Maternity Final Exam Questions Last Set 100% Solution Guide

. A 20-year-old woman tells the nurse that she performs breast self-examination (BSE) on a regular basis. The nurse evaluates the woman's understanding of BSE and ability to perform the technique correctly. Which actions by the woman indicate that she needs further instruction regarding BSE? (Circle all that apply.) A. Performs BSE every month on the first day of her menstrual cycle. B. Observes the size of her breasts, direction of her nipples, and appearance of her skin, including the presence of dimpling, when looking at her breasts in the mirror. C. Lies down on a bed and puts a pillow under the shoulder of the breast she is going to palpate. Then she places the arm on that side under her head. D. Uses the tips of two fingers to palpate her breast. E. Palpates her breast, using an overlapping circular pattern around her entire breast. F. Palpates her breasts again, including up into her axillae, while taking a shower.ANSWERS-Choices A and D are correct; a woman should perform BSE every month at the end of menstruation when the breasts are the least tender; she should use the finger- pads of her three middle fingers for palpation. 55. When palpating the small breasts of a young, slender woman the nurse should: A. Wear clean gloves B. Lift the hands when moving from one segment of the breast to another C. Use both hands D. Follow a systematic, overlapping patternANSWERS-Choice D is correct; clean gloves are required only if open lesions are present and when compressing the nipple if discharge is anticipated; fingers should not be lifted; two hands are used for women with large, pendulous breasts. 56. A nurse instructed a female client regarding vulvar self-examination (VSE). Which statement made by the client indicates that further instruction is needed? A. "I will perform this examination at least once a month, especially if I change sexual partners or am sexually active." B. "I will become familiar with how my genitalia look and feel so that I will be able to detect changes." C. "I will use the examination to determine when I should get medications at the pharmacy for infections." D. "I will wash my hands thoroughly before and after I examine myself."ANSWERS-56. Choice C is correct; self-examination should not be used for self-diagnosis but rather to detect early changes, which would call for the guidance of a health care provider. 57. A women's health nurse practitioner is going to perform a pelvic examination on a female client. Which nursing action would be least effective in enhancing the client's comfort and relaxation during the examination? A. Encourage the client to ask questions and express feelings and concerns before and after the examination. B. Ask the client questions as the examination is performed. C. Allow the client to keep her shoes and socks on when placing her feet in the stirrups. D. Instruct the client to place her hands over her diaphragm and take deep, slow breaths.ANSWERS-57. Choice B is correct; do not ask questions during the examination because it may distract the client, inter- fering with relaxation measures she may be using; offer explanations only as needed during the exami- nation. 58. When assessing women it is important for a nurse to keep in mind the possibility that they are victims of violence. The nurse should: A. Use an abuse assessment screen during the assessment of every woman B. Recognize that abuse rarely occurs during pregnancy C. Assess a woman's legs and back as the most commonly injured areas D. Notify the woman's partner immediately if abuse is suspectedANSWERS-58. Choice A is correct; all women should be screened because abuse can happen to any woman; abuse can begin or escalate during pregnancy; the most com- monly injured sites are head, neck, chest, abdomen, breasts, and upper extremities. If abuse is suspected, the nurse needs to assess further to encourage disclo- sure and then assist the woman to take action and formulate a safety plan. Nurses should follow the laws of their state with regard to reporting instances of abuse. 59. A 52-year-old woman asks the nurse practitioner about how often she should be assessed for the common health problems that women of her age could experience. The nurse recommends: A. An endometrial biopsy every 3 to 4 years B. A fecal occult blood test annually C. A mammogram every other year D. Bone mineral density testing annuallyANSWERS-59. Choice B is correct; bone mineral density testing should be initiated at 65 years of age or older unless risk factors are present; endometrial biopsies are not recommended on a routine basis for most women but women at risk for endometrial cancer should have one done at menopause; mammograms should be done annually for women 50 years of age and older. 60. Which statement is most accurate regarding persons who should participate in preconception counseling? A. All women and their partners as they make decisions about their reproductive future, including becoming parents B. Women older than 40 years of age who wish to become pregnant C. Sexually active women who do not use birth control D. Women with chronic illnesses such as diabetes who are planning to get pregnantANSWERS-60. Choice A is correct; all women—not just specific groups—should participate in preconception care approximately 1 year before planning to become pregnant. 61. To enhance the accuracy of the Pap test, the nurse should instruct the woman to: A. Schedule the test just prior to the onset of menses B. Stop taking birth control pills for 2 days before the test C. Avoid intercourse for 24 to 48 hours before the test D. Douche with a specially prepared antiseptic solution on the night before the test"ANSWERS-61. Choice C is correct; women should not use vaginal medications or douche for 24 to 48 hours before the test; oral contraceptives can continue; the best time for the test is midcycle. CH 6ANSWERS- 31. Which woman is at greatest risk for developing hypogonadotropic amenorrhea? A. A 48-year-old woman in Weight Watchers who lost 20 pounds over 6 months B. A 14-year-old figure skater C. An 18-year-old softball player D. A 30-year-old (G3 P3003) breastfeeding womanANSWERS-31. Choice B is correct; the 14-year-old reflects several of the risk factors associated with this menstrual disorder, namely participating in a sport that is stressful, is subjectively scored, and requires contour-revealing clothing and in which success is favored by a prepubertal body shape. 32. Pharmacologic preparations can be used to treat primary dysmenorrhea. Choose the preparation that is least effective in relieving the symptoms of primary dysmenorrhea. A. Combined oral contraceptive pill (OCP) B. Naproxen sodium (Anaprox) C. Acetaminophen (Tylenol) D. Ibuprofen (Motrin)ANSWERS-32. Choice C is correct; choices A, B, and D all interfere with prostaglandin synthesis whereas acetaminophen has no antiprostaglandin properties; prostaglandins are a recognized factor in the etiology of primary dysmenorrhea. 33. Women experiencing primary dysmenorrhea should be advised to avoid: A. Pretzels and potato chips B. Valerian C. Cranberry juice D. Whole-grain cerealsANSWERS-33. Choice A is correct; decreasing the ingestion of salty foods and refined sugars 7 to 10 days before menses decreases fluid retention; asparagus and cranberry juice have a natural diuretic effect that can reduce edema and related discomforts; valerian is an herb that reduces menstrual cramping. 34. The nurse counseling a 30-year-old woman regarding effective measures to use to relieve symptoms associated with PMS could suggest that she: (Circle all that apply.) A. Decrease intake of fruits, especially peaches and watermelon B. Take a bugleweed or evening primrose oil supplement C. Limit alcohol intake to less than 1 oz per day D. Reduce exercise during the luteal phase of the menstrual cycle when symptoms are at their peak E. Eat small, more frequent meals and snacksANSWERS-34. Choices B, C, and E are correct; alcohol as well as tobacco and caffeine can worsen symptoms whereas" "exercise, especially during the luteal phase, relieves symptoms, as can fruits, especially peaches and wa- termelon, and whole grains; sodium intake should be less than 3 g daily; bugleweed and evening primrose oil can reduce breast discomfort. 35. A 28-year-old woman has been diagnosed with endometriosis. She has been placed on a course of treatment with danazol (Danocrine). The woman exhibits understanding of this treatment when she states: (Circle all that apply.) A. "Because this medication stops ovulation, I do not need to use birth control." B. "I will experience more frequent and heavier menstrual periods when I take this medication." C. "I should follow a low-fat diet because this medication can increase the level of cholesterol in my blood." D. "I can experience a decrease in my breast size, oily skin, and hair growth on my face as a result of taking this medication." E. "I will need to spray this medication into my nose twice a day." F. "I may need to use a lubricant during intercourse to reduce discomfort."ANSWERS-35. Choices C, D, and F are correct; women taking da- nazol often experience reversible masculinizing changes; it is taken orally; ovulation may not be fully suppressed, so birth control is essential be- cause the medication is teratogenic; amenorrhea, not increased bleeding, occurs. 36. A female client, age 26 years, describes scant bleeding between her menstrual periods. The nurse records this finding as: A. Metrorrhagia B. Oligomenorrhea C. Menorrhagia D. HypomenorrheaANSWERS-36. Choice A is correct; oligo menorrhea is infrequent menses; menorrhagia is excessive bleeding during menses; hypomenorrhea is scanty bleeding at normal intervals. 37. Dysfunctional uterine bleeding (DUB) is most likely to occur when women: A. Experience ovulatory cycles B. Weigh less than their expected body weight C. Experience signs of the onset of perimenopause D. Secrete high levels of prostaglandinANSWERS-37. Choice C is correct; DUB is most commonly associated with anovulatory cycles in women at the extremes of their reproductive years (puberty, perimenopause); it can also occur when women secrete low levels of pro- gesterone; it is associated with obesity; increased prostaglandins are associated with dysmenorrhea. 38. A 55-year-old woman tells the nurse that she has started to experience pain when she and her husband have intercourse. The nurse would record that this woman is experiencing: A. Dyspareunia B. Dysmenorrhea C. Dysuria D. DyspneaANSWERS-38. Choice A is correct; dysmenorrhea is painful men- struation; dysuria is painful urination; dyspnea is difficulty breathing. 39. A 65-year-old woman is beginning treatment with alendronate sodium (Fosamax). Which statement by this woman indicates the need for further instructions? A. "I will take this medication first thing in the morning." B. "I will sit in a chair and read a book for about 30 minutes after I take this medication." C. "I will take this medication with a full glass of water." D. "I will eat my breakfast just before I take the medication."ANSWERS-39. Choice D is correct; alendronate sodium (Fosamax) should be taken on an empty stomach with a glass of water to enhance absorption; remaining upright will help to decrease gastrointestinal (GI) symptoms. 40. Herbal preparations can be used as part of the treatment for a variety of menstrual disorders. Which herb is beneficial for a woman experiencing menorrhagia? A. Ginger B. Shepherd's purse C. Black cohosh root D. Black hawANSWERS-40. Choice B is correct; see Table 6-2 for an explanation of each herb. CH 7ANSWERS- 27. Infections of the female midreproductive tract such as chlamydia are dangerous primarily because they: A. Are asymptomatic or silent B. Cause infertility C. Lead to pelvic inflammatory disease (PID) D. Are difficult to treat effectivelyANSWERS-Choice A is correct; because these infections are often asymptomatic, they can go undetected and untreated, causing more severe damage, including ascent of the pathogen into uterus and pelvis, resulting in PID and infertility; many effective treatment measures are available, including treatment for chlamydia 28. A finding associated with human papillomavirus (HPV) infection includes: A. White, curdlike adherent discharge B. Soft papillary swellings occurring singly or in clusters C. Vesicles progressing to pustules and then to ulcers D. Yellow to green frothy, malodorous dischargeANSWERS-28. Choice B is correct; choice A is indicative of candi- diasis; choice C is indicative of genital HSV; choice D is indicative of trichomoniasis. 29. A recommended medication effective in the treatment of vulvovaginal candidiasis is: A. Metronidazole B. Clotrimazole C. Benzathine penicillin G D. AcyclovirANSWERS-29. Choice B is correct; metronidazole is used to treat bacterial vaginosis and trichomoniasis; benzathine penicillin G is used to treat syphilis; acyclovir is used to treat genital herpes. 30. A woman is determined to be group B streptococci (GBS) positive at the onset of her labor. The nurse should prepare this woman for: A. Cesarean birth B. Isolation of her newborn after birth C. Intravenous antibiotic prophylaxis (IAP) using penicillin G during labor D. Application of acyclovir to her labial lesionsANSWERS-30. Choice C is correct; cesarean section or isolation is not required; there are no lesions with this bacterial infection; antiviral medication is not appropriate. 31. When providing a woman who is recovering from primary herpes with information regarding the recurrence of herpes infection of the genital tract, the nurse tells her that: (Circle all that apply.) A. Fever and flulike symptoms occur only with primary infection B. Little can be done to control the recurrence of infection C. Transmission of the virus is possible only when lesions are open and draining D. Itching and tingling often occur as prodromal symptoms prior to the appearance of vesicles E. Cleaning lesions twice a day with saline will help to prevent secondary infections F. Acyclovir therapy will cure herpesANSWERS-31. Choices A, D, and E are correct; recurrent infections commonly involve only local symptoms that are less severe; stress reduction, healthy lifestyle practices, cleansing lesions, and acyclovir can reduce recur- rence rate and prevent secondary infection; viral shedding can occur before lesions appear during the prodromal stage; acyclovir cannot cure herpes but can keep it in control. 32. A nurse is teaching a 20-year-old woman about risk-reduction measures. Which measure should the nurse emphasize as the most important? A. Using a female condom B. Knowing her partner C. Reducing the number of partners D. Getting the HPV vaccination"ANSWERS-32. ChoiceBiscorrect;althoughchoicesA,C,andDare measures that should be followed, knowing her part- ner—including the partner's sexual history and pres- ence of any manifestations of infection—is essential. 33. Cervical neoplasia has been linked to which of the following sexually transmitted infections? A. Herpes simplex virus (HSV) B. Human papillomavirus (HPV) C. Human immunodeficiency virus (HIV) D. ChlamydiaANSWERS-33. Choice B is correct; several HPV serotypes are thought to have oncogenic potential and are there- fore the primary cause of cervical cancer. 34. A nurse has just taught a group of parents at a grade school PTA meeting regarding the vaccine Gardisil. Which statement by one of the parents would indicate a need for further instructions? A. "I should make sure that my child receives this vaccine before becoming sexually active." B. "This vaccine will prevent my child from being infected by some of the most common strains of HPV that can cause cervical cancer." C. "My child will need to receive the vaccine in two doses every 6 months for 1 year." D. "Both my daughter and my son should receive the vaccine around the age of 11 to 12 years."ANSWERS-34. Choice C is correct; the vaccine is given in three doses over a 6-month period. CH 8ANSWERS- 40. A single young-adult woman received instructions from the nurse regarding the use of an oral contraceptive. The woman demonstrates a need for further instruction if she: A. Stops asking her sexual partners to use condoms with spermicide B. States that her menstrual periods should be shorter with less blood loss C. Takes a pill every morning D. Uses a barrier method of birth control if she misses two or more pillsANSWERS-40. Choice A is correct; oral contraception provides no protection from STIs; therefore a condom and spermi- cide are still recommended to prevent transmission; choices B, C, and D reflect appropriate actions and recognition of the effects of oral contraceptive pills (OCPs). 41. Oral contraception in the form of a combination of low-dose estrogen and progesterone: A. Reduces the pH of cervical mucus, thereby destroying sperm B. Protects against iron deficiency anemia by reducing menstrual blood loss C. Prevents the transmission of sexually transmitted infections D. Is 90% effective in preventing pregnancy when used correctlyANSWERS-41. Choice B is correct; benefits of low dose pills are decreased menstrual blood loss and iron deficiency "anemia; cervical mucus is thickened, thereby inhibit- ing sperm penetration; ovulation and the development of the endometrium are also inhibited; there is no protection from STIs; the overall effectiveness rate is nearly 100% if used correctly. 42. For some women the most distressing side effect of progestin-only contraception is: A. Irregular vaginal bleeding B. Headache C. Nervousness D. NauseaANSWERS-42. Choice A is correct; women often complain of the irregular bleeding that occurs with progestin-only contraceptives. 43. A 36-year-old woman has chosen depot medroxyprogesterone acetate (DMPA, Depo-Provera) as the method of contraception most suitable for her lifestyle. Which statement made by the woman indicates a lack of understanding and a need for further instruction by the nurse? A. "I will need to receive another injection every 4 weeks." B. "I am going to watch my diet and exercise, because weight gain is common." C. "If I plan to continue with the Depo-Provera, I should have my bone density assessed." D. "This method will result in a smaller amount of thicker cervical mucus."ANSWERS-43. Choice A is correct; the injection is repeated every 11 to 13 weeks (four times per year); choices B, C, and D are accurate. 44. A woman with an IUD should confirm its placement by checking the IUD's string: A. After menses ceases B. After intercourse C. Two days after ovulation D. During menstrual bleedingANSWERS-44. Choice A is correct; the string should be checked after menses, before intercourse, at the time of ovu- lation, and if expulsion is suspected; a missing string or one that becomes longer or shorter should be checked by a health care professional. 45. When teaching women about the effective use of chemical barriers, the nurse should tell them to: A. Insert at least 2 hours prior to intercourse B. Use nonoxynol-9 (N-9) to inhibit the transmission of HIV C. Douche immediately after the last act of intercourse D. Reapply before each act of coitus"ANSWERS-45. Choice D is correct; spermicide should be inserted no longer than 1 hour prior to intercourse; douching or rinsing should not occur for at least 6 hours after the last act of coitus; frequent use of N-9, especially for anal intercourse, may disrupt mucosa, increasing rather than decreasing the risk of HIV transmission. 46. When using a cervical cap (FemCap), the woman should be taught to: A. Apply spermicide only to the outside of the cap and around the rim B. Leave it in place for a minimum of 6 hours after the last act of coitus C. Continue to use the cap during menstrual periods D. Check the position of the cap and insert additional spermicide before each act of coitusANSWERS-46. Choice B is correct; spermicide should be applied inside the cap but not around the rim because a seal will not form to keep the cap in place; use during menses increases the risk for toxic shock syndrome (TSS); checking the cap's position is all that is required before each subsequent act of coitus. 47. Joyce has chosen the diaphragm as her method of contraception. Which actions indicate that Joyce is using the diaphragm effectively? (Circle all that apply.) A. Joyce came to be refitted after healing was complete following the term vaginal birth of her son. B. Joyce applies a spermicide only to the rim of the diaphragm just before insertion. C. Joyce empties her bladder before inserting the diaphragm and after intercourse. D. Joyce applies more spermicide for each act of intercourse. E. Joyce removes the diaphragm within 1 hour of intercourse. F. Joyce always uses the diaphragm during her menstrual periods.ANSWERS-47. Choices A, C, and D are correct; spermicide should be spread on both surfaces of the diaphragm; it should not be removed for at least 6 hours after inter- course nor should it be used during menses because of the risk for TSS. 48. A woman must assess herself for signs that ovulation is occurring. Which signs are associated with ovulation? (Circle all that apply.) A. Increase in the level of LH in her urine 12 to 24 hours before ovulation B. Spinnbarkeit C. Drop in BBT during the luteal phase of her menstrual cycle D. Softened moist cervix, which opens and rises in the vagina E. Decreased libidoANSWERS-48. Choices A, B, and D are correct; BBT rises during the luteal phase and libido increases. 49. A woman has had a ParaGard T380A IUD inserted. The nurse should recognize that the woman needs further teaching if she says: (Circle all that apply.) A. "This IUD remains effective for 10 years." B. "It is normal to experience an increase in bleeding and cramping within the first year after it has been inserted." C. "My IUD works by releasing progesterone." D. "I should avoid using NSAIDs such as Motrin if I have cramping." E. "I must use risk prevention measures, including condoms, to prevent infections in my uterus."ANSWERS-49. Choices C and D are correct; there is no hormone in this IUD; copper serves as a spermicide and it in- flames the endometrium, preventing fertilization; NSAIDs are recommended to decrease cramping, 50. A 40-year-old male has elected to have a vasectomy because he no longer wants to worry that a sexual partner will become pregnant. The nurse describes the procedure along with care requirements before and after the procedure. Which statements by the client indicate the need for further instruction? (Circle all that apply.) A. "I am glad I will not need to use a condom. I hate them!" B. "I will use ice packs for a few hours after I get home to reduce swelling and discomfort." C. "I will wear a scrotal support for a few days to reduce discomfort." D. "I will need to wait about 3 weeks before resuming sexual intercourse." E. "I should not expect to see a decrease in the amount of semen I ejaculate.""ANSWERS-50. Choices A and D are correct; condoms are still needed to reduce risk for STIs and to prevent pregnancy until two consecutive sperm counts are at zero; he may become sexually active when desired but needs to use a condom since sperm may still be in the ejaculate. CH 9ANSWERS- 24. A woman must assess herself for signs that ovulation is occurring. Which of the following is a sign associated with ovulation? A. Reduction in level of luteinizing hormone (LH) in the urine 12 to 24 hours prior to ovulation B. Spinnbarkeit C. Drop in basal body temperature (BBT) following ovulation D. Increased thickness of cervical mucusANSWERS-24. Choice B is correct; spinnbarkeit refers to stretchi- ness of cervical mucus at ovulation to facilitate pas- sage of sperm; there is an LH surge prior to ovulation; BBT rises in response to increased progesterone after ovulation; cervical mucus becomes thinner and more abundant with ovulation. 25. Lifestyle and sexual practices can affect fertility. Which of the following practices could enhance a couple's ability to conceive? A. Use balanced nutrition and exercise to achieve a normal body mass index (BMI). B. Abstain from alcohol. C. Avoid the use of lubricants during intercourse. D. Relax in a hot tub every day before going to bed.ANSWERS-25. Choice A is correct; both male and female obesity can adversely affect fertility; water-soluble lubri- cants can be safely used; daily hot tubs or saunas may increase scrotal temperature enough to interfere with spermatogenesis; although excessive alcohol use can cause erectile dysfunction, abstention from alcohol is not necessary. 26. A woman taking human menopausal gonadotropins for infertility should understand which of the following regarding this medication? A. She should take the medication orally, once a day after breakfast. B. The medication stimulates the pituitary gland to produce the follicle-stimulating hormone (FSH) and the luteinizing hormone (LH). C. She must report for ultrasound testing as scheduled to monitor follicular development. D. Progesterone should be administered after seven doses of the gonadotropins have been taken.ANSWERS-26. Choice C is correct; this medication provides LH and FSH, causing a powerful ovulation stimulation that can result in multiple pregnancy; therefore regular ovarian ultrasound and monitoring of estradiol levels are required to prevent hyperstimulation. It is administered intramuscularly and is used when clomiphene fails to induce ovulation; it is followed by" 27. An infertile woman is given clomiphene citrate (Clomid) to achieve which of the following therapeutic outcomes? A. Stimulate the pituitary gland to secrete FSH and LH B. Enhance the development of a secretory endometrium C. Induce the formation of the corpus luteum D. Increase the secretion of favorable cervical mucus to enhance sperm viabilityANSWERS-27. Choice A is correct; Clomid is used to increase FSH and LH secretion by stimulating the pituitary gland. 28. When caring for a woman who is scheduled for a hysterosalpingogram, the nurse should do which of the following? A. Ensure that the woman is in the secretory phase of her menstrual cycle. B. Explain to the woman that the procedure will allow her to conceive. C. Report any uterine cramping immediately because it may indicate that the woman's uterus was perforated during the procedure. D. Change the woman's position if she complains of shoulder pain following the procedure.ANSWERS-28. Choice D is correct; with passage of radiopaque dye, this test could straighten or unblock the uterine tube if that is the cause of the infertility but it is not a guarantee she will conceive; it is performed 4 to 5 days after menstruation (proliferative phase); uter- ine cramping and referred pain to the shoulder are expected findings and are treated with mild analge- sics and position changes. CH 20ANSWERS- 28. A nurse has assessed a woman who gave birth vaginally 12 hours ago. Which findings would require further assessment? A. Bright to dark red uterine discharge B. Midline episiotomy—approximated, moderate edema, slight erythema, absence of ecchymosis C. Protrusion of abdomen with sight separation of abdominal wall muscles D. Fundus firm at 2 cm above the umbilicus and to the right of midlineANSWERS-28. Choice D is correct; fundus should be at or 1 cm above the umbilicus and at midline; deviation from midline (in this case to the right) could indicate a full bladder; bright to dark red uterine discharge refers to lochia rubra; edema and erythema are common shortly after repair of a wound; decreased abdominal muscle tone and enlarged uterus result in abdominal protrusion; separation of the abdominal muscle walls, diastasis recti abdominis, is common during pregnancy and the postpartum period. 29. A woman, 24 hours after giving birth, complains to the nurse that her sleep was interrupted the night before because of sweating and the need to have her gown and bed linens changed. The nurse's first action is to: A. Assess this woman for signs of infection B. Explain to the woman that the sweating represents her body's attempt to eliminate the fluid that was accumulated during pregnancy C. Notify her physician of the finding D. Document the finding as postpartum diaphoresisANSWERS-29. Choice B is correct; the woman is describing the normal finding of postpartum diaphoresis, which is the body's attempt to excrete fluid retained during pregnancy; documentation is important but not the first nursing action; infection assessment and physician notification are not needed at this time. 30. Which woman at 24 hours following birth is least likely to experience afterpains? A. Primipara who is breastfeeding her twins, who were born at 38 weeks of gestation B. Multipara who is breastfeeding her 10-pound full-term baby girl C. Multipara who is bottle-feeding her 8-pound baby boy D. Primipara who is bottle-feeding her 7-pound baby girlANSWERS-30. Choice D is correct; afterpains are most likely to occur in the following circumstances: multiparity, overdistention of the uterus (macrosomia, multifetal pregnancy), breastfeeding (endogenous oxytocin secretion), and administration of an oxytocic. CH 21ANSWERS- 19. A nurse is prepared to assess a postpartum woman's fundus. To facilitate the accuracy and comfort of the examination, the nurse should tell the woman to: A. Elevate the head of her bed B. Place her hands under her head C. Flex her knees D. Lie flat with legs extended and toes pointedANSWERS-19. Choice C is correct; follow principles for effective and accurate assessment of the abdomen; the woman should be assisted into a supine position with head and shoulders on a pillow, arms at sides, and knees flexed; this facilitates relaxation of abdominal muscles and allows deep palpation. 20. The expected outcome for care when an oxytocic is administered to a postpartum woman is that the woman will: A. Demonstrate expected lochial characteristics B. Achieve relief of pain associated with uterine cramping C. Remain free from infection D. Void spontaneously within 4 hours of birthANSWERS-20. Choice A is correct; an oxytocic contracts the uterus, thereby preventing excessive blood loss; lochia will therefore reflect expected characteristics; this type of medication can cause uterine contractions that are severe enough to require an analgesic. 21. A nurse is preparing to administer RhoGAM to a postpartum woman. Before implementing this care measure the nurse should: A. Ensure that medication is given within 12 hours after the birth B. Verify that the indirect and direct Coombs test results are negative C. Make sure that the newborn is Rh negative D. Cancel the administration of the RhoGAM if it was given to the woman during her pregnancyANSWERS-21. Choice B is correct; a direct and indirect Coombs test must be negative, indicating that antibodies have not been formed, before RhoGAM can be given; it must be given within 72 hours of birth; the newborn needs to be Rh positive; it is often given in the third trimester and then again after birth. 22. When teaching a postpartum woman with an episiotomy about using a sitz bath, the nurse should emphasize: A. Using sterile equipment B. Filling the sitz bath basin with hot water (at least 42 ̊C) C. Taking a sitz bath once a day for 10 minutes D. Squeezing her buttocks together before sitting down, then relaxing them"ANSWERS-22. Choice D is correct; see Box 21-1; squeezing the buttocks together before sitting down will reduce pulling on any perineal repairs; this is a medical aseptic procedure; therefore clean, not sterile, equip- ment is used; the water should be warm at 38°C to 40.6°C; sitz bath is used at least twice a day for 20 minutes each time. 23. Before discharge at 2 days postpartum, the nurse evaluates a woman's level of knowledge regarding the care of her second degree perineal laceration. Which statements made by the woman indicate the need for further instruction before she goes home? (Circle all that apply.) A. "I will wash my stitches at least once a day with mild soap and warm water." B. "I will change my pad every time I go to the bathroom—at least four times each day." C. "I will position my squeeze bottle upward so that the warm water can remove lochia from my vagina." D. "I will use my squeeze bottle filled with warm water to cleanse my stitches after I urinate." E. "I will wear a pair of clean, disposable gloves when I wash my stitches and change my pad just like the nurses did." F. "I will apply the anesthetic cream to my stitches at least six times per day."ANSWERS-23. Choices C, E, and F are correct; squeeze bottle is always pointed backward and not upward into the vagina, which could carry debris through the cervix and into the uterus; topical medications should be used sparingly only three or four times per day; gloves are not needed but she should wash her hands before and after perineal care. 24. When assessing postpartum women during the first 24 hours after birth, the nurse must be alert for signs that could indicate the development of postpartum physiologic complications. Which signs are of concern to the nurse? (Circle all that apply.) A. Temperature—38°C B. Fundus—midline, boggy C. Lochia—three quarters of pad saturated in 3 hours D. Positive Homans sign in right leg E. Anorexia F. Voids approximately 150 to 200 mL of urine in each of the first three voidings after birth"ANSWERS-24. Choices B, D, and E are correct; temperature of 38°C during the first 24 hours may be related to deficient fluid and is therefore not a concern; fundus should be midline but firm, not boggy; saturation of the pad in 15 minutes or less would be a concern; a positive Homans sign could indicate DVT; usually women have a good appetite and eat well after birth; each voiding should be at least 100 to 150 mL. CH 22ANSWERS- 26. During the final phase of the claiming process of a newborn, a mother might say: A. "She has her grandfather's nose." B. "His ears lie nice and flat against his head, not like mine and his sister's, which stick out." C. "She gave me nothing but trouble during pregnancy and now she is so stubborn she won't wake up to breastfeed." D. "He has such a sweet disposition and pleasant expression. I have never seen a baby quite like him before."ANSWERS-26. Choice D is correct; choice A reflects the first phase of identifying likenesses; choice B reflects the sec- ond phase of identifying differences; choice C re- flects a negative reaction of claiming the infant in terms of pain and discomfort; choice D reflects the third or final stage of identifying uniqueness. 27. Which nursing action is least effective in facilitating parental attachment to the new infant? A. Referring the couple to a lactation consultant to ensure continuing success with breastfeeding B. Keeping the baby in the nursery as much as possible for the first 24 hours after birth so the mother can rest C. Extending visiting hours for the woman's partner or significant other as the couple desires D. Providing guidance and support as the parents care for their baby's nutrition and hygiene needsANSWERS-27. Choice B is correct; early close contact is recom- mended to initiate and enhance the attachment process. 28. Which behavior illustrates engrossment? A. A father is sitting in a rocking chair, holding his new baby boy, touching his toes, and making eye contact. B. A mother tells her friends that her baby's eyes and nose are just like hers. C. A mother picks up and cuddles her baby girl when she begins to cry. D. A grandmother gazes into her new grandson's face, which she holds about 8 inches away from her own; she and the baby make eye-to-eye contact.ANSWERS-28. Choice A is correct; engrossment refers to a father's absorption, preoccupation, and interest in his infant; choice B represents the claiming process phase I, identifying likeness; choice C represents reciprocity; choice D represents en face or face-to-face position with mutual gazing. 29. A woman expresses a need to review her labor and birth experience with the nurse who cared for her while in labor. This behavior is most characteristic of which phase of maternal postpartum adjustment? A. Taking-hold (dependent-independent phase) B. Taking-in (dependent phase) C. Letting-go (interdependent)