Maternity Nursing (OB Maternal & Newborn) NCLEX Practice Quiz #2 | 75 Questions| 2022 update with rationales

Maternity Nursing (OB Maternal & Newborn) NCLEX Practice Quiz #2 | 75 Questions 1. 1. Question The nurse is counseling a couple who has sought information about conceiving. The couple asks the nurse to explain when ovulation usually occurs. Which statement by the nurse is correct? o A. Two weeks before menstruation. o B. Immediately after menstruation. o C. Immediately before menstruation. o D. Three weeks before menstruation. Incorrect Correct Answer: A. Two weeks before menstruation Ovulation occurs 14 days before the first day of the menstrual period (A). Although ovulation can occur in the middle of the cycle or 2 weeks after menstruation, this is only true for a woman who has a perfect 28-day cycle. For many women, the length of the menstrual cycle varies. • Option B: After the follicle releases its egg, it changes into the corpus luteum. This structure releases hormones, mainly progesterone and some estrogen. The rise in hormones keeps the uterine lining thick and ready for a fertilized egg to implant. If the woman does get pregnant, her body will produce human chorionic gonadotropin (hCG). This is the hormone pregnancy tests detect. It helps maintain the corpus luteum and keeps the uterine lining thick. If the woman doesn’t get pregnant, the corpus luteum will shrink away and be resorbed. This leads to decreased levels of estrogen and progesterone, which causes the onset of the period. The uterine lining will shed during this period. • Option C: The menstrual phase is the first stage of the menstrual cycle. It’s also when the woman gets her period. This phase starts when an egg from the previous cycle isn’t fertilized. Because pregnancy hasn’t taken place, levels of the hormones estrogen and progesterone drop. The thickened lining of the uterus, which would support a pregnancy, is no longer needed, so it sheds through the vagina. During this period, there is a release of a combination of blood, mucus, and tissue from the uterus. • Option D: During each menstrual cycle, an egg develops and is released from the ovaries. The lining of the uterus builds up. If a pregnancy doesn’t happen, the uterine lining sheds during a menstrual period. Then the cycle starts again. 2. 2. Question The nurse instructs a laboring client to use accelerated blow breathing. The client begins to complain of tingling fingers and dizziness. Which action should the nurse take? • A. Administer oxygen by face mask. • B. Notify the health care provider of the client's symptoms. • C. Have the client breathe into her cupped hands. • D. Check the client's blood pressure and fetal heart rate. Incorrect Correct Answer: C. Have the client breathe into her cupped hands. Tingling fingers and dizziness are signs of hyperventilation (blowing off too much carbon dioxide). Hyperventilation is treated by retaining carbon dioxide. This can be facilitated by breathing into a paper bag or cupped hands. • Option A: Giving oxygen is inappropriate because the carbon dioxide level is low, not the oxygen level. • Option B: Before notifying the healthcare provider, the nurse may first intervene by having the client breathe into her cupped hands. If the client’s situation does not improve, the nurse may notify the physician. • Option D: The client’s blood pressure and fetal heart rate are not related to the low levels of carbon dioxide in her body. It is due to blowing off too much carbon dioxide while using blow breathing exercises. 3. 3. Question When assessing a client at 12 weeks of gestation, the nurse recommends that she and her husband consider attending childbirth preparation classes. When is the best time for the couple to attend these classes? • A. At 16 weeks of gestation. • B. At 20 weeks of gestation. • C. At 24 weeks of gestation. • D. At 30 weeks of gestation. Incorrect Correct Answer: D. At 30 weeks of gestation. Learning is facilitated by an interested pupil. The couple is most interested in childbirth toward the end of the pregnancy when they are beginning to anticipate the onset of labor and the birth of their child. At 30 weeks, is closest to the time when parents would be ready for such classes. • Option A: This would not be the best time during pregnancy for the couple to attend childbirth education classes. At these times they will have other teaching needs. Early pregnancy classes often include topics such as nutrition, physiologic changes, coping with normal discomforts of pregnancy, fetal development, maternal and fetal risk factors, and evolving roles of the mother and her significant others. • Option B: At 20 weeks gestation, the couple may have an ultrasound to check the fetus’ gender. This is also the time when the scan may show the beating of the fetus’ heart, the curve of his spine, or his arms and legs kicking. • Option C: During the 24th week of gestation, the couple may think about where they should have the baby; learn about the signs of preterm labor; and how they could introduce the new baby to his siblings. 4. 4. Question One hour following a normal vaginal delivery, a newborn infant boy’s axillary temperature is 96° F, his lower lip is shaking and, when the nurse assesses for a Moro reflex, the boy’s hands shake. Which intervention should the nurse implement first? • A. Stimulate the infant to cry. • B. Wrap the infant in warm blankets. • C. Feed the infant formula. • D. Obtain a serum glucose level. Incorrect Correct Answer: D. Obtain a serum glucose level. This infant is demonstrating signs of hypoglycemia, possibly secondary to a low body temperature. The nurse should first determine the serum glucose level. • Option A: Stimulating the infant to cry is an intervention for a lethargic infant. • Option B: This intervention should be done based on the temperature, but first the glucose level should be obtained. • Option C: Feeding the infant with formula helps raise the blood sugar, but first, the nurse should determine the glucose level. 5. 5. Question Which statement made by the client indicates that the mother understands the limitations of breastfeeding her newborn? • A. "Breastfeeding my infant consistently every 3 to 4 hours stops ovulation and my period." • B. "Breastfeeding my baby immediately after drinking alcohol is safer than waiting for the alcohol to clear my breast milk." • C. "I can start smoking cigarettes while breastfeeding because it will not affect my breast milk." • D. "When I take a warm shower after I breastfeed, it relieves the pain from being engorged between breastfeedings." Incorrect Correct Answer: A. “Breastfeeding my infant consistently every 3 to 4 hours stops ovulation and my period.” Continuous breastfeeding on a 3- to 4-hour schedule during the day will cause a release of prolactin, which will suppress ovulation and menses, but is not completely effective as a birth control method. • Option B: Drinking alcohol immediately before breastfeeding is incorrect because alcohol can immediately enter breast milk. • Option C: Nicotine is transferred to the infant in breast milk • Option D: Taking a warm shower will stimulate the production of milk, which will be more painful after breastfeedings 6. 6. Question When assessing the adequacy of sperm for conception to occur, which of the following is the most useful criterion? • A. Sperm count • B. Sperm motility • C. Sperm maturity • D. Semen volume Incorrect Correct Answer: B. Sperm motility Although all of the factors listed are important, sperm motility is the most significant criterion when assessing male infertility. To reach and fertilize an egg, sperm must move — wriggling and swimming through a woman’s cervix, uterus, and fallopian tubes. This is known as motility. Males are most likely to be fertile if at least 40% of their sperm are moving. • Option A: A normal sperm count ranges from 15 million sperm to more than 200 million sperm per milliliter (mL) of semen. Anything less than 15 million sperm per milliliter, or 39 million sperm per ejaculate, is considered low. • Option C: Sperm cells are continually being produced by the testes, but not all areas of the seminiferous tubules produce sperm cells at the same time. One immature germ cell takes as long as 74 days to reach final maturation, and during this growth process, there are intermittent resting phases. • Option D: According to the International Society for Sexual Medicine, the average semen volume per ejaculate ranges from 1.25 to 5 milliliters (ml). This amount is the equivalent of one-quarter to 1 teaspoon of semen. It is important to note that semen volumes can vary from one time to another. 7. 7. Question A couple who wants to conceive but has been unsuccessful during the last 2 years has undergone many diagnostic procedures. When discussing the situation with the nurse, one partner states, “We know several friends in our age group, and all of them have their own child already, Why can’t we have one?”. Which of the following would be the most appropriate nursing diagnosis for this couple? • A. Fear related to the unknown. • B. Pain related to numerous procedures. • C. Ineffective family coping related to infertility. • D. Self-esteem disturbance related to infertility. Incorrect Correct Answer: D. Self-esteem disturbance related to infertility. Based on the partner’s statement, the couple is verbalizing feelings of inadequacy and negative feelings about themselves and their capabilities. Thus, the nursing diagnosis of self-esteem disturbance is most appropriate. • Option A: The couple may have felt fear that they may never conceive a child because of unsuccessful attempts. This is an appropriate nursing diagnosis but one that should not be prioritized. • Option B: The couple has undergone a lot of diagnostic procedures for the last 2 years and most likely has felt pain and uncomfortability, however, this comes only as a secondary diagnosis. • Option C: They may experience ineffective coping due to the unsuccessful attempts of conceiving, but this is not a priority diagnosis 8. 8. Question Which of the following urinary symptoms does the pregnant woman most frequently experience during the first trimester? • A. Dysuria • B. Frequency • C. Incontinence • D. Burning Incorrect Correct Answer: B. Frequency Pressure and irritation of the bladder by the growing uterus during the first trimester is responsible for causing urinary frequency. • Option A: The term dysuria is used to describe painful urination, which often signifies an infection of the lower urinary tract. The discomfort is usually described by the patient as burning, stinging, or itching. • Option C: Urinary incontinence — the loss of bladder control — is a common and often embarrassing problem. It can be caused by everyday habits, underlying medical conditions, or physical problems. • Option D: A burning sensation with urination can be caused by infectious (including sexually transmitted infections, or STDs such as chlamydia and gonorrhea) and noninfectious conditions, but it is most commonly due to bacterial infection of the urinary tract affecting the bladder. 9. 9. Question Heartburn and flatulence, common in the second trimester, are most likely the result of which of the following? • A. Increased plasma HCG levels • B. Decreased intestinal motility • C. Decreased gastric acidity • D. Elevated estrogen levels Incorrect Correct Answer: C. Decreased gastric acidity During the second trimester, the reduction in gastric acidity in conjunction with pressure from the growing uterus and smooth muscle relaxation can cause heartburn and flatulence. • Option A: HCG levels increase in the first, not the second, trimester. Typically, the hCG levels will double every 72 hours. The level will reach its peak in the first 8-11 weeks of pregnancy and then will decline and level off for the remainder of the pregnancy. • Option B: Decrease intestinal motility would most likely be the cause of constipation and bloating. The gallbladder enlarges and empties sluggishly in response to meals during pregnancy. Small bowel transit is slowed, and the resting pressure of the lower esophageal sphincter is reduced. All these effects are reversed by delivery; motility reverts toward normal in the postpartum period. The rapid return of normal motility suggests that the effects of pregnancy are hormonally related. • Option D: Estrogen levels decrease in the second trimester. Estrogen is a major hormone that involves a lot of minor hormones like estradiol which was mentioned above. The estrogen hormones in women are critical as they are produced by the placenta and ovaries and play a pivotal role in seeing the pregnancy to term. They do so by maintaining the uterine lining which provides a safe space for the growth of the baby. They also help regulate other hormones like progesterone which are essential for fetal growth. 10. 10. Question In which of the following areas would the nurse expect to observe chloasma? • A. Breast, areola, and nipples • B. Chest, neck, arms, and legs • C. Abdomen, breast, and thighs • D. Cheeks, forehead, and nose Incorrect Correct Answer: D. Cheeks, forehead, and nose Chloasma, also called the mask of pregnancy, is an irregular hyperpigmented area found on the face. It is not seen on the breasts, areola, nipples, chest, neck, arms, legs, abdomen, or thighs. • Option A: The area around the nipples and the skin on the breast might darken, possibly due to hormonal changes. • Option B: The skin on the inner thigh and neck may also darken as a result of an increase in the hormones. • Option C: The woman might notice a dark line from the navel to the pubic bone. This is called linea nigra. 11. 11. Question A pregnant client states that she “waddles” when she walks. The nurse’s explanation is based on which of the following is the cause? • A. The large size of the newborn. • B. Pressure on the pelvic muscles. • C. Relaxation of the pelvic joints. • D. Excessive weight gain. Incorrect Correct Answer: C. Relaxation of the pelvic joints During pregnancy, hormonal changes cause relaxation of the pelvic joints, resulting in the typical “waddling” gait. The loosening of the joints and the downward pressure from the growing belly actually cause the pelvis to get wider. A wider pelvis means a wider stance. That explains part of the waddle. The other part is caused by a shift in the center of balance. • Option A: Changes in posture are related to the growing fetus. The abdominal muscles become stretched as the baby grows. These muscles are less able to contract and keep the lower back in proper alignment. Hormone levels increase during pregnancy and cause joints and ligaments to loosen. • Option B: Pressure on the surrounding muscles causing discomfort is due to the growing uterus. The extra weight of pregnancy often becomes more noticeable in the second trimester. As pregnancy progresses, the uterus puts more and more pressure on the lower body. As the pelvic floor weakens, this pressure can cause a feeling of fullness in the vagina or generalized pain and pressure in the hips and pelvis. • Option D: Weight gain has no effect on gait. Pregnancy leads to several changes in body composition and morphology of women. It is not clear whether the biomechanical changes occurring in this period are due exclusively to body composition and size or to other physiological factors. 12. 12. Question Which of the following represents the average amount of weight gained during pregnancy? • A. 12 to 22 lb • B 15 to 25 lb • C. 24 to 30 lb • D. 25 to 40 lb Incorrect Correct Answer: C. 24 to 30 lb The average amount of weight gained during pregnancy is 24 to 30 lb. This weight gain consists of the following: fetus – 7.5 lb; placenta and membrane – 1.5 lb; amniotic fluid – 2 lb; uterus – 2.5 lb; breasts – 3 lb; and increased blood volume – 2 to 4 lb; extravascular fluid and fat – 4 to 9 lb. • Option A: A gain of 12 to 22 lb is insufficient. • Option B: Whereas a weight gain of 15 to 25 lb is marginal. • Option D: A weight gain of 25 to 40 lb is considered excessive. 13. 13. Question When talking with a pregnant client who is experiencing aching swollen leg veins, the nurse would explain that this is most probably the result of which of the following? • A. Thrombophlebitis • B. Pregnancy-induced hypertension • C. Pressure on blood vessels from the enlarging uterus • D. The force of gravity pulling down on the uterus Incorrect Correct Answer: C. Pressure on blood vessels from the enlarging uterus The pressure of the growing uterus on blood vessels results in an increased risk for venous stasis in the lower extremities. Subsequently, edema and varicose vein formation may occur. • Option A: Thrombophlebitis is an inflammation of the veins due to thrombus formation. The hypercoagulable condition of the immediate antepartum period is responsible, in large part, for the development of superficial thrombophlebitis and DVT in 0.15% and 0.04% of this patient population, respectively. • Option B: Pregnancy-induced hypertension is not associated with these symptoms. Pregnancy-induced hypertension is associated with significant elevations in total peripheral resistance, enhanced responsiveness to angiotensin II, and marked reductions in renal blood flow and glomerular filtration rate, and proteinuria. • Option D: Gravity plays only a minor role with these symptoms. The center of gravity of pregnant women is displaced anteriorly and superiorly, compared to non-pregnant women. Furthermore, changes are seen in body shape. Because the volume of the lower trunk increases structurally, it becomes unstable. Nagai et al. reported that the postural sway of anterior-posterior movements increased during pregnancy because of the increase in the abdominal circumference 14. 14. Question Cervical softening and uterine souffle are classified as which of the following? • A. Diagnostic signs • B. Presumptive signs • C. Probable signs • D. Positive signs Incorrect Correct Answer: C. Probable signs Cervical softening (Goodell sign) and uterine soufflé are two probable signs of pregnancy. Probable signs are objective findings that strongly suggest pregnancy. Other probable signs include Hegar sign, which is softening of the lower uterine segment; Piskacek sign, which is an enlargement and softening of the uterus; serum laboratory tests; changes in skin pigmentation; and ultrasonic evidence of a gestational sac. • Option A: There are no diagnostic signs classified in pregnancy changes. • Option B: Presumptive signs are subjective signs and include amenorrhea; nausea and vomiting; urinary frequency; breast tenderness and changes; excessive fatigue; uterine enlargement; and quickening. • Option D: Positive signs of pregnancy are those signs that are definitely confirmed as a pregnancy. They include fetal heart sounds, ultrasound scanning of the fetus, palpation of the entire fetus, palpation of fetal movements, x-ray, and actual delivery of an infant. 15. 15. Question Which of the following would the nurse identify as a presumptive sign of pregnancy? • A. Hegar sign • B. Nausea and vomiting • C. Skin pigmentation changes • D. Positive serum pregnancy test Incorrect Correct Answer: B. Nausea and vomiting Presumptive signs of pregnancy are subjective signs. Of the signs listed, only nausea and vomiting are presumptive signs. • Option A: Hegar’s sign is a non-sensitive indication of pregnancy in women — its absence does not exclude pregnancy. It pertains to the features of the cervix and the uterine isthmus. It is demonstrated as a softening in the consistency of the uterus, and the uterus and cervix seem to be two separate regions. It is a probable sign of pregnancy. • Option C: The area around the nipples and the skin on the inner thighs, genitals, and neck might darken, possibly due to hormonal changes. The woman might notice a dark line from the navel to the pubic bone (linea nigra). Dark patches might develop on the face (chloasma). Avoid sun exposure, which can worsen chloasma. After childbirth, skin typically returns to its normal pigment over a period of several months. • Option D: A positive serum pregnancy test is considered a probable sign, which is strongly suggestive of pregnancy. 16. 16. Question Which of the following common emotional reactions to pregnancy would the nurse expect to occur during the first trimester? • A. Introversion, egocentrism, narcissism. • B. Awkwardness, clumsiness, and unattractiveness. • C. Anxiety, passivity, extroversion. • D. Ambivalence, fear, fantasies. Incorrect Correct Answer: D. Ambivalence, fear, fantasies During the first trimester, common emotional reactions include ambivalence, fear, fantasies, or anxiety. • Option A: The second trimester is a period of well-being accompanied by the increased need to learn about fetal growth and development. Common emotional reactions during this trimester include narcissism, passivity, or introversion. At times the woman may seem egocentric and self-centered. • Option B: During the third trimester, the woman typically feels awkward, clumsy, and unattractive, often becoming more introverted or reflective of her own childhood. • Option C: The effects of anxiety during pregnancy on offspring’s health are serious and thought-provoking to which the need for identifying and screening of anxiety disorders in prenatal care is necessary. 17. 17. Question During which of the following would the focus of classes be mainly on physiologic changes, fetal development, sexuality, during pregnancy, and nutrition? • A. Prepregnant period • B. First trimester • C. Second trimester • D. Third trimester Incorrect Correct Answer: B. First trimester First-trimester classes commonly focus on such issues as early physiologic changes, fetal development, sexuality during pregnancy, and nutrition. Some early classes may include pregnant couples. • Option A: Preconception health and health care focus on things the woman can do before and between pregnancies to increase the chances of having a healthy baby. For some women, getting their body ready for pregnancy takes a few months. For other women, it might take longer. Before getting pregnant, the woman should talk to her physician about preconception health care. The physician will want to discuss health history and any medical conditions the woman currently has that could affect a pregnancy. He or she also will discuss any previous pregnancy problems, medicines that the woman is currently taking, vaccinations that she might need, and steps she can take before pregnancy to prevent certain birth defects. • Option C: The second trimester is a good time to start a regular, pregnancy-friendly workout. It is a wonderful way to bond with and get support from other moms-to-be. This is also the time when screening tests or amniocentesis will be offered, as well as other chromosomal abnormalities, genetic disorders, and neural tube defects. • Option D: Third-trimester classes may focus on preparation for birth, parenting, and newborn care. 18. 18. Question Which of the following would be a disadvantage of breastfeeding? • A. Involution occurs more rapidly. • B. The incidence of allergies increases due to maternal antibodies. • C. The father may resent the infant’s demands on the mother’s body. • D. There is a greater chance for error during preparation. Incorrect Correct Answer: C. The father may resent the infant’s demands on the mother’s body With breastfeeding, the father’s body is not capable of providing the milk for the newborn, which may interfere with feeding the newborn, providing fewer chances for bonding, or he may be jealous of the infant’s demands on his wife’s time and body. • Option A: Breastfeeding is advantageous because uterine involution occurs more rapidly, thus minimizing blood loss. • Option B: The presence of maternal antibodies in breast milk helps decrease the incidence of allergies in the newborn. • Option D: A greater chance for error is associated with bottle feeding. No preparation is required for breastfeeding. 19. 19. Question Which of the following would cause a false-positive result on a pregnancy test? • A. The test was performed less than 10 days after an abortion. • B. The test was performed too early or too late in the pregnancy. • C. The urine sample was stored too long at room temperature. • D. A spontaneous abortion or a missed abortion is impending. Incorrect Correct Answer: A. The test was performed less than 10 days after an abortion A false-positive reaction can occur if the pregnancy test is performed less than 10 days after an abortion. • Option B: Shortly after a fertilized egg attaches to the uterine lining (implantation), the placenta forms and produces the hormone human chorionic gonadotropin (HCG). This hormone enters the bloodstream and urine. During early pregnancy, the HCG concentration increases rapidly — doubling every two to three days. The earlier the woman takes the home pregnancy test, the harder it might be for the test to detect HCG. • Option C: Leaving the dipstick in the urine stream for the exact amount of time allotted is also important. Consider setting a timer on a stopwatch or the phone. That can help the woman track how long the dipstick has been in her urine stream. • Option D: During pregnancy, hCG levels continue to rise as the placenta grows, doubling every few days and peaking at around 10 weeks. When a pregnancy ends, hCG levels begin to recede, but it’s a slow process. The hormone can remain in the blood and urine for up to six weeks following the end of the pregnancy. It’s possible to have a false-positive test until the hCG levels return to their pre-pregnancy state. 20. 20. Question FHR can be auscultated with a fetoscope as early as which of the following? • A. 5 weeks gestation • B. 10 weeks gestation • C. 15 weeks gestation • D. 20 weeks gestation Incorrect Correct Answer: D. 20 weeks gestation The FHR can be auscultated with a fetoscope at about 20 week’s gestation. FHR usually is auscultated at the midline suprapubic region with a Doppler ultrasound transducer at 10 to 12 week’s gestation. FHR, cannot be heard any earlier than 10 weeks’ gestation. • Option A: A fetal heartbeat may first be detected by a vaginal ultrasound as early as 5 1/2 to 6 weeks after gestation. That’s when a fetal pole, the first visible sign of a developing embryo, can sometimes be seen. • Option B: With all the rapid growth, the woman will probably be able to hear her baby’s heartbeat for the first time around week 9 or week 10 of pregnancy, though it can vary a bit. It will be about 170 beats per minute by this time, a rate that will slow from here on out. Her doctor or midwife will place a handheld ultrasound device called a Doppler on your belly to amplify the sound. • Option C: The baby’s heartbeat may be heard as early as the twelfth week of pregnancy using a highly sensitive Doppler that allows hearing the baby’s heartbeat. The normal range for the baby’s heart rate is 115 to 160 beats per minute. 21. 21. Question A client LMP began July 5, 2020. Her estimated date of delivery (EDD) should be which of the following? • A. January 2, 2021 • B. March 28, 2021 • C. April 12, 2021 • D. October 12, 2020 Incorrect Correct Answer: C. April 12, 2021 LMP of the woman is July 5, 2020. Using Naegele’s rule: Add seven days to the first day of the LMP (5+7=12), then subtract three months (July-3 months= April), lastly add 1 year. The EDD will be on April 12, 2021. • Option A: On January 2, 2021, the woman is at 25 weeks gestation. • Option B: On March 28, 2021, the woman is at 38 weeks gestation. • Option D: On October 12, 2020, the woman is at 14 weeks gestation. 22. 22. Question Which of the following fundal heights indicates less than 12 weeks’ gestation when the date of the LMP is unknown? • A. Uterus in the pelvis • B. Uterus at the xiphoid • C. Uterus in the abdomen • D. Uterus at the umbilicus Incorrect Correct Answer: A. Uterus in the pelvis When the LMP is unknown, the gestational age of the fetus is estimated by uterine size or position (fundal height). The presence of the uterus in the pelvis indicates less than 12 weeks’ gestation. At approximately 12 to 14 weeks, the fundus is out of the pelvis above the symphysis pubis. • Option B: When the fundal height is at the level of the xiphoid, the woman is already at 40 weeks gestation. • Option C: When the physician measures how high the top of the uterus has reached in the mother’s abdomen, he or she is measuring the fundal height. This is a much more accurate way of estimating fetal growth than weighing the mother. • Option D: When the fundal height is at the level of the umbilicus, the woman is approximately 20 weeks gestation. 23. 23. Question Which of the following danger signs should be reported promptly during the antepartum period? • A. Constipation • B. Breast tenderness • C. Nasal stuffiness • D. Leaking amniotic fluid Incorrect Correct Answer: D. Leaking amniotic fluid Danger signs that require prompt reporting leaking of amniotic fluid, vaginal bleeding, blurred vision, rapid weight gain, and elevated blood pressure. • Option A: Postpartum constipation, with symptoms such as pain or discomfort, straining, and hard stool, is a common condition affecting mothers. Hemorrhoids, pain at the episiotomy site, effects of pregnancy hormones, and haematinics used in pregnancy can increase the risk of postpartum constipation. Eating a high-fiber diet and increasing fluid intake is usually encouraged, although laxatives are commonly used in relieving constipation. • Option B: The breasts may be extra tender as early as one or two weeks after conception. This is because the body is making so much estrogen and progesterone in early pregnancy that the glands in the breasts start growing. This hormone surge causes breasts to retain more fluids and feel heavy, sore, or more sensitive than normal PMS tenderness. • Option C: Pregnancy rhinitis is an inflammation of the mucous membranes lining the nose. This causes nasal congestion. Increased blood flow to the nasal passages and enlargement of the nasal veins also play a role. 24. 24. Question Which of the following prenatal laboratory test values would the nurse consider as significant? • A. Hematocrit 33.5% • B. Rubella titer less than 1:8 • C. White blood cells 8,000/mm3 • D. One hour glucose challenge test 110 g/dL Incorrect Correct Answer: B. Rubella titer less than 1:8 A rubella titer should be 1:8 or greater. Thus, a finding of a titer less than 1:8 is significant, indicating that the client may not possess immunity to rubella. • Option A: Hemoglobin levels in the first and second half of pregnancy can predict preeclampsia and premature preterm rupture of membranes. Increased hematocrit levels in the second half of pregnancy or lack of reduction of hematocrit levels in the second half compared to the first half can estimate preeclampsia. Normal values of hematocrit have been determined from 36 to 48 percent for women in childbearing age. The cause of its decrease in adults and during pregnancy is anemia, and the reasons for its increase are myeloproliferative disorders, chronic obstructive pulmonary disease, and other hypoxic lung conditions. • Option C: The average white cell count during pregnancy is about 9-15k. It increases up to term and can go as high as 25k during labor. • Option D: A glucose screening test is a routine test during pregnancy that checks a pregnant woman’s blood glucose (sugar) level. This test checks for gestational diabetes. Most pregnant women have a glucose screening test between 24 and 28 weeks of pregnancy. The test may be done earlier if the woman has a high glucose level in her urine during her routine prenatal visits, or if she has a high risk for diabetes. Most of the time, a normal result for the glucose screening test is a blood sugar that is equal to or less than 140 mg/dL (7.8 mmol/L) 1 hour after drinking the glucose solution. 25. 25. Question Which of the following characteristics of contractions would the nurse expect to find in a client experiencing true labor? • A. Occurring at irregular intervals. • B. Starting mainly in the abdomen. • C. Gradually increasing intervals. • D. Increasing intensity with walking. Incorrect Correct Answer: D. Increasing intensity with walking With true labor, contractions increase in intensity with walking. In addition, true labor contractions occur at regular intervals, usually starting in the back and sweeping around to the abdomen. The interval of true labor contractions gradually shortens. • Option A: Unlike false labor contractions or Braxton Hicks contractions, true labor contractions don’t stop when you change your position or relax. It occurs at regular intervals. • Option B: Labor contractions usually cause discomfort or a dull ache at the back and lower abdomen, along with pressure in the pelvis. • Option C: True labor contractions come at regular intervals and get closer together as time goes on. (Contractions last about 30 to 70 seconds.). 26. 26. Question During which of the following stages of labor would the nurse assess “crowning”? • A. First stage • B. Second stage • C. Third stage • D. Fourth stage Incorrect Correct Answer: B. Second stage Crowing, which occurs when the newborn’s head or presenting part appears at the vaginal opening, occurs during the second stage of labor. • Option A: During the first stage of labor, cervical dilation and effacement occur. Effacement means that the cervix stretches and gets thinner. Dilatation means that the cervix opens. As labor nears, the cervix may start to thin or stretch (efface) and open (dilate). This prepares the cervix for the baby to pass through the birth canal (vagina). • Option C: During the third stage of labor, the newborn and placenta are delivered. This stage is often called delivery of the “afterbirth” and is the shortest stage of labor. It may last from a few minutes to 20 minutes. • Option D: The fourth stage of labor lasts from 1 to 4 hours after birth, during which time the mother and newborn recover from the physical process of birth and the mother’s organs undergo the initial readjustment to the nonpregnant state. 27. 27. Question Barbiturates are usually not given for pain relief during active labor for which of the following reasons? • A. The neonatal effects include hypotonia, hypothermia, generalized drowsiness, and reluctance to feed for the first few days. • B. These drugs readily cross the placental barrier, causing depressive effects in the newborn 2 to 3 hours after intramuscular injection. • C. They rapidly transfer across the placenta, and the lack of an antagonist makes them generally inappropriate during labor. • D. Adverse reactions may include maternal hypotension, allergic or toxic reaction, or partial or total respiratory failure. Incorrect Correct Answer: C. They rapidly transfer across the placenta, and the lack of an antagonist makes them generally inappropriate during labor. Barbiturates are rapidly transferred across the placental barrier, and the lack of an antagonist makes them generally inappropriate during active labor. • Option A: Neonatal side effects of barbiturates include central nervous system depression, prolonged drowsiness, delayed establishment of feeding (e.g. due to poor sucking reflex or poor sucking pressure). Tranquilizers are associated with neonatal effects such as hypotonia, hypothermia, generalized drowsiness, and reluctance to feed for the first few days. • Option B: Narcotic analgesic readily crosses the placental barrier, causing depressive effects in the newborn 2 to 3 hours after intramuscular injection. • Option D: Regional anesthesia is associated with adverse reactions such as maternal hypotension, allergic or toxic reaction, or partial or total respiratory failure. 28. 28. Question Which of the following nursing interventions would the nurse perform during the third stage of labor? • A. Obtain a urine specimen and other laboratory tests. • B. Assess uterine contractions every 30 minutes. • C. Coach for effective client pushing. • D. Promote parent-newborn interaction. Incorrect Correct Answer: D. Promote parent-newborn interaction. During the third stage of labor, which begins with the delivery of the newborn, the nurse would promote parent-newborn interaction by placing the newborn on the mother’s abdomen and encouraging the parents to touch the newborn. • Option A: Collecting a urine specimen and other laboratory tests is done on admission during the first stage of labor. • Option B: Assessing uterine contractions every 30 minutes is performed during the latent phase of the first stage of labor. • Option D: Coaching the client to push effectively is appropriate during the second stage of labor. 29. 29. Question Which of the following actions demonstrates the nurse’s understanding of the newborn’s thermoregulatory ability? • A. Placing the newborn under a radiant warmer. • B. Suctioning with a bulb syringe. • C. Obtaining an Apgar score. • D. Inspecting the newborn’s umbilical cord. Incorrect Correct Answer: A. Placing the newborn under a radiant warmer. The newborn’s ability to regulate body temperature is poor. Therefore, placing the newborn under a radiant warmer aids in maintaining his or her body temperature. • Option B: Suctioning with a bulb syringe helps maintain a patent airway. • Option C: Obtaining an Apgar score measures the newborn’s immediate adjustment to extrauterine life. • Option D: Inspecting the umbilical cord aids in detecting cord anomalies. 30. 30. Question Immediately before expulsion, which of the following cardinal movements occur? • A. Descent • B. Flexion • C. Extension • D. External rotation Incorrect Correct Answer: D. External rotation Immediately before expulsion or birth of the rest of the body, the cardinal movement of external rotation occurs. During this pause, the baby must rotate so that his/her face moves from face-down to facing either of the laboring woman’s inner thighs. This movement, also called restitution, is necessary as the shoulders must fit around and under the pubic arch. • Option A: The baby’s head moves deep into the pelvic cavity and is commonly called lightening. The baby’s head becomes markedly molded when these distances are closely the same. When the occiput is at the level of the ischial spines, it can be assumed that the biparietal diameter is engaged and then descends into the pelvic inlet. • Option B: Flexion occurs during descent and is brought about by the resistance felt by the baby’s head against the soft tissues of the pelvis. The resistance brings about a flexion in the baby’s head so that the chin meets the chest. The smallest diameter of the baby’s head (or suboccipitobregmatic plane) presents into the pelvis. • Option C: After internal rotation is complete and the head passes through the pelvis at the nape of the neck, a rest occurs as the neck is under the pubic arch. Extension occurs as the head, face, and chin are born. 31. 31. Question Before birth, which of the following structures connects the right and left auricles of the heart? • A. Umbilical vein • B. Foramen ovale • C. Ductus arteriosus • D. Ductus venosus Incorrect Correct Answer: B. Foramen ovale The foramen ovale is an opening between the right and left auricles (atria) that should close shortly after birth so the newborn will not have a murmur or mixed-blood traveling through the vascular system. • Option A: The umbilical vein carries oxygenated, nutrient-rich blood from the placenta to the fetus, and the umbilical arteries carry deoxygenated, nutrient-depleted blood from the fetus to the placenta. Any impairment in blood flow within the cord can be a catastrophic event for the fetus. • Option C: At birth, the lungs fill with air with the first breaths, pulmonary vascular resistance drops, and blood flows from the right ventricle to the lungs for oxygenation. The increased arterial oxygen tension and the decreased flow through the ductus arteriosus allow the ductus to constrict. • Option D: In utero, the ductus venosus connects the left portal vein to the inferior vena cava, allowing a portion of the venous blood to bypass the liver and return to the heart. After birth, the ductus venosus generally closes between days of life 2 to 18 in term infants 32. 32. Question Which of the following when present in the urine may cause a reddish stain on the diaper of a newborn? • A. Mucus • B. Uric acid crystals • C. Bilirubin • D. Excess iron Incorrect Correct Answer: B. Uric acid crystals Uric acid crystals in the urine may produce the reddish “brick dust” stain on the diaper. Urate crystals are made up of uric acid, an end product of normal metabolism. Babies are born with a high blood uric acid level because of the amount they get across the placenta, and this is quickly excreted in the urine and stool. If a baby is not making much urine at this time, these urate crystals will be especially concentrated and easy to see. This does not mean, however, that your baby is dehydrated. Instead, you can make sure your baby is properly drinking and urinating enough with a few simple questions. • Option A: Mucus in urine may be positive in other clinical conditions such as urinary tract infection and stones. Secreted from the vesicle glands of the genitourinary tract, mucus is not generally seen in the urine samples of children under the age of 12. • Option C: Bilirubin is a brownish-yellow substance that is produced after red blood cells break down. The body gets rid of bilirubin through the stool and urine. • Option D: Neonates and young children with certain liver disorders characteristically have a very high serum ferritin level. These conditions are gestational alloimmune liver disease (GALD) and hemophagocytic lymphohistiocytosis (HLH). It is not clear what the iron content of the ferritin is in these neonates. Knowing this will be a step toward understanding whether the pathogenesis of these conditions involves iron overload. Additionally, if urine ferritin and iron levels correlate with serum ferritin and iron levels, urine may be used as a non-invasive way to monitor iron status. 33. 33. Question When assessing the newborn’s heart rate, which of the following ranges would be considered normal if the newborn were sleeping? • A. 80 beats per minute • B. 100 beats per minute • C. 120 beats per minute • D. 140 beats per minute Incorrect Correct Answer: B. 100 beats per minute The normal heart rate for a newborn that is sleeping is approximately 100 beats per minute. If the newborn was awake, the normal heart rate would range from 120 to 160 beats per minute. • Option A: 80 beats per minute is below the normal range of a newborn’s heart rate. Neonatal bradycardia is defined as a decrease in heart by 30 bpm from baseline. Regarding neonatal resuscitation, bradycardia is concerning when the heart rate is less than 100 bpm. The primary cause of neonatal bradycardia is hypoxia. Other causes of bradycardia in this age group include hypothermia, hypovolemia, and pneumothorax, head injury, and medications. • Option C: Newborns 0 to 1 month old has a normal range of 70 to 190 beats per minute • Option D: 140 beats per minute is still within the normal range of a newborn’s heart rate. 34. 34. Question Which of the following is true regarding the fontanels of the newborn? • A. The anterior is triangular shaped; the posterior is diamond-shaped. • B. The posterior closes at 18 months; the anterior closes at 8 to 12 weeks. • C. The anterior is large in size when compared to the posterior fontanel. • D. The anterior is bulging; the posterior appears sunken. Incorrect Correct Answer: C. The anterior is large in size when compared to the posterior fontanel. The anterior fontanel is larger in size than the posterior fontanel. Additionally, the anterior fontanel, which is diamond-shaped, closes at 18 months, whereas the posterior fontanel, which is triangular shaped, closes at 8 to 12 weeks. Neither fontanel should appear bulging, which may indicate increased intracranial pressure, or sunken, which may indicate dehydration. • Option A: The anterior fontanelle is the largest of the six fontanelles, and it resembles a diamond-shape ranging in size from 0.6 cm to 3.6 cm with a mean of 2.1 cm. Unlike the anterior fontanelle, the posterior fontanelle is triangular and completely closes within about six to eight weeks after birth. • Option B: The average closure time of the anterior fontanelle ranges from 13 to 24 months. The posterior fontanel completely closes within about six to eight weeks after birth. • Option D: In addition to being the largest, the anterior fontanelle is also the most important clinically. This structure offers insight into the newborn’s state of health, especially hydration and intracranial pressure status. A sunken fontanelle is primarily due to dehydration. Other clinical indicators that support the diagnosis of dehydration are dry mucous membranes, sunken eyes, poor tear production, decreased peripheral perfusion, and lack of wet diapers. Furthermore, a bulging fontanelle may indicate a rise in intracranial pressure, suggesting multiple pathologies: hydrocephalus, hypoxemia, meningitis, trauma, or hemorrhage. 35. 35. Question Which of the following groups of newborn reflexes below are present at birth and remain unchanged through adulthood? • A. Blink, cough, rooting, and gag • B. Blink, cough, sneeze, gag • C. Rooting, sneeze, swallowing, and cough • D. Stepping, blink, cough, and sneeze Incorrect Correct Answer: B. Blink, cough, sneeze, gag Blink, cough, sneeze, swallowing and gag reflexes are all present at birth and remain unchanged through adulthood. Reflexes such as rooting and stepping subside within the first year. • Option A: The rooting reflex is one of the involuntary primitive motor reflexes, which are also known as the frontal release reflexes, that are mediated by the brainstem. It initiates when the corner of an infant’s mouth is stimulated. When the mouth is touched or stroked, the newborn will turn his or her head towards the stimulus and open the mouth with tongue thrusting. The rooting reflex is present at birth (approximately 28 weeks) and lasts about 4 to 6 months until the frontal lobe of the cerebral cortex develops and suppresses the primitive motor reflexes. • Option C: The rooting reflex is essential for survival and growth for it helps the newborn find the source of food (breast or bottle) and initiate feeding. As the frontal lobe matures, the primitive reflexes are replaced with voluntary motor functions. The age when each primitive reflex disappears varies. • Option D: The stepping reflex is also called the walking or dance reflex because a baby appears to take steps or dance when held upright with his or her feet touching a solid surface. This reflex lasts about 2 months. 36. 36. Question Which of the following describes the Babinski reflex? • A. The newborn’s toes will hyperextend and fan apart from the dorsiflexion of the big toe when one side of the foot is stroked upward from the ball of the heel and across the ball of the foot. • B. The newborn abducts and flexes all extremities and may begin to cry when exposed to sudden movement or loud noise. • C. The newborn turns the head in the direction of the stimulus, opens the mouth, and begins to suck when the cheek, lip, or corner of the mouth is touched. • D. The newborn will attempt to crawl forward with both arms and legs when he is placed on his abdomen on a flat surface. Incorrect Correct Answer: A. The newborn’s toes will hyperextend and fan apart from the dorsiflexion of the big toe when one side of the foot is stroked upward from the ball of the heel and across the ball of the foot. With the Babinski reflex, the newborn’s toes hyperextend and fan apart from dorsiflexion of the big toe when one side of the foot is stroked upward from the heel and across the ball of the foot. • Option B: With the startle reflex, the newborn abducts and flexes all extremities and may begin to cry when exposed to sudden movement of loud noise. • Option C: With the rooting and sucking reflex, the newborn turns his head in the direction of the stimulus, opens the mouth, and begins to suck when the cheeks, lip, or corner of the mouth is touched. • Option D: With the crawl reflex, the newborn will attempt to crawl forward with both arms and legs when he is placed on his abdomen on a flat surface. 37. 37. Question Which of the following statements best describes hyperemesis gravidarum? • A. Severe anemia leading to an electrolyte, metabolic, and nutritional imbalances in the absence of other medical problems. • B. Severe nausea and vomiting leading to an electrolyte, metabolic, and nutritional imbalances in the absence of other medical problems • C. Loss of appetite and continuous vomiting that commonly results in dehydration and ultimately decreasing maternal nutrients. • D. Severe nausea and diarrhea that can cause gastrointestinal irritation and possibly internal bleeding. Incorrect Correct Answer: B. Severe nausea and vomiting leading to the electrolyte, metabolic, and nutritional imbalances in the absence of other medical problems. The description of hyperemesis gravidarum includes severe nausea and vomiting, leading to the electrolyte, metabolic, and nutritional imbalances in the absence of other medical problems. • Option A: Hyperemesis is not a form of anemia. The exact cause of nausea and vomiting during pregnancy is not known. However, it is believed to be caused by a rapidly rising blood level of a hormone called human chorionic gonadotropin (HCG). HCG is released by the placenta. Mild morning sickness is common. Hyperemesis gravidarum is less common and more severe. • Option C: Loss of appetite may occur secondary to nausea and vomiting of hyperemesis, which, if it continues, can deplete the nutrients transported to the fetus. Women with hyperemesis gravidarum have extreme nausea and vomiting during pregnancy. It can cause a weight loss of more than 5% of body weight. The condition can happen in any pregnancy, but is a little more likely if the woman is pregnant with twins (or more babies), or if she has a hydatidiform mole. Women are at higher risk for hyperemesis if they have had the problem in previous pregnancies or are prone to motion sickness. • Option D: Diarrhea does not occur with hyperemesis. Constipation is one of the symptoms. Increase fluids during times of the day when there is a feeling of nausea. Seltzer, ginger ale, or other sparkling drinks may help. The woman can also try using low-dose ginger supplements or acupressure wrist bands to ease symptoms. 38. 38. Question Which of the following would the nurse identify as a classic sign of PIH? • A. Edema of the feet and ankles • B. Edema of the hands and face • C. Weight gain of 1 lb/week • D. Early morning headache Incorrect Correct Answer: B. Edema of the hands and face Edema of the hands and face is a classic sign of PIH. Aggressive volume resuscitation may lead to pulmonary edema, which is a common cause of maternal morbidity and mortality. Pulmonary edema occurs most frequently 48-72 hours postpartum, probably due to mobilization of extravascular fluid. Because volume expansion has no demonstrated benefit, patients should be fluid restricted when possible, at least until the period of postpartum diuresis. • Option A: Many healthy pregnant women experience foot and ankle edema. During pregnancy, the extra fluid in the body and the pressure from the growing uterus can cause swelling (or “edema”) in the ankles and feet. The swelling tends to get worse as a woman’s due date nears, particularly near the end of the day and during hotter weather. • Option C: A weight gain of 2 lb or more per week indicates a problem. High pregnancy weight gain was more strongly associated with term preeclampsia than early preterm preeclampsia (eg, 64% versus 43% increased odds per 1 z score difference in weight gain in normal-weight women, and 30% versus 0% in obese women, respectively). • Option D: Early morning headache is not a classic sign of PIH. Dull or severe, throbbing headaches, often described as migraine-like that just won’t go away are cause for concern. 39. 39. Question In which of the following types of spontaneous abortions would the nurse assess dark brown vaginal discharge and a negative pregnancy test? • A. Threatened • B. Imminent • C. Missed • D. Incomplete Incorrect Correct Answer: C. Missed In a missed abortion, there is early fetal intrauterine death, and products of conception are not expelled. The cervix remains closed; there may be a dark brown vaginal discharge, negative pregnancy test, and cessation of uterine growth and breast tenderness. • Option A: A threatened abortion is evidenced with cramping and vaginal bleeding in early pregnancy, with no cervical dilation. • Option B: An imminent-abortion indicated by bleeding and pain along with an effaced cervix. • Option D: An incomplete abortion involves only expulsion of part of the products of conception and bleeding occurs with cervical dilation. 40. 40. Question Which of the following factors would the nurse suspect as predisposing a client to placenta previa? • A. Multiple gestation • B. Uterine anomalies • C. Abdominal trauma • D. Renal or vascular disease Incorrect Correct Answer: A. Multiple gestation Multiple gestation is one of the predisposing factors that may cause placenta previa. Placenta previa is more common in older and multiparous women. The reason is not clear but it may be associated with the aging of the vasculature of the uterus. This causes placental hypertrophy and enlargement which increases the likelihood of the placenta encroaching on lower segment • Option B: Patients with a unicornuate uterus had high rates of placenta or vasa previa, and three of five pregnancies with placenta previa also had placenta accreta. While this represents a small series, placenta accreta in those with placenta previa has been reported to occur with this frequency in women with multiple prior cesarean deliveries. • Option C: The exact etiology of placental abruption is unknown. However, a number of factors are associated with its occurrence. Risk factors can be thought of in 3 groups: health history, including behaviors, and past obstetrical events, current pregnancy, and unexpected trauma. • Option D: Complications of conservative management of placenta percreta described in the literature include bleeding, infection (endometritis, wound infection, peritonitis, pyelonephritis, uterine necrosis), sepsis and septic shock, fistula formation, thrombosis, pulmonary embolism, pulmonary edema, and the side-effects of methotrexate therapy. Acute renal failure has only been described in one case with methotrexate injection into the umbilical cord and was considered an acute side-effect of methotrexate therapy. 41. 41. Question Which of the following would the nurse assess in a client experiencing abruptio placenta? • A. Bright red, painless vaginal bleeding • B. Concealed or external dark red bleeding • C. Palpable fetal outline • D. Soft and nontender abdomen Incorrect Correct Answer: B. Concealed or external dark red bleeding A client with abruptio placentae may exhibit concealed or dark red bleeding, possibly reporting sudden intense localized uterine pain. The uterus is typically firm to board-like, and the fetal presenting part may be engaged. • Option A: Painless vaginal bleeding during the second or third trimester of pregnancy is the usual presentation in placenta previa. The bleeding may be provoked from intercourse, vaginal examinations, labor, and at times there may be no identifiable cause. On speculum examination, there may be minimal bleeding to active bleeding. • Option C: On physical examination, the uterus tends to be soft and fetal parts are readily palpable. With placenta previa, the presenting part is unengaged and malpresentation is common, seen in up to 50% of cases. • Option D: Abdominal examination usually finds the uterus non-tender, soft and relaxed. Leopold’s Maneuvers may find the fetus in an oblique or breech position or lying transverse as a result of the abnormal position of the placenta. Malpresentation is found in about 35% cases. 42. 42. Question Which of the following is described as premature separation of a normally implanted placenta during the second half of pregnancy, usually with severe hemorrhage? • A. Placenta previa • B. Ectopic pregnancy • C. Incompetent cervix • D. Abruptio placenta Incorrect Correct Answer: D. Abruptio placentae Abruptio placenta is described as premature separation of a normally implanted placenta during the second half of pregnancy, usually with severe hemorrhage. • Option A: Placenta previa refers to implantation of the placenta in the lower uterine segment, causing painless bleeding in the third trimester of pregnancy. • Option B: Ectopic pregnancy refers to the implantation of the products of conception in a site other than the endometrium. • Option C: Incompetent cervix is a conduction characterized by painful dilation of the cervical os without uterine contractions. 43. 43. Question Which of the following may happen if the uterus becomes overstimulated by oxytocin during the induction of labor? • A. Weak contraction prolonged to more than 70 seconds. • B. Tetanic contractions prolonged to more than 90 seconds. • C. Increased pain with bright red vaginal bleeding. • D. Increased restlessness and anxiety. Incorrect Correct Answer: B. Tetanic contractions prolonged to more than 90 seconds Hyperstimulation of the uterus such as with oxytocin during the induction of labor may result in tetanic contractions prolonged to more than 90seconds, which could lead to such complications as fetal distress, abruptio placentae, amniotic fluid embolism, laceration of the cervix, and uterine rupture. • Option A: With some methods, the uterus can be overstimulated, causing it to contract too frequently. Too many contractions may lead to changes in the fetal heart rate, umbilical cord problems, and other problems. • Option C: Painless vaginal bleeding during the second or third trimester of pregnancy is the usual presentation in placenta previa. The bleeding may be provoked from intercourse, vaginal examinations, labor, and at times there may be no identifiable cause. On speculum examination, there may be minimal bleeding to active bleeding. • Option D: Synthetic oxytocin, also known as Pitocin, is frequently administered during delivery for the purpose of inducing labor and preventing excessive post-delivery bleeding. One might hypothesize, based on the role that natural oxytocin plays, that women receiving oxytocin might receive some degree of benefit from the peri-partum use of Pitocin; however, a recent study calls this hypothesis into question. This study used population-based data available through the Massachusetts Integrated Clinical Academic Research Database (MiCARD) in order to retrospectively examine the relationship between peripartum synthetic oxytocin administration and the development of depressive and anxiety disorders within the first year postpartum. While the authors expected to observe that women exposed to synthetic oxytocin in this cohort would have a reduced risk of postpartum depressive and/or anxiety disorders than those without any exposure, they actually found the opposite. 44. 44. Question When preparing a client for cesarean delivery, which of the following key concepts should be considered when implementing nursing care? • A. Instruct the mother’s support person to remain in the family lounge until after the delivery. • B. Arrange for a staff member of the anesthesia department to explain what to expect postoperatively. • C. Modify preoperative teaching to meet the needs of either a planned or emergency cesarean birth. • D. Explain the surgery, expected outcome, and kind of anesthetics. Incorrect Correct Answer: C. Modify preoperative teaching to meet the needs of either a planned or emergency cesarean birth A key point to consider when preparing the client for a cesarean delivery is to modify the preoperative teaching to meet the needs of either a planned or emergency cesarean birth, the depth and breadth of instruction will depend on circumstances and time available. • Option A: Allowing the mother’s support person to remain with her as much as possible is an important concept, although doing so depends on many variables. • Option B: Arranging for necessary explanations by various staff members to be involved with the client’s care is a nursing responsibility. • Option D: The nurse is responsible for reinforcing the explanations about the surgery’s expected outcome, and type of anesthetic to be used. The obstetrician is responsible for explaining the surgery and outcome, and the anesthesiology staff is responsible for explanations about the type of anesthesia to be used. 45. 45. Question Which of the following best describes preterm labor? • A. Labor that begins after 20 weeks gestation and before 37 weeks gestation. • B. Labor that begins after 15 weeks gestation and before 37 weeks gestation • C. Labor that begins after 24 weeks gestation and before 28 weeks gestation. • D. Labor that begins after 28 weeks gestation and before 40 weeks gestation. Incorrect Correct Answer: A. Labor that begins after 20 weeks gestation and before 37 weeks gestation Preterm labor is best described as labor that begins after 20 weeks’ gestation and before 37 weeks’ gestation. The other time periods are inaccurate. • Option B: At 15 weeks gestation, the fetus weighs around 4 ounces (oz) and its facial features will be starting to take shape. The bones in its ears will be developing for the first time, and the fetus will be able to hear the sounds of the mother’s heart, digestive system, and voice. Even though the eyes of the fetus will remain closed, it will be able to sense and respond to light. • Option C: At 24 weeks gestation, the branches of the baby’s lungs are forming, as well as the cells that make surfactant, a natural substance that lines the tiny air sacs (called alveoli) in the lungs to make breathing possible.4 While a small amount of surfactant is now present, the lungs are still immature. Babies born this early have a hard time breathing. • Option D: Babies begin having eye movements as early as 14 weeks, but these movements increase around 28 weeks. The higher frequency of eye movements is associated with REM sleep and healthy brain development. 46. 46. Question When PROM occurs, which of the following provides evidence of the nurse’s understanding of the client’s immediate needs? • A. The chorion and amnion rupture 4 hours before the onset of labor. • B. PROM removes the fetus's most effective defense against infection. • C. Nursing care is based on fetal viability and gestational age. • D. PROM is associated with malpresentation and possibly incompetent cervix. Incorrect Correct Answer: B. PROM removes the fetus most effective defense against infection PROM can precipitate many potential and actual problems; one of the most serious is the fetus loss of an effective defense against infection. This is the client’s most immediate need at this time. • Option A: Typically, PROM occurs about 1 hour, not 4 hours, before labor begins. • Option C: Fetal viability and gestational age are less immediate considerations that affect the plan of care. • Option D: Malpresentation and an incompetent cervix may be causes of PROM. 47. 47. Question Which of the following factors is the underlying cause of dystocia? • A. Nutritional •