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159 Cards in this Set
- Front
- Back
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The nurse has received a report about a woman in labor. The woman's last vaginal examination was recorded as 4, 80%, and -2. The nurse's interpretation of this assessment is that:
A) The cervix is dilated 4 cm, it is effaced 80%, and the presenting part is 2 cm below the ischial spines B) The cervix is effaced 4 cm, it is dilated 80%, and the presenting part is 2 cm below the ischial spines. C) The cervix is effaced 4 cm, it is dilated 80%, and the presenting part is 2 cm above the ischial spines D) The cervix is 4 cm dilated, it is effaced 80%, and the presenting part is 2 cm above the ischial spines |
D) The cervix is 4 cm dilated, it is effaced 80%, and the presenting part is 2 cm above the ischial spines
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To adequately care for a laboring woman, the nurse knows that which stage of labor varies the most in length?
A) First B) Fourth C) Third D) Second |
A) First
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Which position would the nurse suggest for second-stage labor if the pelvic outlet needs to be increased?
A) Sitting B) Squatting C) Side-lying D) Semirecumbent |
B) Squatting
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What position would be least effective when gravity is desired to assist in fetal descent?
A) Lithotomy B) Walking C) Kneeling D) Sitting |
A) Lithotomy
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What three measures should the nurse implement to provide intrauterine resuscitation? Select the response that best indicates the priority of actions that should be taken.
A) Reposition the mother, increase intravenous (IV) fluid, and provide oxygen via face mask. B) Perform a vaginal examination, reposition the mother, and provide oxygen via face mask. C) Administer oxygen to the mother, increase IV fluid, and notify the care provider. D) Call the provider, reposition the mother, and perform a vaginal examination |
A) Reposition the mother, increase intravenous (IV) fluid, and provide oxygen via face mask.
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The nurse providing care for the laboring woman should understand that late fetal heart rate (FHR) decelerations are caused by:
A) Altered cerebral blood flow B) Spontaneous rupture of membranes C) Uteroplacental insufficiency D) Umbilical cord compression |
C) Uteroplacental insufficiency
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The nurse providing care for the laboring woman should understand that variable fetal heart rate (FHR) decelerations are caused by:
A) Umbilical cord compression. B) Altered fetal cerebral blood flow C) Fetal hypoxemia. D) Uteroplacental insufficiency |
A) Umbilical cord compression.
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The nurse caring for the woman in labor should understand that maternal hypotension can result in:
A) Uteroplacental insufficiency. B) Spontaneous rupture of membranes C) Fetal dysrhythmias. D) Early decelerations. |
A) Uteroplacental insufficiency.
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he nurse providing care for the laboring woman should understand that accelerations with fetal movement:
A) Are caused by umbilical cord compression B) Are caused by uteroplacental insufficiency C) Warrant close observation D) Are reassuring. |
D) Are reassuring.
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A woman in active labor receives an analgesic, an opioid agonist. Which medication relieves severe, persistent, or recurrent pain; creates a sense of well-being; overcomes inhibitory factors; and may even relax the cervix but should be used cautiously in women with cardiac disease?
A) Meperidine (Demerol) B) Promethazine (Phenergan) C) Butorphanol tartrate (Stadol) D) Nalbuphine (Nubain) |
A) Meperidine (Demerol)
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A laboring woman received meperidine (Demerol) intravenously 90 minutes before she gave birth. Which medication should be available to reduce the postnatal effects of Demerol on the neonate?
A) Fentanyl (Sublimaze) B) Promethazine (Phenergan) C) Naloxone (Narcan) D) Nalbuphine (Nubain) |
C) Naloxone (Narcan)
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A woman in labor has just received an epidural block. The most important nursing intervention is to:
A) Limit parenteral fluids. B) Monitor the fetus for possible tachycardia C) Monitor the maternal blood pressure for possible hypotension. D) Monitor the maternal pulse for possible bradycardia |
C) Monitor the maternal blood pressure for possible hypotension.
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The role of the nurse with regard to informed consent is to:
A) Inform the client about the procedure and have her sign the consent form. B) Act as a client advocate and help clarify the procedure and the options. C) Call the physician to see the client D) Witness the signing of the consent form. |
B) Act as a client advocate and help clarify the procedure and the options.
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Maternal hypotension is a potential side effect of regional anesthesia and analgesia. What nursing interventions could you use to raise the client's blood pressure? Choose all that apply.
A) Place the woman in a supine position. B) Place the woman in a lateral position. C) Increase intravenous (IV) fluids. D) Continuous Fetal Monitor E) Administer ephedrine per MD order |
B) Place the woman in a lateral position.
C) Increase intravenous (IV) fluids. E) Administer ephedrine per MD order |
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Nursing care measures are commonly offered to women in labor. Which nursing measure reflects application of the gate-control theory?
A) Massaging the woman's back B) Changing the woman's position C) Giving the prescribed medication D) Encouraging the woman to rest between contractions |
A) Massaging the woman's back
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A pregnant woman is at 38 weeks of gestation. She wants to know is any signs indicate "labor is getting closer to starting." The nurse informs the woman that which of the following is a sign that labor may begin soon?
a) Weight gain of 1.5 to 2kg (3-4lb) b) Increase in fundal height c) Urinary retention d) Surge of energy |
Surge of energy
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A woman in the active phase of the first stage of labor is using a shallow pattern of breathing, which is about twice the normal adult breathing rate. She starts to complain about feeling lightheaded and dizzy and states that her fingers are tingling. The nurse should:
A) Notify the woman's physician. B) Tell the woman to "calm down" and slow the pace of her breathing. C) Administer oxygen via a mask or nasal cannula. D) Help her breathe into a paper bag |
D) Help her breathe into a paper bag
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With regard to a pregnant woman's anxiety and pain experience, nurses should be aware that:
A) Even mild anxiety must be treated. B) Severe anxiety increases tension, which increases pain, which in turn increases fear and anxiety, and so on. C) Anxiety may increase the perception of pain, but it does not affect the mechanism of labor. D) Women who have had a painful labor will have learned from the experience and have less anxiety the second time because of increased familiarity. |
B) Severe anxiety increases tension, which increases pain, which in turn increases fear and anxiety, and so on.
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Your patient is a nulliparous woman, requesting pain relief. You examine her and she is 8 cm. What is the best option for pain relief at this point?
A) Demerol B) Spinal C) Epidural D) Stadol |
C) Epidural
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A multiparous woman has been in labor for 8 hours. Her membranes have just ruptured. The nurse's initial response would be to:
A) Prepare the woman for imminent birth B) Notify the woman's primary health care provider. C) Document the characteristics of the fluid. D) Assess the fetal heart rate and pattern. |
D) Assess the fetal heart rate and pattern.
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Through vaginal examination the nurse determines that a woman is 4 cm dilated, and the external fetal monitor shows uterine contractions every 3.5 to 4 minutes. The nurse would report this as:
A) First stage, latent phase B) First stage, active phase C) First stage, transition phase D) Second stage, latent phase |
B) First stage, active phase
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The nurse expects to administer an oxytocic (e.g., Pitocin, Methergine) to a woman after expulsion of her placenta to:
A) Relieve pain. B) Stimulate uterine contraction C) Prevent infection D) Facilitate rest and relaxation. |
B) Stimulate uterine contraction
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When planning care for a laboring woman whose membranes have ruptured, the nurse recognizes that the woman's risk for _____ has increased.
A) Intrauterine infection B) Hemorrhage C) Precipitous labor D) Supine hypotension |
) Intrauterine infection
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When managing the care of a woman in the second stage of labor, the nurse uses various measures to enhance the progress of fetal descent. These measures include:
A) Encouraging the woman to try various upright positions, including squatting and standing. Giving positive feedback about her efforts. B) Telling the woman to start pushing as soon as her cervix is fully dilated. C) Stopping the epidural anesthetic so the woman can feel the urge to push and thereby push more effectively D) Coaching the woman to use sustained, 10- to 15-second, closed-glottis bearing-down efforts with each contraction. |
A) Encouraging the woman to try various upright positions, including squatting and standing. Giving positive feedback about her efforts.
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A pregnant woman's amniotic membranes rupture. Prolapsed cord is suspected. What intervention would be the top priority?
A) Starting oxygen by face mask B) Preparing the woman for a cesarean birth C) Covering the cord in sterile gauze soaked in saline D) Placing the woman in the knee-chest position |
D) Placing the woman in the knee-chest position
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In evaluating the effectiveness of magnesium sulfate for the treatment of preterm labor, what finding would alert the nurse to possible side effects?
A) Serum magnesium level of 10 mg/dl B) Respiratory rate of 16 breaths/min C) Deep tendon reflexes 2+ and no clonus D) Urine output of 160 ml in 4 hours |
A) Serum magnesium level of 10 mg/dl
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The nurse is caring for a client whose labor is being augmented with oxytocin. He or she recognizes that the oxytocin should be discontinued immediately if there is evidence of:
A) Uterine contractions occurring every 8 to 10 minutes B) Rupture of the client's amniotic membranes. C) A fetal heart rate (FHR) of 180 with absence of variability. D) The client needing to void. |
C) A fetal heart rate (FHR) of 180 with absence of variability.
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A woman in preterm labor at 30 weeks of gestation receives two 12-mg doses of betamethasone intramuscularly. The purpose of this pharmacologic treatment is to:
A) Suppress uterine contractions. B) Maintain adequate maternal respiratory effort and ventilation during magnesium sulfate therapy. C) Stimulate fetal surfactant production. D) Reduce maternal and fetal tachycardia associated with ritodrine administration |
C) Stimulate fetal surfactant production.
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A primigravida is being monitored in her prenatal clinic for preeclampsia. What finding should concern her nurse?
A) A dipstick value of 3+ for protein in her urine B) Pitting pedal edema at the end of the day C) Blood pressure (BP) increase to 138/86 mm Hg D) Weight gain of 0.5 kg during the past 2 weeks |
A) A dipstick value of 3+ for protein in her urine
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A woman with preeclampsia has a seizure. The nurse's primary duty during the seizure is to:
A) Stay with the client and call for help. B) Insert an oral airway. C) Administer oxygen by mask. D) Suction the mouth to prevent aspiration. |
A) Stay with the client and call for help.
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Magnesium sulfate is given to women with preeclampsia and eclampsia to:
A) Improve patellar reflexes and increase respiratory efficiency. B) Shorten the duration of labor. C) Prevent and treat convulsions. D) Prevent a boggy uterus and lessen lochial flow. |
C) Prevent and treat convulsions.
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A woman at 10 weeks of gestation who is seen in the prenatal clinic with presumptive signs and symptoms of pregnancy likely has:
a) Amenorrhea b) Positive pregnancy test c) Chadwick sign d) Hegar sign |
Amenorrhea
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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 |
She will have increased lordosis
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A nurse is caring for a pregnant client must understand that the hormone essential for maintaining pregnancy is:
a) Estrogen b) Human chorionic gonadotropin (hCG) c) Oxytocin d) Progesterone |
Progesterone
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A nurse providing care to a pregnant woman should know that all are normal gastrointestinal changes in pregnancy except:
a) Ptyalism b) Pyrosis c) Pica d) Decreased peristalsis |
Pica
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Some pregnant clients may complain of changes in their voice and impaired hearing. The nurse can tell these clients that these are common reactions to:
a) A decreased estrogen level b) Displacement of the diaphragm, resulting in thoracic breathing c) Congestion and swelling, which occur because the upper respiratory tract has become more vascular d) Increased blood volume |
Congestion and swelling, which occur because the upper respiratory tract has become more vascular
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In order to reassure and educate pregnant clients about the functioning of their kidneys in eliminating waste products, maternity nurses should be aware that:
a) Increased urinary output makes pregnant women less susceptible to urinary infection b) Increased bladder sensitivity and then compression of the bladder by the enlarging uterus results in the urge to urinate even if the bladder is almost empty c) Renal (kidney) function is more efficient when the woman assumes a supine position d) Using diuretics during pregnancy can help keep kidney function regular |
Increased bladder sensitivity and then compression of the bladder by the enlarging uterus result in the urge to urinate even if the bladder is almost empty
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A first-time mother at 18 weeks of gestation is in 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 b) Increases with walking c) Causes cervical dilation d) Impedes oxygen flow to the fetus |
is painless
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______________ is when the fetus begins to descend and drop into the pelvis.
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Lightening
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Which nutrient's recommended dietary allowance (RDA) is higher during lactation than during energy?
a) Energy b) Iron c) Vitamin A d) Folic acid |
Energy
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A pregnant woman's diet consists almost entirely of whole grain breads and cereals fruits, and vegetables. The nurse is most concerned about this woman's intake of:
a) Calcium b) Protein c) Vitamin B12 d) Folic acid |
Vitamin B12
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Which statement made by a lactating woman leads 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 |
If I drink more than a cup of milk, I usually have abdominal cramps and bloating
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A pregnant woman's diet history indicates that she likes the following. The nurse encourages this woman to consume more of which food in order to increase her calcium intake?
a) Fresh apricots b) Canned clams c) Spaghetti with meat sauce d) Canned sardines |
Canned sardines
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To prevent gastrointestinal (GI) upset, clients should be instructed to take iron supplements:
a) On a full stomach b) At bedtime c) After eating a meal d) With milk |
At bedtime
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After you complete your nutritional counseling for a pregnant woman, you ask her to repeat your instructions so that 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 anemix c) Eating protein will make my baby have strong teeth after he is born d) Eating protein will prevent me from being diabetic |
Protein will help my baby grow
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Pregnant adolescents are at high risk for ______________ due to lower body mass indexes (BMI) and fad dieting.
a) Obesity b) Gestational diabetes c) Low-birth-weight babies d) High-birth weight babies |
Low-birth-weight babies
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With regard to weight gain during pregnancy, maternity nurses should know that:
a) In this case, the woman`s height is not a factor in determining her target weight b) Obese women may have their health concerns, but their risk of giving birth to a child with major congenital defects is the same as with normal-weight women c) Women with inadequate weight gain have an increased risk of delivering an infant with IUGR d) Greater than expected weight gain during pregnancy is almost always due to old-fashioned overeating |
Women with inadequate weight gain have an increased risk of delivering an infant with IUGR
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Which vitamins or minerals can lead to congenital malformations of the fetus if taken in excess by the mother?
a) Zinc b) Vitamin D c) Folic acid d) Vitamin A |
Vitamin A
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While taking a diet history the nurse might be told that the expectant mother has cravings for ice chips, cornstarch, and baking soda. This represents a nutritional problem known as:
a) Preeclampsia b) Pyrosis c) Pica d) Purging |
Pica
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To help a woman reduce the severity of nausea caused by morning sickness, the nurse might suggest that she:
a) Try a tart food or drink, such as lemonade, or salty foods, such as potato chips b) Drink plenty of fluids early in the day c) Brush her teeth immediately after eating d) Never snack before bedtime |
Try a tart food, or drink, such as lemonade, or salty foods, such as potato chips
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A nurse caring for a newly pregnant woman advises her tha ideally prenatal care should begin:
a) Before the first missed menstrual period b) After the first missed menstrual period c) After the second missed menstrual period d) After the third missed menstrual period |
after the first missed menstrual period
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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 b) Fatigue c) Urinary frequency d) Vaginal bleeding |
Vaginal bleeding
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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 recommends that she:
a) Do Kegel exercises b) Do pelvic rock exercises c) Use a softer mattress d) Stay in bed for 24 hours |
Do pelvic rock exercises
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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 is how long the mother will have to be bedridden after birth |
A normal pregnancy lasts about 10 lunar months
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With regard to the initial physical exam of a woman beginning prenatal care, maternity nurses should be aware that:
a) Only women who show physical signs or meet the sociologic profile should be assessed for physical abuse b) The woman should empty her bladder before the pelvic examination c) The distribution, amount, and quality of body hair are of no particular importance d) The size of the uterus is discounted in the initial examination because it is just going to get bigger soon |
The woman should empty her bladder before the pelvic examination
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A woman who is 16 weeks pregnant has come in for a follow-up visit with her significant other. In order to reassure the client regarding fetal well-being it is best for the nurse to:
a) Assess the fetal heart tones with a Doppler stethoscope b) Measure the girth of the woman's abdomen c) Complete an ultrasound examination (sonogram) d) Offer then woman and her family the opportunity to listen to the fetal heart tones |
Offer then woman and her family the opportunity to listen to the fetal heart tones
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When instructing a pregnant client regarding personal hygiene, it is important for a maternity nurse to 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 |
Tub bathing is permitted even in late pregnancy unless membranes have ruptured
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An 18 year old pregnant woman, gravida 1, is admitted to the labor and birth unit whith moderate contractions every 5 minutes that last 40 seconds. The woman states, "My contractions are so strong, I don't know what to do." The nurse should:
a) Assess for fetal well-being b) Encourage the woman to lie on her side c) Disturb the woman as little as possible d) Recognize that pain is personalized for each individual |
Recognize that pain is personalized for each individual
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Your client is in early labor, and you are discussing the pain relief options she is considering. She states that she wants an epidural "no matter what!" Your best response is:
a) Ill make sure you get your epidural b) You may only have an epidural if your doctor allows it c) You may only have any epidural if you are going to deliver vaginally d) The type of analgesia or anesthesia used is determined in part by the stage of your labor and the method of birth |
The type of analgesia or anesthesia used to determined in part by the stage of your labor and the method of birth
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Nurses should be aware that all reputable childbirth methods attempt to meet all these goals except;
a) Increase the woman's sense of control b) Prepare a support person to help in labor c) Guarantee a pain-free childbirth d) Learn distraction techniques |
Guarantee a pain-free childbirth
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While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the fetal heart rate (FHR) for five sequential contractions begins to decelerate late in the contraction, with the nadir of the decelerations occurring after the peak of the contraction. The nurse's first priority is to:
a) Change the womans position b) Notify the health care provider c) Assist with amnioinfusion d) Insert a scalp electrode |
Change the woman's position
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The nurse providing care for the laboring woman understands that variable fetal heart rate (FHR) decelerations are cause by:
a) Altered fetal cerebral blood flow b) Umbilical cord compression c) Uteroplacental insufficiency d) Fetal hypoxemia |
Umbilical cord compression
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The nurse providing care for a high risk laboring woman is alert for late fetal heart rate (FHR) decelerations. These late decelerations may be caused by:
a) Altered cerebral blood flow b) Umbilical cord compression c) Uteroplacental insufficiency d) Meconium fluid |
Uteroplacental insufficiency
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A nurse providing care for a laboring woman understands that amnioinfusion is used to treat:
a) Variable decelerations b) Late decelerations c) Fetal bradycardia d) Fetal tachycardia |
Variable decelerations
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Which fetal heart rate (FHR) finding concerns the nurse during labor?
a) Accelerations with fetal movement b) Early decelerations c) An average FHR of 126 beats/min d) Late decelerations |
Late decelerations
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As a perinatal nurse, you realize that a fetal heart rate (FHR) that is tachycardic, bradycardic, has safe decelerations, or loss of variability is nonreassuring and is associated with:
a) Hypotension b) Cord compression c) Maternal drug use d) Hypoxem |
Hypoxemia
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A normal uterine activity pattern in labor is characterized by:
a) Contractions every 2 to 5 minutes b) Contractions lasting about 2 minutes c) Contractions about 1 minute apart d) A contraction intensity of about 500mm Hg with relaxation at 50mm Hg |
Contractions every 2 to 5 minutes
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When assessing the relative advantages of internal fetal monitoring (EFM), nurses should be cognizant of which of the following clients is not an appropriate choice for this type of fetal surveillance?
a) A client who still has intact membranes b) A woman whose fetus is well engaged in the fetus c) A pregnant woman who has a comorbidity of obesity d) A client whose cervix is dilated to 4 to 5 cm |
A client who still has intact membranes
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The nurse recognizes that a woman is in true labor when she states:
a) I passed some thick, pink mucus when I urinated this morning b) My bag of waters just broke c) The contractions in my uterus are getting stronger and closer together d) My baby dropped, and I have to urinate more frequently noe |
The contractions in my uterus are getting stronger and closer together
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What a nulliparous woman telephones the hospital to report that she is in labor, the nurse initially should:
a) Tell the woman to stay home until her membranes rupture b) Emphasize that food and fluid intake should stop c) Arrange for the woman to come to the hospital for labor evaluation d) Ask the woman to describe why she believes she is in labor |
Ask the woman to describe why she believes she is in labor
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The nurse knows that the second stage of labor, the descent phase, has begun when:
a) The amniotic membranes rupture b) The cervix cannot be felt during a vaginal examination c) The woman experiences a strong urge to bear down d) The presenting part is below the ischial spines |
The woman experiences a strong urge to bear down
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The most critical nursing action in caring for the newborn immediately after birth is:
a) Keeping the airway clear b) fostering parent-newborn attachment c) Drying the newborn and wrapping the infant in a blanket d) Administering eye drops and vitamin K |
Keeping the airway clear
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The nurse expects to administer an oxytocic (e.g., Pitocin, methergine) to a woman after expulsion of her placenta to:
a) Relieve pain b) Stimulate uterine contractions c) Prevent infection d) Facilitate rest and relaxation |
Stimulate uterine contractions
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A means of controlling the birth of the fetal head with a vertex presentation is:
a) The Ritgen maneuver b) Fundal pressure c) The lithotomy position d) The De Lee apparatus |
The Ritgen maneuver
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A 25 year old gravida 2, para 2-0-0-2 gave birth 4 hours ago to a 9lb, 7oz boy after augmentation of labor with oxytocin (Pitocin). She puts on her call light and asks for her nurse right away, stating "Im bleeding a lot." The most likely cause of postpartum hemorrhage in this woman is:
a) Retained placental fragments b) Unrepaired vaginal lacerations c) Uterine atony d) Puerperal infection |
Uterine atony
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In the recovery room, if a woman is asked either to raise her legs (knees extended) off the bed or to flex her knees, place her feet flat on the bed, and raise her buttocks well off the bed, most likely she is being tested to see whether she:
a) Has recovered from epidural or spinal anesthesia b) Has hidden bleeding underneath her c) Has regained some flexibility d) Is a candidate to go home after 6 hours |
Has recovered from epidural or spinal anesthesia
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A newly married couple plans to use natural fertility planning. It is important for them to know how long an ovum can live after ovulation. The nurse knows that teaching is effective when the couple responds that an ovum is considered fertile for:
a) 6-8 hours b) 24 hours c) 2 to 3 days d) 1 week |
24 hours
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A pregnant woman at 25 weeks of 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'r 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 |
Babies respond to sound starting at about 24 weeks of gestation
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At approximately _____ weeks of gestation, lecithin is forming on the alveolar surfaces, the eyelids open, and the fetus measures approximately 27cm crown to rump and weighs approximately 1110g.
a) 20 b) 24 c) 28 d) 30 |
28
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It is important for the nurse to understand that the placenta:
a) Produces nutrients for fetal nutrition b) Secretes both estrogen and progesterone c) Forms a protective impenetrable barrier to microorganisms such as bacteria and viruses d) Excretes prolactin and insulin |
Secretes both estrogen and progesterone
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A nurse caring for a laboring woman should know that meconium is produced by:
a) Fetal intestines b) Fetal kidneys c) Amniotic fluid d) The placenta |
Fetal intestines
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A woman asks the nurse, "What protects my baby's umbilical cord from being squashed while the baby's inside of me?" the nurse's best response is:
a) Your baby's umbilical cord is surrounded by connective tissue called Wharton jelly, which prevents compression of the blood vessels and ensures continued nourishment of your baby b) Your baby's umbilical floats around in blood anyway c) You dont need to be worrying about things like that d) The umbilical cord is a group of blood vessels that are very well protected by the placenta |
Your baby's umbilical cord is surrounded by connective tissue called Wharton jelly, which prevents compression of the blood vessels and ensures continued nourishment of your baby
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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 b) 1.8:1 c) 2:1 d) 1:1 |
2:1
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Sally comes in for her first prenatal examination. This is her first child. She asks you (the nurse), "how does my baby get air inside my uterus?" The correct response is:
a) The baby's lungs work in utero to exchange oxygen and carbon dioxide b) The baby absorbs oxygen from your blood stream c) The placenta provides oxygen to the baby and excretes carbon dioxide into your bloodstream d) The placenta delivers oxygen-rich blood through the umbilical artery to the baby's abdomen |
The placenta provides oxygen to the baby and excretes carbon dioxide into your bloodstream
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The various systems and organs develop at different stages. Which statement is accurate?
a) The cardiovascular system is the first organ system to function in the developing human b) Hematopoiesis originating in the yol sac begins in the liver at 10 weeks c) The body changes from straight to C-shaped at 8 weeks d) The gastrointestinal system is mature at 32 weeks |
The cardiovascular system is teh first organ system to function in the developing human
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Which statement concerning neurologic and sensory development is accurate?
a) Brain waves have been recorded on an EEG as early as the end of the first trimester (12 weeks) b) Fetuses respond to sound by 24 weeks and can be soothed by the sound of the mother's voice c) Eyes are first receptive to light at 34 to 36 weeks d) At term, the fetal brain is at least one third the size of an adult brain |
Fetuses respond to sound by 24 weeks and can be soothed by the sound of the mothers voice
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A perinatal nurse is caring for a woman in the immediate postbirth period. Assessment reveals that the woman is experiencing profuse bleeding. The most likely etiology for the bleeding is:
a) Uterine atony b) Uterine inversion c) Vaginal hematoma d) Vaginal laceration |
Uterine atony
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A primary nursing responsibility when caring for a woman experiencing an obstetric hemorrhage associated with uterine atony is to:
a) Establish venous access b) Perform fundal message c) Prepare the woman for surgical intervention d) Catheterize the bladder |
Perform fundal message
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Which client is at greatest risk for early postpartum hemorrhage (PPH)?
a) A primiparous woman (G2, P1-0-0-1) being prepared for an emergency cesarean birth for fetal distress b) A woman with severe preeclampsia on magnesium sulfate whose labor is being induced c) A multiparous woman (G3, P2-0-0-2) with an 8 hour labor d) A primigravida in spontaneous labor with preterm twins) |
A woman with severe preeclampsia on mag sulfate whose labor is being induced
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When caring for a postpartum woman experiencing hemorrhagic shock, the nurse recognizes that the most objective and least invasive assessment of adequate organ perfusion and oxygenation is:
a) Absence of cyanosis in the buccal mucosa b) Cool, dry skin c) Diminished restlessness d) Urinary output of at least 30ml/hr |
Urinary output of at least 30ml/hr
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The perinatal nurse assisting with establishing lactation is aware that acute mastitis can be minimized by:
a) Washing the nipples and breasts with mild soap and water once a day b) Using proper breastfeeding techniques c) Wearing a nipple shield for the first few days of breastfeeding d) Wearing a supportive bra 24 hours a day |
Using proper breastfeeding techniques
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Lacerations of the cervix, vagina, or perineum are also causes and incidence of obstetric lacerations of the lower genital tract include all except:
a) Operative or precipitate birth b) Adherent retained placenta c) Abnormal presentation of the fetus d) Congenital abnormalities of the maternal soft parts |
Adherent retained placenta
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It is important for the perinatal nurse to be knowledgeable regaring conditions of abnormal adherence of the placenta. This occurs when the zygote implants in an area of defective endometrium and results in little to no zone separation between the placenta and decidua. Which classification of separation is not recognized as an abnormal adherence pattern?
a) Placenta accreta b) Placenta increta c) Placenta percreta d) Placenta abruptio |
Placenta abruptio
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Medications used to manage postpartum hemorrhage (PPH) include: (choose all that apply)
a) Oxytocin b) Methergine c) Terbutaline d) Hemabate e) Magnesium sulfate |
Oxytocin, Methergine, Hemabate
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_____________ is the most common postpartum infection
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Endometritis
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The laboratory results for a postpartum woman are as follows: blood type, A; Rh status, positive; rubella titer, 1:8; hematocrit, 30%. How would the nurse best interpret these data?
a) Rubella vaccine should be given b) A blood transfusion is necessary c) Rh immune globulin is necessary within 72 hours of birth d) A Kleihauer-Betke test should be performed |
Rubella vaccine should be given
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A woman gave birth 48 hours ago to a healthy infant girl. She has decided to bottle-feed. During your assessment you notice that both her breasts are swollen, warm, and tender on palpation. The woman should be advised that this condition can best be treated by:
a) Running warm water on her breasts during a shower b) Applying ice to the breasts for comfort c) Expressing small amounts of milk from the breasts to relieve pressure d) Wearing a loose-fitting bra to prevent nipple irritation |
Applying ice to the breasts for comfort
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A primiparous woman is to be discharged from the hospital tomorrow with her infant girl. Which behavior indicates a need for further intervention by the nurse before the woman can be discharged?
a) The woman is disinterested in learning about infant care b) The woman continues to hold and cuddler her infant after she has fed her c) The woman reads a magazine while her infant sleeps d) The woman changes her infants diaper and then shows the nurse the contents of the diaper |
The woman is disinterested in learning about infant care
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Which finding could prevent early discharge of a newborn who is now 12 hours old?
a) Birth weight of 3000g b) One meconium stool since birth c) Voided, clear, pale urine three times since birth d) Infant breastfed once with some difficulty with latch and sucking and once with some success for about 5 minutes on each breast |
Infant breastfed once with some difficulty with latch and sucking and once with some success for about 5 minutes on each breast
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What is not a postpartum practice for preventing infections?
a) Not letting the mother walk barefoot at the hospital b) Educating the client to wipe from back to front after voiding c) Having staff members with conditions such as strep throat, conjunctivitis, and diarrhea stay home d) Instructing the mother to change her perineal pad from front to back each time she voids or defecates |
Educating the client to wip from back to front after voiding
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What is not a reliable indicator of impending shock from early hemorrhage?
a) Respirations b) Blood pressure c) Skin condition d) Urinary output |
Blood pressure
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Because a full bladder prevents the uterus from contracting normally, nurses intervent to help the woman empty her bladder spontaneously as soon as possible. If all else fails, the last thing the nurse might try is:
a) Pouring water from a squeeze bottle over the woman's perineum b) Placing oil of peppermint in a bedpan under the woman c) Asking the physician to prescribe analgesics d) Inserting a sterile catheter |
Inserting a sterile catheter
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If a woman is at risk for thrombus and is not ready to ambulate, the nurses might intervene by doing all of these interventions except:
a) Putting her in antiembolic stockings (TED hose) and/or sequential compression device (SCD) boots b) Having her flex, extend, and rotate her feet, ankles and legs c) Having her sit in a chair d) Notifying the physician immediately if a positive Homans' sign occurs |
Having her sit in a chair
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With regard to rubella and Rh issues, nurses should be aware that:
a) Breastfeeding mothers cannot be vaccinated with the live attenuated rubella virus b) Woman should be warned that the rubella vaccination is teratogenic and they must avoid pregnancy for at least 1 month after vaccination c) Rh immune globulin is safely administered intravenously because it cannot harm a nursing infant d) Rh immune globulin boosts the immune system and thereby enhances the effectiveness of vaccinations |
Woman should be warned that the rubella vaccination is teratogenic and they must avoid pregnancy for at least 1 month after vaccination
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A woman gave birth to an infant boy 10 hours ago. Where does the nurse expect to locate this womans fundus?
a) At the level of the umbilicus b) Two centimeters below the umbilicus c) Midway between the umbilicus and the symphysis pubis d) Nonpalpable abdominally |
At the level of the umbilicus
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To provide optimum care for the postpartum woman, the nurse understands that teh most common causes of subinvolution are:
a) Postpartum hemorrhage and infection b) Multiple gestation and postpartum hemorrhage c) Uterine tetany and overproduction of oxytocin d) Retained placental fragments and infection |
Retained placental fragments and infection
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A woman who gave birth to a health infant boy 5 days ago. What type of lochia does the nurse expect to find when assessing this woman?
a) Lochia rubra b) Lochia sangra c) Lochia alba d) Lochia serosa |
Lochia serosa
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Which hormone remains elevated in the immediate postpartum period of the breastfeeding woman?
a) Estrogen b) Progesterone c) Prolactin d) Human placental lactogen |
Prolactin
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A nurse caring for a postpartum woman understands that breast engorgement is caused by:
a) Overproduction of colostrum b) Accumulation of milk in the lactiferous ducts and glands c) Hyperplasia of mammary tissue d) Congestion of veins and lymphatics |
Congestion of veins and lymphatics
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A woman gave birth to a 7lb, 6oz infant girl 1 hour age. The birth was vaginal and the estimated blood loss (EBL) was 1500ml. When assessing the woman's vital signs the nurse is concerned to see:
a) Temperature 37.9 C, heart rate 120, respirations 20, blood pressure 90/50 b) Temperature 37.4 C, heart rate 88, respirations 36, blood pressure 126/68 c) Temperature 38 C, heart rate 80, respirations 16, blood pressure 110/80 d) Temperature 36.8 C, heart rate 60, respirations 18, blood pressure 140/90 |
Temperature 37.9 C, heart rate 120, respirations 20, blood pressure 90/50
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With regard to postpartum ovarian function, nurses should be aware that:
a) Almost 75% of women who do not breastfeed resume menstruating within a month after birth b) Ovulation occurs slightly earlier for breastfeeding women c) Because of menstruation/ovulation schedules, contraception considerations can be postponed until after the puerperium d) The first menstrual flow after childbirth usually is heavier than normal |
The first menstrual flow after childbirth usually is heavier than normal
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Part of the health assessment of a newborn is observing the infant's breathing pattern. A full-term newborn's breathing pattern is predominantly:
a) Abdominal with synchronous chest movements b) Chest breathing with nasal flaring c) Diaphragmatic with chest retraction d) Deep with a regular rhythm |
Abdominal with synchronous chest movements
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A newborn is placed under a radiant heat warmer. The nurse knows that thermoregulation presents a problem for newborns because:
a) Their renal function is not fully developed for newborns because b) Their small body surface area favors more rapid heat loss than does an adult's body surface area c) They have a relatively thin layer of subcutaneous fat that provides poor insulation d) Their normal flexed posture favors heat loss through perspiration |
They have a relatively thin layer of subcutaneous fat that provides poor insulation
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An African-American woman noticed some bruises on her newborn girl's buttocks. She asks the nurse who spanked her daughter. The nurse explains that these marks are called:
a) Lanugo b) Vascular nevi c) Nevus flammeus d) Mongolian spots |
Mongolian spots
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While examining a newborn, the nurse notes uneven skin folds on the buttocks and a clunk when performing the Ortolani maneuver. The nurse recognizes these findings as a sign that the newborn probably has:
a) Polydactyly b) Clubfoot c) Hip dysplasia d) Webbing |
Hip dysplasia
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A new mother states that her infant must be cold because teh baby's hands and feet are blue. The nurse explains that this is a common and temporary condition called:
a) Acrocyanosis b) Erythema neonatorum c) Harlequin color d) Vernix caseosa |
Acrocyanosis
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The parents of a newborn ask the nurse how much the newborn can see. The parents specifically want to know what type of visual stimuli they should provide for their newborn. The nurse responds to the parents by telling them:
a) Infants can see very little until about 3 months of age b) Infants can track their parents eyes and can distinguish patterns; they prefer complex patterns c) The infants eyes must be protected. Infants enjoy looking at brightly colored stripes d) Its important to shield the newborn's eyes. Overhead lights help them see better |
Infants can track their parents eyes and can distinguish patterns; they prefer complex patterns
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A client is warm and asks for a fan in her room for her comfort. The nurse enters the room to assess the mother and her infant and finds the infant unwrapped in his crib with the fan blowing over him on high. The nurse instructs the mother that the fan should not be directed toward the newborn and that the newborn should be wrapped in a blanket. The mother asks why. The nurses best response is:
a) Your baby may lose heat by convection, which means that he will lost heat from his body to the cooler ambient air. You should keep him wrapped and prevent cool air from blowing on him b) Your baby may lose heat by conduction, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped and prevent cool air form blowing on him c) Your baby may lose hear by evaporation, which menas that he will lose heat from his body to the cooler ambient air. You should keep him wrapped and prevent cool air from blowing on him d) Your baby will get cold stressed easily and needs to be bundled up at all times |
Your baby may lose heat by convection, which means that he will lost heat from his body to the cooler ambient air. You should keep him wrapped and prevent cool air from blowing on him
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With regard to the functioning of the renal system in newborns, nurses should be aware that:
a) The pediatrician should be notified if the newborn has not voided in 24 hours b) Breastfed infants likely will void more often during the first few days after birth c) "Brick dust" or blood on a diaper is always cause to notify the physician d) Weight loss from fluid loss and other normal factors should be made up in 4 to 7 daus |
The pediatrician should be notified if the newborn has not voided in 24 hours
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All of these statements about physiologic jaundice are true except:
a) Neonatal jaundice is common, but kernicterus is rare b) The appearance of jaundice during the first 24 hours or beyond day 7 indicates a pathologic process c) Because jaundice may not appear before discharge, parents need instruction on how to assess it and when to call for medical help d) Breastfed babies have a lower incidence of jaundice |
Breastfed babies have a lower incidence of jaundice
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An infant boy was born a few minutes ago. The nurse is conducting the intial assessment. Part of the assessment includes the Apgar scores. The Apgar assessment is performed:
a) Only if the newborn is in obvious distress b) Once by the obstetrician, just after the birth c) At least twice, 1 minute and 5 minutes after birth d) Every 15 minutes during the newborn's first hour after birth |
At least twice, 1 minute and 5 minutes after birth
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The nurse administers vitamin K to the newborn for what reason?
a) Most mothers have a diet deficient in vitamin K, which results in the infant being deficient b) Vitamin K prevents the synthesis of prothrombin in the liver and must be given by injection c) Bacteria that synthesize vitamin K are not present in the newborns intestinal tract d) The supply of vitamin K is inadequate for at least 3 to 4 months, and the newborn must be supplemented |
Bacteria that synthesize vitamin K are not present in the newborns intestinal tract
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A newborn is jaundiced and is receiving phototherapy via ultraviolet lights. An appropriate nursing intervention when caring for an infant with hyperbilirubinemia and receiving phototherapy by this method is to:
a) Apply an oil-based lotion to the newborn's skin to prevent drying and cracking b) Limit the newborn's intake of milk to prevent nausea, vomiting and diarrhea c) Place eye shields over the newborns closed eyes d) Change the newborns position every 4 hours |
Place eye shields over the newborns closed eyes
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Early this morning an infant boy was circumcised using the PlastiBell method. The nurse tells the mother that she and the infant can be discharged after:
a) The bleeding stops completely b) Yellow exudate forms over the glans c) The PlastiBell rim falls off d) The infant voids |
The infant voids
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A mother is changing the diaper of the newborn son. She notices that his scrotum appears large and swollen. She asks the nurse, "What is that?" The best response from the nurse is:
a) This is a hydrocele, which is a common findings in newborn males. The swelling usually decreases without intervention b) I dont know, but I'm sure its is nothing c) Your baby might have testicular cancer d) Your baby's urine is backing up into his scrotum |
This is a hydrocele, which is a common finding in newborn males. The swelling usually decreases without intervention
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An assessment tool for pain in newborns uses the acronym CRIES to identify behavioral indicators of pain. In the acronym:
a) R stands for requiring more medication b) I stands for increased vital signs c) E stands for elimination d) S stands for sleepiness |
I stands for increased vital signs
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Although most blood specimens are drawn by laboratory technicians, nurses may be required to perform heelsticks to obtain blood for glucose monitoring or newborn screening. The most serious complication of an infant heelstick is necrotizing osteochondritis resulting from lancet penetration of the bone. To prevent this problem the stick should be made:
a) At the outer aspect of the heel b) On the walking surface of the heel c) In the ball of the foot d) In the area just below the fifth tow |
At the outer aspect of the heel
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The normal term infant has little difficulty clearing its airway after birth. Most secretions are brought up to the oropharynx by the cough reflex. However, if the infant has excess secretions, the mouth and nasal passages can easily be cleared with a bulb syringe. When instructing parents on the correct use of this piece of equipment, it is important that the nurse teach them to:
a) Avoid suctioning the nares b) Insert the compressed bulb into the center of the mouth c) Suction the mouth first d) Remove the bulb syringe from the crib when finished |
Suction the mouth first
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Parents lost their first child to sudden infant death syndrome (SIDS). Therefore, you are teaching then infant CPR. You know they are knowledgeable when they demonstrate infant CPR compressions of ______ per minute.
a) 50 b) 75 c) 100 d) 125 |
100
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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 its 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 |
They can be effective for many couples, but they require motivation
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A woman who has just undergone a first-trimester abortion will be using oral contraceptives. To protect against pregnancy, she should be advised to:
a) Avoid sexual contact for at least 10 days after starting the pill b) Use condoms and foam for the first few weeks as backup c) Use another method of contraception for 1 week after starting the pill d) Begin sexual relations once vaginal bleeding has ended |
Use another method of contraception for 1 week after starting the pill
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A woman currently uses a diaphragm and spermicide for contraception. She asks the nurse what the major differences are between the cervical cap and diaphragm. The nurse's most appropriate response is:
a) No spermicide is used with the cervical cap, so its less messy b) The diaphragm can be left in place longer after intercouse c) Repeated intercourse with the diaphragm is more convenient d) The cervical cap can safely be used for repeated acts of intercourse without adding more spermicide later |
The cervical cap can safely be used for repeated acts of intercourse without adding more spermicide
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An unmarried young woman describes her sex life as "active" and involving "many" partners. She wants a contraceptive method that is reliable and does not interfere with sex. She requests an intrauterine device (IUD). The nurse's most appropriate response is:
a) The IUD does not interfere with sex b) The risk of pelvic inflammatory disease will be higher for you c) The IUD will protect you from sexuall transmitted infections d) Pregnancy rates are high with the IUDs |
The risk of pelvic inflammatory disease will be higher for you
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A woman will be taking oral contraceptives using a 28 day pack. The nurse should advise this woman to protect against pregnancy by:
a) Limiting sexual contact for one cycle after starting the pill b) Using condoms and foam instead of the pill for as long as she takes an antibiotic c) Taking one pill at the same time every day d) Thworing away the pack and using a backup method if she misses two pills during week 1 of her cycle |
Taking one pill at the same time every day
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Which contraceptive method best protects against sexually transmitted infections and HIV?
a) Periodic abstinence b) Barrier methods c) Hormonal methods d) They all offer about the same protection |
Barrier methods
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With regard to the use of intrauterine devices (IUDs), nurses should be aware that:
a) Return to fertility can take several weeks after the device is removed b) IUDs containing copper can provide an emergency contraception option if inserted within a few days of unprotected intercourse c) IUDs offer the same protection against sexually transmitted infections as the diaphragm d) Consent forms are not needed for IUD insertion |
IUDs containing copper can provide an emergency contraception option if inserted within a few days of unprotected intercourse
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Which statement is the most complete and accurate description of medical abortions?
a) They are performed only for maternal health b) They can be achieved through surgical procedures or with drugs c) They are mostly performed in the second trimester d) They can be either elective or therapeutic |
They can be either elective or therapeutic
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A woman gave birth to a baby boy 12 hours ago. Where would the nurse expect to locate the fundus of this woman's uterus?
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>>One centimeter above the umbilicus
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What are the most common causes of subinvolution?
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>>Retained placental fragments and infection
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A woman gave birth to a healthy baby boy 5 days ago. What type of lochia would the nurse expect to find when assessing this woman?
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>>Lochia serosa
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Which of the following hormones remains elevated during the immediate postpartum period of the breastfeeding woman?
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>>Prolactin
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Two days ago, a woman gave birth to a full-term infant. Last night, she awakened several times to urinate, and she noted that her gown and bedding were wet from profuse diaphoresis. What is one mechanism for the diaphoresis and diuresis this woman is experiencing during the early postpartum period?
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>>Loss of increased blood volume associated with pregnancy
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A woman gave birth to a 7-lb 3-oz baby boy 2 hours ago. The nurse determines that the woman's bladder is distended, because her fundus is now 3 cm above the umbilicus and to the right of midline. During the immediate postpartum period, what is the most serious consequence likely to occur from bladder distention?
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>>Excessive uterine bleeding
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Breast engorgement is caused by which of the following?
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>>Congestion of veins and lymphatics
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A woman gave birth to a 7-lb 6-oz baby girl 1 hour ago. Birth was vaginal, and the estimated blood loss was less than 500 cc. When assessing vital signs, what would the nurse expect to see?
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>>Temperature 37.9° C, heart rate 88, respirations 20, blood pressure 110/60
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A 25-year-old gravida 2, para 2 0 0 2, gave birth 4 hours ago to a 9-lb 7-oz boy after augmentation of labor with Pitocin. She puts on her call light and asks for her nurse right away, stating, ""I'm bleeding a lot."" What would be the most likely cause of postpartum hemorrhage in this woman?
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>>Uterine atony
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When examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. What should the nurse do first?
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>Palpate the woman's fundus
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A woman gave birth vaginally to a 9-lb, 12-oz girl yesterday. Her primary health care provider has written orders for perineal ice packs, use of a sitz bath tid, and a stool softener. Which of the following pieces of information is most closely correlated with these orders?
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>>The woman has an episiotomy.
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A woman gave birth 48 hours ago to a healthy baby girl. She has decided to bottle-feed. During your assessment, you notice that both breasts are swollen, warm, and tender upon palpation. The woman should be advised that this condition can best be treated by doing which of the following?
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>>Applying ice to the breasts for comfort
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Which of the following would prevent early discharge of a postpartum woman?
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>>Hgb 9 g
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New parents express concern that, because of the mother's emergency cesarean birth under general anesthesia, they did not have the opportunity to hold and ""bond"" with their daughter immediately after her birth. What should the nurse's response convey to the parents?
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>That attachment or bonding is a process that occurs over time and does not require early contact
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During a phone follow-up conversation with a woman who is 4 days postpartum, the woman tells the nurse, ""I don't know what's wrong. I love my son, but I feel so let down. I seem to cry for no reason!"" The nurse would recognize that the woman is experiencing which of the following?
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>>Postpartum blues
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he perinatal nurse is caring for a woman during the immediate postbirth period. Assessment reveals that the woman is experiencing profuse bleeding. What is the most likely etiology for the bleeding?
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>Uterine atony
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Which of the following women is at greatest risk for early postpartum hemorrhage?
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>>Woman with severe preeclampsia on magnesium sulfate whose labor is being induced
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When caring for a postpartum woman who is experiencing hemorrhagic shock, the nurse recognizes that which of the following is the most objective and least invasive assessment of adequate organ perfusion and oxygenation?
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>Urinary output of at least 30 ml/hour
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Acute mastitis can be avoided by the breastfeeding woman if she does which of the following?
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>Uses proper breastfeeding techniques including latch-on to and removal from the breast
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One of the main concerns when a woman is diagnosed with postpartum depression with psychotic features is that she may do which of the following?
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>>Harm her own infant
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hat options for saying good-bye would the nurse want to discuss with a woman who is diagnosed with having a stillborn girl?
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>""When your baby is born, would you like to see and hold her?""
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A woman is diagnosed with having a stillborn. At first, she appears stunned by the news, cries a little, and then she asks you to call her mother. What is the phase of bereavement the woman is experiencing called?
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>>Acute distress
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