Maternity Final Test Bank Verified Answers (100%)

The nurse is completing a home visit on a family with a 1-month-old infant. During this visit, the nurse is completing a safety assessment. Which finding by the nurse would require further intervention? A. The baby sleeps in a crib right next to the parent's bed B. The baby was found to be swaddled in a light blanket. C. The baby was offered a pacifier at nap time. D. The baby had a strong smell of cigarette smoke.ANSWERS-D. The baby had a strong smell of cigarette smoke. The client says, "I will get some salmon and that kind of orange juice the next time I'm at the store". The nurse knows this meets the expected outcome for which identified problem on the concept map? A. Knowledge deficit related to diet and bone health B. Ineffective health promotion related to Lack of Education Regarding the Relationship of exercise to bone health C. Risk for fracturesANSWERS-A. Knowledge deficit related to diet and bone health During a discharge education, the nurse notes the postpartum patient starting to fall asleep. What is the appropriate nursing response to the patient? A. "you will need to stay awake to learn this important information" B. "You should rest and I will come back later to review this information" C. "you will not be able to go home until tomorrow, since you are having trouble staying awake still" D. "You can nap and I will just review this information with your partner"ANSWERS-B. "You should rest and I will come back later to review this information" A client was diagnosed with endometriosis and asks the nurse what this is. How should the nurse respond? A. "This is inflammation of abnormal endometrial tissue found outside the uterus" B. "This is an infection of the lining of the uterus" C. "This is excessive growth of cells in the uterus" D. "This is a collection of benign growths on the uterus"ANSWERS-A. "This is inflammation of abnormal endometrial tissue found outside the uterus" The nurse is performing an assessment on a neonate. What does the nurse document for the assessment data in the image below? A. Molding B. Cephalhematoma C. Subdural Hematoma D. Caput SuccedaneumANSWERS-D. Caput Succedaneum To prevent heat loss from evaporation immediately after delivery, what is the most important nursing intervention? A. Place the neonate on a chemical mattress. B. Keep the neonate's head covered with a hat C. Dry the neonate gently and replace the wet linen D. Place the neonate in a double walled incubatorANSWERS-C. Dry the neonate gently and replace the wet linen During labor, the nurse notes the presence of meconium stained fluid. What does the nurse prepare for at the time for delivery? A. Suctioning of the infant's mouth and trachea B. Administration of antibiotics to the mother C. Vigorous tactile stimulation of the infant D. Culturing of the placenta for pathologyANSWERS-A. Suctioning of the infant's mouth and trachea A patient is concerned because her 2-hour-old newborn is sleeping skin to skin and will not breastfeed. Which is the best response by the nurse to correctly explain this behavior? A. "The medication you received in labor is affecting the baby's ability to stay awake" B. "This is normal response after birth and may last two to four hours" C. "The baby could be sleepy because of a low glucose level. Try to wake the baby up and breastfeed" D. "We can give the baby a bath to wake the baby up"ANSWERS-B. "This is normal response after birth and may last two to four hours" The nurse completes an initial newborn examination on an infant 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: 54 breaths per minute Temperature: 98.2 Degrees F Length: 49.5 cm (19.5 in) Weight: 3500 gm (7lbs 9oz) 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 heart murmur C. Absent bowel sounds D. WeightANSWERS-C. Absent bowel sounds Which of the following nursing actions are directed at promoting bonding? Select all that apply A. Providing opportunity for parents to hold their newborn as soon as possible following the birth B. Providing opportunities for the couple to talk about their birth experience and about becoming parents. C. Promoting rest and comfort by keeping the newborn in the nursery at night. D. Providing positive comments to parents regarding their interactions with their newborn.ANSWERS-A. Providing opportunity for parents to hold their newborn as soon as possible following the birth B. Providing opportunities for the couple to talk about their birth experience and about becoming parents. D. Providing positive comments to parents regarding their interactions with their newborn. A nurse initiates measures to maintain thermoregulation in a newborn. Which statement best describes why neonates are at higher risk for thermoregulatory problems? A. Neonates have a smaller body surface area B. Neonates have decreased subcutaneous fat C. Neonates are able to shiver and increase heat production D. Neonates have a lower metabolic rateANSWERS-B. Neonates have decreased subcutaneous fat A female patient is admitted to the hospital for a pelvic inflammatory disease (PID). Which organism does the nurse know is most likely to cause PID? A. Chlamydia trachomatis B. Candida albicans C. Escherichia coli D. Human papillomavirusANSWERS-A. Chlamydia trachomatis The primary care nurse is reviewing records for female clients coming in today. Which clients are at higher risk of developing osteoporosis? Select all that apply. A. 48 year old woman with a BMI of 32 B. Caucasian woman who smokes C. 60 year old woman wit autoimmune disease who frequently takes corticosteroids D. African american Womacks with normal Vitamin D level E. Asian small boned woman who drinks 3 alcoholic beverages a dayANSWERS-B. Caucasian woman who smokes C. 60 year old woman wit autoimmune disease who frequently takes corticosteroids E. Asian small boned woman who drinks 3 alcoholic beverages a day A 15 year old female patient with a history of menarche at age 12 reports that she has not had menses for the last three months. Which contributing conditions should the nurse be aware of in order to anticipate laboratory or diagnostic imaging orders? Select all that apply. A. Congenital absence of the vagina or uterus B. Pregnancy C. Eating Disorder D. Thyroid dysfunctionANSWERS-B. Pregnancy C. Eating Disorder D. Thyroid dysfunction A newborn appears large for its gestational age, while a lower score for neurological maturation is noted on the gestational exam. The nurse knows that which cause can best explain this outcome? A. Maternal analgesia B. Maternal diabetes C. Maternal hypertension D. Maternal preeclampsiaANSWERS-B. Maternal diabetes 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 outputANSWERS-A. Provide the baby with routine feedings The mother of a 10 year old girl asks the nurse when she should expect her daughter to have her first period. Which response by the nurse is correct? A. 2 to 2.5 years after the beginning of puberty B. About the time that the breasts begin to develop C. Any time between 13 to 14 years of age D. At the age the mother had menarcheANSWERS-A. 2 to 2.5 years after the beginning of puberty A woman in her late 40s reporting irregular menstrual cycles and asks the nurse if she still needs to use birth control. What is the best response by the nurse? A. "It is possible for a woman to become pregnant during perimenopause" B. "If you are experiencing hot flashes, you have reached menopause and you cannot get pregnant" C. "Until you have gone six months without a menstrual period, you can still get pregnant" D. "It is likely you would get pregnant now, and birth control is not safe to use at your age"ANSWERS-A. "It is possible for a woman to become pregnant during perimenopause" The nurse is assessing a female patient with polycystic ovarian syndrome (PCOS). Which of the following would be subjective assessment finding that would indicate hyperandrogegism associated with PCOS? A. Patient reports menstrual irregularities B. Oily skin with acne C. Hirsutism D. Male-pattern baldnessANSWERS-A. Patient reports menstrual irregularities The nurse is preparing to offer discharge instructions to a postpartum patient. What does the nurse do to prepare for the education session? A. Ask the partner to leave the room B. Turn off all the lights in the room C. Turn off the TV in the room D. Open the door and curtain to the hallwayANSWERS-C. Turn off the TV in the room The nurse is assessing a preterm neonate immediately after delivery. Which assessment finding indicates respiratory distress? Select all that apply. A. Cyanosis of hands and feet B. Low body temperature C. Grunting on exhalation D. Intercostal retraction E. Slow capillary refillANSWERS-C. Grunting on exhalation D. Intercostal retraction A 42 year old female patients scheduled to have a hysterectomy with bilateral sapling-oophorectomy. The nurse is reviewing pre-op instructions with her. Which statement by the patient indicates the need for further teaching? A. "I will not be able to become pregnant again" B. "The surgery will put me in menopause" C. "I will no longer menstruate" D. "I will lose my uterus, but I'll still have my ovaries"ANSWERS-D. "I will lose my uterus, but I'll still have my ovaries" A client in the gynecology clinic asks the nurse about the word "menorrhagia", which the client saw written in their medical record. What is the correct definition of menorrhagia? A. Painful menstruation B. Bleeding between periods C. Heavy menstrual bleeding D. No menstruation in three monthsANSWERS-C. Heavy menstrual bleeding A female client presents to acute care reporting genital blisters that are very painful. She also reports muscle aches and malaise. Which condition does the nurse anticipate the client will be treated for? A. Influenza B. Syphilis C. Genital herpes D. CondylomaANSWERS-C. Genital herpes The nurse is caring for a 12 hour old neonate and incorporating measures to prevent heat loss through conduction. What is the priority nursing action? A. Drying the infant after the first bath B. Placing the infant away from the window C. Warming the stethoscope prior to assessment D. Moving the crib away from air conditioner ventANSWERS-C. Warming the stethoscope prior to assessment A female client has been prescribed oral metronidazole (Flagyl) for the treatment of bacterial vaginosis. What is essential for the nurse to teach the woman? A. Male sexual partners should also be treated B. Avoid alcohol while taking this medication C. Take the medication until the symptoms resolve D. The medication can also treat candidiasisANSWERS-B. Avoid alcohol while taking this medication The mother baby educator is orienting a group of new nurses and discussing the hepatic system. The educator determines the group understands bilirubin production when choosing which statements are correct? Select all that apply A. "The neonate produces more bilirubin after birth due to an increase in RBC production" B. "Direct (conjugated) bilirubin is a water soluble substance" C. "Hyperbilirubin may occur from immature liver function" D. Indirect bilirubin can be excreted in the urine and stool E. Direct bilirubin is deposited in the body tissues and cross the blood brain barrierANSWERS-A. "The neonate produces more bilirubin after birth due to an increase in RBC production" B. "Direct (conjugated) bilirubin is a water soluble substance" C. "Hyperbilirubin may occur from immature liver function" The nurse is performing an assessment on a 1-day old neonate and notes a red rash with papule around the chest and abdomen. What is the priority action of the nurse? A. Obtain a culture B. Notify the physician C. Take the neonate's vital signs and place the infant on isolation D. Document the findings.ANSWERS-D. Document the findings The nurse is teaching a postmenopausal woman about osteoporosis prevention and calcium intake. The client states she is lactose intolerant. Which calcium rich food should the nurse recommend for this client? A. Plain low fat yogurt B. Lean red meat C. Cooked Shrimp D. Green leafy vegetablesANSWERS-D. Green leafy vegetables Four babies have just ben admitted into the neonatal nursery. Which of the babies should the nurse assess first? A. The baby with respirations 52, oxygen saturation 94% B. The baby with Apgar 9/9, weight 2690 grams C. The baby with temperature 96.3 degrees F, length 17 in D. The baby with glucose 60 mg/dL, Heart rate 132ANSWERS-C. The baby with temperature 96.3 degrees F, length 17 in The grandmother of a new infant approaches the nurse in the hallway and questions why the infant is staying in the mother's room. What is the appropriate nursing response? A. "This is how we do it" B. "Rooming-in with the infant facilitates bonding" C. "I cannot discuss the infant with you" D. "Only bottle fed infants spend time in the nursery now"ANSWERS-B. "Rooming-in with the infant facilitates bonding" The nurse is teaching a 16 year old girl about the human papillomavirus (HPV) vaccine. Which statement by the teen indicates more teaching is needed? A. "The vaccine will help prevent cervical cancer" B. "The vaccine will help prevent genital warts" C. "I will need to get three doses of the vaccine" D. "I don't need to have a Pap test if I am fully vaccinated"ANSWERS-D. "I don't need to have a Pap test if I am fully vaccinated" A client calls the nurse to her room and