McKinney Maternal Test Bank for nclex
Latest exam
1. A Labor and Delivery nurse knows that four of the five fetal factors that interact to regulate
the heart rate are which of the following? (Select all that apply.)
a. Uterine activity
b. Autonomic nervous system
c. Baroreceptors
d. Chemoreceptors
e. Adrenal glands - ANSWER-B, C, D, E
The sympathetic and parasympathetic branches of the autonomic nervous system are balanced
forces that regulate FHR. Sympathetic stimulation increases the heart rate, while
parasympathetic responses, through stimulation of the vagus nerve, reduce the FHR and
maintain variability. The baroreceptors stimulate the vagus nerve to slow the FHR and
decrease the blood pressure. These are located in the carotid arch and major arteries. The
chemoreceptors are cells that respond to changes in oxygen, carbon dioxide, and pH. They are
found in the medulla oblongata and the aortic and carotid bodies. The adrenal medulla
secretes epinephrine and norepinephrine in response to stress, causing an acceleration in FHR.
Uterine activity is a maternal factor. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 333 OBJ: Nursing Process: Assessment
MSC: Client Needs: Physiologic Integrity
1. A newborn infant weighing 8 lb needs naloxone (Narcan). This infant should receive
approximately _____ mg. - ANSWER-0.36 The dose of naloxone is 0.1 mg/kg. This baby weighs 3.6 kg, so
0.1 × 3.6 = 0.36 mg. PTS: 1 DIF: Cognitive Level: Application/Applying
REF: Table 18.1 OBJ: Nursing Process: Implementation
MSC: Client Needs: Physiologic Integrity
Chapter 19: Nursing Care during Obstetric Procedures
McKinney: Evolve Resources for Maternal-Child Nursing, 5th Edition MULTIPLE CHOICE
1. A newborn weighs 8.7 pounds. How many kilocalories does this breastfed term infant
require each day? _________ - ANSWER-336 to 395 The breastfed baby needs 85 to 100 kcal/kg/day.
This baby weighs 8.7 pounds (3.95 kg) so
,McKinney Maternal Test Bank for nclex
Latest exam
85 × 3.95 = 85. 3.95 × 100 = 395. PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 481 | Box 23.1 OBJ: Nursing Process: Implementation
MSC: Client Needs: Physiologic Integrity
Chapter 24: The Childbearing Family with Special Needs
McKinney: Evolve Resources for Maternal-Child Nursing, 5th Edition MULTIPLE CHOICE
1. A nurse assesses a woman and gathers the following data:
Dilation: 4 cm
Effacement: 60%
Fetal station: 0
Cervical consistency: medium
Cervical position: middle
Calculate this woman's Bishop score ____________ - ANSWER-8
This scoring system evaluates the woman's cervix and how easily labor can be induced. The
individual components are: 2-2-2-1-1 = 8. PTS: 1 DIF: Cognitive Level: Application/Applying
REF: Table 19.1 OBJ: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
Chapter 20: Postpartum Adaptations
McKinney: Evolve Resources for Maternal-Child Nursing, 5th Edition MULTIPLE CHOICE
1. A nurse assessing a 2-month-old infant notes that the child can briefly hold the head erect
when held against the shoulder. What action by the nurse is best?
a. Document the findings in the child's chart.
b. Notify the provider immediately.
c. Conduct a lead-exposure assessment.
d. Prepare the parents for genetic testing. - ANSWER-A
A 2-month-old infant is able to briefly hold the head erect. If a parent were holding the infant
against the parent's shoulder, the infant would be able to lift his or her head briefly. Since this
is normal behavior, all that is required of the nurse is documentation. There is no need to
,McKinney Maternal Test Bank for nclex
Latest exam
notify the provider immediately, conduct a lead-exposure assessment, or prepare the parents
for genetic testing. PTS: 1 DIF: Cognitive Level: Application/Applying
REF: Table 6.1 OBJ: Nursing Process: Implementation
MSC: Client Needs: Health Promotion and Maintenance
1. A nurse has completed a teaching session for parents about "baby-proofing" the home. Which
statements made by the parents indicate an understanding of the teaching? (Select all that
apply.)
a. "We will put plastic fillers in all electrical plugs."
b. "We will place poisonous substances in a high cupboard."
c. "We will place a gate at the top and bottom of stairways."
d. "We will keep our household hot water heater at 130 degrees."
e. "We will remove front knobs from the stove." - ANSWER-A, C, E
By the time babies reach 6 months of age, they begin to become much more active, curious,
and mobile. Putting plastic fillers on all electrical plugs can prevent an electrical shock.
Putting gates at the top and bottom of stairways will prevent falls. Removing front knobs from
the stove can prevent burns. Poisonous substances should be stored in a locked cabinet not in
a cabinet that children can reach when they begin to climb. The household hot water heater
should be turned down to 120 degrees or less. PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating
REF: p. 97 OBJ: Nursing Process: Evaluation
MSC: Client Needs: Health Promotion and Maintenance
1. A nursing student is helping the nursery nurses with morning vital signs. A baby born 10
hours ago via cesarean section is found to have moist lung sounds. What is the best
interpretation of these data?
a. The nurse should notify the pediatrician stat for this emergency situation.
b. The neonate must have aspirated surfactant.
c. If this baby was born vaginally, it could indicate a pneumothorax.
d. The lungs of a baby delivered by cesarean section may sound moist for 24 hours
, McKinney Maternal Test Bank for nclex
Latest exam
after birth. - ANSWER-D
The condition will resolve itself within a few hours. For this common condition of newborns,
surfactant acts to keep the expanded alveoli partially open between respirations. In vaginal
births, absorption of remaining lung fluid is accelerated by the process of labor and delivery.
Remaining lung fluid will move into interstitial spaces and be absorbed by the circulatory and
lymphatic systems. There is no need to notify the pediatrician. Surfactant is produced by the
lungs, so aspiration is not a concern. Pneumothorax is also not a concern. PTS: 1 DIF: Cognitive Level:
Comprehension/Understanding
REF: p. 425 OBJ: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
1. A patient at 34 weeks of gestation has reported to the OB triage unit for assessment of
oligohydramnios. The nurse assigned to care for this patient is aware that prolonged
oligohydramnios may result in (Select all that apply.)
a. intrauterine limb amputations.
b. clubfoot.
c. delayed lung development.
d. other fetal abnormalities.
e. fetal deformations. - ANSWER-B, C, D
Oligohydramnios, an abnormally small volume of amniotic fluid, reduces the cushion
surrounding the fetus and may result in deformations such as clubfoot. Prolonged
oligohydramnios interferes with fetal lung development because it does not allow normal
development of the alveoli. Oligohydramnios may not be the primary fetal problem but rather
may be related to other fetal anomalies. This does not lead to intrauterine limb amputations or
fetal deformations. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 178 OBJ: Nursing Process: Assessment
MSC: Client Needs: Physiologic Integrity
1. A patient is at 6 weeks' gestation and is having a transvaginal ultrasound. While preparing the
patient for this procedure, she expresses concerns over the necessity for this test. The nurse
Latest exam
1. A Labor and Delivery nurse knows that four of the five fetal factors that interact to regulate
the heart rate are which of the following? (Select all that apply.)
a. Uterine activity
b. Autonomic nervous system
c. Baroreceptors
d. Chemoreceptors
e. Adrenal glands - ANSWER-B, C, D, E
The sympathetic and parasympathetic branches of the autonomic nervous system are balanced
forces that regulate FHR. Sympathetic stimulation increases the heart rate, while
parasympathetic responses, through stimulation of the vagus nerve, reduce the FHR and
maintain variability. The baroreceptors stimulate the vagus nerve to slow the FHR and
decrease the blood pressure. These are located in the carotid arch and major arteries. The
chemoreceptors are cells that respond to changes in oxygen, carbon dioxide, and pH. They are
found in the medulla oblongata and the aortic and carotid bodies. The adrenal medulla
secretes epinephrine and norepinephrine in response to stress, causing an acceleration in FHR.
Uterine activity is a maternal factor. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 333 OBJ: Nursing Process: Assessment
MSC: Client Needs: Physiologic Integrity
1. A newborn infant weighing 8 lb needs naloxone (Narcan). This infant should receive
approximately _____ mg. - ANSWER-0.36 The dose of naloxone is 0.1 mg/kg. This baby weighs 3.6 kg, so
0.1 × 3.6 = 0.36 mg. PTS: 1 DIF: Cognitive Level: Application/Applying
REF: Table 18.1 OBJ: Nursing Process: Implementation
MSC: Client Needs: Physiologic Integrity
Chapter 19: Nursing Care during Obstetric Procedures
McKinney: Evolve Resources for Maternal-Child Nursing, 5th Edition MULTIPLE CHOICE
1. A newborn weighs 8.7 pounds. How many kilocalories does this breastfed term infant
require each day? _________ - ANSWER-336 to 395 The breastfed baby needs 85 to 100 kcal/kg/day.
This baby weighs 8.7 pounds (3.95 kg) so
,McKinney Maternal Test Bank for nclex
Latest exam
85 × 3.95 = 85. 3.95 × 100 = 395. PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 481 | Box 23.1 OBJ: Nursing Process: Implementation
MSC: Client Needs: Physiologic Integrity
Chapter 24: The Childbearing Family with Special Needs
McKinney: Evolve Resources for Maternal-Child Nursing, 5th Edition MULTIPLE CHOICE
1. A nurse assesses a woman and gathers the following data:
Dilation: 4 cm
Effacement: 60%
Fetal station: 0
Cervical consistency: medium
Cervical position: middle
Calculate this woman's Bishop score ____________ - ANSWER-8
This scoring system evaluates the woman's cervix and how easily labor can be induced. The
individual components are: 2-2-2-1-1 = 8. PTS: 1 DIF: Cognitive Level: Application/Applying
REF: Table 19.1 OBJ: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
Chapter 20: Postpartum Adaptations
McKinney: Evolve Resources for Maternal-Child Nursing, 5th Edition MULTIPLE CHOICE
1. A nurse assessing a 2-month-old infant notes that the child can briefly hold the head erect
when held against the shoulder. What action by the nurse is best?
a. Document the findings in the child's chart.
b. Notify the provider immediately.
c. Conduct a lead-exposure assessment.
d. Prepare the parents for genetic testing. - ANSWER-A
A 2-month-old infant is able to briefly hold the head erect. If a parent were holding the infant
against the parent's shoulder, the infant would be able to lift his or her head briefly. Since this
is normal behavior, all that is required of the nurse is documentation. There is no need to
,McKinney Maternal Test Bank for nclex
Latest exam
notify the provider immediately, conduct a lead-exposure assessment, or prepare the parents
for genetic testing. PTS: 1 DIF: Cognitive Level: Application/Applying
REF: Table 6.1 OBJ: Nursing Process: Implementation
MSC: Client Needs: Health Promotion and Maintenance
1. A nurse has completed a teaching session for parents about "baby-proofing" the home. Which
statements made by the parents indicate an understanding of the teaching? (Select all that
apply.)
a. "We will put plastic fillers in all electrical plugs."
b. "We will place poisonous substances in a high cupboard."
c. "We will place a gate at the top and bottom of stairways."
d. "We will keep our household hot water heater at 130 degrees."
e. "We will remove front knobs from the stove." - ANSWER-A, C, E
By the time babies reach 6 months of age, they begin to become much more active, curious,
and mobile. Putting plastic fillers on all electrical plugs can prevent an electrical shock.
Putting gates at the top and bottom of stairways will prevent falls. Removing front knobs from
the stove can prevent burns. Poisonous substances should be stored in a locked cabinet not in
a cabinet that children can reach when they begin to climb. The household hot water heater
should be turned down to 120 degrees or less. PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating
REF: p. 97 OBJ: Nursing Process: Evaluation
MSC: Client Needs: Health Promotion and Maintenance
1. A nursing student is helping the nursery nurses with morning vital signs. A baby born 10
hours ago via cesarean section is found to have moist lung sounds. What is the best
interpretation of these data?
a. The nurse should notify the pediatrician stat for this emergency situation.
b. The neonate must have aspirated surfactant.
c. If this baby was born vaginally, it could indicate a pneumothorax.
d. The lungs of a baby delivered by cesarean section may sound moist for 24 hours
, McKinney Maternal Test Bank for nclex
Latest exam
after birth. - ANSWER-D
The condition will resolve itself within a few hours. For this common condition of newborns,
surfactant acts to keep the expanded alveoli partially open between respirations. In vaginal
births, absorption of remaining lung fluid is accelerated by the process of labor and delivery.
Remaining lung fluid will move into interstitial spaces and be absorbed by the circulatory and
lymphatic systems. There is no need to notify the pediatrician. Surfactant is produced by the
lungs, so aspiration is not a concern. Pneumothorax is also not a concern. PTS: 1 DIF: Cognitive Level:
Comprehension/Understanding
REF: p. 425 OBJ: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
1. A patient at 34 weeks of gestation has reported to the OB triage unit for assessment of
oligohydramnios. The nurse assigned to care for this patient is aware that prolonged
oligohydramnios may result in (Select all that apply.)
a. intrauterine limb amputations.
b. clubfoot.
c. delayed lung development.
d. other fetal abnormalities.
e. fetal deformations. - ANSWER-B, C, D
Oligohydramnios, an abnormally small volume of amniotic fluid, reduces the cushion
surrounding the fetus and may result in deformations such as clubfoot. Prolonged
oligohydramnios interferes with fetal lung development because it does not allow normal
development of the alveoli. Oligohydramnios may not be the primary fetal problem but rather
may be related to other fetal anomalies. This does not lead to intrauterine limb amputations or
fetal deformations. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 178 OBJ: Nursing Process: Assessment
MSC: Client Needs: Physiologic Integrity
1. A patient is at 6 weeks' gestation and is having a transvaginal ultrasound. While preparing the
patient for this procedure, she expresses concerns over the necessity for this test. The nurse
