OB Quiz 1 Flashcards
With regard to amniocentesis, nurses should be aware that:
a. Because of new imaging techniques, amniocentesis is now possible in the first trimester.
b. Despite the use of ultrasound, complications still occur in the mother or infant in 5% to 10% of cases.
c. The shake test, or bubble stability test, is a quick means of determining fetal maturity.
d. The presence of meconium in the amniotic fluid is always cause for concern.
ANS: C
Diluted fluid is mixed with ethanol and shaken. After 15 minutes, the bubbles tell the story. Amniocentesis is possible after the fourteenth week of pregnancy when the uterus becomes an abdominal organ. Complications occur in less than 1% of cases; many have been minimized or eliminated through the use of ultrasound. Meconium in the amniotic fluid before the beginning of labor is not usually a problem.
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.
ANS: C
The acronym HELLP stands for hemolysis (H), elevated liver enzymes (EL), and low platelets (LP). HELLP syndrome is a variant of severe preeclampsia. HELLP syndrome is difficult to identify because the symptoms often are not obvious. It must be diagnosed in the laboratory. Preterm labor is greatly increased, and so is perinatal mortality.
The most common neurologic disorder accompanying pregnancy is:
a. Eclampsia. c. Epilepsy.
b. Bell’s palsy. d. Multiple sclerosis.
ANS: C
The effects of pregnancy on epilepsy are unpredictable. Eclampsia sometimes may be confused with epilepsy, which is the most common neurologic disorder accompanying pregnancy. Bell’s palsy is a form of facial paralysis. Multiple sclerosis is a patchy demyelinization of the spinal cord that does not affect the normal course of pregnancy or birth.
An 18-year-old client who has reached 16 weeks of gestation was recently diagnosed with pregestational diabetes. She attends her centering appointment accompanied by one of her girlfriends. This young woman appears more concerned about how her pregnancy will affect her social life than about her recent diagnosis of diabetes. Several nursing diagnoses are applicable to assist in planning adequate care. The most appropriate diagnosis at this time is:
a. Risk for injury to the fetus related to birth trauma.
b. Noncompliance related to lack of understanding of diabetes and pregnancy and requirements of the treatment plan.
c. Deficient knowledge related to insulin administration.
d. Risk for injury to the mother related to hypoglycemia or hyperglycemia.
ANS: B
Before a treatment plan is developed or goals for the outcome of care are outlined, this client must come to an understanding of diabetes and the potential effects on her pregnancy. She appears to have greater concern for changes to her social life than adoption of a new self-care regimen. Risk for injury to the fetus related to either placental insufficiency or birth trauma may come much later in the pregnancy. At this time the client is having difficulty acknowledging the adjustments that she needs to make to her lifestyle to care for herself during pregnancy. The client may not yet be on insulin. Insulin requirements increase with gestation. The importance of glycemic control must be part of health teaching for this client. However, she has not yet acknowledged that changes to her lifestyle need to be made, and she may not participate in the plan of care until understanding takes place.
Signs and symptoms that a woman should report immediately to her health care provider include (Select all that apply): a. Vaginal bleeding. b. Rupture of membranes. c. Heartburn accompanied by severe headache. d. Decreased libido. e. Urinary frequency.
ANS: A, B, C
Vaginal bleeding, rupture of membranes, and severe headaches all are signs of potential complications in pregnancy. Clients should be advised to report these signs to the health care provider. Decreased libido and urinary frequency are common discomforts of pregnancy that do not require immediate health care interventions.
To reassure and educate their pregnant clients about changes in their blood pressure, maternity nurses should be aware that:
a.
A blood pressure cuff that is too small produces a reading that is too low; a cuff that is too large produces a reading that is too high.
b.
Shifting the client’s position and changing from arm to arm for different measurements produces the most accurate composite blood pressure reading at each visit.
c.
The systolic blood pressure increases slightly as pregnancy advances; the diastolic pressure remains constant.
d.
Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of term pregnancy.
ANS: D
Compression of the iliac veins and inferior vena cava also leads to varicose veins in the legs and vulva. The tightness of a cuff that is too small produces a reading that is too high; similarly the looseness of a cuff that is too large results in a reading that is too low. Because maternal positioning affects readings, blood pressure measurements should be obtained in the same arm and with the woman in the same position. The systolic blood pressure generally remains constant but may decline slightly as pregnancy advances. The diastolic blood pressure first decreases and then gradually increases.
Nurses should be aware that infertility:
a.
Is perceived differently by women and men.
b.
Has a relatively stable prevalence among the overall population and throughout a woman’s potential reproductive years.
c.
Is more likely the result of a physical flaw in the woman than in her male partner.
d.
Is the same thing as sterility.
ANS: A
Women tend to be more stressed about infertility tests and to place more importance on having children. The prevalence of infertility is stable among the overall population, but it increases with a woman’s age, especially after age 40. Of cases with an identifiable cause, about 40% are related to female factors, 40% to male factors, and 20% to both partners. Sterility is the inability to conceive. Infertility, or subfertility, is a state of requiring a prolonged time to conceive.
Diabetes refers to a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin action, insulin secretion, or both. Over time, diabetes causes significant changes in the microvascular and macrovascular circulations. These complications include: a. Atherosclerosis. b. Retinopathy. c. IUFD. d. Nephropathy. e. Neuropathy. Autonomcs neuropathy.
ANS: A, B, D, E
These structural changes are most likely to affect a variety of systems, including the heart, eyes, kidneys, and nerves. Intrauterine fetal death (stillbirth) remains a major complication of diabetes in pregnancy; however, this is a fetal complication.
Menstruation is periodic uterine bleeding:
a. That occurs every 28 days.
b. In which the entire uterine lining is shed.
c. That is regulated by ovarian hormones.
d. That leads to fertilization.
ANS: C
Menstruation is periodic uterine bleeding that is controlled by a feedback system involving three cycles: endometrial, hypothalamic-pituitary, and ovarian. The average length of a menstrual cycle is 28 days, but variations are normal. During the endometrial cycle, the functional two thirds of the endometrium is shed. Lack of fertilization leads to menstruation.
Congenital disorders refer to conditions that are present at birth. These disorders may be inherited and caused by environmental factors or maternal malnutrition. Toxic exposures have the greatest effect on development between 15 and 60 days of gestation. For the nurse to be able to conduct a complete assessment of the newly pregnant client, she should understand the significance of exposure to known human teratogens. These include (Select all that apply): a. Infections. b. Radiation. c. Maternal conditions. d. Drugs. e. Chemicals.
ANS: A, B, C, D, E
Exposure to radiation and numerous infections may result in profound congenital deformities. These include but are not limited to varicella, rubella, syphilis, parvovirus, cytomegalovirus, and toxoplasmosis. Certain maternal conditions such as diabetes and phenylketonuria may also affect organs and other parts of the embryo during this developmental period. Drugs such as antiseizure medication and some antibiotics as well as chemicals, including lead, mercury, tobacco, and alcohol, also may result in structural and functional abnormalities.
With regard to medications, herbs, shots, and other substances normally encountered by pregnant women, the maternity nurse should be aware that:
a.
Both prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus.
b.
The greatest danger of drug-caused developmental deficits in the fetus is seen in the final trimester.
c.
Killed-virus vaccines (e.g., tetanus) should not be given during pregnancy, but live-virus vaccines (e.g., measles) are permissible.
d.
No convincing evidence exists that secondhand smoke is potentially dangerous to the fetus.
ANS: A
Both prescription and OTC drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus. This is especially true for new medications and combinations of drugs. The greatest danger of drug-caused developmental defects exists in the interval from fertilization through the first trimester, when a woman may not realize that she is pregnant. Live-virus vaccines should be part of postpartum care; killed-virus vaccines may be administered during pregnancy. Secondhand smoke is associated with fetal growth restriction and increases in infant mortality.
The nurse caring for the laboring woman should know that meconium is produced by: a. Fetal intestines. c. Amniotic fluid. b. Fetal kidneys. d. The placenta.
ANS: A
As the fetus nears term, fetal waste products accumulate in the intestines as dark green-to-black, tarry meconium.
Compared with contraction stress test (CST), nonstress test (NST) for antepartum fetal assessment:
a. Has no known contraindications.
b. Has fewer false-positive results.
c. Is more sensitive in detecting fetal compromise.
d. Is slightly more expensive.
ANS: A
CST has several contraindications. NST has a high rate of false-positive results, is less sensitive than the CST, and is relatively inexpensive.
As related to the care of the patient with miscarriage, nurses should be aware that:
a. It is a natural pregnancy loss before labor begins.
b. It occurs in fewer than 5% of all clinically recognized pregnancies.
c. It often can be attributed to careless maternal behavior such as poor nutrition or excessive exercise.
d. If it occurs before the twelfth week of pregnancy, it may manifest only as moderate discomfort and blood loss.
ANS: D
Before the sixth week the only evidence may be a heavy menstrual flow. After the twelfth week more severe pain, similar to that of labor, is likely. Miscarriage is a natural pregnancy loss, but by definition it occurs before 20 weeks of gestation, before the fetus is viable. Miscarriages occur in approximately 10% to 15% of all clinically recognized pregnancies. Miscarriage can be caused by a number of disorders or illnesses outside of the mother’s control or knowledge.
A woman was treated recently for toxic shock syndrome (TSS). She has intercourse occasionally and uses over-the-counter protection. On the basis of her history, what contraceptive method should she and her partner avoid? a. Cervical cap c. Vaginal film b. Condom d. Vaginal sheath
ANS: A
Women with a history of TSS should not use a cervical cap. Condoms, vaginal films, and vaginal sheaths are not contraindicated for a woman with a history of TSS.
A physician prescribes clomiphene citrate (Clomid, Serophene) for a woman experiencing infertility. She is very concerned about the risk of multiple births. The nurse’s most appropriate response is:
a.
“This is a legitimate concern. Would you like to discuss this further before your treatment begins?”
b.
“No one has ever had more than triplets with Clomid.”
c.
“Ovulation will be monitored with ultrasound so that this will not happen.”
d.
“Ten percent is a very low risk, so you don’t need to worry too much.”
ANS: A
The incidence of multiple pregnancies with the use of these medications is significantly increased. The patient’s concern is legitimate and should be discussed so that she can make an informed decision. Stating that no one has ever had “more than triplets” is inaccurate and negates the patient’s concerns. Ultrasound cannot ensure that a multiple pregnancy will not occur. The percentage quoted in this statement is inaccurate. The comment “don’t worry” discredits the patient’s concern.
Postcoital contraception with Ovral:
a.
Requires that the first dose be taken within 72 hours of unprotected intercourse.
b.
Requires that the woman take second and third doses at 24 and 36 hours after the first dose.
c.
Must be taken in conjunction with an IUD insertion.
d.
Is commonly associated with the side effect of menorrhagia.
ANS: A
Emergency contraception is most effective when used within 72 hours of intercourse; however, it may be used with lessened effectiveness 120 hours later. Insertion of the copper IUD within 5 days of intercourse may also be used and is up to 99% effective. The most common side effect of postcoital contraception is nausea.
An abortion in which the fetus dies but is retained within the uterus is called a(n):
a. Inevitable abortion c. Incomplete abortion
b. Missed abortion d. Threatened abortion
ANS: B
Missed abortion refers to retention of a dead fetus in the uterus. An inevitable abortion means that the cervix is dilating with the contractions. An incomplete abortion means that not all of the products of conception were expelled. With a threatened abortion the woman has cramping and bleeding but not cervical dilation.
Injectable progestins (DMPA, Depo-Provera) are a good contraceptive choice for women who:
a.
Want menstrual regularity and predictability.
b.
Have a history of thrombotic problems or breast cancer.
c.
Have difficulty remembering to take oral contraceptives daily.
d.
Are homeless or mobile and rarely receive health care.
ANS: C
Advantages of DMPA include a contraceptive effectiveness comparable to that of combined oral contraceptives with the requirement of only four injections a year. Disadvantages of injectable progestins are prolonged amenorrhea and uterine bleeding. Use of injectable progestin carries an increased risk of venous thrombosis and thromboembolism. To be effective, DMPA injections must be administered every 11 to 13 weeks. Access to health care is necessary to prevent pregnancy or potential complications.
Which symptom described by a patient is characteristic of premenstrual syndrome (PMS)?
a.
“I feel irritable and moody a week before my period is supposed to start.”
b.
“I have lower abdominal pain beginning the third day of my menstrual period.”
c.
“I have nausea and headaches after my period starts, and they last 2 to 3 days.”
d.
“I have abdominal bloating and breast pain after a couple days of my period.”
ANS: A
PMS is a cluster of physical, psychologic, and behavioral symptoms that begin in the luteal phase of the menstrual cycle and resolve within a couple of days of the onset of menses. Complaints of lower abdominal pain, nausea and headaches, and abdominal bloating all are associated with PMS. However, the timing reflected is inaccurate.
A woman inquires about herbal alternative methods for improving fertility. Which statement by the nurse is the most appropriate when instructing the client in which herbal preparations to avoid while trying to conceive?
a.
“You should avoid nettle leaf, dong quai, and vitamin E while you are trying to get pregnant.”
b.
“You may want to avoid licorice root, lavender, fennel, sage, and thyme while you are trying to conceive.”
c.
“You should not take anything with vitamin E, calcium, or magnesium. They will make you infertile.”
d.
“Herbs have no bearing on fertility.”
ANS: B
Herbs that a woman should avoid while trying to conceive include licorice root, yarrow, wormwood, ephedra, fennel, golden seal, lavender, juniper, flaxseed, pennyroyal, passionflower, wild cherry, cascara, sage, thyme, and periwinkle. Nettle leaf, dong quai, and vitamin E all promote fertility. Vitamin E, calcium, and magnesium may promote fertility and conception. All supplements and herbs should be purchased from trusted sources.
There is little consensus on the management of premenstrual dysphoric disorder (PMDD). However, nurses can advise women on several self-help modalities that often improve symptoms. The nurse knows that health teaching has been effective when the client reports that she has adopted a number of lifestyle changes, including (Select all that apply): a. Regular exercise. b. Improved nutrition. c. A daily glass of wine. d. Smoking cessation. e. Oil of evening primrose.
ANS: A, B, D, E
These modalities may provide significant symptom relief in 1 to 2 months. If there is no improvement after these changes have been made, the patient may need to begin pharmacologic therapy. Women should decrease both their alcohol and caffeinated beverage consumption if they have PMDD.
A couple comes in for an infertility workup, having attempted to get pregnant for 2 years. The woman, 37, has always had irregular menstrual cycles but is otherwise healthy. The man has fathered two children from a previous marriage and had a vasectomy reversal 2 years ago. The man has had two normal semen analyses, but the sperm seem to be clumped together. What additional test is needed? a. Testicular biopsy b. Antisperm antibodies c. Follicle-stimulating hormone (FSH) level d. Examination for testicular infection
ANS: C
The woman has irregular menstrual cycles. The scenario does not indicate that she has had any testing related to this irregularity. Hormone analysis is performed to assess endocrine function of the hypothalamic-pituitary-ovarian axis when menstrual cycles are absent or irregular. Determination of blood levels of prolactin, FSH, luteinizing hormone (LH), estradiol, progesterone, and thyroid hormones may be necessary to diagnose the cause of irregular menstrual cycles. A testicular biopsy would be indicated only in cases of azoospermia (no sperm cells) or severe oligospermia (low number of sperm cells). Antisperm antibodies are produced by a man against his own sperm. This is unlikely to be the case here because the man has already produced children. Examination for testicular infection would be done before semen analysis. Infection would affect spermatogenesis.
Prophylaxis of subacute bacterial endocarditis is given before and after birth when a pregnant woman has:
a. Valvular disease. c. Arrhythmias.
b. Congestive heart disease. d. Postmyocardial infarction.
ANS: A
Prophylaxis for intrapartum endocarditis and pulmonary infection may be provided for women who have mitral valve stenosis. Prophylaxis for intrapartum endocarditis is not indicated for congestive heart disease, arrhythmias, or after myocardial infarction.
A first-time mother at 18 weeks of gestation comes for her regularly scheduled prenatal visit. The client tells the nurse that she is afraid that she is going into premature labor because she is beginning to have regular contractions. The nurse explains that this is the Braxton Hicks sign and teaches the client that this type of contraction: a. Is painless. c. Causes cervical dilation. b. Increases with walking. d. Impedes oxygen flow to the fetus.
ANS: A
Uterine contractions can be felt through the abdominal wall soon after the fourth month of gestation. Braxton Hicks contractions are regular and painless and continue throughout the pregnancy. Although they are not painful, some women complain that they are annoying. Braxton Hicks contractions usually cease with walking or exercise. They can be mistaken for true labor; however, they do not increase in intensity or frequency or cause cervical dilation. In addition, they facilitate uterine blood flow through the intervillous spaces of the placenta and promote oxygen delivery to the fetus.
Which statement about a condition of pregnancy is accurate?
a.
Insufficient salivation (ptyalism) is caused by increases in estrogen.
b.
Acid indigestion (pyrosis) begins early but declines throughout pregnancy.
c.
Hyperthyroidism often develops (temporarily) because hormone production increases.
d.
Nausea and vomiting rarely have harmful effects on the fetus and may be beneficial.
ANS: D
Normal nausea and vomiting rarely produce harmful effects, and nausea and vomiting periods may be less likely to result in miscarriage or preterm labor. Ptyalism is excessive salivation, which may be caused by a decrease in unconscious swallowing or stimulation of the salivary glands. Pyrosis begins in the first trimester and intensifies through the third trimester. Increased hormone production does not lead to hyperthyroidism in pregnant women.
In presenting to obstetric nurses interested in genetics, the genetic nurse identifies the primary risk(s) associated with genetic testing as:
a.
Anxiety and altered family relationships.
b.
Denial of insurance benefits.
c.
High false-positive results associated with genetic testing.
d.
Ethnic and socioeconomic disparity associated with genetic testing.
ANS: B
Decisions about genetic testing are shaped by socioeconomic status and the ability to pay for the testing. Some types of genetic testing are expensive and are not covered by insurance benefits. Anxiety and altered family relationships, high false-positive results, and ethnic and socioeconomic disparity are factors that may be difficulties associated with genetic testing, but they are not risks associated with testing.
The multiple marker test is used to assess the fetus for which condition? a. Down syndrome c. Congenital cardiac abnormality b. Diaphragmatic hernia d. Anencephaly
ANS: A
The maternal serum level of alpha-fetoprotein is used to screen for Down syndrome, neural tube defects, and other chromosome anomalies. The multiple marker test would not detect diaphragmatic hernia, congenital cardiac abnormality, or anencephaly. Additional testing, such as ultrasonography and amniocentesis, would be required to diagnose these conditions.
A couple has been counseled for genetic anomalies. They ask you, “What is karyotyping?” Your best response is:
a.
“Karyotyping will reveal if the baby’s lungs are mature.”
b.
“Karyotyping will reveal if your baby will develop normally.”
c.
“Karyotyping will provide information about the gender of the baby and the number and structure of the chromosomes.”
d.
“Karyotyping will detect any physical deformities the baby has.”
ANS: C
Karyotyping provides genetic information such as gender and chromosome structure. The L/S, not karyotyping, reveals lung maturity. Although karyotyping can detect genetic anomalies, the range of normal is nondescriptive. Although karyotyping can detect genetic anomalies, not all such anomalies display obvious physical deformities. The term deformities is a nondescriptive word. Physical anomalies may be present that are not detected by genetic studies (e.g., cardiac malformations).
When the pregnant diabetic woman experiences hypoglycemia while hospitalized, the nurse should intervene by having the patient:
a. Eat six saltine crackers.
b. Drink 8 oz of orange juice with 2 tsp of sugar added.
c. Drink 4 oz of orange juice followed by 8 oz of milk.
d. Eat hard candy or commercial glucose wafers.
ANS: A
Crackers provide carbohydrates in the form of polysaccharides. Orange juice and sugar will increase the blood sugar but not provide a slow-burning carbohydrate to sustain the blood sugar. Milk is a disaccharide and orange juice is a monosaccharide. They will provide an increase in blood sugar but will not sustain the level. Hard candy or commercial glucose wafers provide only monosaccharides.
A pregnant woman’s biophysical profile score is 8. She asks the nurse to explain the results. The nurse’s best response is:
a. “The test results are within normal limits.”
b. “Immediate delivery by cesarean birth is being considered.”
c. “Further testing will be performed to determine the meaning of this score.”
d. “An obstetric specialist will evaluate the results of this profile and, within the next week, will inform you of your options regarding delivery.”
ANS: A
The normal biophysical score ranges from 8 to 10 points if the amniotic fluid volume is adequate. A normal score allows conservative treatment of high-risk patients. Delivery can be delayed if fetal well-being is indicated. Scores less than 4 should be investigated, and delivery could be initiated sooner than planned. This score is within normal range, and no further testing is required at this time. The results of the biophysical profile are usually available immediately after the procedure is performed.
Along with gas exchange and nutrient transfer, the placenta produces many hormones necessary for normal pregnancy. These include (select all that apply) a. Human chorionic gonadotropin (hCG) b. Insulin c. Estrogen d. Progesterone e. Testosterone
ANS: A, C, D
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; cause growth of the ductal system in the breasts; and, as term approaches, play 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 numerous growth factors. Human placental lactogen promotes normal nutrition and growth of the fetus and maternal breast development for lactation. This hormone decreases maternal insulin sensitivity and utilization of glucose, making more glucose available for fetal growth. If a Y chromosome is present in the male fetus, hCG causes the fetal testes to secrete testosterone necessary for the normal development of male reproductive structures.
A pregnant woman reports that she is still playing tennis at 32 weeks of gestation. The nurse would be most concerned that during and after tennis matches this woman consumes:
a. Several glasses of fluid.
b. Extra protein sources such as peanut butter.
c. Salty foods to replace lost sodium.
d. Easily digested sources of carbohydrate.
ANS: A
If no medical or obstetric problems contraindicate physical activity, pregnant women should get 30 minutes of moderate physical exercise daily. Liberal amounts of fluid should be consumed before, during, and after exercise because dehydration can trigger premature labor. The woman’s calorie intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise.
A man’s wife is pregnant for the third time. One child was born with cystic fibrosis, and the other child is healthy. The man wonders what the chance is that this child will have cystic fibrosis. This type of testing is known as: a. Occurrence risk. c. Predictive testing. b. Recurrence risk. d. Predisposition testing.
ANS: B
The couple already has a child with a genetic disease so they will be given a recurrence risk test. If a couple has not yet had children but are known to be at risk for having children with a genetic disease, they are given an occurrence risk test. Predictive testing is used to clarify the genetic status of an asymptomatic family member. Predisposition testing differs from presymptomatic testing in that a positive result does not indicate 100% risk of a condition developing.
While providing care in an obstetric setting, the nurse should understand that postpartum care of the woman with cardiac disease:
a. Is the same as that for any pregnant woman.
b. Includes rest, stool softeners, and monitoring of the effect of activity.
c. Includes ambulating frequently, alternating with active range of motion.
d. Includes limiting visits with the infant to once per day.
ANS: B
Bed rest may be ordered, with or without bathroom privileges. Bowel movements without stress or strain for the woman are promoted with stool softeners, diet, and fluid. Care of the woman with cardiac disease in the postpartum period is tailored to the woman’s functional capacity. The woman will be on bed rest to conserve energy and reduce the strain on the heart. Although the woman may need help caring for the infant, breastfeeding and infant visits are not contraindicated.
Informed consent concerning contraceptive use is important because some of the methods: a. Are invasive procedures that require hospitalization b. Require a surgical procedure to insert c. May not be reliable d. Have potentially dangerous side effects
ANS: D
To make an informed decision about the use of contraceptives, it is important for couples to be aware of potential side effects. The only contraceptive method that is a surgical procedure and requires hospitalization is sterilization. Some methods have greater efficacy than others, and this should be included in the teaching.
During a client’s physical examination the nurse notes that the lower uterine segment is soft on palpation. The nurse would document this finding as: a. Hegar’s sign c. Chadwick’s sign b. McDonald’s sign d. Goodell’s sign
ANS: A
At approximately 6 weeks of gestation, softening and compressibility of the lower uterine segment occur; this is called Hegar’s sign. McDonald’s sign indicates a fast food restaurant. Chadwick’s sign is the blue-violet coloring of the cervix caused by increased vascularity; this occurs around the fourth week of gestation. Softening of the cervical tip is called Goodell’s sign, which may be observed around the sixth week of pregnancy.
A married couple is discussing alternatives for pregnancy prevention and has asked about fertility awareness methods (FAMs). The nurse’s most appropriate reply is:
a.
“They’re not very effective, and it’s very likely you’ll get pregnant.”
b.
“They can be effective for many couples, but they require motivation.”
c.
“These methods have a few advantages and several health risks.”
d.
“You would be much safer going on the pill and not having to worry.”
ANS: B
FAMs are effective with proper vigilance about ovulatory changes in the body and adherence to coitus intervals. They are effective if used correctly by a woman with a regular menstrual cycle. The typical failure rate for all FAMs is 25% during the first year of use. FAMs have no associated health risks. The use of birth control has associated health risks. In addition, taking a pill daily requires compliance on the client’s part.
Prenatal testing for human immunodeficiency virus (HIV) is recommended for:
a.
All women, regardless of risk factors.
b.
A woman who has had more than one sexual partner.
c.
A woman who has had a sexually transmitted infection.
d.
A woman who is monogamous with her partner.
ANS: A
Testing for the antibody to HIV is strongly recommended for all pregnant women. A HIV test is recommended for all women, regardless of risk factors. Women who test positive for HIV can be treated, reducing the risk of transmission to the fetus.
The nurse providing care in a women’s health care setting must be aware regarding which sexually transmitted infection that can be successfully treated and cured? a. Herpes b. Acquired immunodeficiency syndrome (AIDS) c. Venereal warts d. Chlamydia
ANS: D
The usual treatment for infection by the bacterium Chlamydia is doxycycline or azithromycin. Concurrent treatment of all sexual partners is needed to prevent recurrence. There is no known cure for herpes, and treatment focuses on pain relief and preventing secondary infections. Because there is no known cure for AIDS, prevention and early detection are the primary focus of care management. Condylomata acuminata are caused by human papillomavirus. No treatment eradicates the virus.
Maternal nutritional status is an especially significant factor of the many factors that influence the outcome of pregnancy because:
a. It is very difficult to adjust because of people’s ingrained eating habits.
b. It is an important preventive measure for a variety of problems.
c. Women love obsessing about their weight and diets.
d. A woman’s preconception weight becomes irrelevant.
ANS: B
Nutritional status draws so much attention not only for its effect on a healthy pregnancy and birth but also because significant changes are within relatively easy reach.
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 today. There are now four categories based on threats to the health of the woman and the outcome of pregnancy. Which of the following is not one of these categories?
a. Biophysical c. Geographic
b. Psychosocial d. Environmental
ANS: C
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 also are included. Biophysical is one of the broad categories used for determining risk. These include genetic considerations, nutritional status, and medical and obstetric disorders. 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. Environmental risks are risks that can affect both fertility and fetal development. These include infections, chemicals, radiation, pesticides, illicit drugs, and industrial pollutants.
A woman is 15 weeks pregnant with her first baby. She asks how long it will be before she feels the baby move. The best answer is:
a.
“You should have felt the baby move by now.”
b.
“Within the next month, you should start to feel fluttering sensations.”
c.
“The baby is moving; however, you can’t feel it yet.”
d.
“Some babies are quiet, and you don’t feel them move.
ANS: B
Maternal perception of fetal movement usually begins 16 to 20 weeks after conception. Because this is her first pregnancy, movement is felt toward the later part of the 16- to 20-week time period. Stating that “you should have felt the baby move by now” is incorrect and may be alarming to the patient. Fetal movement should be felt by 16 to 20 weeks. If movement is not felt by the end of that time, further assessment will be necessary.
Which symptom is considered a first-trimester warning sign and should be reported immediately by the pregnant woman to her health care provider? a. Nausea with occasional vomiting c. Urinary frequency b. Fatigue d. Vaginal bleeding
ANS: D
Signs and symptoms that must be reported include severe vomiting, fever and chills, burning on urination, diarrhea, abdominal cramping, and vaginal bleeding. These symptoms may be signs of potential complications of the pregnancy. Nausea with occasional vomiting, fatigue, and urinary frequency are normal first-trimester complaints. Although they may be worrisome or annoying to the mother, they usually are not indications of pregnancy problems.
The exact cause of breast cancer remains undetermined. Researchers have found that there are many common risk factors that increase a woman’s chance of developing a malignancy. It is essential for the nurse who provides care to women of any age to be aware of which of the following risk factors (Select all that apply)? a. Family history b. Late menarche c. Early menopause d. Race e. Nulliparity or first pregnancy after age 30
ANS: A, D, E
Family history, race, and nulliparity are known risk factors for the development of breast cancer. Other risk factors include age, personal history of cancer, high socioeconomic status, sedentary lifestyle, hormone replacement therapy, recent use of oral contraceptives, never having breastfed a child, and drinking more than one alcoholic beverage per day. Early menarche and late menopause are risk factors for breast malignancy, not late menarche and early menopause.
A key finding from the Human Genome Project is:
a.
Approximately 20,000 genes make up the genome.
b.
All human beings are 80.99% identical at the DNA level.
c.
Human genes produce only one protein per gene; other mammals produce three proteins per gene.
d.
Single gene testing will become a standardized test for all pregnant clients in the future.
ANS: A
Approximately 20,500 genes make up the human genome; this is only twice as many as make up the genomes of roundworms and flies. Human beings are 99.9% identical at the DNA level. Most human genes produce at least three proteins. Single gene testing (e.g., alpha-fetoprotein) is already standardized for prenatal care.
The use of methamphetamine (meth) has been described as a significant drug problem in the United States. In order to provide adequate nursing care to this client population the nurse must be cognizant that methamphetamine:
a. Is similar to opiates.
b. Is a stimulant with vasoconstrictive characteristics.
c. Should not be discontinued during pregnancy.
d. Is associated with a low rate of relapse.
ANS: B
Methamphetamines are stimulants with vasoconstrictive characteristics similar to cocaine and are used similarly. As is the case with cocaine users, methamphetamine users are urged to immediately stop all use during pregnancy. Unfortunately, because methamphetamine users are extremely psychologically addicted, the rate of relapse is very high.
With regard to the estimation and interpretation of the recurrence of risks for genetic disorders, nurses should be aware that:
a.
With a dominant disorder, the likelihood of the second child also having the condition is 100%.
b.
An autosomal recessive disease carries a one in eight risk of the second child also having the disorder.
c.
Disorders involving maternal ingestion of drugs carry a one in four chance of being repeated in the second child.
d.
The risk factor remains the same no matter how many affected children are already in the family.
ANS: D
Each pregnancy is an independent event. The risk factor (e.g., one in two, one in four) remains the same for each child, no matter how many children are born to the family.
In a dominant disorder, the likelihood of recurrence in subsequent children is 50% (one in two). An autosomal recessive disease carries a one in four chance of recurrence. In disorders involving maternal ingestion of drugs, subsequent children would be at risk only if the mother continued to take drugs; the rate of risk would be difficult to calculate.
When assessing a patient for amenorrhea, the nurse should be aware that this is unlikely to be caused by: a. Anatomic abnormalities. c. Lack of exercise. b. Type 1 diabetes mellitus. d. Hysterectomy.
ANS: C
Lack of exercise is not a cause of amenorrhea. Strenuous exercise may cause amenorrhea. Anatomic abnormalities, type 1 diabetes mellitus, and hysterectomy all are possible causes of amenorrhea.
A laboring woman with no known risk factors suddenly experiences spontaneous rupture of membranes (ROM). The fluid consists of bright red blood. Her contractions are consistent with her current stage of labor. There is no change in uterine resting tone. The fetal heart rate begins to decline rapidly after the ROM. The nurse should suspect the possibility of:
a. Placenta previa.
b. Vasa previa.
c. Severe abruptio placentae.
d. Disseminated intravascular coagulation (DIC).
ANS: B
Vasa previa is the result of a velamentous insertion of the umbilical cord. The umbilical vessels are not surrounded by Wharton jelly and have no supportive tissue. They are at risk for laceration at any time, but laceration occurs most frequently during ROM. The sudden appearance of bright red blood at the time of ROM and a sudden change in the fetal heart rate without other known risk factors should immediately alert the nurse to the possibility of vasa previa. The presence of placenta previa most likely would be ascertained before labor and would be considered a risk factor for this pregnancy. In addition, if the woman had a placenta previa, it is unlikely that she would be allowed to pursue labor and a vaginal birth. With the presence of severe abruptio placentae, the uterine tonicity would typically be tetanus (i.e., a boardlike uterus). DIC is a pathologic form of diffuse clotting that consumes large amounts of clotting factors and causes widespread external bleeding, internal bleeding, or both. DIC is always a secondary diagnosis, often associated with obstetric risk factors such as HELLP syndrome. This woman did not have any prior risk factors.
A woman is 16 weeks pregnant and has elected to terminate her pregnancy. The nurse knows that the most common technique used for medical termination of a pregnancy in the second trimester is: a. Dilation and evacuation (D&E). b. Instillation of hypertonic saline into the uterine cavity. c. Intravenous administration of Pitocin. d. Vacuum aspiration.
ANS: A
The most common technique for medical termination of a pregnancy in the second trimester is D&E. It is usually performed between 13 and 16 weeks. Hypertonic solutions injected directly into the uterus account for less than 1% of all abortions because other methods are safer and easier to use. Intravenous administration of Pitocin is used to induce labor in a woman with a third-trimester fetal demise. Vacuum aspiration is used for abortions in the first trimester.
A woman complains of severe abdominal and pelvic pain around the time of menstruation that has gotten worse over the last 5 years. She also complains of pain during intercourse and has tried unsuccessfully to get pregnant for the past 18 months. These symptoms are most likely related to: a. Endometriosis. c. Primary dysmenorrhea. b. PMS. d. Secondary dysmenorrhea.
ANS: A
Symptoms of endometriosis can change over time and may not reflect the extent of the disease. Major symptoms include dysmenorrhea and deep pelvic dyspareunia (painful intercourse). Impaired fertility may result from adhesions caused by endometriosis. Although endometriosis may be associated with secondary dysmenorrhea, it is not a cause of primary dysmenorrhea or PMS. In addition, this woman is complaining of dyspareunia and infertility, which are associated with endometriosis, not with PMS or primary or secondary dysmenorrhea.
In presenting to obstetric nurses interested in genetics, the genetic nurse identifies the primary risk(s) associated with genetic testing as:
a.
Anxiety and altered family relationships.
b.
Denial of insurance benefits.
c.
High false-positive results associated with genetic testing.
d.
Ethnic and socioeconomic disparity associated with genetic testing.
ANS: B
Decisions about genetic testing are shaped by socioeconomic status and the ability to pay for the testing. Some types of genetic testing are expensive and are not covered by insurance benefits. Anxiety and altered family relationships, high false-positive results, and ethnic and socioeconomic disparity are factors that may be difficulties associated with genetic testing, but they are not risks associated with testing.
Because pregnant women may need surgery during pregnancy, nurses should be aware that:
a. The diagnosis of appendicitis may be difficult because the normal signs and symptoms mimic some normal changes in pregnancy.
b. Rupture of the appendix is less likely in pregnant women because of the close monitoring.
c. Surgery for intestinal obstructions should be delayed as long as possible because it usually affects the pregnancy.
d. When pregnancy takes over, a woman is less likely to have ovarian problems that require invasive responses.
ANS: A
Both appendicitis and pregnancy are linked with nausea, vomiting, and increased white blood cell count. Rupture of the appendix is two to three times more likely in pregnant women. Surgery to remove obstructions should be done right away. It usually does not affect the pregnancy. Pregnancy predisposes a woman to ovarian problems.
The nurse caring for the laboring woman should know that meconium is produced by: a. Fetal intestines. c. Amniotic fluid. b. Fetal kidneys. d. The placenta.
ANS: A
As the fetus nears term, fetal waste products accumulate in the intestines as dark green-to-black, tarry meconium.
A woman is in her seventh month of pregnancy. She has been complaining of nasal congestion and occasional epistaxis. The nurse suspects that:
a.
This is a normal respiratory change in pregnancy caused by elevated levels of estrogen.
b.
This is an abnormal cardiovascular change, and the nosebleeds are an ominous sign.
c.
The woman is a victim of domestic violence and is being hit in the face by her partner.
d.
The woman has been using cocaine intranasally.
ANS: A
Elevated levels of estrogen cause capillaries to become engorged in the respiratory tract. This may result in edema in the nose, larynx, trachea, and bronchi. This congestion may cause nasal stuffiness and epistaxis. Cardiovascular changes in pregnancy may cause edema in lower extremities. Determining that the woman is a victim of domestic violence and was hit in the face cannot be made on the basis of the sparse facts provided. If the woman had been hit in the face, she most likely would have additional physical findings. Determination of the use of cocaine by the woman cannot be made on the basis of the sparse facts provided.
hich congenital malformations result from multifactorial inheritance (Select all that apply)? a. Cleft lip b. Congenital heart disease c. Cri du chat syndrome d. Anencephaly e. Pyloric stenosis
ANS: A, B, D, E
All these congenital malformations are associated with multifactorial inheritance. Cri du chat syndrome is related to a chromosome deletion.
Which factor is known to increase the risk of gestational diabetes mellitus?
a. Underweight before pregnancy
b. Maternal age younger than 25 years
c. Previous birth of large infant
d. Previous diagnosis of type 2 diabetes mellitus
ANS: C
Previous birth of a large infant suggests gestational diabetes mellitus. Obesity (BMI of 30 or greater) creates a higher risk for gestational diabetes. A woman younger than 25 years generally is not at risk for gestational diabetes mellitus. The person with type 2 diabetes mellitus already has diabetes and will continue to have it after pregnancy. Insulin may be required during pregnancy because oral hypoglycemia drugs are contraindicated during pregnancy.
A patient at 24 weeks of gestation contacts the nurse at her obstetric provider’s office to complain that she has cravings for dirt and gravel. The nurse is aware that this condition is known as \_\_\_\_\_\_\_\_ and may indicate anemia. a. Ptyalism c. Pica b. Pyrosis d. Decreased peristalsis
ANS: C
Pica (a desire to eat nonfood substances) is an indication of iron deficiency and should be evaluated. Ptyalism (excessive salivation), pyrosis (heartburn), and decreased peristalsis are normal findings of gastrointestinal change during pregnancy. Food cravings during pregnancy are normal.
Which contraceptive method best protects against sexually transmitted infections (STIs) and human immunodeficiency virus (HIV)? a. Periodic abstinence b. Barrier methods c. Hormonal methods d. They all offer about the same protection.
ANS: B
Barrier methods such as condoms best protect against STIs and HIV. Periodic abstinence and hormonal methods (“the pill”) offer no protection against STIs or HIV.
Nurses, certified nurse-midwives, and other advanced practice nurses have the knowledge and expertise to assist women in making informed choices regarding contraception. A multidisciplinary approach should ensure that the woman’s social, cultural, and interpersonal needs are met. Which action should the nurse take first when meeting with a new client to discuss contraception?
a.
Obtain data about the frequency of coitus.
b.
Determine the woman’s level of knowledge about contraception and commitment to any particular method.
c.
Assess the woman’s willingness to touch her genitals and cervical mucus.
d.
Evaluate the woman’s contraceptive life plan.
ANS: B
This is the primary step of this nursing assessment and necessary before completing the process and moving on to a nursing diagnosis. Once the client’s level of knowledge is determined, the nurse can interact with the woman to compare options, reliability, cost, comfort level, protection from sexually transmitted infections, and a partner’s willingness to participate. Although important, obtaining data about the frequency of coitus is not the first action that the nurse should undertake when completing an assessment. Data should include not only the frequency of coitus but also the number of sexual partners, level of contraceptive involvement, and partner’s objections. Assessing the woman’s willingness to touch herself is a key factor for the nurse to discuss should the client express interest in using one of the fertility awareness methods of contraception. The nurse must be aware of the client’s plan regarding whether she is attempting to prevent conception, delay conception, or conceive.
Because of the effect of cyclic ovarian changes on the breast, the best time for breast self-examination (BSE) is:
a. 5 to 7 days after menses ceases.
c. Midmenstrual cycle.
b. Day 1 of the endometrial cycle.
d. Any time during a shower or
ANS: A
The physiologic alterations in breast size and activity reach their minimal level about 5 to 7 days after menstruation stops. All women should perform BSE during this phase of the menstrual cycle.
A woman has come to the clinic for preconception counseling because she wants to start trying to get pregnant in 3 months. She can expect the following advice:
a. “Discontinue all contraception now.”
b. “Lose weight so that you can gain more during pregnancy.”
c. “You may take any medications you have been taking regularly.”
d. “Make sure that you include adequate folic acid in your diet.”
ANS: D
A healthy diet before conception is the best way to ensure that adequate nutrients are available for the developing fetus. A woman’s folate or folic acid intake is of particular concern in the periconception period. Neural tube defects are more common in infants of women with a poor folic acid intake. Depending on the type of contraception used, discontinuing all contraception may not be appropriate advice. Losing weight is not appropriate advice. Depending on the type of medication the woman is taking, continuing its use may not be appropriate.
Glucose metabolism is profoundly affected during pregnancy because:
a. Pancreatic function in the islets of Langerhans is affected by pregnancy.
b. The pregnant woman uses glucose at a more rapid rate than the nonpregnant woman.
c. The pregnant woman increases her dietary intake significantly.
d. Placental hormones are antagonistic to insulin, thus resulting in insulin resistance.
ANS: D
Placental hormones, estrogen, progesterone, and human placental lactogen (HPL) create insulin resistance. Insulin also is broken down more quickly by the enzyme placental insulinase. Pancreatic functioning is not affected by pregnancy. The glucose requirements differ because of the growing fetus. The pregnant woman should increase her intake by 200 calories a day.
The reported incidence of ectopic pregnancy in the United States has risen steadily over the past 2 decades. Causes include the increase in STDs accompanied by tubal infection and damage. The popularity of contraceptive devices such as the IUD has also increased the risk for ectopic pregnancy. The nurse who suspects that a patient has early signs of ectopic pregnancy should be observing her for symptoms such as (Select all that apply):
a. Pelvic pain
b. Abdominal pain
c. Unanticipated heavy bleeding
d. Vaginal spotting or light bleeding
e. Missed period
ANS: A, B, D, E
A missed period or spotting can easily be mistaken by the patient as early signs of pregnancy. More subtle signs depend on exactly where the implantation occurs. The nurse must be thorough in her assessment because pain is not a normal symptom of early pregnancy. As the fallopian tube tears open and the embryo is expelled, the patient often exhibits severe pain accompanied by intraabdominal hemorrhage. This may progress to hypovolemic shock with minimal or even no external bleeding. In about half of women, shoulder and neck pain results from irritation of the diaphragm from the hemorrhage.
The placenta allows exchange of oxygen, nutrients, and waste products between the mother and fetus by:
a.
Contact between maternal blood and fetal capillaries within the chorionic villi.
b.
Interaction of maternal and fetal pH levels within the endometrial vessels.
c.
A mixture of maternal and fetal blood within the intervillous spaces.
d.
Passive diffusion of maternal carbon dioxide and oxygen into the fetal capillaries.
ANS: A
Fetal capillaries within the chorionic villi are bathed with oxygen-rich and nutrient-rich maternal blood within the intervillous spaces. The endometrial vessels are part of the uterus. There is no interaction with the fetal blood at this point. Maternal and fetal blood do not normally mix. Maternal carbon dioxide does not enter into the fetal circulation.
The microscopic examination of scrapings from the cervix, endocervix, or other mucous membranes to detect premalignant or malignant cells is called: a. Bimanual palpation. c. A Papanicolaou (Pap) test. b. Rectovaginal palpation. d. A four As procedure.
ANS: C
The Pap test is a microscopic examination for cancer that should be performed regularly, depending on the client’s age. Bimanual palpation is a physical examination of the vagina. Rectovaginal palpation is a physical examination performed through the rectum. The four As is an intervention procedure to help a patient stop smoking.
A new mother asks the nurse about the “white substance” covering her infant. The nurse explains that the purpose of vernix caseosa is to:
a.
Protect the fetal skin from amniotic fluid.
b.
Promote normal peripheral nervous system development.
c.
Allow transport of oxygen and nutrients across the amnion.
d.
Regulate fetal temperature.
ANS: A
Prolonged exposure to amniotic fluid during the fetal period could result in breakdown of the skin without the protection of the vernix caseosa. Normal development of the peripheral nervous system is dependent on nutritional intake of the mother. The amnion is the inner membrane that surrounds the fetus. It is not involved in the oxygen and nutrient exchange. The amniotic fluid aids in maintaining fetal temperature.
Despite warnings, prenatal exposure to alcohol continues to exceed by far exposure to illicit drugs. A diagnosis of fetal alcohol syndrome (FAS) is made when there are visible markers in each of three categories. Which is category is not associated with a diagnosis of FAS? a. Respiratory conditions c. CNS abnormality b. Impaired growth d. Craniofacial dysmorphologies
ANS: A
Respiratory difficulties are not a category of conditions that are related to FAS. Abnormalities related to FAS include organ deformities, genital malformations, and kidney and urinary defects. Impaired growth is a visible marker for FAS. CNS abnormalities with neurologic and intellectual impairments are categories used to assist in the diagnosis of FAS. An infant with FAS manifests at least two craniofacial abnormalities, such as microcephaly, short palpebral fissures, poorly developed philtrum, thin upper lip, or flattening of the maxilla.
A woman who has completed one pregnancy with a fetus (or fetuses) reaching the stage of fetal viability is called a: a. Primipara. c. Multipara. b. Primigravida. d. Nulligravida.
ANS: A
A primipara is a woman who has completed one pregnancy with a viable fetus. To remember terms, keep in mind: gravida is a pregnant woman; para comes from parity, meaning a viable fetus; primi means first; multi means many; and null means none. A primigravida is a woman pregnant for the first time. A multipara is a woman who has completed two or more pregnancies with a viable fetus. A nulligravida is a woman who has never been pregnant.
You are a maternal-newborn nurse caring for a mother who just delivered a baby born with Down syndrome. What nursing diagnosis would be the most essential in caring for the mother of this infant? a. Disturbed body image c. Anxiety b. Interrupted family processes d. Risk for injury
ANS: B
This mother likely will experience a disruption in the family process related to the birth of a baby with an inherited disorder. Women commonly experience “body image disturbances in the postpartum period”; however, this is unrelated to giving birth to a child with Down syndrome. The mother likely will have a mix of emotions that may include anxiety, guilt, and denial, but this is not the most essential nursing diagnosis for this family. “Risk for injury” is not an applicable nursing diagnosis.
As relates to dysfunctional uterine bleeding (DUB), the nurse should be aware that:
a.
It is most commonly caused by anovulation.
b.
It most often occurs in middle age.
c.
The diagnosis of DUB should be the first considered for abnormal menstrual bleeding.
d.
The most effective medical treatment is steroids.
ANS: A
Anovulation may occur because of hypothalamic dysfunction or polycystic ovary syndrome. DUB most often occurs when the menstrual cycle is being established or when it draws to a close at menopause. A diagnosis of DUB is made only after all other causes of abnormal menstrual bleeding have been ruled out. The most effective medical treatment is oral or intravenous estrogen.
The role of the professional nurse caring for childbearing families has evolved to emphasize:
a. Providing care to patients directly at the bedside.
b. Primarily hospital care of maternity patients.
c. Practice using an evidence-based approach.
d. Planning patient care to cover longer hospital stays.
ANS: C
Professional nurses are part of the team of health care providers who collaboratively care for patients throughout the childbearing cycle. Providing care to patients directly at the bedside is one of the nurse’s tasks; however, it does not encompass the concept of the evolved professional nurse. Throughout the prenatal period, nurses care for women in clinics and physician’s offices and teach classes to help families prepare for childbirth. Nurses also care for childbearing families in birthing centers and in the home. Nurses have been critically important in developing strategies to improve the well-being of women and their infants and have led the efforts to implement clinical practice guidelines using an evidence-based approach. Maternity patients have experienced a decreased, rather than an increased, length of stay over the past 2 decades.
Since the gene for cystic fibrosis was identified in 1989, data can be collected for the purposes of genetic counseling for couples regarding carrier status. According to statistics, how often does cystic fibrosis occur in Caucasian live births?
a. 1 in 100 c. 1 in 2500
b. 1 in 1200 d. 1 in 3000
ANS: D
Cystic fibrosis occurs in about 1 in 3000 Caucasian live births.
What type of cultural concern is the most likely deterrent to many women seeking prenatal care? a. Religion c. Ignorance b. Modesty d. Belief that physicians are evil
ANS: B
A concern for modesty is a deterrent to many women seeking prenatal care. For some women, exposing body parts, especially to a man, is considered a major violation of their modesty. Many cultural variations are found in prenatal care. Even if the prenatal care described is familiar to a woman, some practices may conflict with the beliefs and practices of a subculture group to which she belongs.
In assessing the knowledge of a pregestational woman with type 1 diabetes concerning changing insulin needs during pregnancy, the nurse recognizes that further teaching is warranted when the client states:
a. “I will need to increase my insulin dosage during the first 3 months of pregnancy.”
b. “Insulin dosage will likely need to be increased during the second and third trimesters.”
c. “Episodes of hypoglycemia are more likely to occur during the first 3 months.”
d. “Insulin needs should return to normal within 7 to 10 days after birth if I am bottle-feeding.”
ANS: A
Insulin needs are reduced in the first trimester because of increased insulin production by the pancreas and increased peripheral sensitivity to insulin. “Insulin dosage will likely need to be increased during the second and third trimesters,” “Episodes of hypoglycemia are more likely to occur during the first 3 months,” and “Insulin needs should return to normal within 7 to 10 days after birth if I am bottle-feeding” are accurate statements and signify that the woman has understood the teachings regarding control of her diabetes during pregnancy.
A pregnant woman at 18 weeks of gestation calls the clinic to report that she has been experiencing occasional backaches of mild-to-moderate intensity. The nurse would recommend that she: a. Do Kegel exercises. c. Use a softer mattress. b. Do pelvic rock exercises. d. Stay in bed for 24 hours.
ANS: B
Pelvic rock exercises may help stretch and strengthen the abdominal and lower back muscles and relieve low back pain. Kegel exercises increase the tone of the pelvic area, not the back. A softer mattress may not provide the support needed to maintain proper alignment of the spine and may contribute to back pain. Stretching and other exercises to relieve back pain should be performed several times a day.
A client asks her nurse, “My doctor told me that he is concerned with the grade of my placenta because I am overdue. What does that mean?” The best response by the nurse is:
a. “Your placenta changes as your pregnancy progresses, and it is given a score that indicates the amount of calcium deposits it has. The more calcium deposits, the higher the grade, or number, that is assigned to the placenta. It also means that less blood and oxygen can be delivered to your baby.”
b. “Your placenta isn’t working properly, and your baby is in danger.”
c. “This means that we will need to perform an amniocentesis to detect if you have any placental damage.”
d. “Don’t worry about it. Everything is fine.”
ANS: A
An accurate and appropriate response is, “Your placenta changes as your pregnancy progresses, and it is given a score that indicates the amount of calcium deposits it has. The more calcium deposits, the higher the grade, or number, that is assigned to the placenta. It also means that less blood and oxygen can be delivered to your baby.” Although “Your placenta isn’t working properly, and your baby is in danger” may be valid, it does not reflect therapeutic communication techniques and is likely to alarm the client. An ultrasound, not an amniocentesis, is the method of assessment used to determine placental maturation. The response “Don’t worry about it. Everything is fine” is not appropriate and discredits the client’s concerns.
Healthy People 2020 has established national health priorities that focus on a number of maternal-child health indicators. Nurses are assuming greater roles in assessing family health and providing care across the perinatal continuum. Therefore it is important for the nurse to be aware that significant progress has been made in:
a. The reduction of fetal deaths and use of prenatal care.
b. Low birth weight and preterm birth.
c. Elimination of health disparities based on race.
d. Infant mortality and the prevention of birth defects.
ANS: A
Trends in maternal child health indicate that progress has been made in relation to reduced infant and fetal deaths and increased prenatal care. Notable gaps remain in the rates of low birth weight and preterm births. According to the March of Dimes, persistent disparities still exist between African Americans and non-Hispanic Caucasians. Many of these negative outcomes are preventable through access to prenatal care and the use of preventive health practices. This demonstrates the need for comprehensive community-based care for all mothers, infants, and families.
At approximately \_\_\_\_\_ weeks of gestation, lecithin is forming on the alveolar surfaces, the eyelids open, and the fetus measures approximately 27 cm crown to rump and weighs approximately 1110 g. a. 20 c. 28 b. 24 d. 30
ANS: C
These milestones human development occur at approximately 28 weeks.
A client who has undergone a dilation and curettage for early pregnancy loss is likely to be discharged the same day. The nurse must ensure that vital signs are stable, bleeding has been controlled, and the woman has adequately recovered from the administration of anesthesia. To promote an optimal recovery, discharge teaching should include (Select all that apply):
a. Iron supplementation.
b. Resumption of intercourse at 6 weeks following the procedure.
c. Referral to a support group if necessary.
d. Expectation of heavy bleeding for at least 2 weeks.
e. Emphasizing the need for rest.
ANS: A, C, E
The woman should be advised to consume a diet high in iron and protein. For many women iron supplementation also is necessary. Acknowledge that the client has experienced a loss, albeit early. She can be taught to expect mood swings and possibly depression. Referral to a support group, clergy, or professional counseling may be necessary. Discharge teaching should emphasize the need for rest. Nothing should be placed in the vagina for 2 weeks after the procedure. This includes tampons and vaginal intercourse. The purpose of this recommendation is to prevent infection. Should infection occur, antibiotics may be prescribed. The client should expect a scant, dark discharge for 1 to 2 weeks. Should heavy, profuse, or bright bleeding occur, she should be instructed to contact her provider.
A woman who is 32 weeks’ pregnant is informed by the nurse that a danger sign of pregnancy could be:
a.
Constipation.
b.
Alteration in the pattern of fetal movement.
c.
Heart palpitations.
d.
Edema in the ankles and feet at the end of the day.
ANS: B
An alteration in the pattern or amount of fetal movement may indicate fetal jeopardy. Constipation, heart palpitations, and ankle and foot edema are normal discomforts of pregnancy that occur in the second and third trimesters.
The diagnosis of pregnancy is based on which positive signs of pregnancy (Select all that apply)? a. Identification of fetal heartbeat b. Palpation of fetal outline c. Visualization of the fetus d. Verification of fetal movement e. Positive hCG test
ANS: A, C, D
Identification of fetal heartbeat, visualization of the fetus, and verification of fetal movement all are positive, objective signs of pregnancy. Palpation of fetal outline and a positive hCG test are probable signs of pregnancy. A tumor also can be palpated. Medication and tumors may lead to false-positive results on pregnancy tests.
When the nurse is alone with a battered patient, the patient seems extremely anxious and says, “It was all my fault. The house was so messy when he got home and I know he hates that.” The best response by the nurse is:
a.
“No one deserves to be hurt. It’s not your fault. How can I help you?”
b.
“What else do you do that makes him angry enough to hurt you?”
c.
“He will never find out what we talk about. Don’t worry. We’re here to help you.”
d.
“You have to remember that he is frustrated and angry so he takes it out on you.”
ANS: A
The nurse should stress that the patient is not at fault. Asking what the patient did to make her husband angry is placing the blame on the woman and would be an inappropriate statement. The nurse should not provide false reassurance. To assist the woman, the nurse should be honest. Often the batterer will find out about the conversation.
- Which of the following statements about the various forms of hepatitis is accurate?
a.
A vaccine exists for hepatitis C but not for hepatitis B.
b.
Hepatitis A is acquired by eating contaminated food or drinking polluted water.
c.
Hepatitis B is less contagious than human immunodeficiency virus (HIV).
d.
The incidence of hepatitis C is decreasing.
ANS: B
Contaminated milk and shellfish are common sources of infection with hepatitis A. A vaccine exists for hepatitis B but not for hepatitis C. Hepatitis B is more contagious than HIV. The incidence of hepatitis C is increasing.
In her work with pregnant women of various cultures, a nurse practitioner has observed various practices that seemed strange or unusual. She has learned that cultural rituals and practices during pregnancy seem to have one purpose in common. Which statement best describes that purpose? a. To promote family unity b. To ward off the “evil eye” c. To appease the gods of fertility d. To protect the mother and fetus during pregnancy
ANS: D
The purpose of all cultural practices is to protect the mother and fetus during pregnancy. Although many cultures consider pregnancy normal, certain practices are expected of women of all cultures to ensure a good outcome. Cultural prescriptions tell women what to do, and cultural proscriptions establish taboos. The purposes of these practices are to prevent maternal illness resulting from a pregnancy-induced imbalanced state and to protect the vulnerable fetus.
Fibrocystic changes in the breast most often appear in women in their 20s and 30s. The etiology is unknown, but it may be an imbalance of estrogen and progesterone. The nurse who cares for this client should be aware that treatment modalities are conservative. One proven modality that may provide relief is: a. Diuretic administration. b. Including caffeine daily in the diet. c. Increased vitamin C supplementation. d. Application of cold packs to the breast as necessary.
ANS: A
Diuretic administration plus a decrease in sodium and fluid intake are recommended. Although not supported by research, some advocate eliminating dimethylxanthines (caffeine) from the diet. Smoking should also be avoided, and alcohol consumption should be reduced. Vitamin E supplements are recommended; however, the client should avoid megadoses because this is a fat-soluble vitamin. Pain relief measures include applying heat to the breast, wearing a supportive bra, and taking nonsteroidal antiinflammatory drugs.
While teaching the expectant mother about personal hygiene during pregnancy, maternity nurses should be aware that:
a.
Tub bathing is permitted even in late pregnancy unless membranes have ruptured.
b.
The perineum should be wiped from back to front.
c.
Bubble bath and bath oils are permissible because they add an extra soothing and cleansing action to the bath.
d.
Expectant mothers should use specially treated soap to cleanse the nipples.
ANS: A
The main danger from taking baths is falling in the tub. The perineum should be wiped from front to back. Bubble baths and bath oils should be avoided because they may irritate the urethra. Soap, alcohol, ointments, and tinctures should not be used to cleanse the nipples because they remove protective oils. Warm water is sufficient.
The two primary areas of risk for sexually transmitted infections (STIs) are:
a.
Sexual orientation and socioeconomic status.
b.
Age and educational level.
c.
Large number of sexual partners and race.
d.
Risky sexual behaviors and inadequate preventive health behaviors.
ANS: D
Risky sexual behaviors and inadequate preventive health behaviors put a person at risk for acquiring or transmitting an STI. Although low socioeconomic status may be a factor in avoiding purchasing barrier protection, sexual orientation does not put one at higher risk. Younger individuals and individuals with less education may be unaware of proper prevention techniques; however, these are not the primary areas of risk for STIs. Having a large number of sexual partners is a risk-taking behavior, but race does not increase the risk for STIs.
Which statement made by a lactating woman would lead the nurse to believe that the woman might have lactose intolerance?
a. “I always have heartburn after I drink milk.”
b. “If I drink more than a cup of milk, I usually have abdominal cramps and bloating.”
c. “Drinking milk usually makes me break out in hives.”
d. “Sometimes I notice that I have bad breath after I drink a cup of milk.”
ANS: B
Abdominal cramps and bloating are consistent with lactose intolerance. One problem that can interfere with milk consumption is lactose intolerance, which is the inability to digest milk sugar because of a lack of the enzyme lactose in the small intestine. Milk consumption may cause abdominal cramping, bloating, and diarrhea people who are lactose intolerant, although many affected individuals can tolerate small amounts of milk without symptoms.
Nafarelin is currently used as a treatment for mild-to-severe endometriosis. The nurse should tell a woman taking this medication that the drug:
a.
Stimulates the secretion of gonadotropin-releasing hormone (GnRH), thereby stimulating ovarian activity.
b.
Should be sprayed into one nostril every other day.
c.
Should be injected into subcutaneous tissue BID.
d.
Can cause her to experience some hot flashes and vaginal dryness.
ANS: D
Nafarelin is a GnRH agonist, and its side effects are similar to effects of menopause. The hypoestrogenism effect results in hot flashes and vaginal dryness. Nafarelin is a GnRH agonist that suppresses the secretion of GnRH and is administered twice daily by nasal spray.
Intrauterine growth restriction (IUGR) is associated with numerous pregnancy-related risk factors (Select all that apply).
a. Poor nutrition
b. Maternal collagen disease
c. Gestational hypertension
d. Premature rupture of membranes
e. Smoking
ANS: A, B, C, E
Poor nutrition, maternal collagen disease, gestational hypertension, and smoking all are risk factors associated with IUGR. Premature rupture of membranes is associated with preterm labor, not IUGR.
he nurse must be cognizant that an individual’s genetic makeup is known as his or her: a. Genotype. c. Karyotype. b. Phenotype. d. Chromotype.
ANS: A
The genotype comprises all the genes the individual can pass on to a future generation. The phenotype is the observable expression of an individual’s genotype. The karyotype is a pictorial analysis of the number, form, and size of an individual’s chromosomes. Genotype refers to an individual’s genetic makeup.
The musculoskeletal system adapts to the changes that occur during pregnancy. A woman can expect to experience what change?
a.
Her center of gravity will shift backward.
b.
She will have increased lordosis.
c.
She will have increased abdominal muscle tone.
d.
She will notice decreased mobility of her pelvic joints.
ANS: B
An increase in the normal lumbosacral curve (lordosis) develops, and a compensatory curvature in the cervicodorsal region develops to help the woman maintain her balance. The center of gravity shifts forward. She will have decreased muscle tone. She will notice increased mobility of her pelvic joints.
A pregnant woman at 25 weeks’ gestation tells the nurse that she dropped a pan last week and her baby jumped at the noise. Which response by the nurse is most accurate?
a.
“That must have been a coincidence; babies can’t respond like that.”
b.
“The fetus is demonstrating the aural reflex.”
c.
“Babies respond to sound starting at about 24 weeks of gestation.”
d.
“Let me know if it happens again; we need to report that to your midwife.”
ANS: C
“Babies respond to sound starting at about 24 weeks of gestation” is an accurate statement. “That must have been a coincidence; babies can’t respond like that” is inaccurate. Acoustic stimulations can evoke a fetal heart rate response. There is no such thing as an aural reflex. The statement, “Let me know if it happens again; we need to report that to your midwife” is not appropriate; it gives the impression that something is wrong.
Nurses should be aware that the biophysical profile (BPP):
a. Is an accurate indicator of impending fetal death.
b. Is a compilation of health risk factors of the mother during the later stages of pregnancy.
c. Consists of a Doppler blood flow analysis and an amniotic fluid index.
d. Involves an invasive form of ultrasound examination.
ANS: A
An abnormal BPP score is an indication that labor should be induced. The BPP evaluates the health of the fetus, requires many different measures, and is a noninvasive procedure.
A couple is trying to cope with an infertility problem. They want to know what they can do to preserve their emotional equilibrium. The nurse’s most appropriate response is:
a.
“Tell your friends and family so they can help you.”
b.
“Talk only to other friends who are infertile because only they can help.”
c.
“Get involved with a support group. I’ll give you some names.”
d.
“Start adoption proceedings immediately because it is very difficult to obtain an infant.”
ANS: C
Venting negative feelings may unburden the couple. A support group may provide a safe haven for the couple to share their experiences and gain insight from others’ experiences. Although talking about their feelings may unburden them of negative feelings, infertility can be a major stressor that affects the couple’s relationships with family and friends. Limiting their interactions to other infertile couples may be a beginning point for addressing psychosocial needs, but depending on where the other couple is in their own recovery process, this may or may not help them. The statement about adoption proceedings is not supportive of the psychosocial needs of this couple and may be detrimental to their well-being.
Three servings of milk, yogurt, or cheese plus two servings of meat, poultry, or fish adequately supply the recommended amount of protein for a pregnant woman. Many patients are concerned about the increased levels of mercury in fish and may be afraid to include this source of nutrients in their diet. Sound advice by the nurse to assist the client in determining which fish is safe to consume would include:
a. Canned white tuna is a preferred choice.
b. Avoid shark, swordfish, and mackerel.
c. Fish caught in local waterways are the safest.
d. Salmon and shrimp contain high levels of mercury.
ANS: B
As a precaution, the pregnant patient should avoid eating all of these and the less common tilefish. High levels of mercury can harm the developing nervous system of the fetus. It is essential for the nurse to assist the client in understanding the differences between numerous sources of this product. A pregnant client can 12 ounces a week of canned light tuna; however, canned white, albacore, or tuna steaks contain higher levels of mercury and should be limited to no more than 6 ounces per week. It is a common misconception that fish caught in local waterways are the safest. Pregnant women and mothers of young children should check with local advisories about the safety of fish caught by families and friends in nearby bodies of water. If no information is available, these fish sources should be avoided, limited to less than 6 ounces, or the only fish consumed that week. Commercially caught fish that are low in mercury include salmon, shrimp, pollock, or catfish.
In practical terms regarding genetic health care, nurses should be aware that:
a.
Genetic disorders affect people of all socioeconomic backgrounds, races, and ethnic groups equally.
b.
Genetic health care is more concerned with populations than individuals.
c.
The most important of all nursing functions is providing emotional support to the family during counseling.
d.
Taking genetic histories is the province of large universities and medical centers.
ANS: C
Nurses should be prepared to help with various stress reactions from a couple facing the possibility of a genetic disorder. Although anyone may have a genetic disorder, certain disorders appear more often in certain ethnic and racial groups. Genetic health care is highly individualized because treatments are based on the phenotypic responses of the individual. Individual nurses at any facility can take a genetic history, although larger facilities may have better support services.
Some of the embryo’s intestines remain within the umbilical cord during the embryonic period because the:
a.
Umbilical cord is much larger at this time than it will be at the end of pregnancy.
b.
Intestines begin their development within the umbilical cord.
c.
Nutrient content of the blood is higher in this location.
d.
Abdomen is too small to contain all the organs while they are developing.
ANS: D
The abdominal contents grow more rapidly than the abdominal cavity, so part of their development takes place in the umbilical cord. By 10 weeks of gestation, the abdomen is large enough to contain them. Intestines begin their development within the umbilical cord, but only because the liver and kidneys occupy most of the abdominal cavity. Blood supply is adequate in all areas.
The most basic information a maternity nurse should have concerning conception is that:
a.
Ova are considered fertile 48 to 72 hours after ovulation.
b.
Sperm remain viable in the woman’s reproductive system for an average of 12 to 24 hours.
c.
Conception is achieved when a sperm successfully penetrates the membrane surrounding the ovum.
d.
Implantation in the endometrium occurs 6 to 10 days after conception.
ANS: D
After implantation, the endometrium is called the decidua. Ova are considered fertile for about 24 hours after ovulation. Sperm remain viable in the woman’s reproductive system for an average of 2 to 3 days. Penetration of the ovum by the sperm is called fertilization. Conception occurs when the zygote, the first cell of the new individual, is formed.
The uterus is a muscular, pear-shaped organ that is responsible for:
a. Cyclic menstruation.
c. Fertilization.
b. Sex hormone production.
d. Sexual arousal.
ANS: A
The uterus is an organ for reception, implantation, retention, and nutrition of the fertilized ovum; it also is responsible for cyclic menstruation. Hormone production and fertilization occur in the ovaries. Sexual arousal is a feedback mechanism involving the hypothalamus, the pituitary gland, and the ovaries.
To reassure and educate pregnant clients about changes in their breasts, nurses should be aware that:
a.
The visibility of blood vessels that form an intertwining blue network indicates full function of Montgomery’s tubercles and possibly infection of the tubercles.
b.
The mammary glands do not develop until 2 weeks before labor.
c.
Lactation is inhibited until the estrogen level declines after birth.
d.
Colostrum is the yellowish oily substance used to lubricate the nipples for breastfeeding.
ANS: C
Lactation is inhibited until after birth. The visible blue network of blood vessels is a normal outgrowth of a richer blood supply. The mammary glands are functionally complete by midpregnancy. Colostrum is a creamy, white-to-yellow premilk fluid that can be expressed from the nipples before birth.
The drug of choice for treatment of gonorrhea is: a. Penicillin G. c. Ceftriaxone. b. Tetracycline. d. Acyclovir.
ANS: C
Ceftriaxone is effective for treatment of all gonococcal infections. Penicillin is used to treat syphilis. Tetracycline is prescribed for chlamydial infections. Acyclovir is used to treat herpes genitalis.
Along with gas exchange and nutrient transfer, the placenta produces many hormones necessary for normal pregnancy. These include (select all that apply) a. Human chorionic gonadotropin (hCG) b. Insulin c. Estrogen d. Progesterone e. Testosterone
ANS: A, C, D
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; cause growth of the ductal system in the breasts; and, as term approaches, play 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 numerous growth factors. Human placental lactogen promotes normal nutrition and growth of the fetus and maternal breast development for lactation. This hormone decreases maternal insulin sensitivity and utilization of glucose, making more glucose available for fetal growth. If a Y chromosome is present in the male fetus, hCG causes the fetal testes to secrete testosterone necessary for the normal development of male reproductive structures.
The nurse guides a woman to the examination room and asks her to remove her clothes and put on an examination gown with the front open. The woman states, “I have special undergarments that I do not remove for religious reasons.” The most appropriate response from the nurse would be:
a.
“You can’t have an examination without removing all your clothes.”
b.
“I’ll ask the doctor to modify the examination.”
c.
“Tell me about your undergarments. I’ll explain the examination procedure, and then we can discuss how you can have your examination comfortably.”
d.
“What? I’ve never heard of such a thing! That sounds different and strange.”
ANS: C
This statement reflects cultural competence by the nurse and shows respect for the woman’s religious practices. The nurse must respect the rich and unique qualities that cultural diversity brings to individuals. In recognizing the value of these differences, the nurse can modify the plan of care to meet the needs of each woman.
A woman in week 34 of pregnancy reports that she is very uncomfortable because of heartburn. The nurse would suggest that the woman:
a. Substitute other calcium sources for milk in her diet.
b. Lie down after each meal.
c. Reduce the amount of fiber she consumes.
d. Eat five small meals daily.
ANS: D
Eating small, frequent meals may help with heartburn, nausea, and vomiting. Substituting other calcium sources for milk, lying down after eating, and reducing fiber intake are inappropriate dietary suggestions for all pregnant women and do not alleviate heartburn.
The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the Pitocin infusion, the nurse reviews the woman’s latest laboratory test findings, which reveal a platelet count of 90,000, an elevated aspartate transaminase (AST) level, and a falling hematocrit. The nurse notifies the physician because the laboratory results are indicative of:
a. Eclampsia.
b. Disseminated intravascular coagulation (DIC).
c. HELLP syndrome.
d. Idiopathic thrombocytopenia.
ANS: C
HELLP syndrome is a laboratory diagnosis for a variant of severe preeclampsia that involves hepatic dysfunction characterized by hemolysis (H), elevated liver enzymes (EL), and low platelets (LP). Eclampsia is determined by the presence of seizures. DIC is a potential complication associated with HELLP syndrome. Idiopathic thrombocytopenia is the presence of low platelets of unknown cause and is not associated with preeclampsia.
With regard to the noncontraceptive medical effects of combined oral contraceptive pills (COCs), nurses should be aware that:
a.
COCs can cause toxic shock syndrome if the prescription is wrong.
b.
Hormonal withdrawal bleeding usually is a bit more profuse than in normal menstruation and lasts a week.
c.
COCs increase the risk of endometrial and ovarian cancer.
d.
The effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements.
ANS: D
The effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements. Toxic shock syndrome can occur in some diaphragm users, but it is not a consequence of taking oral contraceptive pills. Hormonal withdrawal bleeding usually is lighter than in normal menstruation and lasts a couple of days. Oral contraceptive pills offer protection against the risk of endometrial and ovarian cancers.
A woman who is 6 months pregnant has sought medical attention, saying she fell down the stairs. What scenario would cause an emergency department nurse to suspect that the woman has been a victim of intimate partner violence (IPV)?
a.
The woman and her partner are having an argument that is loud and hostile.
b.
The woman has injuries on various parts of her body that are in different stages of healing.
c.
Examination reveals a fractured arm and fresh bruises.
d.
She avoids making eye contact and is hesitant to answer questions.
ANS: B
The patient may have multiple injuries in various stages of healing that indicates a pattern of violence. An argument is not always an indication of battering. A fractured arm and fresh bruises could be caused by the reported fall and doesn’t necessarily indicate IPV. . It is normal for the woman to have a flat affect.
A woman has a history of drug use and is screened for hepatitis B during the first trimester. What is an appropriate action?
a. Provide a low-protein diet.
b. Offer the vaccine.
c. Discuss the recommendation to bottle-feed her baby.
d. Practice respiratory isolation.
ANS: B
A person who has a history of high risk behaviors should be offered the hepatitis B vaccine. Care is supportive and includes bed rest and a high-protein, low-fat diet. The first trimester is too early to discuss feeding methods with a woman in the high risk category. Hepatitis B is transmitted through blood.
The hormone responsible for maturation of mammary gland tissue is:
a. Estrogen.
c. Prolactin.
b. Testosterone.
d. Progesterone.
ANS: D
Progesterone causes maturation of the mammary gland tissue, specifically acinar structures of the lobules. Estrogen increases the vascularity of the breast tissue. Testosterone has no bearing on breast development. Prolactin is produced after birth and released from the pituitary gland. It is produced in response to infant suckling and emptying of the breasts.
After a mastectomy a woman should be instructed to perform all of the following except:
a.
Emptying surgical drains twice a day and as needed.
b.
Avoiding lifting more than 4.5 kg (10 lb) or reaching above her head until given permission by her surgeon.
c.
Wearing clothing with snug sleeves to support the tissue of the arm on the operative side.
d.
Reporting immediately if inflammation develops at the incision site or in the affected arm.
ANS: C
The woman should not be advised to wear snug clothing. Rather, she should be advised to avoid tight clothing, tight jewelry, and other causes of decreased circulation in the affected arm. As part of the teaching plan, the woman should be instructed to empty surgical drains, to avoid lifting more than 10 lb or reaching above her head, and to report the development of incision site inflammation.
At 35 weeks of pregnancy a woman experiences preterm labor. Tocolytics are administered and she is placed on bed rest, but she continues to experience regular uterine contractions, and her cervix is beginning to dilate and efface. What would be an important test for fetal well-being at this time?
a. Percutaneous umbilical blood sampling (PUBS)
b. Ultrasound for fetal size
c. Amniocentesis for fetal lung maturity
d. Nonstress test (NST)
ANS: C
Amniocentesis would be performed to assess fetal lung maturity in the event of a preterm birth. Indications for PUBS include prenatal diagnosis or inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection, determination of the acid-base status of a fetus with intrauterine growth restriction, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus. Typically, fetal size is determined by ultrasound during the second trimester and is not indicated in this scenario. NST measures the fetal response to fetal movement in a noncontracting mother.
The measurement of lecithin in relation to sphingomyelin (L/S ratio) is used to determine fetal lung maturity. Which ratio reflects maturity of the lungs? a. 1.4:1 c. 2:1 b. 1.8:1 d. 1:1
ANS: C
A ratio of 2:1 indicates a two-to-one ratio of L/S, an indicator of lung maturity. Ratios of 1.4:1, 1.8:1, and 1:1 indicate immaturity of the fetal lungs.
A woman has a thick, white, lumpy, cottage cheese–like discharge, with patches on her labia and in her vagina. She complains of intense pruritus. The nurse practitioner would order which preparation for treatment? a. Fluconazole c. Clindamycin b. Tetracycline d. Acyclovir
ANS: A
Fluconazole, metronidazole, and clotrimazole are the drugs of choice to treat candidiasis. Tetracycline is used to treat syphilis. Clindamycin is used to treat bacterial vaginosis. Acyclovir is used to treat genital herpes.
Which statement regarding acronyms in nutrition is accurate?
a. Dietary reference intakes (DRIs) consist of recommended dietary allowances (RDAs), adequate intakes (AIs), and upper limits (ULs).
b. RDAs are the same as ULs except with better data.
c. AIs offer guidelines for avoiding excessive amounts of nutrients.
d. They all refer to green leafy vegetables, whole grains, and fruit.
ANS: A
DRIs consist of RDAs, AIs, and ULs. AIs are similar to RDAs except that they deal with nutrients about which data are insufficient for certainty (RDA status). ULs are guidelines for avoiding excesses of nutrients for which excess is toxic. Green leafy vegetables, whole grains, and fruit are important, but they are not the whole nutritional story.
Transvaginal ultrasonography is often performed during the first trimester. While preparing your 6-week gestation patient for this procedure, she expresses concerns over the necessity for this test. The nurse should explain that this diagnostic test may be indicated for a number of situations (Select all that apply).
a. Multifetal gestation
b. Obesity
c. Fetal abnormalities
d. Amniotic fluid volume
e. Ectopic pregnancy
ANS: A, B, C, E
Transvaginal ultrasound is useful in obese women whose thick abdominal layers cannot be penetrated with traditional abdominal ultrasound. This procedure is also used for identifying multifetal gestation, ectopic pregnancy, estimating gestational age, confirming fetal viability, and identifying fetal abnormalities. Amniotic fluid volume is assessed during the second and third trimester. Conventional ultrasound would be used.
A 36-year-old woman has been given a diagnosis of uterine fibroids. When planning care for this patient, the nurse should know that:
a.
Fibroids are malignant tumors of the uterus that require radiation or chemotherapy.
b.
Fibroids increase in size during the perimenopausal period.
c.
Menorrhagia is a common finding.
d.
The woman is unlikely to become pregnant as long as the fibroids are in her uterus.
ANS: C
The major symptoms associated with fibroids are menorrhagia and the physical effects produced by large myomas. Fibroids are benign tumors of the smooth muscle of the uterus, and their etiology is unknown. Fibroids are estrogen sensitive and shrink as levels of estrogen decline. Fibroids occur in 25% of women of reproductive age and are seen in 2% of pregnant women.
A 25-year-old single woman comes to the gynecologist’s office for a follow-up visit related to her abnormal Papanicolaou (Pap) smear. The test revealed that the patient has human papillomavirus (HPV). The client asks, “What is that? Can you get rid of it?” Your best response is:
a.
“It’s just a little lump on your cervix. We can freeze it off.”
b.
“HPV stands for ‘human papillomavirus.’ It is a sexually transmitted infection (STI) that may lead to cervical cancer.”
c.
“HPV is a type of early human immunodeficiency virus (HIV). You will die from this.”
d.
“You probably caught this from your current boyfriend. He should get tested for this.”
ANS: B
It is important to inform the patient about STIs and the risks involved with HPV. The health care team has a duty to provide proper information to the patient, including information related to STIs. HPV and HIV are both viruses that can be transmitted sexually, but they are not the same virus. The onset of HPV can be insidious. Often STIs go unnoticed. Abnormal bleeding frequently is the initial symptom. The client may have had HPV before her current boyfriend. You cannot make any deductions from this limited information.
While working with the pregnant woman in her first trimester, the nurse is aware that chorionic villus sampling (CVS) can be performed during pregnancy at:
a. 4 weeks c. 10 weeks
b. 8 weeks d. 14 weeks
ANS: C
CVS can be performed in the first or second trimester, ideally between 10 and 13 weeks of gestation. During this procedure, a small piece of tissue is removed from the fetal portion of the placenta. If performed after 9 completed weeks of gestation, the risk of limb reduction is no greater than in the general population.
Which statement about pregnancy is accurate?
a.
A normal pregnancy lasts about 10 lunar months.
b.
A trimester is one third of a year.
c.
The prenatal period extends from fertilization to conception.
d.
The estimated date of confinement (EDC) is how long the mother will have to be bedridden after birth.
ANS: A
A lunar month lasts 28 days, or 4 weeks. Pregnancy spans 9 calendar months but 10 lunar months. A trimester is one third of a normal pregnancy, or about 13 to 14 weeks. The prenatal period covers the full course of pregnancy (prenatal means before birth). The EDC is now called the EDB, or estimated date of birth. It has nothing to do with the duration of bed rest.
To manage her diabetes appropriately and ensure a good fetal outcome, the pregnant woman with diabetes will need to alter her diet by:
a. Eating six small equal meals per day.
b. Reducing carbohydrates in her diet.
c. Eating her meals and snacks on a fixed schedule.
d. Increasing her consumption of protein.
ANS: C
Having a fixed meal schedule will provide the woman and the fetus with a steadier blood sugar level, provide better balance with insulin administration, and help prevent complications. It is more important to have a fixed meal schedule than equal division of food intake. Approximately 45% of the food eaten should be in the form of carbohydrates.
A 23-year-old African-American woman is pregnant with her first child. Based on the statistics for infant mortality, which plan is most important for the nurse to implement?
a. Perform a nutrition assessment.
b. Refer the woman to a social worker.
c. Advise the woman to see an obstetrician, not a midwife.
d. Explain to the woman the importance of keeping her prenatal care appointments.
ANS: D
Consistent prenatal care is the best method of preventing or controlling risk factors associated with infant mortality. Nutritional status is an important modifiable risk factor, but a nutrition assessment is not the most important action a nurse should take in this situation. The patient may need assistance from a social worker at some time during her pregnancy, but a referral to a social worker is not the most important aspect the nurse should address at this time. If the woman has identifiable high-risk problems, her health care may need to be provided by a physician. However, it cannot be assumed that all African-American women have high-risk issues. In addition, advising the woman to see an obstetrician is not the most important aspect on which the nurse should focus at this time, and it is not appropriate for a nurse to advise or manage the type of care a patient is to receive.
Which minerals and vitamins usually are recommended to supplement a pregnant woman’s diet?
a. Fat-soluble vitamins A and D c. Iron and folate
b. Water-soluble vitamins C and B6 d. Calcium and zinc
ANS: C
Iron generally should be supplemented, and folic acid supplements often are needed because folate is so important. Fat-soluble vitamins should be supplemented as a medical prescription, as vitamin D might be for lactose-intolerant women. Water-soluble vitamin C sometimes is consumed in excess naturally; vitamin B6 is prescribed only if the woman has a very poor diet. Zinc sometimes is supplemented. Most women obtain enough calcium through their regular diet.
A 40-year-old woman is 10 weeks pregnant. Which diagnostic tool would be appropriate to suggest to her at this time?
a. Biophysical profile (BPP)
b. Amniocentesis
c. Maternal serum alpha-fetoprotein (MSAFP) screening
d. Transvaginal ultrasound
ANS: D
Ultrasound would be performed at this gestational age for biophysical assessment of the infant. BPP would be a method of biophysical assessment of fetal well-being in the third trimester. Amniocentesis is performed after the fourteenth week of pregnancy. MSAFP screening is performed from week 15 to week 22 of gestation (weeks 16 to 18 are ideal).
A woman is 15 weeks pregnant with her first baby. She asks how long it will be before she feels the baby move. The best answer is:
a.
“You should have felt the baby move by now.”
b.
“Within the next month, you should start to feel fluttering sensations.”
c.
“The baby is moving; however, you can’t feel it yet.”
d.
“Some babies are quiet, and you don’t feel them move.”
ANS: B
Maternal perception of fetal movement usually begins 16 to 20 weeks after conception. Because this is her first pregnancy, movement is felt toward the later part of the 16- to 20-week time period. Stating that “you should have felt the baby move by now” is incorrect and may be alarming to the patient. Fetal movement should be felt by 16 to 20 weeks. If movement is not felt by the end of that time, further assessment will be necessary.
Cardiovascular system changes occur during pregnancy. Which finding would be considered normal for a woman in her second trimester? a. Less audible heart sounds (S1, S2) b. Increased pulse rate c. Increased blood pressure d. Decreased red blood cell (RBC) production
ANS: B
Between 14 and 20 weeks of gestation, the pulse increases about 10 to 15 beats/min, which persists to term. Splitting of S1 and S2 is more audible. In the first trimester, blood pressure usually remains the same as at the prepregnancy level, but it gradually decreases up to about 20 weeks of gestation. During the second trimester, both the systolic and the diastolic pressures decrease by about 5 to 10 mm Hg. Production of RBCs accelerates during pregnancy.
With regard to the assessment of female, male, and couple infertility, nurses should be aware that:
a.
The couple’s religious, cultural, and ethnic backgrounds provide emotional clutter that does not affect the clinical scientific diagnosis.
b.
The investigation takes 3 to 4 months and a significant financial investment.
c.
The woman is assessed first; if she is not the problem, the male partner is analyzed.
d.
Semen analysis is for men; the postcoital test is for women.
ANS: B
Fertility assessment and diagnosis take time, money, and commitment from the couple. Religious, cultural, and ethnic-bred attitudes about fertility and related issues always have an impact on diagnosis and assessment. Both partners are assessed systematically and simultaneously, as individuals and as a couple. Semen analysis is for men, but the postcoital test is for the couple.
Which congenital malformations result from multifactorial inheritance (Select all that apply)? a. Cleft lip b. Congenital heart disease c. Cri du chat syndrome d. Anencephaly e. Pyloric stenosis
ANS: A, B, D, E
All these congenital malformations are associated with multifactorial inheritance. Cri du chat syndrome is related to a chromosome deletion.
After you complete your nutritional counseling for a pregnant woman, you ask her to repeat your instructions so you can assess her understanding of the instructions given. Which statement indicates that she understands the role of protein in her pregnancy?
a. “Protein will help my baby grow.”
b. “Eating protein will prevent me from becoming anemic.”
c. “Eating protein will make my baby have strong teeth after he is born.”
d. “Eating protein will prevent me from being diabetic.”
ANS: A
Protein is the nutritional element basic to growth. An adequate protein intake is essential to meeting the increasing demands of pregnancy. These demands arise from the rapid growth of the fetus; the enlargement of the uterus, mammary glands, and placenta; the increase in the maternal blood volume; and the formation of amniotic fluid. Iron intake prevents anemia. Calcium intake is needed for fetal bone and tooth development. Glycemic control is needed in diabetics; protein is one nutritional factor to consider, but this is not the primary role of protein intake.
Which diagnostic test is used to confirm a suspected diagnosis of breast cancer? a. Mammogram c. Fine-needle aspiration (FNA) b. Ultrasound d. CA 15.3
ANS: C
When a suspicious mammogram is noted or a lump is detected, diagnosis is confirmed by FNA, core needle biopsy, or needle localization biopsy. Mammography is a clinical screening tool that may aid early detection of breast cancers. Transillumination, thermography, and ultrasound breast imaging are being explored as methods of detecting early breast carcinoma. CA 15.3 is a serum tumor marker that is used to test for residual disease.
A nurse practitioner performs a clinical breast examination on a woman diagnosed with fibroadenoma. The nurse knows that fibroadenoma is characterized by:
a.
Inflammation of the milk ducts and glands behind the nipples.
b.
Thick, sticky discharge from the nipple of the affected breast.
c.
Lumpiness in both breasts that develops 1 week before menstruation.
d.
A single lump in one breast that can be expected to shrink as the woman ages.
ANS: D
Fibroadenomas are characterized by discrete, usually solitary lumps smaller than 3 cm in diameter. Fibroadenomas increase in size during pregnancy and shrink as the woman ages. Inflammation of the milk ducts is associated with mammary duct ectasia, not fibroadenoma. A thick, sticky discharge is associated with galactorrhea, not fibroadenoma. Lumpiness before menstruation is associated with fibrocystic changes of the breast.
When evaluating a patient whose primary complaint is amenorrhea, the nurse must be aware that lack of menstruation is most often the result of: a. Stress. c. Pregnancy. b. Excessive exercise. d. Eating disorders.
ANS: C
Amenorrhea, or the absence of menstrual flow, is most often a result of pregnancy. Although stress, excessive exercise, and eating disorders all may be contributing factors, none is the most common factor associated with amenorrhea.
Which of the following statements indicate that the nurse is practicing appropriate family-centered care techniques (Select all that apply)?
a. The nurse commands the mother to do as she is told.
b. The nurse allows time for the partner to ask questions.
c. The nurse allows the mother and father to make choices when possible.
d. The nurse informs the family about what is going to happen.
e. The nurse tells the patient’s sister, who is a nurse, that she cannot be in the room during the delivery.
ANS: B, C
Including the partner in the care process and allowing the couple to make choices are important elements of family-centered care. The nurse should never tell the mother what to do. Family-centered care involves collaboration between the health care team and the client. Unless an institutional policy limits the number of attendants at a delivery, the client should be allowed to have whomever she wants present (except when the situation is an emergency and guests are asked to leave).
When managing health care for pregnant women at a prenatal clinic, the nurse should recognize that the most significant barrier to access to care is the pregnant woman’s:
a. Age.
c. Educational level.
b. Minority status.
d. Inability to pay.
ANS: D
The most significant barrier to health care access is the inability to pay for services; this is compounded by the fact that many physicians refuse to care for women who cannot pay. Although adolescent pregnant clients statistically receive less prenatal care, age is not the most significant barrier. Significant disparities in morbidity and mortality rates exist for minority women; however, minority status is not the most significant barrier to access of care. Disparities in educational level are associated with morbidity and mortality rates; however, educational level is not the most significant barrier to access of
The \_\_\_\_\_ is/are responsible for oxygen and carbon dioxide transport to and from the maternal bloodstream. a. Decidua basalis c. Germ layer b. Blastocyst d. Chorionic villi
ANS: D
Chorionic villi are fingerlike projections that develop out of the trophoblast and extend into the blood-filled spaces of the endometrium. The villi obtain oxygen and nutrients from the maternal bloodstream and dispose of carbon dioxide and waste products into the maternal blood. The decidua basalis is the portion of the decidua (endometrium) under the blastocyst where the villi attach. The blastocyst is the embryonic development stage after the morula. Implantation occurs at this stage. The germ layer is a layer of the blastocyst.
_____ use/abuse during pregnancy causes vasoconstriction and decreased placental perfusion, resulting in maternal and neonatal complications.
a. Alcohol c. Tobacco
b. Caffeine d. Chocolate
ANS: C
Smoking in pregnancy is known to cause a decrease in placental perfusion and has serious health risks, including bleeding complications, low birth weight, prematurity, miscarriage, stillbirth, and sudden infant death syndrome. Prenatal alcohol exposure is the single greatest preventable cause of mental retardation. Alcohol use during pregnancy can cause high blood pressure, miscarriage, premature birth, stillbirth, and anemia. Caffeine and chocolate may safely be consumed in small quantities during pregnancy
A woman is undergoing a nipple-stimulated contraction stress test (CST). She is having contractions that occur every 3 minutes. The fetal heart rate (FHR) has a baseline of approximately 120 beats/min without any decelerations. The interpretation of this test is said to be:
a. Negative. c. Satisfactory.
b. Positive. d. Unsatisfactory.
ANS: A
Adequate uterine activity necessary for a CST consists of the presence of three contractions in a 10-minute time frame. If no decelerations are observed in the FHR pattern with the contractions, the findings are considered to be negative. A positive CST indicates the presence of repetitive later FHR decelerations. Satisfactory and unsatisfactory are not applicable terms.
The viral sexually transmitted infection (STI) that affects most people in the United States today is: a. Herpes simplex virus type 2 (HSV-2). b. Human papillomavirus (HPV). c. Human immunodeficiency virus (HIV). d. Cytomegalovirus (CMV).
ANS: B
HPV infection is the most prevalent viral STI seen in ambulatory health care settings. HSV-2, HIV, and CMV all are viral STIs but are not the most prevalent viral STIs.
A woman who is 16 weeks pregnant asks the nurse, “Is it possible to tell by ultrasound if the baby is a boy or girl yet?” The best answer is:
a.
“A baby’s sex is determined as soon as conception occurs.”
b.
“The baby has developed enough that we can determine the sex by examining the genitals through ultrasound.”
c.
“Boys and girls look alike until about 20 weeks after conception, and then they begin to look different.”
d.
“It might be possible to determine your baby’s sex, but the external organs look very similar right now.”
A woman who is 16 weeks pregnant asks the nurse, “Is it possible to tell by ultrasound if the baby is a boy or girl yet?” The best answer is:
a.
“A baby’s sex is determined as soon as conception occurs.”
b.
“The baby has developed enough that we can determine the sex by examining the genitals through ultrasound.”
c.
“Boys and girls look alike until about 20 weeks after conception, and then they begin to look different.”
d.
“It might be possible to determine your baby’s sex, but the external organs look very similar right now.”
Physiologically, sexual response can be characterized by: a. Coitus, masturbation, and fantasy. c. Erection and orgasm. b. Myotonia and vasocongestion. d. Excitement, plateau, and orgasm.
ANS: B
Physiologically, according to Masters (1992), sexual response can be analyzed in terms of two processes: vasocongestion and myotonia. Coitus, masturbation, and fantasy are forms of stimulation for the physical manifestation of the sexual response. Erection and orgasm occur in two of the four phases of the sexual response cycle. Excitement, plateau, and orgasm are three of the four phases of the sexual response cycle.
A woman who is 14 weeks pregnant tells the nurse that she always had a glass of wine with dinner before she became pregnant. She has abstained during her first trimester and would like to know if it is safe for her to have a drink with dinner now. The nurse would tell her:
a.
“Since you’re in your second trimester, there’s no problem with having one drink with dinner.”
b.
“One drink every night is too much. One drink three times a week should be fine.”
c.
“Since you’re in your second trimester, you can drink as much as you like.”
d.
“Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy.”
ANS: D
The statement “Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy” is accurate. A safe level of alcohol consumption during pregnancy has not yet been established. Although the consumption of occasional alcoholic beverages may not be harmful to the mother or her developing fetus, complete abstinence is strongly advised.
A woman is using the basal body temperature (BBT) method of contraception. She calls the clinic and tells the nurse, “My period is due in a few days, and my temperature has not gone up.” The nurse’s most appropriate response is:
a.
“This probably means that you’re pregnant.”
b.
“Don’t worry; it’s probably nothing.”
c.
“Have you been sick this month?”
d.
“You probably didn’t ovulate during this cycle.”
ANS: D
The absence of a temperature decrease most likely is the result of lack of ovulation. Pregnancy cannot occur without ovulation (which is being measured using the BBT method). A comment such as “Don’t worry; it’s probably nothing” discredits the client’s concerns. Illness would most likely cause an increase in BBT.
Congenital anomalies can occur with the use of antiepileptic drugs (AEDs), including (Select all that apply):
a. Cleft lip.
b. Congenital heart disease.
c. Neural tube defects.
d. Gastroschisis.
e. Diaphragmatic hernia.
ANS: A, B, C
Congenital anomalies that can occur with AEDs include cleft lip or palate, congenital heart disease, urogenital defects, and neural tube defects. Gastroschisis and diaphragmatic hernia are not associated with the use of AEDs.
With regard to nutritional needs during lactation, a maternity nurse should be aware that:
a. The mother’s intake of vitamin C, zinc, and protein now can be lower than during pregnancy.
b. Caffeine consumed by the mother accumulates in the infant, who may be unusually active and wakeful.
c. Critical iron and folic acid levels must be maintained.
d. Lactating women can go back to their prepregnant calorie intake.
ANS: B
A lactating woman needs to avoid consuming too much caffeine. Vitamin C, zinc, and protein levels need to be moderately higher during lactation than during pregnancy. The recommendations for iron and folic acid are lower during lactation. Lactating women should consume about 500 kcal more than their prepregnancy intake, at least 1800 kcal daily overall.
When providing care for a pregnant woman, the nurse should be aware that one of the most frequently reported maternal medical risk factors is:
a. Diabetes mellitus.
c. Chronic hypertension.
b. Mitral valve prolapse (MVP).
d. Anemia.
ANS: A
The most frequently reported maternal medical risk factors are diabetes and hypertension associated with pregnancy. Both of these conditions are associated with maternal obesity. There are no studies that indicate MVP is among the most frequently reported maternal risk factors. Hypertension associated with pregnancy, not chronic hypertension, is one of the most frequently reported maternal medical risk factors. Although anemia is a concern in pregnancy, it is not one of the most frequently reported maternal medical risk factors in pregnancy.
A woman with asthma is experiencing a postpartum hemorrhage. Which drug would not be used to treat her bleeding because it may exacerbate her asthma?
a. Pitocin
b. Nonsteroidal antiinflammatory drugs (NSAIDs)
c. Hemabate
d. Fentanyl
ANS: C
Prostaglandin derivatives should not be used to treat women with asthma, because they may exacerbate symptoms. Pitocin would be the drug of choice to treat this woman’s bleeding because it would not exacerbate her asthma. NSAIDs are not used to treat bleeding. Fentanyl is used to treat pain, not bleeding
When discussing work and travel during pregnancy with a pregnant patient, nurses should instruct them that:
a.
Women should sit for as long as possible and cross their legs at the knees from time to time for exercise.
b.
Women should avoid seat belts and shoulder restraints in the car because they press on the fetus.
c.
Metal detectors at airport security checkpoints can harm the fetus if the woman passes through them a number of times.
d.
While working or traveling in a car or on a plane, women should arrange to walk around at least every hour or so.
ANS: D
Periodic walking helps prevent thrombophlebitis. Pregnant women should avoid sitting or standing for long periods and crossing the legs at the knees. Pregnant women must wear lap belts and shoulder restraints. The most common injury to the fetus comes from injury to the mother. Metal detectors at airport security checkpoints do not harm fetuses.
In caring for a pregnant woman with sickle cell anemia, the nurse is aware that signs and symptoms of sickle cell crisis include:
a. Anemia. c. Fever and pain.
b. Endometritis. d. Urinary tract infection.
ANS: C
Women with sickle cell anemia have recurrent attacks (crisis) of fever and pain, most often in the abdomen, joints, and extremities. These attacks are attributed to vascular occlusion when RBCs assume the characteristic sickled shape. Crises are usually triggered by dehydration, hypoxia, or acidosis. Women with sickle cell anemia are not iron deficient. Therefore, routine iron supplementation, even that found in prenatal vitamins, should be avoided in order to prevent iron overload. Women with sickle cell trait usually are at greater risk for postpartum endometritis (uterine wall infection); however, this is not likely to occur in pregnancy and is not a sign of crisis. These women are at an increased risk for UTIs; however, this is not an indication of sickle cell crisis.
The nurse should know that once human immunodeficiency virus (HIV) enters the body, seroconversion to HIV positivity usually occurs within: a. 6 to 10 days. c. 6 to 8 weeks. b. 2 to 4 weeks. d. 6 months.
ANS: C
Seroconversion to HIV positivity usually occurs within 6 to 8 weeks after the virus has entered the body.
A woman arrives for evaluation of her symptoms, which include a missed period, adnexal fullness, tenderness, and dark red vaginal bleeding. On examination the nurse notices an ecchymotic blueness around the woman’s umbilicus and recognizes this assessment finding as:
a. Normal integumentary changes associated with pregnancy.
b. Turner’s sign associated with appendicitis.
c. Cullen’s sign associated with a ruptured ectopic pregnancy.
d. Chadwick’s sign associated with early pregnancy.
ANS: C
Cullen’s sign, the blue ecchymosis seen in the umbilical area, indicates hematoperitoneum associated with an undiagnosed ruptured intraabdominal ectopic pregnancy. Linea nigra on the abdomen is the normal integumentary change associated with pregnancy. It manifests as a brown, pigmented, vertical line on the lower abdomen. Turner’s sign is ecchymosis in the flank area, often associated with pancreatitis. Chadwick’s sign is the blue-purple color of the cervix that may be seen during or around the eighth week of pregnancy.
To prevent gastrointestinal upset, clients should be instructed to take iron supplements:
a. On a full stomach. c. After eating a meal.
b. At bedtime. d. With milk.
ANS: B
Clients should be instructed to take iron supplements at bedtime. Iron supplements are best absorbed if they are taken when the stomach is empty. Bran, tea, coffee, milk, and eggs may reduce absorption. Iron can be taken at bedtime if abdominal discomfort occurs when it is taken between meals.
During her gynecologic checkup, a 17-year-old girl states that recently she has been experiencing cramping and pain during her menstrual periods. The nurse would document this complaint as: a. Amenorrhea. c. Dyspareunia. b. Dysmenorrhea. d. Premenstrual syndrome (PMS).
ANS: B
Dysmenorrhea is pain during or shortly before menstruation. Amenorrhea is the absence of menstrual flow. Dyspareunia is pain during intercourse. PMS is a cluster of physical, psychologic, and behavioral symptoms that begin in the luteal phase of the menstrual cycle and resolve within a couple of days of the onset of menses.
A pregnant woman experiencing nausea and vomiting should:
a. Drink a glass of water with a fat-free carbohydrate before getting out of bed in the morning.
b. Eat small, frequent meals (every 2 to 3 hours).
c. Increase her intake of high-fat foods to keep the stomach full and coated.
d. Limit fluid intake throughout the day.
ANS: B
Eating small, frequent meals is the correct suggestion for a woman experiencing nausea and vomiting. A pregnant woman experiencing nausea and vomiting should avoid consuming fluids early in the day or when nauseated, but should compensate by drinking fluids at other times. A pregnant woman experiencing nausea and vomiting should reduce her intake of fried and other fatty foods.
As related to the care of the patient with anemia, the nurse should be aware that:
a. It is the most common medical disorder of pregnancy.
b. It can trigger reflex brachycardia.
c. The most common form of anemia is caused by folate deficiency.
d. Thalassemia is a European version of sickle cell anemia.
ANS: A
Combined with any other complication, anemia can result in congestive heart failure. Reflex bradycardia is a slowing of the heart in response to the blood flow increases immediately after birth. The most common form of anemia is iron deficiency anemia. Both thalassemia and sickle cell hemoglobinopathy are hereditary but not directly related or confined to geographic areas.
