Test Bank For Maternal Child Nursing Care with Women's Health Companion 2nd Edition, Susan

Test Bank For Maternal Child Nursing Care with Women's Health Companion 2nd Edition, Susan YOU CAN FIND MORE QUESTIONS AND ANSWERS, just go HERE MULTIPLE CHOICE Chapter 1: Traditional and Community Nursing Care for Women, Families, and Children 1. The clinic nurse understands the new description of nursing art/aesthetics as the way that nurses and patients help each other through a circular process. What is the event that begins this process?

A. A health threat B. Experiencing new possibilities for health C. Hope and understanding for the future D. Relationship building 2. A nurse manager in a community clinic is concerned because the local refugee population does not seek health care routinely. What action by the nurse would be most helpful?

A. Assess clinic staff and procedures for evidence of ethnocentrism.

B. Put up flyers advertising the clinic’s services in local retailers.

C. Reward preventative health patients with coupons for needed items.

D. Try to meet with community leaders to work on the problem.

3. The nursing faculty explains to students that ethnopluralism is an important force shaping health care today. What concept is most important in understanding this trend?

A. The decreased need for cultural competency B. The growth in one ethnic group in a single area C. The increased impact of diverse cultures on health care D. The percentage increase of the non-Caucasian population 4. A nursing faculty member is explaining recent shifts in nursing practice. What change has been important in applying the nursing process?

A. A change to a spiral or circular process B. A focus on more independent nursing actions C. A return to the nurse-as-expert model of care D. An emphasis on attaining a disease-free state 5. A nurse is working in an urban clinic with a diverse population. What action by the nurse is most important?

A. Determine patients’ definitions of health and desired outcomes of health care.

B. Explain policies such as appointment cancellations to ensure compliance.

C. Learn to speak one or two common languages of the patients in the clinic.

D. Read about different folk remedies common among the populations seen.

6. A nurse is working with a minority group that has a high incidence of cardiovascular disease, including hypertension and stroke. When participating in a community health fair with this group, what

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action by the nurse will be most effective?

A. Educate the participants about weight loss and a low-sodium, low-fat diet.

B. Explain the genetic basis for the high incidence of cardiovascular disease in the group.

C. Help participants make lifestyle changes that are culturally congruent.

D. Present statistics on the mortality and morbidity of cardiovascular disease.

7. What does the practicing nurse understand to be the most important influence on interdependent, assertive nursing practice today?

A. Higher education of registered nurses B. Improved working conditions and salaries C. Increased numbers of female physicians D. Use of the nursing process for patient care 8. A child who has been hospitalized for a long time is preparing to go home, where care will be continued. Which action by the nurse is most beneficial to assist the family in this transition?

A. Advise the family to call the local visiting nurses association for home visits.

B. Call the child’s school to inquire about requirements for returning to school.

C. Consult a social worker to help evaluate insurance coverage and transportation.

D. Give the family brochures for the local support group for chronically ill children.

9. A nurse manager wants to make the pediatric clinic a more family-centered health-care setting. Which of the following actions by the nursing staff would best meet this goal?

A. Encourage family members to be present in the exam room and to ask questions.

B. Incorporate the use of a community health map for all new patients in the clinic.

C. Recognize family members as experts on their child and incorporate them in decision making.

D. Use evidence-based practice to develop policies and procedures used in the clinic.

10. A clinic nurse is explaining to a student nurse the function of the community health map in assessing families. Which description of this assessment tool is most accurate?

A. It assesses how the family interacts with outside social systems.

B. It locates health-care settings in, or close to, their neighborhood.

C. It outlines family problems and social resources to help with them.

D. It shows how the health of the community impacts each family.

Chapter 2: Contemporary Issues in Women’s, Families’, and Children’s Health Care 1. The clinic nurse is working with a mother and her 3-year-old child who have arrived for the child’s routine checkup. The nurse encourages the mother to return for her child’s measles-mumps-rubella immunization prior to the child’s entering school. This intervention is an example of what type of care?

A. Mandatory health care B. Primary health prevention C. Secondary health prevention D. Tertiary health prevention 2. A nurse wishing to be an advocate for access to health care would most likely choose to participate in which of the following activities?

A. Lobby for improved insurance access for all individuals, whether or not they are employed.

B. Help establish fast-track or minor illness areas in local emergency rooms.

C. Partner with medical centers to provide free services for low-income patients.

D. Work with visiting nurses associations to create on-site clinics at day-care centers.

3. A nurse working with an after-school program is concerned about the lack of health literacy in the students’ parents. What action would best address this need?

A. Conduct a monthly health-related seminar for parents.

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B. Investigate grants or other funding for a computer bank.

C. Invite parents to healthy cooking demonstrations.

D. Provide brochures on a variety of health problems.

4. A nurse is caring for a patient near the end of life whose wishes regarding care are not known. The two sons disagreed with the two daughters about future medical plans for the patient during a recent family conference, and now the sons and daughters are not talking to one another. What action by the nurse would be best to help resolve this dilemma?

A. Call the facility’s ethics committee and request a formal consultation.

B. Have social work coordinate another family meeting to discuss the issue.

C. Meet with the sons and daughters separately to discuss their wishes.

D. Request that the physician tell the family what is in the patient’s best interests.

5. A mother and her 12-year-old daughter visit the clinic often because of the daughter’s asthma. The clinic nurse recognizes that one of the most important nursing actions in this situation is which of the following?

A. Continue to schedule regular clinic visits for the child to follow her condition.

B. Give the mother time to talk about her daughter’s illness while she is present.

C. Listen patiently to the child as she talks about her illness, letting her tell her story.

D. Regulate and modify the child’s medications in response to her asthma symptoms.

6. The nurse managing a pediatric clinic often sees single mothers with children. What action by the nurse would best help this population of women access health care?

A. Arrange to have evening and weekend hours.

B. Offer sample medications instead of prescriptions.

C. Provide a play center for waiting children.

D. Provide bus tokens for transportation to the clinic.

7. A community health nurse explains to the nursing student that the best health-related programming includes which of the following elements?

A. Has both individual and societal components B. Is directed toward individual responsibility C. Provides incentives to compensate healthy choices D. Requires legislation to truly be effective 8. A nursing student wishes to investigate national health goals. Where should the student research this information?

A. Cochrane Database B. Cumulative Index of Nursing and Allied Health Literature C. Government websites D. Healthy People initiative 9. A nurse is interested in primary prevention programs. Which of the following activities would this nurse choose to do?

A. Assist with blood pressure screening at the local mall.

B. Collect and distribute used eyeglasses for poor people.

C. Staff a mobile mammogram unit for underserved groups.

D. Teach teenagers about the dangers of texting and driving.

10. A nurse wants to work in the community providing secondary prevention activities. Which action would this nurse choose to do?

A. Educate teenage girls about birth control options.

B. Provide STD/STI testing at the local youth center.

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C. Staff the county health department flu shot clinic.

D. Volunteer to drive cancer patients to receive their treatments.

Chapter 3: The Evolving Family 1. The clinic nurse is taking a history from a woman who came to the clinic to get test results. The patient brought a coworker with her because she is worried. The patient asks to have her coworker remain in the exam room when the doctor describes the test findings. The patient states that the friend is “like a sister.” The nurse would most correctly identify the two women as which of the following?

A. Extended family B. Family C. Family of choice D. Family of origin 2. The clinic nurse understands that children who come for well-child visits at age 10 are in the process of developing which of the following attributes?

A. Attachment B. Coordination C. Personal values D. Self-identity 3. A new mother with a 2-month-old daughter tells the family clinic nurse that she is experiencing a lack of sleep because of infant night feedings and her husband’s shift work and excessive overtime. Which of the following is the best description of this family concern?

A. Caregiver strain B. Coping stress C. Lack of support D. Parental maladaptation 4. A patient describes her spouse’s dependence on oxycodone terephthalate (Percocet), which began following knee surgery last year. Although the prescription was finished some time ago, the spouse continues to obtain and take Percocet. Because of the spouse’s “need” for the medication, the patient “has to” do all the yard work, child care, and meal preparation. How would the nurse describe the patient’s behavior?

A. Enabler B. Impaired caregiver C. Inadequate dyad partner D. Overstressed parent 5. A mother brings her 8-year-old daughter to the clinic for the third time in 2 months. The mother states that her daughter is very active and often falls down. The mother states that her daughter eats well, but the child’s weight falls below the 10th percentile. The clinic record shows the child had multiple bruises on her arms at the time of the last two visits. Today the nurse notes that the child has areas of ecchymosis on her left leg and ankle. Which action by the nurse is best?

A. Ask the child and her mother again about the child’s bruises.

B. Question the child about her accident-prone behaviors.

C. Speak with the child alone, asking if she feels safe at home.

D. Teach the mother to keep a diary of what her child is eating.

6. The clinic nurse notices that each time a child with leukemia is brought in to see the doctor, her mother and aunt accompany her. The mother states that she finds her daughter’s illness to be very traumatic and is having difficulty coping. The child’s aunt encourages the child’s mother and distracts the child while her blood work is being drawn. The child’s aunt could be described as taking on which

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of the following roles?

A. Child-caregiver role B. Kinship role C. Socializer role D. Therapist role 7. The nurse observes a woman and her sister who live together. They are trying to support one another and provide extended care to their mother who has recently been diagnosed with Alzheimer’s disease.

The two sisters describe their experience with a homemaker who visits their home to help bathe their mother. They say she is “humorous and cheerful” and absorbs their mother’s attention for the whole time she is present. This is a positive description of which component of Bowen’s family systems theory?

A. Communication B. Family relationship building C. Family rituals D. Triangulation 8. A nurse is assessing a single person at a clinic visit. How would the nurse classify this patient’s family?

A. Family of choice B. Family of origin C. Not in a family D. Nuclear family 9. A patient tells the nurse about living in a commune. What does the nurse understand about this family structure?

A. Family with distant relatives included B. Group of men, women, and children C. Kinship care provided to children D. Unmarried man and woman living together 10. A nurse is assessing a child with very poor social skills. What conclusion can the nurse make about the child’s family?

A. Emotional or mental illness B. Not filling socialization needs C. Poorly educated, poor job skills D. Probably lower-income status Chapter 4: Caring for Women, Families, and Children Across the Life Span 1. The clinic nurse knows that providing an influenza vaccination clinic for patients aged 65 years and older is best described as an example of what kind of health care?

A. Disease prevention B. Health promotion C. Health screening D. Secondary prevention 2. The family clinic nurse encourages a patient to continue breastfeeding her 8-month-old infant to facilitate maturation of the infant’s immune system. When does this occur?

A. 12 months B. 16 months C. 18 months D. 24 months

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3. The clinic nurse is working with a mother who wants to know the best age for teaching children about the names and functions of sexual organs. What should the nurse tell her?

A. 5 to 6 years of age B. 6 to 7 years of age C. 8 to 9 years of age D. 9 to 11 years of age 4. The pediatric clinic nurse tells the parents that infants can roll over, presenting a safety hazard, at what age?

A. 1 month B. 2 months C. 3 months D. 4 months 5. The family clinic nurse reviews nutritional information with a 15-year-old patient. The patient is concerned about being short and wonders if growth will continue. The nurse explains that the typical increase in height during adolescence is how much?

A. 15% B. 25% C. 30% D. 35% 6. A school nurse is interviewing a high school student sent to the office for frequent crying episodes.

The student admits to thinking of suicide and has made a previous attempt. The nurse determines that the teen has a suicide plan but does not yet have access to the materials needed to carry out the plan.

How does the nurse interpret and act on this information?

A. High risk: Call the school district counselor.

B. High risk: Contact 911 immediately.

C. Low risk: Send a referral home with the student.

D. Moderate risk: Call the parents to come get the teen.

7. The family clinic nurse initiates conversation with a 16-year-old adolescent male who is 5 feet 10 inches and weighs 250 pounds (113.6 kg). Which of the following is the most appropriate question for the nurse to ask the adolescent regarding his weight?

A. “Are you willing to talk about your weight gain this year?”

B. “Do you realize your weight puts you into an obese category?”

C. “Do you participate in any activities or exercise?”

D. “What do you think about your weight right now?”

8. A nurse is observing a mother and her 10-month-old infant. The mother is interacting happily with the child while letting the baby eat pieces of hot dog. What action by the nurse is best?

A. Compliment the mother on her parenting skills.

B. Document that the baby is eating finger foods now.

C. Stop the mother from feeding the hot dog to the baby.

D. Teach the mother that hot dogs are poor nutrition.

9. A nurse is teaching new parents about dental care for their baby. Which information should the nurse provide?

A. Brush the baby’s teeth with special baby toothpaste.

B. The child should see a dentist before the age of 2.

C. All teeth should be in by age 2.

D. Wipe the baby’s gums with moist gauze.

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10. A public health nurse is visiting a family home where there is a newborn. Which assessment finding by the nurse warrants immediate intervention?

A. A cat is sitting on the kitchen counter by the stove.

B. Roaches are evident in the kitchen and in the pantry.

C. The baby is on a carpet that is stained and worn out.

D. The crib has dirty bumper pads and a dirty comforter.

Chapter 5: Reproductive Anatomy and Physiology 1. The perinatal nurse reads in a chart that a woman has a lesion on her perineum. Where would the nurse assess this lesion?

A. Greater vestibular or vulvovaginal glands B. Skin-covered region between the vagina and the anus C. Small portion of tissue around the anus D. Small portion of tissue surrounding the vaginal opening 2. The perinatal nurse knows that the lowest portion of the true pelvis is which of the following anatomical landmarks ?

A. Pelvic outlet B. Linea terminalis C. Sacral promontory D. Sacrum 3. The clinic nurse knows that the part of the uterine cycle that occurs during the period of time between ovulation and the onset of menses is known as which of the following?

A. Ischemic phase B. Menstrual phase C. Proliferative phase D. Secretory phase 4. The perinatal nurse explains to the new nurse that the maternal pelvic shape can determine the fetal presentation. A fetus in a transverse presentation may be due to which maternal pelvic type?

A. Android B. Anthropoid C. Gynecoid D. Platypelloid 5. The clinic nurse explains to a student that the hormone responsible for limiting the maternal immune response to pregnancy is which of the following?

A. Human chorionic gonadotropin B. Progesterone C. Prostaglandin D. Relaxin 6. A woman who might be pregnant is excited to learn when she will know the gender of the baby. What is the best response by the nurse?

A. 5 weeks B. 6 weeks C. 8 weeks D. 12 weeks 7. The pediatric nurse explains to the student that production of testosterone by the male embryo causes what to occur?

A. Creation of a gonad

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B. Formation of the male genital tract C. Production of spermatozoa D. Stimulation of external genitalia growth 8. The nursing instructor explains to the students that external female genitalia develop under what influence?

A. Absence of androgens B. Ductal pair dominance C. Ovary production D. Process of oogonia 9. A woman sustained a moderate blow to the lower pelvic region in an occupational accident. She is surprised to find out that no bones were broken. What explanation by the nurse is best?

A. “Blunt force trauma doesn’t cause fractures.”

B. “Pelvic bones are very hard to fracture.”

C. “Some fractures don’t show up right away.”

D. “You have a fat pad in front of your pelvis.”

10. A new nurse is attempting to catheterize a female patient. The nurse has a difficult time and after three attempts, finally inserts the catheter into the bladder and has urine output. What suggestion by the more experienced nurse is best?

A. “Leave the incorrectly placed catheters where they are while inserting a fresh one.”

B. “Place the patient in a high Fowler’s position and have another nurse adduct the legs.”

C. “Position the patient prone with another nurse abducting the patient’s legs.”

D. “To save the patient some charges, use the same catheter for two attempts.”

Chapter 6: Human Sexuality and Fertility 1. The reproductive health nurse counsels a 17-year-old woman who is interested in initiating contraception. Which of the following would be a short-term positive outcome of the visit?

A. Able to describe how to obtain and use the contraceptive chosen B. Continued use and pregnancy prevention for 6 months C. Lack of side effects and complaints about the method after 3 months D. Voiced satisfaction with this method over 6 months 2. The clinic nurse is counseling a woman who had a Nexplanon rod implanted. The nurse reminds her that she will need an appointment to replace this birth control method in what time frame?

A. 12 months B. 24 months C. 36 months D. 48 months 3. A 24-year-old lactating woman asks about contraceptive options. The family planning clinic nurse recommends an oral contraceptive formulated with which ingredients?

A. Biphasic formulation B. Estrogen-progestin C. Progestin only D. Triphasic formulation 4. A woman is interested in the transdermal contraceptive patch. She is 5’5” tall and weighs 200 lb (90.9 kg). What information should the nurse provide this patient as a priority?

A. It may cause skin irritation.

B. She can’t use the patch at her weight.

C. The patch is about 95% effective.

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D. Withdrawal bleeding occurs monthly.

5. A nurse works with many women who self-identify as lesbian or bisexual. What action by the nurse would best address this population’s needs?

A. Aggressive screening for sexually transmitted infections B. Assisting with procedures related to conception C. Providing information on increased cancer risks D. Using questions that do not assume sexual orientation 6. The nurse working in a family practice clinic assesses women for sexual dysfunction. Which woman would the nurse assess as having a sexual dysfunction?

A. Complains about lack of arousal but still has intercourse B. Enjoys a platonic relationship with her “gentleman friend” C. Needs increased foreplay in order to reach an orgasm D. No desire for intimacy and is comfortable with the situation 7. A nurse is working with a patient who has the nursing diagnosis of altered sexuality patterns. What action by the nurse takes priority?

A. Assists with the physical exam B. Establishes a trusting relationship C. Reviews the past medical history D. Takes a comprehensive sexual history 8. A nurse is assessing a patient who complains of an inability to achieve orgasm. The patient was recently started on several new medications. Which one would the nurse evaluate as possibly contributing to this problem?

A. Atenolol (Tenormen) B. Clonidine (Catapres) C. Levothyroxine (Synthroid) D. Sertraline (Zoloft) 9. The nurse is assessing a sexually active heterosexual woman who does not use birth control. The nurse explains that the chance of becoming pregnant with each act of unprotected intercourse is what percentage?

A. 5–10% B. 10–15% C. 15–20% D. 20–25% 10. A nurse is working with a young woman planning to become sexually active. She has the nursing diagnosis of knowledge deficit related to contraceptive choices. Which action by the patient would indicate that a priority goal has been met?

A. Can describe how to use method chosen and its side effects B. Is able to choose the “best fit” from contraceptive choices C. Obtains the contraceptive method previously desired D. Willing and able to explain contraceptive method to partner Chapter 7: Conception and Development of the Embryo and Fetus 1. A faculty member explains the Human Genome Project to a class of nursing students. Which information about this project is correct?

A. It began in the 1980s to find the basic building blocks of human proteins.

B. The findings will be used to create better matches for animal-to-human transplants.

C. The goal is to identify exact DNA sequences and genes occurring in humans.

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D. Information from the project is being used to find preventative measures for diseases.

2. A nurse is interested in studying the functions and interactions of the genes in the human genome.

What branch of science should this nurse pursue?

A. Biology B. Genetics C. Genomics D. Inheritance 3. A nursing instructor is explaining genetic concepts to a class of students. Where in the cell does the instructor tell the students that each person’s genes can be found?

A. Golgi body B. Lysosome C. Mitochondria D. Nucleus 4. A couple wishes to determine the chances of having a blue-eyed baby. Both parents have brown eyes, but have heterozygous gene pairs for eye color. Calculate the odds of their having a child with blue eyes.

A. 10% B. 20% C. 25% D. 50% 5. A nurse reads in a patient’s chart that the patient has a condition caused by monosomy X. What can the nurse conclude about this patient?

A. Female with one missing X chromosome B. Female with very feminine features C. Male with one extra X chromosome D. Male with very feminine features 6. A nurse has completed a family pedigree on a patient with a known autosomal dominant inheritance disorder. No one else in the family has been affected by this disorder. How does the nurse explain this finding to the patient?

A. Genetic variation occurred via a mutation.

B. Information about the family is incorrect.

C. The patient is not biologically related to the family.

D. The patient’s diagnosis must be incorrect.

7. A nurse is counseling a couple whose child has been diagnosed with cystic fibrosis. They understand that this is an inherited disease, but don’t know how the child got it, as neither of them is affected. What response by the nurse is best?

A. “Are you certain that you (points to man) are the biological father?”

B. “Maybe each of you has a mild case that hasn’t been diagnosed yet.”

C. “Something in your environment must have altered one of the genes.”

D. “This is a recessive disorder, meaning that each of you is just a carrier.”

8. A couple wishes to know the chances of passing on an X-linked dominant heritable disorder to their four sons. The father’s family has the disorder. The sons appear healthy, but the couple wants to be prepared for possible future events related to the disease. What information does the nurse give them?

A. “All of them will be affected.”

B. “Half of them will be affected.”

C. “None of your sons will be affected.”

D. “One of the four will be affected.”

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9. A nursing faculty member is explaining the process of fertilization to a class of students. One student asks the instructor to clarify the term “secondary oocyte.” What description is best?

A. An oocyte in the secondary position during transportation B. An oocyte in which the first meiotic division has occurred C. The second egg released by the ovary during ovulation D. The second egg to reach its place in the fallopian tube 10. The perinatal nurse understands that 4 days after fertilization, the morula now contains how many cells?

A. 2 B. 4 C. 8 D. 16 Chapter 8: Physiological and Psychosocial Changes During Pregnancy 1. The nurse has learned that which hormone is primarily responsible for maintaining a pregnancy?

A. Estrogen B. Human chorionic gonadotropin C. Oxytocin D. Progesterone 2. A patient who is 28 weeks pregnant calls the obstetrical clinic and complains of irregular, painless contractions that last for 10 to 15 seconds. What response by the nurse is best?

A. “If they last more than 60 seconds or become regular, come in.”

B. “Oh, you are just having what are called Braxton Hicks contractions.”

C. “Pregnant women often experience this type of contraction.”

D. “You should come in to the clinic as soon as possible today.”

3. The nurse caring for perinatal patients understands the term decidua to mean which of the following?

A. Collateral uterine circulation B. Endometrial lining of the uterus C. Endometrial tissue covering the embryo D. Placental remnants left in the uterus 4. A nurse is assessing a patient in the women’s clinic for Chadwick’s sign. How does the nurse perform this assessment?

A. Auscultates the woman’s abdomen for fetal heart tones B. Inspects the vulva and vagina for a bluish tint C. Palpates the woman’s abdomen for a fluid wave D. Percusses the woman’s abdomen for uterine margins 5. An instructor is explaining to students in the OB rotation that Goodell’s sign is which of the following?

A. Bluish cervical discoloration B. Cervical softening C. False labor contractions D. Slowed fetal heart tones 6. A nurse is teaching a woman who is in her first trimester of pregnancy about physical changes she can expect. Which information should the nurse provide?

A. Diminishing sexual interest occurs.

B. Harmful agents are able to invade the uterus.

C. Leukorrhea is an abnormal condition.

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D. Pregnant women are more susceptible to yeast infections.

7. A woman who gave birth 2 months ago calls the perinatal clinic crying because her hair is falling out in large amounts. What action by the nurse is most appropriate?

A. Advise the woman to make an appointment with a dermatologist.

B. Explain that this symptom will end once she stops breastfeeding.

C. Reassure the woman that her hair will grow back within a year.

D. Tell the woman it’s really extra hair that grew in pregnancy.

8. A pregnant woman in the perinatal clinic complains of a diffuse, reddish discoloration of her palms.

What action by the nurse is most appropriate?

A. Ask if she has been exposed to measles.

B. Assess her for Reynaud’s phenomenon.

C. Explain that this is a normal finding.

D. Take the woman’s vital signs.

9. A woman in her third trimester of pregnancy complains of a painful burning sensation in her hands and lower arms. Which action by the nurse is best?

A. Advise the woman to elevate her hands at night.

B. Document the finding and alert the provider.

C. Encourage the woman to see a neurologist.

D. Request a prescription for pregabalin (Lyrica).

10. A pregnant woman in the perinatal clinic complains of occasional fainting. Which action by the nurse is best?

A. Educate her that this is a frequent occurrence in pregnancy.

B. Encourage her to carry small snacks with her at all times.

C. Instruct her to lie down when the warning signs occur.

D. Tell her to lie down on her left side if she has warning signs.

Chapter 9: The Prenatal Assessment 1. The nurse places his or her hands on the maternal abdomen to gently palpate the fundal region of the uterus. This action is described as which Leopold maneuver?

A. First maneuver B. Second maneuver C. Third maneuver D. Fourth maneuver 2. The nurse includes screening for intimate partner violence in the first prenatal visit for all patients.

Which of the following is an appropriate question for the nurse to ask?

A. “I need to ask you, do you feel safe from abuse right now?”

B. “Is your partner threatening or harming you in any way right now?”

C. “This is something we ask everyone: Do you have any abuse in your life right now?”

D. “We ask everyone this: Do you feel safe in your living environment and relationships?”

3. The clinic nurse talks with a patient about her possible pregnancy. The patient has experienced amenorrhea for 2 months, nausea during the day with vomiting every other morning, and breast tenderness. She is convinced she is pregnant and is reluctant to pay for a pregnancy test. Which action by the nurse is best?

A. Agree that these signs usually signal pregnancy so no test is needed.

B. Delete the order for the pregnancy test and inform the provider.

C. Explain that these symptoms can be caused by other conditions.

D. Inform the woman that this is standard procedure and must be done.

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4. A woman in the prenatal clinical is concerned because her partner, who was supportive and excited about becoming pregnant, has suddenly become more withdrawn and seems ambivalent toward the pregnancy. What response by the nurse is best?

A. “Are you in a relationship that causes you to be afraid?”

B. “Oh don’t worry; they all feel this way sometimes.”

C. “This is a normal reaction to the reality of the pregnancy.”

D. “Your partner will come around to being excited soon.”

5. A nurse is working with a pregnant woman who has the nursing diagnosis of altered family processes.

What statement by the patient indicates that a major goal for this diagnosis has been met?

A. “At least I’m getting better sleep now that I don’t urinate every 2 hours.”

B. “My husband has been doing more around the house so I can rest more.”

C. “The kids are really excited about getting a new baby brother or sister.”

D. “We finally have the nursery painted and furnished so it’s ready for baby.”

6. A nurse is reviewing the prenatal care schedule for a woman who is 10 weeks pregnant. When does the nurse advise the woman to return for her next appointment?

A. 2 weeks B. 4 weeks C. 6 weeks D. 8 weeks 7. A woman who is 32 weeks pregnant has concluded a prenatal visit. The nurse should schedule the next prenatal visit for which gestational week?

A. 33 weeks B. 34 weeks C. 38 weeks D. 40 weeks 8. The prenatal nurse believes in advocating for the patient. What action by the nurse best reflects this role?

A. Documenting the patient’s preferences for childbirth care B. Helping the woman formulate and vocalize questions C. Informing women of options related to labor and birth D. Teaching women about physical changes during pregnancy 9. The nursing student in the perinatal clinic asks the registered nurse why so many pregnant women seem to be stressed despite their “happy” condition. What response by the nurse is best?

A. “It’s the effect of all those hormones.”

B. “Many are afraid of labor and birth.”

C. “Most pregnant women don’t feel well.”

D. “Pregnancy is a developmental crisis.”

10. A prenatal nurse manager wants to help pregnant women in the clinic decrease their stress. Which action by the manager would be best?

A. Conduct childbirth preparation classes on site B. Display pictures of fetal development C. Institute primary nursing care for all patients D. Partner with a counseling service for referrals Chapter 10: Promoting a Healthy Pregnancy 1. The prenatal clinic nurse visits with a 32-year-old man. His partner is pregnant with her first child and is now at 12 weeks of gestation. The man states that he has been experiencing nausea and vomiting,

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fatigue, and weight gain. Which action by the nurse is most appropriate?

A. Ask the woman’s health-care provider to prescribe the man anti-nausea medication.

B. Assess for cancer risk factors, as weight gain and vomiting are unusual together.

C. Encourage the man to make an appointment with his primary health-care provider.

D. Explain that these symptoms are normal and often seen in men with pregnant partners.

2. After questioning a pregnant woman about her fluid intake, the nurse discovers that the patient is drinking four glasses of diet cola per day. Which response by the nurse is best?

A. “As long as you get enough fluid, soda is all right to drink.”

B. “Less than two cups of caffeine a day is probably OK.” C. “The major worry with soda is the sugar content.”

D. “You really should switch to decaffeinated colas.”

3. A perinatal nurse is assessing a pregnant woman’s medications and finds that one of them is categorized as Category D. What information should the nurse provide this patient?

A. “Studies have not found human fetal risk, although animal fetuses are harmed by it.”

B. “There are no associated fetal risks with this drug and it is safe to take in pregnancy.”

C. “There haven’t been any studies of this drug in human fetuses; I wouldn’t take it.”

D. “We have to decide if the benefits of this drug outweigh the risk, as it can harm the fetus.”

4. The nurse explains to the prenatal class attendees that at full term about 10 to 11% of the maternal weight gain is attributed to which of the following?

A. Blood, uterine, and breast tissue B. Fetal tissue C. Maternal reserves D. Placental fluid 5. The prenatal clinic nurse meets with a 30-year-old woman who is experiencing her first pregnancy.

The patient’s quadruple-marker screen result is positive at 17 weeks of gestation. Which action by the nurse is most important?

A. Call the social worker for a consultation.

B. Document the findings in the woman’s chart.

C. Facilitate a referral to a genetics counselor.

D. Prepare the woman for intrauterine death.

6. A nurse is teaching a nonsmoking pregnant woman about the iron tablets she was just prescribed.

What information is most important for the nurse to teach the patient?

A. Calling the doctor right away for dark, tarry stools B. Drinking at least one glass of orange juice a day C. Stopping the prenatal vitamins while taking iron D. Taking the medication between meals and with milk 7. A 21-year-old pregnant woman smokes 8 to 10 cigarettes per day. The clinic nurse reviews the patient’s diet with her and notes that she does not eat fruits or vegetables. Which action should the nurse recommend to this patient?

A. Cut down on smoking and eventually quit.

B. Eat non-produce sources of vitamin C. C. Take an over-the-counter vitamin C supplement.

D. Try to drink one glass of orange juice daily.

8. An 18-year-old woman at 18 weeks’ gestation is being seen in the prenatal clinic. Her weight gain is 25 pounds over her prepregnant weight. Which is the perinatal nurse’s best approach to care at this visit?

A. Ask the patient to complete a 3-day dietary recall while she is in the clinic.

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B. Explain the possible concerns related to excessive weight gain in pregnancy C. Explain to the patient that weight gain is not a concern in pregnancy.

D. Teach the patient about the expected normal weight gain during pregnancy.

9. A woman comes to the clinic for her 24-week prenatal visit. This is her second pregnancy. The patient does not wish to know her weight and when her clinic record is reviewed, her total weight gain for this pregnancy is 5 pounds. She is very concerned about her changing body shape. What disorder does the nurse suspect?

A. Anemia B. Anorexia nervosa C. Gestational diabetes D. Gestational hypertension 10. A 24-year-old pregnant woman at 26 weeks’ gestation is experiencing her third pregnancy. The patient’s obstetric history includes one full-term birth and one preterm birth; both children are alive and well. Today, the patient arrives at the clinic with complaints of fatigue, insomnia, and continuous backache. She reports that she is a nurse on an oncology unit and is worried about continuing to work her 12-hour shifts. What advice by the nurse would be most appropriate?

A. “Can you ask your manager about light-duty work at your job?”

B. “See if you can take more breaks at work to rest and drink water.”

C. “With your previous premature birth, you might need to reduce your working hours.”

D. “You can continue to work as long as you want to and feel able to.”

Chapter 11: Caring for the Woman Experiencing Complications During Pregnancy 1. A woman presents to the perinatal clinic with abdominal pain. She has missed one period and, following a transvaginal ultrasound, pregnancy is confirmed. However, implantation has occurred in the right fallopian tube. The ectopic mass is 3 cm and has not ruptured. The nurse prepares the patient for which therapy?

A. Laparoscopic salpingostomy B. Methotrexate C. Partial salpingectomy D. Salpingectomy by laparotomy 2. The prenatal clinic nurse assesses a woman at 15 weeks’ gestation. The patient’s blood pressure, measured twice at intervals 1 hour apart with a cuff that fits appropriately, is 146/96 mm Hg. The nurse understands the patient has which condition?

A. Chronic hypertension B. Gestational hypertension C. Preeclampsia D. Transient hypertension 3. The perinatal nurse is assessing a woman who is at 35 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/minute. A vaginal examination performed by the health-care provider reveals no cervical changes since her last examination. Ultrasound examination reveals the presence of V-shaped cervical funneling. Which action by the nurse is most appropriate?

A. Educate the woman on benefits of corticosteroids.

B. Facilitate admission to the high-risk OB unit.

C. Prepare to administer a dose of magnesium sulfate.

D. Reassure the woman that she is not in preterm labor.

4. The perinatal nurse is caring for a woman at 26 weeks’ gestation who has a history of hypertension

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that has been well controlled. Today she presents with a blood pressure of 156/102 mm Hg and she has 2+ protein on urine dipstick. Which initial action by the nurse is most appropriate?

A. Arrange admission to the high-risk OB unit.

B. Instruct the woman on strict bedrest.

C. Obtain a clean-catch urine sample.

D. Prepare to administer IV anti-hypertensives.

5. A 22-year-old woman presents to the emergency department with abdominal pain and vaginal bleeding. Her blood pressure is 90/58 mm Hg, her pulse is 120 beats/minute, and she complains of dizziness. Which action by the nurse takes priority?

A. Assess the woman for sexually transmitted infections.

B. Collect a urine sample for pregnancy testing.

C. Obtain informed consent for a salpingectomy.

D. Start two large-bore IVs for fluid replacement.

6. A woman in her second trimester of pregnancy presents to the perinatal clinic with complaints of scant vaginal bleeding, abdominal pain, and shoulder pain. What action should the nurse perform first?

A. Assess her for a history of preterm labor.

B. Obtain a blood sample for a b-hCG test.

C. Prepare the woman for a pelvic exam.

D. Request an order for methotrexate (Rheumatrex).

7. A nurse is caring for a patient who has been diagnosed with an incomplete molar pregnancy. Which action by the nurse is most appropriate?

A. Advise the woman that she can try to get pregnant in 3 months.

B. Arrange a consultation with a radiation oncology nurse.

C. Facilitate screening for systemic lupus erythematosus (SLE).

D. Give the patient information on perinatal loss support groups.

8. A nurse is assessing a 52-year-old primigravida woman who presents complaining of moderate darkbrown vaginal bleeding. On physical exam, her uterus is large for dates. Which action by the nurse is most appropriate?

A. Assess the woman’s diet for folic acid intake.

B. Facilitate an ultrasound examination.

C. Instruct the woman on a fetal kick count.

D. Prepare the woman for pelvic cultures.

9. A woman who recently had a miscarriage is in the clinic for follow-up. She sees the diagnosis “spontaneous abortion” on her chart and becomes visibly upset, stating, “I did not have an abortion!”

Which response by the nurse is best?

A. “Don’t be upset; that is just a medical term used commonly.”

B. “I can come back and talk to you when you are not so upset.”

C. “I see you are upset. Does it help to know this means miscarriage?”

D. “No one is accusing you of having an abortion.”

10. A student in a perinatal clinic asks the clinic nurse what an incomplete abortion is. Which response by the nurse is best?

A. Complete loss of all products of conception before 20 weeks’ gestation B. Fetal death before 20 weeks with retention of all products of conception C. Loss of some, but not all, products of conception before 20 weeks D. When the patient initiates an abortion, but then stops the procedure Chapter 12: The Process of Labor and Birth

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1. The perinatal nurse is assessing a woman at 36 weeks’ gestation. Her fundal height measurement was last recorded at 34 cm. The patient’s abdomen appears to be widest from side to side. The nurse suspects the possibility of which type of fetal presentation?

A. Breech B. Cephalic C. Face D. Shoulder 2. The perinatal nurse assessing a laboring woman’s contraction intensity by internal monitoring would expect, during the transition phase, a reading in which of the following ranges?

A. 10 to 12 mm Hg B. 20 to 40 mm Hg C. 50 to 70 mm Hg D. 70 to 90 mm Hg 3. The perinatal nurse knows that when the fetal head is fully extended and the occiput is near the spine, the delivery team should prepare for the presenting fetal part to be which of the following?

A. Brow B. Chin C. Face D. Sacrum 4. The perinatal nurse describes different breech positions to the student nurse. The fetal position with extended legs toward the fetal shoulders is best described as which of the following?

A. Complete breech B. Footling breech C. Frank breech D. Incomplete breech 5. The perinatal nurse is describing the process of fetal engagement to a group of first-time parents in a prenatal class. The nurse explains that in primigravidas, the usual time for engagement to occur is which of the following?

A. 2 weeks before the due date B. 4 weeks before the due date C. 6 weeks before the due date D. During labor 6. A nurse is measuring the frequency of a laboring woman’s contractions. How does the nurse accomplish this correctly?

A. Counts the number of contractions measured at the same intensity in 1 full minute B. Feels the fundus during the acme of the contraction and notes the fundal firmness C. Measures the beginning of one contraction to the beginning of the next contraction D. Measures the time from the beginning of one contraction to the end of the same contraction 7. A patient’s cervix is 8 cm dilated and she is 100% effaced. What action by the nurse is most important at this time?

A. Allow the support person to be at the bedside.

B. Encourage the woman to bear down.

C. Have the woman avoid pushing at this time.

D. Instruct the woman to rest between contractions.

8. A nurse reads in a woman’s chart that the fetus is in a longitudinal lie. What can the nurse conclude about this situation?

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A. The fetal head is flexed prior to delivery.

B. The fetal head-to-tailbone axis is at a 90° angle to the woman’s head-to-tailbone axis.

C. The fetal head-to-tailbone axis is the same as the woman’s head-to-tailbone axis.

D. Vaginal birth will be very difficult.

9. At 9:00 a.m., the OB nurse assesses fetal station at 0. The laboring woman has strong, regular contractions. At 10:30 a.m., the nurse again assesses fetal station at 0. What action by the nurse is best?

A. Document the findings and continue to assess frequently.

B. Encourage the woman to bear down during contractions.

C. Increase the woman’s IV fluid rate and reassess in 30 minutes.

D. Inform the provider and prepare for possible cesarean delivery.

10. A nurse assesses the fetal position in a laboring woman. The fetal position is documented as LSP. What action by the nurse is best?

A. Continue to support the woman’s labor efforts.

B. Document the findings in the woman’s chart.

C. Inform the provider; prepare for possible cesarean delivery.

D. Turn the woman on her left side; reassess in 30 minutes.

Chapter 13: Promoting Patient Comfort During Labor and Birth 1. The perinatal nurse explains to the student nurse that which of the following may increase labor discomfort?

A. Amniotomy B. Correct use of breathing methods C. Fetus in an occiput anterior position D. Positional changes during active labor 2. The perinatal nurse is caring for a woman in early labor with a fetus in the occiput posterior position.

What action should the nurse perform to increase the woman’s comfort?

A. Assist the woman into a hands-and-knees position.

B. Encourage the woman to assume a sitting position.

C. Have the woman walk to the bathroom and void.

D. Provide soothing music as a distraction technique.

3. The perinatal nurse suggests that a laboring woman may wish to use the birth ball. The patient questions the rationale for this suggestion. The best answer by the nurse is that use of the birth ball will facilitate what action?

A. Decreased maternal anxiety B. Decreased transmission of pain C. Fetal descent D. Increased number of opioid receptors 4. The perinatal nurse observes a woman entering the transition phase of labor while she uses a patterned breathing method to cope with the increasing strength of contractions. She complains of lightheadedness and tingling in her fingers. The most appropriate intervention by the nurse is to assist the patient in doing which of the following?

A. Breathing more slowly and taking a cleansing breath B. Cupping her hands and breathing into them C. Putting her head between her knees D. Returning to bed and lying on her left side 5. The perinatal nurse is aware that a 25-year-old woman with gestational hypertension in labor would benefit most from which pharmacological pain relief medication?

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A. Epidural bupivacaine B. Fentanyl intravenously C. Morphine intrathecally D. Secobarbital sodium per mouth 6. The perinatal nurse prepares the laboring woman for an epidural anesthesia insertion. What action is best to help prevent maternal hypotension?

A. Administer an intravenous infusion of 500 mL of normal saline.

B. Assess vital signs every 5 minutes after the epidural insertion.

C. Assist the woman to lie down in a supine position.

D. Encourage frequent cleansing breaths during the procedure.

7. The perinatal nurse understands that the purpose of combining an opioid with a local anesthetic agent in an epidural is primarily for which of the following?

A. Decrease the number of side effects B. Increase the intensity of the block C. Increase the total anesthetic volume D. Preserve more maternal motor function 8. A woman has just given birth to an infant weighing 9 lb, 15 oz (4,350 g) with the assistance of forceps and an episiotomy. The patient received a pudendal block 12 minutes before the birth. The perinatal nurse would expect which of the following responses to the block?

A. Appropriate for adequate pain relief B. Too close to birth; causing fetal depression C. Too early and probably worn off D. Too late to provide anesthesia 9. A woman is being prepared for an elective cesarean birth. The perinatal nurse assists the anesthesiologist with the spinal block and then positions the patient in a supine position. The patient’s blood pressure drops to 90/52 mm Hg and there is a decrease in the fetal heart rate to 110 beats/minute.

Which response by the nurse is best?

A. Administer naloxone (Narcan) per protocol.

B. Discontinue the patient’s intravenous infusion.

C. Have ephedrine ready for administration.

D. Place a wedge under the patient’s left hip.

10. The perinatal nurse is caring for a Native American woman in labor with her first baby. The patient asks about the possibility of burning sweet grass, a part of her cultural tradition, during labor. Which of the following is the best response by the nurse?

A. “Burning any type of substance is not allowed by policy in the hospital. Is there something else that I can do that would be similar?”

B. “Can you explain to me a bit more about this custom and what it means to you so that I can understand it better?”

C. “I need to confer with the charge nurse. I want to know if this practice can be allowed so I will ask to see if it is possible.”

D. “I understand that this cultural practice is important to you; however, I am unable to accommodate your request at this time.”

Chapter 14: Caring for the Woman Experiencing Complications During Labor and Birth 1. The perinatal nurse explains to a nursing student that the most appropriate patient for an amnioinfusion is a woman who has a fetal heart rate tracing that exhibits which pattern?

A. Absent variability

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B. Early decelerations C. Late decelerations D. Variable decelerations 2. The perinatal nurse notes a rapid decrease in the fetal heart rate (FHR) that does not recover immediately following an amniotomy. What action should the nurse perform first?

A. Administer oxygen at 100%.

B. Assess the maternal temperature.

C. Perform a vaginal examination.

D. Recheck the FHR in 30 minutes.

3. The perinatal nurse has administered a dose of dinoprostone (Cervidil) to a woman prior to a labor induction with oxytocin (Pitocin). The nurse then notices that the admission database is incomplete.

What conditions should the nurse quickly question the patient about?

A. Asthma B. Gallbladder disease C. IV drug use D. Penicillin allergy 4. During the postpartum assessment, the perinatal nurse notes that a patient who has just experienced a forceps-assisted birth now has a large amount of bright red vaginal bleeding. Her uterine fundus is firm.

The most appropriate action by the nurse is to collaborate with the health-care provider in which activity?

A. Bladder assessment and catheterization B. Preparing the woman for a hysterectomy C. Uterine massage and oxytocin infusion D. Vaginal assessment and repair 5. The perinatal nurse is caring for a patient with preeclampsia. What intervention does the nurse include on this patient’s care plan?

A. Administer magnesium sulfate per agency policy.

B. Assess the patient’s blood pressure every 6 hours.

C. Encourage the patient to rest on her back.

D. Notify the physician of urine output greater than 30 mL/hr.

6. The perinatal nurse is providing care to 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 betamethasone (Celestone), prescribed by the physician. The patient asks, “What is this injection for again?” Which of the following is the best response by the nurse?

A. Helps your baby grow and develop B. Helps your baby’s lungs to mature C. Prepares your body to begin labor D. Stabilizes your blood pressure 7. The perinatal nurse provides information to a laboring woman with twins that the second twin will normally be born within what time frame?

A. Within 5 minutes of the first twin B. Within 15 minutes of the first twin C. Within 30 minutes of the first twin D. Within 60 minutes of the first twin 8. The perinatal nurse providing care to a laboring woman recognizes a non-reassuring fetal heart rate tracing. Which of the following is the most appropriate initial action by the nurse?

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A. Assist the woman to a left lateral position.

B. Decrease the rate of the intravenous solution.

C. Document the fetal heart rate and variability.

D. Request that the provider apply a fetal scalp electrode.

9. The perinatal nurse is providing care to a multiparous woman in labor. Upon arrival to the birthing suite, the cervix is 5 cm dilated and the patient is experiencing contractions every 1 to 2 minutes that she describes as “strong.” The patient states that she labored for 1 hour at home and is feeling some rectal pressure. The patient is most likely experiencing what condition?

A. Hypertonic contractions B. Hypotonic contractions C. Precipitous labor D. Uterine hyperstimulation 10. The perinatal nurse determines by vaginal examination that a patient’s cervix is fully dilated and the fetal presenting part is descending rapidly with the patient’s pushing efforts. The most appropriate nursing intervention at this time would be to do which of the following?

A. Assist the patient with breathing patterns to slow down her pushing.

B. Document the patient’s progress and coping abilities in labor.

C. Notify the health-care provider to come now for the birth.

D. Provide information to the patient’s partner about her stage of labor.

Chapter 15: Caring for the Postpartal Woman and Her Family 1. The perinatal nurse demonstrates the correct technique of postpartum uterine palpation for a student nurse. The nurse explains that support for the lower uterine segment is critical, because without it there is an increased risk of which complication?

A. Incorrect measurement B. Intensifying the patient’s pain C. Uterine edema D. Uterine inversion 2. The perinatal nurse and student nurse are conducting an assessment on a postpartal woman. The nurse demonstrates percussion of the bladder. They hear a dull, thudding sound. How should the nurse document this information?

A. A bladder containing about 500 cc of urine B. A full bladder C. An empty bladder D. An overdistended bladder 3. The perinatal nurse describes the need for an assessment for deep vein thrombosis (DVT) in the postpartum patient. Which of the following is one test that can be used as a screening measure for DVT? A. Chadwick’s sign B. Homans’ sign C. Grey Turner’s sign D. McBurney’s sign 4. A woman gave birth 12 hours ago. The patient complains of severe abdominal cramping when she breastfeeds her infant. The perinatal nurse should document this condition as which of the following?

A. Afterpains B. Bladder hypertonia C. Rectus abdominis diastasis D. Uterine hypertonia

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5. A postpartum woman is Rho(D)-negative and needs an injection of Rho(D) immune globulin. Which of the following doses would the perinatal nurse expect to be ordered?

A. 120 µg B. 250 µg C. 300 µg D. 350 µg 6. The perinatal nurse listens as the patient describes her labor and emergency cesarean birth. Providing an opportunity to review this experience may assist the patient in doing which of the following?

A. Decreasing her ambivalence about her labor and birth B. Developing more positive feelings about her labor and birth C. Initiating her role development in the “letting-go” stage D. Understanding the various demands associated with the maternal role 7. The perinatal nurse is teaching the patient about breastfeeding and explains that which of the following is the most appropriate time to breastfeed?

A. Four to 5 hours after the last feeding B. Only when her infant exhibits hunger-related crying C. When her infant is in a quiet alert state D. When her infant is in an active alert state 8. The perinatal nurse observes the new mother watching her baby daughter closely, touching her face, and asking many questions about infant feeding. This is best described as which stage of mothering?

A. Taking charge B. Taking hold C. Taking in D. Taking time 9. A postpartum woman who experienced a spontaneous vaginal birth 12 hours ago describes a headache that is worsening. The patient was given two regular-strength acetaminophen (Tylenol) tablets approximately 30 minutes ago but has had no relief from the pain. The most appropriate nursing action at this time is to do which of the following?

A. Ask any visitors to leave now or stay quiet.

B. Dim the lights in the patient’s room.

C. Notify the patient’s health-care provider.

D. Perform a comprehensive pain assessment.

10. A postpartum woman is complaining of a headache that is worsening despite having taken Tylenol (acetaminophen) an hour ago. She delivered yesterday with epidural anesthesia. What action by the nurse is best?

A. Assess if the pain is worse when she sits upright.

B. Call the provider and ask for stronger analgesics.

C. Document the findings in the patient’s chart.

D. Notify the health-care provider immediately.

Chapter 16: Caring for the Woman Experiencing Complications During the Postpartal Period 1. The perinatal nurse is aware that a key factor contributing to suboptimal outcomes for pregnant women and their families is which of the following?

A. Decreased knowledge regarding signs and symptoms of complications B. Delayed communication between health-care provider call groups C. Lack of family and other social support during pregnancy D. Suboptimal nursing resources to provide care during labor and birth

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2. The perinatal nurse accurately defines postpartum hemorrhage to a group of nursing students by including a decrease in hematocrit levels from prebirth to postbirth by which percentage?

A. 5% B. 8% C. 10% D. 15% 3. The perinatal nurse recognizes that which common organism is responsible for postpartum infection manifesting with scant, odorless lochia?

A. Beta-hemolytic streptococcus B. Chlamydia trachomatis C. Escherichia coli D. Treponema pallidum 4. The perinatal nurse teaches the postpartum woman about warning signs regarding the development of postpartum infection. The nurse teaches that fever and which of the following symptoms need to be assessed by a health-care provider?

A. Breast engorgement B. Diarrhea C. Emotional lability D. Uterine tenderness 5. The perinatal nurse administers heparin as ordered to the postpartum woman with newly diagnosed deep vein thrombosis. The patient asks about the purpose of the medication. Which response by the nurse is best?

A. Assists with breakdown of the thromboses B. Decreases clotting time and circulatory clotting factors C. Prevents extension of the clot and new clot formation D. Prevents the formation of any new clots only 6. A nursing student is preparing to give a pregnant woman heparin for a deep vein thrombosis (DVT).

The student questions the dose, as it is higher than what the student has given to other patients. What response by the perinatal nurse is most appropriate?

A. Have the student hold the dose and double-check the order with the provider.

B. Inform the student that physiological changes in pregnancy require higher doses.

C. Remind the student that large doses are needed to dissolve the existing clot.

D. Tells the student to administer the dose and check results of the next laboratory draw.

7. The perinatal nurse routinely screens pregnant women for postpartum depression. Which woman does the nurse screen as the priority?

A. Adolescent B. Age 35 years or older C. Ambivalent at first visit D. First pregnancy 8. A G2 TPAL 2002 patient experienced a precipitous birth 90 minutes ago. Her infant weighed 4,200 g, and a repair of a second-degree laceration was needed following the birth. The nurse assesses that the patient’s uterus is boggy and deviated to the right. The patient’s vaginal bleeding has increased. Which action by the nurse takes priority?

A. Assess the vital signs, including blood pressure and pulse.

B. Call the health-care provider to examine the woman now.

C. Massage the uterine fundus with continual lower-segment support.

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D. Measure and document each used perineal pad to assess blood loss.

9. A nurse is caring for a patient who has excessive blood loss post-delivery from uterine atony. The perinatal nurse notifies the health-care provider while another nurse performs uterine massage. Which medication does the nurse anticipate to be given as the priority?

A. Carboprost (Hemabate) B. Ergonovine (Ergotrate) C. Methylergonovine (Methergine) D. Oxytocin (Pitocin) 10. A postpartum patient is hemorrhaging despite receiving several medications and fundal massage.

What action by the nurse takes priority?

A. Begin weighing all used perineal pads.

B. Obtain informed consent for surgery.

C. Place the woman on her left side.

D. Switch the IV solution to dextrose.

Chapter 17: Physiological Transition of the Newborn 1. A woman gives birth to a healthy baby boy at 35 weeks’ gestation. What factor 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, secretion of intrapulmonary fluid increases.

B. Lung expansion after birth suppresses the further release of surfactant.

C. Surfactant increases alveolar surface tension, allowing re-expansion after exhalation.

D. Surfactant production is sufficient to maintain alveolar stability by about 34 weeks.

2. A nurse in the high-risk obstetrical unit monitors a student nurse preparing to give a patient a dose of betamethasone (Celestone). Which action by the student warrants intervention by the nurse?

A. Assesses the patient’s lung sounds prior to administration B. Draws up 12 mg in a syringe with a 20-gauge needle C. Gently shakes the medication before drawing it up D. Prepares to administer medication in the deltoid muscle 3. A perinatal nurse has orders to administer betamethasone (Celestone) to the following women in preterm labor. For which patient should the nurse question this order?

A. Emergency cesarean section B. Fetal cardiac abnormalities C. Maternal diabetes D. Severe preeclampsia/eclampsia 4. The perinatal nurse explains the cardiopulmonary adaptations that occur in the neonate to a student nurse. Which 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.”

5. The nurse is assessing the cardiovascular status of a newborn. Which of the following findings indicates adequate systemic circulation?

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A. Capillary refill 2 seconds B. Capillary refill 4 seconds C. Pale mucous membranes in a dark-skinned baby D. Truncal cyanosis 6. New parents are concerned that after initially breastfeeding their baby 2 hours after being born, she is sleeping soundly and will not awaken. What action by the nurse is most appropriate?

A. Call the rapid response team.

B. Document the neonate’s behavior in the chart.

C. Reassure the parents that this is normal.

D. Stimulate the baby to wake her up.

7. A nurse suspects that an infant in the intensive care unit has had intrauterine exposure to one of the TORCH infections. What finding is indicative of in utero exposure to a TORCH infection?

A. Decreased IgA B. Decreased IgG C. Increased IgG D. Increased IgM 8. A neonatal nurse who is caring for newborns suggests the best time for a mother to first attempt breastfeeding is during which of the following stages of activity?

A. First period of inactivity and sleep B. First period of reactivity C. Second period of inactivity and sleep D. Second period of reactivity 9. The nurse caring for a woman about to deliver a baby at 33 weeks’ gestation knows that what factor might have accelerated surfactant production?

A. Fetal hemolytic disorders B. Incorrect dates C. Maternal hypertension D. Multiple gestation 10. The nursing professor is explaining to a class of students that which chemical factor in the blood directly leads to the initiation of respirations in the newborn?

A. Bilirubin B. Carbon dioxide C. High arterial pH D. Low arterial pH Chapter 18: Caring for the Normal Newborn 1. The nurse is assessing the neonate’s skin and notes the presence of small irregular red patches on the cheeks that turn into single yellow pimples on the baby’s chest. What treatment and care does the nurse recommend to the parents to help resolve this rash?

A. Apply aloe vera lotion to lesions and skin.

B. Apply hormonal skin cream twice a day.

C. None; it will disappear within about a month.

D. Vigorously wash and cleanse the baby’s skin.

2. The nurse completes an initial newborn examination. The nurse’s findings include the following: heart rate, 136 beats/minute; respiratory rate, 64 breaths/minute; temperature, 98.2°F (36.8°C). The nurse also documents 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 finding requires immediate

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consultation with the health-care provider?

A. Absent bowel sounds B. Heart murmur C. Respiratory rate D. Temperature 3. The nursery nurse notes the presence of diffuse edema on a newborn baby’s head. Review of the birth record indicates that her mother experienced a prolonged labor and difficult childbirth. What action by the nurse is best?

A. Document the findings in the infant’s chart.

B. Measure head circumference every 12 hours.

C. Prepare to administer IV osmotic diuretics.

D. Transfer the baby to the NICU for monitoring .

4. The perinatal nurse teaches new parents that the best sleeping position for infants is which of the following?

A. Prone B. Side-lying C. Side-lying with a blanket roll behind the infant’s back D. Supine 5. A student nurse is verbalizing disappointment in a new mother’s seeming lack of interest in her newborn baby. The student complains to the registered nurse that the mother just wants to sleep and have someone else care for the infant. What response by the registered nurse is best?

A. “Assess closely; we may need to call social work.”

B. “Don’t judge other people until you have had a baby.”

C. “The mother may be completely exhausted from the childbirth experience.”

D. “We have to accept that everyone’s experience is different.”

6. The perinatal nurse wants to contact the pediatrician about a heart murmur that was auscultated during a newborn assessment. During what time frame would hearing the murmur lead the nurse to contact the health-care provider?

A. 8 to 12 hours B. 12 to 24 hours C. 24 to 48 hours D. 48 to 72 hours 7. The perinatal nurse teaches the new mother and her family about appropriate infant care to prevent omphalitis. Information given would include which of the following instructions?

A. Apply a mild soap and lotion to dry skin.

B. Change diapers frequently following circumcision.

C. Keep the base of the umbilical cord clean and dry.

D. Take rectal temperatures twice a day for a week.

8. When assessing a newborn baby, which action should the nurse perform first?

A. Auscultate the baby’s heart and lungs.

B. Don clean gloves before taking the baby.

C. Record the parents’ choice of name.

D. Suction the nares and then the mouth.

9. In order to promote thermal stabilization in a neonate, which action by the nurse is best?

A. Lay the infant in an incubator.

B. Place the infant in skin-to-skin contact with the mom.

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C. Put a knitted cap on the baby’s head.

D. Wrap the baby in warmed blankets.

10. A new nurse is suctioning a neonate. What action by the new nurse would cause the preceptor to intervene?

A. Assesses the infant for secretions in the airway B. Places suction bulb into the baby’s cheek C. Positions the suction bulb at the back of the throat D. Suctions the baby’s mouth first, then the nares Chapter 19: Caring for the Newborn at Risk 1. The pediatric nurse prepares a newborn for phototherapy. The nurse explains to the parents that certain organs need to be protected during treatment. Which organs are these?

A. Eyes and ears B. Eyes and hands C. Eyes and genitals D. Genitals and hands 2. The pediatric nurse is receiving a morning report via phone call on an infant who will be arriving in the neonatal intensive care unit. The report indicates that shoulder dystocia may have occurred during the birth process. The nurse assesses the neonate as at risk for which additional condition?

A. Brachial plexus injury B. Hyperbilirubinemia C. Hypoglycemia D. Intracranial hemorrhage 3. The pediatric nurse explains to the nursing student that respiratory distress syndrome results from a developmental lack of which substance?

A. Calcium B. Lecithin C. Magnesium D. Surfactant 4. A baby with brachial plexus injury is being discharged home. What information should the nurse include on the teaching plan?

A. Encourage the baby to move the arm by holding out toys to reach for.

B. Keep the baby’s arm in the sling for 23 out of every 24 hours.

C. Perform passive range-of-motion exercises to affected extremity.

D. Return to the hospital on day 7 for microsurgical repair.

5. A postterm baby is born, and the nurse notes that the baby has dirty-looking skin and nails. The baby has moderate respiratory distress with rales and rhonchi noted. What nursing care does the nurse anticipate providing for this infant?

A. Giving the baby oxygen via an oxygen hood B. Increasing oxygenation by using CPAP C. Providing chest physiotherapy every 8 hours D. Sitting the infant upright to feed and sleep 6. An infant who is possibly infected with herpes simplex infection is being dismissed. What medication should the nurse anticipate instructing the parents on giving?

A. Acyclovir (Avirax) B. Ampicillin (Omnipen) C. Cephtriaxone (Rocephin)

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D. Hydroxyzine (Atarax) 7. An infant in the NICU has persistent pulmonary hypertension. The nurse places highest priority on which of the following nursing diagnoses?

A. Ineffective tissue perfusion: cardiopulmonary B. Ineffective tissue perfusion: cerebral C. Ineffective tissue perfusion: peripheral D. Ineffective tissue perfusion: neurovascular 8. The pediatric nurse is providing care to an infant diagnosed with phenylketonuria. What education is vital for this nurse to provide the parents?

A. Information available from the Centers for Disease Control and Prevention B. High-protein, low-carbohydrate diet for the life of the baby C. Special phenylalanine-free infant formula and diet restriction D. Very-low-protein diet supplemented with thiamine during childhood 9. A preterm infant in the NICU is receiving oxygen, and the nurse notes that the oxygen saturation is 98%. Which action by the nurse is most appropriate?

A. Call respiratory therapy to draw an arterial blood gas.

B. Document the findings and continue to monitor.

C. Lower the infant’s oxygen concentration and reassess.

D. See if the infant can tolerate more stimulation and activity.

10. A nurse explains to a student that which of the following is the mechanism by which circulation of oxygen is increased to the organs of a newborn?

A. Deeper respirations B. Increased stroke volume C. Increased tidal volume D. Tachycardia Chapter 20: Caring for the Developing Child 1. The pediatric nurse explains to a new mother that two factors, “nature” and “nurture,” may influence the formation of her child’s essence. Which factor among the following would be considered “nature”?

A. Cultural aspects B. Parenting skills C. The era in which the child develops D. Traits inherent in the infant 2. The pediatric nurse teaches the parents of a 3-month-old baby the principles of growth and development that will occur in their child’s lifetime. Which statement accurately describes one of these principles?

A. Each child progresses through predictable stages within a predictable timeframe.

B. Growth and development begin in infancy and continue until the adult years.

C. Growth refers to the ongoing process of adapting throughout the life span.

D. Within each child, body systems develop at the same rate.

3. A pediatric nurse works with the family of twins at designated stages in their lives to help the parents anticipate and move through the periods of disequilibrium. What is the model of child development that focuses on disruptive periods of development?

A. Bowlby’s attachment theory of development B. Brazelton’s touchpoints model of development C. Erikson’s stages of development D. Freud’s stages of psychosexual development

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4. During a well-child visit, the pediatric nurse assesses a 2-year-old child for language development.

Which developmental domain is the nurse assessing?

A. Cognitive B. Family development C. Moral/spiritual D. Psychosocial 5. A mother takes her 10-year-old son to the pediatrician for a sprained wrist. During the medical history, the pediatric nurse listens to the mother describe her son as “busy playing basketball all day long with the other boys in the neighborhood.” Based on the nurse’s assessment, which stage of Freud’s psychosocial development is this child experiencing?

A. Anal stage B. Genital stage C. Latency stage D. Phallic stage 6. A pediatric nurse examines a 7-year-old at a well-child visit. Based on Erikson’s theory, which basic task does the nurse anticipate for this child?

A. Balance independence and self-sufficiency against uncertainty and misgiving.

B. Develop a sense of confidence through mastery of different tasks.

C. Develop resourcefulness to achieve and learn new things without self-reproach.

D. Recognize there are people in his or her life who can be trusted to take care of basic needs.

7. A 15-year-old adolescent tells the school nurse that he is busy preparing for a forensics competition and would like to be a lawyer one day. According to Piaget’s stages of development, the adolescent is in which stage of cognitive development?

A. Concrete operational stage B. Formal operational stage C. Preoperational stage D. Sensorimotor stage 8. A 7-year-old hospitalized for a fracture following a car crash tells the pediatric nurse “God is in heaven with his angels and is looking down on me.” Which stage of Fowler’s spiritual development is this child exhibiting?

A. Intuitive-projective stage B. Mythical-literal stage C. Synthetic-convention stage D. Undifferentiated stage 9. A young couple brings their 20-month-old daughter to the pediatrician’s office for immunizations.

The mother tells the nurse that she is going back to work and is looking for a day-care center in the vicinity of the clinic. What assessment is priority before recommending a day-care center that would help the parent and child adapt to the experience?

A. Available financial assets B. Available support people C. Potty-training status D. The child’s temperament 10. The pediatric nurse is examining a newborn infant and notes a turning in of the foot and turning out of the toes when the sole of the foot is stroked. Which action by the nurse is most appropriate?

A. Arrange a consultation with a developmental specialist.

B. Assess the parents’ family histories for genetic defects.

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C. Document the findings in the patient’s chart.

D. Instruct the parents on required follow-up care.

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