Test Bank Maternity Nursing 8th Edition, Lowdermilk
Chapter 01: 21st Century Maternity Nursing: Culturally Competent, Family and Community Focused
1. A 23-year-old African-American woman is pregnant with her first child. Based on the statistics for infant mortality, which plan is most important for the nurse to implement?
a. Perform a nutrition assessment.
b. Refer the woman to a social worker.
c. Advise the woman to see an obstetrician, not a midwife.
d. Explain to the woman the importance of keeping her prenatal care appointments.
2. When managing health care for pregnant women at a prenatal clinic, the nurse should recognize that the most significant barrier to access to care is the pregnant woman’s:
b. Minority status.
c. Educational level.
d. Inability to pay.
3. What is the primary role of practicing nurses in the research process?
a. Designing research studies
b. Collecting data for other researchers
c. Identifying researchable problems
d. Seeking funding to support research studies
4. The nurse caring for the pregnant woman should be aware that the U.S. birth rate shows what trend?
a. Births to unmarried women are more likely to have less favorable outcomes.
b. Birth rates for women 40 to 44 years of age are beginning to decline.
c. Cigarette smoking among pregnant women continues to increase.
d. The rates of pregnancy and abortion among teens are lower in the United States than in any other industrialized country.
5. When the nurse is unsure about how to perform a patient care procedure, the best action would be to:
a. Ask another nurse.
b. Discuss the procedure with the patient’s physician.
c. Look up the procedure in a nursing textbook.
d. Consult the agency procedure manual and follow the guidelines for the procedure.
6. Alternative and complementary therapies:
a. Replace conventional Western modalities of treatment.
b. Are used by only a small number of American adults.
c. Recognize the value of patients’ input into their health care.
d. Focus primarily on the disease an individual is experiencing.
7. Contemporary maternity nursing is exemplified by:
a. The use of midwives for all vaginal deliveries.
b. Family-centered care.
c. Free-standing birth clinics.
d. Physician-driven care.
8. A 38-year-old Hispanic woman delivered a 9-pound, 6-ounce baby girl vaginally after being in labor for 43 hours. The baby died 3 days later from sepsis. On what grounds would the woman potentially have a legitimate legal case for negligence?
a. She is Hispanic.
b. She delivered a girl.
c. The standards of care were not met.
d. She refused fetal monitoring.
9. All of the following conditions have contributed to the increase in maternity-related health care costs except:
a. Early postpartum discharges.
b. Liability costs.
c. The use of high-tech equipment.
d. The cost of care for low-birth-weight (LBW) infants.
10. Maternity nurses can work to dispel the health disparities among women through:
a. Increased education for mothers.
b. Late prenatal care.
c. Increased number of cesarean sections.
d. Making all women take more vitamins.
Chapter 02: Assessment and Health Promotion
1. The two primary functions of the ovary are:
a. Normal female development and sex hormone release.
b. Ovulation and internal pelvic support.
c. Sexual response and ovulation.
d. Ovulation and hormone production.
2. Because of the effect of cyclic ovarian changes on the breast, the best time for breast self-examination (BSE) is:
a. Five to 7 days after menses ceases.
b. Day 1 of the endometrial cycle.
c. Midmenstrual cycle.
d. Any time during a shower or bath.
3. Sexual assault is:
a. Limited to rape.
b. An act of force in which an unwanted and uncomfortable sexual act occurs.
c. A legal term for sexual violence.
d. An act of violence in which the partner is unknown.
4. Individual irregularities in the ovarian (menstrual) cycle are most often caused by:
a. Variations in the follicular (preovulatory) phase.
b. An intact hypothalamic-pituitary feedback mechanism.
c. A functioning corpus luteum.
d. A prolonged ischemic phase.
5. Prostaglandins are produced in most organs of the body, most notably the endometrium. Another/Other source(s) of prostaglandins is/are:
b. Breast milk.
c. Menstrual blood.
d. The vagina.
6. Physiologically, sexual response can be characterized by:
a. Coitus, masturbation, and fantasy.
b. Myotonia and vasocongestion.
c. Erection and orgasm.
d. Excitement, plateau, and orgasm.
7. One purpose of preconception care is to:
a. Ensure that pregnancy complications do not occur.
b. Identify women who should not become pregnant.
c. Encourage healthy lifestyles for families desiring pregnancy.
d. Ensure that women know about prenatal care.
8. Concerning the use and abuse of legal drugs or substances, nurses should be aware that:
a. Although cigarette smoking causes a number of health problems, it has little direct effect on maternity-related health.
b. Women ages 21 to 34 have the highest rates of specific alcohol-related problems.
c. Coffee is a stimulant that can interrupt body functions and has been related to birth defects.
d. Prescription psychotherapeutic drugs taken by the mother do not affect the fetus; otherwise they would not have been prescribed.
9. During a health history interview, a woman tells the nurse that her husband physically abuses her. The nurse’s first response should be to:
a. Advise the woman of mandatory state reporting laws pertaining to abuse and confidentiality.
b. Reassure the woman that the abuse is not her fault.
c. Give the woman referrals to local agencies and shelters where she can obtain help.
d. Formulate an escape plan for the woman that she can use the next time her husband abuses her.
10. As a powerful central nervous system stimulant, which of these substances can lead to miscarriage, preterm labor, premature separation of the placenta, and stillbirth?
Chapter 03: Common Concerns
1. When assessing the patient for amenorrhea, the nurse should be aware that this may be caused by all conditions except:
a. Anatomic abnormalities.
b. Type 1 diabetes mellitus.
c. Lack of exercise.
2. The nurse who is teaching a group of women about breast cancer would tell the women that:
a. Risk factors identify more than 50% of women who will develop breast cancer.
b. Nearly 90% of lumps found by women are malignant.
c. One in ten women in the United States will develop breast cancer in her lifetime.
d. The exact cause of breast cancer is unknown.
3. When a nurse is counseling a woman for primary dysmenorrhea, which nonpharmacologic intervention would most likely be recommended?
a. Increasing the intake of red meat and simple carbohydrates
b. Reducing the intake of diuretic foods such as peaches and asparagus
c. Temporarily substituting physical activity for a sedentary lifestyle
d. Using a heating pad on the abdomen to relieve cramping
4. An essential component of counseling women regarding safe sex practices includes discussion regarding avoiding the exchange of body fluids. The physical barrier promoted for the prevention of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) is the condom. Nurses can help motivate patients to use condoms by initiating a discussion related to a number of aspects of condom use. The most important of these is:
a. Strategies to enhance condom use.
b. Choice of colors and special features.
c. Leaving the decision up to the male partner.
d. Places to safely carry condoms.
5. A woman complains of severe abdominal and pelvic pain around the time of menstruation that has gotten worse over the last 5 years. She also complains of pain during intercourse and has tried unsuccessfully to get pregnant for the past 18 months. These symptoms are most likely related to:
c. Primary dysmenorrhea.
d. Secondary dysmenorrhea.
6. While interviewing a 31-year-old woman before her routine gynecologic examination, the nurse collects data about the woman’s recent menstrual cycles. The nurse should collect additional information in regard to which statement?
a. The woman says her menstrual flow lasts 5 to 6 days.
b. She describes her flow as very heavy.
c. She reports that she has had a small amount of spotting midway between her periods for the past 2 months.
d. She says the length of her menstrual cycle varies from 26 to 29 days.
7. A nurse practitioner performs a clinical breast examination on a woman diagnosed with fibroadenoma. The nurse knows that fibroadenoma is characterized by:
a. Inflammation of the milk ducts and glands behind the nipples.
b. Thick, sticky discharge from the nipple of the affected breast.
c. Lumpiness in both breasts that develops 1 week before menstruation.
d. A single lump in one breast that can be expected to shrink as the woman ages.
8. A 36-year-old woman has been diagnosed as having uterine fibroids. When planning care for this patient, the nurse should know that:
a. Fibroids are malignant tumors of the uterus that require radiation or chemotherapy.
b. Fibroids will increase in size during the perimenopausal period.
c. Menorrhagia is a common finding.
d. The woman is unlikely to become pregnant as long as the fibroids are in her uterus.
9. With regard to endometriosis, nurses should be aware that:
a. It is characterized by the presence and growth of endometrial tissue inside the uterus.
b. It is found more often in African-American women than in Caucasian or Asian women.
c. It may worsen with repeated cycles or remain asymptomatic and disappear after menopause.
d. It is unlikely to affect sexual intercourse or fertility.
10. With regard to dysfunctional uterine bleeding (DUB), the nurse should be aware that:
a. It is most commonly caused by anovulation.
b. It most often occurs in middle age.
c. The diagnosis of DUB should be the first considered for abnormal menstrual bleeding.
d. The most effective medical treatment involves steroids.
Chapter 04: Contraception, Abortion, and Infertility
1. A married couple is discussing alternatives for pregnancy prevention and has asked about fertility awareness methods (FAMs). The nurse’s most appropriate reply is:
a. “They’re not very effective, and it’s very likely you’ll get pregnant.”
b. “They can be effective for many couples, but they require motivation.”
c. “These methods have a few advantages and several health risks.”
d. “You would be much safer going on the pill and not having to worry.”
2. Which test used to diagnose the basis of infertility is done during the luteal or secretory phase of the menstrual cycle?
b. Endometrial biopsy
d. Follicle-stimulating hormone (FSH) level
3. A man smokes two packs of cigarettes a day. He wants to know if smoking is contributing to the difficulty he and his wife are having getting pregnant. The nurse’s most appropriate response is:
a. “Your sperm count seems to be okay based on the first semen analysis.”
b. “Only marijuana cigarettes affect sperm count.”
c. “Smoking can give you lung cancer, even though it has no effect on sperm.”
d. “Smoking can reduce the quality of your sperm.”
4. A couple is trying to cope with an infertility problem. They want to know what they can do to preserve their emotional equilibrium. The nurse’s most appropriate response is:
a. “Tell your friends and family so they can help you.”
b. “Talk only to other friends who are infertile because only they can help.”
c. “Get involved with a support group. I’ll give you some names.”
d. “Start adoption proceedings immediately because it is very difficult to obtain an infant.”
5. Which contraceptive method has a failure rate of less than 25%?
a. Standard days
b. Periodic abstinence
c. Ovulation method
d. Coitus interruptus
6. The nurse working with a patient who has infertility concerns should be aware that Lupron (Leuprolide acetate, a gonadotropin-releasing hormone [GnRH] agonist) may be prescribed for an infertile woman to treat:
a. Anovulatory cycles.
b. Uterine fibroids.
c. Polycystic ovarian disease (POD).
d. Luteal phase inadequacy.
7. In vitro fertilization–embryo transfer (IVF-ET) is a common approach for women with blocked fallopian tubes or unexplained infertility and for men with very low sperm counts. A husband and wife have arrived for their preprocedural interview. The husband asks the nurse to explain what the procedure entails. The nurse’s most appropriate response is:
a. “IVF is a type of assisted reproductive therapy that involves collecting eggs from your wife’s ovaries, fertilizing them in the lab with your sperm, and transferring the embryo to her uterus.”
b. “A donor embryo will be transferred into your wife’s uterus.”
c. “Donor sperm will be used to inseminate your wife.”
d. “Don’t worry about the technical stuff; that’s what we are here for.”
8. A woman has chosen the calendar method of conception control. During the assessment process, it is most important that the nurse:
a. Obtain a history of menstrual cycle lengths for the past 6 months.
b. Determine the woman’s weight gain and loss pattern for the previous year.
c. Examine skin pigmentation and hair texture for hormonal changes.
d. Explore the woman’s previous experiences with conception control.
9. A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks the nurse about the pill as a contraceptive choice. The nurse’s most appropriate response would be:
a. “This is a highly effective method, but it has some side effects.”
b. “Your current medications will reduce the effectiveness of the pill.”
c. “The pill will reduce the effectiveness of your seizure medication.”
d. “This is a good choice for a woman of your age and personal history.”
10. 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 it’s less messy.”
b. “The diaphragm can be left in place longer after intercourse.”
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.”
Chapter 05: Genetics, Conception, and Fetal Development
1. A father and mother are carriers of phenylketonuria (PKU). Their 2-year-old daughter has PKU. The couple tells the nurse that they are planning to have a second baby. Because their daughter has PKU, they are sure that their next baby won’t be affected. What response by the nurse is most accurate?
a. “Good planning; you need to take advantage of the odds in your favor.”
b. “I think you’d better check with your doctor first.”
c. “You are both carriers, so each baby has a 25% chance of being affected.”
d. “The ultrasound indicates a boy, and boys are not affected by PKU.”
2. With regard to the structure and function of the placenta, the maternity nurse should be aware that:
a. As the placenta widens, it gradually thins to allow easier passage of air and nutrients.
b. As one of its early functions, the placenta acts as an endocrine gland.
c. The placenta is able to keep out most potentially toxic substances such as cigarette smoke to which the mother is exposed.
d. Optimal blood circulation is achieved through the placenta when the woman is lying on her back or standing.
3. The nurse is providing genetic counseling for an expectant couple who already have a child with trisomy 18. The nurse should:
a. Tell the couple they need to have an abortion within 2 to 3 weeks.
b. Explain that the fetus has a 50% chance of having the disorder.
c. Discuss options with the couple, including amniocentesis to determine whether the fetus is affected.
d. Refer the couple to a psychologist for emotional support.
4. In presenting to obstetric nurses interested in genetics, the genetic nurse identifies the primary risk(s) associated with genetic testing as:
a. Anxiety and altered family relationships.
b. Denial of insurance benefits.
c. High false positives associated with genetic testing.
d. Ethnic and socioeconomic disparity associated with genetic testing.
5. A woman’s cousin gave birth to an infant with a congenital heart anomaly. The woman asks the nurse when such anomalies occur during development. Which response by the nurse is most accurate?
a. “We don’t really know when such defects occur.”
b. “It depends on what caused the defect.”
c. “They occur between the third and fifth weeks of development.”
d. “They usually occur in the first 2 weeks of development.”
6. A key finding from the Human Genome Project is:
a. Approximately 30,000 to 40,000 genes make up the genome.
b. All human beings are 80.99% identical at the DNA level.
c. Human genes produce only one protein per gene; other mammals produce three proteins per gene.
d. Single gene testing will become a standardized test for all pregnant patients in the future.
7. You are a maternal-newborn nurse caring for a mother who just delivered a baby born with Down syndrome. What nursing diagnosis would be the most essential in caring for the mother of this infant?
a. Disturbed body image
b. Interrupted family processes
d. Risk for injury
8. The nurse caring for the laboring woman should know that meconium is produced by:
a. Fetal intestines.
b. Fetal kidneys.
c. Amniotic fluid.
d. The placenta.
9. In practical terms regarding genetic health care, nurses should be aware that:
a. Genetic disorders affect equally people of all socioeconomic backgrounds, races, and ethnic groups.
b. Genetic health care is more concerned with populations than individuals.
c. The most important of all nursing functions is providing emotional support to the family during counseling.
d. Taking genetic histories is the province of large universities and medical centers.
10. With regard to prenatal genetic testing, nurses should be aware that:
a. Maternal serum screening can determine whether a pregnant woman is at risk of carrying a fetus with Down syndrome.
b. Carrier screening tests look for gene mutations of people already showing symptoms of a disease.
c. Predisposition testing predicts with near certainty that symptoms will appear.
d. Presymptomatic testing is used to predict the likelihood of breast cancer.
Chapter 06: Anatomy and Physiology of Pregnancy
1. A woman’s obstetric history indicates that she is pregnant for the fourth time and all of her children from previous pregnancies are living. One child was born at 39 weeks of gestation, twins were born at 34 weeks of gestation, and another child was born at 35 weeks of gestation. What is her gravidity and parity using the GTPAL system?
2. A woman is 6 weeks pregnant. She has had a previous spontaneous abortion at 14 weeks of gestation and a pregnancy that ended at 38 weeks with the birth of a stillborn girl. What is her gravidity and parity using the GTPAL system?
3. Over-the-counter (OTC) pregnancy tests usually rely on which technology to test for human chorionic gonadotropin (hCG)?
b. Radioreceptor assay
c. Latex agglutination test
d. Enzyme-linked immunosorbent assay (ELISA)
4. A woman at 10 weeks of gestation who is seen in the prenatal clinic with presumptive signs and symptoms of pregnancy likely will have:
b. Positive pregnancy test.
c. Chadwick’s sign.
d. Hegar’s sign.
5. The nurse teaches a pregnant woman about the presumptive, probable, and positive signs of pregnancy. The woman demonstrates understanding of the nurse’s instructions if she states that a positive sign of pregnancy is:
a. A positive pregnancy test.
b. Fetal movement palpated by the nurse-midwife.
c. Braxton Hicks contractions.
6. A woman is at 14 weeks of gestation. The nurse would expect to palpate the fundus at which level?
a. Not palpable above the symphysis at this time
b. Slightly above the symphysis pubis
c. At the level of the umbilicus
d. Slightly above the umbilicus
7. Cardiovascular system changes occur during pregnancy. Which finding would be considered normal for a woman in her second trimester?
a. Less audible heart sounds (S1, S2)
b. Increased pulse rate
c. Increased blood pressure
d. Decreased red blood cell (RBC) production
8. 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.
9. A woman is in her seventh month of pregnancy. She has been complaining of nasal congestion and occasional epistaxis. The nurse suspects that:
a. This is a normal respiratory change in pregnancy caused by elevated levels of estrogen.
b. This is an abnormal cardiovascular change, and the nosebleeds are an ominous sign.
c. The woman is a victim of domestic violence and is being hit in the face by her partner.
d. The woman has been using cocaine intranasally.
10. The nurse caring for the pregnant patient must understand that the hormone essential for maintaining pregnancy is:
b. Human chorionic gonadotropin (hCG).
Chapter 07: Nursing Care of the Family during Pregnancy
1. The nurse caring for the newly pregnant woman would advise her that 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.
2. With regard to follow-up visits for women receiving prenatal care, nurses should be aware that:
a. The interview portions become more intensive as the visits become more frequent over the course of the pregnancy.
b. Monthly visits are scheduled for the first trimester, every 2 weeks for the second trimester, and weekly for the third trimester.
c. During the abdominal examination, the nurse should be alert for supine hypotension.
d. For pregnant women a systolic blood pressure (BP) of 130 and a diastolic BP of 80 is sufficient to be considered hypertensive.
3. A woman arrives at the clinic for a pregnancy test. The first day of her last menstrual period (LMP) was February 14, 2010. Her expected date of birth (EDB) would be:
a. September 17, 2010.
b. November 7, 2010.
c. November 21, 2010.
d. December 17, 2010.
4. Prenatal testing for the human immunodeficiency virus (HIV) is recommended for which women?
a. All women, regardless of risk factors
b. A woman who has had more than one sexual partner
c. A woman who has had a sexually transmitted infection
d. A woman who is monogamous with her partner
5. With regard to work and travel during pregnancy, nurses should be aware that:
a. Women should sit for as long as possible and cross their legs at the knees from time to time for exercise.
b. Women should avoid seat belts and shoulder restraints in the car, because they press on the fetus.
c. Metal detectors at airport security checkpoints can harm the fetus if the woman passes through them a number of times.
d. While working or traveling in a car or on a plane, women should arrange to walk around at least every hour or so.
6. Which symptom is considered a first-trimester warning sign and should be reported immediately by the pregnant woman to her health care provider?
a. Nausea with occasional vomiting
c. Urinary frequency
d. Vaginal bleeding
7. Which blood pressure (BP) finding during the second trimester indicates a risk for pregnancy-induced hypertension?
a. Baseline BP 120/80, current BP 126/85
b. Baseline BP 100/70, current BP 130/85
c. Baseline BP 140/85, current BP 130/80
d. Baseline BP 110/60, current BP 110/60
8. The quadruple marker test is used to assess the fetus for which condition?
a. Down syndrome
b. Diaphragmatic hernia
c. Congenital cardiac abnormality
9. With regard to medications, herbs, shots, and other substances normally encountered, the maternity nurse should be aware that:
a. Both prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus.
b. The greatest danger of drug-caused developmental deficits in the fetus is seen in the final trimester.
c. Killed-virus vaccines (e.g., tetanus) should not be given during pregnancy, but live-virus vaccines (e.g., measles) are permissible.
d. No convincing evidence exists that secondhand smoke is potentially dangerous to the fetus.
10. A pregnant woman at 18 weeks of gestation calls the clinic to report that she has been experiencing occasional backaches of mild-to-moderate intensity. The nurse would recommend that she:
a. Do Kegel exercises.
b. Do pelvic rock exercises.
c. Use a softer mattress.
d. Stay in bed for 24 hours.
Chapter 08: Maternal and Fetal Nutrition
1. A 22-year-old woman pregnant with a single fetus has a preconception body mass index (BMI) of 24. When she was seen in the clinic at 14 weeks of gestation, she had gained 1.8 kg (4 lb) since conception. How would the nurse interpret this?
a. This weight gain indicates possible gestational hypertension.
b. This weight gain indicates that the woman’s infant is at risk for intrauterine growth restriction (IUGR).
c. This weight gain cannot be evaluated until the woman has been observed for several more weeks.
d. The woman’s weight gain is appropriate for this stage of pregnancy.
2. Which of the following meals would provide the most absorbable iron?
a. Toasted cheese sandwich, celery sticks, tomato slices, and a grape drink
b. Oatmeal, whole wheat toast, jelly, and low-fat milk
c. Black bean soup, wheat crackers, ambrosia (orange sections, coconut, and pecans), and prunes
d. Red beans and rice, cornbread, mixed greens, and decaffeinated tea
3. Which nutrient’s recommended dietary allowance (RDA) is higher during lactation than during pregnancy?
a. Energy (kcal)
c. Vitamin A
d. Folic acid
4. A pregnant woman experiencing nausea and vomiting should:
a. Drink a glass of water with a fat-free carbohydrate before getting out of bed in the morning.
b. Eat small, frequent meals (every 2 to 3 hours).
c. Increase her intake of high-fat foods to keep the stomach full and coated.
d. Limit fluid intake throughout the day.
5. Which statement made by a lactating woman would lead the nurse to believe that the woman might have lactose intolerance?
a. “I always have heartburn after I drink milk.”
b. “If I drink more than a cup of milk, I usually have abdominal cramps and bloating.”
c. “Drinking milk usually makes me break out in hives.”
d. “Sometimes I notice that I have bad breath after I drink a cup of milk.”
6. A pregnant woman’s diet history indicates that she likes the following list of foods. The nurse would encourage this woman to consume more of which food to increase her calcium intake?
a. Fresh apricots
b. Canned clams
c. Spaghetti with meat sauce
d. Canned sardines
7. A 27-year-old pregnant woman had a preconceptual body mass index (BMI) of 18.0. The nurse knows that this woman’s total recommended weight gain during pregnancy should be at least:
a. 20 kg (44 lb).
b. 16 kg (35 lb).
c. 12.5 kg (27.5 lb).
d. 10 kg (22 lb).
8. A woman in week 34 of pregnancy reports that she is very uncomfortable because of heartburn. The nurse would suggest that the woman:
a. Substitute other calcium sources for milk in her diet.
b. Lie down after each meal.
c. Reduce the amount of fiber she consumes.
d. Eat five small meals daily.
9. A woman has come to the clinic for preconception counseling because she wants to start trying to get pregnant in 3 months. She can expect the following advice:
a. “Discontinue all contraception now.”
b. “Lose weight so that you can gain more during pregnancy.”
c. “You may take any medications you have been taking regularly.”
d. “Make sure that you include adequate folic acid in your diet.”
10. To prevent gastrointestinal upset, patients should be instructed to take iron supplements:
a. On a full stomach.
b. At bedtime.
c. After eating a meal.
d. With milk.
Chapter 09: Labor and Birth Processes
1. A new mother asks the nurse when the “soft spot” on her son’s head will go away. The nurse’s answer is based on the knowledge that the anterior fontanel closes after birth by:
a. 2 months.
b. 8 months.
c. 12 months.
d. 18 months.
2. When assessing a woman in labor, the nurse is aware that the relationship of the fetal body parts to one another is called fetal:
3. When assessing the fetus using Leopold maneuvers, the nurse feels a round, firm, movable fetal part in the fundal portion of the uterus and a long, smooth surface in the mother’s right side close to midline. What is the likely position of the fetus?
4. The nurse has received a report about a woman in labor. The woman’s last vaginal examination was recorded as 3 cm, 30%, and -2. The nurse’s interpretation of this assessment is that:
a. The cervix is effaced 3 cm, it is dilated 30%, and the presenting part is 2 cm above the ischial spines.
b. The cervix is 3 cm dilated, it is effaced 30%, and the presenting part is 2 cm above the ischial spines.
c. The cervix is effaced 3 cm, it is dilated 30%, and the presenting part is 2 cm below the ischial spines.
d. The cervix is dilated 3 cm, it is effaced 30%, and the presenting part is 2 cm below the ischial spines.
5. Which position would the nurse suggest for second-stage labor if the pelvic outlet needs to be increased?
6. To adequately care for a laboring woman, the nurse should know which stage of labor varies the most in length?
7. The nurse would expect which maternal cardiovascular finding during labor?
a. Increased cardiac output
b. Decreased pulse rate
c. Decreased white blood cell (WBC) count
d. Decreased blood pressure
8. The factors that affect the process of labor and birth, known commonly as the five Ps, include all except:
9. With regard to fetal positioning during labor, nurses should be aware that:
a. Position is a measure of the degree of descent of the presenting part of the fetus through the birth canal.
b. Birth is imminent when the presenting part is at +4 to +5 cm, below the spine.
c. The largest transverse diameter of the presenting part is the suboccipitobregmatic diameter.
d. Engagement is the term used to describe the beginning of labor.
10. With regard to primary and secondary powers, the maternity nurse should know that:
a. Primary powers are responsible for effacement and dilation of the cervix.
b. Effacement generally is well ahead of dilation in women giving birth for the first time; they are closer together in time in subsequent pregnancies.
c. Scarring of the cervix caused by a previous infection or surgery may make the delivery a bit more painful, but it should not slow or inhibit dilation.
d. Pushing in the second stage of labor is more effective if the woman can breathe deeply and control some of her involuntary needs to push, as the nurse directs.
Chapter 10: Management of Discomfort
1. An 18-year-old pregnant woman, gravida 1, is admitted to the labor and birth unit with moderate contractions every 5 minutes that last 40 seconds. The woman states, “My contractions are so strong that 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.
2. 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
3. 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.
4. 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 slow the pace of her breathing.
c. Administer oxygen via a mask or nasal cannula.
d. Help her breathe into a paper bag.
5. A woman has requested an epidural for her pain. She is 5 cm dilated and 100% effaced. The baby is in a vertex position and is engaged. The nurse increases the woman’s intravenous fluid for a preprocedural bolus. She reviews her laboratory values and notes that the woman’s hemoglobin is 12 g/dl, hematocrit is 38%, platelets are 67,000, and white blood cells (WBCs) are 12,000/mm3. Which factor would contraindicate an epidural for the woman?
a. She is too far dilated.
b. She is anemic.
c. She has thrombocytopenia.
d. She is septic.
6. The role of the nurse with regard to informed consent is to:
a. Inform the patient about the procedure and have her sign the consent form.
b. Act as a patient advocate and help clarify the procedure and the options.
c. Call the physician to see the patient.
d. Witness the signing of the consent form.
7. A first-time mother is concerned about the type of medications she will receive during labor. She is in a fair amount of pain and is nauseous. In addition, she appears to be very anxious. You explain that opioid analgesics often are used with sedatives because:
a. “The two together work the best for you and your baby.”
b. “Sedatives help the opioid work better, and they also will help relax you and relieve your nausea.”
c. “They work better together so you can sleep until you have the baby.”
d. “This is what the doctor has ordered for you.”
8. To help patients manage discomfort and pain during labor, nurses should be aware that:
a. The predominant pain of the first stage of labor is the visceral pain located in the lower portion of the abdomen.
b. Referred pain is the extreme discomfort between contractions.
c. The somatic pain of the second stage of labor is more generalized and related to fatigue.
d. Pain during the third stage is a somewhat milder version of the second stage.
9. Which statement correctly describes the effects of various pain factors?
a. Higher prostaglandin levels arising from dysmenorrhea can blunt the pain of childbirth.
b. Upright positions in labor increase the pain factor because they cause greater fatigue.
c. Women who move around trying different positions are experiencing more pain.
d. Levels of pain-mitigating β-endorphins are higher during a spontaneous, natural childbirth.
10. Nurses with an understanding of cultural differences regarding likely reactions to pain may be better able to help patients. Nurses should know that _____ women may be stoic until late in labor, when they may become vocal and request pain relief.
b. Arab or Middle Eastern
Chapter 11: Fetal Assessment during Labor
1. The nurse providing care for the laboring woman should understand that variable fetal heart rate (FHR) decelerations are caused by:
a. Altered fetal cerebral blood flow.
b. Umbilical cord compression.
c. Uteroplacental insufficiency.
d. Fetal hypoxemia.
2. 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 woman’s position.
b. Notify the care provider.
c. Assist with amnioinfusion.
d. Insert a scalp electrode.
3. The nurse caring for the laboring woman should understand that early decelerations are caused by:
a. Altered fetal cerebral blood flow.
b. Umbilical cord compression.
c. Uteroplacental insufficiency.
d. Spontaneous rupture of membranes.
4. 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. Call the provider, reposition the mother, and perform a vaginal examination.
b. Administer oxygen by face mask, assist the woman to a side-lying position, and increase maternal blood volume by increasing the rate of the primary IV.
c. Administer oxygen to the mother, increase IV fluid, and notify the care provider.
d. Perform a vaginal examination, reposition the mother, and provide oxygen via face mask.
5. The nurse caring for the woman in labor should understand that maternal hypotension can result in:
a. Early decelerations.
b. Fetal dysrhythmias.
c. Uteroplacental insufficiency.
d. Spontaneous rupture of membranes.
6. While evaluating an external monitor tracing of a woman in active labor whose labor is being induced, the nurse notes that the fetal heart rate (FHR) begins to decelerate at the onset of several contractions and returns to baseline before each contraction ends. The nurse should:
a. Change the woman’s position.
b. Discontinue the oxytocin infusion.
c. Insert an internal monitor.
d. Document the finding in the patient’s record.
7. 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. Umbilical cord compression.
c. Uteroplacental insufficiency.
d. Meconium fluid.
8. Perinatal nurses are legally responsible for:
a. Correctly interpreting fetal heart rate (FHR) patterns, initiating appropriate nursing interventions, and documenting the outcomes.
b. Greeting the patient on arrival, assessing her, and starting an intravenous line.
c. Applying the external fetal monitor and notifying the care provider.
d. Making sure that the woman is comfortable.
9. As a perinatal nurse you realize that a fetal heart rate that is tachycardic, is bradycardic, or has late decelerations or loss of variability is nonreassuring and is associated with:
b. Cord compression.
c. Maternal drug use.
10. A new patient and her partner arrive on the labor, delivery, recovery, and postpartum unit for the birth of their first child. You apply the electronic fetal monitor (EFM) to the woman. Her partner asks you to explain what is printing on the graph, referring to the EFM strip. He wants to know what the baby’s heart rate should be. Your best response is:
a. “Don’t worry about that machine; that’s my job.”
b. “The top line graphs the baby’s heart rate. Generally the heart rate is between 110 and 160. The heart rate will fluctuate in response to what is happening during labor.”
c. “The top line graphs the baby’s heart rate, and the bottom line lets me know how strong the contractions are.”
d. “Your doctor will explain all of that later.”
Chapter 12: Nursing Care of the Family during Labor and Birth
1. The nurse teaches a pregnant woman about the characteristics of true labor contractions. The nurse evaluates that the woman understands the instructions when she states:
a. “True labor contractions will subside when I walk around.”
b. “True labor contractions will cause discomfort over the top of my uterus.”
c. “True labor contractions will continue and get stronger even if I relax and take a shower.”
d. “True labor contractions will remain irregular but become stronger.”
2. When 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.
3. 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
c. Precipitous labor
d. Supine hypotension
4. The uterine contractions of a woman early in the active phase of labor are assessed by an internal uterine pressure catheter (IUPC). The nurse notes that the intrauterine pressure at the peak of the contraction ranges from 65 to 70 mm Hg and the resting tone range is 6 to 10 mm Hg. The uterine contractions occur every 3 to 4 minutes and last an average of 55 to 60 seconds. On the basis of this information, the nurse should:
a. Notify the woman’s primary health care provider immediately.
b. Prepare to administer an oxytocic to stimulate uterine activity.
c. Document the findings because they reflect the expected contraction pattern for the active phase of labor.
d. Prepare the woman for the onset of the second stage of labor.
5. When assessing a woman in the first stage of labor, the nurse recognizes that the most conclusive sign that uterine contractions are effective would be:
a. Dilation of the cervix.
b. Descent of the fetus.
c. Rupture of the amniotic membranes.
d. Increase in bloody show.
6. The nurse who performs vaginal examinations to assess a woman’s progress in labor should:
a. Perform an examination at least once every hour during the active phase of labor.
b. Perform the examination with the woman in the supine position.
c. Wear two clean gloves for each examination.
d. Discuss the findings with the woman and her partner.
7. 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.
8. A nulliparous woman who has just begun the second stage of her labor would most likely:
a. Experience a strong urge to bear down.
b. Show perineal bulging.
c. A period of rest and relative calm.
d. Show an increase in bright red bloody show.
9. 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.
b. Telling the woman to start pushing as soon as her cervix is fully dilated.
c. Continuing an epidural anesthetic so pain is reduced and the woman can relax.
d. Coaching the woman to use sustained, 10- to 15-second, closed-glottis bearing-down efforts with each contraction.
10. Through vaginal examination the nurse determines that a woman is 4 cm dilated, and the external fetal monitor shows uterine contractions every 3½ 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.
Chapter 13: Maternal Physiologic Changes
1. A woman gave birth to an infant boy 10 hours ago. Where would the nurse expect to locate this woman’s fundus?
a. One centimeter above the umbilicus
b. Two centimeters below the umbilicus
c. Midway between the umbilicus and the symphysis pubis
d. Nonpalpable abdominally
2. Which woman is most likely to experience strong afterpains?
a. A woman who experienced oligohydramnios
b. A woman who is a gravida 4, para 4-0-0-4
c. A woman who is bottle-feeding her infant
d. A woman whose infant weighed 5 pounds, 3 ounces
3. A woman gave birth to a healthy infant boy 5 days ago. What type of lochia would the nurse expect to find when assessing this woman?
a. Lochia rubra
b. Lochia sangra
c. Lochia alba
d. Lochia serosa
4. Which hormone remains elevated in the immediate postpartum period of the breastfeeding woman?
d. Human placental lactogen
5. Two days ago a woman gave birth to a full-term infant. Last night she awakened several times to urinate and noted that her gown and bedding were wet from profuse diaphoresis. One mechanism for the diaphoresis and diuresis that this woman is experiencing during the early postpartum period is:
a. Elevated temperature caused by postpartum infection.
b. Increased basal metabolic rate after giving birth.
c. Loss of increased blood volume associated with pregnancy.
d. Increased venous pressure in the lower extremities.
6. The nurse caring for the postpartum woman understands that breast engorgement is caused by:
a. Overproduction of colostrum.
b. Accumulation of milk in the lactiferous ducts.
c. Hyperplasia of mammary tissue.
d. Congestion of veins and lymphatics.
7. A woman gave birth to a 7-pound, 6-ounce infant girl 1 hour ago. The birth was vaginal, and the estimated blood loss (EBL) was approximately 1500 ml. When assessing the woman’s vital signs, the nurse would be concerned to see:
a. Temperature 37.9° C, heart rate 120, respirations 20, blood pressure (BP) 90/50.
b. Temperature 37.4° C, heart rate 88, respirations 36, BP 126/68.
c. Temperature 38° C, heart rate 80, respirations 16, BP 110/80.
d. Temperature 36.8° C, heart rate 60, respirations 18, BP 140/90.
8. The interval between the birth of the newborn and the return of the reproductive organs to their normal nonpregnant state is called the:
a. Involutionary period because of what happens to the uterus.
b. Lochia period because of the nature of the vaginal discharge.
c. Mini-tri period because it lasts only 3 to 6 weeks.
d. Puerperium, or fourth trimester of pregnancy.
9. The self-destruction of excess hypertrophied tissue in the uterus is called:
10. With regard to the postpartum uterus, nurses should be aware that:
a. At the end of the third stage of labor, it weighs approximately 500 g.
b. After 2 weeks postpartum, it should not be palpable abdominally.
c. After 2 weeks postpartum, it weighs 100 g.
d. It returns to its original (prepregnancy) size by 6 weeks postpartum.
Chapter 14: Nursing Care of the Family during the Fourth Trimester
1. A 25-year-old gravida 2, para 2-0-0-2 gave birth 4 hours ago to a 9-pound, 7-ounce 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.” 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.
2. On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. The nurse’s first action is to:
a. Begin an intravenous (IV) infusion of Ringer’s lactate solution.
b. Assess the woman’s vital signs.
c. Call the woman’s primary health care provider.
d. Massage the woman’s fundus.
3. A woman gave birth vaginally to a 9-pound, 12-ounce girl yesterday. Her primary health care provider has written orders for perineal ice packs, use of a sitz bath tid, and a stool softener. What information is most closely correlated with these orders?
a. The woman is a gravida 2, para 2.
b. The woman had a vacuum-assisted birth.
c. The woman received epidural anesthesia.
d. The woman has an episiotomy.
4. The laboratory results for a postpartum woman are as follows: blood type, A; Rh status, positive; rubella titer, 1:8 (EIA 0.8); 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.
5. 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 of 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.
6. A 25-year-old multiparous woman gave birth to an infant boy 1 day ago. Today her husband brings a large container of brown seaweed soup to the hospital. When the nurse enters the room, the husband asks for help with warming the soup so that his wife can eat it. The nurse’s most appropriate response is:
a. “Didn’t you like your lunch?”
b. “Does your doctor know that you are planning to eat that?”
c. “What is that anyway?”
d. “I’ll warm the soup in the microwave for you.”
7. Which finding could prevent early discharge of a newborn who is now 12 hours old?
a. Birth weight of 3000 g
b. One meconium stool since birth
c. Voided, clear, pale urine three times since birth
d. Infant breastfed once with some difficulty latching on and sucking and once with some success for about 5 minutes on each breast.
8. 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.
9. Under the Newborns’ and Mothers’ Health Protection Act, all health plans are required to allow new mothers and newborns to remain in the hospital for a minimum of _____ hours after a normal vaginal birth and for _____ hours after a cesarean birth.
a. 24, 73
b. 24, 96
c. 48, 96
d. 48, 120
10. In a variation of rooming-in, called couplet care, the mother and infant share a room, and the mother shares the care of the infant with:
a. The father of the infant.
b. Her mother (the infant’s grandmother).
c. Her eldest daughter (the infant’s sister).
d. The nurse.
Chapter 15: Transition to Parenthood
1. After giving birth to a healthy infant boy, a primiparous woman, 16, is admitted to the postpartum unit. An appropriate nursing diagnosis for her at this time is risk for impaired parenting related to deficient knowledge of newborn care. In planning for the woman’s discharge, what should the nurse be certain to include in the plan of care?
a. Tell the woman how to feed and bathe her infant.
b. Give the woman written information on bathing her infant.
c. Advise the woman that all mothers instinctively know how to care for their infants.
d. Provide time for the woman to bathe her infant after she views an infant bath demonstration.
2. The nurse observes several interactions between a postpartum woman and her new son. What behavior, if exhibited by this woman, would the nurse identify as a possible maladaptive behavior regarding parent-infant attachment?
a. Talks and coos to her son
b. Seldom makes eye contact with her son
c. Cuddles her son close to her
d. Tells visitors how well her son is feeding
3. 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. The nurse’s response should convey to the parents that:
a. Attachment, or bonding, is a process that occurs over time and does not require early contact.
b. The time immediately after birth is a critical period for people.
c. Early contact is essential for optimum parent-infant relationships.
d. They should just be happy that the infant is healthy.
4. The nurse can help a father in his transition to parenthood by:
a. Pointing out that the infant turned at the sound of his voice.
b. Encouraging him to go home to get some sleep.
c. Telling him to tape the infant’s diaper a different way.
d. Suggesting that he let the infant sleep in the bassinet.
5. The nurse notes that a Vietnamese woman does not cuddle or interact with her newborn other than to feed him, change his diapers or soiled clothes, and put him to bed. In evaluating the woman’s behavior with her infant, the nurse realizes that:
a. What appears to be a lack of interest in the newborn is in fact the Vietnamese way of demonstrating intense love by attempting to ward off evil spirits.
b. The woman is inexperienced in caring for newborns.
c. The woman needs a referral to a social worker for further evaluation of her parenting behaviors once she goes home with the newborn.
d. Extra time needs to be planned for assisting the woman in bonding with her newborn.
6. In follow-up appointments or visits with parents and their new baby, it may be useful if the nurse can identify parental behaviors that can either facilitate or inhibit attachment. Which is a facilitating behavior?
a. The parents have difficulty naming the infant.
b. The parents hover around the infant, directing attention to and pointing at the infant.
c. The parents make no effort to interpret the actions or needs of the infant.
d. The parents do not move from fingertip touch to palmar contact and holding.
7. With regard to parents’ early and extended contact with their infant and the relationships built, nurses should be aware that:
a. Immediate contact is essential for the parent-child relationship.
b. Skin-to-skin contact is preferable to contact with the body totally wrapped in a blanket.
c. Extended contact is especially important for adolescents and low-income women because they are at risk for parenting inadequacies.
d. Mothers need to take precedence over their partners and other family matters.
8. In the United States the en face position is preferred immediately after birth. Nurses can facilitate this process by all of these actions except:
a. Washing both the infant’s face and the mother’s face.
b. Placing the infant on the mother’s abdomen or breast with their heads on the same plane.
c. Dimming the lights.
d. Delaying the instillation of prophylactic antibiotic ointment in the infant’s eyes.
9. In addition to eye contact, early sensual contacts between infant and mother involve sound and smell. Nurses should be aware that, despite what folk wisdom might say:
a. High-pitched voices irritate newborns.
b. Infants can learn to distinguish their mother’s voice from others soon after birth.
c. All babies in the hospital smell alike.
d. A mother’s breast milk has no distinctive odor.
10. After birth a crying infant may be soothed by being held in a position in which the newborn can hear the mother’s heartbeat. This phenomenon is known as:
Chapter 16: Physiologic and Behavioral Adaptations of the Newborn
1. A woman gave birth to a healthy 7-pound, 13-ounce infant girl. The nurse suggests that the woman place the infant to her breast within 15 minutes after birth. The nurse knows that breastfeeding is effective during the first 30 minutes after birth because this is the:
a. Transition period.
b. First period of reactivity.
c. Organizational stage.
d. Second period of reactivity.
2. 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.
3. While assessing the newborn, the nurse should be aware that the average expected apical pulse range of a full-term, quiet, alert newborn is:
a. 80 to 100 beats/min.
b. 100 to 120 beats/min.
c. 120 to 140 beats/min.
d. 150 to 180 beats/min.
4. A newborn is placed under a radiant heat warmer, and the nurse evaluates the infant’s body temperature every hour. Maintaining the newborn’s body temperature is important for preventing:
a. Respiratory depression.
b. Cold stress.
5. 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:
b. Vascular nevi.
c. Nevus flammeus.
d. Mongolian spots.
6. A new mother states that her infant must be cold because the baby’s hands and feet are blue. The nurse explains that this is a common and temporary condition called:
b. Erythema neonatorum.
c. Harlequin color.
d. Vernix caseosa.
7. The nurse assessing a newborn knows that the most critical physiologic change required of the newborn is:
a. Closure of fetal shunts in the circulatory system.
b. Full function of the immune defense system at birth.
c. Maintenance of a stable temperature.
d. Initiation and maintenance of respirations.
8. 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 parent’s eyes and distinguish patterns; they prefer complex patterns.”
c. “The infant’s eyes must be protected. Infants enjoy looking at brightly colored stripes.”
d. “It’s important to shield the newborn’s eyes. Overhead lights help them see better.”
9. While evaluating the reflexes of a newborn, the nurse notes that with a loud noise the newborn symmetrically abducts and extends his arms, his fingers fan out and form a “C” with the thumb and forefinger, and he has a slight tremor. The nurse would document this finding as a positive:
a. Tonic neck reflex.
b. Glabellar (Myerson) reflex.
c. Babinski reflex.
d. Moro reflex.
10. While assessing the integument of a 24-hour-old newborn, the nurse notes a pink, papular rash with vesicles superimposed on the thorax, back, and abdomen. The nurse should:
a. Notify the physician immediately.
b. Move the newborn to an isolation nursery.
c. Document the finding as erythema toxicum.
d. Take the newborn’s temperature and obtain a culture of one of the vesicles.
Chapter 17: Assessment and Care of the Newborn and Family
1. An infant boy was born just a few minutes ago. The nurse is conducting the initial assessment. Part of the assessment includes the Apgar score. 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.
2. A new father wants to know what medication was put into his infant’s eyes and why it is needed. The nurse explains to the father that the purpose of the Ilotycin ophthalmic ointment is to:
a. Destroy an infectious exudate caused by Staphylococcus that could make the infant blind.
b. Prevent gonorrheal and chlamydial infection of the infant’s eyes potentially acquired from the birth canal.
c. Prevent potentially harmful exudate from invading the tear ducts of the infant’s eyes, leading to dry eyes.
d. Prevent the infant’s eyelids from sticking together and help the infant see.
3. The nurse is using the Ballard scale to determine the gestational age of a newborn. Which assessment finding is consistent with a gestational age of 40 weeks?
a. Flexed posture
b. Abundant lanugo
c. Smooth, pink skin with visible veins
d. Faint red marks on the soles of the feet
4. A 3.8-kg infant was delivered vaginally at 39 weeks after a 30-minute second stage. There was a nuchal cord. After birth the infant is noted to have petechiae over the face and upper back. Information given to the infant’s parents should be based on the knowledge that petechiae:
a. Are benign if they disappear within 48 hours of birth.
b. Result from increased blood volume.
c. Should always be further investigated.
d. Usually occur with forceps delivery.
5. A newborn is jaundiced and receiving phototherapy via ultraviolet bank lights. An appropriate nursing intervention when caring for an infant with hyperbilirubinemia and receiving phototherapy by this method would be 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 newborn’s closed eyes.
d. Change the newborn’s position every 4 hours.
6. 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.
7. A mother expresses fear about changing her infant’s diaper after he is circumcised. What does the woman need to be taught to take care of the infant when she gets home?
a. Cleanse the penis with prepackaged diaper wipes every 3 to 4 hours.
b. Apply constant, firm pressure by squeezing the penis with the fingers for at least 5 minutes if bleeding occurs.
c. Cleanse the penis gently with water and put petroleum jelly around the glans after each diaper change.
d. Wash off the yellow exudate that forms on the glans at least once every day to prevent infection.
8. When preparing to administer a hepatitis B vaccine to a newborn, the nurse should:
a. Obtain a syringe with a 25-gauge, -inch needle.
b. Confirm that the newborn’s mother has been infected with the hepatitis B virus.
c. Assess the dorsogluteal muscle as the preferred site for injection.
d. Confirm that the newborn is at least 24 hours old.
9. As part of Standard Precautions, nurses wear gloves when handling the newborn. The chief reason is:
a. To protect the baby from infection.
b. That it is part of the Apgar protocol.
c. To protect the nurse from contamination by the newborn.
d. Because the nurse has primary responsibility for the baby during the first 2 hours.
10. At 1 minute after birth the nurse assesses the infant and notes: a heart rate of 80 beats/min, some flexion of extremities, a weak cry, grimacing, and a pink body but blue extremities. The nurse would calculate an Apgar score of:
Chapter 18: Newborn Nutrition and Feeding
1. A new mother recalls from prenatal class that she should try to feed her newborn daughter when she exhibits feeding readiness cues rather than waiting until her infant is crying frantically. On the basis of this information, this woman should feed her infant about every 2½ to 3 hours when she:
a. Waves her arms in the air.
b. Makes sucking motions.
c. Has the hiccups.
d. Stretches her legs out straight.
2. A new father is ready to take his wife and newborn son home. He proudly tells the nurse who is discharging them that within the next week he plans to start feeding the infant cereal between breastfeeding sessions. The nurse can explain to him that beginning solid foods before 4 to 6 months may:
a. Decrease the infant’s intake of sufficient calories.
b. Lead to early cessation of breastfeeding.
c. Help the infant sleep through the night.
d. Limit the infant’s growth.
3. A pregnant woman wants to breastfeed her infant; however, her husband is not convinced that there are any scientific reasons to do so. The nurse can give the couple printed information comparing breastfeeding and bottle-feeding. Which statement is true? Bottle-feeding using commercially prepared infant formulas:
a. Increases the risk that the infant will develop allergies.
b. Helps the infant sleep through the night.
c. Ensures that the infant is getting iron in a form that is easily absorbed.
d. Requires that multivitamin supplements be given to the infant.
4. A postpartum woman telephones about her 4-day-old infant. She is not scheduled for a weight check until the infant is 10 days old, and she is worried about whether breastfeeding is going well. Effective breastfeeding is indicated by the newborn who:
a. Sleeps for 6 hours at a time between feedings.
b. Has at least one breast milk stool every 24 hours.
c. Gains 1 to 2 ounces per week.
d. Has at least six to eight wet diapers per day.
5. A breastfeeding woman develops engorged breasts at 3 days’ postpartum. What action would help this woman achieve her goal of reducing the engorgement? The woman:
a. Skips feedings to let her sore breasts rest.
b. Avoids using a breast pump.
c. Breastfeeds her infant every 2 hours.
d. Reduces her fluid intake for 24 hours.
6. At a 2-month well-baby examination, it was discovered that a breastfed infant had only gained 10 ounces in the past 4 weeks. The mother and the nurse agree that, to gain weight faster, the infant needs to:
a. Begin solid foods.
b. Have a bottle of formula after every feeding.
c. Add at least one extra breastfeeding session every 24 hours.
d. Start iron supplements.
7. A new mother wants to be sure that she is meeting her daughter’s needs while feeding her commercially prepared infant formula. The nurse should evaluate the mother’s knowledge about appropriate infant care. The mother meets her child’s needs when she:
a. Adds rice cereal to her formula at 2 weeks of age to ensure adequate nutrition.
b. Warms the bottles using a microwave oven.
c. Burps her infant during and after the feeding as needed.
d. Refrigerates any leftover formula for the next feeding.
8. The nurse is discussing storage of breast milk with a mother whose infant is preterm and in the special care unit. Which statement would indicate that the mother needs additional teaching?
a. “I can store my breast milk in the refrigerator for 3 months.”
b. “I can store my breast milk in the freezer for 3 months.”
c. “I can store my breast milk at room temperature for 8 hours.”
d. “I can store my breast milk in the refrigerator for 3 to 5 days.”
9. According to the recommendations of the American Academy of Pediatrics on infant nutrition:
a. Infants should be given only human milk for the first 6 months of life.
b. Infants fed on formula should be started on solid food sooner than breastfed infants.
c. If infants are weaned from breast milk before 12 months, they should receive cow’s milk, not formula.
d. After 6 months, mothers should shift from breast milk to cow’s milk.
10. Which statement concerning the benefits or limitations of breastfeeding is NOT accurate?
a. Breast milk changes over time to meet changing needs as infants grow.
b. Long-term studies have shown that the benefits of breast milk continue after the infant is weaned.
c. Breast milk/breastfeeding may enhance cognitive development.
d. Breastfeeding increases the risk of childhood obesity.
Chapter 19: Assessment of High Risk Pregnancy
1. A woman arrives at the clinic seeking confirmation that she is pregnant. The following information is obtained: She is 24 years old and has a body mass index (BMI) of 17.5. She admits to having used cocaine “several times” during the past year and drinks alcohol occasionally. Her blood pressure (BP) is 108/70 mm Hg, her pulse rate is 72 beats/min, and her respiratory rate is 16 breaths/min. The family history is positive for diabetes mellitus and cancer. Her sister recently gave birth to an infant with a neural tube defect (NTD). Which characteristics place the woman in a high risk category?
a. Blood pressure, age, BMI
b. Drug/alcohol use, age, family history
c. Family history, blood pressure, BMI
d. Family history, BMI, drug/alcohol abuse
2. A 39-year-old primigravida thinks that she is about 8 weeks pregnant, although she has had irregular menstrual periods all her life. She has a history of smoking approximately one pack of cigarettes a day, but she tells you that she is trying to cut down. Her laboratory data are within normal limits. What diagnostic technique could be used with this pregnant woman at this time?
a. Ultrasound examination
b. Maternal serum alpha-fetoprotein screening (MSAFP)
d. Nonstress test (NST)
3. A 41-week pregnant multigravida presents in the labor and delivery unit after a nonstress test indicated that her fetus could be experiencing some difficulties in utero. Which diagnostic tool would yield more detailed information about the fetus?
a. Ultrasound for fetal anomalies
b. Biophysical profile (BPP)
c. Maternal serum alpha-fetoprotein screening (MSAFP)
d. Percutaneous umbilical blood sampling (PUBS)
4. At 35 weeks of pregnancy, a woman experiences preterm labor. Although tocolytics are administered and she is placed on bed rest, she continues to experience regular uterine contractions, and her cervix is beginning to dilate and efface. What would be an important test for fetal well-being at this time?
a. Percutaneous umbilical blood sampling (PUBS)
b. Ultrasound for fetal size
c. Amniocentesis for fetal lung maturity
d. Nonstress test
5. A maternal serum alpha-fetoprotein (AFP) test indicates an elevated level. It is repeated and again is reported as higher than normal. What would be the next step in the assessment sequence to determine the well-being of the fetus?
a. Percutaneous umbilical blood sampling (PUBS)
b. Ultrasound for fetal anomalies
c. Biophysical profile (BPP) for fetal well-being
d. Amniocentesis for genetic anomalies
6. A woman asks her nurse, “My doctor told me that he is concerned with the grade of my placenta because I am overdue. What does that mean?” The best response by the nurse is:
a. “Your placenta changes as your pregnancy progresses, and it is given a score that indicates the amount of calcium deposits it has. The more calcium deposits, the higher the grade, or number, that is assigned to the placenta. It also means that less blood and oxygen can be delivered to your baby.”
b. “Your placenta isn’t working properly, and your baby is in danger.”
c. “This means that we will need to perform an amniocentesis to detect if you have any placental damage.”
d. “Don’t worry about it. Everything is fine.”
7. A woman is undergoing a nipple-stimulated contraction stress test (CST). She is having contractions that occur every 3 minutes. The fetal heart rate (FHR) has a baseline of approximately 120 beats/min without any decelerations. The interpretation of this test is said to be:
8. In the United States today:
a. More than 20% of pregnancies meet the definition of high risk to either the mother or the infant.
b. Other than biophysical criteria, the greatest socioeconomic risk factor in high risk pregnancies is the inability to access prenatal care.
c. High risk pregnancy status extends from first confirmation of pregnancy to birth.
d. High risk pregnancy is a less critical medical concern because of the reduction in family size and the decrease in unwanted pregnancies.
9. When nurses help their expectant mothers assess the daily fetal movement counts, they should be aware that:
a. Alcohol or cigarette smoke can irritate the fetus, causing greater activity.
b. “Kick counts” should be taken every half hour and averaged every 6 hours, with every other 6-hour stretch off.
c. The fetal alarm signal should go off when fetal movements stop entirely for 12 hours.
d. Obese mothers familiar with their bodies can assess fetal movement as well as average-size women can.
10. In comparing the abdominal and transvaginal methods of ultrasound examination, nurses should explain to their patients that:
a. Both require the woman to have a full bladder.
b. The abdominal examination is more useful in the first trimester.
c. Initially the transvaginal examination can be painful.
d. The transvaginal examination allows pelvic anatomy to be evaluated in greater detail.
Chapter 20: Pregnancy at Risk: Preexisting Conditions
1. In assessing the knowledge of a pregestational woman with type 1 diabetes concerning changing insulin needs during pregnancy, the nurse recognizes that further teaching is warranted when the woman states:
a. “I will need to increase my insulin dosage during the first 3 months of pregnancy.”
b. “Insulin dosage will likely need to be increased during the second and third trimesters.”
c. “Episodes of hypoglycemia are more likely to occur during the first 3 months.”
d. “Insulin needs should return to normal within 7 to 10 days after birth if I am bottle-feeding.”
2. Preconception counseling is critical to the outcome of diabetic pregnancies because poor glycemic control before and during early pregnancy is associated with:
a. Frequent episodes of maternal hypoglycemia.
b. Congenital anomalies in the fetus.
d. Hyperemesis gravidarum.
3. In teaching the woman with pregestational diabetes about desired glucose levels, the nurse explains that a normal fasting glucose level, such as before breakfast, is in the range of:
a. 65 to 95 mg/dl.
b. 130 to 140 mg/dl.
c. 200 mg/dl.
d. 55 mg/dl.
4. Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the woman mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. The nurse identifies that the fetus is at greatest risk for:
b. Congenital anomalies of the central nervous system.
c. Preterm birth.
d. Low birth weight.
5. A 26-year-old primigravida has come to the clinic for her regular prenatal visit at 12 weeks. She appears thin and somewhat nervous. She reports that she eats a well-balanced diet, although her weight is 5 pounds less than it was at her last visit. The results of laboratory studies confirm that she has a hyperthyroid condition. Based on the available data, the nurse formulates a plan of care. What nursing diagnosis is most appropriate for the woman at this time?
a. Deficient fluid volume
b. Imbalanced nutrition: less than body requirements
c. Imbalanced nutrition: more than body requirements
d. Disturbed sleep pattern
6. Maternal phenylketonuria (PKU) is an important health concern during pregnancy because:
a. It is a recognized cause of preterm labor.
b. The fetus may develop neurologic problems.
c. A pregnant woman is more likely to die without dietary control.
d. Women with PKU are usually retarded and should not reproduce.
7. In terms of the incidence and classification of diabetes, maternity nurses should know that:
a. Type 1 diabetes is most common.
b. Type 2 diabetes often goes undiagnosed.
c. Gestational diabetes mellitus (GDM) means that the woman will be receiving insulin treatment until 6 weeks after birth.
d. Type 1 diabetes may become type 2 during pregnancy.
8. Metabolic changes throughout pregnancy that affect glucose and insulin in the mother and the fetus are complicated but important to understand. Nurses should know that:
a. Insulin crosses the placenta to the fetus only in the first trimester, after which the fetus secretes its own.
b. Women with insulin-dependent diabetes are prone to hyperglycemia during the first trimester because they are consuming more sugar.
c. During the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus.
d. Maternal insulin requirements steadily decline during pregnancy.
9. Methamphetamine use during pregnancy is a growing problem that the nurse working with obstetric patients must be cognizant of. When caring for the patient who uses methamphetamines, it is important for the nurse to be aware of which factor related to the abuse of this substance?
a. Methamphetamine is a depressant.
b. All methamphetamines are vasodilators.
c. Methamphetamine users are extremely psychologically addicted.
d. Rehabilitation is usually successful.
10. With regard to the association of maternal diabetes and other risk situations affecting mother and fetus, nurses should be aware that:
a. Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy.
b. Hydramnios occurs approximately twice as often in diabetic pregnancies.
c. Infections occur about as often and are considered about as serious in diabetic and nondiabetic pregnancies.
d. Even mild-to-moderate hypoglycemic episodes can have significant effects on fetal well-being.
AND MUCH MORE