Test Bank: Maternal-Newborn Nursing: The Critical Components of Nursing Care, 3rd Edition, Roberta Durham, Linda Chapman

  TEST BANK: MATERNAL- NEWBORNNURSING: THE CRITICAL COMPONENTS OF NURSING CARE, 3RD EDITION, ROBERTA DURHAM, LINDA CHAPMAN Test Bank: Maternal-Newborn Nursing: The Critical Components of Nursing Care, 3rd Edition, Roberta Durham, Linda Chapman Chapter 1: Trends and Issues MULTIPLE CHOICE 1. The nurse is caring for a patient who is in labor with her first child. The patient’s mother is present for support and notes that things have changed in the delivery room since she last gave birth in the early 1980s. Which current trend or intervention may the patient’s mother find most different? 1. Fetal monitoring throughout labor 2. Postpartum stay of 10 days 3. Expectant partner and family in operating room for cesarean birth 4. Hospital support for breastfeeding ANS: 4 Chapter: Chapter 1 Trends and Issues Chapter Learning Objective: 1. Discuss current trends in the management of labor and birth Page: 4 Heading: Table 1-1: Past and Present Trends Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Evidence-Based Practice Difficulty: Moderate Feedback 1 This is incorrect. Fetal monitoring during labor began in the late 1970s. As such, this likely would have occurred during the mother’s labor and delivery during the 1980s. 2 This is incorrect. In the past, the average hospital postpartum stay was 10 days. Presently, the average postpartum stay is 48 hours or less. 3 This is incorrect. In the past, expectant partners and families were excluded from the labor and birth experience. Present trends involve the expectant partner and family in the labor and birth experience, including presence in the operating room for cesarean births. 4 This is correct. Hospital support for breastfeeding, including a lactation consultant and employment of the Baby-Friendly Hospital Initiative, were both enacted during the early 1990s. PTS: 1 CON: Evidence-Based Practice 2. A patient with a history of hypertension is giving birth. During delivery, the staff was not able to stabilize the patient’s blood pressure. As a result, the patient died shortly after delivery. This is an example of what type of death? 1. Early maternal death 2. Late maternal death 3. Direct obstetric death 4. Indirect obstetric death ANS: 4 Chapter: Chapter 1 Trends and Issues Chapter Learning Objective: 2. Discuss current trends in maternal and infant health outcomes. Page: 7 Heading: Trends > Maternal Death and Mortality Rates Integrated Processes: Nursing Process Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Application [Applying] Concept: Ante/Intra/Post-partum Difficulty: Hard Feedback 1 This is incorrect. Early maternal death is not an example of maternal death. Examples of maternal death include late maternal death, indirect obstetric death, direct obstetric death, and pregnancy-related death. 2 This is incorrect. Late maternal death occurs 42 days after termination of pregnancy from a direct or indirect obstetric cause. 3 This is incorrect. Direct obstetric death results from complications during pregnancy, labor, birth, and/or postpartum period. 4 This is correct. Indirect obstetric death is caused by a preexisting disease, or a disease that develops during pregnancy. PTS: 1 CON: Ante/Intra/Post-partum 3. The nurse is providing education to a patient who has given birth to her first child and is being discharged home. The patient expressed concern regarding infant mortality and sudden infant death syndrome (SIDS). The patient had an uncomplicated pregnancy, labor, and vaginal delivery. She has a body mass index of 25 and has no other health conditions. The infant is healthy and was delivered full-term. What will be most helpful thing to explain to the patient? 1. Uses of extracorporeal membrane oxygenation therapy (ECMO) 2. Uses of exogenous pulmonary surfactant 3. The Baby-Friendly Hospital Initiative 4. The Safe to Sleep campaign ANS: 4 Chapter: Chapter 1 Trends and Issues Chapter Learning Objective: 3. Identify leading causes of infant death. Page: 7 Heading: Trends > Infant Mortality Rates Integrated Processes: Nursing process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Health Promotion Difficulty: Moderate Feedback 1 This is incorrect. EMCO has been cited as one of the factors that has reduced infant mortality among preterm infants. 2 This is incorrect. Although advances in medical treatments have decreased infant mortality, exogenous pulmonary surfactant is primarily used to reduce mortality of preterm infants. 3 This is incorrect. The Baby-Friendly Hospital Initiative was developed to support breastfeeding and is not directly linked to reduced infant mortality or SIDS. 4 This is correct. The Back to Sleep campaign and the Safe to Sleep campaigns were designed to promote healthy infant sleeping habits. The decrease in SIDS from 1995 to 2015 was attributed to the Safe to Sleep campaign. PTS: 1 CON: Health Promotion 4. The nurse is caring for a 14-year-old patient who is 32 weeks pregnant. After complaining of genital sores and discomfort, the patient tests positive for syphilis. The fetus is at increased risk of which condition? 1. Diabetes 2. Blindness 3. Pneumonia 4. Hypertension ANS: 4 Chapter: Chapter 1 Trends and Issues Chapter Learning Objective: 4. Discuss current maternal and infant health issues. Page: 10 Heading: Issues > Teen Pregnancy > Implications of Teen Pregnancy and Birth Integrated Processes: Nursing Process Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Application [Applying] Concept: Ante/Intra/Post-partum Difficulty: Moderate Feedback 1 This is incorrect. Maternal obesity increases a child’s risk of developing childhood obesity and diabetes. 2 This is correct. Neonatal blindness, maternal death, and neonatal death are all associated with a patient who contracts syphilis during pregnancy. 3 This is incorrect. Chlamydial pneumonia is associated with maternal chlamydia. 4 This is incorrect. Teen mothers may have a higher risk of contracting sexually transmitted illnesses and hypertension during pregnancy; however, maternal syphilis is not associated with fetal hypertension. PTS: 1 CON: Ante/Intra/Post-partum 5. The nurse is caring for a 15-year-old female who is pregnant with her first child. In her previous prenatal visit, the patient tested negative for chlamydia, syphilis, gonorrhea, and HIV. Based on the information provided, which condition is the patient’s baby at higher risk for? 1. Intestinal problems 2. Neonatal conjunctivitis 3. Blindness 4. Pneumonia ANS: 1 Chapter: Chapter 1 Trends and Issues Chapter Learning Objective: 4. Discuss current maternal and infant health issues. Page: 11 Heading: Issues > Teen Pregnancy Integrated Processes: Nursing Process Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Application [Applying] Concept: Health Promotion Difficulty: Difficult Feedback 1 This is correct. Infants born to teen mothers are at increased risk for various conditions related to prematurity, including infant death, intestinal problems, and/or respiratory distress syndrome. 2 This is incorrect. Infants born to teen mothers who have gonorrhea are at increased risk of neonatal conjunctivitis and blindness. 3 This is incorrect. Infants born to teen mothers with syphilis and gonorrhea are at increased risk of blindness. 4 This is incorrect. Infants born to teen mothers with chlamydia may be at increased risk of developing chlamydial pneumonia. PTS: 1 CON: Health Promotion 6. The nurse is caring for a 23-year-old patient who arrives at the clinic for a pregnancy test. The test confirms the patient is pregnant. The patient states, ―I do not need to stop smoking my electronic cigarette because it will not harm my baby.‖ Which is the best response by the nurse? 1. ―You are correct. Electronic cigarettes are not harmful during pregnancy.‖ 2. ―Tobacco products, including electronic cigarettes, should not be used during pregnancy due to risking nicotine toxicity.‖ 3. ―According to the FDA, although electronic cigarettes are safe for you, they can cause harm to the fetus during pregnancy.‖ 4. ―Electronic cigarettes are considered harmful only in the first trimester.‖ ANS: 2 Chapter: Chapter 1 Trends and Issues Chapter Learning Objective: 4. Discuss current maternal and infant health issues. Page: 12 Heading: Issues > Tobacco and Electronic Cigarette Use During Pregnancy Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Ante/Intra/Post-partum Difficulty: Moderate Feedback 1 This is incorrect. Electronic cigarettes can be harmful during pregnancy. 2 This is correct. Pregnant women should not use tobacco products or electronic cigarettes during pregnancy. 3 This is incorrect. Electronic cigarettes are not controlled by the FDA and may be harmful to both mother and fetus. 4 This is incorrect. Electronic cigarettes are considered harmful during pregnancy. PTS: 1 CON: Ante/Intra/Post-partum 7. The nurse is caring for a 16-year-old patient who is 32 weeks pregnant with her first child, who is male. The patient’s mother has accompanied her to today’s visit. During the nursing assessment, the patient mentions that she is no longer in a relationship with the baby’s father but her mother plans to help her. However, the patient’s mother asks whether this will have any impact on the child. Which should the nurse indicate the child is at increased risk of during his adolescence? 1. Hypertension 2. Diabetes 3. Alcohol abuse 4. Intraventricular bleeding ANS: 3 Chapter: Chapter 1 Trends and Issues Chapter Learning Objective: 4. Discuss current maternal and infant health issues. Page: 12 Heading: Issues > Teen Pregnancy > Implications of Teen Pregnancy and Birth Integrated Processes: Nursing Process Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Application [Applying] Concept: Ante/Intra/Post-partum Difficulty: Moderate Feedback 1 This is incorrect. Teen mothers, rather than their children, are at increased risked of hypertension during pregnancy. 2 This is incorrect. Children born to mothers who are obese have an increased risk of developing childhood obesity and childhood diabetes. 3 This is correct. Statistics have shown that adolescent boys without an involved father may be at higher risk of incarceration, dropping out of school, and abusing drugs or alcohol. 4 This is incorrect. Children born to teen mothers are at increased risk for health problems associated with low birth weight, including intraventricular bleeding. PTS: 1 CON: Ante/Intra/Post-partum 8. The nurse is caring for a patient at 7 weeks gestation. The nurse suspects that a pregnant patient may have been using marijuana. With consent, the nurse confirms via urine drug screen. Which statement by the nurse is most appropriate? 1. ―Did you smoke marijuana when pregnant with your other child?‖ 2. ―To avoid negative effects on your baby, you’ll need to stop using marijuana during your last trimester.‖ 3. ―Using marijuana while pregnant can have a negative effect on the neurological development of your baby.‖ 4. ―Marijuana use while pregnant greatly increases your risk of miscarriage.‖ ANS: 3 Chapter: Chapter 1 Trends and Issues Chapter Learning Objective: 3. Identify leading causes of infant death. Page: 13 Heading: Issues > Substance Abuse During Pregnancy Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Ante/Intra/Post-partum Difficulty: Moderate Feedback 1 This is incorrect. Whether or not the woman used marijuana during her previous pregnancy is not relevant to her current care. 2 This is incorrect. Marijuana should not be used at any point during pregnancy. 3 This is correct. Marijuana use during pregnancy may have a negative effect on the neurological development of the fetus. 4 This is incorrect. There currently is no research linking marijuana use to increased risk of miscarriage. PTS: 1 CON: Ante/Intra/Post-partum 9. The nurse is counseling a female patient about alcohol use during pregnancy. Which statement by the patient demonstrates successful patient teaching? 1. ―I will limit my drinking to just one alcoholic beverage per day.‖ 2. ―It’s best for my baby if I avoid drinking during pregnancy.‖ 3. ―An occasional drink on special occasions is okay.‖ 4. ―Drinking alcohol is only acceptable in the first trimester.‖ ANS: 2 Chapter: Chapter 1 Trends and Issues Chapter Learning Objective: 3. Identify leading causes of infant death. Page: 13 Heading: Issues > Substance Abuse During Pregnancy Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Ante/Intra/Post-partum Difficulty: Moderate Feedback 1 This is incorrect. Alcohol should not be consumed while pregnant. 2 This is correct. Drinking alcohol while pregnant can cause low birth weight, fetal alcohol syndrome, mental retardation, and intrauterine growth restriction. 3 This is incorrect. Alcohol should not be consumed while pregnant. 4 This is incorrect. Alcohol should not be consumed while pregnant. PTS: 1 CON: Ante/Intra/Post-partum 10. The nurse is educating the pregnant patient with a body mass index (BMI) of 33. The nurse knows that teaching has been effective when the patient states which of the following? 1. ―My child may be at increased risk for birth injury.‖ 2. ―My child may have a decreased risk of developing childhood diabetes.‖ 3. ―I will probably give birth vaginally.‖ 4. ―I have a lower risk of developing gestational hypertension.‖ ANS: 1 Chapter: Chapter 1 Trends and Issues Chapter Learning Objective: 4. Discuss current maternal and infant health issues. Page: 13 Heading: Issues > Obesity Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Ante/Intra/Post-partum Difficulty: Difficult Feedback 1 This is correct. Shoulder dystocia and other birth injuries are associated with infant macrosomia (large size) due to maternal obesity. 2 This is incorrect. Children born to mothers who are obese are at increased risk of developing childhood obesity and diabetes. 3 This is incorrect. Pregnant patients who are obese are at increased risk of cesarean birth. 4 This is incorrect. Pregnant patients who are obese have an increased risk of developing gestational diabetes and gestational hypertension. PTS: 1 CON: Ante/Intra/Post-partum 11. A pregnant woman weighs 90.9 kg. The nurse is educating the patient on complications that the patient may be at risk for during pregnancy. Which response by the patient indicates that she understands? 1. ―Due to my weight, there is a possibility that I may develop gestational diabetes.‖ 2. ―I am not overweight, but I am still at risk for gestational diabetes.‖ 3. ―My mother had preeclampsia during one of her pregnancies.‖ 4. ―I will need to do a glucose tolerance test in my second trimester.‖ ANS: 1 Chapter: Chapter 1 Trends and Issues Chapter Learning Objective: 4. Discuss current maternal and infant health issues. Page: 13 Heading: Issues > Obesity Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Ante/Intra/Post-partum Difficulty: Difficult Feedback 1 This is correct. The patient is at risk for gestational diabetes due to being obese during pregnancy. 2 This is incorrect. The patient is overweight. 3 This is incorrect. This response is not related to the question. 4 This is incorrect. The patient will need to get the glucose tolerance test in the second trimester, but this response does not relate to the question. PTS: 1 CON: Ante/Intra/Post-partum 12. The nurse is taking a history of a mother who admits to cocaine drug use. Which action should the nurse take first? 1. Refer the patient to a drug abuse program. 2. Screen the infant for side effects associated with cocaine use. 3. Educate the patient of the risks associated with cocaine use during pregnancy. 4. Advise the patient that her baby will be okay even with the history of cocaine use. ANS: 3 Chapter: Chapter 1 Trends and Issues Chapter Learning Objective: 3. Identify leading causes of infant death. Page: 13 Heading: Issues > Substance Abuse During Pregnancy Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Ante/Intra/Post-partum Difficulty: Difficult Feedback 1 This is incorrect. This is appropriate, but not the first action the nurse should take. 2 This is incorrect. The infant is not screened for side effects of maternal drug use until delivery. 3 This is correct. The patient should be educated on possible risks associated with drug use. 4 This is incorrect. It is not appropriate to tell a patient ―your baby will be okay‖ in any circumstance. PTS: 1 CON: Ante/Intra/Post-partum 13. A pregnant patient with a BMI of 35 is concerned about health effects she and her baby may face during pregnancy. During routine testing, the patient tested negative for sexually transmitted illnesses (STIs) and indicated that she is in a committed, long-term relationship with the child’s father. Which of the following is accurate? 1. The patient’s infant is at increased risk of neonatal blindness. 2. The patient’s infant has a decreased risk of birth injury. 3. The patient will have increased risk of wound infection. 4. The patient will have a decreased risk of preeclampsia. ANS: 3 Chapter: Chapter 1 Trends and Issues Chapter Learning Objective: 4. Discuss current maternal and infant health issues. Page: 14 Heading: Issues > Obesity Integrated Processes: Nursing Process Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Application [Applying] Concept: Ante/Intra/Post-partum Difficulty: Difficult Feedback 1 This is incorrect. Infants born to mothers with certain sexually transmitted illnesses (STIs) are at increased risk of neonatal blindness. 2 This is incorrect. Infants born to obese pregnant women have increased risk of birth injury related to macrosomia. 3 This is correct. Obese pregnant patients are at increased risk for wound infections. 4 This is incorrect. Obese pregnant patients have an increased risk of developing certain conditions, including gestational diabetes, gestational hypertension, and preeclampsia. PTS: 1 CON: Ante/Intra/Post-partum 14. The nurse has made it a goal to increase the rate at which women begin prenatal care in the first trimester. The nurse relates this decision to national goals for better maternal and infant outcomes. What guidelines will the nurse use to guide her maternal health goals? 1. WHO Maternal care guidelines 2. State Practice Acts 3. AWHONN white papers 4. Healthy People 2020 ANS: 4 Chapter: Chapter 1 Trends and Issues Chapter Learning Objective: 5. Identify the primary maternal and infant goals of Healthy People 2020. Page: 15 Heading: Maternal and Child Health Goals Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Health Promotion Difficulty: Moderate Feedback 1 This is incorrect. The WHO guidelines are too broad for this purpose, and the nurse will need to use national goals. 2 This is incorrect. State practice acts specify legal requirements rather than health promotion goals. 3 This is incorrect. AWHONN white papers will present positions but not necessarily detail health promotion goals. 4 This is correct. The national goals for improving maternal and infant health are found in Healthy People 2020. PTS: 1 CON: Health Promotion 15. A nursing student is asked to set goals that will decrease the fetal death outcomes during delivery. What guidelines will the nursing student use to assist in setting her goals? 1. WHO Maternal care guidelines 2. Healthy People 2020 3. AWHONN white papers 4. State Practice Act ANS: 2 Chapter: Chapter 1 Trends and Issues Chapter Learning Objective: 5. Identify the primary maternal and infant goals of Healthy People 2020. Page: 15 Heading: Maternal and Child Health Goals Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Health Promotion Difficulty: Moderate Feedback 1 This is incorrect. The WHO guidelines are too broad for this purpose and the nurse will need to use national goals. 2 This is correct. The national goals for improving maternal and infant health are found in Healthy People 2020. 3 This is incorrect. AWHONN white papers will present positions but not necessarily detail health promotion goals. 4 This is incorrect. State practice acts specify legal requirements rather than health promotion goals. PTS: 1 CON: Health Promotion MULTIPLE RESPONSE 1. A woman has recently given birth to an infant born at 35 weeks and 5 days gestation. What long-term effects should the nurse be concerned about with the infant being born at this gestation? Select all that apply. 1. Cerebral palsy 2. Respiratory disorders 3. Developmental delays 4. Visual impairments 5. Hearing impairments ANS: 1, 2, 3, 4, 5 Chapter: Chapter 1 Trends and Issues Chapter Learning Objective: 1. Discuss current trends in the management of labor and birth. Page: 6 Heading: Trends > Preterm Births Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Comprehension [Understanding] Concept: Health Promotion Difficulty: Moderate Feedback 1 This is correct. Cerebral palsy is a long-term effect of preterm birth. 2 This is correct. Respiratory disorders are a long-term effect of preterm birth. 3 This is correct. Developmental delays are a long-term effect of preterm birth. 4 This correct. Visual and hearing impairment is a long-term effect of preterm birth. 5 This is correct. Hearing impairments are a long-term effect of preterm birth. PTS: 1 CON: Health Promotion 2. An infant was recently born weighing 1,498 grams. The nurse understands that the birth weight of this infant is an important indicator of what? Select all that apply. 1. Morbidity rate 2. Prenatal care 3. Mortality rate 4. Infant health outcome 5. Postpartum care ANS: 1, 3, 4 Chapter: Chapter 1 Trends and Issues Chapter Learning Objective: 1. Discuss current trends in the management of labor and birth. Page: 6 Heading: Trends > Neonatal Birth Weight Rates Integrated Processes: Nursing Process Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Application [Applying] Concept: Ante/Intra/Post-partum Difficulty: Moderate Feedback 1 This is correct. Morbidity rate is an outcome of low birth weight. 2 This is incorrect. Prenatal care is not an outcome of low birth weight. 3 This is correct. Mortality rate is an outcome of low birth weight. 4 This is correct. Infant health is an outcome of low birth weight. 5 This is incorrect. Postpartum care is not an outcome of low birth weight. PTS: 1 CON: Ante/Intra/Post-partum 3. The nurse is taking the history of a gravida 2 para 1 patient. Which findings in the patient’s history warrant further action? Select all that apply. 1. Anemia 2. Severe hemorrhage 3. Infections 4. Malnutrition 5. Eclampsia ANS: 1, 2, 3, 5 Chapter: Chapter 1 Trends and Issues Chapter Learning Objective: 2. Discuss current trends in maternal and infant health outcomes. Page: 9 Heading: Trends > Maternal Death and Mortality Rates Integrated Processes: Nursing Process Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Application [Applying] Concept: Ante/Intra/Post-partum Difficulty: Difficult Feedback 1 This is correct. Anemia is a primary cause of maternal death. 2 This is correct. Severe hemorrhage is a primary cause of maternal death. 3 This is correct. Infection is a primary cause of maternal death. 4 This is incorrect. Malnutrition is not a primary cause of maternal death. 5 This is correct. Eclampsia is a primary cause of maternal death. PTS: 1 CON: Ante/Intra/Post-partum 4. A nurse is caring for a single teen mother who has just given birth to her first child. The patient notes that the child’s father ―wants no relationship with his son.‖ The patient goes on to express concerns about the short- and long-term impact of her teen pregnancy on herself and on her child. Which statements made by the nurse are accurate? Select all that apply. 1. ―You are more likely than others to have additional children before you turn 20.‖ 2. ―You may have difficulty completing high school or college.‖ 3. ―Your child is less likely to experience behavioral problems.‖ 4. ―Your child is at increased risk of abusing alcohol when he is a teenager.‖ 5. ―You may not earn enough money to independently support yourself and your child.‖ ANS: 1, 2, 4 Chapter: Chapter 1 Trends and Issues Chapter Learning Objective: 4. Discuss current maternal and infant health issues. Page: 10 Heading: Issues > Teen Pregnancy Integrated Processes: Nursing Process Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Application [Applying] Concept: Health Promotion Difficulty: Moderate Feedback 1 This is correct. Teen mothers are more likely to have additional children than their peers. Roughly 17% of all teen mothers will have at least one more birth before the age of 20. 2 This is correct. Only half of teen mothers earn their high school diploma by age 22. Less than 2% of teen mothers finish college by age 30. 3 This is incorrect. Children of teen mothers are more likely to experience behavioral problems. 4 This is correct. Teenage males without an involved father have a higher risk of abusing alcohol or drugs. 5 This is correct. Around one-fourth of teen mothers begin receiving welfare within 3 years of the birth of their first child. 66% of teen mothers are poor. PTS: 1 CON: Health Promotion 5. The nurse is caring for a woman who is pregnant. The patient reports that she has also smoked less than five cigarettes per day and that she has continued to smoke during her pregnancy. Routine prenatal examination and diagnostics have indicated she tested negative for sexually transmitted infections and has a BMI of 25. Based on statistics, which is likely true about the patient and the developing fetus? Select all that apply. 1. She will breastfeed her infant. 2. She is probably aged 20–24. 3. She likely has earned a college degree. 4. Her child may have impaired brain development. 5. Her child is more likely to be born prematurely. ANS: 2, 4, 5 Chapter: Chapter 1 Trends and Issues Chapter Learning Objective: 3. Identify leading causes of infant death. Page: 12 Heading: Issues > Tobacco and Electronic Cigarette Use During Pregnancy Integrated Processes: Nursing Process Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Application [Applying] Concept: Ante/Intra/Post-partum Difficulty: Moderate 1 This is incorrect. Mother who smoke during pregnancy are less likely to breastfeed their infants. 2 This is correct. Only 4.5% of mothers over 35 smoke during pregnancy, which is the lowest smoking prevalence rate of age ranges listed. Mothers aged 20–24 have the highest prevalence of smoking during pregnancy (13%). 3 This is incorrect. Statistics indicate that mothers with less than a high school diploma have the highest prevalence of smoking during pregnancy (14.1%). Patients with a bachelor’s degree or higher have the lowest prevalence of smoking during pregnancy (0.9%). 4 This is correct. Fetal brain development may be impaired when the mother continues to smoke throughout pregnancy. 5 This is correct. Tobacco exposure during development is toxic to developing fetuses. It may contribute to a variety adverse effects, including abruptio placenta and premature birth. PTS: 1 CON: Ante/Intra/Post-partum Chapter 2: Ethics and Standards of Practice Issues Multiple Choice 1. An ethical dilemma unique to perinatal nursing is the: a. Innate conflict between maternal and fetal rights b. Intensive use of technology c. Shortage of health-care resources d. Risk of violation of the principle of veracity ANS: a Feedback a. A unique aspect of maternity nursing is that the nurse advocates for two individuals: the woman and the fetus.b. The use of technology is not unique to perinatal nursing.c. Currently, in the United States, decisions in perinatal nursing are not based on resources available.d. In perinatal nursing, the obligation to tell the truth is generally adhered to. KEY: Integrated Process: Caring | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate2. The American Nurses Association Code of Ethics for Nurses directs nurses to provide patient care that is: a. Curative b. Utilitarian c. Negotiable d. Respectful ANS: d Feedback a. Adaptation rather than cure is the goal of nursing.b. Nursing does not define the value of a person by his or her utility.c. The Code of Ethics outlines the nursing profession’s nonnegotiable ethical standard.d. Respect for the inherent dignity, worth, and uniqueness of every individual is part of the Code of Ethics.KEY: Integrated Process: Caring | Cognitive Level: Analysis | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate 3. Evidence-based practice is the integration of the best: a. Randomized clinical trials, clinical expertise, and patients’ requestsb. Research evidence, clinical expertise, and patients’ valuesc. Quantitative research, clinical expertise, and patients’ preferencesd. Research findings, clinical experience, and patients’ preferences ANS: b Feedback a. Evidence-based practice is the use of evidence that may include research beyond randomized clinical trials.b. These elements are the accepted definition of evidence-based practice.c. Qualitative research, as well as quantitative research, contributes to evidence-based practice.d. Clinical expertise, as well as clinical experience, defines evidence-based practice. KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: EasyMultiple Response 4. Infants whose mothers were obese during pregnancy are at higher risk for which of the following? (Select all that apply.) a. Childhood diabetesb. Heart defects c. Hypospadias d. Respiratory distress ANS: a, b, c Fetuses and/or infants of women who were obese during pregnancy are at higher risk for spina bifida, health defects, anorectal atresia, hypospadias, intrauterine fetal death, birth injuries related to macrosomia, and childhood obesity and diabetes. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Peds/Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate Chapter 3: Genetics, Conception, Fetal Development, and ReproductiveTechnology Multiple Choice 1. The color of a person’s hair is an example of which of the following? a. Genome b. Sex-link inheritance c. Genotype d. Phenotype ANS: d Feedback a. Genome is an organism’s complete set of DNA.b. Sex-link inheritance refers to genes or traits that are located only on the X chromosome.c. Genotype refers to a person’s genetic mak eup.d. Correct. Phenotype refers to how genes are outwardly expressed, such as eye color, hair color, and height. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Analysis | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy 2. Which of the following statements by a pregnant woman indicates she needs additional teaching on ways to reduce risk s to her unborn child from the potential effects of exposure to toxoplasmosis? a. ―I will avoid rare lamb. b. ―I will wear a mask when cleaning my cat’s litter box. c. ―I understand that exposure to toxoplasmosis can cause blindness in the baby. d. ―I will avoid rare beef.‖ ANS: b Feedback a. Exposure occurs when the protozoan parasite found in cat feces and uncook ed or rare beef and lamb is ingested.b. Correct. Pregnant women and women who are attempting pregnancy should avoid contact with cat feces. Exposure occurs when the protozoan parasite found in cat feces and uncook ed or rare beef and lamb is ingested. Wearing a mask will not decrease the risk through ingestion of the parasite.c. Exposure to toxoplasmosis can cause fetal death, mental retardation, and blindness.d. Exposure occurs when the protozoan parasite found in cat feces and uncook ed or rare beef and lamb is ingested. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate 3. The fetal circulatory structure that connects the pulmonary artery with the descending aorta is k nown as which of the following? a. Ductus venosus b. Foramen ovale c. Ductus arteriosus d. Internal iliac artery ANS: c Feedback a. The ductus venosus connects the umbilical vein to the inferior vena cava.b. The foramen ovale is the opening between the right and left atria.c. Correct.d. The internal iliac artery connects the external iliac artery to the umbilical artery.KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Easy 4. A woman at 40 week s’ gestation has a diagnosis of oligohydramnios. Which of the following statements related to oligohydramnios is correct? a. It indicates that there is a 25% increase in amniotic fluid.b. It indicates that there is a 25% reduction of amniotic fluid.c. It indicates that there is a 50% increase in amniotic fluid.d. It indicates that there is a 50% reduction of amniotic fluid. ANS: d Feedback a. Oligohydramnios is a decrease, not an increase in amniotic fluid.b. Oligohydramnios is a 50% reduction in amniotic fluid.c. Oligohydramnios is a decrease, not an increase in amniotic fluid.d. Correct. Oligohydramnios refers to a decreased amount of amniotic fluid of less than 500 mL at term or 50% reduction of normal amounts.KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Reduction of Risk Potential | Difficulty Level: Moderate 5. A diagnostic test commonly used to assess problems of the fallopian tubes is: a. Endometrial biopsyb. Ovarian reserve testingc. Hysterosalpingogramd. Screening for sexually transmitted infections ANS: c Feedback a. Endometrial biopsy provides information on the response of the uterus to hormonal signals.b. Ovarian reserve testing is used to assess ovulatory functioning.c. Correct. Hysterosalpingogram provides information on the endocervical canal, uterine cavity, and fallopian tubes.d. STIs can cause adhesions within the fallopian tubes, but screening cannot confirm that adhesions are present.KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate 6. The nurse is interviewing a gravid woman during the first prenatal visit. The woman confides to the nurse that she lives with a number of pets. The nurse should advise the woman to be especially careful to refrain from coming in contact with the stool of which of the pets? a. Catb. Dogc. Hamsterd. Bird ANS: a Feedback a. The patient should refrain from coming in direct contact with cat feces. Cats often harbor toxoplasmosis, a teratogenic illness.b. No pathology has been associated with the feces of pet dogs.c. No pathology has been associated with the feces of pet hamsters.d. No pathology has been associated with the feces of pet birds. KEY: Integrated Process: Nursing Process: Implementation; Teaching and Learning | Cognitive Level: Application | Content Area: Antepartum Care; Disease Prevention | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy 7. A client is to tak e Clomiphene Citrate for infertility. Which of the following is the expected action of this medication? a. Decrease the symptoms of endometriosisb. Increase serum progesterone levelsc. Stimulate release of FSH and LHd. Reduce the acidity of vaginal secretions ANS: c Feedback a. Clomiphene Citrate will not reduce a client’s symptoms of endometriosis.b. Clomiphene Citrate will not increase a client’s progesterone levels.c. Clomiphene Citrate stimulates release of FSH and LH.d. Clomiphene Citrate will not reduce the acidity of vaginal secretions. KEY: Integrated Process: Nursing Process: Evaluation | Cognitive Level: Comprehension | Content Area: Pharmacological and Parenteral Therapies: Expected Effects/Outcomes | Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies | Difficulty Level: Moderate 8. The nurse tak es the history of a client, G2 P1, at her first prenatal visit. The client is referred to a genetic counselor, due to her previous child having a diagnosis of . a. Unilateral amblyopiab. Subdural hematomac. Sick le cell anemiad. Glomerular nephritis ANS: c Feedback a. Amblyopia rarely results from a genetic predisposition.b. A subdural hematoma does not result from a genetic defect.c. Sick le cell anemia is an autosomal recessive illness. This client needs to be seen by a genetic counselor.d. Glomerular nephritis does not result from a genetic defect. KEY: Integrated Process: Communication and Documentation; Nursing Process: Assessment | Cognitive Level: Application | Content Area: Antepartum Care; Collaboration with Interdisciplinary Team; Health History; Referrals | Client Need: Health Promotion and Maintenance; Safe and Effective Care Environment: Referrals | Difficulty Level: Moderate 9. A nurse is teaching a woman about her menstrual cycle. The nurse states that is the most important change that happens during the secretory phase of the menstrual cycle. a. Maturation of the graafian follicleb. Multiplication of the fimbriaec. Secretion of human chorionic gonadotropind. Proliferation of the endometrium ANS: d Feedback a. The maturation of the graafian follicle occurs during the follicular phase.b. There is no such thing as the multiplication of the fimbriae.c. Human chorionic gonadotropin is secreted by the fertilized ovum during the early week s of a pregnancy.d. The proliferation of the endometrium occurs during the secretory phase of the menstrual cycle. KEY: Integrated Processes: Nursing Process: Implementation; Teaching and Learning | Cognitive Level: Knowledge | Content Area: Health and Wellness | Client Need: Health Promotion and Maintenance | Difficulty Level: Difficult 10. An ultrasound of a fetus’ heart shows that ―normal fetal circulation is occurring.‖ Which of the following statements is consistent with the finding? a. A right to left shunt is seen between the atria.b. Blood is returning to the placenta via the umbilical vein.c. Blood is returning to the right atrium from the pulmonary system.d. A right to left shunt is seen between the umbilical arteries. ANS: a Feedback a. This is correct. The foramen ovale is a duct between the atria. In fetal circulation, there is a right to left shunt through the duct.b. Blood returns to the placenta via the umbilical arteries.c. Most of the blood bypasses the pulmonary system. The blood that does enter the pulmonary system returns to the left atrium.d. There is no duct between the umbilical arteries. KEY: Integrated Process: Nursing Process: Analysis | Cognitive Level: Comprehension | Content Area: Antepartum Care | Client Need: Health Promotion and Maintenance | Difficulty Level: Difficult 11. The clinic nurse k nows that the part of the endometrial cycle occurring from ovulation to just prior to menses is k nown as the: a. Menstrual phaseb. Proliferative phasec. Secretory phased. Ischemic phase ANS: c Feedback a. The menstrual phase is the time of vaginal bleeding, approximately days 1 to 6.b. The proliferative phase ends the menses through ovulation, approximately days 7 to 14.c. The secretory phases occurs from the time of ovulation to the period just prior to menses, or approximately days 15 to 26.d. The ischemic phase occurs from the end of the secretory phase to the onset of menstruation, approximately days 27 to 28. KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy 12. A clinic nurse explains to the pregnant woman that the amount of amniotic fluid present at 24 week s’ gestation is approximately: a. 500 mLb. 750 mLc. 800 mLd. 1000 mL ANS: c Amniotic fluid first appears at about 3 week s. There are approximately 30 mL of amniotic fluid present at 10 week s’ gestation, and this amount increases to approximately 800 mL at 24 week s’ gestation. After that time, the total fluid volume remains fairly stable until it begins to decrease slightly as the pregnancy reaches term. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Easy 13. Information provided by the nurse that addresses the function of the amniotic fluid is that the amniotic fluid helps the fetus to maintain a normal body temperature and also: a. Facilitates asymmetrical growth of the fetal limbsb. Cushions the fetus from mechanical injuryc. Promotes development of muscle toned. Promotes adherence of fetal lung tissue ANS: b Feedback a. Amniotic fluid allows for symmetrical fetal growth.b. Amniotic fluid cushions the fetus from mechanical injury.c. Amniotic fluid does not promote muscle tone.d. Amniotic fluid prevents adherence of the amnion to the fetus. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Comprehension | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate 14. During preconception counseling, the clinic nurse explains that the time period when the fetus is most vulnerable to the effects of teratogens occurs from: a. 2 to 8 week sb. 4 to12 week sc. 5 to 10 week sd. 6 to 15 week s ANS: a The period of organogenesis lasts from approximately the second until the eighth week of gestation during which time the embryo undergoes rapid growth and differentiation. During organogenesis, the embryo is extremely vulnerable to teratogens such as medications, alcohol, tobacco, caffeine, illegal drugs, radiation, heavy metals, and maternal (TORCH) infections. Structural fetal defects are most lik ely to occur during this period because exposure to teratogens either before or during a critical period of development of an organ can cause a malformation. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Physiological Integrity | Difficulty Level: Easy 15. A major fetal development characteristic at 16 week s’ gestation is: a. The average fetal weight is 450 gramsb. Lanugo covers entire bodyc. Brown fat begins to developd. Teeth begin to form ANS: d Feedback a. The average fetal weight at 16 week s is 200 grams.b. Lanugo is present on the head.c. Brown fat begins to develop at 20 week s.d. This is the correct answer. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Physiological Integrity | Difficulty Level: Moderate 16. Karen, a 26-year-old woman, has come for preconception counseling and ask s about caring for her cat as she has heard that she ―should not touch the cat during pregnancy.‖ The clinic nurse’s best response is: a. It is best if someone other than you changes the cat’s litter pan during pregnancy so that you have no risk of toxoplasmosis during pregnancy.b. It is important to have someone else change the litter pan during pregnancy and also avoid consuming raw vegetables.c. Have you had any ―flu-lik e‖ symptoms since you got your cat? If so, you may have already had toxoplasmosis and there is nothing to worry about.d. Toxoplasmosis is a concern during pregnancy, so it is important to have someone else change the cat’s litter pan and also to avoid consuming uncook ed meat. ANS: d Feedback a. The nurse should also explain that the patient should not eat uncook ed meat as it is a potential source for toxoplasmosis.b. Raw vegetables are not a source for toxoplasmosis.c. This is not an accurate way to diagnose if the woman has had toxoplasmosis.d. Women need to be aware that Toxoplasma gondii, a single-celled parasite, is responsible for the infection toxoplasmosis. The majority of individuals who become infected with toxoplasmosis are asymptomatic, although when present, symptoms are described as ―flu lik e‖ and include glandular pain and enlargement and myalgia. Severe toxoplasmosis infection may cause damage to the fetal brain, eyes, or other organs. Toxoplasmosis is usually acquired by consuming raw or poorly cook ed meat that has been contaminated with T. gondii. Toxoplasmosis may also be acquired through close contact with feces from an infected animal (usually cats) or soil that has been contaminated with T. gondii. KEY: Integrated Processes: Caring | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate 17. A couple who has sought infertility counseling has been told that the man’s sperm count is very low. The nurse advises the couple that spermatogenesis is impaired when which of the following occur? a. The testes are overheated.b. The vas deferens is ligated.c. The prostate gland is enlarged.d. The flagella are segmented. ANS: a Feedback a. Spermatogenesis occurs in the testes. High temperatures harm the development of the sperm.b. When the vas deferens is ligated, a man has had a vasectomy and is sterile. The sterility is not due to impaired spermatogenesis, but rather to the inability of the sperm to migrate to the woman’s reproductive track .c. The enlarged prostrate has no effect on spermatogenesis.d. The flagella are the ―tails‖ of the sperm. They are normally divided into the middle segment and an end segment. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy 18. A nurse work ing with an infertile couple has made the following nursing diagnosis: Sexual dysfunction related to decreased libido. Which of the following assessments is the lik ely reason for this diagnosis? a. The couple has established a set schedule for their sexual encounters.b. The couple has been married for more than 8 years.c. The couple lives with one set of parents.d. The couple has close friends who gave birth within the last year. ANS: a Feedback a. Couples who ―schedule‖ intercourse often complain that their sexual relationship is unsatisfying.b. Years of marriage are not directly related to a couple’s sexual relationship.c. The fact that the couple lives with one set of parents is unlik ely related to their sexual relationship.d. Although it can be very difficult to be around couples who have become pregnant or have healthy babies, this factor is not usually related to a couple’s sexual relationship. KEY: Integrated Process: Critical Think ing | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate True/False 19. The perinatal nurse explains to the student nurse that in the fetal circulation, the lowest level of oxygen concentration is found in the umbilical arteries. ANS: True The highest oxygen concentration (PO2 = 30–35 mm Hg) is found in the blood returning from the placenta via the umbilical vein; the lowest oxygen concentration occurs in blood shunted to the placenta where reoxygenation tak es place. The blood with the highest oxygen content is delivered to the fetal heart, head, neck , and upper limbs, and the blood with the lowest oxygen content is shunted toward the placenta. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy Fill-in-the-Blank 20. After birth, the perinatal nurse explains to the new mother that is the hormone responsible for stimulating milk production. ANS: prolactinFollowing birth and delivery of the placenta, there is an abrupt decrease in estrogen. This event triggers an increased secretion of prolactin (the hormone that stimulates milk production) by the anterior pituitary gland. The posterior pituitary and hypothalamus play a role in the production and secretion of oxytocin, a hormone that causes release of milk from the alveoli. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy 21. During prenatal class, the childbirth educator describes the two membranes that envelop the fetus. The contains the amniotic fluid, and the is the thick , outer membrane. ANS: amnion; chorionThe embryonic membranes (chorion and amnion) are early protective structures that begin to form at the time of implantation. The thick chorion, or outer membrane, forms first. It develops from the trophoblast and encloses the amnion, embryo, and yolk sac. The amnion arises from the ectoderm during early embryonic development. The amnion is a thin, protective structure that contains the amniotic fluid. With embryonic growth, the amnion expands and comes into contact with the chorion. The two fetal membranes are slightly adherent and form the amniotic sac. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Easy 22. The perinatal nurse is teaching nursing students about fetal circulation and explains that fetal blood flows through the superior vena cava into the right via the . ANS: atrium; foramen ovaleBlood flows through the vein from the placenta to the fetus. Most of the blood bypasses the liver and then enters the inferior vena cava by way of the ductus venosus, a vascular channel that connects the umbilical vein to the inferior vena cava. The blood then empties into the right atrium, passes through the foramen ovale (an opening in the septum between the right and left atrium) into the left atrium, and then moves into the right ventricle and on into the aorta. From the aorta, blood travels to the head, upper extremities, and lower extremities. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate 23. The perinatal nurse explains to the student nurse that the growing embryo is called a beginning at 8 week s of gestational age. ANS: fetusMajor organs are being formed (organogenesis) during the first week s following fertilization. During this time, the developing organism is called an embryo. By the end of 8 week s, the embryo has sufficiently developed to be called a fetus. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Easy 24. The perinatal nurse defines a as any substance that adversely affects the growth and development of the embryo/fetus. ANS: teratogenTeratogens (drugs, radiation, and infectious agents that can cause development of abnormal structures in an embryo) and a variety of internal and external developmental events may cause structural and functional defects. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Physiological Integrity | Difficulty Level: Easy 25. is when sperm and oocytes are mixed outside the woman’s body and then placed into the fallopian tube via laparoscopy. ANS: Gamete intrafallopian transferGamete intrafallopian transfer, also referred to as GIFT, is used when there is a history of failed infertility treatment for anovulation, or unexplained infertility, or low sperm count. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Physiological Integrity | Difficulty Level: Moderate Multiple Response 26. A woman seek s care at an infertility clinic. Which of the following tests may this woman undergo to determine what, if any, infertility problem she may have? (Select all that apply.) a. Chorionic villus samplingb. Endometrial biopsyc. Hysterosalpingogramd. Serum FSH analysis ANS. b, c, d Feedback a. Chorionic villus sampling is done to assess for genetic disorders of the fetus. b. Endometrial biopsy is performed about 1 week following ovulation to detect the endometrium’s response to progesterone.c. Hysterosalpingogram is used to determine if fallopian tubes are patent.d. Serum FSH levels are used to assess ovarian function. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate 27. A couple who has been attempting to become pregnant for 5 years is seek ing assistance from an infertility clinic. The nurse assesses the clients’ emotional responses to their infertility. Which of the following responses would the nurse expect to find? (Select all that apply.) a. Anger at others who have babies.b. Feelings of failure because they cannot mak e a baby.c. Sexual excitement because they want to conceive a baby.d. Guilt on the part of one partner because he or she is unable to give the other a baby. ANS: a, b, d Feedback a. Infertile couples often feel anger toward couples who have babies.b. Infertile couples often express feelings of personal failure.c. Infertile couples undergoing infertility testing and treatment often express an aversion to sex.d. Guilt is often expressed by the couple. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate 28. Which of the following places a couple at higher risk for conceiving a child with a genetic abnormality? (Select all that apply.) a. Maternal age over 35 yearsb. Partner who has a genetic disorderc. Maternal type 1 diabetesd. Paternal heart disease ANS: a, bFertility decreases after 35 years. A partner contributes half of the chromosomal mak eup, and genetic disorders can be inherited. Maternal diabetes can have an effect on the fetus/neonate, such as causing complications such as macrosomia and hypoglycemia, but these are not genetic disorders. Paternal heart disease can place the neonate at risk for heart disease later in life, but this is not referred to as a genetic disorder, such as is trisomy 21 and hemophilia. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Analysis | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Difficult 29. The ovarian cycle includes which of the following phases? (Select all that apply.)a. Follicular phaseb. Secretory phasec. Ovulatory phased. Luteal phasee. Menstrual phase ANS: a, c, d Follicular phase, ovulatory phase, and luteal phase are part of the ovarian cycle. Secretory and menstrual phases are part of the endometrial cycle. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Easy 30. A couple is undergoing an infertility work up. The semen analysis indicates a decreased number of sperm and immature sperm. Which of the following factors can have a potential effect on sperm maturity? (Select all that apply.) a. The man rides a bik e to and from work each day.b. The man tak es a calcium channel block er for the treatment of hypertension.c. The man drink s 6 cups of coffee a day.d. The man was treated for prostatitis 12 months ago and has been symptom free since treatment. ANS: a, bThe daily riding of a bik e can be the cause of prolonged heat exposure to the testicles. Prolonged heat exposure is a gonadotoxin. A number of medications, such as calcium channel block ers, can have an effect on sperm production. Coffee has not been associated with low sperm counts. Prostatitis or other infections within the last 3 months may have an effect on the sperm analysis. This man’s episode of prostatitis was 12 months prior.KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate 31. The clinic nurse recognizes that pregnant women who are in particular need of support are those who (select all that apply): a. Are experiencing a second pregnancyb. Are awaiting genetic testing resultsc. Are experiencing a first pregnancyd. Are trying to conceal this pregnancy as long as possible ANS: b, dA second pregnancy is not an indication of a woman in need of additional support. A support system may be lack ing for women who are trying to conceal a pregnancy or for women who are trying to k eep the news of their pregnancy from relatives or friends until results from genetic tests are k nown. These individuals may need additional support from their nurses and other health-care providers, as they are placed in a powerless situation while awaiting results and face a pregnancy that may be in jeopardy. KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: frequent meals of dry, bland foods and include high-protein snack s in their diet. Chapter 4: Physiological Aspects of AntepartumCare(FREE) Chapter 4: Physiological Aspects of Antepartum Care Multiple Choice 1. Folic acid supplementation during pregnancy is to:a. Improve the bone density of pregnant women b. Decrease the incidence of neural tube defects in the fetus c. Decrease the incidence of Down syndrome in the fetusd. Improve calcium uptake in pregnant women ANS: b Feedback a. Folic acid is not related to bone density. b. Correct. The use of folic acid has decreased the incidence of neural tube defects by 50%. c. The use of folic acid is not associated with a reduction in Down syndrome. d. Folic acid is not related to calcium uptake in women. KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Pharmacological/Parenteral Therapies | Difficulty Level: Moderate 2. The positive signs of pregnancy are:a. All physiological and anatomical changes of pregnancyb. All subjective signs of pregnancyc. All those physiological changes perceived by the woman herselfd. The objective signs of pregnancy that can only be attributed to the fetus ANS: d Feedback a. Physiological and anatomical changes of pregnancy are presumptive signs of pregnancy. b. All subjective signs of pregnancy are the probable signs of pregnancy. c. All those physiological changes perceived by the woman herself are presumptive signs of pregnancy. d. Correct. Positive signs of pregnancy are the objective signs of pregnancy that can only be attributed to the fetus, such as fetal heart tones. KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Easy 3. During a routine prenatal visit in the third trimester, a woman reports she is dizzy and lightheaded when she is lying on her back. The most appropriate nursing action would be to:a. Order an EKG. b. Report this abnormal finding immediately to her care provider. c. Teach the woman to avoid lying on her back and to rise slowly because of supine hypotension. d. Order a nonstress test to assess fetal well-being. ANS: c Feedback a. This is a normal occurrence in pregnancy and does not indicate pathology. The probable cause of the problem is supine hypotension. b. This is a normal finding that does not warrant immediate notification to her care provider. c. Correct. Teaching the woman to avoid lying on her back because of occlusion of the vena cava with the gravid uterus causes supine hypotension syndrome. d. Antenatal testing is not indicated with supine hypotension. KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Analysis | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Moderate 4. Blood volume expansion during pregnancy leads to: a. Iron-deficiency anemiab. Maternal iron stores being insufficient to meet the demands for iron in fetal developmentc. Plasma fibrin increase of 40% and fibrinogen increase of 50%d. Physiological anemia of pregnancy ANS: d Feedback a. Iron-deficiency anemia is treated with iron supplementation. Iron-deficiency anemia is defined as hemoglobin of less than 11 g/dL and hematocrit less than 33%. b. Maternal iron stores that are insufficient to meet the demands for iron in fetal development result in iron-deficiency anemia. c. Hypercoagulation that occurs during pregnancy is to decrease the risk of postpartum hemorrhage. These changes taking place are not related to blood volume expansion. d. Correct. Physiological anemia of pregnancy, also referred to as pseudo-anemia of pregnancy, is due to hemodilution. The increase in plasma volume is relatively larger than the increase in RBCs that results in decreased hemoglobin and hematocrit values. KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Analysis | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Moderate 5. Intimate partner violence (IPV) against women consists of actual or threatened physical or sexual violence and psychological and emotional abuse. Screening for IPV during pregnancy is recommended for:a. Pregnant women with a history of domestic violenceb. All pregnant womenc. All low-income pregnant womend. Pregnant adolescents ANS: b Feedback a. Intimate partner violence is underreported by women, necessitating universal screening. b. Correct. AWHONN advocates for universal screening for domestic violence for all pregnant women. Homicide is the most likely cause of death for pregnant or recently pregnant women, and a significant portion of those homicides are committed by their intimate partners. One in six pregnant women reported physical or sexual abuse during pregnancy, seriously impacting maternal and fetal health and infant birth weight. c. IPV crosses all ethnic, racial, religious, and socioeconomic levels. d. IPV crosses all ethnic, racial, religious, and socioeconomic levels. KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Psychosocial Integrity | Difficulty Level: Moderate 6. A woman presents to the prenatal clinic at 30 weeks’ gestation reporting dysuria, frequency, and urgency with urination. Appropriate nursing actions include:a. Obtain clean-ca