study questions 3

8/18/2019 Study Questions 3

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maternal and child health nursing MCQ 71. The nurse in charge is caring for a patient who is in the first stage of labor. What is the shortest but

most difficult part of this stage?

a. Active phaseb. Complete phasec. Latent phased. Transitional phaseAnswer D

The transitional phase, which lasts 1 to hours, is the shortest but most difficult part of the first stageof labor. This phase is characteri!ed b" intense uterine contractions that occur ever" 1 # to $ minutesand last %& to '( seconds. The active phase lasts % # to ) hours* it is characteri!ed b" contractions thatstarts out moderatel" intense, grow stronger, and last about )( seconds. The complete phase occursduring the second, not first, stage of labor. The latent phase lasts & to + hours and is mared b" mild,short, irregular contractions.

$. The nurse is teaching a pregnant woman with t"pe 1 diabetes about her diet during pregnanc". Whichclient statement indicates that the nurse-s teaching was successful?

A /0-ll basicall" follow the same diet that 0 was following before 0 became pregnant./ /ecause 0 need e2tra protein, 0-ll have to increase m" intae of mil and meat./C /3regnanc" affects insulin production, so 0-ll need to mae ad4ustments in m" diet./D /0-ll ad4ust m" diet and insulin based on the results of m" urine tests for glucose./A56*C0n pregnanc", placental hormones cause insulin resistance at a level that tends to parallel growth of thefetoplacental unit. 5utritional management focuses on maintaining balanced glucose levels. Thus, thewoman will probabl" need to mae ad4ustments in her diet. 3rotein needs increase during pregnanc",but this is unrelated to diabetes. lood glucose monitoring results t"picall" guide therap".

. Which factor would the nurse identif" as being most important in helping to reduce thematernal7fetal7neonatal complications associated with pregnanc" and diabetes?

A 6tabilit" of the woman-s emotional and ps"chological status Degree of gl"cemic control achieved during the pregnanc"C 8valuation of retinopath" b" an ophthalmologistD lood urea nitrogen level 9:5 within normal limits

A56*Therapeutic management for the woman with diabetes focuses on tight glucose control, thereb"minimi!ing the riss to the mother, fetus, and neonate. The woman-s emotional and ps"chologicalstatus is highl" variable and ma" or ma" not affect the pregnanc". 8valuating for long;term diabeticcomplications such as retinopath" or nephropath", as evidenced b" laborator" testing such as :5levels, is an important aspect of preconception care to ensure that the mother enters the pregnanc" inan optimal state.

%. ecause a pregnant client-s diabetes has been poorl" controlled throughout her pregnanc", the nursewould be alert for which of the following in the neonate at birth?

A


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&. A woman with diabetes is considering becoming pregnant. 6he ass the nurse whether she will be ableto tae oral h"pogl"cemics when she is pregnant. The nurse-s response is based on the understandingthat oral h"pogl"cemics>

A Can be used as long as the" control serum glucose levels Can be taen until the degeneration of the placenta occursC Are usuall" suggested primaril" for women who develop gestational diabetesD 6how promising results but more studies are needed to confirm their effectivenessA56*D6everal studies have used gl"buride an oral h"pogl"cemic agent with promising results. =owever, moreintensive research is needed to establish the drug-s safet" and efficac" during pregnanc".

). A 1(;wee pregnant woman with diabetes has a gl"cos"lated hemoglobin 9=bA1c level of 1. At thistime the nurse should be most concerned about which of the following possible fetal outcomes?

A Congenital anomalies 0ncompetent cervi2C 3lacenta previaD Abruptio placentaeA56*AA =bA1c level of 1 indicates poor glucose control. This, in con4unction with the woman being in thefirst trimester, increases the ris for congenital anomalies in the fetus. 8levated glucose levels are notassociated with incompetent cervi2, placenta previa, or abruptio placentae.

@. After teaching a group of students about the use of antiretroviral agents in pregnant women who are=0;positive, the instructor determines that the teaching was successful when the group identifieswhich of the following as the underl"ing rationale?

A Beduction in viral loads in the blood Treatment of opportunistic infectionsC Ad4unct therap" to radiation and chemotherap"D Can cure acute =07A0D6 infectionsA56*ADrug therap" is the mainsta" of treatment and is important in reducing the viral load as much aspossible. Antiretroviral agents do not treat opportunistic infections and are not ad4unctive therap".There is no cure for =07A0D6.

+. Assessment of a pregnant woman and her fetus reveals tach"cardia and h"pertension. There is alsoevidence suggesting vasoconstriction. The nurse would uestion the woman about use of whichsubstance?

A


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childhood developmental conseuences. 82cessive weight gain, higher pain tolerance, and longergestational periods are not associated with substance abuse.

1(. A client who is =0;positive is in her second trimester and remains as"mptomatic. 6he voices concernabout her newborn-s ris for the infection. Which of the following statements b" the nurse would bemost appropriate?

A /ou-ll probabl" have a cesarean birth to prevent e2posing "our newborn./ /Antibodies cross the placenta and provide immunit" to the newborn./C /Wait until after the infant is born and then something can be done./D /Antiretroviral medications are available to help reduce the ris of transmission./

A56*DDrug therap" is the mainsta" of treatment for pregnant women infected with =0. The goal of therap"is to reduce the viral load as much as possible* this reduces the ris of transmission to the fetus.Decisions about the method of deliver" should be based on the woman-s viral load, duration of rupturedmembranes, progress of labor, and other pertinent clinical factors. The newborn is at ris for =0because of potential perinatal transmission. Waiting until after the infant is born ma" be too late.

11.When assessing a pregnant woman with heart disease throughout the antepartal period, the nurse wouldbe especiall" alert for signs and s"mptoms of cardiac decompensation at which time?

A 1) to $( wees- gestation $( to $% wees- gestationC $% to $+ wee-s gestation

D $+ to $ wee-s gestationA56*DA pregnant woman with heart disease is most vulnerable for cardiac decompensation from $+ to $wees- gestation.

1$. When preparing a schedule of follow;up visits for a pregnant woman with chronic h"pertension, whichof the following would be most appropriate?

A


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high;fiber foods.

1.3lace the mother in the supine position$.Document the findings and continue to monitor the fetal patterns.Administer o2"gen via face mas%.0ncrease the rate of pitocin 0 infusionAns>

Late decelerations are due to uteroplacental insufficienc" as the result of decreased blood flow ando2"gen to the fetus during the uterine contractions. This causes h"po2emia* therefore o2"gen isnecessar". The supine position is avoided because it decreases uterine blood flow to the fetus. Theclient should be turned to her side to displace pressure of the gravid uterus on the inferior vena cava.An intravenous pitocin infusion is discontinued when a late deceleration is noted.

1+. After spontaneous rupture of membranes, the nurse notices a prolapsed cord. The nurse immediatel"places the woman in which position?

A 6upine 6ide;l"ingC 6itting

D Gnee;chestA56*D3ressure on the cord needs to be relieved. Therefore, the nurse would position the woman in amodified 6ims, Trendelenburg, or nee;chest position. 6upine, side;l"ing, or sitting would not providerelief of cord compression.

1'. A primigravida whose labor was initiall" progressing normall" is now e2periencing a decrease in thefreuenc" and intensit" of her contractions. The nurse would assess the woman for which condition?

A A low;l"ing placenta


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Eetopelvic disproportionC Contraction ringD :terine bleedingA56*The woman is e2periencing d"stocia most liel" due to h"potonic uterine d"sfunction and fetopelvicdisproportion associated with a large fetus. A low;l"ing placenta, contraction ring, or uterine bleedingwould not be associated with a change in labor pattern.

$(. The nurse would be alert for possible placental abruption during labor when assessment reveals whichof the following?

A


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e2periencing less pain. 0mmediate cesarean birth is not indicated unless there is evidence of fetaldistress. F2"tocin would add to the woman-s alread" high level of pain.

$%. A woman gave birth to a newborn via vaginal deliver" with the use of a vacuum e2tractor. The nursewould be alert for which of the following in the newborn?

A Asph"2ia Clavicular fractureC Caput succedaneumD Central nervous s"stem in4ur"A56*C

:se of forceps or a vacuum e2tractor poses the ris of tissue trauma, such as ecch"moses, facial andscalp lacerations, facial nerve in4ur", cephalhematoma, and caput succedaneum. Asph"2ia ma" berelated to numerous causes but it is not associated with use of a vacuum e2tractor. Clavicular fractureis associated with shoulder d"stocia. Central nervous s"stem in4ur" is not associated with the use of avacuum e2tractor.

$&. A pregnant client undergoing labor induction is receiving an o2"tocin infusion. Which of the followingfindings would reuire immediate intervention?

A Eetal heart rate of 1&( beats7minute Contractions ever" $ minutes, lasting %& secondsC :terine resting tone of 1% mm =gD :rine output of $( mL7hour

A56*DF2"tocin can lead to water into2ication. Therefore, a urine output of $( mL7hour is below acceptablelimits of ( mL7hour and reuires intervention. E=B of 1&( beats7minute is within the accepted rangeof 1$( to 1)( beats7minutes. Contractions should occur ever" $ to minutes, lasting %( to )( seconds.A uterine resting tone greater than $( mm =g would reuire intervention.

$). A woman with a histor" of crac cocaine abuse is admitted to the labor and birth area. While caring forthe client, the nurse notes a sudden onset of fetal brad"cardia. 0nspection of the abdomen reveals anirregular wall contour. The client also complains of acute abdominal pain that is continuous. Which ofthe following would the nurse suspect?

A Amniotic fluid embolism 6houlder d"stocia

C :terine ruptureD :mbilical cord prolapseA56*C:terine rupture is associated with crac cocaine use, and generall" the first and most reliable sign issudden fetal distress accompanied b" acute abdominal pain, vaginal bleeding, hematuria, irregular wallcontour, and loss of station in the fetal presenting part. Amniotic fluid embolism often is manifestedwith a sudden onset of respirator" distress. 6houlder d"stocia is noted when continued fetal descent isobstructed after the fetal head is delivered. :mbilical cord prolapse is noted as the protrusion of thecord alongside or ahead of the presenting part of the fetus.

$@. When assessing several women for possible AC, which woman would the nurse identif" as being thebest candidate?

A Fne who has undergone a previous m"omectom" Fne who had a previous cesarean birth via a low transverse incisionC Fne who has a histor" of a contracted pelvisD Fne who has a vertical incision from a previous cesarean birthAC is an appropriate choice for women who have had a previous cesarean birth with a lowerabdominal transverse incision. 0t is contraindicated in women who have a prior classic uterine incision9vertical, prior transfundal surger", such as m"omectom", or a contracted pelvis.


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$+. A woman is to undergo an amnioinfusion. Which statement would be most appropriate to include whenteaching the woman about this procedure?

A /ou-ll need to sta" in bed while "ou-re having this procedure./ /We-ll give "ou an analgesic to help reduce the pain./C /After the infusion, "ou-ll be scheduled for a cesarean birth./D /A suction cup is placed on "our bab"-s head to help bring it out./A56*AAn amnioinfusion involves the instillation of a volume of warmed, sterile normal saline or Binger-slactate into the uterus via an intrauterine pressure catheter. The client must remain in bed during theprocedure. The use of analgesia is unrelated to this procedure. A cesarean birth is necessar" onl" if the

E=B does not improve after the amnioinfusion. Application of a suction cup to the head of the fetusrefers to a vacuum;assisted birth.

$'. Which finding would indicate to the nurse that a woman-s cervi2 is ripe in preparation for laborinduction?

A 3osterior position EirmC ClosedD 6hortenedA56*DA ripe cervi2 is shortened, centered 9anterior, softened, and partiall" dilated. An unripe cervi2 is long,closed, posterior, and firm.

(. A woman with preterm labor is receiving magnesium sulfate. Which finding would reuire the nurse tointervene immediatel"?

A Bespirator" rate of 1) breaths per minute Diminished deep tendon refle2esC :rine output of %& mL7hourD Alert level of consciousnessA56*Diminished deep tendon refle2es suggest magnesium to2icit", which reuires immediate intervention.Additional signs of magnesium to2icit" include a respirator" rate less than 1$ breaths7minute, urineoutput less than ( mL7hour, and a decreased level of consciousness.

1. A woman who is %$ wees pregnant comes to the clinic. Which of the following would be mostimportant?

A Determining an accurate gestational age Asing her about the occurrence of contractionsC Checing for spontaneous rupture of membranesD


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A56*T"picall", breast;feeding is initiated earl" as soon as possible after birth to promote bonding. Thewoman ma" need to use alternate positioning techniues to reduce incisional discomfort. 6plinting withpillows helps to reduce the discomfort associated with coughing. 8arl" ambulation is encouraged toprevent respirator" and cardiovascular problems and promote peristalsis. An indwelling urinar"catheter is t"picall" inserted to drain the bladder. 0t usuall" remains in place for appro2imatel" $%hours.

. A client arrives at a birthing center in active labor. =er membranes are still intact, and the nurse;midwife prepares to perform an amniotom". A nurse who is assisting the nurse;midwife e2plains to theclient that after this procedure, she will most liel" have>

1.Less pressure on her cervi2$.0ncreased efficienc" of contractions.Decreased number of contractions%.The need for increased maternal blood pressure monitoringAnswer> $

Amniotom" can be used to induce labor when the condition of the cervi2 is favorable 9ripe or toaugment labor if the process begins to slow. Bupturing of membranes allows the fetal head to contactthe cervi2 more directl" and ma" increase the efficienc" of contractions.

%. A nurse is monitoring a client in labor. The nurse suspects umbilical cord compression if which of thefollowing is noted on the e2ternal monitor tracing during a contraction?

1.8arl" decelerations$.ariable decelerations.Late decelerations%.6hort;term variabilit"Ans> $

ariable decelerations occur if the umbilical cord becomes compressed, thus reducing blood flowbetween the placenta and the fetus. 8arl" decelerations result from pressure on the fetal head duringa contraction. Late decelerations are an ominous pattern in labor because it suggests uteroplacentalinsufficienc" during a contraction. 6hort;term variabilit" refers to the beat;to;beat range in the fetalheart rate.

&. A primipara client gave birth vaginall" to a health" newborn girl 1$ hours ago. The nurse palpates theclient-s fundus, e2pecting it to be>

A Two fingerbreadths above the umbilicus At the level of the umbilicusC Two fingerbreadths below the umbilicusD Eour fingerbreadths below the umbilicusA56*During the first few da"s after birth, the uterus t"picall" descends downward from the level of theumbilicus at a rate of 1 cm 91 fingerbreadth per da" so that b" da"s, the fundus lies $ to fingerbreadths below the umbilicus.

). When caring for a mother who has had a cesarean birth, the nurse would e2pect the client-s lochia to

be>

A Hreater than after a vaginal deliver" About the same as after a vaginal deliver"C Less than after a vaginal deliver"D 6aturated with clots and mucusA56*CWomen who have had cesarean births tend to have less flow because the uterine debris is removedmanuall" along with deliver" of the placenta.


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@. The nurse is developing a teaching plan for a client who has decided to bottle feed her newborn.Which of the following would the nurse include in the teaching plan to facilitate suppression oflactation?

A 8ncouraging the woman to manuall" e2press mil 6uggesting that she tae freuent warm showers to soothe her breastsC Telling her to limit the amount of fluids that she drinsD 0nstructing her to appl" ice pacs to both breasts ever" other hourA56*D0f the woman is not breast;feeding, relief measures for engorgement include wearing a tight supportivebra $% hours dail", appl"ing ice to her breasts for appro2imatel" 1& to $( minutes ever" other hour, and

not stimulating her breasts b" suee!ing or manuall" e2pressing mil. Warm showers enhance the let;down refle2 and would be appropriate if the woman was breast;feeding. Limiting fluid intae isinappropriate. Eluid intae is important for all postpartum women, regardless of the feeding methodchosen.

+. The nurse is maing a follow;up home visit to a woman who is 1$ da"s postpartum. Which of thefollowing would the nurse e2pect to find when assessing the client-s fundus?

A Cannot be palpated $ cm below the umbilicusC ) cm below the umbilicusD 1( cm below the umbilicusA56*A

" the end of 1( da"s, the fundus usuall" cannot be palpated because it has descended into the truepelvis.

'. A client who is breast;feeding her newborn tells the nurse, /0 notice that when 0 feed him, 0 feel fairl"strong contraction;lie pain. Labor is over. Wh" am 0 having contractions now?/ Which response b" thenurse would be most appropriate?

A /our uterus is still shrining in si!e* that-s wh" "ou-re feeling this pain./ /Let me chec "our vaginal discharge 4ust to mae sure ever"thing is fine./C /our bod" is responding to the events of labor, 4ust lie after a tough worout./D /The bab"-s sucing releases a hormone that causes the uterus to contract./A56*DThe woman is describing afterpains, which are usuall" stronger during breast;feeding because o2"tocin

released b" the sucing refle2 strengthens uterine contractions. Afterpains are associated with uterineinvolution, but the woman-s description strongl" correlates with the hormonal events of breast;feeding.All women e2perience afterpains, but the" are more acute in multiparous women secondar" torepeated stretching of the uterine muscles.

%( When the nurse is assessing a postpartum client appro2imatel" ) hours after deliver", which findingwould warrant further investigation?

A Deep red, flesh";smelling lochia oiding of &( ccC =eart rate of 1$( beats7minuteD 3rofuse sweatingA56*C

Tach"cardia in the postpartum woman warrants further investigation. 0t ma" indicate h"povolemia,deh"dration, or hemorrhage. Deep red, flesh";smelling lochia is a normal finding ) hours postpartum.oiding in small amounts such as less than 1&( cc would indicate a problem, but &( cc would beappropriate. 3rofuse sweating also is normal during the postpartum period.

%1 A postpartum client who is bottle feeding her newborn ass, /When should m" period will return?/Which response b" the nurse would be most appropriate?

A /0t-s difficult to sa", but it will probabl" return in about $ to wees./ /0t varies, but "ou can estimate it returning in about @ to ' wees./


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C /ou won-t have to worr" about it returning for at least months./D /ou don-t have to worr" about that now. 0t-ll be uite a while./A56*Eor the nonlactating woman, menstruation resumes @ to ' wees after giving birth, with the first c"clebeing anovulator". Eor the lactating woman, menses can return an"time from $ to 1+ months afterchildbirth.

%$. The nurse interprets which of the following as evidence that a client is in the taing;in phase?

A Client states, /=e has m" e"es and nose./ Client shows interest in caring for the newborn.

C Client performs self;care independentl".D Client confidentl" cares for the newborn.A56*ADuring the taing;in phase, new mothers when interacting with their newborns spend time claiming thenewborn and touching him or her, commonl" identif"ing specific features in the newborn such as /hehas m" nose/ or /his fingers are long lie his father-s./ 0ndependence in self;care and interest in caringfor the newborn are t"pical of the taing;hold phase. Confidence in caring for the newborn isdemonstrated during the letting;go phase.

%. Which of the following would the nurse interpret as being least indicative of paternal engrossment?

A Demonstrating pleasure when touching or holding the newborn 0dentif"ing imperfections in the newborn-s appearance

C eing able to distinguish his newborn from others in the nurser"D 6howing feelings of pride with the birth of the newbornA56*0dentif"ing imperfections would not be associated with engrossment. 8ngrossment is characteri!ed b"seven behaviors> visual awareness of the newborn, tactile awareness of the newborn, perception of thenewborn as perfect, strong attraction to the newborn, awareness of distinct features of the newborn,e2treme elation, and increased sense of self;esteem.

%%. A postpartum client comes to the clinic for her );wee postpartum chec;up. When assessing theclient-s cervi2, the nurse would e2pect the e2ternal cervical os to appear>

A 6hapeless Circular

C TriangularD 6lit;lieA56*DThe e2ternal cervical os is no longer shaped lie a circle but instead appears as a 4agged slit;lieopening, often described as a /fish mouth./

%&. The nurse teaches a postpartum client how to do Gegel e2ercises for which reason?

A Beduce lochia 3romote uterine involutionC 0mprove pelvic floor toneD Alleviate perineal painA56*C

Gegel e2ercises help to improve pelvic floor tone, strengthen perineal muscles, and promote healing,ultimatel" helping to prevent urinar" incontinence later in life. Gegel e2ercises have no effect onlochia, involution, or pain.

%). A father of a newborn tells the nurse, /0 ma" not now ever"thing about being a dad, but 0-m going to dothe best 0 can for m" son./ The nurse interprets this as indicating the father is in which stage ofadaptation?

A 82pectations Transition to master"


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C Bealit"D Taing;inA56*The father-s statement reflects transition to master" because he is maing a conscious decision to taecontrol and be at the center of the newborn-s life regardless of his preparedness. The e2pectationsstage involves preconceptions about how life will be with a newborn. Bealit" occurs when fathersreali!e their e2pectations are not realistic. Taing;in is a phase of maternal adaptation.

%@. A postpartum client is e2periencing subinvolution. When reviewing the woman-s labor and birth histor",which of the following would the nurse identif" as being least significant to this condition?

A 8arl" ambulation 3rolonged laborC Large fetusD :se of anestheticsA56*AEactors that inhibit involution include prolonged labor and difficult birth, incomplete e2pulsion ofamniotic membranes and placenta, uterine infection, overdistention of uterine muscles 9such as b"multiple gestation, h"dramnios, or large singleton fetus, full bladder 9which displaces the uterus andinterferes with contractions, anesthesia 9which rela2es uterine muscles, and close childbirth spacing.Eactors that facilitate uterine involution include complete e2pulsion of amniotic membranes andplacenta at birth, complication;free labor and birth process, breast;feeding, and earl" ambulation.

%+. Which of the following would lead the nurse to suspect that a postpartum woman is having a problem?

A 8levated white blood cell count Acute decrease in hematocritC 0ncreased levels of clotting factorsD 3ulse rate of )( beats7minuteA56*Despite a decrease in blood volume after birth, hematocrit levels remain relativel" stable and ma"even increase. An acute decrease is not an e2pected finding.The WC count remains elevated for the first % to ) da"s and clotting factors remain elevated for $ to wees. rad"cardia 9&( to @( beats per minute for the first two wees reflects the decrease in cardiacoutput.

%'. A woman who gave birth $% hours ago tells the nurse, /0-ve been urinating so much over the past several

hours./ Which response b" the nurse would be most appropriate?

A /ou must have an infection, so let me get a urine specimen./ /our bod" is undergoing man" changes that cause "our bladder to fill uicl"./C /our uterus is not contracting as uicl" as it should./D /The anesthesia that "ou received is wearing off and "our bladder is woring again./A56*3ostpartum diuresis occurs as a result of several mechanisms> the large amounts of 0 fluids givenduring labor, a decreasing antidiuretic effect of o2"tocin as its level declines, the buildup and retentionof e2tra fluids during pregnanc", and a decreasing production of aldosteroneIthe hormone thatdecreases sodium retention and increases urine production. All these factors contribute to rapid fillingof the bladder within 1$ hours of birth. Diuresis begins within 1$ hours after childbirth and continuesthroughout the first wee postpartum.

&(. A woman who is 1$ hours postpartum had a pulse rate around +( beats per minute during pregnanc".5ow, the nurse finds a pulse of )( beats per minute. Which of these actions should the nurse tae?

A Document the finding, as it is a normal finding at this time. Contact the ph"sician, as it indicates earl" D0C.C Contact the ph"sician, as it is a first sign of postpartum eclampsia.D Fbtain an order for a CC, as it suggests postpartum anemia.


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A56*AAs a result of the changes in blood volume and cardiac output after deliver", relative brad"cardia ma"be noted. The woman-s pulse rate ma" range from &( to @( beats per minute.

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