NUR 3501 - NUR 3501 OB Test Bank Chapter 1 – 18 : (Latest 2019/20) A+ Guide.

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NUR 3501 OB Test Bank Chapter 1 – 18. 1. Since 1995 there has been a significant decrease in the rate of infant death related to which of the following: a. Disorders associated with short gestatio... n and low birth weight b. Accidents c. Sudden infant death d. Newborns affected by complications of placenta, cord, and membranes 2. Tobacco use during pregnancy is associated with adverse effects on the unborn infant such as intrauterine growth restriction, preterm births, and respiratory problems. By race, which has the highest percentages of smokers? a. American Indian and Alaskan Natives b. Asian or Pacific Islanders c. Non-Hispanic blacks d. Non-Hispanic whites 3. Which of the following women is at the highest risk for health disparity? a. A white, middle-class, 16-year-old woman b. An African American, middle-class, 25-year-old woman c. An African American, upper-middle-class, 19-year-old woman d. An Asian, low-income, 30-year-old woman 4. A neonate born at 36 weeks gestation is classified as which of the following? a. Very premature b. Moderately premature c. Late premature d. Term 5. The perinatal nurse explains to the student nurse that a goal of the Healthy People 2020 report is to: a. Increase proportion of infants who are breastfed to 93.1%. b. Increase proportion of infants who are breastfed to 90.7%. c. Increase proportion of infants who are breastfed to 85.6%. d. Increase proportion of infants who are breastfed to 83.9%. 6. The perinatal nurse explains to the student nurse that __________ is the leading cause of infant death in the United States. a. Sudden Infant Death Syndrome b. Respiratory distress of newborns c. Disorders related to short gestation and low birth weight d. Congenital malformations and chromosomal abnormalities 7. Which of the following statements are true related to teen pregnancies? (Select all that apply.) a. Teen mothers are at higher risk for HIV. b. Teen mothers are at higher risk for hypertensive problems. c. The birth rate for teenaged women has increased in the past 15 years. d. Infants born to teen mothers are at higher risk for health problems. Chapter 2: Ethics and Standards of Practice Issues Multiple Choice 4. Infants whose mothers were obese during pregnancy are at higher risk for which of the following? (Select all that apply.) a. Childhood diabetes b. Heart defects c. Hypospadias d. Respiratory distress Chapter 3: Genetics, Conception, Fetal Development, and Reproductive Technology Multiple Choice 1. The color of a person’s hair is an example of which of the following?a. Genomeb. Sex-link inheritancec. Genotyped. Phenotype 6. The nurse is interviewing a gravid woman during the first prenatal visit. The woman confides to the nurse that she lives with a number of pets. The nurse should advise the woman to be especially careful to refrain from coming in contact with the stool of which of the pets? a. Cat b. Dog c. Hamster d. Bird 7. A client is to take Clomiphene Citrate for infertility. Which of the following is the expected action of this medication? a. Decrease the symptoms of endometriosis b. Increase serum progesterone levels c. Stimulate release of FSH and LH d. Reduce the acidity of vaginal secretions 8. The nurse takes the history of a client, G2 P1, at her first prenatal visit. The client is referred to a genetic counselor, due to her previous child having a diagnosis of __________. a. Unilateral amblyopia b. Subdural hematoma c. Sickle cell anemia d. Glomerular nephritis 9. A nurse is teaching a woman about her menstrual cycle. The nurse states that __________ is the most important change that happens during the secretory phase of the menstrual cycle. a. Maturation of the graafian follicle b. Multiplication of the fimbriae c. Secretion of human chorionic gonadotropin d. Proliferation of the endometrium 10. An ultrasound of a fetus’ heart shows that “normal fetal circulation is occurring.” Which of the following statements is consistent with the finding? a. A right to left shunt is seen between the atria. b. Blood is returning to the placenta via the umbilical vein. c. Blood is returning to the right atrium from the pulmonary system. d. A right to left shunt is seen between the umbilical arteries. 11. The clinic nurse knows that the part of the endometrial cycle occurring from ovulation to just prior to menses is known as the: a. Menstrual phase b. Proliferative phase c. Secretory phase d. Ischemic phase 12. A clinic nurse explains to the pregnant woman that the amount of amniotic fluid present at 24 weeks’ gestation is approximately: a. 500 mL b. 750 mL c. 800 mL d. 1000 mL 13. Information provided by the nurse that addresses the function of the amniotic fluid is that the amniotic fluid helps the fetus to maintain a normal body temperature and also: a. Facilitates asymmetrical growth of the fetal limbs b. Cushions the fetus from mechanical injury c. Promotes development of muscle tone d. Promotes adherence of fetal lung tissue 14. During preconception counseling, the clinic nurse explains that the time period when the fetus is most vulnerable to the effects of teratogens occurs from: a. 2 to 8 weeks b. 4 to12 weeks c. 5 to 10 weeks d. 6 to 15 weeks 15. A major fetal development characteristic at 16 weeks’ gestation is: a. The average fetal weight is 450 grams b. Lanugo covers entire body c. Brown fat begins to develop d. Teeth begin to form 16. Karen, a 26-year-old woman, has come for preconception counseling and asks about caring for her cat as she has heard that she “should not touch the cat during pregnancy.” The clinic nurse’s best response is: a. It is best if someone other than you changes the cat’s litter pan during pregnancy so that you have no risk of toxoplasmosis during pregnancy. b. It is important to have someone else change the litter pan during pregnancy and also avoid consuming raw vegetables. c. Have you had any “flu-like” symptoms since you got your cat? If so, you may have already had toxoplasmosis and there is nothing to worry about. d. Toxoplasmosis is a concern during pregnancy, so it is important to have someone else change the cat’s litter pan and also to avoid consuming uncooked meat. 17. A couple who has sought infertility counseling has been told that the man’s sperm count is very low. The nurse advises the couple that spermatogenesis is impaired when which of the following occur? a. The testes are overheated. b. The vas deferens is ligated. c. The prostate gland is enlarged. d. The flagella are segmented. 18. A nurse working with an infertile couple has made the following nursing diagnosis: Sexual dysfunction related to decreased libido. Which of the following assessments is the likely reason for this diagnosis? a. The couple has established a set schedule for their sexual encounters. b. The couple has been married for more than 8 years. c. The couple lives with one set of parents. d. The couple has close friends who gave birth within the last year. True/False 19. The perinatal nurse explains to the student nurse that in the fetal circulation, the lowest level of oxygen concentration is found in the umbilical arteries. T Fill-in-the-Blank 20. After birth, the perinatal nurse explains to the new mother that is the hormone responsible for stimulating milk production. 21. During prenatal class, the childbirth educator describes the two membranes that envelop the fetus. The Amnion contains the amniotic fluid, and the is the thick, outer membrane. 22. The perinatal nurse is teaching nursing students about fetal circulation and explains that fetal blood flows through the superior vena cava into the right via the 23. The perinatal nurse explains to the student nurse that the growing embryo is called a beginning at 8 weeks of gestational age. 24. The perinatal nurse defines a as any substance that adversely affects the growth and development of the embryo/fetus. 25. __________ __________ __________ is when sperm and oocytes are mixed outside the woman’s body and then placed into the fallopian tube via laparoscopy. Multiple Response 26. A woman seeks care at an infertility clinic. Which of the following tests may this woman undergo to determine what, if any, infertility problem she may have? (Select all that apply.) a. Chorionic villus sampling b. Endometrial biopsy c. Hysterosalpingogram d. Serum FSH analysis 27. A couple who has been attempting to become pregnant for 5 years is seeking assistance from an infertility clinic. The nurse assesses the clients’ emotional responses to their infertility. Which of the following responses would the nurse expect to find? (Select all that apply.) a. Anger at others who have babies. b. Feelings of failure because they cannot make a baby. c. Sexual excitement because they want to conceive a baby. d. Guilt on the part of one partner because he or she is unable to give the other a baby. 28. Which of the following places a couple at higher risk for conceiving a child with a genetic abnormality? (Select all that apply.) a. Maternal age over 35 years b. Partner who has a genetic disorder c. Maternal type 1 diabetes d. Paternal heart disease 29. The ovarian cycle includes which of the following phases? (Select all that apply.) a. Follicular phase b. Secretory phase c. Ovulatory phase d. Luteal phase e. Menstrual phase 30. A couple is undergoing an infertility workup. The semen analysis indicates a decreased number of sperm and immature sperm. Which of the following factors can have a potential effect on sperm maturity? (Select all that apply.) a. The man rides a bike to and from work each day. b. The man takes a calcium channel blocker for the treatment of hypertension. c. The man drinks 6 cups of coffee a day. d. The man was treated for prostatitis 12 months ago and has been symptom free since treatment.ANS: a, b 31. The clinic nurse recognizes that pregnant women who are in particular need of support are those who (select all that apply): a. Are experiencing a second pregnancy b. Are awaiting genetic testing results c. Are experiencing a first pregnancy d. Are trying to conceal this pregnancy as long as possible Chapter 5: Psycho-Social-Cultural Aspects of the Antepartum Period Multiple Choice 1. Sally is in her third trimester and has begun to sing and talk to the fetus. Sally is probably exhibiting signs of:a. Mental illnessb. Delusionsc. Attachmentd. Crisis 2. What is the most common expected emotional reaction of a woman to the news that she is pregnant? a. Jealousyb. Acceptancec. Ambivalenced. Depression 3. Which of the following information regarding sexual activity would the nurse give a pregnant woman who is 35 weeks’ gestation? a. Sexual activity should be avoided from now until 6 weeks postpartum.b. Sexual desire may be affected by nausea and fatigue. c. Sexual desire may be increased due to increased pelvic congestion.d. Sexual activity may require different positions to accommodate the woman’s comfort. 4. Which statement best exemplifies adaptation to pregnancy in relation to the adolescent?a. Adolescents adapt to motherhood in a similar way to other childbearing women.b. Social support has very little effect on adolescent adaptation to pregnancy. c. The pregnant adolescent faces the challenge of multiple developmental tasks.d. Pregnant adolescents of all ages can be capable and active participants in health-care decisions. 5. Jane’s husband Brian has begun to put on weight. What is this a possible sign of? a. Culturalism syndromeb. Couvade syndromec. Moratorium phased. Attachment 6. Cathy is pregnant for the second time. Her son, Steven, has just turned 2 years old. She asks you what she should do to help him get ready for the expected birth. What is the nurse’s most appropriate response?a. Steven will probably not understand any explanations about the arrival of the new baby, so Cathy should do nothing.b. If Steven’s sleeping arrangements need to be changed, it should be done well in advance of the birth.c. Steven should come to the next prenatal visit and listen to the fetal heartbeat to encourage sibling attachment. d. Steven should be encouraged to plan an elaborate welcome for the newborn. 8. Which of the following would be a priority for the nurse when caring for a pregnant woman who has recently emigrated from another country?a. Help her develop a realistic, detailed birth plan.b. Identify her support system.c. Teach her about expected emotional changes of pregnancy.d. Refer her to a doula for labor support. 9. A pregnant client at 20 weeks’ gestation comes to the clinic for her prenatal visit. Which of the following client statements would indicate a need for further assessment? a. “I hate it when the baby moves.”b. “I’ve started calling my mom every day.”c. “My partner and I can’t stop talking about the baby.”d. “I still don’t know much time I’m going to take off work after the baby comes.” 10. A pregnant client asks the nurse why she should attend childbirth classes. The nurse’s response would be based on which of the following information? a. Attending childbirth class is a good way to make new friends.b. Childbirth classes will help new families develop skills to meet the challenges of childbirth and parenting.c. Attending childbirth classes will help a pregnant woman have a shorter labor.d. Childbirth classes will help a pregnant woman decrease her chance of having a cesarean delivery. | Content Area: Maternity | Client Need: Psychosocial Integrity | Difficulty Level: Easy 11. A woman presents for prenatal care at 6 weeks’ gestation by LMP. Which of the following findings would the nurse expect to see? a. Multiple pillow orthopnea b. Maternal ambivalence c. Fundus at the umbilicus d. Pedal and ankle edema 12. A first-time father is experiencing couvade syndrome. He is likely to exhibit which of the following symptoms or behaviors? a. Urinary frequency b. Hypotension c. Bradycardia d. Prostatic hypertrophy 13. When providing a psychosocial assessment on a pregnant woman at 21 weeks’ gestation, the nurse would expect to observe which of the following signs? a. Ambivalence b. Depression c. Anxiety d. Happiness 14. An example of a cultural prescriptive belief during pregnancy is: a. Remain active during pregnancy b. Coldness in any form should be avoided c. Do not have your picture taken d. Avoid sexual intercourse during the third trimester 15. Taboos are cultural restrictions that: a. Have serious supernatural consequences b. Have serious clinical consequences c. Have superstitious consequences d. Are functional and neutral practices 16. Jenny, a 21-year-old single woman, comes for her first prenatal appointment at 31 weeks’ gestation with her first pregnancy. The clinic nurse’s most appropriate statement is: a. “Jenny, it is late in your pregnancy to be having your first appointment, but it is nice to meet you and I will try to help you get caught up in your care.” b. “Jenny, have you had care in another clinic? I can’t believe this is your first appointment!” c. “Jenny, by the date of your last menstrual period, you are 31 weeks and now that you are finally here, we need you to come monthly for the next two visits and then weekly.” d. “Jenny, by your information, you are 31 weeks’ gestation in this pregnancy. Do you have questions for me before I begin your prenatal history and information sharing?” ANS: d 17. The clinic nurse visits with Wayne, a 32-year-old man whose partner is pregnant for the first time and is at 12 weeks. Wayne describes nausea and vomiting, fatigue, and weight gain. His symptoms are best described as: a. Influenza b. Couvade syndrome c. Acid reflux d. Cholelithiasis Multiple Response 18. The clinic nurse encourages paternal attachment during pregnancy by including the father in (select all that apply): a. Prenatal visits b. Ultrasound appointments c. Prenatal class information d. History taking and obtaining prenatal screening information 19. The perinatal nurse screens all pregnant women early in pregnancy for maternal attachment risk factors, which include (select all that apply): a. Adolescence b. Low educational level c. History of depression d. A strong support system for the pregnancy 20. Strategies for culturally responsive care include (select all that apply): a. Practicing ethnocentrism b. Applying stereotyping c. Examining one’s own biases d. Learning another language Chapter 6: Antepartal Tests 1. Your pregnant patient is in her first trimester and is scheduled for an abdominal ultrasound. When explaining the rationale for early pregnancy ultrasound, the best response is: a. “The test will help to determine the baby’s position.”b. “The test will help to determine how many weeks you are pregnant.”c. “The test will help to determine if your baby is growing appropriately.”d. “The test will help to determine if you have a boy or girl.” 2. Your pregnant patient is having maternal alpha-fetoprotein (AFP) screening. She does not understand how a test on her blood can indicate a birth defect in the fetus. The best reply by the nurse is:a. “We have done this test for a long time.”b. “If babies have a neural tube defect, alpha-fetoprotein leaks out of the fetus and is absorbed into your blood, causing your level to rise. This serum blood test detects that rise.”c. “Neural tube defects are a genetic anomaly, and we examine the amount of alpha-fetoprotein in your DNA.”d. “If babies have a neural tube defect, this results in a decrease in your level of alpha-fetoprotein.” 3. The primary complications of amniocentesis are:a. Damage to fetal organsb. Puncture of umbilical cordc. Maternal paind. Infection 4. Your patient is 34 weeks pregnant and during a regular prenatal visit tells you she does not understand how to do “kick counts.” The best response by the nurse would be to explain:a. “Here is an information sheet on how to do kick counts.”b. “It is not important to do kick counts because you have a low-risk pregnancy.”c. “Fetal kick counts are not a reliable indicator of fetal well-being in the third trimester.”d. “Fetal movements are an indicator of fetal well-being. You should count twice a day, and you should feel 10 fetal movements in 2 hours.” 5. Your patient is a 37-year-old pregnant woman who is 5 weeks pregnant and is considering genetic testing. During your discussion, the woman asks the nurse what the advantages of chorionic villus sampling (CVS) are over amniocentesis. The best response is:a. “You will need anesthesia for amniocentesis, but not for CVS.”b. “CVS is a faster procedure.”c. “CVS provides more detailed information than amniocentesis.”d. “CVS can be done earlier in your pregnancy, and the results are available more quickly.” 6. The clinic nurse meets with Rebecca, a 30-year-old woman who is experiencing her first pregnancy. Rebecca’s quadruple marker screen result is positive at 17 weeks’ gestation. The nurse explains that Rebecca needs a referral to: a. A genetics counselor/specialist b. An obstetrician c. A gynecologist d. A social worker 7. A 37-year-old woman who is 17 weeks pregnant has had an amniocentesis. Before discharge, the nurse teaches the woman to call her doctor if she experiences which of the following side effects? a. Pain at the puncture site b. Macular rash on the abdomen c. Decrease in urinary output d. Cramping of the uterus 8. A laboratory report indicates the L/S ratio (lecithin/sphingomyelin) results from an amniocentesis of a gravid patient with preeclampsia are 2:1. The nurse interprets the result as which of the following? a. The baby’s lung fields are mature. b. The mother is high risk for hemorrhage. c. The baby’s kidneys are functioning poorly. d. The mother is high risk for eclampsia. Chapter 7: High-Risk Antepartum Nursing Care Multiple Choice 1. A client on 2 gm/hr of magnesium sulfate has decreased deep tendon reflexes. Identify the priority nursing assessment to ensure client safety.a. Assess uterine contractions continuously.b. Assess fetal heart rate continuously.c. Assess urinary output.d. Assess respiratory rate. 2. A pregnant client with a history of multiple sexual partners is at highest risk for which of the following complications:a. Premature rupture of membranesb. Gestational diabetesc. Ectopic pregnancyd. Pregnancy-induced hypertension 3. Identify the hallmark of placenta previa that differentiates it from abruptio placenta.a. Sudden onset of painless vaginal bleedingb. Board-like abdomen with severe painc. Sudden onset of bright red vaginal bleedingd. Severe vaginal pain with bright red bleeding 4. Which of the following assessments would indicate instability in the client hospitalized for placenta previa?a. BP <90/60 mm/Hg, Pulse <60 BPM or >120 BPMb. FHR moderate variability without accelerationsc. Dark brown vaginal discharge when voidingd. Oral temperature of 99.9°F 5. During pregnancy, poorly controlled asthma can place the fetus at risk for:a. Hyperglycemiab. IUGRc. Hypoglycemiad. Macrosomia ANS: b 6. Which of the following nursing diagnoses is of highest priority for a client with an ectopic pregnancy who has developed disseminated intravascular coagulation (DIC)?a. Risk for deficient fluid volumeb. Risk for family process interruptedc. Risk for disturbed identityd. High risk for injury 7. Which of the following laboratory values is most concerning in a client with pregnancy-induced hypertension?a. Total urine protein of 200 mg/dLb. Total platelet count of 40,000 mm c. Uric acid level of 8 mg/dLd. Blood urea nitrogen 24 mg/dL 8. Which of the following medications administered to the pregnant client with GDM and experiencing preterm labor requires close monitoring of the client’s blood glucose levels?a. Nifedipineb. Betamethasone c. Magnesium sulfated. Indomethacin 9. While educating the client with class II cardiac disease, at 28 weeks’ gestation, the nurse instructs the client to notify the physician if she experiences which of the following conditions? a. Emotional stress at workb. Increased dyspnea while restingc. Mild pedal and ankle edemad. Weight gain of 1 pound in 1 week 10. The nurse working in a prenatal clinic is providing care to three primigravida patients. Which of the patient findings would the nurse highlight for the physician? a. 15 weeks, denies feeling fetal movement b. 20 weeks, fundal height at the umbilicus c. 25 weeks, complains of excess salivation d. 30 weeks, states that her vision is blurry 11. The perinatal nurse is assessing a woman in triage who is 34 + 3 weeks’ gestation in her first pregnancy. She is worried about having her baby “too soon,” and she is experiencing uterine contractions every 10 to 15 minutes. The fetal heart rate is 136 beats per minute. A vaginal examination performed by the health-care provider reveals that the cervix is closed, long, and posterior. The most likely diagnosis would be: 12. The perinatal nurse knows that the term to describe a woman at 26 weeks’ gestation with a history of elevated blood pressure who presents with a urine showing 2+ protein (by dipstick) is: a. Preeclampsia b. Chronic hypertension c. Gestational hypertension 13. A patient is receiving magnesium sulfate for severe preeclampsia. The nurse must notify the attending physician immediately of which of the following findings? a. Patellar and biceps reflexes of +4 b. Urinary output of 50 mL/hr c. Respiratory rate of 10 rpm d. Serum magnesium level of 5 mg/dL 14. A woman in labor and delivery is being given subcutaneous terbutaline for preterm labor. Which of the following common medication effects would the nurse expect to see in the mother? a. Serum potassium level increases b. Diarrhea c. Urticaria d. Complaints of nervousness Integrity: Pharmacological and Parenteral Therapies | Difficulty Level: Moderate 15. Which of the following signs or symptoms would the nurse expect to see in a woman with concealed abruptio placentae? a. Increasing abdominal girth measurements b. Profuse vaginal bleeding c. Bradycardia with an aortic thrill d. Hypothermia with chills 16. A woman who has had no prenatal care was assessed and found to have hydramnios on admission to the labor unit and has since delivered a baby weighing 4500 grams. Which of the following complications of pregnancy likely contributed to these findings? a. Pyelonephritis b. Pregnancy-induced hypertension c. Gestational diabetes d. Abruptio placentae 17. For the patient with which of the following medical problems should the nurse question a physician’s order for beta agonist tocolytics? a. Type 1 diabetes mellitus b. Cerebral palsy c. Myelomeningocele d. Positive group B streptococci culture 18. The nurse is caring for two laboring women. Which of the patients should be monitored most carefully for signs of placental abruption? a. The patient with placenta previa b. The patient whose vagina is colonized with group B streptococci c. The patient who is hepatitis B surface antigen positive d. The patient with eclampsia 19. The nurse is caring for a woman at 28 weeks’ gestation with a history of preterm delivery. Which of the following laboratory data should the nurse carefully assess in relation to this diagnosis? a. Human relaxin levels b. Amniotic fluid levels c. Alpha-fetoprotein levels d. Fetal fibronectin levels 20. Which of the following statements is most appropriate for the nurse to say to a patient with a complete placenta previa? a. “During the second stage of labor you will need to bear down.” b. “You should ambulate in the halls at least twice each day.” c. “The doctor will likely induce your labor with oxytocin.” d. “Please promptly report if you experience any bleeding or feel any back discomfort.” 21. A woman at 32 weeks’ gestation is diagnosed with severe preeclampsia with HELLP syndrome. The nurse will identify which of the following as a positive patient care outcome? a. Rise in serum creatinine b. Drop in serum protein c. Resolution of thrombocytopenia d. Resolution of polycythemia 22. A 16-year-old patient is admitted to the hospital with a diagnosis of severe preeclampsia. The nurse must closely monitor the woman for which of the following? a. High leukocyte count b. Explosive diarrhea c. Fractured pelvis d. Low platelet count 23. A woman at 10 weeks’ gestation is diagnosed with gestational trophoblastic disease (hydatiform mole). Which of the following findings would the nurse expect to see? a. Platelet count of 550,000/ mm3 b. Dark brown vaginal bleeding c. White blood cell count 17,000/ mm3 d. Macular papular rash 24. After an education class, the nurse overhears an adolescent woman discussing safe sex practices. Which of the following comments by the young woman indicates that additional teaching about sexually transmitted infection (STI) control issues is needed? a. “I could get an STI even if I just have oral sex.” b. “Girls over 16 are less likely to get STDs than younger girls.” c. “The best way to prevent an STI is to use a diaphragm.” d. “Girls get human immunodeficiency virus (HIV) easier than boys do.” 25. A woman who is admitted to labor and delivery at 30 weeks’ gestation, is 1 cm dilated, and is contracting q 5 minutes. She is receiving magnesium sulfate IV piggyback. Which of the following maternal vital signs is most important for the nurse to assess each hour? a. Temperature b. Pulse c. Respiratory rate d. Blood pressure 26. You are caring for a patient who was admitted to labor and delivery at 32 weeks’ gestation and diagnosed with preterm labor. She is currently on magnesium sulfate, 2 gm per hour. Upon your initial assessment you note that she has a respiratory rate of 8 with absent deep tendon reflexes. What will be your first nursing intervention? a. Elevate head of the bed b. Notify the MD c. Discontinue magnesium sulfate d. Draw a serum magnesium level 27. A 34-weeks’ gestation multigravida, G3 P1 is admitted to the labor suite. She is contracting every 7 minutes and 40 seconds. The woman has several medical problems. Which of the following of her comorbidities is most consistent with the clinical picture? a. Kyphosis b. Urinary tract infection c. Congestive heart failure d. Cerebral palsy 28. A primiparous woman has been admitted at 35 weeks’ gestation and diagnosed with HELLP syndrome. Which of the following laboratory changes is consistent with this diagnosis? a. Hematocrit dropped to 28%. b. Platelets increased to 300,000 cells/mm3. c. Red blood cells increased to 5.1 million cells/mm3. d. Sodium dropped to 132 mEq/dL. 29. A labor nurse is caring for a patient, 39 weeks’ gestation, who has been diagnosed with placenta previa. Which of the following physician orders should the nurse question? a. Type and cross-match her blood. b. Insert an internal fetal monitor electrode. c. Administer an oral stool softener. d. Assess her complete blood count. 30. A type 1 diabetic patient has repeatedly experienced elevated serum glucose levels throughout her pregnancy. Which of the following complications of pregnancy would the nurse expect to see? a. Postpartum hemorrhage b. Neonatal hyperglycemia c. Postpartum oliguria d. Neonatal macrosomia 31. According to agency policy, the perinatal nurse provides the following intrapartal nursing care for the patient with preeclampsia: a. Take the patient’s blood pressure every 6 hours b. Encourage the patient to rest on her back c. Notify the physician of a urine output greater than 30 mL/hr d. Administer magnesium sulfate according to agency policy 32. The perinatal nurse is providing care to Marilyn, a 25-year-old G1 TPAL 0000 woman hospitalized with severe hypertension at 33 weeks’ gestation. The nurse is preparing to administer the second dose of beta-methasone prescribed by the physician. Marilyn asks: “What is this injection for again?” The nurse’s best response is: a. “This is to help your baby’s lungs to mature.” b. “This is to prepare your body to begin the labor process.” c. “This is to help stabilize your blood pressure.” d. “This is to help your baby grow and develop in preparation for birth.” 33. A woman who is 36 weeks pregnant presents to the labor and delivery unit with a history of congestive heart disease. Which of the following findings should the nurse report to the primary health-care practitioner? a. Presence of chloasma b. Presence of severe heartburn c. 10-pound weight gain in a month d. Patellar reflexes +1 34. The single most important risk factor for preterm birth includes: a. Uterine and cervical anomalies b. Infection c. Increased BMI d. Prior preterm birth 35. Your antepartal patient is 38 weeks’ gestation, has a history of thrombosis, and has been on strict bed rest for the last 12 hours. She is now experiencing shortness of breath. What about the patient may be a contributing factor for her shortness of breath? a. Physiologic changes in pregnancy result in vasodilation, which increases the tendency to form blood clots. b. Physiologic changes in pregnancy result in vasoconstriction, which increases the tendency to form blood clots. c. Physiologic changes in pregnancy result in anemia, which increases the tendency to form blood clots. d. Physiologic changes in pregnancy result in decreased perfusion to the lungs, which increases the tendency to form blood clots. 36. Metabolic changes during pregnancy __________ glucose tolerance. a. lower b. increase c. maintain d. alter Multiple Response 43. The perinatal nurse describes risk factors for placenta previa to the student nurse. Placenta previa risk factors include (select all that apply): a. Cocaine use b. Tobacco use c. Previous caesarean birth d. Previous use of medroxyprogesterone (Depo-Provera) 44. Kerry, a 30-year-old G3 TPAL 0110 woman presents to the labor unit triage with complaints of lower abdominal cramping and urinary frequency at 30 weeks’ gestation. An appropriate nursing action would be to (select all that apply): a. Assess the fetal heart rate b. Obtain urine for culture and sensitivity c. Assess Kerry’s blood pressure and pulse d. Palpate Kerry’s abdomen for contractions 45. The perinatal nurse knows that tocolytic agents are most often used to (select all that apply): a. Prevent maternal infection b. Prolong pregnancy to 40 weeks’ gestation c. Prolong pregnancy to facilitate administration of antenatal corticosteroids d. Allow for transport of the woman to a tertiary care facility 46. The perinatal nurse provides a hospital tour for couples and families preparing for labor and birth in the future. Teaching is an important component of the tour. Information provided about preterm labor and birth prevention includes (select all that apply): a. Encouraging regular, ongoing prenatal care b. Reporting symptoms of urinary frequency and burning to the health-care provider c. Coming to the labor triage unit if back pain or cramping persist or become regular d. Lying on the right side, withholding fluids, and counting fetal movements if contractions occur every 5 minutes 47. The perinatal nurse describes for the new nurse the various risks associated with prolonged premature preterm rupture of membranes. These risks include (select all that apply): a. Chorioamnionitis b. Abruptio placentae c. Operative birth d. Cord prolapse 48. Betamethasone is a steroid that is given to a pregnant woman with signs of preterm labor. The purpose of giving steroids is to (select all that apply): a. Stimulate the production of surfactant in the preterm infant b. Be given between 24 and 34 weeks’ gestation c. Increase the severity of respiratory distress d. Accelerate fetal lung maturity 49. Marked hemodynamic changes in pregnancy can impact the pregnant woman with cardiac disease. Signs and symptoms of deteriorating cardiac status include (select all that apply): a. Orthopnea b. Nocturnal dyspnea c. Palpitations d. Irritation Multiple Choice 1. In caring for a primiparous woman in labor, one of the factors to evaluate is uterine activity. This is referred to as the POWER KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Easy 2. The provision of support during labor has demonstrated that women experience a decrease in anxiety and a feeling of being in more control. In clinical situations, this has resulted in:a. A decrease in interventionsb. Increased epidural ratesc. Earlier admission to the hospitald. Improved gestational age 3. When caring for a primiparous woman being evaluated for admission for labor, a key distinction between true versus false labor is:a. True labor contractions result in rupture of membranes, and with false labor, the membranes remain intact.b. True labor contractions result in increasing anxiety and discomfort, and false labor does not.c. True labor contractions are accompanied by loss of the mucus plug and bloody show, and with false labor there is no vaginal discharge. d. True labor contractions bring about changes in cervical effacement and dilation, and with false labor there are irregular contractions with little or no cervical changes. 4. The mechanism of labor known as cardinal movements of labor are the positional changes that the fetus goes through to best navigate the birth process. These cardinal movements are:a. Engagement, Descent, Flexion, Extension, Internal rotation, External rotation, Expulsion b. Engagement, Descent, Flexion, Internal rotation, Extension, External rotation, Expulsion c. Engagement, Flexion, Internal rotation, Extension, External rotation, Descent, Expulsion d. Engagement, Flexion, Internal rotation, Extension, External rotation, Flexion, Expulsion KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Comprehension | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Moderate 5. A woman is considered in active labor when:a. Cervical dilation progresses from 4 to 7 cm with effacement of 40% to 80%, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds.b. Cervical dilation progresses to 3 cm with effacement of 30, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds.c. Cervical dilation progresses to 8 cm with effacement of 80%, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds.d. Cervical dilation progresses to 10 cm with effacement of 90%, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds. 6. You are caring for a woman in labor who is 6 cm dilated with a reassuring FHT pattern and regular strong UCs. The fetal heart rate (FHR) should be:a. Monitored continuouslyb. Monitored every 15 minutesc. Monitored every 30 minutesd. Monitored every 60 minutes 7. A woman you are caring for in labor requests an epidural for pain relief in labor. Included in your preparation for epidural placement is a baseline set of vital signs. The most common vital sign to change after epidural placement:a. Blood pressure, hypotension b. Blood pressure, hypertension c. Pulse, tachycardia d. Pulse, bradycardia 8. The labor patient you are caring for is ambulating in the hall. Her vaginal exam 1 hour ago indicated she was 4/70/–1 station. She tells you she has fluid running down her leg. Your priority nursing intervention is to:a. Assess the color, odor, and amount of fluid.b. Assist your patient to the bathroom.c. Assess the fetal heart rate.d. Call the care provider. 9. You are in the process of admitting a multiparous woman to labor and delivery from the triage area. One hour ago her vaginal exam was 4/70/0. While completing your review of her prenatal record and completing the admission questionnaire, she tells you she has an urge to have a bowel movement and feels like pushing. Your priority nursing intervention is to:a. Reassure the patient and rapidly complete the admission.b. Assist your patient to the bathroom to have a bowel movement.c. Assess the fetal heart rate and uterine contractions.d. Perform a vaginal exam. 10. The Apgar score consists of a rapid assessment of five physiological signs that indicate the physiological status of the newborn and includes:a. Apical pulse strength, respiratory rate, muscle flexion, reflex irritability, and colorb. Heart rate, clarity of lungs, muscle tone, reflexes, and colorc. Apical pulse strength, respiratory rate, muscle tone, reflex irritability, and color of extremitiesd. Heart rate, respiratory rate, muscle tone, reflex irritability, and color 11. The perinatal nurse is assessing a woman in triage who is 34 + 3 weeks’ gestation in her first pregnancy. She is worried about having her baby “too soon,” and she is experiencing uterine contractions every 10 to 15 minutes. The fetal heart rate is 136 beats per minute. A vaginal examination performed by the health-care provider reveals that the cervix is closed, long, and posterior. The most likely diagnosis would be: a. Preterm labor b. Term labor c. Back labor d. Braxton-Hicks contractions Chapter 15: Physiological and Behavioral Responses of the Neonate Multiple Choice 1. A woman gave birth to a 3200 g baby girl with an estimated gestational age of 40 weeks. The baby is 1 hour of age. In preparation of giving the baby an injection of vitamin K, the nurse will: a. Explain to the parents the action of the medication and answer their questions. b. Remove the neonate from the room so the parents will not be distressed by seeing the injection. c. Completely undress the neonate to identify the injection site. d. Replace needle with a 21 gauge 5/8 needle. ANS: a 2. To accurately measure the neonate’s head, the nurse places the measuring tape around the head: a. Just above the ears and eyebrows b. Middle of the ear and over the eyes c. Middle of the ear and over the bridge of the nose d. Just below the ears and over the upper lip 3. Which of the following neonates is at highest risk for cold stress? a. A 36 gestational week LGA neonate b. A 32 gestational week AGA neonate c. A 33 gestational week SGA neonate d. A 38 gestational week AGA neonate 4. When assessing the apical pulse of the neonate, the stethoscope should be placed at the: a. First or second intercostal space b. Second or third intercostal space c. Third or fourth intercostal space d. Fourth or fifth intercostal space 5. Which of the following breath sounds are normal to hear in the neonate during the first few hours postbirth? a. Scattered crackles b. Wheezes c. Stridor d. Grunting 6. The nurse assesses that a full-term neonate’s temperature is 36.2°C. The first nursing action is to: a. Turn up the heat in the room. b. Place the neonate on the mother’s chest with a warm blanket over the mother and baby. c. Take the neonate to the nursery and place in a radiant warmer. d. Notify the neonate’s primary provider. 7. A nurse is assessing for the tonic neck reflex. This is elicited by: a. Making a load sound near the neonate. b. Placing the neonate in a sitting position. c. Turning the neonate’s head to the side so that the chin is over the shoulder while the neonate is in a supine position. d. Holding the neonate in a semi-sitting position and letting the head slightly drop back. 8. An infant admitted to the newborn nursery has a blood glucose level of 55 mg/dL. Which of the following actions should the nurse perform at this time? a. Provide the baby with routine feedings. b. Assess the baby’s blood pressure. c. Place the baby under the infant warmer. d. Monitor the baby’s urinary output. 9. Four babies have just been admitted into the neonatal nursery. Which of the babies should the nurse assess first? a. The baby with respirations 52, oxygen saturation 98% b. The baby with Apgar 9/9, weight 2960 grams c. The baby with temperature 96.3°F, length 17 inches d. The baby with glucose 60 mg/dL, heart rate 132 10. The nurse is about to elicit the rooting reflex on a newborn baby. Which of the following responses should the nurse expect to see? a. When the cheek of the baby is touched, the newborn turns toward the side that is touched. b. When the lateral aspect of the sole of the baby’s foot is stroked, the toes extend and fan outward. c. When the baby is suddenly lowered or startled, the neonate’s arms straighten outward and the knees flex. d. When the newborn is supine and the head is turned to one side, the arm on that same side extends. 11. A mother refused to allow her son to receive the vitamin K injection at birth. Which of the following signs or symptoms might the nurse observe in the baby as a result? a. Skin color is dusky. b. Vital signs are labile. c. Glucose levels are subnormal. d. Circumcision site oozes blood. 12. A nurse is assisting a physician during a baby’s circumcision. Which of the following demonstrates that the nurse is acting as the baby’s patient care advocate? a. The nurse requests that oral sucrose be ordered as a pain relief measure. b. The nurse restrains the baby on the circumcision board. c. The nurse wears a surgical mask during the procedure. d. The nurse provides the physician with an iodine solution for cleansing the skin. 13. A neonate is admitted to the nursery. The nurse makes the following assessments: weight 2845 grams, overriding sagittal suture, closed posterior fontanel, and point of maximum intensity at the xiphoid process. Which of the assessments should be reported to the health-care practitioner? a. Birth weight b. Sagittal suture line c. Closed posterior fontanel d. Point of maximum intensity 14. The nurse is about to elicit the Moro reflex. Which of the following responses should the nurse expect to see? a. When the cheek of the baby is touched, the newborn turns toward the side that is touched. b. When the lateral aspect of the sole of the baby’s foot is stroked, the toes extend and fan outward. c. When the baby is suddenly lowered or startled, the neonate’s arms straighten outward and the knees flex. d. When the newborn is supine and the head is turned to one side, the arm on that same side extends. 15. A nurse is doing a newborn assessment on a new admission to the nursery. Which of the following actions should the nurse make when evaluating the baby for developmental dysplasia of the hip? a. Grasp the inner aspects of the baby’s calves with thumbs and forefingers. b. Gently abduct the baby’s thighs. c. Palpate the baby’s patellae to assess for subluxation of the bones. d. Dorsiflex the baby’s feet. 16. A certified nursing assistant (CNA) is working with a registered nurse (RN) in the neonatal nursery. Which of the following actions would be appropriate for the nurse to delegate to the CNA? a. Admit a newly delivered baby to the nursery. b. Bathe and weigh a 3-hour-old baby. c. Provide discharge teaching to the mother of a 4-day-old baby. d. Interpret a bilirubin level reported by the laboratory. 17. A pregnant patient at 35 weeks’ gestation gives birth to a healthy baby boy. What factors regarding the development of the normal respiratory system should the nurse consider when performing an assessment of the neonate? a. As the fetus approaches term, there is an increase in the secretion of intrapulmonary fluid. b. Lung expansion after birth suppresses the release of surfactant. c. Surfactant causes an increased surface tension within the alveoli, which allows for alveolar reexpansion following each exhalation. d. Under normal circumstances, by the 34th to 36th weeks of gestation, surfactant is produced in sufficient amounts to maintain alveolar stability. 18. The perinatal nurse explains to a student nurse the cardiopulmonary adaptations that occur in the neonate. Which one of the following statements accurately describes the sequence of these changes? a. As air enters the lungs, the PO2 rises in the alveoli, which causes pulmonary artery relaxation and results in an increase in pulmonary vascular resistance. b. As the pulmonary vascular resistance increases, pulmonary blood flow increases, reaching 100% by the first 24 hours of life. c. Decreased pulmonary blood volume contributes to the conversion from fetal to newborn circulation. d. Once the pulmonary circulation has been functionally established, blood is distributed throughout the lungs. 19. A perinatal nurse assesses the skin condition of a newborn, which is characterized by a yellow coloration of the skin, sclera, and oral mucous membranes. What condition is most likely the cause of this symptom? a. Hypoglycemia b. Physiologic anemia of infancy c. Low glomerular filtration rate d. Jaundice 20. The nurse is assessing the neonate’s skin and notes the presence of small, irregular, red patches on the cheeks that will develop into single, yellow pimples on the chest or abdomen. The name for this common neonatal skin condition is: a. Milia b. Neonatal acne c. Erythema toxicum d. Pustular melanosis 21. The nurse completes an initial newborn examination on a baby boy at 90 minutes of age. The baby was born at 40 weeks’ gestation with no birth trauma. The nurse’s findings include the following parameters: heart rate, 136 beats per minute; respiratory rate, 64 breaths per minute; temperature, 98.2°F (36.8°C); length, 49.5 cm; and weight, 3500 g. The nurse documents the presence of a heart murmur, absence of bowel sounds, symmetry of ears and eyes, no grunting or nasal flaring, and full range of movement of all extremities. Which assessment would warrant further investigation and require immediate consultation with the baby’s health-care provider? a. Respiratory rate b. Presence of a heart murmur c. Absent bowel sounds d. Weight 22. The nursery nurse notes the presence of diffuse edema on a baby girl’s head. Review of the birth record indicates that her mother experienced a prolonged labor and difficult childbirth. By the second day of life, the edema has disappeared. The nurse documents the following condition in the infant’s chart. a. Caput succedaneum b. Cephalhematoma c. Subperiosteal hemorrhage d. Epstein pearls 23. The perinatal nurse contacts the pediatrician about a heart murmur that was auscultated during a routine newborn assessment. This finding would be abnormal at: a. 8 to 12 hours b. 12 to 24 hours c. 24 to 48 hours d. 48 to 72 hours 24. Heat loss through radiation can be reduced by: a. Closing door to room b. Warming equipment used on the neonate c. Drying the neonate d. Placing crib near a warm wall Multiple Response 25. A healthy, full-term baby is scheduled for a circumcision. Nursing actions prior to the procedure include which of the following? (Select all that apply.) a. Obtain written consent from the mother. b. Administer acetaminophen PO 1 hour before procedure per MD order. c. Feed the neonate glucose water 30 minutes before the procedure. d. Obtain the neonate’s protime. 26. A first-time mother informs her nurse that another staff member came in and wanted to take her baby to the nursery. The mother refused to let the woman take her baby because the staff member did not have a picture ID. The nurse should do which of the following? (Select all that apply.) a. Praise the mother for not allowing a person without proper ID to take her baby. b. Check with the nursery to see if a staff member was recently in the patient’s room. c. Notify security of an unauthorized person in the unit. d. Alert staff of the incident. 27. The clinical nurse recalls that the newborn has four mechanisms by which heat is lost following birth: evaporation, conduction, convection, and radiation. Which of the following are examples of heat lost via convection? (Select all that apply.) a. An infant loses heat when not dried adequately after birth b. An infant is placed on a cold scale c. An infant is placed under a ceiling fan d. An infant is placed near an open window 28. A perinatal nurse assesses a term newborn for respiratory functioning. The nurse knows that which of the following conditions is normal for newborns? (Select all that apply.) a. A respiratory rate of 60 to 80 breaths per minute b. A breathing pattern that is often shallow, diaphragmatic, and irregular c. Periodic episodes of apnea d. The neonate’s lung sounds may sound moist during early auscultation 29. The perinatal nurse observed the pediatrician completing the Ballard Gestational Age by Maturity Rating tool. The maturity components used with this assessment tool are (select all that apply): a. Physical b. Behavioral c. Reflexive d. Neuromuscular True/False Chapter 16: Discharge Planning and Teaching Multiple Choice 1. A nurse is making a home visit on the seventh postpartum day to assess a 23-year-old primipara woman and her full-term, healthy baby. Breastfeeding is the method of infant nutrition. The woman tells the nurse that she does not think her milk is good because it looks very watery when she expresses a little before each feeding. The nurse’s best response is: a. “This is normal. You only have to be concerned when your baby does not gain weight.” b. “What types of foods are you eating? A lack of protein in the diet can cause watery looking breast milk.” c. “How much fluid are you drinking while you are nursing your baby? Too much fluid during the feeding session can dilute the breast milk.” d. “This is normal and is referred to as foremilk which is higher in water content. Later in the feeding the fat content increases and the milk becomes richer in appearance.” 2. A postpartum woman, who gave birth 12 hours ago, is breastfeeding her baby. She tells her nurse that she is concerned that her baby is not getting enough food since her milk has not come in. The best response for this patient is: a. “I understand your concern, but your baby will be okay until your milk comes in.” b. “Your baby seems content, so you should not worry about him getting enough to eat.” c. “Milk normally comes in around the third day. Prior to that, he is getting colostrum which is high in protein and immunoglobulins which are important for your baby’s health.” d. “You can bottle feed until your milk comes in.” 3. Which of the following positions for breastfeeding is preferred for a 2-day post-cesarean-birth woman? a. Lying down on side b. Sitting c. Cradle d. Cross-cradle 4. Painful nipples are a major reason why women stop breastfeeding. A primary intervention to decrease nipple irritation is: a. Teaching proper techniques for latching-on and releasing of suction b. Applying hot compresses to breast prior to feeding c. Instructing woman to express colostrum or milk at the end of the feeding session and rub it on her nipples d. Air drying nipples for 10 minutes at the end of the feeding session 5. The nurse is developing a discharge teaching plan for a 21-year-old first-time mom. This was an unplanned pregnancy. She had a prolonged labor and an early postpartum hemorrhage. The woman plans to breastfeed her baby. She plans to return to work when her baby is 3 months old. Based on this information, the three primary learning needs of this woman are: a. Breastfeeding, bathing of the newborn, and infant safety b. Breastfeeding, storage of milk, and nutrition c. Breastfeeding, contraception, infant safety d. Breastfeeding, storage of milk, and rest 6. Instructions to a mother of an uncircumcised male infant should include which of the following? a. Instruct her to use a cotton swab to clean under the foreskin. b. Instruct her to clean the penis by retracting the foreskin. c. Instruct her to clean the penis with alcohol. d. Instruct her not to retract the foreskin. 7. A mother of a 10-day-old infant calls the clinic and reports that her baby is having loose, green stools. The mother is breastfeeding her infant. Which of the following is the best nursing action? a. Instruct the woman to bring her infant to the clinic. b. Instruct the woman to decrease the amount of feeding for 24 hours and to call if the stools continue to be loose. c. Explain that this is a normal stool pattern. d. Instruct the woman to eat a bland diet for the next 24 hours and call back if the stools continue to be loose and green. 8. The perinatal nurse is teaching her new mother about breastfeeding and explains that the most appropriate time to breastfeed is: a. 3 to 4 hours after the last feeding b. When her infant is in a quiet alert state c. When her infant is in an active alert state d. When her infant exhibits hunger-related crying 9. Felicity Chan, a new mother, is accompanied by her mother during her hospital stay on the postpartum unit. Felicity’s mother makes specific, various requests of the nurses including bringing warm tea, a cot to sleep on, and that the baby not be bathed at this time. Felicity’s mother is also concerned about the amount of work that Felicity may be doing in the provision of infant care. Felicity asks for help with breastfeeding. After Felicity has finished breastfeeding, her mother asks for a bottle so they can warm it and “feed” the baby. How would the perinatal nurse best respond to Felicity’s mother in a culturally sensitive way? a. Ask Felicity’s mother to leave for 30 minutes to allow for some private time with Felicity to explore her learning needs privately. b. Ask both Felicity and her mother about the preferred infant feeding method, and assess what they already know. c. Convey to Felicity and her mother an understanding of the concepts of “hot” and “cold” within their belief system. d. Ask Felicity what she knows about breastfeeding, and provide information to both women to support Felicity’s decision. 10. A neonatal nurse caring for newborns knows that the best time for a mother to first attempt breastfeeding is during which one of the following stages of activity? a. First period of reactivity b. First period of inactivity and sleep c. Second period of reactivity d. Second period of inactivity and sleep 11. A nurse is providing discharge teaching to the parents of a 2-day-old neonate. Which of the following information should be included in the discharge teaching on umbilical cord care? a. Cleanse the cord twice a day with hydrogen peroxide. b. Remove the cord with sterile tweezers if the cord does not fall off by 10 days of age. c. Call the doctor if greenish discharge appears. d. Cover the cord with sterile dressing until it falls off. 12. The nurse is teaching the parents of a 1-day-old baby how to give their baby a bath. Which of the following actions should be included? a. Clean the eye from the outer canthus to the inner canthus. b. Keep the door of the room open to allow for ventilation. c. Gather all supplies before beginning the bath. d. Check the temperature of the water with your fingertip. 13. The nurse is teaching the parents of a female baby how to change a baby’s diapers. Which of the following should be included in the teaching? a. Always wipe the perineum from front to back. b. Remove any vernix caseosa from the labia folds. c. Put powder on the buttocks every time the baby stools. d. Weigh every diaper in order to assess for hydration. 14. The nurse is advising parents of a full-term neonate being discharged from the hospital regarding car seat safety. Which of the following should be included in the teaching plan? a. Put the car seat facing forward only after the baby reaches 20 pounds. b. The infant car seat should be placed facing the rear seat in the front seat of the car. c. A fist should fit between the straps of the seat and the baby’s body. d. Seat belt adjusters should always be used to support infant car seats. 15. The nurse is teaching the parents of a healthy newborn about infant safety. Which of the following should be included in the teaching plan? a. Water temperature for the infant’s bath should be 39°C. b. Crib slates should be a maximum of 3 inches apart. c. Cover electrical outlets once the infant is crawling. d. Remove strings from infant sleepwear. 16. Which of the following statements indicates that a new mother needs additional teaching? a. “I need to supervise my cat when she is in the same room as my baby.” b. “I will place my baby on her back when she is sleeping.” c. “I will not leave my baby on an elevated flat surface after she is able to turn over on her own.” d. “I have asked my husband to install safety latches on the lower cabinets.” Multiple Response 17. The let-down reflex occurs in response to the release of oxytocin. Which of the following can stimulate the release of oxytocin? (Select all that apply.) a. Prolactin release b. Infant suckling c. Infant crying d. Sexual activity 18. Which of the following are disadvantages of bottle feeding? (Select all that apply.) a. Hampers mother–infant attachment b. Increases cost c. Increases risk of infection d. Increases risk of childhood obesity 19. The clinic nurse teaches expectant mothers about the differences between breast milk and commercially prepared infant formulas. When compared to commercially prepared formulas, breast milk has (select all that apply): a. More carbohydrates b. Less protein c. Fewer nutrients d. Less cholesterol 20. The perinatal nurse is teaching the new mother who has chosen to formula feed her infant. Appropriate instructions to be given to this mother include (select all that apply): a. Mix the formula with hot water only. b. Periodically check the nipple for slow flow. c. Prepare only enough formula to last for 24 hours. d. Discard any unused formula that remains in a bottle following use. 21. The perinatal nurse describes infant feeding cues to a new mother. These feeding cues include (select all that apply): a. Vocalizations b. Mouth movements c. Moving the hand to the mouth 22. Typical signs of abusive head trauma (Shaken Baby Syndrome) include which of the following? (Select all that apply.) a. Broken clavicle b. Poor feeding c. Vomiting d. Breathing problems 23. General skin care for full-term infants includes which of the following? (Select all that apply.) a. Avoid daily bathing with soap. b. Use a cleanser with an alkaline pH. c. Avoid fragrant soaps. d. Apply petrolatum-based ointments sparingly to dry skin, but avoid head and face. 24. A nurse is going to teach her postpartum patient about newborn bathing, diapering, and swaddling. Which of the following indicates that the nurse incorporated teaching/learning principles in her teaching plans? (Select all that apply.) a. Asked family members to leave b. Turned off TV c. Closed the door of the room d. Administered analgesics a few hours before teaching session True/False Chapter 17: High-Risk Neonatal Nursing Care Multiple Choice 1. A neonate is born at 33 weeks’ gestation with a birth weight of 2400 grams. This neonate would be classified as: a. Low birth weightb. Very low birth weightc. Extremely low birth weightd. Very premature. KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Analysis | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Moderate 2. A nurse assesses that a 3-day-old neonate who was born at 34 weeks’ gestation has abdominal distention and vomiting. These assessment findings are most likely related to:a. Respiratory Distress Syndrome (RDS)b. Bronchopulmonary Dysplasia (BPD)c. Periventricular Hemorrhage (PVH)d. Necrotizing Enterocolitis (NEC) 3. A full-term neonate who is 30 hours old has a bilirubin level of 10 mg/dL. The neonate has a yellowish tint to the skin of the face. The mother is breastfeeding her newborn. The nurse caring for this neonate would anticipate which of the following interventions?a. Phototherapyb. Feeding neonate every 2 to 3 hoursc. Switch from breastfeeding to bottle feeding d. Assess red blood cell count 4. A NICU nurse is caring for a full-term neonate being treated for group B streptococcus. The mother of the neonate is crying and shares that she cannot understand how her baby became infected. The best response by the nurse is:a. “Newborns are more susceptible to infections due to an immature immune system. Would you like additional information on the newborn immune system?”b. “The infection was transmitted to your baby during the birthing process. Do you have a history of sexual transmitted infections?”c. “Approximately 10% to 30% of women are asymptomatic carries of group B streptococcus which is found in the vaginal area. What other questions do you have regarding your baby’s health?”d. “I see that this is very upsetting for you. I will come back later and answer your questions.” 5. A nursery nurse observes that a full-term AGA neonate has nasal congestion, hypertonia, and tremors and is extremely irritable. Based on these observations, the nurse suspects which of the following?a. Hypoglycemiab. Hypercalcemiac. Cold stressd. Neonatal withdrawal 6. The following four babies are in the neonatal nursery. Which of the babies should be seen by the neonatologist as soon as possible? a. 1-day-old, HR 170 bpm, crying b. 2-day-old, T 98.9°F, slightly jaundice c. 3-day-old, breastfeeding q 2 h, rooting d. 4-day-old, RR 70 rpm, dusky coloring 7. A multipara, 26 weeks’ gestation and accompanied by her husband, has just delivered a fetal demise. Which of the following nursing actions is appropriate at this time? a. Encourage the parents to pray for the baby’s soul. b. Advise the parents that it is better for the baby to have died than to have had to live with a defect. c. Encourage the parents to hold the baby. d. Advise the parents to refrain from discussing the baby’s death with their other children. 8. The nurse is assessing a baby girl on admission to the newborn nursery. Which of the following findings should the nurse report to the neonatologist? a. Intermittent strabismus b. Startling c. Grunting d. Vaginal bleeding 9. It is noted that the amniotic fluid of a 42-week gestation baby, born 30 seconds ago, is thick and green. Which of the following actions by the nurse is critical at this time? a. Perform a gavage feeding immediately. b. Assess the brachial pulse. c. Assist a physician with intubation. d. Stimulate the baby to cry. 10. A 42-week gestation neonate is admitted to the NICU (neonatal intensive care unit). This neonate is at risk for which complication? a. Meconium aspiration syndrome b. Failure to thrive c. Necrotizing enterocolitis d. Intraventricular hemorrhage 11. A 1-day-old neonate in the well-baby nursery is suspected of suffering from drug withdrawal because he is markedly hyperreflexic and is exhibiting which of the following additional sign or symptom? a. Prolonged periods of sleep b. Hypovolemic anemia c. Repeated bouts of diarrhea d. Pronounced pustular rash 12. A baby boy was just born to a mother who had positive vaginal cultures for group B streptococci. The mother was admitted to the labor room 30 minutes before the birth. For which of the following should the nursery nurse closely observe this baby? a. Grunting b. Acrocyanosis c. Pseudostrabismus d. Hydrocele 13. The laboratory reported that the L/S ratio (lecithin/sphingomyelin) results from an amniocentesis of a gravid client with preeclampsia are 2:1. The nurse interprets the result as which of the following? a. The baby’s lung fields are mature. b. The mother is high risk for hemorrhage. c. The baby’s kidneys are functioning poorly. d. The mother is high risk for eclampsia. 14. Which of the following neonatal signs or symptoms would the nurse expect to see in a neonate with an elevated bilirubin level? a. Low glucose b. Poor feeding c. Hyperactivity d. Hyperthermia 15. The perinatal nurse is assisting the student nurse with completion of documentation. The laboring woman has just given birth to a 2700 gram infant at 36 weeks’ gestation. The most appropriate term for this is: a. Preterm birth b. Term birth c. Small for gestational age infant d. Large for gestational age infant 16. The NICU nurse recognizes that respiratory distress syndrome results from a developmental lack of: a. Lecithin b. Calcium c. Surfactant d. Magnesium 17. The NICU nurse is providing care to a 35-week-old infant who has been in the neonatal intensive care unit for the past 3 weeks. His mother wants to breastfeed her son naturally but is currently pumping her breasts to obtain milk. His mother is concerned that she is only producing about 1 ounce of milk every 3 hours. The nurse’s best response to the patient’s mother would be: a. “Pumping is hard work and you are doing very well. It is good to get about 1 ounce of milk every 3 hours.” b. “Natural breastfeeding will be a challenging goal for your baby. Beginning today, you will need to begin to pump your breasts more often.” c. “Your baby will not be ready to go home for at least another week. You can begin to pump more often in the next few days in preparation for taking your child home.” d. “You have been working hard to give your son your breast milk. We can map out a schedule to help you begin today to pump more often to prepare to take your baby home.” 18. A nurse is caring for a 2-day-old neonate who was born at 31 weeks’ gestation. The neonate has a diagnosis of respiratory distress syndrome (RDS). Which of the following medical treatments would the nurse anticipate for this neonate? (Select all that apply.) a. Exogenous surfactant b. Corticosteroids c. Continuous positive airway pressure (CPAP) d. Bronchodilators KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Comprehension | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Moderate 19. Which of the following factors increases the risk of necrotizing enterocolitis (NEC) in very premature neonates? (Select all that apply.) a. Early oral feedings with formula b. Prolonged use of mechanical ventilation c. Hyperbilirubinemia d. Nasogastic feedings 20. Nursing actions that decrease the risk of skin breakdown include which of the following? (Select all that apply.) a. Using gelled mattresses b. Using emollients in groin and thigh areas c. Using transparent dressings d. Drying thoroughly 21. Nursing actions that minimize oxygen demands in the neonate include which of the following? (Select all that apply.) a. Providing frequent rest breaks when feeding b. Placing neonate on back for sleeping c. Maintaining a neutral thermal environment (NTE) d. Clustering nursing care 22. A nurse is caring for a 10-day-old neonate who was born at 33 weeks’ gestation. Which of the following actions assist the nurse in assessing for signs of feeding tolerance? (Select all that apply.) a. Check for presence of bowel sounds b. Assess temperature c. Check gastric residual by aspirating stomach contents d. Assess stools 23. Which of the following are common assessment findings of postmature neonates? (Select all that apply.) a. Dry and peeling skin b. Abundant vernix caseosa c. Hypoglycemia d. Thin, wasted appearance 24. A nurse is caring for a 40 weeks’ gestation neonate. The neonate is 12 hours post-birth and has been admitted to the NICU for meconium aspiration. The nurse recalls that the following are potential complications related to meconium aspiration (select all that apply): a. Obstructed airway b. Hyperinflation of the alveoli c. Hypoinflation of the alveoli d. Decreased surfactant proteins 25. A nurse is completing the initial assessment on a neonate of a mother with type I diabetes. Important assessment areas for this neonate include which of the following? (Select all that apply.) a. Assessment of cardiovascular system b. Assessment of respiratory system c. Assessment of musculoskeletal system d. Assessment of neurological system 26. A baby was born 4 days ago at 34 weeks’ gestation. She is receiving phototherapy as ordered by the physician for physiological jaundice. She has symptoms of temperature instability, dry skin, poor feeding, lethargy, and irritability. The nurse’s priority nursing action(s) is (are) to (select all that apply): a. Verify laboratory results to check for hypomagnesia. b. Verify laboratory results to check for hypoglycemia. c. Monitor the baby’s temperature to check for hypothermia. d. Calculate 24-hour intake and output to check for dehydration. 27. The perinatal nurse caring for Emily, a 24-year-old mother of an infant born at 26 weeks’ gestation, is providing discharge teaching. Emily is going to travel to the specialty center approximately 200 miles away where her daughter is receiving care. The nurse tells Emily that it is normal for Emily to feel (select all that apply): a. In control b. Anxious c. Guilty d. Overwhelmed 28. A baby has just been admitted into the neonatal intensive care unit with a diagnosis of intrauterine growth restriction (IUGR). Which of the following maternal problems could have resulted in this complication? (Select all that apply.) a. Cholecystitis b. Hypertension c. Cigarette smoker d. Candidiasis e. Cerebral palsy Chapter 18: Well Women’s Health Multiple Response 1. Physical activity can lower a woman’s risk for (select all that apply): a. Endometriosis b. Depression c. Colon cancer d. Arthritis ANS: b, c According to the US Department of Health and Human Services, Office of Women’s Health, physical activity can lower a woman’s risk for heart disease, type 2 diabetes, colon cancer, breast cancer, falls, and depression. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Health Promotion | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate 2. During a routine physical of a 31-year-old non-Hispanic black woman, it was noted that the woman’s BMI is 32, her only exercise is taking care of her two children, her last Pap test was 2 years ago, and her last clinical breast exam was 2 years ago. Based on this information the woman (select all that apply): a. Needs to be scheduled for a Pap test b. Needs to be scheduled for a clinical breast exam /[‘.c. Is at risk for type 2 diabetes d. Is at risk for depression 3. Excessive drinking places the woman at risk for (select all that apply): a. Suicide b. Stroke c. Breast cancer d. Menstrual disorders 4. The woman’s health clinic nurse is providing information to a 21-year-old woman who is being scheduled for a pelvic exam and Pap test. This information should include (select all that apply): a. The Pap test is a diagnostic test for cervical cancer. b. The woman should not use tampons or vaginal medication or engage in sexual intercourse within 48 hours of the exam. c. The best time to have a Pap test is 5 days after the menstrual period has ended. d. The woman should have a yearly Pap test. 5. A 60-year-old woman is scheduled for a dual-energy X-ray absorptiometry scan (DXA). The woman’s health clinic nurse should provide the following information: a. DXA is a diagnostic test for osteoporosis. b. DXA measures the bone density of the hip, spine, and forearm. c. The T score is a comparison of the woman’s bone density with that of other women her age. d. Osteoporosis can cause a stooped posture. Answers a, b, and d are true statements. A T-score is a comparison of the woman’s bone density with that of a woman 30 years of age and the same race. 8. Which of the following women is at highest risk for osteoporosis? a. A 70-year-old non-Hispanic white woman who has smoked for 50 years b. A 70-year-old non-Hispanic black woman who is a heavy drinker c. A 60-year-old Asian woman who takes steroids to treat SLE d. A 70-year-old Hispanic woman who has had weight loss surgery Multiple Choice 9. A 65-year-old woman is complaining of jaw pain, nausea, shortness of breath without chest pain, and sweating. These are warning signs of: a.. Heart attack b. Stroke c. Diabetes d. Dental disease 10. Which of the following foods is highest in calcium? a. An 8 oz. glass of milk b. A 1.5 oz. piece of cheddar cheese c. An 8 oz. container of plain, low-fat yogurt d. A 3 oz. piece of salmon Chapter 19: Alterations in Women’s Health Multiple Response 1. Postoperative nursing care for a woman who had a total hysterectomy includes (select all that apply): a. Administering hormone replacement therapy as per MD orders b. Informing the woman that she will experience small amounts of vaginal bleeding for several days c. Instructing the woman to use tampons d. Instructing the woman to increase her ambulation to facilitate return of normal intestinal peristalsis 2. Menorrhagia may result from (select all that apply): a. Anovulatory cycle b. Metritis c. Anorexia d. Emotional distress 3. Secondary amenorrhea results from (select all that apply): a. Polycystic ovary syndrome b. Diabetes c. Metritis d. Pregnancy 4. During a health visit, a 23-year-old patient shares with her health-care provider that she has been experiencing a yellowish mucus vaginal discharge, pain during sexual intercourse, and burning on urination. A culture of the cervical epithelial cells is obtained. Based on the patient information, the culture is obtained to assist in the diagnosis of which of the following? (Select all that apply.) a. Chlamydia b. Gonorrhea c. Genital herpes d. Syphilis 5. A woman who is receiving radiation therapy for treatment of stage I cervical cancer is experiencing diarrhea. She contacts the oncology advice nurse. The advice nurse recommends that the woman (select all that apply): a. Eat five or six small meals a day instead of three large meals b. Eat cooked vegetables instead of raw vegetables c. Use baby wipes instead of toilet paper d. Reduce fluid intake to four glasses of water 6. A primary topic for health promotion for a 25-year-old woman with a history of polycystic ovary syndrome is (select the most important topic): a. The adverse effects of cigarette smoking b. The adverse effects of excessive alcohol consumption c. Nutrition d. Self-esteem issues 7. Which of the following is correct regarding endometriosis? a. The physical symptoms of endometriosis can affect the woman’s mental health. b. The abnormal tissue bleeds into surrounding tissue during the secretory stage of the menstrual cycle. c. Endometriosis causes sterility. d. Metronidazole is used to treat endometriosis. 8. The daughter of an 85-year-old woman informs the doctor that her mother has suddenly become disoriented/confused and that she is dizzy and having difficulty with her balance. She is agitated and has fallen twice in the last 24 hours. The patient’s blood pressure and VS are within normal limits. Her medications include Synthroid, Lisinopril, and Crestor. Based on this data, the woman is most likely experiencing: a. Stroke b. Beginning stages of dementia c. Urinary tract infection d. Adverse reaction to her medications 9. A total hysterectomy is the removal of: a. The uterus b. The uterus and cervix c. The uterus, cervix, fallopian tubes, and ovaries d. The uterus, cervix, fallopian tubes, ovaries, upper portion of the vagina, and lymph nodes [Show More]

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