the nurse include in her teaching? Select all that apply.
```
A. Transport for the ovum
B. Provides a site for fertilization
C. Supports and protects contents
D. Forms the axis of the birth canal
E. Inhibits uterine contraction and relaxes smooth muscle
```
D, E
52
```
The student is learning about the menstrual cycle and the influence of hormones on the cycle. Which response suggests the student understands the function of progesterone on the menstrual cycle? Select all that apply.
A. Temperature rise of 0.5 to 1.0°F
B. Cervix secretes thick mucus
C. Growth of body hair
D. Maturation of ovarian follicles
E. Vaginal epithelium proliferates
```
A, B, E
53
The nurse is explaining the difference between meiosis and mitosis. Which statement does the nurse include? Select all that apply.
A. Meiosis is the division of a cell into two exact copies of the original cell.
B. Mitosis is the splitting of one cell into two, each with half the chromosomes of the original cell.
C. Meiosis is the process by which gametes, or the sperm and ova, are formed.
D. Mitosis occurs in most of the cells of the body.
E. Meiotic division leads to cells that halve the original genetic material.
C, E
54
The nurse has completed a presentation on reproduction. Which participants statement indicates that the teaching has been successful?
A. "A male is born with all the sperm he will ever produce."
B. "Females create new ova throughout their reproductive life."
C. "Ova separate into two unequally sized cells."
D. "Each primary spermatocyte divides into four haploid cells."
C
55
After teaching a class about the female reproductive system, the nurse asks the attendees to describe the process of meiosis. Which student response suggests successful comprehension of the material?
A. "Completion of the second meiotic division results in formation of three polar bodies and one ovum."
B. "At the time of ovulation, the first meiotic division begins."
C. "Completion of the first meiotic division produces three polar bodies and one primary oocyte."
D. "At the time of puberty, the second meiotic division begins."
A
56
You are counseling a young woman regarding contraception. When asked if she currently uses any form of contraception, she replies, "I can't get pregnant because I don't have intercourse on the day I ovulate." Based upon her response, what information should you include in your teaching?
A. Refrain from intercourse on the day of ovulation will effectively prevent pregnancy.
B. Sperm are believed to be healthy and highly fertile for at least five days.
C. After ovulation, ova are considered fertile for about 72 to 96 hours.
D. Sperm survive 48 to 72 hours in the female reproductive tract.
D
57
When evaluating information taught about conception and fetal development, the patient verbalizes understanding about transportation time of the zygote through the fallopian tube and into the cavity of the uterus with which statement?
A. "It will take at least three days for the egg to reach the uterus."
B. "It will take eight days for the egg to reach the uterus."
C. "It will only take 12 hours for the egg to go through the fallopian tube."
D. "It will take 18 hours for the fertilized egg to implant in the uterus."
A
58
If only a small volume of sperm is discharged into the vagina, an insufficient quantity of enzymes might be released when sperm encounters the ovum. In that case, pregnancy would probably not result because:
A. Peristalsis of the fallopian tube would decrease, making it difficult for the ovum to enter the uterus.
B. The block to polyspermy (cortical reaction) would not occur.
C. The fertilized ovum would be unable to implant in the uterus.
D. Sperm would be unable to penetrate the zona pellucida of the ovum.
D
59
The nurse is caring for a client who is pregnant with twins. Which statement indicates the client needs additional information?
A. "Because both of my twins are boys, I know that they are identical."
B. "If my twins came from one fertilized egg that split, they are identical."
C. "If I have one boy and one girl, I will know they came from two eggs."
D. "It is rare for twins to both be within the same amniotic sac."
A
60
A pregnant client asks you to describe the differences between monozygotic and dizygotic twins. Which statement should you include in your teaching?
A. "Dizygotic twinning occurs less frequently than does monozygotic twinning."
B. "Monozygotic twins originate from division of the fertilized ovum at different stages."
C. "Dizygotic twins share one placenta and one chorion."
D. "Monozygotic twins are also referred to as 'fraternal twins."
B
61
Which statement by a pregnant client would indicate that additional teaching was necessary?
A. "Because of their birth relationship, fraternal twins are more similar to each other than if they had been born singly."
B. "Identical twins can be the same or different sex."
C. "Congenital abnormalities are more prevalent in identical twins."
D. "Identical twins occur more frequently than fraternal twins."
C
62
The nurse is creating a poster for pregnant mothers. Which description of fetal development does the nurse include?
A. Four layers of cells form after the embryo is at the ball stage.
B. After fertilization, the cells only become larger for several weeks.
C. Most organs are formed by 8 weeks after fertilization.
D. The embryonic stage is from fertilization until 5 months.
C
63
The nurse is presenting an early pregnancy class to a group of pregnant women. Which statement indicates a need for further education?
A. "The placenta develops and grows larger until about 20 weeks' gestation."
B. "The placenta creates hormones and enzymes that are necessary during pregnancy."
C. "The placenta ages and becomes less permeable during the last month of pregnancy."
D. "The placenta floats in the amniotic sac and filters waste products from the fetus."
D
64
The nurse is working with a client who has experienced a fetal death in utero at 20 weeks. The client asks what her baby will look like when it is delivered. Which statement by the nurse is the best response?
A. "Your baby will be covered in fine hair called lanugo."
B. "Your child will have arm and leg buds, but not fully formed limbs."
C. "A white, cheesy substance called vernix caseosa will be on the skin."
D. "The genitals of the baby will be ambiguous."
A
65
At her first prenatal visit, the client states, "I'm five weeks' pregnant now and I would like to hear my baby's heartbeat today." How should the nurse respond?
A. Prepare to assist with auscultation of the fetal heartbeat using a fetoscope.
B. Explain to the client that the fetal heart does not begin to beat until approximately 7 weeks' gestation.
C. Anticipate that the client will be scheduled for Doppler ultrasound.
D. Explain to the client that the fetal heartbeat is not yet detectable at 5 weeks' gestation.
D
66
The client, at 18 weeks' gestation, thinks she might have been exposed to a toxin at work that could affect fetal development. The client asks the nurse what organs might be affected at this point in pregnancy. The best response of the nurse is:
A. "The brain is developing now and could be affected."
B. "Because you are in the second trimester, there is no danger."
C. "The internal organs like the heart and lungs could be impacted."
D. "Its best to not worry about possible problems with your baby."
A
67
The nurse is preparing a preconception information class. Information about causes of fetal organ malformation in the first trimester will be presented. What prenatal influences on the intrauterine environment should be included in the instruction? Select all that apply.
```
A. The use of saunas or hot tubs
B. The use of drugs
C. The quality of the sperm or ovum
D. Maternal nutrition
E. Age of the mother at conception
```
A, B, D
68
A woman at 20 weeks' gestation finds that her blood type is O. She tells the nurse that her boyfriends blood type is AB, and asks what blood type her child will have. Which blood types should the nurse tell the woman her child may have? Select all that apply.
```
A. O
B. A
C. B
D. OA
E. AB
```
B, C
69
A woman had a genetic evaluation and it is discovered that she carries on autosomal dominant gene for Huntington's disease, while her husbands history is ordinary. Which family members should be referred for genetic counseling? Select all that apply.
```
A. The woman's brothers
B. The woman's sisters
C. The woman's parents
D. The woman's husband
E. The woman's children
```
A, B, C, E
70
The clinic nurse is returning phone calls. Which call should the nurse return first?
A. A 22-year-old client reporting that she has menstrual cramps and vomiting every month
B. A 17-year-old client asking if there is a problem with using one tampon for a whole day
C. A 46-year-old mother of a teen wondering if her daughter should be on birth control
D. A 34-year-old client requesting information on douching after intercourse
B
71
When taking a sexual history from a client, the nurse should:
A. Ask questions that the client can answer with a "yes" or "no."
B. Ask mostly open-ended questions.
C. Have the client fill out a comprehensive questionnaire and review it after the client leaves.
D. Try not to make much direct eye contact.
B
72
Which client would the nurse document as exhibiting signs and symptoms of primary dysmenorrhea?
A. A 17-year-old female who has never had a menstrual cycle.
B. A 16-year-old female who had regular menses for 4 years, but has had no menses in four months.
C. A 19-year-old female who had regular menses for 5 years that have suddenly become painful.
D. A 14-year-old female who had irregular menses for one year, experiences cramping every cycle.
D
73
A client asks her nurse, "Is it okay for me to use a vaginal douche each day when I'm on my period?" The nurse's correct response is:
A. "Douching should be avoided when you're on your period."
B. "Using a douche each day will help prevent vaginal infections from occurring."
C. "During your period, douching will help promote the flow of menstrual secretions."
D. "Regular douching is necessary in order to promote good hygiene."
A
74
What should the gynecology clinic nurse recommend for the client experiencing premenstrual syndrome?
A. "Eat more chocolate and drink more caffeine beginning a week prior to when your menstrual cycle bleeding should begin."
B. "Engage in aerobic activity often throughout the month, and continue exercising when your symptoms begin."
C. "Decrease your dietary intake of dairy and soy slightly during the month, and especially during your days of bleeding."
D. "Increase your consumption of red meat when you feel symptoms, and eat three large meals per day."
B
75
A client comes to the clinic complaining of severe menstrual cramps. She has never been pregnant, has been diagnosed with ovarian cysts, and has had an intrauterine device (IUD) for two years. The most likely cause for the client's complaint is:
A. Primary dysmenorrhea.
B. Secondary dysmenorrhea.
C. Menorrhagia.
D. Hypermenorrhea.
B
76
Which issues should the nurse consider when counseling a client on contraceptive methods? Select all that apply.
```
A. Cultural perspectives on menstruation and pregnancy
B. Efficacy of the method
C. Future childbearing plans
D. Whether the patient is a vegetarian
E. Age at menarche
```
A, B, C
77
A client has decided to use a vaginal contraceptive ring as her method of contraception. Which statement suggests the client needs further instruction?
A. "I do not need to be examined in order to determine the contraceptive ring size that is correct for me."
B. "Every three months, I will need to remove the contraceptive ring and replace it with a new one."
C. "When I store my replacement rings, I should keep them in my refrigerator."
D. "The contraceptive ring provides a sustained release of low-dose contraceptive."
B
78
Which client is not a good candidate for Depo-Provera (DMPA)?
A. One who wishes to get pregnant within three months
B. One who wishes to breastfeed
C. One with a vaginal prolapse
D. One who weighs 200 pounds
A
79
The public health nurse receives a phone call from a 16-year-old female who asks, "Do I need to have a Pap smear just because I'm sexually active?" What is the nurse's correct response?
A. "Yes, all sexually active females should be screened for both cervical cancer and HPV."
B. "No, you do not need to be screened for cervical cancer until you are 21 years old."
C. "Yes, all women under the age of 29 should be screened for both cervical cancer and HPV."
D. "No, but you will need to begin your screenings for both cervical cancer and HPV when you are 18 years old."
B
80
A nurse is providing a client with instructions regarding breast self-examination (BSE). Which of the following statements by the client would indicate the likelihood that she understands how to detect changes such as lumps in her breast? Select all that apply.
A. "I should perform BSE one week prior to the start of my period."
B. "When I reach menopause, I will perform BSE every two months."
C. "Knowing the texture and feel of my breasts is important."
D. "I should inspect my breasts in a circular manner."
E. "I should inspect my breasts while in a supine position, with my arms at my sides."
C, D
81
What is the best indicator that the client is experiencing menopause?
A. No menses for 8 consecutive months
B. Hot flashes and night sweats
C. High serum FSH with low serum estrogen
D. Diagnosed with osteoporosis 4 months ago
C
82
A 63-year-old female client requests information about complementary and alternative therapies that promote wellness during menopause. Which therapies should the nurse recommend?
A. Non-weight-bearing exercise, such as swimming.
B. Increased consumption of phytoestrogens (i.e., plant products with estrogen properties) for women with a history of endometriosis or fibroids.
C. Calcium intake of 600 mg per day to help prevent osteoporosis.
D. Soy for reducing insomnia symptoms.
D
83
The nurse is presenting a session on intimate partner violence. Which statement indicates a need for further education?
A. "My daughter is not to blame for the violence in her marriage."
B. "Everyone experiences anger and hitting in a relationship."
C. "Abusers can be either husbands or boyfriends or girlfriends."
D. "The honeymoon period follows an episode of violence."
B
84
When a woman who has been raped is admitted to the emergency department, which nursing intervention has priority?
A. Explain exactly what will need to be done to preserve legal evidence.
B. Assure the woman that everything will be all right.
C. Create a safe, secure atmosphere for the woman.
D. Contact family members.
C
85
The nurse in the obstetrical clinic is setting appointments for clients seeking pre-conceptual care. Which client should be seen first?
A. A 36-year-old female who has never been pregnant. She takes medication for a seizure disorder.
B. A 15-year-old female who smokes one pack per day. She had a miscarriage four months ago.
C. A 22-year-old female who runs long distances. She has been on the pill for six years.
D. A 29-year-old female who has had two abortions. She takes a multiple-vitamin supplement.
A
86
While teaching a preconception class, the nurse should include which of the following recommendations concerning intake of vitamins during pregnancy?
A. Take a daily supplement of folic acid daily to reduce the risk of trisomy 21 (Down syndrome).
B. The pregnant woman should consult the recommended dietary allowance (RDA) guidelines regarding vitamins.
C. Take Vitamin C daily to reduce the risk of neural tube defects.
D. The pregnant woman should consume the greatest quantity of vitamins possible.
B
87
A 38-year-old woman with no prior pregnancies calls the clinic to inquire about preconception counseling. Which element of early prenatal education should the nurse expect to facilitate?
A. Availability of prenatal and genetic testing
B. Birth choices
C. Infertility counseling
D. Nutrition classes
A
88
A client comes to the clinic for birth control, while reviewing the history the client tells the nurse that she has had Toxic shock syndrome (TSS). Which forms of birth control should the nurse teach the client to avoid? Select all that apply.
```
A. Depo-Provera
B. Sponge
C. Vaginal condom
D. Ring
E. Intrauterine device (IUD)
```
B, C
89
A woman who was raped three months ago comes to the family practitioner for a ruddy rash on the palms of her hands and soles of her feet, and flulike symptoms. When taking a history, the nurse discovers history of rape and last month the woman had a small painless lesion that went away. The nurse is to administer 2.4 million units of Penicillin G intramuscularly. The medication is available as 1,200,000 units per milliliter (mL). How many milliliters (mLs) should the nurse administer?
A. 0.50 mLs
B. 0.2 mLs
C. 0.20 mLs
D. 2 mLs
D
90
The nurse is auscultating fetal heart tones in a client who is 37 weeks' gestation. While in a supine position, the client states, "I'm getting lightheaded and dizzy, and I feel clammy." Which of the following nursing actions is most appropriate?
A. Place a wedge beneath the client's right hip.
B. Prepare for administration of packed red blood cells (PRBCs).
C. Help the client turn onto her right side.
D. Administer supplemental oxygen.
A
91
The client with a normal prepregnancy weight asks why she has been told to gain 25-35 pounds during her pregnancy, but her underweight friend was told to gain more weight. The nurse should tell the client that recommended weight gain during pregnancy should be:
A. 25 to 35 pounds, regardless of a client's pre-pregnancy weight.
B. More than 25 to 35 pounds for an overweight patient.
C. More than 25 to 35 pounds for an underweight woman.
D. The same for a normal-weight woman as for an overweight woman.
C
92
The nurse is reviewing the assessment findings of a client who is 35 weeks' gestation. Which of the following data suggests the need for further investigation?
A. Melasma gravidarum
B. Pseudoanemia
C. Funic souffle
D. Glycosuria
D
93
The client in the prenatal clinic tells the nurse that she is sure that she is pregnant because she has not had a menstrual cycle for three months, and her breasts are getting bigger. What response by the nurse is best?
A. "Lack of menses and breast enlargement are presumptive signs of pregnancy."
B. "The changes you are describing are definitely indicators that you are pregnant."
C. "Lack of menses can be caused by many things. We need to do a pregnancy test."
D. "Breast and menstrual changes are positive signs of pregnancy. Congratulations."
C
94
The nurse has completed a presentation for newly-pregnant women about the changes of pregnancy. Which participant's statement reflects accurate comprehension of the information?
A. "A positive Goodell's sign is a probable change of pregnancy."
B. "Three positive pregnancy tests in a one week period is considered to be a positive change of pregnancy."
C. "Uterine souffle is a positive change of pregnancy."
D. "Changes in the pelvic organs are presumptive signs of pregnancy."
A
95
A client who is experiencing her first pregnancy has just completed the initial prenatal examination with a certified nurse-midwife. Which statement indicates that the client has a correct understanding of her condition?
A. "Because we heard the baby's heartbeat, I am undoubtedly pregnant."
B. "Since I haven't felt the baby move yet, we don't know if I'm pregnant."
C. "My last period was two months ago, which means I'm two months along."
D. "The increased size of my uterus means that I am finally pregnant."
A
96
The adolescent client reports to the clinic nurse that her period is late but that her home pregnancy test is negative. Which response is most appropriate?
A. "This means you are not pregnant."
B. "You might be pregnant, but it might be too early for your home test to be accurate."
C. "We don't trust home tests. Come to the clinic for a blood test."
D. "Most people don't use the tests correctly. Did you read the instructions?"
B
97
A 28-year-old client who is pregnant with her first child reports increased dental caries (cavities) since becoming pregnant. How should the nurse explain the likely cause for this change?
A. "When a woman is pregnant, her teeth lose calcium and she is more susceptible to getting cavities."
B. "It may be necessary to pay extra attention to dental care while you're pregnant, especially if you're vomiting frequently."
C. "Each woman experiences changes that affect her teeth while she's pregnant."
D. "During pregnancy, tooth enamel softens and the woman is more susceptible to getting cavities."
B
98
A client at 30 weeks' gestation is tearful at the time of her follow-up visit. She tells the prenatal clinic nurse she is excited to finally become a mother and that she has been thinking about what kind of parent she will be. However, she is upset because her mother has told her that she doesn't want to be a grandmother because she doesn't feel old enough. Meanwhile, the client's husband has said that the pregnancy doesn't feel real to him yet and that he will become excited when the baby is actually here. What is the most likely explanation for what is happening within this family?
A. Her husband will not attach with this child and will not be a good father.
B. Her mother is rejecting the role of grandparent and will not help out.
C. The client is not progressing through the developmental tasks of pregnancy.
D. Each family member is adjusting to the role change at his own pace.
D
99
The partner of a pregnant patient at 16 weeks' gestation accompanies her to the clinic. The partner tells you that the baby just doesn't seem real to him, and he's having a hard time relating to his partner's fatigue and food aversions. Which of the following statements would be best for the nurse to make?
A. "If you would concentrate harder, you'd be aware of the reality of this pregnancy."
B. "My husband had no problem with this. What was your childhood like?"
C. "You might need professional psychological counseling. Ask your physician."
D. "Many men feel this way. Feeling the baby move will help make it real."
D
100
A 20-year-old client who is at 10 weeks' gestation is preparing for her first prenatal visit. She confides, "This pregnancy was unplanned. I'm not sure if I want to be pregnant or not. I haven't even told my boyfriend I'm pregnant. And I haven't decided if I'm going to continue the pregnancy." Which of the following statements should the nurse make next?
A. "It's really unusual for a pregnant woman to feel this way early in the pregnancy."
B. "These thoughts are because your mother died when you were 4 years old."
C. "You should go to a pregnancy support group to be a good mother."
D. "It's common to feel ambiguous about pregnancy in the first trimester."
D
101
A 25-year-old woman is in the second trimester of her pregnancy. During the interview, you ask her partner what changes they have noticed during the pregnancy. Which of the following answers would indicate a typical response to pregnancy?
A. "She has been more tense and anxious than usual, and she is not sleeping well."
B. "She daydreams about what kind of parent she is going to be."
C. "I haven't noticed anything. I just found out she was pregnant."
D. "She has been having dreams at night about misplacing the baby."
B
102
A client who is at 14 weeks' gestation is in the clinic for a regular prenatal visit. The client is accompanied by her mother. The client's mother states that she is very uncertain about how to be a good grandmother to this baby, due to working full time and being so busy. The client's mother notes that her own grandmother was retired and was always available when needed by a grandchild. The best response to this concern would be:
A. "Don't worry. You'll be a wonderful grandmother. It will all work out fine."
B. "Grandmothers are supposed to be available. You should retire from your job."
C. "As long as there is another grandmother available, you don't have to worry."
D. "How do you envision your role as grandmother?"
D
103
The labor and delivery nurse is talking with a client who is expected to deliver her baby within the next several hours. The client and her husband are Lebanese immigrants.
During conversation, the nurse asks the couple if they have chosen a name for their baby. The client's husband explains that their Muslim beliefs require that they choose the baby's name after the delivery, as it is God's will whether or not the baby will be born. Which nursing response is appropriate?
A. "Thank you for explaining that to me. By sharing your cultural beliefs with me, you're helping me to provide you with the best possible care."
B. "In the United States, you can feel free to choose your baby's name prior to the delivery."
C. "We have a very low rate of complications at this facility."
D. "Are you afraid your baby will not live?"
A
104
The nurse is presenting an in-service to nursing staff regarding the provision of culturally competent client care. Which statement should the nurse include in the presentation?
A. "Many immigrants to a new
country will adopt the beliefs and practices of the dominant culture."
B. "Developed countries are becoming increasingly more ethnically diverse."
C. "The rituals and customs of a group reflect the values of the dominant culture."
D. "Identification of cultural values is a task that is unrelated to providing culturally sensitive care."
B
105
The clinical nurse is reviewing the assessment findings of a client who is 10 weeks' gestation. Which of the following data suggests that need for further investigation? Select all that apply.
```
A. Breast tenderness
B. Cramping
C. Bleeding
D. Melasma
E. Fatigue
```
B, C
106
A client who is at 18 weeks' gestation comes to the clinic for a regular prenatal visit. The client is accompanied by her school-age son. The nurse understands which things could help the son take part in the pregnancy experience. Select all that apply.
```
A. Help put the crib together.
B. Go with mom to have blood drawn.
C. Listen to the fetal heartbeat.
D. Take part in family discussions regarding the pregnancy.
E. Go to sibling classes.
```
C, D, E
107
The pregnant client has completed the prenatal questionnaire and asks the nurse why this form had to be completed. The best response by the nurse is:
A. "Some people have things that have happened in the past that could impact their current pregnancy."
B. "The doctor wants all of the pregnant patients to complete the form so that our records are complete."
C. "We occasionally identify a health problem that puts the current pregnancy at higher risk."
D. "This form is designed to predict who will develop problems with their pregnancy or delivery."
C
108
The pregnant client's prenatal record indicates that she is a gravida 4 para 2022. The nurse understands that this indicates the client had four pregnancies and:
A. Has four living children.
B. Delivered two infants preterm.
D. Is pro-abortion.
D. Delivered two term infants.
D
109
A multigravida gave birth to an 18-week fetus last week. She is in the clinic for follow-up and notices that her chart states she has had one abortion. The client is upset over the use of this word. How can the nurse best explain this terminology to the patient?
A. "Abortion is the medical term for all pregnancies that end before 28 weeks."
B. "Abortion is the word we use when someone has miscarried."
C. "Abortion is how we label pregnancies that end in the second trimester."
D. "Abortion is what we call all babies who are stillborn."
A
110
Which of the following clients would be considered a multipara?
A. A client at 34 weeks' gestation who previously had one spontaneous abortion
B. A client at 13 weeks' gestation who previously delivered two term infants
C. A client at 28 weeks' gestation with no previous pregnancies
D. A client at 32 weeks' gestation who previously delivered one term infant
B
111
The patient has delivered her first child at 39 weeks. The nurse would explain this to the client as what type of delivery?
A. Preterm
B. Post-term
C. Term
D. Near term
C
112
The prenatal clinic nurse is designing a new prenatal intake information form for pregnant patients. Which question is best to include on this form?
A. Where was the father of the baby born?
B. Do genetic diseases run in the family of the baby's father?
C. What is the name of the baby's father?
D. Are you married to the father of the baby?
B
113
The nurse is assessing a primiparous client. The client indicates that her religion is Judaism. This information is important for the nurse to assess because:
A. Religious and cultural background can impact what a client eats during pregnancy.
B. It provides a baseline from which to ask questions about the client's religious and cultural background.
C. Knowing what the client's beliefs and behaviors regarding pregnancy are is important.
D. Clients sometimes encounter problems in their pregnancies based on what religion they practice.
B
114
The clinic nurse is assisting with an initial prenatal assessment. The following findings are present: spider nevi present on lower legs; dark pink, edematous nasal mucosa; mild enlargement of the thyroid gland; mottled skin and pallor on palms and nail beds; heart rate 88 with murmur present. What is the best action for the nurse to take based on these findings?
A. Document the findings on the prenatal chart.
B. Have the physician see the patient today.
C. Instruct the patient to avoid direct sunlight.
D. Analyze previous thyroid hormone lab results.
B
115
A 25-year-old primigravida is 20 weeks' gestation. At the clinic, her nurse begins a prenatal assessment and obtains the following vital signs. Which finding would require the nurse to contact the physician?
A. Pulse 88/min
B. Respirations 30/min
C. Temperature 37.4°C (99.3°F)
D. Blood pressure 134/82
B
116
The nurse is seeing prenatal clients in the clinic. Which client is exhibiting expected findings?
A. Primip at 12 weeks with fetal heart tones heard by Doppler fetoscope
B. Multip at 22 weeks who reports no fetal movement felt yet
C. Primip at 26 weeks with fundal height of 30 cm
D. Multip at 12 weeks reports bright red vaginal bleeding.
A
117
The nurse receives a phone call from a client who thinks she is pregnant. The client reports that she has regular menses that occur every 28 days and last 5 days. The first day of her last menses was April 10. What is the client's estimated date of delivery (EDD)?
A. November 13
B. January 17
C. January 10
D. December 3
B
118
The nurse explains to a pregnant woman that her antepartum assessment will include assessment of clinical pelvimetry. Which client response reflects understanding of the reason for this test?
A. "It will help understand how big a baby I can have."
B. "It will be used to find out whether my baby has a chromosomal abnormality."
C. "It will help tell whether my pelvis is big enough to deliver my baby vaginally."
D. "It will be used to screen for gestational diabetes."
C
119
The nurse is assisting a physician during a prenatal examination. The physician seeks to estimate the adequacy of the client's pelvis for birth. The nurse understands that the physician will need to perform which measurement vaginally?
A. True conjugate
B. Diagonal conjugate
C. Transverse outlet diameter
D. Obstetrical conjugate
B
120
The nurse is working with a prenatal client. Which statement indicates that additional teaching is necessary?
A. "I will have Rh testing, even though this is my first pregnancy."
B. My vagina will be cultured at 36 weeks for group B strep."
C. "Because I am married, I won't have the STI screening."
D. "My blood will be checked for hemoglobin level."
C
121
Which phone call should the prenatal clinic nurse return first?
A. Primipara at 32 weeks, reports headache and blurred vision
B. Multipara at 18 weeks, reports no fetal movement this pregnancy
C. Primipara at 16 weeks, reports increased urinary frequency
D. Multipara at 40 weeks, reports sudden gush of fluid and contractions
A
122
The nurse is completing an assessment for a prenatal visit. Which statement indicates that further teaching is necessary?
A. "Because I'm in my third trimester, I should return to the clinic in a month."
B. "Now that I've felt fetal movement, I should feel movement regularly."
C. "Before I take any over-the-counter medications, I should contact my doctor."
D. "Alcohol is possibly harmful to my baby, even at the end of my pregnancy."
A
123
A client's first pregnancy ended in a spontaneous abortion at 15 weeks, subsequently she became pregnant and delivered at 37+6 weeks' gestation. The client is now pregnant for the third time. Using the traditional approach her obstetrical history would be recorded as ________.
Answer: gravida 3, para 1, ab 1
124
The clinic nurse is completing a prenatal history. The client reports that she has regular menses that occur every 28 days and last 5 days. The first day of her last menses was June 20, 2016. What is the client's estimated due date (EDD)?
A. 3/20/17
B. 3/27/17
C. 3/25/17
D. 3/15/17
B
125
The nurse is assisting an expectant couple in developing a birth plan. Which of the following instructions would the nurse include in the teaching plan?
A. The birth plan includes only patient choices and does not take into account standard choices of the healthcare provider.
B. The birth plan allows the patient to make choices about the birth process; however, these choices cannot be altered.
C. The birth plan is a legally binding contract between the patient and the healthcare provider.
D. The birth plan is a communication tool between the patient and the healthcare provider.
D
126
A couple would like their 5-year-old to attend the birth. Which statement by the nurse would assist in the family's plan to include their 5-year-old in the birth?
A. "You should let your child stay home because you will be focusing on the birth."
B. "Children under 12 are not allowed to be present at the birth."
C. "You should bring someone who will tend to any specific needs of your child."
D. "Bring some toys to keep your child occupied."
C
127
The nurse is presenting a prenatal class for couples beginning prenatal care. What information is most important for the nurse to include?
A. You can have a certified nurse-midwife or a physician for your provider.
B. You can give birth in either of two different types of rooms, each with different equipment.
C. The birthing unit was remodeled and redecorated last year.
D. Some of the providers recommend circumcision for the male child.
A
128
An expectant couple desires to determine compatibility with a care provider. They ask the nurse for assistance. Which of the following questions should the nurse encourage the couple to ask first?
A. "Can my children attend the birth?"
B. "If I have a cesarean birth, can my husband attend?"
C. "What is your philosophy of birth?"
D. "What percentage of your patients have episiotomies?"
C
129
The prenatal clinic nurse has presented information on prenatal class options to a couple pregnant for the first time. Which statement made by the couple indicates that additional information is necessary?
Prenatal classes:
A. Eliminate the risk of needing a vacuum extraction or cesarean birth.
B. Help parents cope with the discomforts and unknowns of childbirth.
C. Facilitate better communication between both partners.
D. Encourage participants to write a list of their requests for labor and birth
A
130
The patient who experienced an emergency cesarean birth with her first child expresses anxiety about her upcoming birth. How can the nurse teaching the patient's prenatal classes help decrease her anxiety?
A. Encourage muscle tightening with each contraction.
B. Explain that patterned breathing increases anxiety and should be avoided.
C. Instruct the patient to hire a therapeutic massage therapist for labor.
D. Practice progressive relaxation and encourage her to use the technique in labor.
D
131
Regardless of the method of childbirth preparation, most childbirth classes:
A. Present ways of alleviating fear.
B. Teach imagery for relaxation.
C. Use patterned, paced breathing techniques.
D. Present the benefits of epidural anesthesia.
A
132
The nurse assesses her patient to have mild anxiety concerning the birth process. The patient states that she is not interested in Lamaze classes because she is single and does not want to have natural childbirth. The nurse's best response would be:
A. "Lamaze classes promise painless childbirth. If you learn their methods, your pain is minimal."
B. "Lamaze classes can teach you relaxation methods and also the benefits and risks of pain-relief methods. This assists you in making the best decision for you."
C. "You are very nervous. I think these classes would be best for you."
D. "Lamaze classes are geared toward couples. You might want to find a different class."
B
133
A 29-year-old woman who is pregnant with her first child asks the nurse which childbirth preparation class is most highly recommended for couples. Which nursing response is best?
A. "For couples, the International Childbirth Education Association (ICEA) recommends the Bradley method, which is a partner-coached childbirth."
B. "Lamaze would be the ideal choice of preparation for you and your husband."
C. "Ideally, you can learn about each method, and then choose the one that's best for you."
D. "Any of the methods will work well, as long as you and your husband do not deviate from the instructions related to that specific method."
C
134
The nurse is presenting a prenatal education class about the use of Lamaze during childbirth. Which concept should the nurse include in his teaching?
A. Dissociative relaxation
B. Partner-coached childbirth
C. The extended McRoberts position
D. Touch relaxation
A
135
The nurse is planning a "train the trainer" class for labor and delivery nurses learning to teach prenatal classes. Which statement indicates that teaching has been effective?
A. "Women like to be in a semi-sitting position when giving birth."
B. "Teaching alternatives available at our hospital facilitates decision making."
C. "I will explain that bright lights in the room are best for moms and babies."
D. "Patients should be taught not to make noise during labor or birth."
B
136
Continuous labor support facilitates the birth process. What other things does labor support help to do? Select all that apply.
```
A. Reduces medical intervention
B. Increases the mother's memory of the birth
C. Reduces anxiety in the newborn
D. Strengthens bonding
E. Increases newborn APGAR scoring
```
A, B, D
137
The philosophy of the Coalition for Improving Maternity Services (CIMs) include which cornerstones of mother-friendly care? Select all that apply.
```
A. Empowerment
B. Autonomy
C. Responsibility
D. Beneficence
E. Redundancy
```
A, B, C
138
A 32-year-old primipara who is 8 weeks' gestation asks you if she should expect any respiratory changes as her pregnancy progresses. What should the nurse tell her?
A. "By the third trimester, you will no longer feel as though you're short of breath."
B. "If you develop shortness of breath, it should improve in the last few weeks of your pregnancy, as lightening occurs."
C. "Shortness of breath is an abnormal finding during any stage of pregnancy, and it's considered a serious complication."
D. "You may experience shortness of breath due to stretching of the round ligament."
B
139
The client in her first trimester of pregnancy is experiencing nausea. To promote self-care, the nurse should help the pregnant client understand that the nausea might be relieved by:
A. Eating spicy foods.
B. Not eating until two hours after rising.
C. Eating small, frequent meals.
D. Avoiding carbonated beverages.
C
140
A client in her third trimester of pregnancy reports frequent leg cramps. What strategy would be most appropriate for the nurse to suggest?
A. Point the toes of the affected leg.
B. Increase intake of protein-rich foods.
C. Limit activity for several days.
D. Flex the foot to stretch the calf.
D
141
The prenatal client in her third trimester tells the clinic nurse that she works eight hours a day as a cashier and stands when at work. What response by the nurse is best?
A. "No problem. Your baby will be fine."
B. "Do you get regular breaks for eating?"
C. "Your risk of preterm labor is higher."
D. "Standing might increase ankle swelling."
C
142
The pregnant client has asked the nurse what kinds of medications cause birth defects. Which statement would best answer this question?
A. "Birth defects are very rare. Don't worry; your doctor will watch for problems."
B. "To be safe, don't take any medication without talking to your doctor."
C. "Too much vitamin C is one of the most common issues but is avoidable."
D. "Almost all medications will cause birth defects in the first trimester."
B
143
A pregnant client who swims 3 to 5 times per week asks the nurse if she should stop this activity. What is the appropriate nursing response?
A. "You should decrease the number of times you swim per week."
B. "You should continue your exercise program because it would be beneficial."
C. "You should discontinue your exercise program immediately."
D. "You should increase the number of times you swim per week."
B
144
The pregnant client who is at 21 weeks' gestation and is planning a vacation with her family. She asks the nurse which method of travel would be recommended for her to use. How should the nurse respond? "The safest method of travel is to:
A. "Take an automobile."
B. "Fly on an airplane."
C. "Travel by train."
D. "Not travel this late in pregnancy."
C
145
A client who is at 10 weeks' gestation tells her nurse, "I'm making too much saliva, and I spit on people every time I talk! What's wrong with me?" How should the nurse respond?
A. "Let's schedule you for a doctor's appointment, because excessive salivation can signal a complication of pregnancy."
B. "That's called ptyalism, and it's usually caused by increased salt intake during the second trimester."
C. "You should avoid astringent mouthwashes and chewing gum."
D. "Excess salivation commonly occurs during the first trimester, although the cause is unknown."
D
146
The nurse is preparing a class for expectant fathers. Which information should the nurse include?
A. Siblings adjust readily to the new baby.
B. Sexual activity is safe for normal pregnancy.
C. The expectant mother decides the feeding method. D. Fathers are expected to be involved in labor and birth.
B
147
The nurse is caring for a pregnant client. The client's husband has come to the prenatal visit. Which question is best for the nurse to use to assess the adaptation to pregnancy by the father-to-be?
A. "What kind of work do you do?"
B. "What furniture have you gotten for the baby?"
C. "How moody has your wife been lately?"
D. "How are you feeling about becoming a father?"
D
148
The nurse is caring for a client in the prenatal clinic. The client recently arrived in the United States as a refugee from a country in Africa. This is the first client from this cultural background with whom the nurse has worked. Which intervention is most appropriate in the care of this client?
A. Ask the client about her expectations during the labor and birth.
B. Determine if the client has been tested for tuberculosis.
C. Help the client into the paper dressing gown prior to her exam.
D. Look for written handouts on prenatal care in the client's language.
A
149
A Hispanic American client who is 26 weeks pregnant asks if her curandero, or folk healer, may accompany her to all future prenatal appointments. Which response by the nurse reflects respect for the client's cultural beliefs?
A. "Yes, we will work as a team as much as possible in taking care of you."
B. "National law prohibits the inclusion of anyone who is unlicensed to practice health care from giving health-related advice."
C. "Because of the risks to your baby, we do not recommend that clients use alternative healthcare methods."
D. "We prefer that only the father of the baby and your relatives accompany you to your prenatal visits."
A
150
A Chinese woman who is 16 weeks pregnant reports to the nurse that ginseng and bamboo leaves help to reduce her anxiety. How should the nurse respond to this client?
A. Advise the client to avoid the use of all herbs.
B. Assess the amount and frequency with which the client is using the remedy.
C. Tell the client that her remedies have no scientific foundation.
D. Assess where the client obtains her remedy, and investigate the source.
D
151
A 23-year-old client is 10 weeks' gestation with her first pregnancy. She expresses worry over feeling no sexual desire for her husband and asks if this is normal. How should the nurse respond?
A. "That sounds normal. In many cases, sexual desire decreases in the first trimester, but it increases again during the second trimester."
B. "That's unusual. Usually, there are minimal changes in sexual desire throughout a healthy pregnancy."
C. "That sounds normal. During the first trimester, sexual desire often decreases; however, by the third trimester, sexual desire is usually greater than before pregnancy."
D. "That's unusual. Throughout a healthy pregnancy, sexual desire usually increases with each trimester."
A
152
The prenatal clinic nurse is caring for a 15-year-old primiparous client at 8 weeks' gestation. The client is 64 inches tall and weighs 115 pounds. The client asks the nurse why she is supposed to gain so much weight. What is the best response by the nurse?
A. "Gaining 25 to 35 pounds is recommended for healthy fetal growth."
B. "It's what your certified nurse-midwife recommended for you."
C. "Inadequate weight gain delays lactation after delivery."
D. "Weight gain is important to assure that you get enough vitamins."
C
153
The nurse is preparing an antenatal nutrition class for pregnant women. Which material should be included in the teaching?
A. Dietary protein can only be obtained through consuming dairy, meat, and eggs.
B. During pregnancy, consumption of oily fish should be avoided.
C. Iron absorption is generally higher for vegetable products than for animal products.
D. Nutritional iodine requirements generally can be met through intake of iodized salt.
D
154
The nurse is presenting a preconception counseling class. The nurse instructs the participants that niacin intake should increase during pregnancy to promote metabolic coenzyme activity. The nurse would know that teaching has been effective if a patient suggests which of the following foods as a source of niacin?
A. Fish
B. Apples
C. Broccoli
D. Milk
A
155
The nurse evaluates the diet of a pregnant client and finds that it is low in zinc. The nurse knows that zinc intake should increase during pregnancy to promote protein metabolism. Which of the following foods should the nurse suggest in order to increase intake of zinc?
A. Shellfish
B. Bananas
C. Yogurt
D. Cabbage
A
156
The nurse is providing nutritional counseling for a postpartum client with a hemoglobin of 8.0. Which statement indicates that additional teaching is necessary?
A. "My iron is low, but it will increase as I take iron supplements."
B. "I need to increase food sources that contain iron."
C. "If I drink lots of milk, I will increase my iron level faster."
D. "I might feel less energetic and tire more easily while my iron is low."
C
157
The breastfeeding mother is concerned that her milk production has decreased. The nurse knows that further client teaching is needed based on which statement?
A. "I am drinking a minimum of 8 to 10 glasses of liquid a day."
B. "I have started cutting back on my protein intake."
C. "At least three times a day, I am drinking a glass of milk."
D. "I try to take a nap in the morning and afternoon when the baby is sleeping."
B
158
The nurse is conducting a postpartum home visit. The client has been home for a week and is formula feeding her infant. Which statement by the client indicates that she understands the teaching?
A. "I have increased my caloric intake by 600 calories per day."
B. "My dietician has set my weight loss goal at 1 to 2 pounds per week."
C. "Instead of making another doctor's appointment, I started a diet that my best friend recommended."
D. "My daily regimen includes taking extra vitamin A, vitamin C, and thiamine in order to meet my body's increased need for nutrients after pregnancy."
B
159
The nurse is planning an educational session for pregnant vegans. What information should the nurse include?
A. Eating beans and rice provides complete protein needs.
B. Soy is not a good source of protein for vegans.
C. Rice contains a high level of vitamin B12.
D. Vegan diets are high in iron.
A
160
A pregnant client who is a lacto-ovo vegetarian asks the nurse to help her plan a diet that includes adequate protein intake. What instruction should the nurse give?
A. "Because you don't eat meat, eggs, or dairy products, it's important to eat adequate plant-based proteins."
B. "To improve protein absorption, avoid simultaneous intake of animal protein and plant protein."
C. "Following a vegan diet will require you to take a daily supplement of vitamin B12."
D. "In addition to eggs and dairy products, beans, peanut butter, and soy milk can be effective sources of plant-based proteins."
D
161
Which client statement on cultural or religious influences on nutrition requires intervention?
A. "My grandmother makes sure I eat a serving of greens each day."
B. "I avoid milk and meat at meals because I am Jewish."
C. "My auntie sent me clay from the south to eat every day."
D. "Because I am Muslim, I do not ever eat any pork products."
C
162
The nurse is working with a pregnant 14-year-old. The patient confides that she's concerned she may be struggling with bulimia nervosa. Which nursing observation best supports the patient's statement?
A. The patient is of normal weight for her height and reports binge eating followed by purging.
B. Despite being extremely underweight, the patient describes herself as being fat.
C. The patient reports dietary cravings for soil and clay.
D. In terms of food variety and quantity, the patient's diet is extremely restrictive.
A
163
When preparing nutritional instruction, which of the following pregnant clients would the nurse consider highest priority?
A. 40-year-old gravida 2
B. 22-year-old primigravida
C. 35-year-old gravida 4
D. 15-year-old nulligravida
D
164
Which statement is best to include when teaching a pregnant adolescent about nutritional needs of pregnancy?
A. "It is important eat iron-rich foods like meat every day."
B. "Calcium and milk aren't needed until the third trimester."
C. "Folic acid intake is the key to having a healthy baby."
D. "You just need to pay attention to what you eat now."
A
165
The school nurse is planning a class about nutrition for pregnant teens. The nurse knows that several of the pregnant teenage clients have been diagnosed with iron-deficiency anemia. Which should the nurse encourage the teens to consume more of in order to increase iron absorption?
A. Gatorade
B. Orange juice
C. Milk
D. Green tea
B
166
The nurse is working with a pregnant teen. In order to accurately assess the teen's nutritional intake, the nurse should:
A. Assess laboratory values.
B. Ask her to complete a 24-hour dietary recall.
C. Observe for clinical signs of malnutrition.
D. Ask about her cooking facilities.
B
167
The nurse is leading a session on nutrition for newly delivered women. Which statement indicates that teaching has been effective?
A. "Because I am breastfeeding, I need a low calcium intake."
B. "Breastfeeding requires that I eat lots of protein daily.
C. "Since I am bottle feeding, I don't have to eat vegetables."
D. "Bottle feeding moms like me require a high sodium intake."
B
168
The nurse is preparing a prenatal class about infant feeding methods. The maternal nutritional requirements for breastfeeding and formula feeding will be discussed. What statement should the nurse include?
A. "Breastfeeding requires a continued high intake of protein and calcium."
B. "Formula-feeding mothers should protect their health with a lot of calcium."
C. "Producing breast milk requires calories, but any source of food is fine."
D. "Formula-feeding mothers need a high protein intake to avoid fatigue."
A
169
The nurse is observing the meal selections of a group of pregnant and postpartal clients. One meal consists of a cup of skim milk, soy burger on a bun, baked beans, 8 ounces of water, four carrot sticks, and a mixed fresh fruit cup. For which client is this meal the best choice?
A. 27-year-old primipara, 8 weeks' gestation, Hgb 11.0
B. 30-year-old multipara two days postpartum, bottle-feeding
C. 15-year-old primipara, one day postpartum, breastfeeding
D. 20-year-old multipara, 32 weeks' gestation, reports fatigue.
C
170
Which statements by a breastfeeding class participant indicate that teaching was effective? Select all that apply.
A. "Breastfed infants get more skin-to-skin contact and sleep better."
B. "Breastfeeding raises the level of a hormone that makes me feel good."
C. "Breastfeeding is complex and difficult, and I probably won't succeed."
D. "Breastfeeding is worthwhile, even if it costs more overall."
E. "Breastfed infants have fewer digestive and respiratory illnesses."
A, B, E
171
During pregnancy a woman should consume 3 servings of ________ per day and ________ calorie intake by ________.
calcium, increase, 300
172
What are the principals related to weight gain during pregnancy? Select all that apply.
A. Average of 1 pound a week gained in the 2nd and 3rd trimesters
B. Total gain of average 35 to 45 pounds
C. Gain should be consistent throughout pregnancy
D. Total gain average 25 to 35 pounds
E. Gain 2 pounds a week in the 3rd trimester
A, C, D
173
The nurse is responding to phone calls. Which call should the nurse return first?
A. 37 weeks' gestation, reports no fetal movement for 24 hours
B. 29 weeks' gestation, reports increased fetal movement
C. 32 weeks' gestation, reports decreased fetal movement for 2 days
D. 35 weeks' gestation, reports decreased fetal movement for 4 hours
A
174
A woman at 28 weeks' gestation is asked to keep a fetal activity diary and to bring the results with her to her next clinic visit. One week later, she calls the clinic and anxiously tells the nurse that she has not felt the baby move for over 30 minutes. The most appropriate initial comment by the nurse would be:
A. "You need to come to the clinic right away for further evaluation."
B. "Have you been smoking?"
C. "When did you eat last?"
D. "Your baby might be asleep."
D
175
The nurse is preparing a client in her second trimester for a three-dimensional ultrasound examination. Which statement indicates that teaching had been effective?
A. "If the ultrasound is normal, it means my baby has no abnormalities."
B. "The nuchal translucency measurement will diagnose Down syndrome."
C. "I might be able to see who the baby looks like with the ultrasound."
D. "Measuring the length of my cervix will determine if I will deliver early."
C
176
A woman is at 32 weeks' gestation. Her fundal height measurement at this clinic appointment is 26 centimeters. After reviewing her ultrasound results, the healthcare provider asks the nurse to schedule the patient for a series of sonograms to be done every two weeks. The nurse should make sure that the patient understands that the main purpose for this is to:
A. Assess for congenital anomalies.
B. Evaluate fetal growth.
C. Determine fetal presentation.
D. Rule out a suspected hydatidiform mole.
B
177
In assisting with an abdominal ultrasound procedure for determination of fetal age, the nurse:
A. Asks the woman to sign an operative consent form prior to the procedure.
B. Has the woman empty her bladder before the test begins.
C. Assists the woman into a supine position on the examining table.
D. Instructs the woman to eat a fat-free meal two hours before the scheduled test time.
C
178
The prenatal clinic nurse is responding to a client who has had an assessment for fetal well-being. Which statement indicates that the client understands the test result?
A. "The normal Doppler velocimetry wave result indicates my placenta is getting enough blood to the baby."
B. "The reactive nonstress test means that my baby is not growing because of a lack of oxygen."
C. "Because my contraction stress test was positive, we know that my baby will tolerate labor well."
D. "My biophysical profile score of 6 points indicates everything being normal and healthy for my baby."
A
179
At 32 weeks' gestation, a woman is scheduled for a second nonstress test (following the one she had at 28 weeks' gestation). Which response by the client would indicate an adequate understanding of this procedure?
A. "I can't get up and walk around during the test."
B. "I'll have an IV started before the test."
C. "I must avoid drinks containing caffeine for 24 hours before the test."
D. "I need to have a full bladder for this test."
A
180
During a nonstress test, the nurse notes that the fetal heart rate decelerates about 15 beats during a period of fetal movement. The decelerations occur twice during the test and last 20 seconds each. The nurse realizes these results will be interpreted as:
A. A negative test.
B. A reactive test.
C. A non-reactive test.
D. An equivocal test
C
181
A pregnant woman is having a nipple-stimulated contraction stress test. Which result indicates hyperstimulation?
A. The fetal heart rate decelerates when three contractions occur within a 10-minute period.
B. The fetal heart rate accelerates when contractions last up to 60 seconds.
C. There are more than five fetal movements in a 10-minute period.
D. There are more than three uterine contractions in a 6-minute period
D
182
Of all the clients who have been scheduled to have a biophysical profile, for which patient should the nurse clarify the physician's order?
A. A gravida with intrauterine growth restriction
B. A gravida with mild hypertension of pregnancy
C. A gravida who is post-term
D. A gravida who complains of decreased fetal movement for 2 days
B
183
The nurse is reviewing nursing documentation related to the care of a client who had an amniocentesis. Which nursing notes reflect appropriate client care?
A. An Rh-positive client received RhoGAM after the amniocentesis.
B. The client was monitored for 30 minutes after completion of the test.
C. Prior to discharge, the client demonstrated vaginal spotting.
D. The client reported that she takes insulin before each meal and at bedtime.
B
184
Each of the following pregnant women is scheduled for a 14-week antepartum visit. In planning care, the nurse would give priority teaching on amniotic fluid alpha-fetoprotein (AFP) screening to which client?
A. 28-year-old with history of rheumatic heart disease
B. 18-year-old with exposure to HIV
C. 20-year-old with a history of preterm labor
D. 35-year-old with a child with spina bifida
D
185
The nurse is creating a client education brochure describing amniocentesis. Which statement is most important for the nurse to include in the brochure?
A. "Prior to the amniocentesis, you will be asked to sign a consent form."
B. "After the amniocentesis, your vital signs will be monitored."
C. "During the amniocentesis, you might experience leaking of fluid."
D. "Following the amniocentesis, you can return to normal activities."
B
186
A woman who is 12 weeks' gestation asks the nurse if she can undergo chorionic villus sampling (CVS) testing in order to determine whether her baby has a neural tube defect. Which response is best?
A. "Yes, at 12 weeks' gestation, CVS can be used to diagnose a neural tube defect."
B. "No, because CVS testing is not performed until after 20 weeks' gestation."
C. "Yes, at 12 weeks' gestation, CVS is combined with amniocentesis to diagnose neural tube defects."
D. "No, because CVS testing alone at any stage cannot detect neural tube defects."
D
187
A woman who is 15 weeks' gestation received normal chorionic villus sampling (CVS) results and abnormal quadruple screen test results. For detection of congenital anomalies, which test should the nurse expect the woman to be offered next?
A. Amniocentesis
B. Ultrasound
C. Contraction Stress Test (CST)
D. Nonstress test (NST)
A
188
Prior to performing amniocentesis, which nursing action is appropriate?
A. Administering Rh immune globulin to a woman who is Rh-negative
B. Prepping the abdominal skin with povidone-iodine (Betadine)
C. Assisting the woman with assuming a right lateral position
D. Providing non-sterile gloves for use by the physician performing the procedure
B
189
The nurse is assisting a nurse-midwife with performing a contraction stress test (CST) on a client who is 30 weeks' gestation. The monitor reveals a hypersystole pattern. What order should the nurse expect to receive from the physician?
A. Change the client's position to Trendelenburg.
B. Assist the client with application of an electric breast pump.
C. Obtain a 15-minute recording of uterine activity
D. Administer a tocolytic medication.
D
190
The nurse is explaining the importance of fetal activity assessment to the client. What should the nurse do to best reinforce the significance of fetal kick counting to the client?
A. Perform daily phone calls to the client at work or home.
B. Review the client's written record of fetal movement at each visit.
C. Ask the client to remember to count the fetal movements.
D. Explain the rationale for counting fetal movement to the client.
B
191
A woman at 15 weeks' gestation is to have an amniocentesis completed for genetic diagnosis. What important information does the woman need to know before this procedure?
A. The test is only 75 percent accurate in diagnosing genetic abnormalities.
B. A regional anesthetic will be administered by 18-gauge needle.
C. The bladder must be full to proceed with the test.
D. Complications occur in 10 percent of cases.
C
192
Nursing care for the woman that just completed amniocentesis testing includes (select all that apply):
A. Continually monitor and obtain an CST after the procedure.
B. Monitor maternal heart rate for 4-hours after the procedure.
C. Assess for uterine contractions and irritability.
D. Assess the fetal blood type.
E. Assess I & O.
B, C
193
The nurse is caring for a pregnant woman who admits to cocaine and ecstasy use on a regular basis. The client states,
"Everybody knows that alcohol is bad during pregnancy, but what's the big deal about ecstasy?" The best response by the nurse is:
A. "Ecstasy can cause a high fever in you and therefore cause the baby harm."
B. "Ecstasy leads to deficiencies of thiamine and folic acid, which help the baby develop."
C. "Ecstasy produces babies with small heads and short bodies with brain function alterations."
D. "Ecstasy produces intrauterine growth restriction and meconium aspiration."
A
194
The nurse is doing preconception counseling with a 28-year-old woman with no prior pregnancies. Which of the following statements made by the client indicates to the nurse that the client has understood the teaching?
A. "I can continue to drink alcohol until I am diagnosed as pregnant."
B. "I need to stop drinking alcohol completely when I start trying to get pregnant."
C. "A beer once a week will not damage the fetus."
D. "I can drink alcohol while breastfeeding since it doesn't pass into breast milk."
B
195
A woman's history and appearance suggest drug abuse. The nurse's best approach would be to:
A. Ask the woman directly, "Do you use any street drugs?"
B. Ask the woman if she would like to talk to a counselor.
C. Ask some questions about over-the-counter medications and avoid the mention of illicit drugs.
D. Explain how harmful drugs can be for her baby.
A
196
A 20-year-old woman is at 28 weeks' gestation. Her prenatal history reveals past drug abuse, and urine screening indicates that she has recently used heroin. The nurse should recognize that the woman is at increased risk for:
A. Erythroblastosis fetalis.
B. Diabetes mellitus.
C. Abruptio placentae.
D. Pregnancy-induced hypertension.
D
197
The client with insulin-dependent type 2 diabetes and an HbA1c of 5.0% is planning to become pregnant soon. What anticipatory guidance should the nurse provide this client?
A. Insulin needs decrease in the first trimester and increase during the third trimester.
B. The risk of ketoacidosis decreases during the length of the pregnancy.
C. Vascular disease that accompanies diabetes slows progression.
D. The baby is likely to have a congenital abnormality because of the diabetes.
A
198
A newly diagnosed type 1, insulin-dependent diabetic with good blood sugar control is at 20 weeks' gestation. She asks the nurse how her diabetes will affect her baby. The best explanation would include:
A. "Your baby may be smaller than average at birth."
B. "Your baby will probably be larger than average at birth."
C. "As long as you control your blood sugar, your baby will not be affected at all."
D. "Your baby might have high blood sugar for several days."
B
199
A 26-year-old multigravida is 28 weeks pregnant. She has developed gestational diabetes. She is following a program of regular exercise, which includes walking, bicycling, and swimming. What instructions should be included in a teaching plan for this client?
A. "Exercise either just before meals or wait until two hours after a meal."
B. "Carry hard candy (or other simple sugar) when exercising."
C. "If your blood sugar is 120 mg/dL, eat 20 g of carbohydrate."
D. "If your blood sugar is more than 120 mg/dL, drink a glass of whole milk."
B
200
A 31-year-old woman who is at high risk for diabetes is at 18 weeks' gestation. During her first antenatal visit, which is the accurate approach to evaluating the patient for diabetes?
A. Begin serial testing of the patient's serum glucose and HA1c at 24 weeks' gestation.
B. If diabetes is diagnosed, consider this condition to be gestational diabetes mellitus (GDM).
C. Recognize HA1c equal to or greater than 4.5 percent or a fasting plasma glucose level equal to or greater than 90 mg/dL as being diagnostic of diabetes.
D. Conduct screening for type 2 diabetes mellitus as soon as possible.
D
201
The pregnant client at 23 weeks' gestation has a hemoglobin of 9.5. Which diet choice indicates that teaching has been effective?
A. Tofu with mixed vegetables in curry, milk, whole-wheat bun
B. Roast beef, steamed spinach, tomato soup, orange juice
C. Pork chop, mashed potatoes and gravy, cauliflower, tea
D. Broiled fish, lettuce salad, grapefruit half, carrot sticks
B
202
A woman at 30 weeks' gestation and a history including sickle cell anemia presents to the clinic complaining of fever, chills, and diarrhea for 3 days. What are the most serious potential complications faced by this client?
A. Electrolyte imbalance
B. Sickle cell crisis
C. Fetal neural tube defects
D. Severe lethargy
B
203
A client who is at 18 weeks' gestation has been newly diagnosed with megaloblastic anemia. Which statement by the client indicates that she understands the teaching?
A. "I should include fresh leafy green vegetables, red meat, fish, poultry, and legumes in my diet."
B. "Whenever possible, I should boil my vegetables in at least 2 quarts of water."
C. "Megaloblastic anemia is not known to cause any serious risks to my baby."
D. "My body makes red blood cells that are smaller than they should be."
A
204
The patient at 9 weeks' gestation has been told that her HIV test was positive. The patient is very upset and tells the nurse, "I didn't know I had HIV! What will this do to my baby?" The nurse knows teaching has been effective when the patient states:
A. "I cannot take the medications that control HIV during my pregnancy because they will harm the baby."
B. "My baby will probably be born with anti-HIV antibodies, but that doesn't mean it is infected."
C. "The pregnancy will increase the progression of my disease and will reduce my CD4 counts."
D. "The HIV won't affect my baby, and I will have a low-risk pregnancy without additional testing."
B
205
During her first antepartal visit, a client who is at 10 weeks' gestation reports that she is HIV-positive. Which statement made by the client indicates an understanding of the plan of care both during the pregnancy and postpartally?
A. "I'm supposed to take highly active antiretroviral therapy (HAART), but only during the first trimester."
B. "I should not breastfeed my baby."
C. "If I have a cesarean section, there's an increased risk that my HIV will be passed to my baby."
D. "When my baby is 2 months old, he or she will be tested for HIV."
B
206
A woman is 32 weeks pregnant. She is HIV-positive, but asymptomatic. What would be important in managing her pregnancy and delivery?
A. An amniocentesis at 30 and 36 weeks
B. Weekly nonstress testing beginning at 32 weeks' gestation
C. Application of a fetal scalp electrode as soon as her membranes rupture in labor
D. Administration of intravenous antibiotics during labor and delivery
B
207
A pregnant woman is married to an intravenous drug user. She had a negative HIV screening test just after missing her first menstrual period. What would indicate that the client needs to be retested for HIV?
A. Hemoglobin of 11 g/dL and a rapid weight gain
B. Elevated blood pressure and ankle edema
C. Shortness of breath and frequent urination
D. Unusual fatigue and recurring Candida vaginitis
D
208
The nurse is reviewing prenatal charts. A patient at 24 weeks has a history of class II heart disease secondary to rheumatic fever. What would the nurse expect to see in the chart?
A. Dyspnea and chest pain with mild exertion
B. Elective cesarean birth scheduled for 37 weeks
C. Discussed need for labor epidural and vacuum extraction
D. Respiratory rate 28, pulse 110, 3+ pre-tibial edema bilaterally
C
209
The prenatal clinic nurse has received four phone calls. Which client should be called first?
A. Primip at 28 weeks with history of asthma reporting difficulty breathing and shortness of breath
B. Multip at 6 weeks with a seizure disorder inquiring what foods are good folic acid sources for her
C. Primip at 35 weeks with a positive HBsAG wondering what treatment her baby will receive after birth
D. Multip at 11 weeks with untreated hyperthyroidism describing the onset of vaginal bleeding
A
210
The client was found to have hepatitis B surface antigen (HBsAG) early in her pregnancy. The nurse is explaining to the client what will happen during labor and birth because the client is contagious for hepatitis B. Which statement by the client indicates that additional teaching is needed?
A. "An internal fetal monitor will be applied as soon as possible during labor."
B. "My baby will get a bath as soon as its temperature is stable."
C. "Two shots will be given to my baby to prevent transmission of hepatitis B."
D. "Breastfeeding is a good feeding method for my baby."
A
211
What normal change could pose serious problems to the postpartum woman with cardiac disease?
A. WBC decrease
B. Diuresis
C. Involution
D. Increased protein intake
B
212
The woman with diabetes mellitus is prone to what factors during pregnancy? Select all that apply.
```
A. Diarrhea
B. Infection
C. Palpitations
D. Decreased tissue perfusion
E. Preeclampsia
```
B, D, E
213
The nurse is supervising care in the emergency department. Which situation most requires an intervention?
A. Moderate vaginal bleeding at 36 weeks' gestation; patient has an IV of lactated Ringer's solution running at 125 mL/hour
B. Spotting of pinkish-brown discharge at 6 weeks' gestation and abdominal cramping; ultrasound scheduled in one hour
C. Bright red bleeding with clots at 32 weeks' gestation; pulse = 110, blood pressure 90/50, respirations = 20
D. Dark red bleeding at 30 weeks' gestation with normal vital signs; patient reports an absence of fetal movement
C
214
The prenatal clinic nurse is caring for a patient with hyperemesis gravidarum at 14 weeks' gestation. The vital signs are: blood pressure 95/48, pulse 114, respirations 24. Which order should the nurse implement first?
A. Weigh the patient.
B. Give 1 liter of lactated Ringer's solution IV.
C. Administer 30 ml Maalox (magnesium hydroxide) orally.
D. Encourage clear liquids orally.
B
215
A 28-year-old woman who is at 16 weeks' gestation has just undergone screening for ABO incompatibility. She asks the nurse why her blood contains anti-A antibodies. What is the nurse's best response?
A. "Anti-A antibodies occur naturally, as a result of exposure to foods and different infections."
B. "It's most likely that you contracted anti-A antibodies through sexual activity."
C. "Anti-A antibodies are inherited; usually, they are genetically passed down from father to daughter."
D. "You may have contracted anti-A antibodies as a result of a viral infection."
A
216
While preparing a class on maternal-fetal ABO incompatibility for antepartum patients, the nurse is creating a brochure. Which statement should be included in the brochure information?
A. In most cases, ABO incompatibility is limited to Type A mothers with a Type B or O fetus.
B. Group A infants, because they have no antigenic sites on the red blood cells (RBCs), are never affected regardless of the mother's blood type.
C. In most cases, ABO incompatibility is limited to Type O mothers with a Type A or B fetus.
D. ABO incompatibility occurs as a result of the fetal serum antibodies present and interaction between the antigen sites on the maternal RBCs.
C
217
A client who is at 32 weeks' gestation is determined to be at high risk for ABO incompatibility. Which intervention should the nurse anticipate implementing?
A. Intramuscular administration of 300 mcg of Rh immune globulin (RhoGAM) to the patient
B. Notify the patient's primary care provider and document the potential need for treatment of fetal hemolytic anemia in the patient's baby after delivery.
C. Obtain an antibody screen (indirect Coombs' test) to determine whether the patient has developed isoimmunity.
D. Note the potential for ABO incompatibility and plan to carefully assess the patient's neonate for the development of hyperbilirubinemia.
D
218
The nurse identifies the following assessment findings on a patient with preeclampsia: blood pressure 158/100; urinary output 50 mL/hour; lungs clear to auscultation; urine protein 11 on dipstick; and edema of the hands, ankles, and feet. On the next hourly assessment, which of the following new assessment findings would be an indication of worsening of the preeclampsia?
A. Blood pressure 158/104
B. Urinary output 20 mL/hour
C. Reflexes 21
D. Platelet count 150,000
B
219
The community nurse is working with a client at 32 weeks' gestation who has been diagnosed with pre-eclampsia. Which statement indicates that additional information is needed?
A. "I should call the doctor if I develop a headache or blurred vision."
B. "Lying on my left side as much as possible is good for the baby."
C. "My urine may become darker and smaller in amount each day."
D. "Pain in the top of my abdomen is a sign my condition is worsening."
C
220
The nurse is assessing a newly admitted client who is 32 weeks' gestation. The client's chief complaints are sudden onset of intense nausea and a frontal headache for the past two days. The client's initial blood pressure is 158/98 and she reports scant urination over the past 24 hours. Which intervention should the nurse anticipate implementing?
A. Placing a wedge under the client's left hip so that she is in a right lateral tilt position
B. Administration of diuretics and facilitating a dietary regimen of strict sodium restriction
C. Conducting a urine dipstick test to assess for proteinuria
D. Ordering a low-protein diet plan for the patient
C
221
The nurse receives the following report on a client who delivered 36 hours ago: para 1, rubella immune, A-negative, antibody screen negative, newborn B-positive, Coombs' negative, discharge orders are written for both mother and newborn. What should be the priority action by the nurse?
A. Ask if she is breastfeeding or bottle feeding.
B. Administer rubella vaccine.
C. Determine if RhoGAM has been given.
D. Discuss the discharge education with the patient.
C
222
The patient with blood type A, Rh-negative delivered yesterday. Her infant is blood type AB, Rh-positive. Which statement indicates that teaching has been effective?
A. "I need to get RhoGAM so I don't have problems with my next pregnancy."
B. "Because my baby is Rh-positive, I don't need RhoGAM."
C. "If my baby had the same blood type I do, it might cause complications."
D. "Before my next pregnancy, I will need to have a RhoGAM shot."
A
223
Which maternal-child client should the nurse see first?
A. Blood type O, Rh-negative
B. Indirect Coombs' test negative
C. Direct Coombs' test positive
D. Blood type B, Rh-positive
C
224
Which situation in the high-risk antepartal unit requires immediate intervention?
A. A third-trimester client pregnant with twins who required an appendectomy yesterday is positioned in a supine position.
B. Oxygen is being administered at 2 L via nasal cannula to a client in her third trimester who underwent an urolithotomy today.
C. Fetal monitoring is being performed on a client in her third trimester who is scheduled for a cholecystectomy tomorrow.
D. The client in her third trimester who returned from bowel resection surgery has a nasogastric tube attached to intermittent suction.
A
225
The nurse is caring for a client at 35 weeks' gestation who has been critically injured in a shooting. Which statement by the paramedics bringing the woman to the hospital would cause the greatest concern?
A. "Blood pressure 110/68, pulse 90."
B. "Entrance wound present below the umbilicus."
C. "Patient is positioned in a left lateral tilt."
D. "Clear fluid is leaking from the vagina."
B
226
The nurse is admitting a client at 28 weeks' gestation to the emergency department following an episode of domestic abuse resulting in ecchymosis and lacerations. Which question is most critical to ask?
A. "What did you do to make your spouse so angry?"
B. "How many times has this happened in the past?"
C. "Do you have a safe place that you can go?"
D. "Will you be pressing charges against your spouse?"
C
227
Which statement indicates that teaching has been effective?
A. "Because I have toxoplasmosis, my baby might be born with an abnormally long body."
B. "The rubella infection I experienced in my second trimester may lead me to become deaf."
C. "My baby may develop a serious blood infection because I have group B strep in my vagina."
D. "My 8-year-old's parvovirus infection won't affect my baby because I am four months along."
C
228
The nurse is teaching an early pregnancy class for clients in the first trimester of pregnancy. Which statement requires immediate intervention by the nurse?
A. "When my nausea is bad, I will drink some ginger tea."
B. "The fatigue I am experiencing will improve in the second trimester."
C. "It is normal for my vaginal discharge to get green-colored."
D. "I will urinate less often during the middle of my pregnancy."
C
229
Upon arriving at the prenatal clinic in the morning, the nurse receives messages from four clients. Which client complaint should be addressed first?
A. Primip at 9 weeks' gestation with increased fatigue and nocturia
B. Multip at 30 weeks' gestation with vaginal bleeding after performing yoga
C. Primip at 24 weeks' gestation with ankle edema
D. Multip at 35 weeks' gestation with new onset of hemorrhoids
B
230
Match the type of spontaneous abortion with its category.
1. Some of the products of conception are retained, most often the placenta. The internal cervical os is dilated slightly.
2. The cervix is closed. Bleeding may persist for days. It may be followed by partial or complete expulsion of the embryo or fetus, placenta, and membrane or it may resolve without threatening the fetus.
3. Abortion occurs consecutively in three or more pregnancies.
4. Presence of infection. May occur with prolonged, unrecognized rupture of the membranes; pregnancy with an intrauterine device (IUD) in utero; or attempts by unqualified individuals to terminate a pregnancy.
5. Bleeding and cramping increase. The internal cervical os dilates. Membranes may rupture.
6. All the products of conception are expelled.
7. The fetus dies in utero but is not expelled. Uterine growth ceases, breast changes regress, and the woman may report a brownish vaginal discharge. The cervix is closed.
```
________ A. Threatened abortion
________ B. Imminent abortion
________ C. Septic abortion
________ D. Recurrent pregnancy loss
________ E. Complete abortion
________ F. Missed abortion
________ G. Incomplete abortion
```
Answer: 1/G, 2/A, 3/D, 4/C, 5/B, 6/E, 7/F
231
Nursing diagnoses that may apply for a woman with an ectopic pregnancy include (select all that apply):
A. Fluid volume: deficient, related to hypovolemia secondary to maternal blood loss
B. Pain, acute, related to abdominal bleeding secondary to tubal rupture
C. Fluid volume: deficient, related to excessive bleeding secondary to spontaneous abortion
D. Grieving related to loss of the pregnancy
E. Fear related to the possible development of choriocarcinoma
A, B, D
