OB - Exam 3 - Evolve Questions

Question 1

A 3.8-kg infant was delivered vaginally at 39 weeks after a 30-minute second stage. There was a nuchal cord. After birth the infant is noted to have petechiae over the face and upper back. Information given to the infant’s parents should be based on the knowledge that petechiae:

a. Are benign if they disappear within 48 hours of birth
b. Result from increased blood volume
c. Should always be further investigated
d. Usually occur with forceps delivery

Answer 1

Answer: A

a. Are benign if they disappear within 48 hours of birth

Petechiae, or pinpoint hemorrhagic areas, acquired during birth may extend over the upper portion of the trunk and face. These lesions are benign if they disappear within 2 days of birth and no new lesions appear.

b. Result from increased blood volume

Petechiae may result from decreased platelet formation.

c. Should always be further investigated

In this situation the presence of petechiae is most likely a soft-tissue injury resulting from the nuchal cord at birth. Unless they do not dissipate in 2 days, there is no reason to alarm the family.

d. Usually occur with forceps delivery

Petechiae usually occur with a breech presentation vaginal birth.

Question 2

A mother expresses fear about changing her infant’s diaper after he is circumcised. What does the woman need to be taught to take care of the infant when she gets home?

a. Cleanse the penis with prepackaged diaper wipes every 3 to 4 hours.
b. Apply constant, firm pressure by squeezing the penis with the fingers for at least 5 minutes if bleeding occurs.
c. Cleanse the penis gently with water and put petroleum jelly around the glans after each diaper change.
d. Wash off the yellow exudate that forms on the glans at least once every day to prevent infection.

Answer 2

Answer: C

a. Cleanse the penis with prepackaged diaper wipes every 3 to 4 hours.
With each diaper change, the penis should be washed off with warm water to remove any urine or feces.

b. Apply constant, firm pressure by squeezing the penis with the fingers for at least 5 minutes if bleeding occurs.
If bleeding occurs, the nurse should apply gentle pressure to the site of the bleeding with a sterile gauze square.

c. Cleanse the penis gently with water and put petroleum jelly around the glans after each diaper change.
This action is appropriate when caring for an infant who has had a circumcision.

d. Wash off the yellow exudate that forms on the glans at least once every day to prevent infection.
Yellow exudate covers the glans penis in 24 hours after the circumcision. This is part of normal healing and not an infective process. The exudate should not be removed.

Question 3

An Apgar score of 10 at 1 minute after birth indicates:

a. An infant having no difficulty adjusting to extrauterine life and needing no further testing
b. An infant in severe distress that needs resuscitation
c. A prediction of a future free of neurologic problems
d. An infant having no difficulty adjusting to extrauterine life but who should be assessed again at 5 minutes after birth

Answer 3

Answer: D

a. An infant having no difficulty adjusting to extrauterine life and needing no further testing
A score of 10 at 1 minute of life indicates excellent transition to extrauterine life; however, the score needs to be repeated at 5 minutes of life.
b. An infant in severe distress that needs resuscitation
An infant in need of resuscitation has a very low Apgar score.
c. A prediction of a future free of neurologic problems
The Apgar scores do not predict neurologic outcome but are useful for describing the newborn’s transition to their extrauterine environment.
d. An infant having no difficulty adjusting to extrauterine life but who should be assessed again at 5 minutes after birth
An initial Apgar score of 10 is a good sign of healthy adaptation; it must be repeated at the 5-minute mark.

Question 4

With regard to umbilical cord care, nurses should be aware that:

a. The stump can easily become infected
b. A nurse noting bleeding from the vessels of the cord should immediately call for assistance
c. The cord clamp is removed at cord separation
d. The average cord separation time is 5 to 7 days

Answer 4

Answer: A

With regard to umbilical cord care, nurses should be aware that:

a. The stump can easily become infected
The cord stump is an excellent medium for bacterial growth.

b. A nurse noting bleeding from the vessels of the cord should immediately call for assistance
The nurse should first check the clamp (or tie) and apply a second one. If the bleeding does not stop, then the nurse calls for assistance.

c. The cord clamp is removed at cord separation
The cord clamp is removed after 24 hours when it is dry.

d. The average cord separation time is 5 to 7 days
The average cord separation time is 10 to 14 days.

Question 5

All of these statements are helpful and accurate nursing advice concerning bathing the new baby except:

a. Newborns should be bathed every day, for the bonding as well as the cleaning
b. Tub baths may be given before the infant’s umbilical cord falls off and the umbilicus is healed
c. Only plain warm water should be used to preserve the skin’s acid mantle
d. Powders are not recommended because the infant can inhale powder

Answer 5

Answer: A

a. Newborns should be bathed every day, for the bonding as well as the cleaning
Newborns do not need a bath every day, even if the parents enjoy it. The diaper area and creases under the arms and neck need more attention.

b. Tub baths may be given before the infant’s umbilical cord falls off and the umbilicus is healed
Tub baths may be given as soon as an infant’s temperature has stabilized.

c. Only plain warm water should be used to preserve the skin’s acid mantle
Unscented mild soap is appropriate to use to wash the infant.

d. Powders are not recommended because the infant can inhale powder
Powder is not recommended due to the risk of inhalation. Should a parent elect to use baby powder, it should never be sprinkled directly onto the baby’s skin. The parent can apply a small amount of powder to his or her own hand and then apply to the infant.

Question 6

As part of their teaching function at discharge, nurses should tell parents that the baby’s respiration should be protected by the following procedures except:

a. Prevent exposure to people with upper respiratory tract infections
b. Keep the infant away from secondhand smoke
c. Avoid loose bedding, waterbeds, and beanbag chairs
d. Don’t let the infant sleep on his or her back

Answer 6

Answer: D

a. Prevent exposure to people with upper respiratory tract infections
Infants are vulnerable to respiratory infections; infected people must be kept away.

b. Keep the infant away from secondhand smoke
Secondhand smoke can damage lungs.

c. Avoid loose bedding, waterbeds, and beanbag chairs
Infants can suffocate in loose bedding and furniture that can trap them.

d. Don’t let the infant sleep on his or her back
The infant should be laid down to sleep on his or her back for better breathing and to prevent sudden infant death syndrome.

Question 7

When weighing a newborn, the nurse should:

a. Leave its diaper on for comfort
b. Place a sterile scale paper on the scale for infection control
c. Keep a hand on the newborn’s abdomen for safety
d. Weigh the newborn at the same time each day for accuracy

Answer 7

Answer: D

a. Leave its diaper on for comfort
The baby should be weighed without a diaper or clothes.

b. Place a sterile scale paper on the scale for infection control
Clean scale paper is acceptable; it does not need to be sterile.

c. Keep a hand on the newborn’s abdomen for safety
The nurse’s hand should be above, not on, the abdomen for safety.

d. Weigh the newborn at the same time each day for accuracy
Weighing a newborn at the same time each day allows for the most accurate weight.

Question 8

Vitamin K is given to the newborn to:

a. Reduce bilirubin levels
b. Increase the production of red blood cells
c. Enhance the ability of blood to clot
d. Stimulate the formation of surfactant

Answer 8

Answer: C

a. Reduce bilirubin levels
Vitamin K does not reduce bilirubin levels.

b. Increase the production of red blood cells
Vitamin K does not increase the production of red blood cells.

c. Enhance the ability of blood to clot
Newborns have a deficiency of vitamin K until intestinal bacteria that produce vitamin K are formed. Vitamin K is required for the production of certain clotting factors.

d. Stimulate the formation of surfactant
Vitamin K does not stimulate the formation of surfactant.

Question 9

A nurse must administer erythromycin ophthalmic ointment to a newborn after birth. The nurse should:

a. Instill within 15 minutes of birth for maximum effectiveness
b. Cleanse eyes from inner to outer canthus before administration if necessary
c. Apply directly over the cornea
d. Flush eyes 10 minutes after instillation to reduce irritation

Answer 9

Answer: B

a. Instill within 15 minutes of birth for maximum effectiveness
Instillation of the ointment can be delayed for up to 2 hours to facilitate eye-to-eye contact between the newborn and parents, an activity that fosters bonding and attachment, especially for fathers.

b. Cleanse eyes from inner to outer canthus before administration if necessary
The newborn’s eyes should be cleansed if necessary before the administration of erythromycin ointment.

c. Apply directly over the cornea
Erythromycin ointment should be applied into the conjunctival sac to avoid accidental injury to the eye.

d. Flush eyes 10 minutes after instillation to reduce irritation
The eyes should not be flushed after instillation of the erythromycin ointment.

Question 10

When placing a newborn under a radiant heat warmer to stabilize temperature after birth, the nurse should:

a. Place the thermistor probe on the left side of the chest
b. Cover the probe with a nonreflective material
c. Recheck temperature by periodically taking a rectal temperature
d. Perform all examinations and activities under the warmer

Answer 10

Answer: D

a. Place the thermistor probe on the left side of the chest
b. Cover the probe with a nonreflective material
c. Recheck temperature by periodically taking a rectal temperature
d. Perform all examinations and activities under the warmer

Question 11

All of these statements indicate the effect of breastfeeding on the family or society at large except:

a. Breastfeeding requires fewer supplies and less cumbersome equipment
b. Breastfeeding saves families money
c. Breastfeeding costs employers in terms of time lost from work
d. Breastfeeding benefits the environment

Answer 11

Answer: C

a. Breastfeeding requires fewer supplies and less cumbersome equipment
Breastfeeding is convenient because it does not require cleaning or transporting bottles and other equipment.

b. Breastfeeding saves families money
Breastfeeding saves families money because the cost of formula far exceeds the cost of extra food for the lactating mother.

c. Breastfeeding costs employers in terms of time lost from work
Less time is lost from work by breastfeeding mothers, in part because infants are healthier.

d. Breastfeeding benefits the environment
Breastfeeding uses a renewable resource; it does not need fossil fuels, advertising, shipping, or disposal.

Question 12

In helping the breastfeeding mother position the baby, nurses should keep in mind that:

a. The cradle position is usually preferred by mothers who had a cesarean birth
b. Women with perineal pain and swelling prefer the modified cradle position
c. Whatever the position used, the infant is “belly to belly” with the mother
d. While supporting the head, the mother should push gently on the occiput

Answer 12

C

a. The cradle position is usually preferred by mothers who had a cesarean birth
The football position usually is preferred after cesarean birth.

b. Women with perineal pain and swelling prefer the modified cradle position
Women with perineal pain and swelling prefer the side-lying position because they can rest while breastfeeding.

c. Whatever the position used, the infant is “belly to belly” with the mother
The infant inevitably faces the mother, belly to belly.

d. While supporting the head, the mother should push gently on the occiput
The mother should never push on the back of the head. It may cause the baby to bite, hyperextend the neck, or develop an aversion to being brought near the breast.

Question 13

The maternity nurse must be cognizant that cultural practices have significant influence on infant feeding methods. Many regional and ethnic cultures can be found within the United States. One cannot assume generalized observations about any cultural group will hold for all members of the group. Which statement related to cultural practices influencing infant feeding practice is correct?

a. A common practice among Mexican women is known as los dos.
b. Muslim cultures do not encourage breastfeeding due to modesty concerns.
c. Latino women born in the United States are more likely to breastfeed.
d. East Indian and Arab women believe that cold foods are best for a new mother.

Answer 13

Answer: A

a. A common practice among Mexican women is known as los dos.
A common practice among Mexican women is los dos. This refers to combining breastfeeding and commercial infant formula. It is based on the belief that by combining the two feeding methods, the mother and infant receive the benefits of breastfeeding along with the additional vitamins from formula.

b. Muslim cultures do not encourage breastfeeding due to modesty concerns.
Among the Muslim culture, breastfeeding for 24 months is customary. Muslim women may choose to bottle-feed formula or expressed breast milk while in the hospital.

c. Latino women born in the United States are more likely to breastfeed.
Latino women born in the United States are less likely to breastfeed.

d. East Indian and Arab women believe that cold foods are best for a new mother.
East Indian and Arab women believe that hot foods, such as chicken and broccoli, are best for the new mother. The descriptor hot has nothing to do with the temperature or spiciness of the food.

Question 14

The birth weight of a breastfed newborn was 8 lb, 4 oz. On the third day the newborn’s weight was 7 lb, 12 oz. On the basis of this finding, the nurse should:

a. Encourage the mother to continue breastfeeding because it is effective in meeting the newborn’s nutrient and fluid needs
b. Suggest that the mother switch to bottle feeding because breastfeeding is ineffective in meeting newborn needs for fluid and nutrients
c. Notify the physician because the newborn is being poorly nourished
d. Refer the mother to a lactation consultant to improve her breastfeeding technique

Answer 14

Answer: A

a. Encourage the mother to continue breastfeeding because it is effective in meeting the newborn’s nutrient and fluid needs
Weight loss of 8 oz falls within the 5% to 10% expected weight loss from birth weight during the first few days of life, which for this newborn would be 6.6 to 13.2 oz. Breastfeeding is effective at this time.

b. Suggest that the mother switch to bottle feeding because breastfeeding is ineffective in meeting newborn needs for fluid and nutrients
Breastfeeding is effective, and bottle feeding does not need to be initiated at this time.

c. Notify the physician because the newborn is being poorly nourished
The infant is not undernourished, and the physician does not need to be notified.

d. Refer the mother to a lactation consultant to improve her breastfeeding technique
The weight loss is within normal limits; breastfeeding is effective.

Question 15

Which action of a breastfeeding mother indicates the need for further instruction?

a. Holds breast with four fingers along bottom and thumb at top
b. Leans forward to bring breast toward the baby
c. Stimulates the rooting reflex and then inserts nipple and areola into newborn’s open mouth
d. Puts her finger into newborn’s mouth before removing breast

Answer 15

Answer: B

a. Holds breast with four fingers along bottom and thumb at top
Holding the breast with four fingers along the bottom and the thumb at top is a correct technique.

b. Leans forward to bring breast toward the baby
To maintain a comfortable, relaxed position, the mother should bring the baby to the breast, not the breast to the baby. The mother would need further demonstration and teaching to correct the ineffective action.

c. Stimulates the rooting reflex and then inserts nipple and areola into newborn’s open mouth
Stimulating the rooting reflex is correct.

d. Puts her finger into newborn’s mouth before removing breast
Placing the finger in the mouth to remove the baby from the breast is correct.

Question 16

The nurse taught new parents the guidelines to follow regarding the bottle feeding of their newborn. They will be using formula from a can of concentrate. The parents would demonstrate an understanding of the nurse’s instructions if they:

a. Wash the top of can and can opener with soap and water before opening the can
b. Adjust the amount of water added according to weight gain pattern of the newborn
c. Add some honey to sweeten the formula and make it more appealing to a fussy newborn
d. Warm formula in a microwave oven for a couple of minutes prior to feeding

Answer 16

Answer: A

a. Wash the top of can and can opener with soap and water before opening the can
Washing the top of the can and can opener with soap and water before opening the can of formula is a good habit for parents to get into to prevent contamination.

b. Adjust the amount of water added according to weight gain pattern of the newborn
Directions on the can for dilution should be followed exactly and not adjusted according to weight gain to prevent nutritional and fluid imbalances.

c. Add some honey to sweeten the formula and make it more appealing to a fussy newborn
Honey is not necessary and could contain botulism spores.

d. Warm formula in a microwave oven for a couple of minutes prior to feeding
The formula should be warmed in a container of hot water because a microwave can easily overheat it.

Question 17

Which statement regarding infant weaning is correct?

a. Weaning should proceed from breast to bottle to cup.
b. The feeding of most interest should be eliminated first.
c. Abrupt weaning is easier than gradual weaning.
d. Weaning can be mother or infant initiated.

Answer 17

Answer: D

a. Weaning should proceed from breast to bottle to cup.
Infants can be weaned directly from the breast to a cup. Bottles are usually offered to infants less than 6 months. If the infant is weaned prior to 1 year of age iron-fortified formula rather than cow’s milk should be offered.

b. The feeding of most interest should be eliminated first.
The feeding of least interest to the baby or the one through which the infant is likely to sleep should be eliminated first. Every few days thereafter the mother drops another feeding.

c. Abrupt weaning is easier than gradual weaning.
Gradual weaning over a period of weeks or months is easier for both the mother and the infant than an abrupt weaning.

d. Weaning can be mother or infant initiated.
Weaning is initiated by the mother or the infant. With infant-led weaning the infant moves at his or her own pace in omitting feedings, which leads to a gradual decrease in the mother’s milk supply. Mother-led weaning means that the mother decides which feedings to drop.

Question 18

With regard to the long-term consequences of infant feeding practices, the nurse should instruct the obese client that the best strategy to decrease the risk for childhood obesity for her infant is:

a. An on-demand feeding schedule
b. Breastfeeding
c. Lower-calorie infant formula
d. Smaller, more frequent feedings

Answer 18

Answer: B

a. An on-demand feeding schedule
All breastfed infants should be fed on demand.

b. Breastfeeding
Breastfeeding is the best prevention strategy for decreasing childhood and adolescent obesity. Breastfeeding also assists the woman to return to her prepregnant weight sooner.

c. Lower-calorie infant formula
Lower-calorie formula is an inappropriate strategy that does not meet the infant’s nutritional needs. Breastfeeding is the most appropriate choice for infant feeding.

d. Smaller, more frequent feedings
Smaller feedings are not necessary. Infants should continue to be fed every 2 to 3 hours in the newborn period.

Question 19

A 40-year-old woman with a high body mass index (BMI) is 10 weeks pregnant. Which diagnostic tool is appropriate to suggest to her at this time?

a. Biophysical profile
b. Amniocentesis
c. Maternal serum alpha-fetoprotein (MSAFP)
d. Transvaginal ultrasound

Answer 19

Answer: D

a. Biophysical profile
A biophysical profile is a method of biophysical assessment of fetal well-being in the third trimester.

b. Amniocentesis
An amniocentesis is performed after the fourteenth week of pregnancy.

c. Maternal serum alpha-fetoprotein (MSAFP)
A MSAFP test is performed from week 15 to week 22 of the gestation (weeks 16 to 18 are ideal).

d. Transvaginal ultrasound
An ultrasound is the method of biophysical assessment of the infant that is performed at this gestational age. Transvaginal ultrasound is especially useful for obese women whose thick abdominal layers cannot be penetrated adequately with the abdominal approach.

Question 20

A nurse providing care for the antepartum woman should understand that the contraction stress test (CST):

a. Sometimes uses vibroacoustic stimulation
b. Is an invasive test; however, contractions are stimulated
c. Is considered negative if no late decelerations are observed with the contractions
d. Is more effective than nonstress test (NST) if the membranes have already been ruptured

Answer 20

Answer: C

a. Sometimes uses vibroacoustic stimulation
Vibroacoustic stimulation is sometimes used with NST.

b. Is an invasive test; however, contractions are stimulated
CST is invasive if stimulation is by IV oxytocin but not if by nipple stimulation.

c. Is considered negative if no late decelerations are observed with the contractions
No late decelerations indicate a negative CST.

d. Is more effective than nonstress test (NST) if the membranes have already been ruptured
CST is contraindicated if the membranes have ruptured.

Question 21

In the past, factors to determine whether a woman was likely to develop a high risk pregnancy were evaluated primarily from a medical point of view. A broader more comprehensive approach to high risk pregnancy has been adopted. There are now four categories based on threats to the health of the woman and the outcome of pregnancy. These categories include all of these except:

a. Biophysical
b. Psychosocial
c. Geographic
d. Environmental

Answer 21

Answer: C

a. Biophysical
Biophysical is one of the broad categories used for determining risk. These include genetic considerations, nutritional status, and medical and obstetric disorders.

b. Psychosocial
Psychosocial risks include smoking, caffeine, drugs, alcohol, and psychologic status. All of these adverse lifestyles can have a negative effect on the health of the mother or fetus.

c. Geographic
This category is correctly referred to as sociodemographic risk. These factors stem from the mother and her family. Ethnicity may be one of the risks to pregnancy; however, it is not the only factor in this category. Low income, lack of prenatal care, age, parity, and marital status are included.

d. Environmental
Environmental risks are those that can affect fertility and fetal development. These include infections, chemicals, radiation, pesticides, illicit drugs, and industrial pollutants.

Question 22

A woman who is at 36 weeks of gestation is having a nonstress test. Which statement indicates her correct understanding of the test?

a. “I will need to have a full bladder for the test to be done accurately.”
b. “I should have my husband drive me home after the test because I may be nauseated.”
c. “This test will help to determine if the baby has Down syndrome or a neural tube defect.”
d. “This test observes for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby.”

Answer 22

Answer: D

a. “I will need to have a full bladder for the test to be done accurately.”
An ultrasound requires a full bladder.

b. “I should have my husband drive me home after the test because I may be nauseated.”
An amniocentesis is the test that a pregnant woman should be driven home afterward.

c. “This test will help to determine if the baby has Down syndrome or a neural tube defect.”
A maternal serum alpha-fetoprotein test is used in conjunction with unconjugated estriol levels, and human chorionic gonadotropin helps to determine Down syndrome.

d. “This test observes for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby.”
The nonstress test is one of the most widely used techniques to determine fetal well-being and is accomplished by monitoring fetal heart rate in conjunction with fetal activity and movements.

Question 23

What is an appropriate indicator for performing a contraction stress test?

a. Increased fetal movement and small for gestational age
b. Maternal diabetes mellitus and postmaturity
c. Adolescent pregnancy and poor prenatal care
d. History of preterm labor and intrauterine growth restriction

Answer 23

Answer: B

a. Increased fetal movement and small for gestational age
Decreased fetal movement is an indicator for performing a contraction stress test; the size (small for gestational age) is not an indicator.

b. Maternal diabetes mellitus and postmaturity
Maternal diabetes mellitus and postmaturity are two indications for performing a contraction stress test.

c. Adolescent pregnancy and poor prenatal care
Although adolescent pregnancy and poor prenatal care are risk factors of poor fetal outcomes, they are not indicators for performing a contraction stress test.

d. History of preterm labor and intrauterine growth restriction
Intrauterine growth restriction is an indicator; history of a previous stillbirth, not preterm labor, is another indicator.

Question 24

The nurse sees a woman for the first time when she is 30 weeks pregnant. The woman has smoked throughout the pregnancy, and fundal height measurements now are suggestive of growth restriction in the fetus. In addition to ultrasound to measure fetal size, what would be another tool useful in confirming the diagnosis?

a. Doppler blood flow analysis
b. Contraction stress test (CST)
c. Amniocentesis
d. Daily fetal movement counts

Answer 24

Answer: A

a. Doppler blood flow analysis
Doppler blood flow analysis allows the examiner to study the blood flow noninvasively in the fetus and the placenta. It is a helpful tool in the management of high risk pregnancies because of intrauterine growth restriction (IUGR), diabetes mellitus, multiple fetuses, or preterm labor.

b. Contraction stress test (CST)
Because of the potential risk of inducing labor and causing fetal distress, a CST is not performed on a woman whose fetus is preterm.

c. Amniocentesis
Indications for an amniocentesis include diagnosis of genetic disorders or congenital anomalies, assessment of pulmonary maturity, and the diagnosis of fetal hemolytic disease, not IUGR.

d. Daily fetal movement counts
Fetal kick count monitoring is performed to monitor the fetus in pregnancies complicated by conditions that may affect fetal oxygenation. Although this may be a useful tool at some point later in this woman’s pregnancy, it is not used to diagnose IUGR.

Question 25

Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy, including that:

a. Chorionic villus sampling (CVS) is becoming more popular because it provides early diagnosis
b. Screening for maternal serum alpha-fetoprotein (MSAFP) levels is recommended only for women at risk for neural tube defects
c. Percutaneous umbilical blood sampling (PUBS) is one of the quad-screen tests for Down syndrome
d. MSAFP is a screening tool only; it identifies candidates for more definitive procedures

Answer 25

Answer: D

a. Chorionic villus sampling (CVS) is becoming more popular because it provides early diagnosis
CVS does provide a rapid result, but it is declining in popularity because of advances in noninvasive screening techniques.

b. Screening for maternal serum alpha-fetoprotein (MSAFP) levels is recommended only for women at risk for neural tube defects
MSAFP screening is recommended for all pregnant women.

c. Percutaneous umbilical blood sampling (PUBS) is one of the quad-screen tests for Down syndrome
MSAFP, not PUBS, is part of the quad-screen tests for Down syndrome.

d. MSAFP is a screening tool only; it identifies candidates for more definitive procedures
This is correct. MSAFP is a screening tool, not a diagnostic tool. Further diagnostic testing is indicated after an abnormal MSAFP.

Question 26

A woman with severe preeclampsia is receiving a magnesium sulfate infusion. The nurse becomes concerned after assessment when the woman exhibits:

a. A sleepy, sedated affect
b. A respiratory rate of 10 breaths/min
c. Deep tendon reflexes of 2+
d. Absent ankle clonus

Answer 26

Answer: B

a. A sleepy, sedated affect
Because magnesium sulfate is a central nervous system (CNS) depressant, the client will most likely become sedated when the infusion is initiated.

b. A respiratory rate of 10 breaths/min
A respiratory rate of 10 breaths/min indicates that the client is experiencing respiratory depression (bradypnea) from magnesium toxicity.

c. Deep tendon reflexes of 2+
Deep tendon reflexes of 2+ are a normal finding.

d. Absent ankle clonus
Absent ankle clonus is a normal finding.

Question 27

A nurse caring for pregnant women must be aware that the most common medical complication of pregnancy is:

a. Hypertension
b. Hyperemesis gravidarum
c. Hemorrhagic complications
d. Infections

Answer 27

Answer: A

a. Hypertension
Preeclampsia and eclampsia are two noted, deadly forms of hypertension.

b. Hyperemesis gravidarum
A large percentage of pregnant women have nausea and vomiting, but a relative few have the severe form called hyperemesis gravidarum.

c. Hemorrhagic complications
Hemorrhagic complications are the second most common medical complication of pregnancy; hypertension is the most common.

d. Infections
Hypertension is the most common medical complication of pregnancy.

Question 28

With regard to preeclampsia and eclampsia, nurses should be aware that:

a. Preeclampsia is a condition of the first trimester; eclampsia is a condition of the second and third trimesters
b. Preeclampsia results in decreased function in such organs as the placenta, kidneys, liver, and brain
c. The causes of preeclampsia and eclampsia are well documented
d. Severe preeclampsia is defined as preeclampsia plus proteinuria

Answer 28

Answer: B

a. Preeclampsia is a condition of the first trimester; eclampsia is a condition of the second and third trimesters
Preeclampsia occurs after week 20 of gestation and can run the duration of the pregnancy.

b. Preeclampsia results in decreased function in such organs as the placenta, kidneys, liver, and brain
Vasospasms diminish the diameter of blood vessels, which impedes blood flow to all organs.

c. The causes of preeclampsia and eclampsia are well documented
The causes of preeclampsia and eclampsia are unknown, although several have been suggested.

d. Severe preeclampsia is defined as preeclampsia plus proteinuria
Preeclampsia includes proteinuria; severe cases are characterized by greater proteinuria or any of nine other conditions.

Question 29

A woman with severe preeclampsia is being treated with an IV infusion of magnesium sulfate. This treatment is considered successful if:

a. Blood pressure is reduced to prepregnant baseline
b. Seizures do not occur
c. Deep tendon reflexes become hypotonic
d. Diuresis reduces fluid retention

Answer 29

Answer: B

a. Blood pressure is reduced to prepregnant baseline
A temporary decrease in blood pressure can occur; however, this is not the purpose of administering this medication.

b. Seizures do not occur
Magnesium sulfate is a central nervous system (CNS) depressant given primarily to prevent seizures.

c. Deep tendon reflexes become hypotonic
Hypotonia is a sign of an excessive serum level of magnesium. It is critical that calcium gluconate be on hand to counteract the depressant effects of magnesium toxicity.

d. Diuresis reduces fluid retention
Diuresis is not an expected outcome of magnesium sulfate administration.

Question 30

A woman with severe preeclampsia has been receiving magnesium sulfate by IV infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature 37.1° C, pulse rate 96 beats/min, respiratory rate 24 breaths/min, blood pressure 155/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the physician, anticipating an order for:

a. Hydralazine
b. Magnesium sulfate bolus
c. Diazepam
d. Calcium gluconate

Answer 30

Answer: A

a. Hydralazine
Hydralazine is an antihypertensive commonly used to treat hypertension in severe preeclampsia.

b. Magnesium sulfate bolus
An additional bolus of magnesium sulfate may be ordered for increasing signs of central nervous system irritability related to severe preeclampsia (e.g., clonus) or if eclampsia develops.

c. Diazepam
Diazepam sometimes is used to stop or shorten eclamptic seizures.

d. Calcium gluconate
Calcium gluconate is used as the antidote for magnesium sulfate toxicity. The client is not currently displaying any signs or symptoms of magnesium toxicity.

Question 31

Nurses should be aware that HELLP syndrome:

a. Is a mild form of preeclampsia
b. Can be diagnosed by a nurse alert to its symptoms
c. Is characterized by hemolysis, elevated liver enzymes, and low platelets
d. Is associated with preterm labor but not perinatal mortality

Answer 31

Answer: C

a. Is a mild form of preeclampsia
HELLP syndrome is a variant of severe preeclampsia.

b. Can be diagnosed by a nurse alert to its symptoms
HELLP syndrome is difficult to identify, because the symptoms often are not obvious. It must be diagnosed in the laboratory.

c. Is characterized by hemolysis, elevated liver enzymes, and low platelets
The acronym HELLP stands for hemolysis (H), elevated liver enzymes (EL), and low platelets (LP).

d. Is associated with preterm labor but not perinatal mortality
Preterm labor is greatly increased and so is perinatal mortality.

Question 32

A woman presents to the emergency department complaining of bleeding and cramping. The initial nursing history is significant for a last menstrual period 6 weeks ago. On sterile speculum examination, the primary health care provider finds that the cervix is closed. The anticipated plan of care for this woman is based on a probable diagnosis of which type of spontaneous abortion?

a. Incomplete
b. Inevitable
c. Threatened
d. Septic

Answer 32

Answer C

a. Incomplete
A woman with an incomplete abortion presents with heavy bleeding, mild to severe cramping, and cervical dilation.

b. Inevitable
An inevitable abortion presents with the same symptomatology as an incomplete abortion: heavy bleeding, mild to severe cramping, and cervical dilation.

c. Threatened
A woman with a threatened abortion presents with spotting, mild cramps, and no cervical dilation.

d. Septic
A woman with a septic abortion presents with malodorous bleeding and typically a dilated cervix.

Question 33

. The most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is:

a. Bleeding
b. Intense abdominal pain
c. Uterine activity
d. Cramping

Answer 33

Answer B

a. Bleeding
Bleeding may be present in varying degrees for both placental conditions.

b. Intense abdominal pain
Pain is absent with placenta previa and may be agonizing with abruptio placentae.

c. Uterine activity
Uterine activity may be present with both placental conditions.

d. Cramping
Cramping is a form of uterine activity that may be present in both placental conditions.

Question 34

A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of:

a. Eclamptic seizure
b. Rupture of the uterus
c. Placenta previa
d. Placental abruption

Answer 34

Answer: D

a. Eclamptic seizure
Eclamptic seizures are evidenced by the presence of generalized tonic-clonic convulsions.

b. Rupture of the uterus
Uterine rupture presents as hypotonic uterine activity, signs of hypovolemia, and in many cases the absence of pain.

c. Placenta previa
Placenta previa presents with bright red, painless vaginal bleeding.

d. Placental abruption
Uterine tenderness in the presence of increasing tone may be the earliest finding of premature separation of the placenta (abruptio placentae or placental abruption). Women with hypertension are at increased risk for an abruption.

Question 35

In caring for the woman with disseminated intravascular coagulation (DIC), what order should the nurse anticipate?

a. Administration of blood
b. Preparation of the woman for invasive hemodynamic monitoring
c. Restriction of intravascular fluids
d. Administration of steroids

Answer 35

Answer: A

a. Administration of blood
Primary medical management in all cases of DIC involves correction of the underlying cause, volume replacement, blood component therapy, optimization of oxygenation and perfusion status, and continued reassessment of laboratory parameters.

b. Preparation of the woman for invasive hemodynamic monitoring
Central monitoring would not be ordered initially in a woman with DIC because this can contribute to more areas of bleeding.

c. Restriction of intravascular fluids
Management of DIC includes volume replacement, not volume restriction.

d. Administration of steroids
Steroids are not indicated for the management of DIC.

Question 36

Signs of a threatened abortion (miscarriage) are noted in a woman at 8 weeks of gestation. What is an appropriate management approach for this type of abortion?

a. Prepare the woman for a dilation and curettage (D&C).
b. Place the woman on bed rest for at least 1 week and reevaluate.
c. Prepare the woman for an ultrasound and bloodwork.
d. Comfort the woman by telling her that if she loses this baby, she may attempt to get pregnant again in 1 month.

Answer 36

Answer: C

a. Prepare the woman for a dilation and curettage (D&C).
D&C is not considered until signs of the progress to inevitable abortion are noted or the contents are expelled and incomplete.

b. Place the woman on bed rest for at least 1 week and reevaluate.
Bed rest is recommended for 48 hours initially.

c. Prepare the woman for an ultrasound and bloodwork.
Repetitive transvaginal ultrasounds and measurement of human chorionic gonadotropin (hCG) and progesterone levels may be performed to determine if the fetus is alive and within the uterus. If the pregnancy is lost, the woman should be guided through the grieving process.

d. Comfort the woman by telling her that if she loses this baby, she may attempt to get pregnant again in 1 month.
Telling the client that she can get pregnant again soon is not a therapeutic response because it discounts the importance of this pregnancy.

Question 37

A woman diagnosed with marginal placenta previa gave birth vaginally 15 minutes ago. At the present time she is at the greatest risk for:

a. Hemorrhage
b. Infection
c. Urinary retention
d. Thrombophlebitis

Answer 37

Answer: A

a. Hemorrhage
Hemorrhage is the most immediate risk because the lower uterine segment has limited ability to contract to reduce blood loss.

b. Infection
Infection is a risk because of the location of the placental attachment site; however, it is not a priority concern at this time.

c. Urinary retention
Placenta previa poses no greater risk for urinary retention than with a normally implanted placenta.

d. Thrombophlebitis
There is no greater risk for thrombophlebitis than with a normally implanted placenta.

Question 38

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

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

Answer 38

Answer: D

a. Mother’s age
Although advanced maternal age may pose some health risks, for the woman with pregestational diabetes the most important factor remains the degree of glycemic control during pregnancy.

b. Number of years since diabetes was diagnosed
The number of years since diagnosis is not as relevant to outcomes as the degree of glycemic control.

c. Amount of insulin required prenatally
The key to reducing risk in the pregestational diabetic woman is not the amount of insulin required but rather the level of glycemic control.

d. Degree of glycemic control during pregnancy
Women with excellent glucose control and no blood vessel disease should have good pregnancy outcomes.

Question 39

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

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

Answer 39

Answer: B

a. With good control of maternal glucose levels, sudden and unexplained stillbirth is no longer a major concern
Even with good control, sudden and unexplained stillbirth remains a major concern.

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

c. Infants of mothers with diabetes have the same risks for respiratory distress syndrome because of the careful monitoring
Infants of diabetic mothers are at increased risk for respiratory distress syndrome.

d. At birth, the neonate of a diabetic mother is no longer in any greater risk
The transition to extrauterine life often is marked by hypoglycemia and other metabolic abnormalities.

Question 40

A pregnant woman at 28 weeks of gestation has been diagnosed with gestational diabetes. The nurse caring for this client understands that:

a. Oral hypoglycemic agents can be used if the woman is reluctant to give herself insulin
b. Dietary modifications and insulin are both required for adequate treatment
c. Glucose levels are monitored by testing urine four times a day and at bedtime
d. Dietary management involves distributing nutrient requirements over three meals and two or three snacks

Answer 40

Answer: D

a. Oral hypoglycemic agents can be used if the woman is reluctant to give herself insulin
Oral hypoglycemic agents can be harmful to the fetus and less effective than insulin in achieving tight glucose control.

b. Dietary modifications and insulin are both required for adequate treatment
In some women gestational diabetes can be controlled with dietary modifications alone.

c. Glucose levels are monitored by testing urine four times a day and at bedtime
Blood, not urine, glucose levels are monitored several times a day. Urine is tested for ketone content; results should be negative.

d. Dietary management involves distributing nutrient requirements over three meals and two or three snacks
Small frequent meals over a 24-hour period help decrease the risk for hypoglycemia and ketoacidosis.

Question 41

Hypothyroidism occurs in 2 to 3 pregnancies per 1000. Pregnant women with untreated hypothyroidism are at risk for all except:

a. Miscarriage
b. Macrosomia
c. Gestational hypertension
d. Placental abruption

Answer 41

Answer: B

a. Miscarriage
Hypothyroidism is often associated with both infertility and an increased risk of miscarriage.

b. Macrosomia
Infants born to mothers with hypothyroidism are more likely to be of low birth weight or preterm. These outcomes can be improved with early diagnosis and treatment. The average birth weight for babies is about 7 pounds. Babies with macrosomia have a birth weight of at least 8 pounds, 13 ounces or more.

c. Gestational hypertension
Pregnant women with hypothyroidism are more likely to experience both preeclampsia and gestational hypertension.

d. Placental abruption
Placental abruption and stillbirth are risks associated with hypothyroidism.

Question 42

A pregnant woman at 14 weeks of gestation is admitted to the hospital with a diagnosis of hyperemesis gravidarum. The primary goal of her treatment at this time is to:

a. Rest the gastrointestinal (GI) tract by restricting all oral intake for 48 hours
b. Reduce emotional distress by encouraging the woman to discuss her feelings
c. Reverse fluid, electrolyte, and acid-base imbalances
d. Restore the woman’s ability to take and retain oral fluid and foods

Answer 42

Answer: C

a. Rest the gastrointestinal (GI) tract by restricting all oral intake for 48 hours
Resting the GI tract is a component of treatment; however, it is not an immediate goal for this client.

b. Reduce emotional distress by encouraging the woman to discuss her feelings
Discussing her feelings is also a component of treatment but not an immediate goal at this time.

c. Reverse fluid, electrolyte, and acid-base imbalances
Fluid, electrolyte, and acid-base imbalances present the greatest immediate danger to the well-being of the mother and fetus and should be corrected as soon as possible.

d. Restore the woman’s ability to take and retain oral fluid and foods
The ability to retain oral fluid and foods is a longer-term goal of treatment for this condition. Hyperemesis gravidarum is extreme, persistent nausea and vomiting during pregnancy that can lead to dehydration. Extreme nausea and vomiting during pregnancy can happen if you are pregnant with twins (or more babies) or if you have a hydatidiform mole.

Question 43

Which opiate causes euphoria, relaxation, drowsiness, and detachment from reality and has possible effects on the pregnancy, including preeclampsia, intrauterine growth restriction, and premature rupture of membranes?

a. Heroin
b. Alcohol
c. Phencyclidine palmitate (PCP)
d. Cocaine

Answer 43

Answer: A

a. Heroin
The opiates include opium, heroin, meperidine, morphine, codeine, and methadone. The signs and symptoms of heroin use are euphoria, relaxation, relief from pain, detachment from reality, impaired judgment, drowsiness, constricted pupils, nausea, constipation, slurred speech, and respiratory depression. Possible effects on pregnancy include preeclampsia, intrauterine growth restriction, miscarriage, premature rupture of membranes, infections, breech presentation, and preterm labor.

b. Alcohol
Alcohol is not an opiate.

c. Phencyclidine palmitate (PCP)
PCP is not an opiate.

d. Cocaine
Cocaine is not an opiate.

Question 44

During pregnancy, alcohol withdrawal may be treated using:

a. Disulfiram (Antabuse)
b. Corticosteroids
c. Benzodiazepines
d. Aminophylline

Answer 44

Answer: C

a. Disulfiram (Antabuse)
Disulfiram is contraindicated in pregnancy because it is teratogenic.

b. Corticosteroids
Corticosteroids are not used to treat alcohol withdrawal.

c. Benzodiazepines
Symptoms that occur during alcohol withdrawal can be managed with short-acting barbiturates or benzodiazepines.

d. Aminophylline
Aminophylline is not used to treat alcohol withdrawal.

Question 45

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

a. Is more likely to occur in women with more than two children
b. Is rarely delusional and then usually about someone trying to harm her (the mother)
c. Although serious, is not likely to need psychiatric hospitalization
d. Is typified by auditory or visual hallucinations

Answer 45

Answer: D

a. Is more likely to occur in women with more than two children
PPD is more likely to occur in first-time mothers.

b. Is rarely delusional and then usually about someone trying to harm her (the mother)
Delusions may be present in 50% of women with PPD, usually about something being wrong with the infant.

c. Although serious, is not likely to need psychiatric hospitalization
PPD with psychosis is a psychiatric emergency that requires hospitalization.

d. Is typified by auditory or visual hallucinations
Hallucinations are present in 25% of women with this disorder, paranoid or grandiose delusions, elements of delirium or disorientation, and extreme deficits in judgment accompanied by high levels of impulsivity that may contribute to risks of suicide or infanticide.

Question 46

Nurses must be cognizant of the growing problem of methamphetamine use during pregnancy. When caring for a woman who uses methamphetamines, it is important for the nurse to be aware of which factor related to the abuse of this substance?

a. Methamphetamine is a depressant.
b. All methamphetamines are vasodilators.
c. Methamphetamine users are extremely psychologically addicted.
d. Rehabilitation is usually successful.

Answer 46

Answer: C

a. Methamphetamine is a depressant.
This substance is a stimulant.

b. All methamphetamines are vasodilators.
Methamphetamines are vasoconstrictors.

c. Methamphetamine users are extremely psychologically addicted.
“Meth” users are extremely psychologically addicted. Typically these women display poor control over their behavior and a low threshold for pain. This substance is relatively inexpensive and easy to obtain.

d. Rehabilitation is usually successful.
The rate of relapse for methamphetamine users is very high.

Question 47

Screening questions for alcohol and drug abuse should be included in the overall assessment during the first prenatal visit for all women. The 4 Ps-Plus is a screening tool designed specifically to identify when there is a need for a more in-depth assessment. The 4 Ps include all except:

a. Present
b. Partner
c. Past
d. Pregnancy

Answer 47

Answer: A

a. Present
The first P is Parents. The woman should be asked, “Did either of your parents have a problem with alcohol or drugs?”

b. Partner
The second P is Partner. “Does your partner have a problem with alcohol or drugs?”

c. Past
The third P is Past. “Have you ever had any beer, wine, or liquor?”

d. Pregnancy
The fourth P is Pregnancy. “In the month before you knew you were pregnant, how many cigarettes did you smoke? How much beer, wine, or liquor did you drink?”

Question 48

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

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

Answer 48

Answer: A

a. If the nerves are stretched with no avulsion, they should recover completely in 3 to 6 months
If the ganglia are disconnected completely from the spinal cord, the damage is permanent.

b. Erb palsy is damage to the lower plexus
Erb palsy is damage to the upper plexus and is less serious than brachial palsy.

c. Parents of children with brachial palsy are taught to pick up the child from under the axillae
Parents of children with brachial palsy are taught to avoid picking up the child under the axillae or by pulling on the arms.

d. Breastfeeding is not recommended for infants with facial nerve paralysis until the condition resolves
Breastfeeding is not contraindicated, but both mother and infant will need help from the nurse at the start.

Question 49

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

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

Answer 49

Answer: B

a. Congenital infection progresses slower than health care-associated infection
Congenital (early onset) infections progress more rapidly than health care–associated (late onset) infections.

b. Health care-associated infection can be prevented by effective handwashing; early onset cannot
Handwashing is an effective preventative measure for late onset (health care–associated) infections because these infections come from the environment around the infant. Early onset, or congenital, infections are caused by the normal flora at the maternal vaginal tract. Congenital (early onset) infections progress more rapidly than health care–associated (late onset) infections.

c. Infections occur with about the same frequency in boy and girl infants, although female mortality is higher
Infection occurs about twice as often in boys and results in higher mortality. Congenital (early onset) infections progress more rapidly than health care–associated (late onset) infections.

d. The clinical sign of a rapid, high fever makes infection easier to diagnose
Clinical signs of neonatal infection are nonspecific and similar to noninfectious problems, making diagnosis difficult. Congenital (early onset) infections progress more rapidly than health care–associated (late onset) infections

Question 50

Which TORCH infection could be contracted by the infant because the mother owned a cat?

a. Toxoplasmosis
b. Varicella-zoster
c. Parvovirus B19
d. Rubella

Answer 50

Answer: A

a. Toxoplasmosis
Cats that eat birds infected with the Toxoplasma gondii protozoan excrete infective oocysts. Humans (including pregnant women) can become infected if they fail to wash their hands after cleaning the litterbox. The infection is passed through the placenta.

b. Varicella-zoster
The varicella-zoster virus is responsible for chickenpox and shingles. Approximately 90% of childbearing women are immune. This virus cannot be contracted from a cat.

c. Parvovirus B19
During pregnancy infection with parvovirus can result in abortion, fetal anemia, hydrops (occurs when abnormal amounts of fluid buildup in two or more body areas of a fetus or newborn), intrauterine growth restriction (IUGR), and stillbirth. This virus is spread by vertical transmission, not by felines.

d. Rubella
Since vaccination for rubella was begun in 1969, cases of congenital rubella infection have been reduced significantly. Vaccination failures, lack of compliance, and the migration of nonimmunized persons result in periodic outbreaks of rubella (German measles).

Note: The TORCH screen is a group of blood tests that check for several different infections in a newborn. TORCH stands for toxoplasmosis, rubella, cytomegalovirus, herpes simplex, and HIV, but it can also include other newborn infections. Cytomegalovirus is a kind of herpesvirus that usually produces very mild symptoms in an infected person but may cause severe neurological damage in people with weakened immune systems and in the newborn. Rubella is a contagious viral disease, with symptoms like mild measles. It can cause fetal malformation if contracted in early pregnancy.

Question 51

In caring for a mother who has abused (or is abusing) alcohol and for her infant, nurses should be aware that:

a. The pattern of growth restriction of the fetus begun in prenatal life is halted after birth, and normal growth takes over
b. Two thirds of newborns with fetal alcohol syndrome (FAS) are boys
c. Alcohol-related neurodevelopmental disorders (ARNDs) not sufficient to meet FAS criteria (learning disabilities, speech and language problems) are often not detected until the child goes to school
d. Both the distinctive facial features of the FAS infant and the diminished mental capacities tend toward normal over time

Answer 51

Answer: C

a. The pattern of growth restriction of the fetus begun in prenatal life is halted after birth, and normal growth takes over
The pattern of growth restriction persists after birth.

b. Two thirds of newborns with fetal alcohol syndrome (FAS) are boys
Two thirds of newborns with FAS are girls.

c. Alcohol-related neurodevelopmental disorders (ARNDs) not sufficient to meet FAS criteria (learning disabilities, speech and language problems) are often not detected until the child goes to school
Some learning problems do not become evident until the child is in school.

d. Both the distinctive facial features of the FAS infant and the diminished mental capacities tend toward normal over time
Although the distinctive facial features of the FAS infant tend to become less evident, the mental capacities never become normal.

Question 52

Antidepressant medication is the mainstay treatment for maternal depression, with selective serotonin reuptake inhibitors (SSRIs) being the first line of pharmacotherapy. Reports of cardiac defects have been associated with the use of which SSRI?

a. Citalopram
b. Fluoxetine
c. Sertraline
d. Paroxetine

Answer 52

Answer: D

a. Citalopram
The absolute risk of any congenital abnormality associated with citalopram use is small.

b. Fluoxetine
The absolute risk of any congenital abnormality associated with fluoxetine use is small.

c. Sertraline
The absolute risk of any congenital abnormality associated with sertraline use is small.

d. Paroxetine
The American College of Obstetricians and Gynecologists (ACOG) has issued a recommendation that paroxetine be avoided both during pregnancy and in women considering pregnancy. There have also been reports linking paroxetine to other abnormalities such as omphalocele, craniosynostosis, and anencephaly.

Question 53

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

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

Answer 53

Answer: C

a. Birth injury
This infant is macrosomic and at risk for hypoglycemia. The description is indicative of a macrocosmic infant. The tremors are jitteriness that is associated with hypoglycemia.

b. Hypocalcemia
This infant is macrosomic and at risk for hypoglycemia. The description is indicative of a macrocosmic infant. The tremors are jitteriness that is associated with hypoglycemia.

c. Hypoglycemia
Hypoglycemia is common in the macrosomic infant. Signs of hypoglycemia include jitteriness, apnea, tachypnea, and cyanosis.

d. Seizures
This infant is macrosomic and at risk for hypoglycemia. The description is indicative of a macrocosmic infant. The tremors are jitteriness that is associated with hypoglycemia.