Test Bank Maternity Womens Health Care 11th Edition, Lowdermilk
Chapter 01: 21st Century Maternity and Women’s Health Nursing
1. In evaluating the level of a pregnant woman’s risk of having a low-birth-weight (LBW) infant, which factor is the most important for the nurse to consider?
a. African-American race
b. Cigarette smoking
c. Poor nutritional status
d. Limited maternal education
2. 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
3. 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.
4. During a prenatal intake interview, the nurse is in the process of obtaining an initial assessment of a 21-year-old Hispanic client with limited English proficiency. Which action is the most important for the nurse to perform?
a. Use maternity jargon to enable the client to become familiar with these terms.
b. Speak quickly and efficiently to expedite the visit.
c. Provide the client with handouts.
d. Assess whether the client understands the discussion.
5. The nurses working at a newly established birthing center have begun to compare their performance in providing maternal-newborn care against clinical standards. This comparison process is most commonly known as what?
a. Best practices network
b. Clinical benchmarking
c. Outcomes-oriented practice
d. Evidence-based practice
6. Which statement best exemplifies contemporary maternity nursing?
a. Use of midwives for all vaginal deliveries
b. Family-centered care
c. Free-standing birth clinics
d. Physician-driven care
7. A 38-year-old Hispanic woman vaginally delivered a 9-pound, 6-ounce baby girl after being in labor for 43 hours. The baby died 3 days later from sepsis. On what grounds could the woman have a legitimate legal case for negligence?
a. Inexperienced maternity nurse was assigned to care for the client.
b. Client was past her due date by 3 days.
c. Standard of care was not met.
d. Client refused electronic fetal monitoring.
8. When the nurse is unsure how to perform a client care procedure that is high risk and low volume, his or her best action in this situation would be what?
a. Ask another nurse.
b. Discuss the procedure with the client’s physician.
c. Look up the procedure in a nursing textbook.
d. Consult the agency procedure manual, and follow the guidelines for the procedure.
9. The National Quality Forum has issued a list of “never events” specifically pertaining to maternal and child health. These include all of the following except:
a. infant discharged to the wrong person.
b. kernicterus associated with the failure to identify and treat hyperbilirubinemia.
c. artificial insemination with the wrong donor sperm or egg.
d. foreign object retained after surgery.
10. A nurse caring for a pregnant client 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 declining.
c. Cigarette smoking among pregnant women continues to increase.
d. Rates of pregnancy and abortion among teenagers are lower in the United States than in any other industrialized country.
Chapter 02: Community Care: The Family and Culture
1. A married couple lives in a single-family house with their newborn son and the husband’s daughter from a previous marriage. Based on this information, what family form best describes this family?
a. Married-blended family
b. Extended family
c. Nuclear family
d. Same-sex family
2. Which key factors play the most powerful role in the behaviors of individuals and families?
a. Rituals and customs
b. Beliefs and values
c. Boundaries and channels
d. Socialization processes
3. Using the family stress theory as an interventional approach for working with families experiencing parenting challenges, the nurse can assist the family in selecting and altering internal context factors. Which statement best describes the components of an internal context?
a. Biologic and genetic makeup
b. Maturation of family members
c. Family’s perception of the event
d. Prevailing cultural beliefs of society
4. The nurse is developing a plan of care for a Hispanic client who just delivered a newborn. Which cultural variation is most important to include in the care plan?
a. Breastfeeding is encouraged immediately after birth.
b. Male infants are typically circumcised.
c. Maternal grandmother participates in the care of the mother and her infant.
d. Bathing is encouraged immediately after delivery.
5. Which health care service represents a primary level of prevention?
b. Breast self-examination (BSE)
c. Home care for high-risk pregnancies
d. Blood pressure screening
6. What is the primary difference between hospital care and home health care?
a. Home care is routinely and continuously delivered by professional staff.
b. Home care is delivered on an intermittent basis by professional staff.
c. Home care is delivered for emergency conditions.
d. Home care is not available 24 hours a day.
7. To provide culturally competent care to an Asian-American family, which question should the nurse include during the assessment interview?
a. “Do you prefer hot or cold beverages?”
b. “Do you want some milk to drink?”
c. “Do you want music playing while you are in labor?”
d. “Do you have a name selected for the baby?”
8. The woman’s family members are present when the nurse arrives for a postpartum and newborn visit. What should the nurse do?
a. Observe the family members’ interactions with the newborn and one another.
b. Ask the woman to meet with her and the baby alone.
c. Perform a brief assessment on all family members who are present.
d. Reschedule the visit for another time so that the mother and infant can be privately assessed.
9. What is a limitation of a home postpartum visit?
a. Distractions limit the nurse’s ability to teach.
b. Identified problems cannot be resolved in the home setting.
c. Necessary items for infant care are not available.
d. Home visits to different families may require the nurse to travel a great distance.
10. During the childbearing experience, which behavior might the nurse expect from an African-American client?
a. Seeking prenatal care early in her pregnancy
b. Avoiding self-treatment of pregnancy-related discomfort
c. Requesting liver in the postpartum period to prevent anemia
d. Arriving at the hospital in advanced labor
Chapter 03: Nursing and Genomics
1. A father and mother are carriers of phenylketonuria (PKU). Their 2-year-old daughter has the condition. The couple tells the nurse that they are having a second baby. Because their daughter has PKU, they are certain that this baby will not be affected. Which response by the nurse is the most accurate?
a. “Good planning. You need to take advantage of the odds that are in your favor.”
b. “I think you’d better first check with your physician.”
c. “You are both carriers; therefore, each baby has a 25% chance of being affected.”
d. “The ultrasound indicates a boy, and boys are not affected by PKU.”
2. A client is 5 months pregnant. On a routine ultrasound scan, the physician discovers that the fetus has a diaphragmatic hernia. The woman becomes distraught and asks the nurse what she should do. Which response would be most suitable?
a. Talk to the client, and refer her to a genetic counselor.
b. Suggest that the client travel to a fetal treatment center for intrauterine surgery.
c. Tell her that everything is going to be fine.
d. Sit with the client, and calmly suggest that she consider terminating this pregnancy.
3. A client who is gravida 2 and 16 weeks of gestation comes in for her prenatal appointment. Her 2-year-old daughter is with her and is wearing a sleeveless top. While interacting with her daughter, you note axillary freckling and several café-au-lait spots (>2 cm). In reviewing her chart, the nurse should assess for documentation of which genetic disease?
a. Tay-Sachs disease
c. Neurofibromatosis (NF)
4. A new father has just been told that his infant has trisomy 18. Which identifying physical feature is unique to an infant with this genetic disorder?
a. Microcephaly and capillary hemangiomas
b. Epicanthal folds and a simian crease
c. Oblique palpebral fissures and Cri du chat syndrome
d. Rocker-bottom feet and clenched hands with overlapping fingers
5. A nurse is assessing the knowledge of new parents of a child born with Klinefelter syndrome. Which statement accurately describes this genetic disorder?
a. Klinefelter syndrome is a sex chromosome abnormality.
b. It affects only female children.
c. The disorder is expressed as trisomy XYY.
d. The child with this disorder will grow to be infertile.
6. Which factor is least likely to influence the decision to undergo genetic testing?
a. Anxiety and altered family relationships
b. Cost of testing or denial of insurance benefits
c. Imperfection of test results
d. Ethnic and socioeconomic disparity associated with genetic testing
7. A 32-year-old woman is pregnant for the third time. One child was born with cystic fibrosis, and the other child is healthy. The client and her husband wonder what chance this child has of having cystic fibrosis. This type of testing is most commonly known as what?
a. Occurrence risk
b. Recurrence risk
c. Predictive testing
d. Predisposition testing
8. Cancer is now recognized as a genetic disorder that begins with one or more genetic mutations. Which type of cancer is specifically being investigated in this regard?
a. Lung cancer
b. Liver cancer
c. Colorectal cancer
d. Oral cancer
9. Which statement describes a key finding of the Human Genome Project?
a. Humans produce one protein per gene.
b. All human beings are 99.9% identical at the deoxyribonucleic acid (DNA) level.
c. The Human Genome Project has not yet been able to translate the accumulating raw research into anything medically practical.
d. Humans have more genes than other species.
10. Which condition or treatment reduces the risk of morbidity in women with the inherited factor V Leiden disorder?
a. Anticoagulant therapy
c. Oral contraceptives
d. Hormone replacement therapy
Chapter 04: Assessment and Health Promotion
1. Due to the effects of cyclic ovarian changes in the breast, when is the best time for breast self-examination (BSE)?
a. Between 5 and 7 days after menses ceases
b. Day 1 of the endometrial cycle
c. Midmenstrual cycle
d. Any time during a shower or bath
2. Individual irregularities in the ovarian (menstrual) cycle are most often caused by what?
a. Variations in the follicular (preovulatory) phase
b. Intact hypothalamic-pituitary feedback mechanism
c. Functioning corpus luteum
d. Prolonged ischemic phase
3. How would the physiologic process of the sexual response best be characterized?
a. Coitus, masturbation, and fantasy
b. Myotonia and vasocongestion
c. Erection and orgasm
d. Excitement, plateau, and orgasm
4. Which action would be inappropriate for the nurse to perform before beginning the health history interview?
a. Smile and ask the client whether she has any special concerns.
b. Speak in a relaxed manner with an even, nonjudgmental tone.
c. Make the client comfortable.
d. Tell the client her questions are irrelevant.
5. The nurse guides a woman to the examination room and asks her to remove her clothes and put on an examination gown with the front open. The woman replies, “I have special undergarments that I do not remove for religious reasons.” Which is the most appropriate response from the nurse?
a. “You can’t have an examination without removing all your clothes.”
b. “I’ll ask the physician to modify the examination.”
c. “Tell me about your undergarments. I’ll explain the examination procedure, and then we can discuss how you can comfortably have your examination.”
d. “I have no idea how we can accommodate your beliefs.”
6. A woman arrives at the clinic for her annual examination. She tells the nurse that she thinks she has a vaginal infection, and she has been using an over-the-counter cream for the past 2 days to treat it. How should the nurse initially respond?
a. Inform the woman that vaginal creams may interfere with the Papanicolaou (Pap) test for which she is scheduled.
b. Reassure the woman that using vaginal cream is not a problem for the examination.
c. Ask the woman to describe the symptoms that indicate to her that she has a vaginal infection.
d. Ask the woman to reschedule the appointment for the examination.
7. Preconception and prenatal care have become important components of women’s health. What is the guiding principal of preconception care?
a. Ensure that pregnancy complications do not occur.
b. Identify the woman who should not become pregnant.
c. Encourage healthy lifestyles for families desiring pregnancy.
d. Ensure that women know about prenatal care.
8. Ovarian function and hormone production decline during which transitional phase?
9. Which statement indicates that a client requires additional instruction regarding BSE?
a. “Yellow discharge from my nipple is normal if I’m having my period.”
b. “I should check my breasts at the same time each month, after my period.”
c. “I should also feel in my armpit area while performing my breast examination.”
d. “I should check each breast in a set way, such as in a circular motion.”
10. A blind woman has arrived for an examination. Her guide dog assists her to the examination room. She appears nervous and says, “I’ve never had a pelvic examination.” What response from the nurse would be most appropriate?
a. “Don’t worry. It will be over before you know it.”
b. “Try to relax. I’ll be very gentle, and I won’t hurt you.”
c. “Your anxiety is common. I was anxious when I first had a pelvic examination.”
d. “I’ll let you touch each instrument that I’ll use during the examination as I tell you how it will be used.”
Chapter 05: Violence Against Women
1. Historically, what was the justification for the victimization of women?
a. Women were regarded as possessions.
b. Women were the “weaker sex.”
c. Control of women was necessary to protect them.
d. Women were created subordinate to men.
2. What is the primary theme of the feminist perspective regarding violence against women?
a. Role of testosterone as the underlying cause of men’s violent behavior
b. Basic human instinctual drive toward aggression
c. Male dominance and coercive control over women
d. Cultural norm of violence in Western society
3. Which trait is least likely to be displayed by a woman experiencing intimate partner violence (IPV)?
a. Socially isolated
b. Assertive personality
c. Struggling with depression
d. Dependent partner in a relationship
4. A woman who is 6 months pregnant has sought medical attention, saying she fell down the stairs. What scenario would cause an emergency department nurse to suspect that the woman has been a victim of IPV?
a. The woman and her partner are having an argument that is loud and hostile.
b. The woman has injuries on various parts of her body that are in different stages of healing.
c. Examination reveals a fractured arm and fresh bruises.
d. She avoids making eye contact and is hesitant to answer questions.
5. Which statement is most accurate regarding the reporting of IPV in the United States?
a. Asian women report more IPV than do other minority groups.
b. Caucasian women report less IPV than do non-Caucasians.
c. Native-American women report IPV at a rate similar to other groups.
d. African-American women are less likely to report IPV than Caucasian women.
6. Intervention for the sexual abuse survivor is often not attempted by maternity and women’s health nurses because of the concern about increasing the distress of the woman and the lack of expertise in counseling. What initial intervention is appropriate and most important in facilitating the woman’s care?
a. Initiating a referral to an expert counselor
b. Setting limits on what the client discloses
c. Listening and encouraging therapeutic communication skills
d. Acknowledging the nurse’s discomfort to the client as an expression of empathy
7. A young woman arrives at the emergency department and states that she thinks she has been raped. She is sobbing and expresses disbelief that this could happen because the perpetrator was a very close friend. Which statement is most appropriate at this time?
a. “Rape is not limited to strangers and frequently occurs by someone who is known to the victim.”
b. “I would be very upset if my best friend did that to me; that is very unusual.”
c. “You must feel very betrayed. In what way do you think you might have led him on?”
d. “This does not sound like rape. Didn’t you just change your mind about having sex after the fact?”
8. Nurses are often the first health care professional with whom a woman comes into contact after being sexually assaulted. Which statement best describes the initial care of a rape victim?
a. All legal evidence is preserved during the physical examination.
b. The victim appreciates the legal information; however, decides not to pursue legal proceedings.
c. The victim states that she is going to advocate against sexual violence.
d. The victim leaves the health care facility without feeling re-victimized.
9. When the nurse is alone with a battered client, the client seems extremely anxious and says, “It was all my fault. The house was so messy when he got home, and I know he hates that.” What is the most suitable response by the nurse?
a. “No one deserves to be hurt. It’s not your fault. How can I help you?”
b. “What else do you do that makes him angry enough to hurt you?”
c. “He will never find out what we talk about. Don’t worry. We’re here to help you.”
d. “You have to remember that he is frustrated and angry so he takes it out on you.”
10. Nurses who provide care to victims of IPV should be keenly aware of what?
a. Relationship violence usually consists of a single episode that the couple can put behind them.
b. Violence often declines or ends with pregnancy.
c. Financial coercion is considered part of IPV.
d. Battered women are generally poorly educated and come from a deprived social background.
Chapter 06: Reproductive System Concerns
1. Which condition is the least likely cause of amenorrhea in a 17–year–old client?
a. Anatomic abnormalities
b. Type 1 diabetes mellitus
2. When a nurse is counseling a woman for primary dysmenorrhea, which nonpharmacologic intervention might be recommended?
a. Increasing the intake of red meat to replace blood loss
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
3. Nafarelin (Synarel) is used to treat mild–to–severe endometriosis. What instruction or information should the nurse provide to a client regarding nafarelin administration?
a. Nafarelin stimulates the secretion of gonadotropin-releasing hormone (GnRH), thereby stimulating ovarian activity.
b. It should be administered by intramuscular (IM) injection.
c. Nafarelin should be administered by a subcutaneous implant.
d. It can cause the client to experience some hot flashes and vaginal dryness.
4. While interviewing a 31-year-old woman before her routine gynecologic examination, the nurse collects data about the client’s recent menstrual cycles. Which statement by the client should prompt the nurse to collect further information?
a. “My menstrual flow lasts 5 to 6 days.”
b. “My flow is very heavy.”
c. “I have had a small amount of spotting midway between my periods for the past 2 months.”
d. “The length of my menstrual cycles varies from 26 to 29 days.”
5. A 21–year–old client complains of severe pain immediately after the commencement of her menses. Which gynecologic condition is the most likely cause of this client’s presenting complaint?
a. Primary dysmenorrhea
b. Secondary dysmenorrhea
6. Which symptom described by a client is characteristic of premenstrual syndrome (PMS)?
a. “I feel irritable and moody a week before my period is supposed to start.”
b. “I have lower abdominal pain beginning on the third day of my menstrual period.”
c. “I have nausea and headaches after my period starts, and they last 2 to 3 days.”
d. “I have abdominal bloating and breast pain after a couple days of my period.”
7. A client complains of severe abdominal and pelvic pain around the time of menstruation. This pain has become progressively worse over the last 5 years. She also complains of pain during intercourse and has tried unsuccessfully to become pregnant for the past 18 months. To which condition are these symptoms most likely related?
c. Primary dysmenorrhea
d. Secondary dysmenorrhea
8. Which menopausal discomfort would the nurse anticipate when evaluating a woman for signs and symptoms of the climacteric?
b. Hot flashes
c. Mood swings
d. Vaginal dryness with dyspareunia
9. Which risk factor would the nurse recognize as being frequently associated with osteoporosis?
a. African-American race
b. Low–protein intake
d. Cigarette smoking
10. A perimenopausal client has arrived for her annual gynecologic examination. Which preexisting condition would be extremely important for the nurse to identify during a discussion regarding the risks and benefits of hormone therapy?
a. Breast cancer
b. Vaginal and urinary tract atrophy
Chapter 07: Sexually Transmitted and Other Infections
1. Syphilis is a complex disease that can lead to serious systemic illness and even death if left untreated. Which manifestation differentiates primary syphilis from secondary syphilis?
a. Fever, headache, and malaise
b. Widespread rash
c. Identified by serologic testing
d. Appearance of a chancre 2 months after infection
2. The human papillomavirus (HPV), also known as genital warts, affects 79 million Americans, with an estimated number of 14 million new infections each year. The highest rate of infection occurs in young women, ages 20 to 24 years. Prophylactic vaccination to prevent the HPV is now available. Which statement regarding this vaccine is inaccurate?
a. Only one vaccine for the HPV is available.
b. The vaccine is given in three doses over a 6-month period.
c. The vaccine is recommended for both boys and girls.
d. Ideally, the vaccine is administered before the first sexual contact.
3. Which sexually transmitted infection (STI) is the most commonly reported in American women?
4. The Centers for Disease Control and Prevention (CDC) recommends which therapy for the treatment of the HPV?
a. Miconazole ointment
b. Topical podofilox 0.5% solution or gel
c. Two doses of penicillin administered intramuscularly (IM)
d. Metronidazole by mouth
5. A client exhibits a thick, white, lumpy, cottage cheese–like discharge, along with white patches on her labia and in her vagina. She complains of intense pruritus. Which medication should the nurse practitioner order to treat this condition?
6. Which laboratory testing is used to detect the human immunodeficiency virus (HIV)?
a. HIV screening
b. HIV antibody testing
c. Cluster of differentiation 4 (CD4) counts
d. Cluster of differentiation 8 (CD8) counts
7. Which condition is the most life-threatening virus to the fetus and neonate?
a. Hepatitis A virus (HAV)
b. Herpes simplex virus (HSV)
c. Hepatitis B virus (HBV)
d. Cytomegalovirus (CMV)
8. Which treatment regime would be most appropriate for a client who has been recently diagnosed with acute pelvic inflammatory disease (PID)?
a. Oral antiviral therapy
b. Bed rest in a semi-Fowler position
c. Antibiotic regimen continued until symptoms subside
d. Frequent pelvic examination to monitor the healing progress
9. On vaginal examination of a 30-year-old woman, the nurse documents the following findings: profuse, thin, grayish-white vaginal discharge with a “fishy” odor and complaints of pruritus. Based upon these findings, which condition would the nurse suspect?
a. Bacterial vaginosis
10. Which viral sexually transmitted infection is characterized by a primary infection followed by recurrent episodes?
a. Herpes simplex virus 2 (HSV-2)
Chapter 08: Contraception and Abortion
1. A woman has chosen the calendar method of conception control. Which is the most important action the nurse should perform during the assessment process?
a. Obtain a history of the woman’s menstrual cycle lengths for the past 6 to 12 months.
b. Determine the client’s weight gain and loss pattern for the previous year.
c. Examine skin pigmentation and hair texture for hormonal changes.
d. Explore the client’s previous experiences with conception control.
2. A married couple is discussing alternatives for pregnancy prevention and has asked about fertility awareness methods (FAMs). Which response by the nurse is most appropriate?
a. “They’re not very effective, and it is very likely that you’ll get pregnant.”
b. “FAMs can be effective for many couples; however, 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.”
3. A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks the nurse about the pill as a contraceptive choice. What is the nurse’s best response?
a. “Oral contraceptives are a highly effective method, but they have some side effects.”
b. “Your current medications will reduce the effectiveness of the pill.”
c. “Oral contraceptives will reduce the effectiveness of your seizure medication.”
d. “The pill is a good choice for a woman of your age and with your personal history.”
4. A woman who has just undergone a first-trimester abortion will be using oral contraceptives. To protect against pregnancy, the client should be advised to do what?
a. Avoid sexual contact for at least 10 days after starting the pill.
b. Use condoms and foam for the first few weeks as a backup.
c. Use another method of contraception for 1 week after starting the pill.
d. Begin sexual relations once vaginal bleeding has ended.
5. Which client would be an ideal candidate for injectable progestins such as Depo-Provera (DMPA) as a contraceptive choice?
a. The ideal candidate for DMPA wants menstrual regularity and predictability.
b. The client has a history of thrombotic problems or breast cancer.
c. The ideal candidate has difficulty remembering to take oral contraceptives daily.
d. The client is homeless or mobile and rarely receives health care.
6. A client currently uses a diaphragm and spermicide for contraception. She asks the nurse to explain the major differences between the cervical cap and the diaphragm. What is the mostappropriate response by the nurse?
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 be safely used for repeated acts of intercourse without adding more spermicide later.”
7. Which statement regarding emergency contraception is correct?
a. Emergency contraception requires that the first dose be taken within 72 hours of unprotected intercourse.
b. Emergency contraception may be taken right after ovulation.
c. Emergency contraception has an effectiveness rate in preventing pregnancy of approximately 50%.
d. Emergency contraception is commonly associated with the side effect of menorrhagia.
8. An unmarried young woman describes her sex life as “active” and involving “many” partners. She wants a contraceptive method that is reliable and does not interfere with sex. She requests an intrauterine device (IUD). Which information is most important for the nurse to share?
a. “The IUD does not interfere with sex.”
b. “The risk of pelvic inflammatory disease will be higher with the IUD.”
c. “The IUD will protect you from sexually transmitted infections.”
d. “Pregnancy rates are high with the IUD.”
9. A woman is 16 weeks pregnant and has elected to terminate her pregnancy. Which is the mostcommon technique used for the termination of a pregnancy in the second trimester?
a. Dilation and evacuation (D&E)
b. Methotrexate administration
c. Prostaglandin administration
d. Vacuum aspiration
10. A woman will be taking oral contraceptives using a 28-day pack. What advice should the nurse provide to protect this client from an unintended pregnancy?
a. Limit sexual contact for one cycle after starting the pill.
b. Use condoms and foam instead of the pill for as long as the client takes an antibiotic.
c. Take one pill at the same time every day.
d. Throw away the pack and use a backup method if two pills are missed during week 1 of her cycle.
Chapter 09: Infertility
1. Which test is performed around the time of ovulation to diagnose the basis of infertility?
d. Follicle-stimulating hormone (FSH) level
2. An infertility specialist prescribes clomiphene citrate (Clomid, Serophene) for a woman experiencing infertility. She is very concerned about the risk of multiple pregnancies. What is the nurse’s most appropriate response?
a. “This is a legitimate concern. Would you like to discuss further the chances of multiple pregnancies before your treatment begins?”
b. “No one has ever had more than triplets with Clomid.”
c. “Ovulation will be monitored with ultrasound to ensure that multiple pregnancies will not happen.”
d. “Ten percent is a very low risk, so you don’t need to worry too much.”
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. Which guidance should the nurse provide?
a. “Your sperm count seems to be okay in the first semen analysis.”
b. “Only marijuana cigarettes affect sperm count.”
c. “Although smoking has no effect on sperm count, it can give you lung cancer.”
d. “Smoking can reduce the quality of your sperm.”
4. A couple comes in for an infertility workup, having attempted to achieve pregnancy for 2 years. The woman, 37 years of age, has always had irregular menstrual cycles but is otherwise healthy. The man has fathered two children from a previous marriage and had a vasectomy reversal 2 years ago. The man has had two normal semen analyses, but the sperm seem to be clumped together. What additional testing is needed?
a. Testicular biopsy
b. Antisperm antibodies
c. FSH level
d. Examination for testicular infection
5. A couple is attempting to cope with an infertility problem. They want to know what they can do to preserve their emotional equilibrium. What is the nurse’s most appropriate response?
a. “Tell your friends and family so that 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 adopting an infant can be very difficult.”
6. The nurse working with clients who have infertility concerns should be aware of the use of leuprolide acetate (Lupron) as a gonadotropin-releasing hormone (GnRH) agonist. For which condition would this medication be prescribed?
a. Anovulatory cycles
b. Uterine fibroids
c. Polycystic ovary disease (PCOD)
d. Luteal phase inadequacy
7. Which condition would be inappropriate to treat with exogenous progesterone (human chorionic gonadotropin)?
a. Thyroid dysfunction
b. Recent miscarriage
d. Oocyte retrieval
8. In vitro fertilization–embryo transfer (IVF-ET) is a common approach for women with blocked fallopian tubes or with unexplained infertility and for men with very low sperm counts. A husband and wife have arrived for their preprocedural interview. Which explanation regarding the procedure is most accurate?
a. “The procedure begins with collecting eggs from your wife’s ovaries.”
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.”
9. With regard to the assessment of female, male, or couple infertility, the nurse should be aware of which important information?
a. The couple’s religious, cultural, and ethnic backgrounds provide emotional clutter that does not affect the clinical scientific diagnosis.
b. The investigation will take several months and can be very costly.
c. The woman is assessed first; if she is not the problem, then the male partner is analyzed.
d. Semen analysis is for men; the postcoital test is for women.
10. The nurse is having her first meeting with a couple experiencing infertility. The nurse has formulated the nursing diagnosis, “Deficient knowledge, related to lack of understanding of the reproductive process with regard to conception.” Which nursing intervention does not apply to this diagnosis?
a. Assess the current level of factors promoting conception.
b. Provide information regarding conception in a supportive manner.
c. Evaluate the couple’s support system.
d. Identify and describe the basic infertility tests.
Chapter 10: Problems of the Breast
1. A nurse is providing breast care education to a client after mammography. Which information regarding fibrocystic changes in the breast is important for the nurse to share?
a. Fibrocystic breast disease is a disease of the milk ducts and glands in the breasts.
b. It is a premalignant disorder characterized by lumps found in the breast tissue.
c. Healthy women with fibrocystic breast disease find lumpiness with pain and tenderness in varying degrees in the breast tissue during menstrual cycles.
d. Lumpiness is accompanied by tenderness after menses.
2. A nurse is providing education to a support group of women newly diagnosed with breast cancer. It is important for the nurse to discuss which factor related to breast cancer with the group?
a. Genetic mutations account for 50% of women who will develop breast cancer.
b. Breast cancer is the leading cause of cancer death in women.
c. In the United States, 1 in 10 women will develop breast cancer in her lifetime.
d. The exact cause of breast cancer remains unknown.
3. Which diagnostic test is used to confirm a suspected diagnosis of breast cancer?
c. Needle-localization biopsy
d. Magnetic resonance imaging (MRI)
4. A healthy 60-year-old African-American woman regularly receives health care at her neighborhood clinic. She is due for a mammogram. At her first visit, her health care provider is concerned about the 3-week wait at the neighborhood clinic and made an appointment for her to have a mammogram at a teaching hospital across town. She did not keep her appointment and returned to the clinic today to have the nurse check her blood pressure. What is the mostappropriate statement for the nurse to make to this client?
a. “Do you have transportation to the teaching hospital so that you can get your mammogram?”
b. “I’m concerned that you missed your appointment; let me make another one for you.”
c. “It’s very dangerous to skip your mammograms; your breasts need to be checked.”
d. “Would you like me to make an appointment for you to have your mammogram here?”
5. A client’s oncologist has just finished explaining the diagnostic workup results to her, and she still has questions. The woman states, “The physician says I have a slow-growing cancer. Very few cells are dividing. How does she know this?” What is the name of the test that gave the health care provider this information?
a. Tumor ploidy
b. S-phase index
c. Nuclear grade
d. Estrogen-receptor assay
6. Breast pain occurs in many women during their perimenopausal years. Which information is a priority for the nurse to share with the client?
a. Breast pain is an early indication of cancer.
b. Pain is almost always an indication of a solid mass.
c. Distinguishing between cyclical and noncyclical pain is important.
d. Breast pain is most often treated with narcotics.
7. After a mastectomy, which activity should the client be instructed to avoid?
a. Emptying surgical drains twice a day and as needed
b. Lifting more than 4.5 kg (10 lb) or reaching above her head until given permission by her surgeon
c. Wearing clothing with snug sleeves to support the tissue of the arm on the operative side
d. Immediately reporting inflammation that develops at the incision site or in the affected arm
8. A health care provider performs a clinical breast examination on a woman diagnosed with fibroadenoma. How would the nurse explain the defining characteristics of a fibroadenoma?
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. Single lump in one breast that can be expected to shrink as the woman ages
9. What important, immediate postoperative care practice should the nurse remember when caring for a woman who has had a mastectomy?
a. The blood pressure (BP) cuff should not be applied to the affected arm.
b. Venipuncture for blood work should be performed on the affected arm.
c. The affected arm should be used for intravenous (IV) therapy.
d. The affected arm should be held down close to the woman’s side.
10. A woman has a breast mass that is not well delineated and is nonpalpable, immobile, and nontender. Which condition is this client experiencing?
c. Intraductal papilloma
d. Mammary duct ectasia
Chapter 11: Structural Disorders and Neoplasms of the Reproductive System
1. The nurse should be aware that a pessary is most effective in the treatment of which disorder?
b. Uterine prolapse
d. Stress urinary incontinence
2. A postmenopausal woman has been diagnosed with two leiomyomas (fibroids). Which clinical finding is most commonly associated with the presence of leiomyomas?
a. Abnormal uterine bleeding
c. Weight loss
d. Acute abdominal pain
3. Which woman is at the greatest risk for psychologic complications after hysterectomy?
a. 55-year-old woman who has been having abnormal bleeding and pain for 3 years
b. 46-year-old woman who has had three children and has just been promoted at work
c. 62-year-old widow who has three friends who have had uncomplicated hysterectomies
d. 19-year-old woman who had a ruptured uterus after giving birth to her first child
4. A 48-year-old woman has just had a hysterectomy for endometrial cancer. Which statement alerts the nurse that further teaching is needed?
a. “I can’t wait to go on the cruise that I have planned for this summer.”
b. “I know that the surgery saved my life, but I will miss having sexual intercourse with my husband.”
c. “I have asked my daughter to come and stay with me next week after I am discharged from the hospital.”
d. “Well, I don’t have to worry about getting pregnant anymore.”
5. The nurse provides education to a client about to undergo external radiation therapy. Which statement by the client reassures the nurse that the teaching has been effective?
a. “I am using ointment to keep my skin from drying out.”
b. “I wash the irradiated area with deodorant soap.”
c. “My diet is high in protein, and I drink at least 2000 ml of fluid a day.”
d. “I wash off the markings for the radiation site after each treatment.”
6. With regard to the treatment plan for a pregnant woman with gynecologic cancer, which statement about timing or type of treatment is correct?
a. The fetus is most at risk during the first trimester.
b. The fetus is most at risk during the second trimester.
c. The fetus is most at risk during the third trimester.
d. Surgery is more risky than chemotherapy in the first trimester.
7. Which precaution should the nurse take while caring for a client who is undergoing internal radiation therapy for cervical cancer?
a. Wear gloves when assessing the cervical intracavity implant.
b. Instruct the client to urinate in the lead-lined bedpan or “hat” every 2 hours.
c. Prepare the client for an enema before inserting the implant.
d. Limit staff or visitor exposure to 30 minutes or less in an 8-hour period.
8. What is the most common reproductive tract cancer associated with pregnancy?
d. Fallopian tube
9. When caring for clients with neoplasms of the reproductive system, the nurse must begin by assessing the woman’s knowledge of the disorder, its management, and prognosis. This assessment should be followed by a nursing diagnosis. Which diagnosis fails to address the psychologic effect of these disorders?
a. Anxiety, related to surgical procedures
b. Disturbed body image, as a result of changes in anatomy
c. Risk for injury, related to lack of skill for self-care
d. Interrupted family processes
10. The prevalence of urinary incontinence (UI) increases as women age, with more than one third of the women in the United States suffering from some form of this disorder. The symptoms of mild-to-moderate UI can be successfully decreased by a number of strategies. Which of these should the nurse instruct the client to use first?
a. Pelvic floor support devices
b. Bladder training and pelvic muscle exercises
Chapter 12: Conception and Fetal Development
1. A newly married couple plans to use the natural family planning method of contraception. Understanding how long an ovum can live after ovulation is important to them. The nurse knows that his or her teaching was effective when the couple responds that an ovum is considered fertile for which period of time?
a. 6 to 8 hours
b. 24 hours
c. 2 to 3 days
d. 1 week
2. What kind of fetal anomalies are most often associated with oligohydramnios?
3. A pregnant woman at 25 weeks of gestation tells the nurse that she dropped a pan last week and her baby jumped at the noise. Which response by the nurse is most accurate?
a. “That must have been a coincidence; babies can’t respond like that.”
b. “The fetus is demonstrating the aural reflex.”
c. “Babies respond to sound starting at approximately 24 weeks of gestation.”
d. “Let me know if it happens again; we need to report that to your midwife.”
4. At a routine prenatal visit, the nurse explains the development of the fetus to her client. At approximately ____ weeks of gestation, lecithin is forming on the alveolar surfaces, the eyelids open, and the fetus measures approximately 27 cm crown to rump and weighs approximately 1110 g. The client is how many weeks of gestation at today’s visit?
5. Which statement regarding the structure and function of the placenta is correct?
a. Produces nutrients for fetal nutrition
b. Secretes both estrogen and progesterone
c. Forms a protective, impenetrable barrier to microorganisms such as bacteria and viruses
d. Excretes prolactin and insulin
6. A woman in labor passes some thick meconium as her amniotic fluid ruptures. The client asks the nurse where the baby makes the meconium. What is the correct response by the nurse?
a. Fetal intestines
b. Fetal kidneys
c. Amniotic fluid
7. A woman asks the nurse, “What protects my baby’s umbilical cord from being squashed while the baby’s inside of me?” What is the nurse’s best response?
a. “Your baby’s umbilical cord is surrounded by connective tissue called Wharton’s jelly, which prevents compression of the blood vessels.”
b. “Your baby’s umbilical cord floats around in blood and amniotic fluid.”
c. “You don’t need to be worrying about things like that.”
d. “The umbilical cord is a group of blood vessels that are very well protected by the placenta.”
8. Which structure is responsible for oxygen and carbon dioxide transport to and from the maternal bloodstream?
a. Decidua basalis
c. Germ layer
d. Chorionic villi
9. A woman who is 8 months pregnant asks the nurse, “Does my baby have any antibodies to fight infection?” What is the most appropriate response by the nurse?
a. “Your baby has all the immunoglobulins necessary: immunoglobulin G (IgG), immunoglobulin M (IgM), and immunoglobulin A (IgA).”
b. “Your baby won’t receive any antibodies until he is born and you breastfeed him.”
c. “Your baby does not have any antibodies to fight infection.”
d. “Your baby has IgG and IgM.”
10. The measurement of lecithin in relation to sphingomyelin (lecithin/sphingomyelin [L/S] ratio) is used to determine fetal lung maturity. Which ratio reflects fetal maturity of the lungs?
Chapter 13: 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 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. Which presumptive sign or symptom of pregnancy would a client experience who is approximately 10 weeks of gestation?
b. Positive pregnancy test
c. Chadwick sign
d. Hegar sign
3. A client is seen at the clinic at 14 weeks of gestation for a follow-up appointment. At which level does the nurse expect to palpate the fundus?
a. Nonpalpable above the symphysis at 14 weeks of gestation
b. Slightly above the symphysis pubis
c. At the level of the umbilicus
d. Slightly above the umbilicus
4. The musculoskeletal system adapts to the changes that occur throughout the pregnancy. Which musculoskeletal alteration should the client expect?
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.
5. A 31-year-old woman believes that she may be pregnant. She took an over-the-counter (OTC) pregnancy test 1 week ago after missing her period; the test was positive. During her assessment interview, the nurse inquires about the woman’s last menstrual period and asks whether she is taking any medications. The client states that she takes medicine for epilepsy. She has been under considerable stress lately at work and has not been sleeping well. Her physical examination does not indicate that she is pregnant. She has an ultrasound scan, which confirms that she is not pregnant. What is the most likely cause of the false-positive pregnancy test result?
a. The pregnancy test was taken too early.
b. Anticonvulsant medications may cause the false-positive test result.
c. The woman has a fibroid tumor.
d. She has been under considerable stress and has a hormone imbalance.
6. A woman is in her seventh month of pregnancy. She has been complaining of nasal congestion and occasional epistaxis. Which statement best describes why this may be happening to this client?
a. This respiratory change is normal in pregnancy and caused by an elevated level of estrogen.
b. This cardiovascular change is abnormal, 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 intranasally using cocaine.
7. The nurse is providing education to a client regarding the normal changes of the breasts during pregnancy. Which statement regarding these changes is correct?
a. The visibility of blood vessels that form an intertwining blue network indicates full function of the Montgomery tubercles and possibly an infection of the tubercles.
b. The mammary glands do not develop until 2 weeks before labor.
c. Lactation is inhibited until the estrogen level declines after birth.
d. Colostrum is the yellowish oily substance used to lubricate the nipples for breastfeeding.
8. Which hormone is essential for maintaining pregnancy?
9. Which clinical finding in a primiparous client at 32 weeks of gestation might be an indication of anemia?
d. Decreased peristalsis
10. Why might it be more difficult to diagnose appendicitis during pregnancy?
a. The appendix is displaced upward and laterally, high and to the right.
b. The appendix is displaced upward and laterally, high and to the left.
c. The appendix is deep at the McBurney’s point.
d. The appendix is displaced downward and laterally, low and to the right.
Chapter 14: Nursing Care of the Family During Pregnancy
1. Ideally, when should prenatal care 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. A woman arrives at the clinic for a pregnancy test. Her last menstrual period (LMP) was February 14, 2015. What is the client’s expected date of birth (EDB)?
a. September 17, 2015
b. November 7, 2015
c. November 21, 2015
d. December 17, 2015
3. Which women should undergo prenatal testing for the human immunodeficiency virus (HIV)?
a. All women, regardless of risk factors
b. Women who have had more than one sexual partner
c. Women who have had a sexually transmitted infection (STI)
d. Woman who are monogamous with one partner
4. Which sign or symptom is considered a first-trimester warning sign and should be immediately reported by the pregnant woman to her health care provider?
a. Nausea with occasional vomiting
c. Urinary frequency
d. Vaginal bleeding
5. Which client might be well advised to continue condom use during intercourse throughout her pregnancy?
a. Unmarried pregnant women
b. Women at risk for acquiring or transmitting STIs
c. All pregnant women
d. Women at risk for candidiasis
6. Which condition is likely to be identified by the quadruple marker screen?
a. Down syndrome
b. Diaphragmatic hernia
c. Congenital cardiac abnormality
7. 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. Which intervention should the nurse recommend?
a. Kegel exercises
b. Pelvic rock exercises
c. Softer mattress
d. Bed rest for 24 hours
8. A woman is 3 months pregnant. At her prenatal visit she tells the nurse that she does not know what is happening; one minute she is happy that she is pregnant and the next minute she cries for no reason. Which response by the nurse is most appropriate?
a. “Don’t worry about it; you’ll feel better in a month or so.”
b. “Have you talked to your husband about how you feel?”
c. “Perhaps you really don’t want to be pregnant.”
d. “Hormone changes during pregnancy commonly result in mood swings.”
9. What is the primary role of the nonpregnant partner during pregnancy?
a. To provide financial support
b. To protect the pregnant woman from “old wives’ tales”
c. To support and nurture the pregnant woman
d. To make sure the pregnant woman keeps prenatal appointments
10. During the first trimester, which of the following changes regarding her sexual drive should a client be taught to expect?
a. Increased sexual drive, because of enlarging breasts
b. Decreased sexual drive, because of nausea and fatigue
c. No change in her sexual drive
d. Increased sexual drive, because of increased levels of female hormones
Chapter 15: Maternal and Fetal Nutrition
1. Which nutrient’s recommended dietary allowance (RDA) is higher during lactation than during pregnancy?
a. Energy (kcal)
c. Vitamin A
d. Folic acid
2. A pregnant woman’s diet consists almost entirely of whole grain breads and cereals, fruits, and vegetables. Which dietary requirement is the nurse most concerned about?
c. Vitamin B12
d. Folic acid
3. Which statement made by a lactating woman leads the nurse to believe that the client 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.”
4. A client states that she does not drink milk. Which foods should the nurse encourage this woman to consume in greater amounts to increase her calcium intake?
a. Fresh apricots
b. Canned clams
c. Spaghetti with meat sauce
d. Canned sardines
5. A 27-year-old pregnant woman had a preconceptual body mass index (BMI) of 19. What is this client’s total recommended weight gain during pregnancy?
a. 20 kg (44 lb)
b. 16 kg (35 lb)
c. 12.5 kg (27.5 lb)
d. 10 kg (22 lb)
6. A woman has come to the clinic for preconception counseling because she wants to start trying to get pregnant. Which guidance should she expect to receive?
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 regularly taking.”
d. “Make sure you include adequate folic acid in your diet.”
7. To prevent gastrointestinal (GI) upset, when should a pregnant client be instructed to take the recommended iron supplements?
a. On a full stomach
b. At bedtime
c. After eating a meal
d. With milk
8. After the nurse completes nutritional counseling for a pregnant woman, she asks the client to repeat the instructions to assess the client’s understanding. Which statement indicates that the client understands the role of protein in her pregnancy?
a. “Protein will help my baby grow.”
b. “Eating protein will prevent me from becoming anemic.”
c. “Eating protein will make my baby have strong teeth after he is born.”
d. “Eating protein will prevent me from being diabetic.”
9. Pregnant adolescents are at greater risk for decreased BMI and “fad” dieting with which condition?
b. Gestational diabetes
c. Low-birth-weight babies
d. High-birth-weight babies
10. Maternal nutritional status is an especially significant factor of the many that influence the outcome of pregnancy. Why is this the case?
a. Maternal nutritional status is extremely difficult to adjust because of an individual’s ingrained eating habits.
b. Adequate nutrition is an important preventive measure for a variety of problems.
c. Women love obsessing about their weight and diets.
d. A woman’s preconception weight becomes irrelevant.
Chapter 16: Labor and Birth Processes
1. A new mother asks the nurse when the “soft spot” on her son’s head will go away. What is the nurse’s best response, based upon her understanding of when the anterior frontal closes?
a. 2 months
b. 8 months
c. 12 months
d. 18 months
2. The nurse is performing an initial assessment of a client in labor. What is the appropriate terminology for the relationship of the fetal body parts to one another?
3. When assessing the fetus using Leopold’s maneuvers, the nurse feels a round, firm, and 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 position of the fetus?
4. Which statement by the client would lead the nurse to believe that labor has been established?
a. “I passed some thick, pink mucus when I urinated this morning.”
b. “My bag of waters just broke.”
c. “The contractions in my uterus are getting stronger and closer together.”
d. “My baby dropped, and I have to urinate more frequently now.”
5. The nurse has received a report regarding a client in labor. The woman’s last vaginal examination was recorded as 3 cm, 30%, and –2. What is the nurse’s interpretation of this assessment?
a. Cervix is effaced 3 cm and dilated 30%; the presenting part is 2 cm above the ischial spines.
b. Cervix is dilated 3 cm and effaced 30%; the presenting part is 2 cm above the ischial spines.
c. Cervix is effaced 3 cm and dilated 30%; the presenting part is 2 cm below the ischial spines.
d. Cervix is dilated 3 cm and effaced 30%; the presenting part is 2 cm below the ischial spines.
6. A pregnant woman is at 38 weeks of gestation. She wants to know whether there are any signs that “labor is getting close to starting.” Which finding is an indication that labor may begin soon?
a. Weight gain of 1.5 to 2 kg (3 to 4 lb)
b. Increase in fundal height
c. Urinary retention
d. Surge of energy
7. Which stage of labor varies the most in length?
8. The nurse expects 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
9. What is the correct term describing the slight overlapping of cranial bones or shaping of the fetal head during labor?
c. Ferguson reflex
d. Valsalva maneuver
10. Which presentation is accurately described in terms of both the resenting part and the frequency of occurrence?
a. Cephalic: occiput, at least 96%
b. Breech: sacrum, 10% to 15%
c. Shoulder: scapula, 10% to 15%
d. Cephalic: cranial, 80% to 85%
Chapter 17: Maximizing Comfort for the Laboring Woman
1. An 18-year-old pregnant woman, gravida 1, para 0, is admitted to the labor and birth unit with moderate contractions every 5 minutes that last 40 seconds. The client states, “My contractions are so strong, I don’t know what to do.” Before making a plan of care, what should the nurse’s first action be?
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. A woman who is pregnant for the first time is dilated 3 cm and having contractions every 5 minutes. She is groaning and perspiring excessively; she states that she did not attend childbirth classes. What is the optimal intervention for the nurse to provide at this time?
a. Notify the woman’s health care provider.
b. Administer the prescribed narcotic analgesic.
c. Assure her that her labor will be over soon.
d. Assist her with simple breathing and relaxation instructions.
3. Nursing care measures are commonly offered to women in labor. Which nursing measure reflects the application of the gate-control theory?
a. Massage the woman’s back.
b. Change the woman’s position.
c. Give the prescribed medication.
d. Encourage the woman to rest between contractions.
4. Breathing patterns are taught to laboring women. Which breathing pattern should the nurse support for the woman and her coach during the latent phase of the first stage of labor if the couple has attended childbirth preparation classes?
a. Slow-paced breathing
b. Deep abdominal breathing
c. Modified-paced breathing
d. Patterned-paced breathing
5. A laboring woman has received meperidine (Demerol) intravenously (IV), 90 minutes before giving birth. Which medication should be available to reduce the postnatal effects of meperidine on the neonate?
a. Fentanyl (Sublimaze)
b. Promethazine (Phenergan)
c. Naloxone (Narcan)
d. Nalbuphine (Nubain)
6. What should the laboring client who receives an opioid antagonist be told to expect?
a. Her pain will decrease.
b. Her pain will return.
c. She will feel less anxious.
d. She will no longer feel the urge to push.
7. A client is in early labor, and her nurse is discussing the pain relief options she is considering. The client states that she wants an epidural “no matter what!” What is the nurse’s best response?
a. “I’ll make sure you get your epidural.”
b. “You may only have an epidural if your physician allows it.”
c. “You may only have an epidural if you are going to deliver vaginally.”
d. “The type of analgesia or anesthesia used is determined, in part, by the stage of your labor and the method of birth.”
8. What is the role of the nurse as it applies to informed consent?
a. Inform the client about the procedure, and ask her to sign the consent form.
b. Act as a client advocate, and help clarify the procedure and the options.
c. Call the physician to see the client.
d. Witness the signing of the consent form.
9. A first-time mother is concerned about the type of medications she will receive during labor. The client is in a fair amount of pain and is nauseated. In addition, she appears to be very anxious. The nurse explains that opioid analgesics are often used along with sedatives. How should the nurse phrase the rationale for this medication combination?
a. “The two medications, together, reduce complications.”
b. “Sedatives enhance the effect of the pain medication.”
c. “The two medications work better together, enabling you to sleep until you have the baby.”
d. “This is what your physician has ordered for you.”
10. The nurse should be cognizant of which physiologic effect of pain?
a. Predominant pain of the first stage of labor is visceral pain that is located in the lower portion of the abdomen.
b. Referred pain is the extreme discomfort experienced between contractions.
c. 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 pain experienced during the second stage.
Chapter 18: Fetal Assessment During Labor
1. What is the most likely cause for early decelerations in the fetal heart rate (FHR) pattern?
a. Altered fetal cerebral blood flow
b. Umbilical cord compression
c. Uteroplacental insufficiency
d. Spontaneous rupture of membranes
2. Which clinical finding or intervention might be considered the rationale for fetal tachycardia to occur?
a. Maternal fever
b. Umbilical cord prolapse
c. Regional anesthesia
d. Magnesium sulfate administration
3. While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the 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. What is the nurse’s firstpriority?
a. Change the woman’s position.
b. Notify the health care provider.
c. Assist with amnioinfusion
d. Insert a scalp electrode.
4. What is the most likely cause for variable FHR decelerations?
a. Altered fetal cerebral blood flow
b. Umbilical cord compression
c. Uteroplacental insufficiency
d. Fetal hypoxemia
5. The nurse providing care for a high-risk laboring woman is alert for late FHR decelerations. Which clinical finding might be the cause for these late decelerations?
a. Altered cerebral blood flow
b. Umbilical cord compression
c. Uteroplacental insufficiency
d. Meconium fluid
6. Which alteration in the FHR pattern would indicate the potential need for an amnioinfusion?
a. Variable decelerations
b. Late decelerations
c. Fetal bradycardia
d. Fetal tachycardia
7. Which FHR finding is the most concerning to the nurse who is providing care to a laboring client?
a. Accelerations with fetal movement
b. Early decelerations
c. Average FHR of 126 beats per minute
d. Late decelerations
8. What three measures should the nurse implement to provide intrauterine resuscitation?
a. Call the provider, reposition the mother, and perform a vaginal examination.
b. Turn the client onto her side, provide oxygen (O2) via face mask, and increase intravenous (IV) fluids.
c. Administer O2 to the mother, increase IV fluids, and notify the health care provider.
d. Perform a vaginal examination, reposition the mother, and provide O2 via face mask.
9. The nurse who provides care to clients in labor must have a thorough understanding of the physiologic processes of maternal hypotension. Which outcome might occur if the interventions for maternal hypotension are inadequate?
a. Early FHR decelerations
b. Fetal arrhythmias
c. Uteroplacental insufficiency
d. Spontaneous rupture of membranes
10. What are the legal responsibilities of the perinatal nurses?
a. Correctly interpreting FHR patterns, initiating appropriate nursing interventions, and documenting the outcomes
b. Greeting the client on arrival, assessing her status, and starting an IV line
c. Applying the external fetal monitor and notifying the health care provider
d. Ensuring that the woman is comfortable
Chapter 19: Nursing Care of the Family During Labor and Birth
1. Which statement by the client will assist the nurse in determining whether she is in true labor as opposed to false labor?
a. “I passed some thick, pink mucus when I urinated this morning.”
b. “My bag of waters just broke.”
c. “The contractions in my uterus are getting stronger and closer together.”
d. “My baby dropped, and I have to urinate more frequently now.”
2. When a nulliparous woman telephones the hospital to report that she is in labor, what guidance should the nurse provide or information should the nurse obtain?
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. The nurse is caring for a client in early labor. Membranes ruptured approximately 2 hours earlier. This client is at increased risk for which complication?
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 uterine contractions occur every 3 to 4 minutes and last an average of 55 to 60 seconds. They are becoming more regular and are moderate to strong. Based on this information, what would a prudent nurse do next?
a. Immediately notify the woman’s primary health care provider.
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. Which action is correct when palpation is used to assess the characteristics and pattern of uterine contractions?
a. Placing the hand on the abdomen below the umbilicus and palpating uterine tone with the fingertips
b. Determining the frequency by timing from the end of one contraction to the end of the next contraction
c. Evaluating the intensity by pressing the fingertips into the uterine fundus
d. Assessing uterine contractions every 30 minutes throughout the first stage of labor
6. When assessing a woman in the first stage of labor, which clinical finding will alert the nurse that uterine contractions are effective?
a. Dilation of the cervix
b. Descent of the fetus to –2 station
c. Rupture of the amniotic membranes
d. Increase in bloody show
7. The nurse performs a vaginal examination to assess a client’s labor progress. Which action should the nurse take next?
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.
8. A multiparous woman has been in labor for 8 hours. Her membranes have just ruptured. What is the nurse’s highest priority in this situation?
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 (FHR) and pattern.
9. Under which circumstance should the nurse assist the laboring woman into a hands-and-knees position?
a. Occiput of the fetus is in a posterior position.
b. Fetus is at or above the ischial spines.
c. Fetus is in a vertex presentation.
d. Membranes have ruptured.
10. A nulliparous woman has just begun the latent phase of the second stage of her labor. The nurse should anticipate which behavior?
a. A nulliparous woman will experience a strong urge to bear down.
b. Perineal bulging will show.
c. A nulliparous woman will remain quiet with her eyes closed between contractions.
d. The amount of bright red bloody show will increase.
Chapter 20: Postpartum Physiologic Changes
1. A woman gave birth to an infant boy 10 hours ago. Where does the nurse expect to locate this woman’s fundus?
a. 1 centimeter above the umbilicus
b. 2 centimeters below the umbilicus
c. Midway between the umbilicus and the symphysis pubis
d. Nonpalpable abdominally
2. What are the most common causes for subinvolution of the uterus?
a. Postpartum hemorrhage and infection
b. Multiple gestation and postpartum hemorrhage
c. Uterine tetany and overproduction of oxytocin
d. Retained placental fragments and infection
3. Which client is most likely to experience strong and uncomfortable 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
4. A woman gave birth to a healthy infant boy 5 days ago. What type of lochia does the nurse expect to find when evaluating this client?
a. Lochia rubra
b. Lochia sangra
c. Lochia alba
d. Lochia serosa
5. Which hormone remains elevated in the immediate postpartum period of the breastfeeding woman?
d. Human placental lactogen
6. 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. Which physiologic alteration is the cause for the diaphoresis and diuresis that this client is experiencing?
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
7. Which term best describes the interval between the birth of the newborn and the return of the reproductive organs to their normal nonpregnant state?
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
8. 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 1500 ml. When evaluating the woman’s vital signs, which finding would be of greatest concern to the nurse?
a. Temperature 37.9° C, heart rate 120 beats per minute (bpm), respirations 20 breaths per minute, and blood pressure 90/50 mm Hg
b. Temperature 37.4° C, heart rate 88 bpm, respirations 36 breaths per minute, and blood pressure 126/68 mm Hg
c. Temperature 38° C, heart rate 80 bpm, respirations 16 breaths per minute, and blood pressure 110/80 mm Hg
d. Temperature 36.8° C, heart rate 60 bpm, respirations 18 breaths per minute, and blood pressure 140/90 mm Hg
9. A client is concerned that her breasts are engorged and uncomfortable. What is the nurse’s explanation for this physiologic change?
a. Overproduction of colostrum
b. Accumulation of milk in the lactiferous ducts and glands
c. Hyperplasia of mammary tissue
d. Congestion of veins and lymphatic vessels
10. After delivery, excess hypertrophied tissue in the uterus undergoes a period of self-destruction. What is the correct term for this process?
AND MUCH MORE