NR 327 Exam 1 - 48 Questions Flashcards
Similar question A medical-surgical nurse is asked to float to a women’s health unit to care for patients who are scheduled for therapeutic abortions. The nurse refuses to accept this assignment and expresses her personal beliefs as being incongruent with this medical practice. The nursing supervisor states that the unit is short-staffed and the nurse is familiar with caring for postoperative patients. In consideration of legal and ethical practices, can the nursing supervisor enforce this assignment?
a.
The staff nurse has the responsibility of accepting any assignment that is made while working for a health care unit, so the nursing supervisor is within his or her rights to enforce this assignment.
b.
Because the unit is short-staffed, the staff nurse should accept the assignment to provide care by benefit of her or his experience to patients who need care.
c.
The staff nurse has expressed a legitimate concern based on his or her feelings; the nursing supervisor does not have the authority to enforce this assignment.
d. The nursing supervisor should emphasize that this assignment requires care of a surgical patient for which the staff nurse is adequately trained and should therefore enforce the assignment
ANS: C
The Nurse Practice Act allows nurses to refuse assignments that involve practices that they have expressed as being opposed to their religious, cultural, ethical, and/or moral values. Although the nursing supervisor has a right to arrange assignments, the supervisor, if made aware of a potential bias or limitation, must act accordingly and accept the nurse’s position. This should be upheld regardless of staffing limitations and independent of persuasive efforts to make the nurse feel guilty for her or his stated beliefs.
Ethical Principles
-Autonomy
-Fidelity
-Beneficence
-Accountability
-Maleficence
-Fidelity
-Justice
Autonomy - Self determination
Beneficence - Greatest good
Accountability - Accepting responsibility
Maleficence - DO NO HARM*
Fidelity - Faithful, loyal - stating in good faith
Justice - Be treated equally
SATA
Along with gas exchange and nutrient transfer, the placenta produces many hormones necessary for normal pregnancy, including which of the following? (Select all that apply.)
a.Insulin
b.Estrogen
c. Progesterone
d. Testosterone
e. Human chorionic gonadotropin (hCG)
ANS: B, C, E
HCG causes the corpus luteum to persist and produce the necessary estrogens and progesterone for the first 6 to 8 weeks. Estrogens cause enlargement of the woman’s uterus and breasts and growth of the ductal system in the breasts and, as term approaches, plays a role in the initiation of labor. Progesterone causes the endometrium to change, providing early nourishment. Progesterone also protects against spontaneous abortion by suppressing maternal reactions to fetal antigens and reduces unnecessary uterine contractions. Other hormones produced by the placenta include hCT, hCA, and a number of growth factors. Insulin and testosterone are not secreted by the placenta.
- What is the physiologic reason for vascular volume increasing by 40% to 60% during pregnancy?
a.Prevents maternal and fetal dehydration
b.Eliminates metabolic wastes of the mother
c.Provides adequate perfusion of the placenta
d.Compensates for decreased renal plasma flow
ANS: C
The primary function of increased vascular volume is to transport oxygen and nutrients to the fetus via the placenta. Preventing maternal and fetal dehydration is not the primary reason for the increase in volume. Assisting with pulling metabolic wastes from the fetus for maternal excretion is one purpose of the increased vascular volume. Renal plasma flow increases during pregnancy.
- Which finding is a positive sign of pregnancy?
a. Amenorrhea
b. Breast changes
c. Fetal movement felt by the woman
d.Visualization of fetus by ultrasound
ANS: D
The only positive signs of pregnancy are auscultation of fetal heart tones, visualization of the fetus by ultrasound, and fetal movement felt by the examiner. Amenorrhea is a presumptive sign of pregnancy. Breast changes are a presumptive sign of pregnancy. Fetal movement is a presumptive sign of pregnancy.
- An expected change during pregnancy is a darkly pigmented vertical midabdominal line. The nurse recognizes this alteration as
a.
epulis.
b.
linea nigra.
c.
melasma.
d.
striae gravidarum.
ANS: B
The linea nigra is a dark pigmented line from the fundus to the symphysis pubis. Epulis refers to gingival hypertrophy. Melasma is a different kind of dark pigmentation that occurs on the face. Striae gravidarum (stretch marks) are lines caused by lineal tears that occur in connective tissue during periods of rapid growth.
- Which physiologic finding is consistent with normal pregnancy?
a.
Systemic vascular resistance increases as blood pressure decreases.
b.
Cardiac output increases during pregnancy.
c.
Blood pressure remains consistent independent of position changes.
d.
Maternal vasoconstriction occurs in response to increased metabolism.
ANS: B
Cardiac output increases during pregnancy as a result of increased stroke volume and heart rate. Systemic vascular resistance decreases while blood pressure remains the same. Maternal blood pressure changes in response to patient positioning. In response to increased metabolism, maternal vasodilation is seen during pregnancy.
- Which physiologic adaptation of pregnancy may lead to increased constipation during the pregnancy?
a.
Increased emptying time in the intestines
b.
Abdominal distention and bloating
c.
Decreased absorption of water
d.
Decreased motility in the intestines
Question asked which hormone contributes to constipation - ANSWER: Progesterone
ANS: D
Decreased motility in the intestines leading to increased water absorption would cause constipation. Increased emptying time in the intestines leads to increased nutrient absorption. Abdominal distention and bloating are a result of increased emptying time in the intestines.
*EDD Question
- Use Nägele’s rule to determine the EDD (estimated day of birth) for a patient whose last menstrual period started on April 12.
a.
February 19
b.
January 19
c.
January 21
d.
February 7
Subtract 3 months & Add 7 Days
ANS: B
Nägele’s rule subtracts 3 months from the month of the last menstrual period (month 4 – 3 = January) and adds 7 days to the day that the last menstrual period started (April 12 + 7 days = April 19), so the correct answer is January 19 of the following calendar year.
Med Cal
1. What is the value of the main line fluid rate for your patient, whose total fluid intake is ordered at 150 mL/hour and who is also being given magnesium sulfate at 1 g/hour (1 g = 25 mL/hour) IV piggyback and pitocin at 15 mU/minute (l mU/minute = 1 mL/hour) IV piggyback. ______
ANS:
110
The rate of infusion of magnesium sulfate (25 mL/hour) and pitocin (15 mL/hour) equals 40 mL/hour. Subtracting the 40 mL from the total ordered of 150 mL leaves 110 mL of main line fluid to be infused per hour.
- What is the rationale for a woman in her first trimester of pregnancy to expect to visit her health care provider every 4 weeks?
a.
Problems can be eliminated.
b.
She develops trust in the health care team.
c.
Her questions about labor can be answered.
d.
The conditions of the expectant mother and fetus can be monitored.
ANS: D
This routine allows for monitoring maternal health and fetal growth and ensures that problems will be identified early. All problems cannot be eliminated because of prenatal visits; however, they can be identified early. Developing a trusting relationship should be established during these visits, but that is not the primary reason. Most women do not have questions concerning labor until the last trimester of the pregnancy.
- A patient, gravida 2, para 1, comes for a prenatal visit at 20 weeks of gestation. Her fundus is palpated 3 cm below the umbilicus. This finding is
a.
appropriate for gestational age.
b.
a sign of impending complications.
c.
lower than normal for gestational age.
d.
higher than normal for gestational age.
ANS: C
By 20 weeks, the fundus should reach the umbilicus. The fundus should be at the umbilicus at 20 weeks, so 3 cm below the umbilicus is an inappropriate height and needs further assessment. This is lower than expected at this date. It may be a complication, but it may also be because of incorrect dating of the pregnancy
- Which complaint made by a patient at 35 weeks of gestation requires additional assessment? a.
Abdominal pain
b.
Ankle edema in the afternoon
c.
Backache with prolonged standing
d.
Shortness of breath when climbing stairs
ANS: A
Abdominal pain at 35 weeks gestation may indicate preeclampsia, or abruptio placentae. Ankle edema in the afternoon is a normal finding at this stage of the pregnancy. Backaches while standing is a normal finding in the later stages of pregnancy. Shortness of breath is an expected finding at 35 weeks.
- Which information is covered by early pregnancy classes offered in the first and second trimesters?
a.
Methods of pain relief
b.
The phases and stages of labor
c.
Coping with common discomforts of pregnancy
d.
Prebirth and postbirth care of a patient having a cesarean birth
ANS: C
Early pregnancy classes focus on the first two trimesters and cover information on adapting to pregnancy, dealing with early discomforts, and understanding what to expect in the months ahead. Methods of pain relief are discussed in a childbirth preparation class. The phases and stages of labor are usually covered in a childbirth preparation class. Cesarean birth preparation classes discuss prebirth and postbirth of a patient having a cesarean birth.
SATA 2. The nurse is planning care for a patient in her first trimester of pregnancy. The patient is experiencing nausea and vomiting. Which interventions should the nurse plan to share with this patient? (Select all that apply.)
a.
Suck on hard candy.
b.
Take prenatal vitamins in the morning.
c.
Try some herbal tea to relieve the nausea.
d.
Drink fluids frequently but separate from meals.
e. Eat crackers or dry cereal before arising in the morning.
ANS: A, D, E
A patient experiencing nausea and vomiting should be taught to suck on hard candy, drink fluids frequently but separately from meals, and eat crackers, dry toast, or dry cereal before arising in the morning. Prenatal vitamins should be taken at bedtime because they may increase nausea if taken in the morning. Before taking herbal tea, the patient should check with her health care provider.
