NCLEX OBSTETRIC (OB) NCLEX EXAM Multiple Choice Questions (MCQs)

NCLEX OBSTETRIC (OB) NCLEX EXAM Multiple Choice Questions (MCQs) NCLEX OBSTETRIC (OB) NCLEX EXAM Multiple Choice Questions (MCQs) Which of the following tasks may be delegated to the nursing assistant? a. checking the cervix of the patient who is less likely to deliver soon b. administering oxygen to the mother who has decreasing oxygen saturations c. providing ice chips for a mother who complains of a dry mouth d. Tearing off a strip of paper from the fetal heart rate monitor and putting it in the chart C- Rationale: When working in L&D the UAP can help with ADLs. They cannot be delegated tasks that require formulating a care plan, taking off orders, or administering medications Which of the following situations would most likely warrant contact with a physician for further orders for care or treatment? A. A patient has a 3rd degree perineal laceration after delivery B. A patient has lost 100 mL of blood with delivery C. A patient has a boggy uterus that does not firm with massage D. A patient is having rectal pain C. Rationale: When caring for postpartum patients, the nurse must be familiar with what conditions are common occurrences following delivery and what situations warrant a call to the physician for further help. Postpartum complications often include infection, blood clots, and hemorrhage. Excess bleeding may occur when the uterus is boggy and it does not firm up with massage. Following removal of the epidural, the patient develops a severe headache when she sits up in bed. The physician has instructed the patient that she will need a blood patch. Which best describes this procedure? A. Removing blood from a vein in the patient and injecting it into the epidural space in the back B. Placement of a large bandage over the site of the epidural insertion. C. Replacement of the epidural catheter into the same space for long-term control D. Placement of a nerve block in the spinal column at the location of the affected epidural space A- Rationale: When CSF leaks out of the epidural space a severe headache in the patient can occur. A blood patch can be performed by a physician to close the site. The small amount of blood is withdrawn from the mother's arm and the blood clots in the space. Which of the patients described should the nurse see first? A. 20 yr old patient who just had her first baby and doesn't know how to breastfeed B. 27 yr old diabetic patient who delivered her second child yesterday and needs her morning dose of insulin C. 24 yr old patient who has had a large amount of lochia and has developed a hematoma on her perineum D. 30 yr old patient who needs to take a shower and eat breakfast before the physician comes to dismiss her C. A patient with a hematoma is at risk of hemorrhage and the nurse should assess her first On the first following delivery, the physician ordered a hemoglobin level for the patient; the result was 9.9 g/dL. The physician did not list any other orders in the patient's chart since that time. Which response of the nurse is most appropriate> A. call the physician and ask if he wants a blood transfusion for the patient B. ask the physician about the hemoglobin level when he comes in for rounds C. Contact the laboratory and ask them to repeat the test D. continue to monitor the patient and document the result B. Rationale: A postpartum patient is at risk of hemorrhage following delivery; often the physician will order a hemoglobin level 1-2 days after delivery to check the mother's risk status. A level of 9.9 g/dL is lower than normal for a female patient, but is not necessarily low enough to warrant a blood transfusion. The patient's medical record states that she tested positive for group B Streptococcus infection. which of the following precautions should be given in this situation? A. the patient should receive antibiotics at this time b. the patient should be given antibiotics during labor c. the fetus should receive antibiotics as a prenatal infusion d. there is no treatment necessary B- B. Rationale: Streptococcus can be transferred to the baby during delivery to cause an infection. the test for the bacteria is performed at approximately 35 weeks gestation, but antibiotics are typically not given until the mother is in labor to reduce the chance that she will pass the infection to her child When reviewing information about infant care, the nurse should explain that the postpartum client should call the physician if her infant developed which of the following conditions? A. The infant is only sleeping 4 hours at night B. the baby wants to eat every hour C. The baby's cord has not fallen off within 7 days D. The baby has a dry mouth D- Rationale: If a baby has dry mouth or dry mucous membranes, he or she could be dehydrated and not getting enough to eat. Which of the following patients would be at high risk of developing pre-eclampsia? Select all that apply. A. A patient who is pregnant with her 3rd child B. A patient who is married C. A patient who is 40 yrs old D. A patient who is overweight E. A patient who is pregnant with twins C, D, E- Rationale: Pre-eclampsia is a state that develops during pregnancy in which a mother has high blood pressure and starts losing protein into the urine.Certain risks that increase such as a first time pregnancy, advanced maternal age, overweight or obesity in the mother, and pregnancy with multiple babies A high risk pregnant patient has had a complicated delivery and is in the recovery room with active bleeding. The physician has ordered hetastarch in sodium chloride (Hespan) IV infusion. Which best describes the indications for this fluid? A. increasing plasma volume during shock or bleeding B. Causing blood coagulation to promote blood clotting C. Improving circulation by causing vasodilation D. Increasing cardiac contractility to improve circulation A- Rationale: Hetastarch in sodium chloride (Hespan) is a type of plasma expanding solution that is used to increase the volume of the intravascular system during times of blood loss. Hespan is typically used for volume replacement to prevent complications of severe hemorrhage, such as hypovolemic shock A patient with high bp during labor has been given magnesium sulfate IV. In addition to regulation of bp, which of the following results would the nurse expect to see after administration of this medication? A. cool, pale skin B. Constipation C. Muscle weakness D. Neck pain C- Rationale: Administration of magnesium sulfate is a form of treatment used for some women who have pre-eclampsia during pregnancy and labor. Magnesium sulfate is given to prevent preterm delivery but it can also cause some negative effects in the mother, including muscle weakness, blurred vision, headache, nausea, and vomiting A patient receiving TPN with lipids thru a central line placed in the subclavian vein. Which complication is most closely associated with this type of fluid administration? A. Fractured ribs B. Pneumothorax C. Mental confusion D. Allergic reaction Pneumothorax A patient who is 28 weeks' gestation undergoes a nonstress test when she noticed that the baby hasn't moved recently. the results are considered reactive. What does this mean? A. the baby has normal heart rate accelerations b. the baby does not have any noted birth defects c. the baby is most likely neurologically impaired d. the baby is going to be born preterm A- Rationale: NST may be performed on a pregnant patient after approximately 28 weeks' gestation. the NST is noninvasive and involves monitoring the baby's heart rate and movements for a period of about 30 minutes. A reactive test indicates that the baby has changes in heart rate in response to movement, which is normal Which of the following increases the risk of postpartum bleeding in a patient? Select all that apply. a. complications during delivery b. retained placental fragments c. involution of the uterus d. administration of oxytocin during delivery e. precipitous delivery A, B, E- Rationale: postpartum hemorrhage is a potential complication following delivery that the nurse must remain aware of and continue to assess while caring for a postpartum patient. The patient has excess bleeding following delivery, which include complications during delivery, such as the use of forceps or vacuum extraction; retained placental fragments, subinvolution of the uterus, use of magnesium sulfate during labor, and a precipitous delivery Which of the following demonstrates the effects of chronic stress during pregnancy? Select all that apply. a. increased risk of miscarriage b. low birth weight c. increased risk of preterm birth d. decreased bonding and attachment e. postpartum hemorrhage A, B, C- Rationale: chronic stress leads to increased release of the hormone cortisol and chronic inflammation in the blood vessels. A pregnant patient may have an increased risk of miscarriage early in the pregnancy, she may deliver a baby who has a low birth weight, and she has an increased risk of preterm birth a pregnant client is undergoing a laparoscopic cholecystectomy because of severe abdominal pain. Which of the following factors must the nurse consider when providing care to this patient? a. remind the patient that there is an increased risk of bleeding with this procedure during pregnancy b. avoid administering pain medications after surgery to reduce the risk of fetal suppression c. tell the patient that it is riskier to delay treatment of gallstones than to have laparoscopic surgery to correct the situation d. encourage the patient to limit her fluid intake for 48 hrs prior to surgery C- Rationale: pregnancy increases the risk of gallstone development and a percentage of women will need to have a cholecystectomy during pregnancy for management and prevention of complications. Studies have shown that the risks of the laparoscopic surgery are less than if the symptomatic patient were left to manage the gallstones without surgery, which could ultimately lead to significant pain and tissue necrosis A woman who is 23 weeks' pregnant is at risk for preterm birth and the physician decides to place a cerclage. which information must the nurse tell this patient as part of routine care with a cerclage? a. the cerclage will stay in place for two weeks b. the patient will need to remain on bed rest for the remainder of pregnancy c. the cerclage may cause a small amount of bleeding after it is placed d. the patient will need to have induced labor at 37 weeks C- Rationale: When a pregnant patient is at increased risk of preterm labor because of an incompetent cervix, the physician may place a cerclage which is a small stitch in the opening of the cervix that keeps it closed. this prevents the cervix from opening and prematurely delivering the baby. the cerclage may cause a small amount of bleeding in the time directly after placement, but this should resolve within about a day. Which of the following best describes an indication for fetal fibronectin screening? a. to assess the risk of preterm delivery b. to determine if the patient is at risk of hemorrhage c. to assess the amount of amniotic fluid present d. to determine if the mother has a vaginal infection A- Rationale: The test can be performed on some women who are at risk of preterm labor. Fetal fibronectin is a protein that attaches the amniotic sac to the lining of the uterus; the protein is found in vaginal secretions after about 22 weeks' gestation. A patient may be at increased risk of preterm labor if there are increased levels of the protein found in vaginal secretions a patient who is 37 weeks' pregnant has collapsed in the hallway of the hospital. a nurse responds and notes that the patient does not have a heart rate. which intervention must be modified because of this patient's pregnancy in order to respond to this situation? a. the nurse must open the patient's airway using the jaw thrust b. the nurse must displace the uterus slightly before performing chest compressions c. the nurse cannot use an AED on a pregnant patient d. the nurse should provide compressions at a rate of 200/min on the pregnant patient B- Rationale: Cardiopulmonary resuscitation and AED can be used on a pregnant patient with some modifications. if the nurse must perform chest compressions, she should still provide the same rate as to a non pregnant patient, but she may need to slightly displace the uterus to perform the compressions a nurse notes that the patient is actively bleeding and her blood pressure has dropped from 110/78 mm Hg to 94/58 mmHg. Which factor would most likely increase the risk of hemorrhage after cesarean section? a. having a large baby b. a history of oligohydramnios c. use of staples to close the incision d. a history of deep vein thrombosis A- Rationale: Postpartum hemorrhage is a risk that is apparent whether a patient has delivered thru vaginal or cesarean methods when bleeding occurs after a cesarean section, the nurse must manage the condition as if it were a surgical complication, since the patient has undergone surgery. risks of post-op bleeding after cesarean section include having a large baby, which can stretch the size of the uterus and put pressure on the blood vessels, increasing the risk of hemorrhage When planning a diet with a pregnant woman the nurse's FIRST action would be to: A. review the woman's current dietary intake. B. teach the woman about the food pyramid. C. caution the woman to avoid large doses of vitamins, especially those that are fat-soluble. D. instruct the woman to limit the intake of fatty foods. Rationale: A. A pregnant woman with a body mass index (BMI) of 22 asks the nurse how she should be gaining weight during pregnancy. The nurse's BEST response would be to tell the woman that her pattern of weight gain should be approximately: A. a pound a week throughout pregnancy. B. 2 to 5 lbs during the first trimester, then a pound each week until the end of pregnancy. C. a pound a week during the first two trimesters, then 2 lbs per week during the third trimester. D. a total of 25 to 35 lbs. B- Rationale: Pound a week is not the correct guideline. 25-35 lb total weight gain or about 2-5 lbs in the first trimester and about 1 lb/wk during the 2nd and third trimester are not accurate guidelines for weight gain during pregnancy. TOTAL IS CORRECT BUT PATTERN NEEDS TO BE EXPLAINED most weight gain should occur in the last 2 trimesters A pregnant woman at 7 weeks of gestation complains to her nurse midwife about frequent episodes of nausea during the day with occasional vomiting. She asks what she can do to feel better. The nurse midwife could suggest that the woman: A. drink warm fluids with each of her meals. B. eat a high-protein snack before going to bed. C. keep crackers and peanut butter at her bedside to eat in the morning before getting out of bed. D. schedule three meals and one midafternoon snack a day. B- Rationale: Fluids should be taken between not with meals to provide nutrient uptake. slowly digested protein is especially important to PREVENT HYPOGLYCEMIA which would contribute to nausea. dry carbs recommended before getting out of bed. frequent meals helps to avoid a DISTENDED OR EMPTY STOMACH A pregnant woman experiencing nausea and vomiting should: A. drink a glass of water with a fat-free carbohydrate before getting out of bed in the morning. B. eat small, frequent meals (every 2 to 3 hours) C. increase her intake of high-fat foods to keep the stomach full and coated. D. limit fluid intake throughout the day. B- Rationale: A pregnant woman experiencing nausea and vomiting should avoid consuming fluids early in the day or when nauseated. This is a correct suggestion for a woman experiencing nausea and vomiting. A pregnant woman experiencing nausea and vomiting should avoid consuming fluids early in the morning or when nauseated but should compensate by drinking fluids at other times. A pregnant woman reports that she is still playing tennis at 32 weeks of gestation. The nurse would be most concerned regarding what this woman consumes during and after tennis matches. Which is the MOST important? A. Several glasses of fluid B. Extra protein sources, such as peanut butter C. Salty foods to replace lost sodium D. Easily digested sources of carbohydrate A- Rationale: If no medical or obstetric problems contraindicate physical activity, pregnant women should get 30 minutes of moderate physical exercise daily. Liberal amounts of fluid should be consumed before, during, and after exercise, because dehydration can trigger premature labor. Also the woman's calorie intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise. All pregnant women should consume the necessary amount of protein in their diet, regardless of level of activity. Many pregnant women of this gestation tend to retain fluid. This may contribute to hypertension and swelling. An adequate fluid intake prior to and after exercise should be sufficient. The woman's calorie and carbohydrate intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise. Women with an inadequate weight gain during pregnancy are at higher risk of giving birth to an infant with: A. spina bifida. B. intrauterine growth restriction C. diabetes mellitus. D. Down syndrome. B- Rationale: An adequate amount of folic acid has been shown to reduce the incidence of this condition. Both normal-weight and underweight women with inadequate weight gain have an increased risk of giving birth to an infant with intrauterine growth restriction. Diabetes mellitus is not related to inadequate weight gain. A gestational diabetic mother is more likely to give birth to a large-for-gestational age infant. Down syndrome is the result of a trisomy 21, not inadequate maternal weight gain. Which minerals and vitamins usually are recommended to supplement a pregnant woman's diet? A. Fat-soluble vitamins A and D B. Water-soluble vitamins C and B6 C. Iron and folate D. Calcium and zinc c- Rationale: Fat-soluble vitamins should be supplemented as a medical prescription, as vitamin D might be for lactose-intolerant women. Water-soluble vitamin C sometimes is consumed in excess naturally; vitamin B6 is prescribed only if the woman has a very poor diet. Iron generally should be supplemented, and folic acid supplements often are needed because folate is so important. Zinc sometimes is supplemented. Most women get enough calcium. With regard to nutritional needs during lactation, a maternity nurse should be aware that: A. the mother's intake of vitamin C, zinc, and protein now can be lower than during pregnancy. B. caffeine consumed by the mother accumulates in the infant, who therefore may be unusually active and wakeful. C. critical iron and folic acid levels must be maintained. D. lactating women can go back to their prepregnant calorie intake. B- Rationale: Vitamin C, zinc, and protein levels need to be moderately higher during lactation than during pregnancy. A lactating woman needs to avoid consuming too much caffeine. The recommendations for iron and folic acid are somewhat lower during lactation. Lactating women should consume about 500 kcal more than their prepregnancy intake, at least 1800 kcal daily overall. When counseling a client about getting enough iron in her diet, the maternity nurse should tell her that: A. milk, coffee, and tea aid iron absorption if consumed at the same time as iron. B. iron absorption is inhibited by a diet rich in vitamin C. C. iron supplements are permissible for children in small doses. D. constipation is common with iron supplements. d- These beverages inhibit iron absorption when consumed at the same time as iron. Vitamin C promotes iron absorption. Children who ingest iron can get very sick and even die. Constipation can be a problem. Over-the-counter (OTC) pregnancy tests usually rely on which technology to test for human chorionic gonadotropin (hCG)? A. Radioimmunoassay B. Radioreceptor assay C. Latex agglutination test D. Enzyme-linked immunosorbent assay (ELISA) d- A nurse teaches a pregnant woman about the presumptive, probable, and positive signs of pregnancy. The woman demonstrates an understanding of the nurse's instructions if she states that a positive sign of pregnancy is: A. a positive pregnancy test. B. fetal movement palpated by the nurse-midwife C. Braxton Hicks contractions. D. quickening. B- Rationale: positive signs of pregnancy are those attributed to the presence of a fetus such as HEARING THE FETAL HEARTBEAT OR PALPATING FETAL MOVEMENT Probable sign of pregnancy- Braxton Hicks contractions Presumptive signs- Quickening Cardiovascular system changes occur during pregnancy. Which finding would be considered normal for a woman in her second trimester? A. Less audible heart sounds (S1, S2) B. Increased pulse rate C. Increased blood pressure D. Decreased red blood cell (RBC) production b-Splitting of S1 and S2 is more audible. between 14-20 weeks of pulse increases about 10 to 15 beats/min, which persists to term. In the first trimester blood pressure usually remains the same as the prepregnancy level, but it gradually decreases up to about 20 weeks of gestation. During the second trimester both the systolic and diastolic pressures decrease by about 5 to 10 mm Hg. Production of RBCs accelerates during pregnancy A woman who has completed one pregnancy with a fetus (or fetuses) reaching the stage of fetal viability is called a: A. primipara B. primigravida C. multipara. D. nulligravida. a- Rationale: A primipara is a woman who has completed one pregnancy with a viable fetus. To remember terms, keep in mind that gravida is a pregnant woman; para comes from parity, meaning a viable fetus;primi means first; multi means many; and null means none. A primigravida is a woman pregnant for the first time. A multipara is a woman who has completed two or more pregnancies with a viable fetus. A nulligravida is a woman who has never been pregnant. Which presumptive signs (felt by the woman) or probable sign (observed by the examiner) of pregnancy is not matched with another possible cause? A. Amenorrhea: stress, endocrine problems B. Quickening: gas, peristalsis C. Goodell sign: cervical polyps D. Chadwick sign: pelvic congestion C- Rationale: Amenorrhea sometimes can be caused by stress, vigorous exercise, early menopause, or endocrine problems. Quickening can be gas or peristalsis. Goodell sign might be the result of pelvic congestion, not polyps. Chadwick sign might be the result of pelvic congestion. Semen analysis is a common diagnostic procedure related to infertility. In instructing a male patient regarding this test, the nurse would tell him to: A. ejaculate into a sterile container. B. obtain the specimen after a period of abstinence from ejaculation of 2 to 5 days. C. transport specimen with container packed in ice. D. ensure that the specimen arrives at the laboratory within 30 minutes of ejaculation. B- Rationale: He should avoid exposing the specimen to extremes of temperature, either heat or cold. The specimen should be taken to the laboratory within 2 hours of ejaculation. Depo-Provera: A. is a combination of progesterone and estrogen. B. is a small adhesive hormonal birth control patch that is applied weekly. C. thickens and decreases cervical mucus, thereby inhibiting sperm penetration and ovulation. D.has an effectiveness rate in preventing pregnancy of 99% when used correctly C- Rationale: Depo-Provera is a progestin-only form of hormonal contraception. Depo-Provera is administered as an intramuscular injection. In addition to the changes in the cervical mucus, some but not all ovulatory cycles are suppressed, and formation of an endometrium capable of supporting implantation is inhibited. The effectiveness rate is 99% or greater over 5 years. A woman inquires about herbal alternative methods for improving fertility. Which statement by the nurse is the most appropriate when instructing the woman in which herbal preparations to avoid while trying to conceive? A. "You should avoid nettle leaf, dong quai, and vitamin E while you are trying to get pregnant." B. "You may want to avoid licorice root, lavender, fennel, sage, and thyme while you are trying to conceive." C. "You should not take anything with vitamin E, calcium, or magnesium. They will make you infertile." D. "Herbs have no bearing on fertility." b- Rationale: Nettle leaf, dong quai, and vitamin E promote fertility. Herbs that a woman should avoid while trying to conceive include licorice root, yarrow, wormwood, ephedra, fennel, goldenseal, lavender, juniper, flaxseed, pennyroyal, passionflower, wild cherry, cascara, sage, thyme, and periwinkle. Vitamin E, calcium, and magnesium may promote fertility and conception. Although most herbal remedies have not been proven clinically to promote fertility, women should avoid the following herbs while trying to conceive: licorice root, yarrow, wormwood, ephedra, fennel, goldenseal, lavender, juniper, flaxseed, pennyroyal, passionflower, wild cherry, cascara, sage, thyme, and periwinkle. A client is using the basal body temperature (BBT) method of contraception .She calls the clinic and tells the nurse, "My period is due in a few days, and my temperature has not gone up." The nurse's most appropriate response is: A. "This probably means you're pregnant." B. "Don't worry; it's probably nothing." C. "Have you been sick this month?" D. "You probably didn't ovulate during this cycle." d- Rationale: Pregnancy cannot occur without ovulation (which is being measured using the BBT method). A comment such as this discredits the client's concerns. Illness would most likely cause an increase in BBT. The absence of a temperature decrease most likely is the result of lack of ovulation. A married woman has made the decision to use a diaphragm as her primary method of birth control. The clinic nurse should provide which instructions regarding care of, insertion, and removal of the diaphragm? (Select all that apply.) A. Remove the diaphragm by catching the rim from below the dome. B. Avoid using mineral oil body products C. On insertion, direct the diaphragm down toward the space below cervix D. Wash diaphragm monthly with mild soap and water E. A dusting of cornstarch is appropriate after drying the diaphragm B C D E- Rationale: The diaphragm should not be removed by trying to catch the rim from below the dome. Oil-based products can cause the breakdown of the rubber. The diaphragm should be inserted into the vagina, directing it inward and downward as far as it will go to the space behind and below the cervix. The diaphragm should be washed after each use with mild soap and water. Cornstarch may be used. The student nurse is giving a presentation about milestones in embryonic development. Which information should he or she include? A. At 8 weeks of gestation, primary lung and urethral buds appear B. At 12 weeks of gestation, the vagina is open or the testes are in position for descent into the scrotum. C. At 20 weeks of age, the vernix caseosa and lanugo appear D. At 24 weeks of age, the skin is smooth, and subcutaneous fat is beginning to collect. c- Rationale: The primary lung and urethral buds appear at 6 weeks of gestation. The vagina is open or the testes are in position for descent into the scrotum at 16 weeks. Two milestones that occur at 20 weeks are the appearance of the vernix caseosa and lanugo. The appearance of smooth skin occurs at 28 weeks, and subcutaneous fat begins to collect at 30 to 31 weeks. A nurse is providing genetic counseling for an expectant couple who already have a child with trisomy 18. The nurse should: A. tell the couple they need to have an abortion within 2 to 3 weeks. B. explain that the fetus has a 50% chance of having the disorder. C. discuss options with the couple, including amniocentesis to determine whether the fetus is affected D. refer the couple to a psychologist for emotional support. c- Rationale: The couple should be given information about the likelihood of having another baby with this disorder so that they can make an informed decision. A genetic counselor is the best source for determining genetic probability ratios. Genetic testing, including amniocentesis, would need to be performed to determine whether the fetus is affected Pelvic examination reveals a bulging in the anterior vaginal wall. This woman is most likely experiencing: a. uterine prolapse cele c. cystocele d. vesicovaginal fistula C- Rationale: Cystocele occurs when the supportive tissue between a woman's bladder and vaginal wall weaken and stretch allowing the bladder to bulge into the vagina. Anterior prolapse= prolapsed bladder. result of straining during vaginal childbirth or with chronic constipation, violent coughing or heavy lifting. Rectocele: prolapse of the wall between the rectum and the vagina. Vesicovaginal fistula: fistulous tract extending between the bladder and the vagina that allows involuntary discharge of urine into the vaginal vault (may result from the necrosis of tissue from the vesicovaginal wall) During the preconception phase, the nurse should teach about which infectious diseases as risk factors for maternal complications? (Select all that apply.) a. Diabetes b.Rubella c.Hepatitis B d. Anemia e.HIV/AIDS B, C, E Women with an inadequate weight gain during pregnancy are at higher risk of giving birth to an infant with: a. spina bifida. b. intrauterine growth restriction c. diabetes mellitus. d. Down syndrome. B. Rationale: Spina bifida is not associated with inadequate maternal weight gain. An adequate amount of folic acid has been shown to reduce the incidence of this condition. Both normal-weight and underweight women with inadequate weight gain have an increased risk of giving birth to an infant with intrauterine growth restriction. Diabetes mellitus is not related to inadequate weight gain. A gestational diabetic mother is more likely to give birth to a large-for-gestational age infant. Down syndrome is the result of a trisomy 21, not inadequate maternal weight gain. With regard to nutritional needs during lactation, a maternity nurse should be aware that: A. the mother's intake of vitamin C, zinc, and protein now can be lower than during pregnancy. B.caffeine consumed by the mother accumulates in the infant, who therefore may be unusually active and wakeful. C.critical iron and folic acid levels must be maintained D. lactating women can go back to their prepregnant calorie intake. B. Rationale: Vitamin C, zinc, and protein levels need to be moderately higher during lactation than during pregnancy. A lactating woman needs to avoid consuming too much caffeine. The recommendations for iron and folic acid are somewhat lower during lactation. Lactating women should consume about 500 kcal more than their prepregnancy intake, at least 1800 kcal daily overa An effective relief measure for primary dysmenorrhea would be to: A. reduce physical activity level until menstruation ceases. B. begin taking prostaglandin synthesis inhibitors on the first day of the menstrual flow. C. decrease intake of salt and refined sugar about 1 week before menstruation is about to occur. D. use barrier methods rather than the oral contraceptive pill (OCP) for birth control. C- Rationale: Staying active is helpful since it facilitates menstrual flow and increases vasodilation to reduce ischemia. Prostaglandin inhibitors should be started a few days before the onset of menstruation. Decreasing intake of salt and refined sugar can reduce fluid retention. OCPs are beneficial in relieving primary dysmenorrhea as a result of inhibition of ovulation and prostaglandin synthesis. Self-care instructions for a woman following a modified radical mastectomy would include that she: A. wears clothing with snug sleeves to support her affected arm. B.use depilatory creams instead of shaving the axilla of her affected arm. c. expect a decrease in sensation or tingling in her affected arm as her body heals. d. empty surgical drains once a day or every other day. C- Rationale: Loose clothing should be worn since tight clothing could impede circulation in the affected arm. The axilla of the affected arm should not be shaved nor should depilatory creams or strong deodorants be used. A decrease in sensation and tingling in the affected arm and in the incision are expected for weeks to months after the surgery. Drains should be emptied at least twice a day and more often if necessary. A woman at 35 weeks of gestation has had an amniocentesis. The results reveal that surface-active phospholipids are present in the amniotic fluid. The nurse is aware that this finding indicates: a. the fetus is at risk for Down syndrome. b. the woman is at high risk for developing preterm labor. c. lung maturity. ium is present in the amniotic fluid. C.- Rationale: Presence of surface-active phospholipids is not an indication of Down syndrome. This result reveals the fetal lungs are mature and in no way indicates risk for preterm labor. The detection of the presence of pulmonary surfactants, surface-active phospholipids, in amniotic fluid has been used to determine fetal lung maturity, or the ability of the lungs to function after birth. This occurs at approximately 35 weeks of gestation. Meconium should not be present in the amniotic fluid. A woman's cousin gave birth to an infant with a congenital heart anomaly. The woman asks the nurse when such anomalies occur during development. Which response by the nurse is most accurate? a. "We don't really know when such defects occur." b. "It depends on what caused the defect." c. "They occur between the third and fifth weeks of development." d."They usually occur in the first 2 weeks of development." c.- Rationale: Regardless of the cause, the heart is vulnerable during its period of development, the third to fifth weeks. The cardiovascular system is the first organ system to function in the developing human. Blood vessel and blood formation begins in the third week, and the heart is developmentally complete in the fifth week. Most of the genetic tests now offered in clinical practice are tests for: single-gene disorders. carrier screening. predictive values. predispositional testing. single gene disorders A pregnant client tells the nurse that she wants to know the gender of her baby as soon as it can be determined. The nurse understands that the client should be able to find out the gender at 12 weeks gestation b/c of which factor? A. appearance of the fetal external genitalia b. beginning of differentiation in the fetal groin testes are descended into the scrotal sac d. internal differences in males and females become apparent A- Rationale: Differentiation occurs at the end of 9th wk. testes descend at the end of the 38 wks. internal differences in the male and female occur at the end of the 7th wk When a client asks why the fertilized ovum stays in the fallopian tube for 3 days what is the nurses best response? a. it promotes the fertilized ovums chances of survival b. it promotes the fertilized ovums exposure to estrogen and progesterone c. it promotes the fertilized ovums normal implantation in the top portion of the uterus d. it promotes the fertilized ovums exposure to luteinizing hormone and fsh C- Rationale: It allows the ovum to develop within the tube. this promotes the normal implantation in the fundal portion of the uterine corpus. Characteristics of amniotic fluid. select all the apply a. allows for fetal movement b. surrounds cushions, and protects the fetus c. maintains the body temp of the fetus d. can be used to measure fetal kidney function e. prevents large particles such as bacteria from passing to the fetus f. provides an exchange of nutrients and waste products between the mother and the fetus A,B,C,D- Rationale: Surrounds, protects, and cushions the fetus. contains urine from the fetus and can be used to assess fetal kidney function. The nurse should include which statement to a pregnant client with a gynecoid pelvis: a. your type of pelvis has a narrow pubic arch b, your type of pelvis is the most favorable for labor and birth c. your type of pelvis is a wide pelvis, but has a short diameter d. you will need a cesarean section because this type of pelvis is not favorable for a vaginal delivery B- Rationale: Normal pelvis and is the most favorable for successful labor and birth ANDROID pelivs= resembles a male pelvis PLATYPELLOID pelvis= wide transverse diameter but anteroposterior diameter is short The nurse is performing an assessment of a pregnant client who is at 28 weeks of gestation. the nurse measures the fundal height in cm and expects which finding? a. 22 cm b. 30 cm c. 36 cm d. 40 cm B- Weeks 18-30 fundal height in cm approx equals the fetus' age in weeks +/- 2 cm. at 36 weeks the fundus is at the xiphoid process Which are probable signs of pregnancy? select all that apply. a. ballottement b. chadwicks sign c. uterine enlargement d. braxton hicks contractions e. fetal hear rate detected by a nonelectronic device f. outline of fetus via radiography or ultrasonography A B C D- Rationale: uterine enlargement, Hegars sign (softening of the lower uterine segment that occurs at about wk 6) Goodells sign (softening of the cervix) Chadwicks sign (violet coloration of the mucous membranes of the vagina, vulva, and cervix) ballottement (rebounding of the fetus against the examiners fingers on palpation), braxton hicks, positive pregnancy test positive signs include fhr active fetal movements palpable by the examiner and outline of the fetus by radiography or ultrasound What is the expected date of delivery if a clients last menstrual period was October 19,2014? a. july 12 2014 b. july 26 2015 c. august 12 2015 d. august 26 2015 B Fetal movements can be noted between which wks of gestation? a. 6-8 b. 8-10 c. 10-12 d. 14-18 D- Quickening is fetal movement that is felt by the mother. in the multiparous woman this can occur as early as the 14-16 wk. nulliparous woman may not notice these sensations until the 8th wk or later The nurse is assessing a primigravida during her 2nd trimester. which finding concerns the nurse and indicates the need for follow-up? a. quickening b. braxton hicks contractions c. fetal heart rate of 190 bpm d. consistent increase in fundal height C- Rationale: Heart rate in the first trimester is usually 160-170 bpm. near and at term the fhr ranges from 110-160 Client has a nonreactive nonstress test. the hcp prescribes a contraction stress test and the results are documented as negative. how should the nurse document this finding? a. a normal test result b. an abnormal test result c. a high risk for fetal demise d. the need for cesarean delivery A- Rationale: Contraction stress test results may be interpreted as negative (NORMAL) positive (ABNORMAL) or equivocal. negative test result indicates that no late deelerations occurred in the fhr although the fetus was stressed by 3 contractions of at least 40 sec duration in 10 min period. options 2-4 are incorrect A client with pica has been ingesting daily amounts of white clay dirt from her backyard. laboratory studies are performed and the nurse determines that which finding indicates a physiological consequence of the client's practice? a. hct 38% b. glucose 86 mg/dL c. hemoglobin 9.1 g/dL d. wbc 12,400 cell/mm C- Rationale: Pica often leads to iron deficiency anemia resulting in a decreased hemoglobin lvl. other lab values are normal for the pregnant mother