Maternal Newborn Nursing The Critical Components of Nursing Care 2nd Edition, Durham Test Bank

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Test Bank For Maternal Newborn Nursing The Critical Components of Nursing Care 2nd Edition, Durham. Note: This is not a text book. Description: ISBN-13: 978-0803637047, ISBN-10: 0803637047.

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Test Bank Maternal Newborn Nursing Critical Components Nursing Care 2nd Edition, Durham

Chapter 1: Trends and Issues
Multiple Choice
1. Since 1995 there has been a significant decrease in the rate of infant death related to which of the following:
a. Disorders associated with short gestation and low birth weight
b. Accidents
c. Sudden infant death
d. Newborns affected by complications of placenta, cord, and membranes
2. Tobacco use during pregnancy is associated with adverse effects on the unborn infant such as intrauterine growth restriction, preterm births, and respiratory problems. By race, which has the highest percentages of smokers?
a. American Indian and Alaskan Natives
b. Asian or Pacific Islanders
c. Non-Hispanic blacks
d. Non-Hispanic whites
3. Which of the following women is at the highest risk for health disparity?
a. A white, middle-class, 16-year-old woman
b. An African American, middle-class, 25-year-old woman
c. An African American, upper-middle-class, 19-year-old woman
d. An Asian, low-income, 30-year-old woman
4. A neonate born at 36 weeks gestation is classified as which of the following?
a. Very premature
b. Moderately premature
c. Late premature
d. Term
5. The perinatal nurse explains to the student nurse that a goal of the Healthy People 2020 report is to:
a. Increase proportion of infants who are breastfed to 93.1%.
b. Increase proportion of infants who are breastfed to 90.7%.
c. Increase proportion of infants who are breastfed to 85.6%.
d. Increase proportion of infants who are breastfed to 83.9%.
6. The perinatal nurse explains to the student nurse that __________ is the leading cause of infant death in the United States.
a. Sudden Infant Death Syndrome
b. Respiratory distress of newborns
c. Disorders related to short gestation and low birth weight
d. Congenital malformations and chromosomal abnormalities
Chapter 2: Ethics and Standards of Practice Issues
Multiple Choice
1. An ethical dilemma unique to perinatal nursing is the:
a. Innate conflict between maternal and fetal rights
b. Intensive use of technology
c. Shortage of health-care resources
d. Risk of violation of the principle of veracity
2. The American Nurses Association Code of Ethics for Nurses directs nurses to provide patient care that is:
a. Curative
b. Utilitarian
c. Negotiable
d. Respectful
3. Evidence-based practice is the integration of the best:
a. Randomized clinical trials, clinical expertise, and patients’ requests
b. Research evidence, clinical expertise, and patients’ values
c. Quantitative research, clinical expertise, and patients’ preferences
d. Research findings, clinical experience, and patients’ preferences
Chapter 3: Genetics, Conception, Fetal Development, and Reproductive Technology
1. The color of a person’s hair is an example of which of the following?
a. Genome
b. Sex-link inheritance
c. Genotype
d. Phenotype
2. Which of the following statements by a pregnant woman indicates she needs additional teaching on ways to reduce risks to her unborn child from the potential effects of exposure to toxoplasmosis?
a. “I will avoid rare lamb.”
b. “I will wear a mask when cleaning my cat’s litter box.”
c. “I understand that exposure to toxoplasmosis can cause blindness in the baby.”
d. “I will avoid rare beef.”
3. The fetal circulatory structure that connects the pulmonary artery with the descending aorta is known as which of the following?
a. Ductus venosus
b. Foramen ovale
c. Ductus arteriosus
d. Internal iliac artery
4. A woman at 40 weeks’ gestation has a diagnosis of oligohydramnios. Which of the following statements related to oligohydramnios is correct?
a. It indicates that there is a 25% increase in amniotic fluid.
b. It indicates that there is a 25% reduction of amniotic fluid.
c. It indicates that there is a 50% increase in amniotic fluid.
d. It indicates that there is a 50% reduction of amniotic fluid.
5. A diagnostic test commonly used to assess problems of the fallopian tubes is:
a. Endometrial biopsy
b. Ovarian reserve testing
c. Hysterosalpingogram
d. Screening for sexually transmitted infections
6. The nurse is interviewing a gravid woman during the first prenatal visit. The woman confides to the nurse that she lives with a number of pets. The nurse should advise the woman to be especially careful to refrain from coming in contact with the stool of which of the pets?
a. Cat
b. Dog
c. Hamster
d. Bird
7. A client is to take Clomiphene Citrate for infertility. Which of the following is the expected action of this medication?
a. Decrease the symptoms of endometriosis
b. Increase serum progesterone levels
c. Stimulate release of FSH and LH
d. Reduce the acidity of vaginal secretions
8. The nurse takes the history of a client, G2 P1, at her first prenatal visit. The client is referred to a genetic counselor, due to her previous child having a diagnosis of __________.
a. Unilateral amblyopia
b. Subdural hematoma
c. Sickle cell anemia
d. Glomerular nephritis
9. A nurse is teaching a woman about her menstrual cycle. The nurse states that __________ is the most important change that happens during the secretory phase of the menstrual cycle.
a. Maturation of the graafian follicle
b. Multiplication of the fimbriae
c. Secretion of human chorionic gonadotropin
d. Proliferation of the endometrium
10. An ultrasound of a fetus’ heart shows that “normal fetal circulation is occurring.” Which of the following statements is consistent with the finding?
a. A right to left shunt is seen between the atria.
b. Blood is returning to the placenta via the umbilical vein.
c. Blood is returning to the right atrium from the pulmonary system.
d. A right to left shunt is seen between the umbilical arteries.
Chapter 4: Physiological Aspects of Antepartum Care
1. Folic acid supplementation during pregnancy is to:
a. Improve the bone density of pregnant women
b. Decrease the incidence of neural tube defects in the fetus
c. Decrease the incidence of Down syndrome in the fetus
d. Improve calcium uptake in pregnant women
2. The positive signs of pregnancy are:
a. All physiological and anatomical changes of pregnancy
b. All subjective signs of pregnancy
c. All those physiological changes perceived by the woman herself
d. The objective signs of pregnancy that can only be attributed to the fetus
3. During a routine prenatal visit in the third trimester, a woman reports she is dizzy and lightheaded when she is lying on her back. The most appropriate nursing action would be to:
a. Order an EKG.
b. Report this abnormal finding immediately to her care provider.
c. Teach the woman to avoid lying on her back and to rise slowly because of supine hypotension.
d. Order a nonstress test to assess fetal well-being.
4. Blood volume expansion during pregnancy leads to:
a. Iron-deficiency anemia
b. Maternal iron stores being insufficient to meet the demands for iron in fetal development
c. Plasma fibrin increase of 40% and fibrinogen increase of 50%
d. Physiological anemia of pregnancy
5. Intimate partner violence (IPV) against women consists of actual or threatened physical or sexual violence and psychological and emotional abuse. Screening for IPV during pregnancy is recommended for:
a. Pregnant women with a history of domestic violence
b. All pregnant women
c. All low-income pregnant women
d. Pregnant adolescents
6. A woman presents to the prenatal clinic at 30 weeks’ gestation reporting dysuria, frequency, and urgency with urination. Appropriate nursing actions include:
a. Obtain clean-catch urine to assess for a possible urinary tract infection.
b. Reassure the woman that the signs are normal urinary changes in the third trimester.
c. Teach the woman to decrease fluid intake to manage these symptoms.
d. Perform a Leopold’s maneuver to assess fetal position and station.
7. At the end of her 32-week prenatal visit, a woman reports discomfort with intercourse and tells you shyly that she wants to maintain a sexual relationship with her partner. The best response is to:
a. Reassure woman/couple of normalcy of response
b. Suggest alternative positions for sexual intercourse and alternative sexual activity to sexual intercourse
c. Recommend cessation of intercourse until after delivery due to advanced gestation
d. Suggest woman discuss this with her care provider at her next appointment
8. The clinic nurse talks to a 30-year-old woman at 34 weeks’ gestation who complains of having difficulty sleeping. Jayne has noticed that getting back to sleep after she has been up at night is difficult. The nurse’s best response is:
a. “This is abnormal; it is important that you describe this problem to the doctor.”
b. “This is normal, and many women have this same problem during pregnancy; try napping for several hours each morning and afternoon.”
c. “This is abnormal; tell the doctor about this problem because diagnostic testing may be necessary.”
d. “This is normal in pregnancy, particularly during the third trimester when you also feel fetal movement at night; try napping once a day.”
9. A 26-year-old woman at 29 weeks’ gestation experienced epigastric pain following the consumption of a large meal of fried fish and onion rings. The pain resolved a few hours later. The most likely diagnosis for this symptom is:
a. Cholelithiasis
b. Influenza
c. Urinary tract infection
d. Indigestion
10. The clinic nurse reviews the complete blood count results for a 30-year-old woman who is now 33 weeks’ gestation. Tamara’s hemoglobin value is 11.2 g/dL, and her hematocrit is 38%. The clinic nurse interprets these findings as:
a. Normal adult values
b. Normal pregnancy values for the third trimester
c. Increased adult values
d. Increased values for 33 weeks’ gestation
Chapter 5: Psycho-Social-Cultural Aspects of the Antepartum Period
1. Sally is in her third trimester and has begun to sing and talk to the fetus. Sally is probably exhibiting signs of:
a. Mental illness
b. Delusions
c. Attachment
d. Crisis
2. What is the most common expected emotional reaction of a woman to the news that she is pregnant? a. Jealousy
b. Acceptance
c. Ambivalence
d. Depression
3. Which of the following information regarding sexual activity would the nurse give a pregnant woman who is 35 weeks’ gestation?
a. Sexual activity should be avoided from now until 6 weeks postpartum.
b. Sexual desire may be affected by nausea and fatigue.
c. Sexual desire may be increased due to increased pelvic congestion.
d. Sexual activity may require different positions to accommodate the woman’s comfort.
4. Which statement best exemplifies adaptation to pregnancy in relation to the adolescent?
a. Adolescents adapt to motherhood in a similar way to other childbearing women.
b. Social support has very little effect on adolescent adaptation to pregnancy.
c. The pregnant adolescent faces the challenge of multiple developmental tasks.
d. Pregnant adolescents of all ages can be capable and active participants in health-care decisions.
5. Jane’s husband Brian has begun to put on weight. What is this a possible sign of?
a. Culturalism syndrome
b. Couvade syndrome
c. Moratorium phase
d. Attachment
6. Cathy is pregnant for the second time. Her son, Steven, has just turned 2 years old. She asks you what she should do to help him get ready for the expected birth. What is the nurse’s most appropriate response?
a. Steven will probably not understand any explanations about the arrival of the new baby, so Cathy should do nothing.
b. If Steven’s sleeping arrangements need to be changed, it should be done well in advance of the birth.
c. Steven should come to the next prenatal visit and listen to the fetal heartbeat to encourage sibling attachment.
d. Steven should be encouraged to plan an elaborate welcome for the newborn.
7. The nurse is interviewing a pregnant client who states she plans to drink chamomile tea to ensure an effective labor. The nurse knows that this is an example of:
a. Cultural prescription
b. Cultural taboo
c. Cultural restriction
d. Cultural demonstration
8. Which of the following would be a priority for the nurse when caring for a pregnant woman who has recently emigrated from another country?
a. Help her develop a realistic, detailed birth plan.
b. Identify her support system.
c. Teach her about expected emotional changes of pregnancy.
d. Refer her to a doula for labor support.
9. A pregnant client at 20 weeks’ gestation comes to the clinic for her prenatal visit. Which of the following client statements would indicate a need for further assessment?
a. “I hate it when the baby moves.”
b. “I’ve started calling my mom every day.”
c. “My partner and I can’t stop talking about the baby.”
d. “I still don’t know much time I’m going to take off work after the baby comes.”
10. A pregnant client asks the nurse why she should attend childbirth classes. The nurse’s response would be based on which of the following information?
a. Attending childbirth class is a good way to make new friends.
b. Childbirth classes will help new families develop skills to meet the challenges of childbirth and parenting.
c. Attending childbirth classes will help a pregnant woman have a shorter labor.
d. Childbirth classes will help a pregnant woman decrease her chance of having a cesarean delivery.
Chapter 6: Antepartal Tests
1. Your pregnant patient is in her first trimester and is scheduled for an abdominal ultrasound. When explaining the rationale for early pregnancy ultrasound, the best response is:
a. “The test will help to determine the baby’s position.”
b. “The test will help to determine how many weeks you are pregnant.”
c. “The test will help to determine if your baby is growing appropriately.”
d. “The test will help to determine if you have a boy or girl.”
2. Your pregnant patient is having maternal alpha-fetoprotein (AFP) screening. She does not understand how a test on her blood can indicate a birth defect in the fetus. The best reply by the nurse is:
a. “We have done this test for a long time.”
b. “If babies have a neural tube defect, alpha-fetoprotein leaks out of the fetus and is absorbed into your blood, causing your level to rise. This serum blood test detects that rise.”
c. “Neural tube defects are a genetic anomaly, and we examine the amount of alpha-fetoprotein in your DNA.”
d. “If babies have a neural tube defect, this results in a decrease in your level of alpha-fetoprotein.”
3. The primary complications of amniocentesis are:
a. Damage to fetal organs
b. Puncture of umbilical cord
c. Maternal pain
d. Infection
4. Your patient is 34 weeks pregnant and during a regular prenatal visit tells you she does not understand how to do “kick counts.” The best response by the nurse would be to explain:
a. “Here is an information sheet on how to do kick counts.”
b. “It is not important to do kick counts because you have a low-risk pregnancy.”
c. “Fetal kick counts are not a reliable indicator of fetal well-being in the third trimester.”
d. “Fetal movements are an indicator of fetal well-being. You should count twice a day, and you should feel 10 fetal movements in 2 hours.”
5. Your patient is a 37-year-old pregnant woman who is 5 weeks pregnant and is considering genetic testing. During your discussion, the woman asks the nurse what the advantages of chorionic villus sampling (CVS) are over amniocentesis. The best response is:
a. “You will need anesthesia for amniocentesis, but not for CVS.”
b. “CVS is a faster procedure.”
c. “CVS provides more detailed information than amniocentesis.”
d. “CVS can be done earlier in your pregnancy, and the results are available more quickly.”
6. The clinic nurse meets with Rebecca, a 30-year-old woman who is experiencing her first pregnancy. Rebecca’s quadruple marker screen result is positive at 17 weeks’ gestation. The nurse explains that Rebecca needs a referral to:
a. A genetics counselor/specialist
b. An obstetrician
c. A gynecologist
d. A social worker
7. A 37-year-old woman who is 17 weeks pregnant has had an amniocentesis. Before discharge, the nurse teaches the woman to call her doctor if she experiences which of the following side effects?
a. Pain at the puncture site
b. Macular rash on the abdomen
c. Decrease in urinary output
d. Cramping of the uterus
8. A laboratory report indicates the L/S ratio (lecithin/sphingomyelin) results from an amniocentesis of a gravid patient with preeclampsia are 2:1. The nurse interprets the result as which of the following?
a. The baby’s lung fields are mature.
b. The mother is high risk for hemorrhage.
c. The baby’s kidneys are functioning poorly.
d. The mother is high risk for eclampsia.
Chapter 7: High-Risk Antepartum Nursing Care
1. A client on 2 gm/hr of magnesium sulfate has decreased deep tendon reflexes. Identify the priority nursing assessment to ensure client safety.
a. Assess uterine contractions continuously.
b. Assess fetal heart rate continuously.
c. Assess urinary output.
d. Assess respiratory rate.
2. A pregnant client with a history of multiple sexual partners is at highest risk for which of the following complications:
a. Premature rupture of membranes
b. Gestational diabetes
c. Ectopic pregnancy
d. Pregnancy-induced hypertension
3. Identify the hallmark of placenta previa that differentiates it from abruptio placenta.
a. Sudden onset of painless vaginal bleeding
b. Board-like abdomen with severe painc. Sudden onset of bright red vaginal bleeding
d. Severe vaginal pain with bright red bleeding
4. Which of the following assessments would indicate instability in the client hospitalized for placenta previa?
a. BP <90/60 mm/Hg, Pulse <60 BPM or >120 BPM
b. FHR moderate variability without accelerationsc. Dark brown vaginal discharge when voiding
d. Oral temperature of 99.9°F
5. During pregnancy, poorly controlled asthma can place the fetus at risk for:
a. Hyperglycemia
c. Hypoglycemia
d. Macrosomia
6. Which of the following nursing diagnoses is of highest priority for a client with an ectopic pregnancy who has developed disseminated intravascular coagulation (DIC)?
a. Risk for deficient fluid volume
b. Risk for family process interrupted
c. Risk for disturbed identity
d. High risk for injury
7. Which of the following laboratory values is most concerning in a client with pregnancy-induced hypertension?
a. Total urine protein of 200 mg/dL
b. Total platelet count of 40,000 mm
c. Uric acid level of 8 mg/dL
d. Blood urea nitrogen 24 mg/dL
8. Which of the following medications administered to the pregnant client with GDM and experiencing preterm labor requires close monitoring of the client’s blood glucose levels?
a. Nifedipine
b. Betamethasone
c. Magnesium sulfate
d. Indomethacin
9. While educating the client with class II cardiac disease, at 28 weeks’ gestation, the nurse instructs the client to notify the physician if she experiences which of the following conditions?
a. Emotional stress at work
b. Increased dyspnea while resting
c. Mild pedal and ankle edema
d. Weight gain of 1 pound in 1 week
10. The nurse working in a prenatal clinic is providing care to three primigravida patients. Which of the patient findings would the nurse highlight for the physician?
a. 15 weeks, denies feeling fetal movement
b. 20 weeks, fundal height at the umbilicus
c. 25 weeks, complains of excess salivation
d. 30 weeks, states that her vision is blurry
Chapter 8: Intrapartum Assessment and Interventions
1. In caring for a primiparous woman in labor, one of the factors to evaluate is uterine activity. This is referred to as the __________ of labor.
a. Passenger
b. Passage
c. Powers
d. Psyche
2. The provision of support during labor has demonstrated that women experience a decrease in anxiety and a feeling of being in more control. In clinical situations, this has resulted in:
a. A decrease in interventions
b. Increased epidural rates
c. Earlier admission to the hospital
d. Improved gestational age
3. When caring for a primiparous woman being evaluated for admission for labor, a key distinction between true versus false labor is:
a. True labor contractions result in rupture of membranes, and with false labor, the membranes remain intact.
b. True labor contractions result in increasing anxiety and discomfort, and false labor does not.
c. True labor contractions are accompanied by loss of the mucus plug and bloody show, and with false labor there is no vaginal discharge.
d. True labor contractions bring about changes in cervical effacement and dilation, and with false labor there are irregular contractions with little or no cervical changes.
4. The mechanism of labor known as cardinal movements of labor are the positional changes that the fetus goes through to best navigate the birth process. These cardinal movements are:
a. Engagement, Descent, Flexion, Extension, Internal rotation, External rotation, Expulsion
b. Engagement, Descent, Flexion, Internal rotation, Extension, External rotation, Expulsion
c. Engagement, Flexion, Internal rotation, Extension, External rotation, Descent, Expulsion
d. Engagement, Flexion, Internal rotation, Extension, External rotation, Flexion, Expulsion
5. A woman is considered in active labor when:
a. Cervical dilation progresses from 4 to 7 cm with effacement of 40% to 80%, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds.
b. Cervical dilation progresses to 3 cm with effacement of 30, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds.
c. Cervical dilation progresses to 8 cm with effacement of 80%, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds.
d. Cervical dilation progresses to 10 cm with effacement of 90%, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds.
6. You are caring for a woman in labor who is 6 cm dilated with a reassuring FHT pattern and regular strong UCs. The fetal heart rate (FHR) should be:
a. Monitored continuously
b. Monitored every 15 minutes
c. Monitored every 30 minutes
d. Monitored every 60 minutes
7. A woman you are caring for in labor requests an epidural for pain relief in labor. Included in your preparation for epidural placement is a baseline set of vital signs. The most common vital sign to change after epidural placement:
a. Blood pressure, hypotension
b. Blood pressure, hypertension
c. Pulse, tachycardia
d. Pulse, bradycardia
8. The labor patient you are caring for is ambulating in the hall. Her vaginal exam 1 hour ago indicated she was 4/70/–1 station. She tells you she has fluid running down her leg. Your priority nursing intervention is to:
a. Assess the color, odor, and amount of fluid.
b. Assist your patient to the bathroom.
c. Assess the fetal heart rate.
d. Call the care provider.
9. You are in the process of admitting a multiparous woman to labor and delivery from the triage area. One hour ago her vaginal exam was 4/70/0. While completing your review of her prenatal record and completing the admission questionnaire, she tells you she has an urge to have a bowel movement and feels like pushing. Your priority nursing intervention is to:
a. Reassure the patient and rapidly complete the admission.
b. Assist your patient to the bathroom to have a bowel movement.
c. Assess the fetal heart rate and uterine contractions.
d. Perform a vaginal exam.
10. The Apgar score consists of a rapid assessment of five physiological signs that indicate the physiological status of the newborn and includes:
a. Apical pulse strength, respiratory rate, muscle flexion, reflex irritability, and color
b. Heart rate, clarity of lungs, muscle tone, reflexes, and color
c. Apical pulse strength, respiratory rate, muscle tone, reflex irritability, and color of extremities
d. Heart rate, respiratory rate, muscle tone, reflex irritability, and color
Chapter 9: Fetal Heart Rate Assessment
1. The nurse uses the external electronic fetal heart monitor to evaluate fetal status. The fetal heart tracing shows accelerations. Accelerations in the fetal heart are:
a. Associated with fetal well-being and oxygenation
b. An indication of potential fetal intolerance to labor
c. Never associated with the uterine contraction pattern
d. A reason to notify the care provider
2. The nurse knows that a FHR monitor printout indicates a Category III abnormal fetal heart rate pattern when:
a. Baseline variability is minimal or absent with decelerations.
b. FHR mirrors the uterine contractions.
c. Occasional periodic accelerations occur.
d. Baseline variability is 6 to 25 bpm with decelerations
3. As the nurse explains the purpose of the tocotransducer (Toco), which she places on the abdomen, she states that this monitoring device provides an accurate evaluation of which of the following?
a. Uterine hypertonus
b. Frequency of contractions
c. Intensity of contractions
d. Progress of labor
4. Early decelerations are probably caused by:
a. Decreased maternal–fetal exchange
b. Umbilical cord occlusion
c. Momentary increase in intracranial pressure due to head compression
d. Compression of umbilical cord
5. Which statement correctly describes the nurse’s responsibility related to electronic fetal monitoring?
a. Teach the woman and her family about the monitoring equipment and discuss any questions they have.
b. Report abnormal findings to the care provider before initiating corrective actions.
c. Inform the support person that the nurse will be responsible for all comfort measures when the electronic equipment is in place.
d. Document the frequency, duration, and intensity of contractions measured by the external device.
6. The nurse is caring for a woman, G2 P1001, 40 weeks’ gestation, in labor.
A 12 P.M. assessment revealed: cervix 4 cm, 80% effaced, –3 station, and fetal heart 124 with moderate variability.
5 p.m. assessment: cervix 6 cm, 90% effaced, –3 station, and fetal heart 120 with minimal variability.
10 a.m. assessment: cervix 8 cm, 100% effaced, –3 station, and fetal heart 124 with absent variability.
Based on the assessments, which of the following should the nurse conclude?
a. Descent is progressing well.
b. Woman is carrying a small-for-gestational age fetus.
c. Baby is potentially acidotic.
d. Woman should begin to push with the next contraction.
7. After assessing the FHR tracing shown below, which of the following interventions should the nurse perform?
a. Turn the woman on her side.
b. Administer oxygen by nasal cannula.
c. Encourage the patient to push with each contraction.
d. Provide the patient with caring labor support.
8. A nurse is preparing to monitor a patient who is to receive an amnioinfusion. Which of the following actions should the nurse make at this time?
a. Attach the patient to an electronic blood pressure cuff.
b. Assist in insertion of an internal uterine pressure catheter.
c. Attach the patient to an oxygen saturation monitor.
d. Perform an amniotic fluid Nitrazine test.
9. The perinatal nurse providing care to a laboring woman recognizes a category II, fetal heart rate tracing. The most appropriate initial action is to:
a. Assist the laboring woman to a left lateral position
b. Decrease the intravenous solution
c. Request that the physician/certified nurse-midwife come to the hospital STAT
d. Document the fetal heart rate and variability
10. The perinatal nurse assists the nursing student who is preparing the patient with oligohydramnios for a fluid infusion into the uterine cavity. This procedure is described as a(n) __________.
Chapter 10: High-Risk Labor and Birth
1. During labor induction with oxytocin, the fetal heart rate baseline is in the 140s with moderate variability. Contraction frequency is assessed to be every 2 minutes with duration of 60 seconds, of moderate strength to palpation. Based on this assessment, the nurse should take which action?
a. Increase oxytocin infusion rate per physician’s protocol.
b. Stop oxytocin infusion immediately.
c. Maintain present oxytocin infusion rate and continue to assess.
d. Decrease oxytocin infusion rate by 2 mU/min and report to physician.
2. If the umbilical cord prolapses during labor, the nurse should immediately:
a. Type and cross-match blood for an emergency transfusion.
b. Await MD order for preparation for an emergency cesarean section.
c. Attempt to reposition the cord above the presenting part.
d. Apply manual pressure to the presenting part to relieve pressure on the cord.
3. Augmentation of labor:
a. Is part of the active management of labor instituted when the labor process is unsatisfactory and uterine contractions are inadequate
b. Relies on more invasive methods when oxytocin and amniotomy have failed
c. Is elective induction of labor
d. Is an operative vaginal delivery that uses vacuum cups
4. Your patient is a 28-year-old gravida 2 para 1 in active labor. She has been in labor for 12 hours. Upon further assessment, the nurse determines that she is experiencing a hypotonic labor pattern. Possible maternal and fetal implications from hypotonic labor patterns are:
a. Intrauterine infection and maternal exhaustion with fetal distress usually occurring early in labor.
b. Intrauterine infection and maternal exhaustion with fetal distress usually occurring late in labor.
c. Intrauterine infection and postpartum hemorrhage with fetal distress early in labor.
d. Intrauterine infection and ruptured uterus and fetal death.
5. A primigravida woman at 42 weeks’ gestation received Prepidil (dinoprostone) for induction 12 hours ago. The Bishop score is now 3. Which of the following actions by the nurse is appropriate?
a. Perform Nitrazine analysis of the amniotic fluid.
b. Report the lack of progress to the obstetrician.
c. Place the woman on her left side.
d. Ask the doctor for an order for oxytocin.
6. The nurse is assisting a physician in the delivery of a baby via vacuum extraction. Which of the following nursing diagnoses for the gravida is appropriate at this time?
a. Risk for injury
b. Colonic constipation
c. Risk for impaired parenting
d. Ineffective individual coping
7. Four women are close to delivery on the labor and delivery unit. The nurse knows to be vigilant to the signs of neonatal respiratory distress in which delivery?
a. 42-week-gestation pregnancy complicated by intrauterine growth restriction
b. 41-week-gestation pregnancy with biophysical profile score of 10 that morning
c. 40-week-gestation pregnancy with estimated fetal weight of 3200 grams
d. 39-week-gestation pregnancy complicated by maternal cholecystitis
8. You are caring for a primiparous woman admitted to labor and delivery for induction of labor at 42 weeks’ gestation. She asks you to explain the factors that contribute to prolonged labor. The best response would be to state the following:
a. Primiparous women are not at risk for dystocia because they usually have small babies.
b. Dystocia is related to uterine contractions, the pelvis, the fetus, the position of the mother, and psychosocial response.
c. Labor is primarily associated with pelvic abnormalities.
d. Dystocia is typically diagnosed prior to labor based on pelvimetry.
9. A patient, G1 P0, is admitted to the labor and delivery unit for induction of labor. The following assessments were made on admission: Bishop score of 4, fetal heart rate 140s with good variability and no decelerations, TPR 98.6ºF, 88, 20, BP 120/80, negative obstetrical history. A prostaglandin suppository was inserted at that time. Which of the following findings, 6 hours after insertion, would warrant the removal of the Cervidil (dinoprostone)?
a. Bishop score of 5
b. Fetal heart of 152 bpm
c. Respiratory rate of 24 rpm
d. Contraction frequency of every 2 minutes
10. A pregnant woman who has a history of cesarean births is requesting to have a vaginal birth after cesarean (VBAC). In which of the following situations should the nurse advise the patient that her request may be declined?
a. Transverse fetal lie
b. Flexed fetal attitude
c. Previous low flap uterine incision
d. Positive vaginal candidiasis
Chapter 11: Intrapartum and Postpartum Care of Cesarean Birth Families
Multiple Response
1. Which of the following is a medical indication for a cesarean birth? (Select all that apply.)
a. Maternal blood pressure of 130/90
b. Cervical dilation of 1.5 cm per hour during the active phase of labor
c. Late deceleration of the fetal heart rate with minimal variability
d. Complete placenta previae. Arrest of fetal descent
2. A nurse is caring for a woman who is 4 hours post-cesarean birth for arrest of labor. The labor and operative records indicate that she had premature rupture of membranes followed by 36 hours of labor. Her IV fluid intake for the past 24 hours is 2500 mL. The estimated blood loss is 1500 mL. Based on this data, the woman is at risk for which of the following? (Select all that apply.)
a. Fluid volume deficit
b. Infection
c. Impaired mother–infant attachment
d. Falls
3. The perinatal nurse teaches the student nurse that deep breathing exercises following a cesarean birth are critical to the prevention of (select all that apply):
a. Pneumonia
b. Atelectasis
c. Abdominal distension
d. Increased tidal volume
4. A nurse is admitting a woman for a scheduled cesarean section. Which of the following assessment data should be immediately reported to the physician?
a. White cell count of 11,000
b. Hemoglobin of 11 g/dL
c. Hematocrit of 33%
d. Platelet count of 97,000
5. A nurse is preparing a woman in early labor for an urgent cesarean birth related to breech presentation. Select the best nursing action for reducing the couple’s anxiety levels.
a. Explain the reason for the need for a cesarean section.
b. Inform parents that their baby is in distress.
c. Ask the couple to share their concerns.
d. Reassure the couple that both the woman and baby are in no danger.
6. A nurse is caring for a woman 10 hours post-cesarean birth. She received a dose of intrathecal morphine at the time of the birth. Which of the following assessment data would require immediate intervention?
a. Itching of the palms and feet
b. Nausea
c. Urinary output of 300 mL in the past 4 hours
d. Respiratory rate of 10 breaths/minute
7. A client delivered a 2800-gram neonate 4 hours ago by cesarean section with epidural anesthesia. Which of the following interventions should the nurse perform on the mother at this time?
a. Maintain the client flat in bed.
b. Assess the client’s patellar reflexes.
c. Monitor hourly urinary outputs.
d. Assess the client’s respiratory rate.
8. A post-cesarean birth woman has been diagnosed with paralytic ileus. Which of the following symptoms would the nurse expect to see?
a. Abdominal distension
b. Polyuria
c. Diastasis recti
d. Dependent edema
9. The perinatal nurse is preparing a woman for a scheduled cesarean birth. The woman will be receiving spinal anesthesia for the birth. In order to prevent maternal hypotension, the nurse:
a. Assists the woman to lie down in a supine position.
b. Administers a rapid intravenous infusion of 500 mL of normal saline.
c. Assesses blood pressure and pulse every 5 minutes, three times, before the spinal insertion.
d. Encourages frequent cleansing breaths after the patient has been placed in the correct position for the anesthesia administration.
10. The perinatal nurse understands that the purpose of combining an opioid with a local anesthetic agent in an epidural is primarily to:
a. Increase the total anesthetic volume
b. Preserve a greater amount of maternal motor function
c. Increase the intensity of the motor and sensory block
d. Decrease the number of side effects
Chapter 12: Postpartum Physiological Assessments and Nursing Care
1. A 25 year-old woman gave birth to her second child 6 hours ago. She informs the nurse that she is bleeding more than with her previous birth experience. The initial nursing action is to:
a. Explain that this is normal for second-time moms.
b. Assess the location and firmness of the fundus.
c. Change her pad and return in 1 hour and reassess.
d. Give her 10 units of oxytocin as per standing order.
2. Which of these medications is commonly used to control postpartum bleeding related to uterine atony?
a. Magnesium sulfate
b. Phytonadione
c. Oxytocin
d. Warfarin
3. During a postpartum assessment, the nurse notes that the uterus is midline and boggy. The immediate nursing action is:a. To notify the patient’s midwife or physician
b. Massage the fundus until firm and reevaluate within 30 minutes
c. Give Syntocinon as per orders
d. Assist the patient to the bathroom and ask her to void
4. On day four following the birth of an average size baby, the nurse would expect the fundus to be at:
a. 1 cm below umbilicus
b. 2 cm below umbilicus
c. 3 cm below umbilicus
d. 4 cm below umbilicus
5. A nurse is preparing to administer RhoGam to a client who delivered a fetal demise. Which of the following must the nurse check before giving the injection?
a. Verify that the direct Coombs test results are positive.
b. Check that the fetus was at least 28 weeks’ gestation.
c. Make sure that the client is at least 3 days postdelivery.
d. Confirm that the client is Rh negative.
6. A nurse is performing a postpartum assessment 30 minutes after a vaginal delivery. Which of the following actions indicates that the nurse is performing the assessment correctly?
a. The nurse measures the fundal height in relation to the symphysis pubis.
b. The nurse monitors the client’s central venous pressure.
c. The nurse assesses the client’s perineum for edema and ecchymoses.
d. The nurse performs a sterile vaginal speculum exam.
7. A woman is 2 days postpartum from a normal vaginal delivery over an intact perineum of a 3000-gram baby. Where would the nurse expect to palpate the client’s fundus?
a. At the umbilicus
b. 2 cm below the umbilicus
c. 2 cm above the symphysis
d. At the symphysis
8. Which of the following clients is most likely to complain of afterbirth pains during her postpartum period?
a. G1 P0, diagnosed with preeclampsia
b. G2 P0, group B streptococci in the vagina
c. G3 P2, gave birth to a 4100-gram baby
d. G4 P1, diagnosed with preterm labor
9. The nurse is providing discharge counseling to a woman who is breastfeeding her baby. The nurse advises the woman that if she experiences unilateral breast inflammation, she should do which of the following?
a. Apply warm soaks to the reddened area.
b. Consume an herbal galactagogue.
c. Bottle feed the baby during the next day.
d. Take expressed breast milk to the laboratory for analysis.
10. The nurse is working with a 36-year-old, married client, G6 P6, who smokes. The woman states, “I don’t expect to have any more kids, but I hate the thought of being sterile.” Which of the following contraceptive methods would be best for the nurse to recommend to this client?
a. Intrauterine device
b. Contraceptive patch
c. Bilateral tubal ligation
d. Birth control pills
Chapter 13: Transition to Parenthood
Multiple Response
1. The nurse is caring for a recently immigrated Chinese woman in the postpartum unit. Based on cultural beliefs and practices of the woman, the nurse would anticipate which of the following? (Select all that apply.)
a. The woman prefers cold water for drinking.
b. The woman prefers not to shower.
c. The woman prefers to have her female relatives care for her baby.
d. The woman prefers to have her family bring her food to eat.
2. The nurse is caring for a postpartum woman who gave birth to a healthy, full-term baby girl. She has a 2-year-old son. She voices concern about her older child’s adjustment to the new baby. Nursing actions that will facilitate the older son’s adjustment to having a new baby in the house would include which of the following? (Select all that apply.)
a. Explain to the mother that she can have her son lie in bed with her when he is visiting her in the hospital.
b. Teach her son how to change the baby’s diapers.
c. Assist her son in holding his new baby sister.
d. Recommend that she spend time reading to her older son while he sits in her lap.
3. Which of the following nursing actions are directed at assisting men in their transition to fatherhood? (Select all that apply.)
a. Encourage the woman to take on the major responsibility for infant care.
b. Talk to the man, away from his partner, about his expectations of the fathering role.
c. Praise the father for his interactions with his infant.
d. Provide information on infant care and behavior to both parents.
4. Which of the following nursing actions are directed at promoting bonding? (Select all that apply.)
a. Providing opportunity for parents to hold their newborn as soon as possible following the birth.
b. Providing opportunities for the couple to talk about their birth experience and about becoming parents.
c. Promoting rest and comfort by keeping the newborn in the nursery at night.
d. Providing positive comments to parents regarding their interactions with their newborn.
5. Which of the following factors place a new mother at risk for parenting? (Select all that apply.)
a. She is 17 years old.
b. Family income is below the average income.
c. Her parents live in the same city and are perceived as helpful.
d. She dropped out of school at age 13.
6. Which of the following nursing actions can assist a man in his transition to fatherhood? (Select all that apply.)
a. Ask the man to share his ideas of what it means to be a father.
b. Demonstrate infant care such as diapering and feeding.
c. Engage couple in a discussion regarding each other’s expectations of the fathering role.
d. Provide the man with information on infant care.
7. A 16-year-old woman delivers a healthy, full-term male infant. The nurse notes the following behaviors 2 hours after the birth: Woman holds baby away from her body; woman refers to baby as “he”; woman verbalizes she wanted a baby girl; woman requests that baby be placed in the bassinet so she can eat her lunch. The most appropriate nursing diagnosis for this woman is:
a. At risk for impaired parenting related to disappointment with baby as evidenced by verbalizing she wanted a girl
b. At risk for impaired parenting related to nonnurturing behaviors as evidenced by holding baby away from body
c. At risk for impaired mother–infant attachment as evidenced by woman requesting baby being placed in bassinet
d. At risk for impaired mother–infant attachment related to disappointment as evidenced by calling baby “he”
8. The nurse notes that a new father gazes at his baby for prolonged periods of time and comments that his baby is beautiful and he is very happy having a baby. These behaviors are commonly associated with:
a. Bonding
b. Engrossment
c. Couvade syndrome
d. Attachment
9. A woman on the day of discharge from the postpartum unit requests clean towels so she can take a shower, asks a number of questions regarding breastfeeding, and shares that she is nervous about taking her baby home and not being able to remember everything she has been taught. These are behaviors associated with:
a. Bonding
b. Taking in
c. Taking hold
d. Attachment
10. The nurse is developing a plan of care for a client who is in the “taking-in” phase after delivering a healthy baby boy. Which of the following should the nurse include in the plan?
a. Provide the client with a nutritious meal.
b. Teach baby care skills like diapering.
c. Discuss the pros and cons of circumcision.
d. Counsel her regarding future sexual encounters.
Chapter 14: High-Risk Postpartum Nursing Care
Multiple Choice
1. A postpartum woman has been diagnosed with postpartum psychosis. Which of the following actions should the nurse perform?
a. Supervise all infant care.
b. Maintain client on strict bed rest.
c. Restrict visitation to her partner.
d. Carefully monitor toileting.
2. Which of the following sites is priority for the nurse to assess when caring for a breastfeeding client, G8 P5, who is 1 hour postdelivery?
a. Nipples
b. Fundus
c. Lungs
d. Rectum
3. A client is 1 hour postpartum from a vacuum delivery over a midline episiotomy of a 4500-gram neonate. Which of the following nursing diagnoses is appropriate for this mother?
a. Risk for altered parenting
b. Risk for imbalanced nutrition: less than body requirements
c. Risk for ineffective individual coping
d. Risk for fluid volume deficit
4. The perinatal nurse accurately defines postpartum hemorrhage by including a decrease in hematocrit levels from pre- to postbirth by:
a. 5%
b. 8%
c. 10%
d. 15%
5. The perinatal nurse teaches the postpartum woman about warning signs regarding development of postpartum infection. Signs and symptoms that merit assessment by the health-care provider include the development of a fever and:
a. Breast engorgement
b. Uterine tenderness
c. Diarrhea
d. Emotional lability
6. The perinatal nurse recognizes that a risk factor for postpartum depression is:
a. Inadequate social support
b. Age >35 years
c. Gestational hypertension
d. Regular schedule of prenatal care
7. Karen, a G2, P1, experienced a precipitous birth 90 minutes ago. Her infant is 4200 grams and a repair of a second-degree laceration was needed following the birth. As part of the nursing assessment, the nurse discovers that Karen’s uterus is boggy. Furthermore, it is noted that Karen’s vaginal bleeding has increased. The nurse’s most appropriate first action is to:
a. Assess vital signs including blood pressure and pulse.
b. Massage the uterine fundus with continual lower segment support.
c. Measure and document each perineal pad changed in order to assess blood loss.
d. Ensure appropriate lighting for a perineal repair if it is needed.
8. The nurse is massaging a boggy uterus. The uterus does not respond to the massage. Which medication would the nurse expect would be given first:
a. Methergine
b. Ergotrate
c. Carboprost
d. Oxytocin or pitocin
9. Approximately 8 hours ago, Juanita, a 32-year-old G1 P0, gave birth after 2 ½ hours of pushing. She required an episiotomy and an assisted birth (forceps) due to the weight and size of her baby (9 lb. 9 oz.). The perinatal nurse is performing an assessment of Juanita’s perineal area. A slight bulge is palpated and the presence of ecchymoses to the right of the episiotomy is noted. The area feels “full” and is approximately 4 cm in diameter. Juanita describes this area as “very tender.” The most likely cause of these signs and symptoms is:
a. Hematoma formation
b. Sepsis in the episiotomy site
c. Inadequate repair of the episiotomy
d. Postpartum hemorrhage
10. The perinatal nurse notifies the physician of the findings related to Juanita’s assessment. The first step in care will most likely be to:
a. Prepare Juanita for surgery
b. Administer intravenous fluids
c. Apply ice to the perineum
d. Insert a urinary catheter
Chapter 15: Physiological and Behavioral Responses of the Neonate
1. A woman gave birth to a 3200 g baby girl with an estimated gestational age of 40 weeks. The baby is 1 hour of age. In preparation of giving the baby an injection of vitamin K, the nurse will:
a. Explain to the parents the action of the medication and answer their questions.
b. Remove the neonate from the room so the parents will not be distressed by seeing the injection.
c. Completely undress the neonate to identify the injection site.
d. Replace needle with a 21 gauge 5/8 needle.
2. To accurately measure the neonate’s head, the nurse places the measuring tape around the head:
a. Just above the ears and eyebrows
b. Middle of the ear and over the eyes
c. Middle of the ear and over the bridge of the nose
d. Just below the ears and over the upper lip
3. Which of the following neonates is at highest risk for cold stress?
a. A 36 gestational week LGA neonate
b. A 32 gestational week AGA neonate
c. A 33 gestational week SGA neonate
d. A 38 gestational week AGA neonate
4. When assessing the apical pulse of the neonate, the stethoscope should be placed at the:
a. First or second intercostal space
b. Second or third intercostal space
c. Third or fourth intercostal space
d. Fourth or fifth intercostal space
5. Which of the following breath sounds are normal to hear in the neonate during the first few hours postbirth?
a. Scattered crackles
b. Wheezes
c. Stridor
d. Grunting
6. The nurse assesses that a full-term neonate’s temperature is 36.2°C. The first nursing action is to:
a. Turn up the heat in the room.
b. Place the neonate on the mother’s chest with a warm blanket over the mother and baby.
c. Take the neonate to the nursery and place in a radiant warmer.
d. Notify the neonate’s primary provider.
7. A nurse is assessing for the tonic neck reflex. This is elicited by:
a. Making a load sound near the neonate.
b. Placing the neonate in a sitting position.
c. Turning the neonate’s head to the side so that the chin is over the shoulder while the neonate is in a supine position.
d. Holding the neonate in a semi-sitting position and letting the head slightly drop back.
8. An infant admitted to the newborn nursery has a blood glucose level of 55 mg/dL. Which of the following actions should the nurse perform at this time?
a. Provide the baby with routine feedings.
b. Assess the baby’s blood pressure.
c. Place the baby under the infant warmer.
d. Monitor the baby’s urinary output.
9. Four babies have just been admitted into the neonatal nursery. Which of the babies should the nurse assess first?
a. The baby with respirations 52, oxygen saturation 98%
b. The baby with Apgar 9/9, weight 2960 grams
c. The baby with temperature 96.3°F, length 17 inches
d. The baby with glucose 60 mg/dL, heart rate 132
10. The nurse is about to elicit the rooting reflex on a newborn baby. Which of the following responses should the nurse expect to see?
a. When the cheek of the baby is touched, the newborn turns toward the side that is touched.
b. When the lateral aspect of the sole of the baby’s foot is stroked, the toes extend and fan outward.
c. When the baby is suddenly lowered or startled, the neonate’s arms straighten outward and the knees flex.
d. When the newborn is supine and the head is turned to one side, the arm on that same side extends.
Chapter 16: Discharge Planning and Teaching
1. A nurse is making a home visit on the seventh postpartum day to assess a 23-year-old primipara woman and her full-term, healthy baby. Breastfeeding is the method of infant nutrition. The woman tells the nurse that she does not think her milk is good because it looks very watery when she expresses a little before each feeding. The nurse’s best response is:
a. “This is normal. You only have to be concerned when your baby does not gain weight.”
b. “What types of foods are you eating? A lack of protein in the diet can cause watery looking breast milk.”
c. “How much fluid are you drinking while you are nursing your baby? Too much fluid during the feeding session can dilute the breast milk.”
d. “This is normal and is referred to as foremilk which is higher in water content. Later in the feeding the fat content increases and the milk becomes richer in appearance.”
2. A postpartum woman, who gave birth 12 hours ago, is breastfeeding her baby. She tells her nurse that she is concerned that her baby is not getting enough food since her milk has not come in. The best response for this patient is:
a. “I understand your concern, but your baby will be okay until your milk comes in.”
b. “Your baby seems content, so you should not worry about him getting enough to eat.”
c. “Milk normally comes in around the third day. Prior to that, he is getting colostrum which is high in protein and immunoglobulins which are important for your baby’s health.”
d. “You can bottle feed until your milk comes in.”
3. Which of the following positions for breastfeeding is preferred for a 2-day post-cesarean-birth woman?
a. Lying down on side
b. Sitting
c. Cradle
d. Cross-cradle
4. Painful nipples are a major reason why women stop breastfeeding. A primary intervention to decrease nipple irritation is:
a. Teaching proper techniques for latching-on and releasing of suction
b. Applying hot compresses to breast prior to feeding
c. Instructing woman to express colostrum or milk at the end of the feeding session and rub it on her nipples
d. Air drying nipples for 10 minutes at the end of the feeding session
5. The nurse is developing a discharge teaching plan for a 21-year-old first-time mom. This was an unplanned pregnancy. She had a prolonged labor and an early postpartum hemorrhage. The woman plans to breastfeed her baby. She plans to return to work when her baby is 3 months old. Based on this information, the three primary learning needs of this woman are:
a. Breastfeeding, bathing of the newborn, and infant safety
b. Breastfeeding, storage of milk, and nutrition
c. Breastfeeding, contraception, infant safety
d. Breastfeeding, storage of milk, and rest
6. Instructions to a mother of an uncircumcised male infant should include which of the following?
a. Instruct her to use a cotton swab to clean under the foreskin.
b. Instruct her to clean the penis by retracting the foreskin.
c. Instruct her to clean the penis with alcohol.
d. Instruct her not to retract the foreskin.
7. A mother of a 10-day-old infant calls the clinic and reports that her baby is having loose, green stools. The mother is breastfeeding her infant. Which of the following is the best nursing action?
a. Instruct the woman to bring her infant to the clinic.
b. Instruct the woman to decrease the amount of feeding for 24 hours and to call if the stools continue to be loose.
c. Explain that this is a normal stool pattern.
d. Instruct the woman to eat a bland diet for the next 24 hours and call back if the stools continue to be loose and green.
8. The perinatal nurse is teaching her new mother about breastfeeding and explains that the most appropriate time to breastfeed is:
a. 3 to 4 hours after the last feeding
b. When her infant is in a quiet alert state
c. When her infant is in an active alert state
d. When her infant exhibits hunger-related crying
9. Felicity Chan, a new mother, is accompanied by her mother during her hospital stay on the postpartum unit. Felicity’s mother makes specific, various requests of the nurses including bringing warm tea, a cot to sleep on, and that the baby not be bathed at this time. Felicity’s mother is also concerned about the amount of work that Felicity may be doing in the provision of infant care. Felicity asks for help with breastfeeding. After Felicity has finished breastfeeding, her mother asks for a bottle so they can warm it and “feed” the baby. How would the perinatal nurse best respond to Felicity’s mother in a culturally sensitive way?
a. Ask Felicity’s mother to leave for 30 minutes to allow for some private time with Felicity to explore her learning needs privately.
b. Ask both Felicity and her mother about the preferred infant feeding method, and assess what they already know.
c. Convey to Felicity and her mother an understanding of the concepts of “hot” and “cold” within their belief system.
d. Ask Felicity what she knows about breastfeeding, and provide information to both women to support Felicity’s decision.
10. A neonatal nurse caring for newborns knows that the best time for a mother to first attempt breastfeeding is during which one of the following stages of activity?
a. First period of reactivity
b. First period of inactivity and sleep
c. Second period of reactivity
d. Second period of inactivity and sleep
Chapter 17: High-Risk Neonatal Nursing Care
1. A neonate is born at 33 weeks’ gestation with a birth weight of 2400 grams. This neonate would be classified as:
a. Low birth weight
b. Very low birth weight
c. Extremely low birth weight
d. Very premature
2. A nurse assesses that a 3-day-old neonate who was born at 34 weeks’ gestation has abdominal distention and vomiting. These assessment findings are most likely related to:
a. Respiratory Distress Syndrome (RDS)
b. Bronchopulmonary Dysplasia (BPD)
c. Periventricular Hemorrhage (PVH)
d. Necrotizing Enterocolitis (NEC)
3. A full-term neonate who is 30 hours old has a bilirubin level of 10 mg/dL. The neonate has a yellowish tint to the skin of the face. The mother is breastfeeding her newborn. The nurse caring for this neonate would anticipate which of the following interventions?
a. Phototherapy
b. Feeding neonate every 2 to 3 hours
c. Switch from breastfeeding to bottle feeding
d. Assess red blood cell count
4. A NICU nurse is caring for a full-term neonate being treated for group B streptococcus. The mother of the neonate is crying and shares that she cannot understand how her baby became infected. The best response by the nurse is:
a. “Newborns are more susceptible to infections due to an immature immune system. Would you like additional information on the newborn immune system?”
b. “The infection was transmitted to your baby during the birthing process. Do you have a history of sexual transmitted infections?”
c. “Approximately 10% to 30% of women are asymptomatic carries of group B streptococcus which is found in the vaginal area. What other questions do you have regarding your baby’s health?”
d. “I see that this is very upsetting for you. I will come back later and answer your questions.”
5. A nursery nurse observes that a full-term AGA neonate has nasal congestion, hypertonia, and tremors and is extremely irritable. Based on these observations, the nurse suspects which of the following?
a. Hypoglycemia
b. Hypercalcemia
c. Cold stress
d. Neonatal withdrawal
6. The following four babies are in the neonatal nursery. Which of the babies should be seen by the neonatologist as soon as possible?
a. 1-day-old, HR 170 bpm, crying
b. 2-day-old, T 98.9°F, slightly jaundice
c. 3-day-old, breastfeeding q 2 h, rooting
d. 4-day-old, RR 70 rpm, dusky coloring
7. A multipara, 26 weeks’ gestation and accompanied by her husband, has just delivered a fetal demise. Which of the following nursing actions is appropriate at this time?
a. Encourage the parents to pray for the baby’s soul.
b. Advise the parents that it is better for the baby to have died than to have had to live with a defect.
c. Encourage the parents to hold the baby.
d. Advise the parents to refrain from discussing the baby’s death with their other children.
8. The nurse is assessing a baby girl on admission to the newborn nursery. Which of the following findings should the nurse report to the neonatologist?
a. Intermittent strabismus
b. Startling
c. Grunting
d. Vaginal bleeding
9. It is noted that the amniotic fluid of a 42-week gestation baby, born 30 seconds ago, is thick and green. Which of the following actions by the nurse is critical at this time?
a. Perform a gavage feeding immediately.
b. Assess the brachial pulse.
c. Assist a physician with intubation.
d. Stimulate the baby to cry.
10. A 42-week gestation neonate is admitted to the NICU (neonatal intensive care unit). This neonate is at risk for which complication?
a. Meconium aspiration syndrome
b. Failure to thrive
c. Necrotizing enterocolitis
d. Intraventricular hemorrhage
Chapter 18: Well Women’s Health
Multiple Response
1. Physical activity can lower a woman’s risk for (select all that apply):
a. Endometriosis
b. Depression
c. Colon cancer
d. Arthritis
2. During a routine physical of a 31-year-old non-Hispanic black woman, it was noted that the woman’s BMI is 32, her only exercise is taking care of her two children, her last Pap test was 2 years ago, and her last clinical breast exam was 2 years ago. Based on this information the woman (select all that apply):
a. Needs to be scheduled for a Pap test
b. Needs to be scheduled for a clinical breast exam
c. Is at risk for type 2 diabetes
d. Is at risk for depression
3. Excessive drinking places the woman at risk for (select all that apply):
a. Suicide
b. Stroke
c. Breast cancer
d. Menstrual disorders
4. The woman’s health clinic nurse is providing information to a 21-year-old woman who is being scheduled for a pelvic exam and Pap test. This information should include (select all that apply):
a. The Pap test is a diagnostic test for cervical cancer.
b. The woman should not use tampons or vaginal medication or engage in sexual intercourse within 48 hours of the exam.
c. The best time to have a Pap test is 5 days after the menstrual period has ended.
d. The woman should have a yearly Pap test.
5. A 60-year-old woman is scheduled for a dual-energy X-ray absorptiometry scan (DXA). The woman’s health clinic nurse should provide the following information:
a. DXA is a diagnostic test for osteoporosis.
b. DXA measures the bone density of the hip, spine, and forearm.
c. The T score is a comparison of the woman’s bone density with that of other women her age.
d. Osteoporosis can cause a stooped posture.
6. Lesbians are at higher risk for breast, cervical, endometrial, and ovarian cancer than heterosexual women due to (select all that apply):
a. A higher percentage of lesbians are smokers
b. Lesbians are less likely to have a Pap test
c. A higher percentage of lesbians are obese
d. Lesbians are less likely to exercise
8. Which of the following women is at highest risk for osteoporosis?
a. A 70-year-old non-Hispanic white woman who has smoked for 50 years
b. A 70-year-old non-Hispanic black woman who is a heavy drinker
c. A 60-year-old Asian woman who takes steroids to treat SLE
d. A 70-year-old Hispanic woman who has had weight loss surgery
9. A 65-year-old woman is complaining of jaw pain, nausea, shortness of breath without chest pain, and sweating. These are warning signs of:
a.. Heart attack
b. Stroke
c. Diabetes
d. Dental disease
10. Which of the following foods is highest in calcium?
a. An 8 oz. glass of milk
b. A 1.5 oz. piece of cheddar cheese
c. An 8 oz. container of plain, low-fat yogurt
d. A 3 oz. piece of salmon
Chapter 19: Alterations in Women’s Health
Multiple Response
1. Postoperative nursing care for a woman who had a total hysterectomy includes (select all that apply):
a. Administering hormone replacement therapy as per MD orders
b. Informing the woman that she will experience small amounts of vaginal bleeding for several days
c. Instructing the woman to use tampons
d. Instructing the woman to increase her ambulation to facilitate return of normal intestinal peristalsis
2. Menorrhagia may result from (select all that apply):
a. Anovulatory cycle
b. Metritis
c. Anorexia
d. Emotional distress
3. Secondary amenorrhea results from (select all that apply):
a. Polycystic ovary syndrome
b. Diabetes
c. Metritis
d. Pregnancy
4. During a health visit, a 23-year-old patient shares with her health-care provider that she has been experiencing a yellowish mucus vaginal discharge, pain during sexual intercourse, and burning on urination. A culture of the cervical epithelial cells is obtained. Based on the patient information, the culture is obtained to assist in the diagnosis of which of the following? (Select all that apply.)
a. Chlamydia
b. Gonorrhea
c. Genital herpes
d. Syphilis
5. A woman who is receiving radiation therapy for treatment of stage I cervical cancer is experiencing diarrhea. She contacts the oncology advice nurse. The advice nurse recommends that the woman (select all that apply):
a. Eat five or six small meals a day instead of three large meals
b. Eat cooked vegetables instead of raw vegetables
c. Use baby wipes instead of toilet paper
d. Reduce fluid intake to four glasses of water
6. A primary topic for health promotion for a 25-year-old woman with a history of polycystic ovary syndrome is (select the most important topic):
a. The adverse effects of cigarette smoking
b. The adverse effects of excessive alcohol consumption
c. Nutrition
d. Self-esteem issues
7. Which of the following is correct regarding endometriosis?
a. The physical symptoms of endometriosis can affect the woman’s mental health.
b. The abnormal tissue bleeds into surrounding tissue during the secretory stage of the menstrual cycle.
c. Endometriosis causes sterility.
d. Metronidazole is used to treat endometriosis.
8. The daughter of an 85-year-old woman informs the doctor that her mother has suddenly become disoriented/confused and that she is dizzy and having difficulty with her balance. She is agitated and has fallen twice in the last 24 hours. The patient’s blood pressure and VS are within normal limits. Her medications include Synthroid, Lisinopril, and Crestor. Based on this data, the woman is most likely experiencing:
a. Stroke
b. Beginning stages of dementia
c. Urinary tract infection
d. Adverse reaction to her medications
9. A total hysterectomy is the removal of:
a. The uterus
b. The uterus and cervix
c. The uterus, cervix, fallopian tubes, and ovaries
d. The uterus, cervix, fallopian tubes, ovaries, upper portion of the vagina, and lymph nodes