OB Evolve Test 4

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1.A 40-year-old woman with a high body mass index (BMI) is 10 weeks
pregnant. Which diagnostic tool is appropriate to suggest to her at this time?
Biophysical profile
Amniocentesis
Maternal serum alpha-fetoprotein (MSAFP)
Transvaginal ultrasound Correct
An ultrasound is the method of biophysical assessment of the infant that is
performed at this gestational age. Transvaginal ultrasound is especially useful for
obese women, whose thick abdominal layers cannot be penetrated adequately with
the abdominal approach. A biophysical profile is a method of biophysical
assessment of fetal well-being in the third trimester. An amniocentesis is performed
after the fourteenth week of pregnancy. A MSAFP test is performed from week 15 to
week 22 of the gestation (weeks 16 to 18 are ideal).Awarded 0.0 points out of 1.0
possible points.
2.A nurse providing care for the antepartum woman should understand that
the contraction stress test (CST):
Sometimes uses vibroacoustic stimulation.
Is an invasive test; however, contractions are stimulated.
Is considered to have a negative result if no late decelerations are observed with
the contractions. Correct
Is more effective than nonstress test (NST) if the membranes have already been
ruptured.
No late decelerations indicate a positive CST result. Vibroacoustic stimulation
is sometimes used with NST. CST is invasive if stimulation is performed by IV
oxytocin but not if by nipple stimulation. CST is contraindicated if the membranes
have ruptured.Awarded 0.0 points out of 1.0 possible points.
3.In the past, factors to determine whether a woman was likely to have a high
risk pregnancy were evaluated primarily from a medical point of view. A broader,
more comprehensive approach to high risk pregnancy has been adopted. There are
now four categories based on threats to the health of the woman and the outcome
of pregnancy. Which of the options listed here is not included as a category?
Biophysical
Psychosocial
Geographic Correct
Environmental
The fourth category is correctly referred to as the sociodemographic risk
category. The factors stem from the mother and her family. Ethnicity may be one of
the risks to pregnancy; however, it is not the only factor in this category. Low
income, lack of prenatal care, age, parity, and marital status are included.
Biophysical is one of the broad categories used for determining risk. It includes
genetic considerations, nutritional status, and medical and obstetric disorders.
Psychosocial risks include smoking, caffeine, drugs, alcohol, and psychologic status.
All of these adverse lifestyles can have a negative effect on the health of the
mother or fetus. Environmental risks are those that can affect fertility and fetal
development. They include infections, chemicals, radiation, pesticides, illicit drugs,
and industrial pollutants.Awarded 0.0 points out of 1.0 possible points.
4.A woman who is at 36 weeks of gestation is having a nonstress test. Which
statement indicates her correct understanding of the test?
I will need to have a full bladder for the test to be done accurately.
I should have my husband drive me home after the test because I may be
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nauseated.
This test will help to determine whether the baby has Down syndrome or a neural
tube defect.
This test observes for fetal activity and an acceleration of the fetal heart rate to
determine the well-being of the baby. Correct
The nonstress test is one of the most widely used techniques to determine
fetal well-being and is accomplished by monitoring fetal heart rate in conjunction
with fetal activity and movements. An ultrasound requires a full bladder. An
amniocentesis is the test after which a pregnant woman should be driven home. A
maternal serum alpha-fetoprotein test is used in conjunction with unconjugated
estriol levels and human chorionic gonadotropin helps to detect Down syndrome.
Awarded 0.0 points out of 1.0 possible points.
5.What is an appropriate indicator for performing a contraction stress test?
Increased fetal movement and small for gestational age
Maternal diabetes mellitus and postmaturity Correct
Adolescent pregnancy and poor prenatal care
History of preterm labor and intrauterine growth restriction
Decreased fetal movement is an indicator for performing a contraction stress
test; the size (small for gestational age) is not an indicator. Although adolescent
pregnancy and poor prenatal care are risk factors for poor fetal outcomes, they are
not indicators for performing a contraction stress test. Intrauterine growth
restriction is an indicator; history of a previous stillbirth, not preterm labor, is
another indicator.Awarded 0.0 points out of 1.0 possible points.
6.The nurse sees a woman for the first time when she is 30 weeks pregnant.
The woman has smoked throughout the pregnancy, and fundal height
measurements now are suggestive of growth restriction in the fetus. In addition to
ultrasound to measure fetal size, what would be another tool useful in confirming
the diagnosis?
Doppler blood flow analysis Correct
Contraction stress test (CST)
Amniocentesis
Daily fetal movement counts
Doppler blood flow analysis allows the examiner to study the blood flow
noninvasively in the fetus and the placenta. It is a helpful tool in the management of
high risk pregnancy due to intrauterine growth restriction (IUGR), diabetes mellitus,
multiple fetuses, or preterm labor. Because of the potential risk of inducing labor
and causing fetal distress, a CST is not performed in a woman whose fetus is
preterm. Indications for an amniocentesis include diagnosis of genetic disorders or
congenital anomalies, assessment of pulmonary maturity, and the diagnosis of fetal
hemolytic disease, not IUGR. Fetal kick count monitoring is performed to monitor
the fetus in pregnancies complicated by conditions that may affect fetal
oxygenation. Although it may be a useful tool at some point later in this womans
pregnancy, it is not used to diagnose IUGR.Awarded 0.0 points out of 1.0 possible
points.
7.Nurses should be aware of the strengths and limitations of various
biochemical assessments during pregnancy, including that:
Chorionic villus sampling (CVS) is becoming more popular because it provides early
diagnosis.
Screening for maternal serum alpha-fetoprotein (MSAFP) levels is recommended
only for women at risk for neural tube defects.
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Percutaneous umbilical blood sampling (PUBS) is one of the quad-screen tests for
Down syndrome.
MSAFP is a screening tool only; it identifies candidates for more definitive
procedures. Correct
CVS does provide a rapid result, but it is declining in popularity because of
advances in noninvasive screening techniques. MSAFP screening is recommended
for all pregnant women. MSAFP, not PUBS, is part of the quad-screen tests for Down
syndrome. MSAFP is a screening tool, not a diagnostic tool. Further diagnostic
testing is indicated after an abnormal result.Awarded 0.0 points out of 1.0 possible
points.
8.When would the best timeframe be to establish gestational age based on
ultrasound?
At term
8 weeks
Between 14 and 22 weeks Correct
36 weeks
Ultrasound determination of gestational age dating is best done between 14
and 22 weeks. It is less reliable after that period because of variability in fetal size.
Standard sets of measurements relative to gestational age are noted around 10 to
after 12 weeks and include crown-rump length (after 10), biparietal diameter (after
12), femur length, and head and abdominal circumferences.Awarded 0.0 points out
of 1.0 possible points.
9.A nurse is providing instruction for an obstetrical patient to perform a daily
fetal movement count (DFMC). Which instructions could be included in the plan of
care? (Select all that apply.)
The fetal alarm signal is reached when there are no fetal movements noted for 5
hours.
The patient can monitor fetal activity once daily for a 60-minute period and note
activity. Correct
Monitor fetal activity two times a day either after meals or before bed for a period of
2 hours or until 10 fetal movements are noted. Correct
Count all fetal movements in a 12-hour period daily until 10 fetal movements are
noted. Correct
The fetal alarm signal is reached when no fetal movements are noted for a
period of 12 hours.Awarded 0.0 points out of 1.0 possible points.
10.A patient has undergone an amniocentesis for evaluation of fetal wellbeing. Which intervention would be included in the nurses plan of care after the
procedure? (Select all that apply.)
Perform ultrasound to determine fetal positioning.
Observe the patient for possible uterine contractions. Correct
Administer RhoGAM to the patient if she is Rh negative. Correct
Perform a minicatheterization to obtain a urine specimen to assess for bleeding.
Ultrasound is used prior to the procedure as a visualization aid to assist
with insertion of transabdominal needle. There is no need to assess the urine for
bleeding as this is not considered to be a typical presentation or complication.
Chapter 27
1.A woman with severe preeclampsia is receiving a magnesium sulfate
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infusion. The nurse becomes concerned after assessment when the woman exhibits:
A sleepy, sedated affect.
A respiratory rate of 10 breaths/min. Correct
Deep tendon reflexes of 2+.
Absence of ankle clonus.
A respiratory rate of 10 breaths/min indicates that the client is experiencing
respiratory depression (bradypnea) from magnesium toxicity. Because magnesium
sulfate is a central nervous system (CNS) depressant, the client will most likely
become sedated when the infusion is initiated. Deep tendon reflexes of 2+ are a
normal finding, as is absence of ankle clonus.Awarded 0.0 points out of 1.0 possible
points.
2.A nurse caring for pregnant women must be aware that the most common
medical complication of pregnancy is:
Hypertension. Correct
Hyperemesis gravidarum.
Hemorrhagic complications.
Infections.
Preeclampsia and eclampsia are two noted, deadly forms of hypertension,
which is the most common medical complication of pregnancy. A large percentage
of pregnant women have nausea and vomiting, but a relative few have the severe
form called hyperemesis gravidarum. Hemorrhagic complications are the second
most common medical complication of pregnancy.Awarded 0.0 points out of 1.0
possible points.
3.With regard to preeclampsia and eclampsia, nurses should be aware that:
Preeclampsia is a condition of the first trimester; eclampsia is a condition of the
second and third trimesters.
Preeclampsia results in decreased function in such organs as the placenta, kidneys,
liver, and brain. Correct
The causes of preeclampsia and eclampsia are well documented.
Severe preeclampsia is defined as preeclampsia plus proteinuria.
Vasospasms diminish the diameter of blood vessels, which impedes blood
flow to all organs. Preeclampsia occurs after week 20 of gestation and can run the
duration of the pregnancy. The causes of preeclampsia and eclampsia are unknown,
although several have been suggested. Preeclampsia includes proteinuria; severe
cases are characterized by greater proteinuria or any of nine other conditions.
4.A woman with severe preeclampsia is being treated with an IV infusion of
magnesium sulfate. This treatment is considered successful if:
Blood pressure is reduced to prepregnant baseline.
Seizures do not occur. Correct
Deep tendon reflexes become hypotonic.
Diuresis reduces fluid retention.
Magnesium sulfate is a central nervous system (CNS) depressant given
primarily to prevent seizures. A temporary decrease in blood pressure can occur but
is not the purpose of administering this medication. Hypotonia is a sign of an
excessive serum level of magnesium. It is critical that calcium gluconate be on hand
to counteract the depressant effects of magnesium toxicity. Diuresis is not an
expected outcome of magnesium sulfate administration.Awarded 0.0 points out of
1.0 possible points.
5.A woman with severe preeclampsia has been receiving magnesium sulfate
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by IV infusion for 8 hours. The nurse assesses the woman and documents the
following findings: temperature 37.1 C, pulse rate 96 beats/min, respiratory rate 24
breaths/min, blood pressure 155/112 mm Hg, 3+ deep tendon reflexes, and no
ankle clonus. The nurse calls the physician, anticipating an order for:
Hydralazine. Correct
Magnesium sulfate bolus.
Diazepam.
Calcium gluconate.
Hydralazine is an antihypertensive commonly used to treat hypertension in
severe preeclampsia. An additional bolus of magnesium sulfate may be ordered for
increasing signs of central nervous system irritability related to severe preeclampsia
(e.g., clonus) or if eclampsia develops. Diazepam sometimes is used to stop or
shorten eclamptic seizures. Calcium gluconate is used as the antidote for
magnesium sulfate toxicity. The client is not currently displaying any signs or
symptoms of magnesium toxicity.Awarded 0.0 points out of 1.0 possible points.
6.Nurses should be aware that HELLP syndrome:
Is a mild form of preeclampsia.
Can be diagnosed by a nurse alert to its symptoms.
Is characterized by hemolysis, elevated liver enzymes, and low platelets. Correct
Is associated with preterm labor but not perinatal mortality.
The acronym HELLP stands for hemolysis (H), elevated liver enzymes (EL),
and low platelets (LP). HELLP syndrome is a variant of severe preeclampsia. It is
difficult to identify, because the symptoms often are not obvious. It must be
diagnosed in the laboratory. Preterm labor is greatly increased with HELLP
syndrome, and so is perinatal mortality.Awarded 0.0 points out of 1.0 possible
points.
7.A pregnant woman who is at 18 weeks of gestation has an elevated blood
pressure of 140/98. Past medical history reveals that the woman has been treated
for hypertension. On the basis of this information, the nurse would classify this
patient as having:
Preeclampsia.
Gestational hypertension.
Superimposed preeclampsia. Correct
Chronic hypertension.
Because this patient already has a medical history of hypertension and is now
exhibiting hypertension prior to the 20th week of gestation, she would be
considered to have superimposed preeclampsia. Preeclampsia would be the
classification in a patient without a history of hypertension who was hypertensive
following the 20th week of pregnancy. Gestational hypertension occurs after the
20th week of pregnancy in a patient who was previously normotensive. Even though
the patient has chronic hypertension, the fact that she is now pregnant determines
that she would be classified as having superimposed preeclampsia.Awarded 0.0
points out of 1.0 possible points.
8.A nurse is monitoring a patients reflexes (DTRs) while receiving
magnesium sulfate therapy for treatment of preeclampsia. Which assessment
finding indicates a cause for concern?
Bilateral DTRs noted at 2+
DTRs response has been noted at 1+ since onset of therapy
Positive clonus response elicited unilaterally Correct
Patient reports no pain upon examination of DTRs by nurse
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Positive clonus response elicited unilaterally is a cause for concern as it

suggests a hyperactive response. Typically, there is no pain associated with
determination of DTRs so this finding would be considered to be normal, as would
bilateral DTRs noted at 2+.
Even though DTRs at 1+ indicate a sluggish or decreased response, this
finding is unchanged since the initiation of therapy. The nurse would continue to
monitor.Awarded 0.0 points out of 1.0 possible points.
9.Which of the following antihypertensive medications would cause a
pregnant woman to have a positive Coombs test result?
Nifedipine (Procardia)
Methyldopa (Aldomet) Correct
Labetalol hydrochloride (Trandate)
Hydralazine (Apresoline)
A positive Coombs test result can occur in about 20% of patients taking
methyldopa (Aldomet). None of the other drugs listed would have this effect.
10.Which laboratory values would be found in a patient diagnosed with
preeclampsia? (Select all that apply.)
Hemoglobin 8g/dL
Platelet count of 75,000 Correct
LDH 100 units/L Correct
Burr cells
BUN 25 mg/dL Correct
Thrombocytopenia below 100,000, an increase in LDH, and an increase in
BUN would be noted. Hemoglobin levels would be increased, but 8 g/dL reflects a
decreased level.
Burr cells would not be present in preeclampsia but would in HELLP
syndrome.Awarded 0.0 points out of 1.0 possible points.
Chapter 28
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1.A woman presents to the emergency department complaining of bleeding

and cramping. The initial nursing history is significant for a last menstrual period 6
weeks ago. On sterile speculum examination, the primary health care provider finds
that the cervix is closed. The anticipated plan of care for this woman is based on a
probable diagnosis of which type of spontaneous abortion?
Incomplete
Inevitable
Threatened Correct
Septic
A woman with a threatened abortion presents with spotting, mild cramps, and
no cervical dilation. Heavy bleeding, mild to severe cramping, and cervical dilation
are the presentation for both incomplete abortion and inevitable abortion. A woman
with a septic abortion presents with malodorous bleeding and, typically, a dilated
cervix.Awarded 0.0 points out of 1.0 possible points.
2.The most prevalent clinical manifestation of abruptio placentae (as opposed
to placenta previa) is:
Bleeding.
Intense abdominal pain. Correct
Uterine activity.
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Cramping.
Pain is absent with placenta previa and may be agonizing with abruptio
placentae. Bleeding, uterine activity, and cramping may be present in varying
degrees for both placental conditions.Awarded 0.0 points out of 1.0 possible points.
3.A woman at 39 weeks of gestation with a history of preeclampsia is
admitted to the labor and birth unit. She suddenly experiences increased
contraction frequency to every 1 to 2 minutes; dark red vaginal bleeding; and a
tense, painful abdomen. The nurse suspects the onset of:
Eclamptic seizure.
Rupture of the uterus.
Placenta previa.
Placental abruption. Correct
Uterine tenderness in the presence of increasing tone may be the earliest
finding of premature separation of the placenta (abruptio placentae or placental
abruption). Women with hypertension are at increased risk for an abruption.
Eclamptic seizures are evidenced by the presence of generalized tonic-clonic
convulsions. Uterine rupture manifests with hypotonic uterine activity, signs of
hypovolemia, and in many cases the absence of pain, and placenta previa with
bright red, painless vaginal bleeding.Awarded 0.0 points out of 1.0 possible points.
4.In caring for the woman with disseminated intravascular coagulation (DIC),
what order should the nurse anticipate?
Administration of blood Correct
Preparation of the woman for invasive hemodynamic monitoring
Restriction of intravascular fluids
Administration of steroids
Primary medical management in all cases of DIC involves correction of the
underlying cause, volume replacement (not volume restriction), blood component
therapy, optimization of oxygenation and perfusion status, and continued
reassessment of laboratory parameters. Central monitoring would not be ordered
initially in a woman with DIC because it could contribute to more areas of bleeding.
Steroids are not indicated for the management of DIC.Awarded 0.0 points out of 1.0
possible points.
5.Signs of a threatened abortion (miscarriage) are noted in a woman at 8
weeks of gestation. What is an appropriate management approach for this type of
abortion?
Prepare the woman for a dilation and curettage (D&C).
Put the woman on bed rest for at least 1 week and reevaluate.
Prepare the woman for an ultrasound and blood work. Correct
Comfort the woman by telling her that if she loses this baby, she may attempt to
get pregnant again in 1 month.
Repetitive transvaginal ultrasounds and measurement of human chorionic
gonadotropin (hCG) and progesterone levels may be performed to determine
whether the fetus is alive and within the uterus. Bed rest is recommended for 48
hours initially. D&C is not considered until signs of the progress to inevitable
abortion are noted or the contents are expelled and incomplete. If the pregnancy is
lost, the woman should be guided through the grieving process. Telling the client
that she can get pregnant again soon is not a therapeutic response because it
discounts the importance of this pregnancy.Awarded 0.0 points out of 1.0 possible
points.
6.ID: 3790798609A woman diagnosed with marginal placenta previa gave
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birth vaginally 15 minutes ago. At present she is at the greatest risk for:
Hemorrhage. Correct
Infection.
Urinary retention.
Thrombophlebitis.
Hemorrhage is the most immediate risk because the lower uterine segment
has limited ability to contract to reduce blood loss. Infection is a risk because of the
location of the placental attachment site; however, it is not a priority concern at this
time. Placenta previa poses no greater risk for urinary retention or thrombophlebitis
than does a normally implanted placenta.Awarded 0.0 points out of 1.0 possible
points.
7.A nurse is evaluating several obstetric patients for their risk for cervical
insufficiency. Which patient would be considered to be most at risk?
Primipara
Grandmultip who has previously had all vaginal deliveries without a problem
Primip who undergoes a cervical cone biopsy for cervical dysplasia prior to the
pregnancy Correct
Multip who had her previous delivery via C section due to cephalopelvic
disproportion (CPD)
Any patient who has had previous surgical interventions (cone biopsy) is at
greater risk for cervical insufficiency. There is no indication that a primip is at risk
for cervical insufficiency. A grandmultip who has previously had vaginal deliveries
without incidence is not necessarily at an increased risk for cervical insufficiency. A
multip who has delivered via C section as a result of CPD would not necessarily be
at an increased risk as the issue involves pelvic adequacy as determined by pelvic
measurements in relationship to the fetus.Awarded 0.0 points out of 1.0 possible
points.
8.The majority of ectopic pregnancies are located in the:
Uterine fundus.
Cervical os.
Ampulla. Correct
Fimbriae.
A pregnancy within the uterus would be considered a normal pregnancy.
Implantation of the pregnancy at the cervical os would be a significant abnormality.
The majority of ectopic pregnancies, approximately 80%, are located in the ampulla
or largest portion of the tube.Awarded 0.0 points out of 1.0 possible points.
9.A nurse is examining a patient who has been admitted for possible ectopic
pregnancy who is approximately 8 weeks pregnant. Which finding would be a
priority concern?
No FHT heard via Doppler
Scant vaginal bleeding noted on peri pad
Ecchymosis noted around umbilicus Correct
Blood pressure 100/80
Because this patient is most likely in the early stages of pregnancy, FHT
would not be able to be auscultated at this time. Scant vaginal bleeding would not
be a priority concern but should still be monitored by the nurse. Ecchymosis around
the umbilicus indicates Cullen sign, which indicates hematoperitoneum, and may
also develop in an undiagnosed, ruptured intraabdominal ectopic pregnancy.
10.Which of the following presentations is associated with early pregnancy
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loss, occurring in less than 12 weeks gestation? (Select all that apply.)
Chromosomal abnormalities Correct
Infection
Cystitis
Antiphospholipid syndrome Correct
Hypothyroidism Correct
Caffeine use
50% of early pregnancy loss results from genetic abnormalities.
Hypothyroidism and antiphospholipid syndrome are associated with early pregnancy
loss. Caffeine use is associated with second-trimester losses as a result of maternal
behavior. Infection is not a likely source of early pregnancy loss. Cystitis in not
associated with early pregnancy loss.Awarded 0.0 points out of 1.0 possible points.
Chapter 29
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1.In planning for the care of a 30-year-old woman with pregestational

diabetes, the nurse recognizes that the most important factor affecting pregnancy
outcome is the:
Mothers age.
Number of years since diabetes was diagnosed.
Amount of insulin required prenatally.
Degree of glycemic control during pregnancy. Correct
Women with excellent glucose control and no blood vessel disease should
have good pregnancy outcomes. Although advanced maternal age may pose some
health risks, the most important factor for the woman with pregestational diabetes
remains the degree of glycemic control during pregnancy. The number of years
since diagnosis and the amount of insulin required are not as relevant to outcomes
as the degree of glycemic control.Awarded 0.0 points out of 1.0 possible points.
2.Diabetes in pregnancy puts the fetus at risk in several ways. Nurses should
be aware that:
With good control of maternal glucose levels, sudden and unexplained stillbirth is no
longer a major concern.
The most important cause of perinatal loss in diabetic pregnancy is congenital
malformations. Correct
Infants of mothers with diabetes have the same risks for respiratory distress
syndrome because of the careful monitoring.
At birth, the neonate of a diabetic mother is no longer in any greater risk.
Congenital malformations account for 30% to 50% of perinatal deaths in
diabetic pregnancies. Even with good control, sudden and unexplained stillbirth
remains a major concern. Infants of diabetic mothers are at increased risk for
respiratory distress syndrome, and the transition to extrauterine life is often marked
by hypoglycemia and other metabolic abnormalities.Awarded 0.0 points out of 1.0
possible points.
3.A pregnant woman at 28 weeks of gestation has been diagnosed with
gestational diabetes. The nurse caring for this client understands that:
Oral hypoglycemic agents can be used if the woman is reluctant to give herself
insulin.
Dietary modifications and insulin are both required for adequate treatment.
Glucose levels are monitored by testing urine four times a day and at bedtime.
Dietary management involves distributing nutrient requirements over three meals
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and two or three snacks. Correct

Small frequent meals over a 24-hour period help decrease the risk for
hypoglycemia and ketoacidosis. In some women gestational diabetes can be
controlled with dietary modifications alone. Blood, not urine, glucose levels are
monitored several times a day. Urine is tested for ketone content; results should be
negative.
Oral hypoglycemic agents can be harmful to the fetus and less effective than
insulin in achieving tight glucose control.Awarded 0.0 points out of 1.0 possible
points.
4.Which of the following findings is not likely to be seen in a pregnant patient
who has hypothyroidism?
Miscarriage
Macrosomia Correct
Gestational hypertension
Placental abruption
Infants born to mothers with hypothyroidism are more likely to be of low birth
weight or preterm; these outcomes can be improved with early diagnosis and
treatment. Hypothyroidism is often associated with both infertility and an increased
risk of miscarriage. Pregnant women with hypothyroidism are more likely to
experience both preeclampsia and gestational hypertension. Placental abruption
and stillbirth are risks associated with hypothyroidism.Awarded 0.0 points out of 1.0
possible points.
5.A pregnant woman at 14 weeks of gestation is admitted to the hospital with
a diagnosis of hyperemesis gravidarum. The primary goal of her treatment at this
time is to:
Rest the gastrointestinal (GI) tract by restricting all oral intake for 48 hours.
Reduce emotional distress by encouraging the woman to discuss her feelings.
Reverse fluid, electrolyte, and acid-base imbalances. Correct
Restore the womans ability to take and retain oral fluid and foods.
Fluid, electrolyte, and acid-base imbalances present the greatest immediate
danger to the well-being of the mother and fetus and should be corrected as soon
as possible. Resting the GI tract and discussing her feelings are components of
treatment but are not immediate goals for this client. The ability to retain oral fluid
and foods is a longer-term goal of treatment for this condition.Awarded 0.0 points
out of 1.0 possible points.
6.A patient who is pregnant already has Type 2 diabetes with a hemoglobin
A1c value of 7. The nurse would categorize this patient as having:
Gestational diabetes.
Insulin-dependent diabetes complicated by pregnancy.
Pregestational diabetes mellitus. Correct
Noninsulin-dependent diabetes with complications.
Pregestational diabetes mellitus is a term used to describe patients with type
1 or type 2 diabetes in whom diabetes existed prior to pregnancy. Gestational
diabetes occurs when a woman becomes diabetic during the pregnancy state. Type
2 diabetes is noninsulin-dependent. None of the information presented indicates
complications at this point, because the hemoglobin A1c is within normal range,
signifying adequate glycemic control.Awarded 0.0 points out of 1.0 possible points.
7.The priority assessment in evaluating a pregnant woman with severe
nausea and vomiting is:
Fasting blood glucose level.
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Ketonuria. Correct
Bilirubin.
White blood cell count.
Determination of ketonuria would be a critical assessment that would lead
towards determination of hyperemesis. A pregnant patient with severe nausea and
vomiting may have hyperemesis gravidarum and as such requires critical
monitoring to determine the nature of the problem. An FBS measurement, although
informative, would not be the priority assessment at this time, nor would a bilirubin
measurement. A WBC count would indicate the possibility of an infectious source
but it would not be a priority assessment in terms of the patients presentation.
8.A pregnant woman has maternal phenylketonuria (PKU) and is interested in
whether or not she will be able to breastfeed her baby. Which reaction by the nurse
indicates accurate information?
The patient can breastfeed the baby as long as she continues to maintain a PKUrestricted diet.
The patient should alternate breastfeeding with bottle feeding in order to reduce
PKU levels provided to the baby.
The patient should be advised to not breastfeed the infant because her breast milk
will contain large amounts of phenylalanine. Correct
The patient can breastfeed for the first 3 months without any untoward effects on
the infant.
Breastfeeding is not advised for a patient who has maternal PKU, because
phenylalanine levels are high in such a patients breast milk. Dietary restriction will
not limit the amount of this substance in breast milk. Alternating feeding sources is
not advised either.Awarded 0.0 points out of 1.0 possible points.
9.A nurse is working with a diabetic patient who recently found out she is
pregnant. In coordinating an interdisciplinary team to help manage the patient
throughout the pregnancy, the nurse would include: (Select all that apply.)
Family practice physician
Dietician Correct
Perinatologist Correct
Occupational therapist
Nephrologist Correct
Speech therapist
An internal medicine practitioner rather than family practice physician would
be included on the interdisciplinary care team. A dietician would be included to help
the patient with dietary planning, a perinatologist to take care of the maternal-fetal
unit, and a nephrologist to monitor renal function. There is no need for an
occupational therapist or a speech therapist unless other issues arise.Awarded 0.0
10.A pregnant patient experiences thyroid storm following delivery of her
infant. What interventions would the nurse anticipate to be ordered by the
physician? (Select all that apply.)
Restriction of intravenous fluids to prevent fluid overload
Administration of oxygen Correct
Antipyretics Correct
Synthroid
PTU Correct
Oxygen would be provided, antipyretics would be given to reduce

fever, and PTU would be administered. IV fluids would be administered to the
patient in order to reverse the hypotension that the patient would be experiencing.
Synthroid would not be given because it is used to treat hypothyroidism, and with
thyroid storm, the patient is suffering from hyperthyroidism.Awarded 0.0 points out
Chapter 30
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D
1.Appendicitis is more difficult to diagnose during pregnancy because the

appendix is:
Covered by the uterus.
Displaced to the left.
Low and to the right.
High and to the right. Correct
The appendix is not hidden by the uterus; rather, it is pushed upward and to
the right from its usual anatomic location, making diagnosis of appendicitis difficult.
2.A nurse is caring for a woman with mitral stenosis who is in the active stage
of labor. Which action should the nurse take to promote cardiac function?
Maintain the woman in a side-lying position with the head and shoulders elevated to
facilitate hemodynamics. Correct
Prepare the woman for delivery by cesarean section because this is the
recommended delivery method to sustain hemodynamics.
Encourage the woman to avoid the use of narcotics or epidural regional analgesia
because these measures alter cardiac function.
Promote the use of the Valsalva maneuver during pushing in the second stage to
improve diastolic ventricular filling.
The side-lying position with the head and shoulders elevated helps facilitate
hemodynamics during labor. A vaginal delivery is the preferred method for a woman
with cardiac disease because it sustains hemodynamics better than a cesarean
section. The use of supportive care, medication, and narcotics or epidural regional
analgesia is not contraindicated for a woman with heart disease. Using the Valsalva
maneuver during pushing in the second stage should be avoided because it reduces
diastolic ventricular filling and obstructs left ventricular outflow.Awarded 0.0 points
3.During a physical assessment of an at-risk client, the nurse notes
generalized edema, crackles at the bases of the lungs, and some pulse irregularity.
These are most likely signs of:
Euglycemia.
Rheumatic fever.
Pneumonia.
Cardiac decompensation. Correct
Symptoms of cardiac decompensation may appear abruptly or gradually.
Euglycemia is a condition of normal glucose levels. Rheumatic fever can cause
heart problems, but it does not manifest with these symptoms. Pneumonia is an
inflammation of the lungs and would not likely generate these symptoms.Awarded
0.0 points out of 1.0 possible points.
4.Thalassemia is a relatively common anemia in which:
An insufficient amount of hemoglobin is produced to fill the red blood cells (RBCs).
B
C
D
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B
C
D
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B
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D
A
B
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B
Correct
RBCs have a normal life span but are sickled in shape.
Folate deficiency occurs.
There are inadequate levels of vitamin B12.
Thalassemia is a hereditary disorder that involves the abnormal synthesis of
the alpha or beta chains of hemoglobin. An insufficient amount of hemoglobin is
produced to fill the RBCs. The statement in B is the underlying description for sickle
cell anemia. Folate deficiency is the most common cause of megaloblastic anemias
during pregnancy. Deficiency of vitamin B12 must also be considered if the pregnant
woman presents with anemia.Awarded 0.0 points out of 1.0 possible points.
5.The severity of symptoms associated with asthma during pregnancy usually
peaks:
In the first trimester.
Between 17 and 24 weeks of gestation. Correct
During the last 4 weeks of pregnancy.
Immediately postpartum.
The severity of asthma symptoms peaks between 17 and 24 weeks of
gestation. Asthma appears to be associated with intrauterine growth restriction and
preterm birth. Women often have few symptoms of asthma during the first
trimester, and during the last 4 weeks of pregnancy, symptoms often subside.
Issues have often resolved by the time the woman delivers.Awarded 0.0 points out
6.A pregnant woman with cardiac disease is informed about signs of cardiac
decompensation. She should be told that the earliest sign of decompensation is
most often:
Orthopnea.
Decreasing energy levels. Correct
Moist frequent cough and frothy sputum.
Crackles (rales) at the bases of the lungs on auscultation.
Decreasing energy level (fatigue) is an early finding in heart failure. Care
must be taken to recognize it as a warning rather than a typical change of the third
trimester. Cardiac decompensation is most likely to occur early in the third
trimester, during childbirth, or during the first 48 hours following birth. Orthopnea,
moist frequent cough, and crackles and rales appear later, when a failing heart
reduces renal perfusion and fluid accumulates in the pulmonary interstitial space,
leading to pulmonary edema.Awarded 0.0 points out of 1.0 possible points.
7.A patient who has cystic fibrosis (CF) is pregnant. Which weight gain
recommendation should be given her?
The amount of weight is not as important as maintaining a well-balanced diet.
Between 30 and 35 pounds
Approximately 25 pounds Correct
Between 10 and 20 pounds
Recommendations for weight gain during pregnancy in a patient with CF
range between 24 and 26 pounds. A well-balanced diet is important, but the patient
with CF is encouraged to be at 90% of her IBW prior to pregnancy.Awarded 0.0
8.Which clinical factor could be associated with the development of adult
respiratory distress syndrome (ARDS) during pregnancy?
Pitocin induction
Cholecystitis
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B
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B
C
D
E
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B
C
D
A
B
Hyperemesis gravidarum
Magnesium sulfate Correct
The use of tocolytics, such as magnesium sulfate, can be associated with the
development of ARDS. Pitocin induction, cholecystitis, and hyperemesis gravidarum
are not associated with ARDS.Awarded 0.0 points out of 1.0 possible points.
9.A patient who is pregnant also has a history of psoriasis. What information
can the nurse provide to the patient relative to this disease process?
Pregnancy has no effect on psoriasis.
As long as the patient stays out of direct sunlight, there will be no progression of
disease.
Psoriasis typically worsens during pregnancy in approximately 50% of patients.
Patients who have psoriasis during pregnancy experience a varied response.
Correct
Psoriasis responds variably to pregnancy; in some women there is no change,
in some the disease gets better, and in about 20% of women it gets worse. There is
no direct correlation between sunlight and psoriasis.Awarded 0.0 points out of 1.0
possible points.
10.A pregnant woman with cystic fibrosis (CF) wants to breastfeed her infant.
Which assessments would have to be performed in order to make sure that the
breastfeedings were safe and effective? (Select all that apply.)
Monitor maternal weight
Monitor maternal urine for ketones
Monitor sodium levels in breast milk Correct
Monitor total fat levels in breast milk Correct
Monitor infant growth pattern Correct
Breast milk should be monitored for sodium, total fat, and chloride
levels in order to establish its safety. Monitoring of the infants growth pattern would
provide evidence that breastfeeding is adequate. Maternal weight monitoring and
urinalysis would not be indicated with regard to the safety of breastfeeding in this
case.Awarded 0.0 points out of 1.0 possible points.
Chapter 31
1.Which opiate causes euphoria, relaxation, drowsiness, and detachment
from reality and has possible effects on the pregnancy, including preeclampsia,
intrauterine growth restriction, and premature rupture of membranes?
Heroin Correct
Alcohol
Phencyclidine palmitate (PCP)
Cocaine
The opiates include opium, heroin, meperidine, morphine, codeine, and
methadone. The signs and symptoms of heroin use are euphoria, relaxation, relief
from pain, detachment from reality, impaired judgment, drowsiness, constricted
pupils, nausea, constipation, slurred speech, and respiratory depression. Possible
effects on pregnancy include preeclampsia, intrauterine growth restriction,
miscarriage, premature rupture of membranes, infections, breech presentation, and
preterm labor. Alcohol, PCP, and cocaine are not opiates.Awarded 0.0 points out of
2.During pregnancy, alcohol withdrawal may be treated using:
Disulfiram (Antabuse).
Corticosteroids.
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D
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B
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D
A
B
C
D
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B
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D
A
B
Benzodiazepines. Correct
Aminophylline.
Symptoms that occur during alcohol withdrawal can be managed with shortacting barbiturates or benzodiazepines. Disulfiram is contraindicated in pregnancy
because it is teratogenic. Corticosteroids and aminophylline are not used to treat
alcohol withdrawal.Awarded 0.0 points out of 1.0 possible points.
3.To provide adequate postpartum care, the nurse should be aware that
postpartum depression (PPD) with psychotic features:
Is more likely to occur in women with more than two children.
Is rarely delusional and is usually about someone trying to harm her (the mother).
Although serious, is not likely to need psychiatric hospitalization.
Is typified by auditory or visual hallucinations. Correct
Hallucinations are present in 25% of women with this disorder; paranoid or
grandiose delusions (present in 50%), elements of delirium or disorientation, and
extreme deficits in judgment accompanied by high levels of impulsivity may
contribute to risks of suicide or infanticide. PPD is more likely to occur in first-time
mothers. PPD with psychosis is a psychiatric emergency that requires
hospitalization.Awarded 0.0 points out of 1.0 possible points.
4.Nurses must be cognizant of the growing problem of methamphetamine
use during pregnancy. When caring for a woman who uses methamphetamines, it is
important for the nurse to be aware of which factor related to the abuse of this
substance?
Methamphetamine is a depressant.
All methamphetamines are vasodilators.
Methamphetamine users are extremely psychologically addicted. Correct
Rehabilitation is usually successful.
Meth users are extremely psychologically addicted. Typically these women
display poor control over their behavior and a low threshold for pain. This substance
is relatively inexpensive and easy to obtain. Methamphetamine is a stimulant and a
vasoconstrictor. The rate of relapse for methamphetamine users is very high.
5.Screening questions for alcohol and drug abuse should be included in the
overall assessment during the first prenatal visit for all women. The 4 Ps-Plus is a
screening tool designed specifically to identify when there is a need for a more indepth assessment. Which of the following is not included in the 4 Ps-Plus screening
tool?
Present Correct
Partner
Past
Pregnancy
The first P is Parents: The woman should be asked, Did either of your parents
have a problem with alcohol or drugs? The second P is Partner: Does your partner
have a problem with alcohol or drugs? The third P is Past: Have you ever had any
beer, wine, or liquor? The fourth P is Pregnancy: In the month before you knew
you were pregnant, how many cigarettes did you smoke? How much beer, wine, or
liquor did you drink?Awarded 0.0 points out of 1.0 possible points.
6.The 5 As screening intervention tool is used to implement smoking
cessation strategies on the basis of patient response. What do the 5 As stand for?
Ask, advise, administer, approve, and admit
Ask, assess, advise, assist, and arrange follow-up Correct
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Assess, assist, advise, apply, and arrange

Assess, apply, advise, ask, and arrange follow-up
The 5 As stand for ask, assess, advise, assist, and arrange follow-up.Awarded
7.Which of these medications would be classified as a Category X substance
that is not to be used during pregnancy?
Lorazepam (Ativan)
Alprazolam (Xanax)
Chlordiazepoxide (Librium)
Temazepam (Restoril) Correct
Restoril is classified as a Category X drug and is contraindicated during
pregnancy on the basis of clinical studies. Ativan, Xanax, and Librium are classified
as Category D drugs and as such would not be given during pregnancy unless a
benefits to risks ratio was established.Awarded 0.0 points out of 1.0 possible points.
8.A nurse is advising a pregnant patient who has a substance abuse problem
about a contingency management program. Which statement identifies an aspect of
this type of program?
Pregnant woman are confined to an inpatient treatment method during their
pregnancy.
Pregnant woman are given biofeedback modalities as stimulus responses to control
their addiction.
Pregnant woman are given motivational incentives as a primary approach to stop
their drug abuse problem. Correct
Pregnant woman must follow a strict medication nutritional program during the
course of pregnancy.
A contingency management program utilizes a motivational incentive
approach with patients to support their efforts to maintain abstinence. The
incentives may include small cash amounts, privileges, or prizes. Contingency
management programs are not limited to inpatient settings and do not involve
biofeedback modalities or medication nutritional programs.Awarded 0.0 points out
9.Where do most deliveries for pregnant women who have mental health
issues take place?
Mental health hospital setting
Midwife assisted births
Community hospital settings Correct
Psychiatric hospitals on locked units
Unless there is some specific psychiatric mental health issue that requires
that a patient remain in a locked unit, most pregnant women who have mental
health issues deliver in community settings. Although midwives are trained to
provide obstetric care, they typically do not take care of complex patients, and a
woman who had a diagnosed mental health issue would be classified as a complex
patient.Awarded 0.0 points out of 1.0 possible points.
10.Which of the following statements about the prevalence of perinatal
mental health problems is true? (Select all that apply.)
The World Health Organization (WHO) recognizes postpartum depression as the
leading cause of disability in women.
Up to a of pregnant women will experience some aspect of depression during
their pregnancies. Correct
Income status plays a significant role in the presentation of perinatal mental health
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A
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D
A
B
problems. Correct
A higher incidence of postpartum depression (PPD) is found in about 50% of the
population.
Between 30 and 50 billion dollars accounts for productivity and direct medical costs
related to depression in women. Correct
The WHO recognizes depression as the leading cause of disability in
women. Between 14% and 23% of women will experience some aspect of
depression during their pregnancies. Low income plays a significant factor in the
presentation of perinatal mental health problems. Higher incidence of PPD is found
in about 25% of women. The economic costs related to depression treatment in
women are extremely high, ranging between 30 and 50 billion dollars.Awarded 0.0
Chapter 32
1.A woman at 26 weeks of gestation is being assessed to determine whether
she is experiencing preterm labor. What finding indicates that preterm labor is
occurring?
Estriol is not found in maternal saliva.
Irregular, mild uterine contractions are occurring every 12 to 15 minutes.
Fetal fibronectin is present in vaginal secretions.
The cervix is effacing and dilated to 2 cm. Correct
Cervical changes such as shortened endocervical length, effacement, and
dilation are predictors of imminent preterm labor. Changes in the cervix
accompanied by regular contractions indicate labor at any gestation. Irregular, mild
contractions that do not cause cervical change are not considered a threat. Estriol is
a form of estrogen produced by the fetus that is present in plasma at 9 weeks of
gestation. Levels of salivary estriol have been shown to increase before preterm
birth. The presence of fetal fibronectin in vaginal secretions between 24 and 36
weeks of gestation could predict preterm labor, but it has only a 20% to 40%
positive predictive value. Of more importance are other physiologic clues of preterm
labor, such as cervical changes.Awarded 0.0 points out of 1.0 possible points.
2.In planning for an expected cesarean birth for a woman who has given birth
by cesarean section previously and who has a fetus in the transverse presentation,
the nurse includes which information?
Because this is a repeat procedure, you are at the lowest risk for complications.
Even though this is your second cesarean birth, you may wish to review the
preoperative and postoperative procedures. Correct
Because this is your second cesarean birth, you will recover faster.
You will not need preoperative teaching because this is your second cesarean
birth.
The statement in B is most appropriate. The statements in A, C, and D are not
accurate. Maternal and fetal risks are associated with every cesarean section.
Physiologic and psychologic recovery from a cesarean section is multifactorial and
individual to each client each time. Preoperative teaching should always be
performed regardless of whether the client has already had this procedure.Awarded
3.For a woman at 42 weeks of gestation, which finding requires more
assessment by the nurse?
Fetal heart rate of 116 beats/min
Cervix dilated 2 cm and 50% effaced
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D
A
B
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D
A
B
C
D
A
B
C
D
Score of 8 on the biophysical profile

One fetal movement noted in 1 hour of assessment by the mother Correct
Self-care in a postterm pregnancy should include performing daily fetal kick
counts three times per day. The mother should feel four fetal movements per hour.
If she feels fewer than four movements, she should count for 1 more hour. Fewer
than four movements in that hour warrants evaluation. The findings described in the
other choices are normal at 42 weeks of gestation.Awarded 0.0 points out of 1.0
possible points.
4.A pregnant womans amniotic membranes rupture. Prolapsed cord is
suspected. Which intervention is the nurses top priority?
Place the woman in the knee-chest position. Correct
Cover the cord in a sterile towel saturated with warm normal saline.
Prepare the woman for a cesarean birth.
Start oxygen by face mask.
The woman is assisted into a position (e.g., modified Sims position,
Trendelenburg position, or knee-chest position) in which gravity keeps the pressure
of the presenting part off the cord. Relieving pressure on the cord is the nursing
priority. The nurse may also use her gloved hand or two fingers to lift the presenting
part off the cord. If the cord is protruding from the vagina it may be covered with a
sterile towel soaked in saline. The nurse should administer O2 by facial mask at 8 to
10 L/min until delivery is complete. If the cervix is fully dilated, the nurse should
prepare for immediate vaginal delivery. Cesarean birth is indicated only if cervical
dilation is not complete.Awarded 0.0 points out of 1.0 possible points.
5.A nurse is caring for a client whose labor is being augmented with oxytocin.
The nurse recognizes that the oxytocin should be discontinued immediately if there
is evidence of:
Uterine contractions occurring every 8 to 10 minutes.
A fetal heart rate (FHR) of 180 with absence of variability. Correct
The client needing to void.
Rupture of the clients amniotic membranes.
A fetal heart rate (FHR) of 180 with absence of variability is nonreassuring;
the oxytocin should be immediately discontinued and the physician should be
notified. The oxytocin should also be discontinued if uterine hyperstimulation
occurs. Uterine contractions that occur every 8 to 10 minutes do not qualify as
hyperstimulation. The client needing to void is not an indication to discontinue the
oxytocin induction immediately or to call the physician. The oxytocin does not need
to be discontinued when the membranes rupture, but the physician should be
notified.Awarded 0.0 points out of 1.0 possible points.
6.With regard to the use of tocolytic therapy to suppress uterine activity,
nurses should be aware that:
The drugs can be given efficaciously up to the designated beginning of term at 37
weeks.
There are no important maternal (as opposed to fetal) contraindications.
Its most important function is to afford the opportunity to administer antenatal
glucocorticoids. Correct
If pulmonary edema develops while the client is receiving tocolytics, IV fluids should
be given.
Buying time for antenatal glucocorticoids to accelerate fetal lung
development might be the best reason to use tocolytics. Once the pregnancy has
reached 34 weeks, the risks of tocolytic therapy outweigh the benefits. There are
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D
A
B
C
D
A
B
C
D
A
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D
E
important maternal contraindications to tocolytic therapy. Tocolytic-induced edema

can be caused by IV fluids.Awarded 0.0 points out of 1.0 possible points.
7.With regard to dysfunctional labor, nurses should be aware that:
Women who are underweight are more at risk.
Women experiencing precipitous labor are about the only women experiencing
dysfunctional labor who are not exhausted. Correct
Hypertonic uterine dysfunction is more common than hypotonic dysfunction.
Abnormal labor patterns are most common in older women.
Precipitous labor lasts less than 3 hours. Short women more than 30 pounds
overweight are more at risk for dysfunctional labor. Hypotonic uterine dysfunction,
in which the contractions become weaker, is more common. Abnormal labor
patterns are more common in women younger than 20 years.Awarded 0.0 points
8.A nurse providing care to a woman in labor should be aware that cesarean
birth:
Is declining in frequency in the United States.
Is more likely to be performed in the poor in public hospitals who do not receive the
nurse counseling that wealthier clients do.
Is performed primarily for the benefit of the fetus. Correct
Can be either elected or refused by women as their absolute legal right.
The most common indications for cesarean birth are danger to the fetus
related to labor and birth complications. Cesarean births are increasing in the
United States. Wealthier women who have health insurance and who give birth in a
private hospital are more likely to experience cesarean birth. A womans right to
elect cesarean surgery is in dispute, as is her right to refuse it if in doing so she
endangers the fetus. Legal issues are not absolutely clear.Awarded 0.0 points out of
9.Which statement is most likely to be associated with a breech presentation?
Least common malpresentation
Descent rapid
Diagnosis by ultrasound only
High rate of neuromuscular disorders Correct
Fetuses with neuromuscular disorders have a higher rate of breech
presentation, perhaps because they are less capable of movement within the
uterus. Breech is the most common malpresentation, affecting 3% to 4% of all
labors. Descent is often slow because the breech is not as good a dilating wedge as
the fetal head. Diagnosis is made by abdominal palpation and vaginal examination,
and is confirmed by ultrasound.Awarded 0.0 points out of 1.0 possible points.
10.Which factors would lead to an increased likelihood of uterine rupture?
(Select all that apply.)
Preterm singleton pregnancy
G3P3 with all vaginal deliveries
Short interval between pregnancies Correct
Patient receiving a trial of labor (TOL) following a VBAC delivery Correct
Patient who had a primary caesarean section with a classic incision Correct
The shorter the interval between pregnancies/deliveries, the higher the
risk of uterine rupture. A patient who is having a TOL following a VBAC and a patient
who has had a C section with a classic incision into the uterus are at increased risk
for uterine rupture. A pregnant woman with a singleton pregnancy (one fetus), even
if preterm, is not considered to be at increased risk for uterine rupture; nor is a
multipara who has delivered all her infants vaginally.Awarded 0.0 points out of 1.0
possible points.
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B
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D
Chapter 33
1.The first and most important nursing intervention when a nurse observes
profuse postpartum bleeding is to:
Call the womans primary health care provider.
Administer the standing order for an oxytocic.
Palpate the uterus and massage it if it is boggy. Correct
Assess maternal blood pressure and pulse for signs of hypovolemic shock.
The initial management of excessive postpartum bleeding is firm massage of
the uterine fundus to stop the bleeding. This is the most important nursing
intervention. Then the primary health care provider should be notified or the nurse
can delegate this task to another staff member. Administering an oxytocic and
ascertaining vital signs are appropriate after assessment has been made and
immediate steps have been taken to control the bleeding.Awarded 0.0 points out of
2.Which PPH conditions are considered medical emergencies that require
immediate treatment?
Inversion of the uterus and hypovolemic shock Correct
Hypotonic uterus and coagulopathies
Subinvolution of the uterus and idiopathic thrombocytopenic purpura (ITP)
Uterine atony and disseminated intravascular coagulation (DIC).
Inversion of the uterus and hypovolemic shock are considered medical
emergencies. A hypotonic uterus can be managed with massage and oxytocin;
coagulopathies should have been identified prior to delivery and treated
accordingly. Although subinvolution of the uterus and ITP are serious conditions,
they do not always require immediate treatment; ITP can be safely managed with
corticosteroids or IV immunoglobulin. DIC and uterine atony are very serious
obstetric complications but are not medical emergencies requiring immediate
intervention.Awarded 0.0 points out of 1.0 possible points.
3.Which postpartum infection is most often contracted by first-time mothers
who are breastfeeding?
Endometritis
Wound infections
Mastitis Correct
Urinary tract infections (UTIs)
Mastitis is infection in a breast, usually confined to a milk duct. Most women
who get it are first-timers who are breastfeeding. Endometritis is the most common
postpartum infection. Its incidence is higher after a cesarean birth, not in first-time
mothers. Wound infections are also a common postpartum complication. Sites of
infection include both a cesarean incision and the episiotomy or repaired laceration.
The gravidity of the mother and her feeding choice are not factors in the
development of a wound infection. UTIs occur in 2% to 4% of all postpartum
women. Risk factors include catheterizations, frequent vaginal exams, and epidural
anesthesia.Awarded 0.0 points out of 1.0 possible points.
4.Despite popular belief, there is a rare type of hemophilia that affects
women of childbearing age. Von Willebrand disease is the most common of the
hereditary bleeding disorders and can affect males and females alike. It results from
a factor VIII deficiency and platelet dysfunction. Although factor VIII levels rise
A
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D
A
B
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D
A
B
naturally during pregnancy, there is an increased risk for postpartum hemorrhage

from birth until 4 weeks postpartum as levels of von Willebrand factor (vWf) and
factor VIII fall. The treatment that should be considered first for the client with von
Willebrand disease who experiences a postpartum hemorrhage is:
Cryoprecipitate
Factor VIII and vWf
Desmopressin Correct
Hemabate
Desmopressin is the primary treatment of choice. This hormone, which can
be administered orally, nasally, and intravenously, promotes the release of factor
VIII and vWf from storage. Treatment with cryoprecipitate or with plasma products
such as factor VIII and vWf is acceptable, but because of the associated risk of
possible viruses from donor blood products, other modalities are considered safer.
Although the administration of the synthetic prostaglandin in Hemabate is known to
promote contraction of the uterus during postpartum hemorrhage, it is not effective
for the client who presents with a bleeding disorder.Awarded 0.0 points out of 1.0
possible points.
5.During rounds, a nurse suspects that a patient who has recently delivered
via vaginal route is having excessive postpartum bleeding. Which intervention
would be the priority action taken by the nurse at this time?
Call the physician.
Massage the uterine fundus. Correct
Increase the rate of intravenous fluids.
Monitor pad count and perform catheterization.
Massaging of the uterine fundus would be a priority action to help expel clots
and stimulate uterine contractions to constrict blood flow. The other actions
described, as well as catheterization (if bladder distention is noted) and lochia flow
monitoring, may be needed, but none of them is the priority action required at this
time.Awarded 0.0 points out of 1.0 possible points.
6.A thrombosis results from the formation of a blood clot or clots inside a
blood vessel and is caused by inflammation or partial obstruction of the vessel.
Three thromboembolic conditions are of concern during the postpartum period;
which of the following is not?
Amniotic fluid embolism (AFE) Correct
Superficial venous thrombosis
Deep vein thrombosis
Pulmonary embolism
An AFE occurs during the intrapartum period, when amniotic fluid containing
particles of debris enters the maternal circulation. Although AFE is rare, the
mortality rate is as high as 80%. A superficial venous thrombosis includes
involvement of the superficial saphenous venous system. With deep vein
thrombosis, the involvement varies but can extend from the foot to the iliofemoral
region. A pulmonary embolism is a complication of deep vein thrombosis, occurring
when part of a blood clot dislodges and is carried to the pulmonary artery, where it
occludes the vessel and obstructs blood flow to the lungs.Awarded 0.0 points out of
7.Which of the following is the most common kind of placental adherence
seen in pregnant women?
Accreta Correct
Placenta previa
C
D
A
B
C
D
A
B
C
D
A
B
C
D
E
A
B
Percreta
Increta
Placenta accreta is the most common kind of placental adherence seen in
pregnant women and is characterized by slight penetration of myometrium. In
placenta previa, the placenta does not embed correctly and results in what is known
as a low-lying placenta. It can be marginal, partial, or complete in how it covers the
cervical os, and it increases the patients risk for painless vaginal bleeding during
the pregnancy and/or delivery process. Placenta percreta leads to perforation of the
uterus and is the most serious and invasive of all types of accrete. Placenta increta
leads to deep penetration of the myometrium.Awarded 0.0 points out of 1.0 possible
points.
8.Which ratio would be used to restore effective circulating volume in a
postpartum patient who is experiencing hypovolemic shock?
4:1
2:1
1:1
3:1 Correct
A 3:1 ratio, of 3 ml fluid infused for every 1 ml of estimated blood loss, is
recommended to restore circulating volume.Awarded 0.0 points out of 1.0 possible
points.
9.Which indicator would lead the nurse to suspect that a postpartum patient
experiencing hemorrhagic shock is getting worse?
Restoration of blood pressure levels to normal range
Capillary refill brisk
Patient complaint of headache and increased reaction time to questioning Correct
Patient statement that she sees stars
Patient complaint of a headache accompanied by an increased reaction
(response) time indicates that cerebral hypoxia is getting worse. Return of blood
pressure to normal range would indicate resolving symptoms. Brisk capillary refill is
a normal finding. The patient may see stars early on in decreased blood flow
states.Awarded 0.0 points out of 1.0 possible points.
10.In which situations would the use of Methergine or prostaglandin be
contraindicated even if the patient was experiencing a postpartum significant
bleed? (Select all that apply.)
Patient has delivered twin pregnancies.
Patients blood pressure postpartum is 180/90. Correct
Patient has a history of asthma. Correct
Patient has a mitral valve prolapse. Correct
Patient is a grand multip.
Twin pregnancies successfully delivered and grand multiparity are not
contraindications to the use of these medications. If a patient is hypertensive or has
cardiovascular disease, these medications would not be used. If a patient has a
history of asthma, prostaglandin medication would not be used.Awarded 0.0 points
out of 1.0 possible points
Chapter 34
1.When providing an infant with a gavage feeding, what should the nurse
document each time?
The infants abdominal circumference after the feeding
The infants heart rate and respirations
C
D
A
B
C
D
A
B
C
D
A
B
C
D
The infants suck and swallow coordination

The infants response to the feeding Correct
Documentation of a gavage feeding should include the size of the feeding
tube, the amount and quality of the residual from the previous feeding, the type and
quantity of the fluid instilled, and the infants response to the procedure. Some
older infants may be learning to suck, but the important factor to document is the
infants response to the feeding (including attempts to suck). Abdominal
circumference is not measured after a gavage feeding. Vital signs may be obtained
prior to feeding, but the infants response is more important.Awarded 0.0 points out
2.A male infant at 26 weeks of gestation arrives from the delivery room
intubated. The nurse weighs the infant, places him under the radiant warmer, and
attaches him to the ventilator at the prescribed settings. A pulse oximeter and
cardiorespiratory monitor are placed. The pulse oximeter is recording oxygen
saturation values of 80%. The prescribed saturation value is 92%. The nurses most
appropriate action is to:
Listen to breath sounds and ensure the patency of the endotracheal tube, increase
oxygen, and notify a physician. Correct
Continue to observe and make no changes until the saturations are 75%.
Continue with the admission process to ensure that a thorough assessment is
completed.
Notify the parents that their infant is not doing well.
The actions described in A are appropriate nursing interventions to assist in
optimal O2 saturation of the infant. Oxygenation of the infant is crucial. O2
saturation should be maintained at more than 92%, and the nurse should delay
other tasks to stabilize the infant. The action described in D is not appropriate.
Further assessment and intervention are warranted prior to determination of fetal
status.Awarded 0.0 points out of 1.0 possible points.
3.Necrotizing enterocolitis (NEC) is an inflammatory disease of the
gastrointestinal mucosa. The signs of NEC are nonspecific. Some generalized signs
are:
Hypertonia, tachycardia, and metabolic alkalosis.
Abdominal distention, temperature instability, and grossly bloody stools. Correct
Hypertension, absence of apnea, and ruddy skin color.
Scaphoid abdomen, no residual with feedings, and increased urinary output.
Some generalized signs of NEC include decreased activity, hypotonia, pallor,
recurrent apnea and bradycardia, decreased oxygen saturation values, respiratory
distress, metabolic acidosis, oliguria, hypotension, decreased perfusion,
temperature instability, cyanosis, abdominal distention, residual gastric aspirates,
vomiting, grossly bloody stools, abdominal tenderness, and erythema of the
abdominal wall.Awarded 0.0 points out of 1.0 possible points.
4.For diagnostic and treatment purposes, nurses should know the birth
weight classifications of high risk infants. For example, extremely low birth weight
(ELBW) is the designation for an infant whose weight is:
Less than 1500 g.
Less than 1000 g. Correct
Less than 2000 g.
Dependent on the gestational age.
ELBW is defined as less than 1000 g. At such weights, problems are so
numerous that ethical issues regarding when to treat arise. Less than 1500 g is the
A
B
C
D
A
B
C
D
A
B
C
D
A
B
C
designation for very low birth rate (VLBW). Less than 2000 g is less than LBW but
too high for VLBW. Gestational age is a factor with weight in the condition of the
preterm birth, but it is not part of the birth weight categorization.Awarded 0.0 points
5.Premature infants who exhibit 5 to 10 seconds of respiratory pauses
followed by 10 to 15 seconds of compensatory rapid respiration are:
Suffering from sleep or wakeful apnea.
Experiencing severe swings in blood pressure.
Trying to maintain a neutral thermal environment.
Breathing in a respiratory pattern common to premature infants. Correct
The pattern of 5 to 10 seconds of respiratory pauses followed by 10 to 15
seconds of rapid respiration is called periodic breathing, which is common to
premature infants. It may require nursing intervention such as oxygen and/or
ventilation. Apnea is a cessation of respirations for 20 seconds or longer. An infant
who presents with fluctuation in systemic blood pressure may have experienced a
central nervous system injury. An infant attempting to maintain body temperature is
likely to present with hypoglycemia, shivering, and mottled color.Awarded 0.0 points
6.A nurse providing care to preterm infants should understand that
nasogastric and orogastric tubes are used to:
Help maintain body temperature.
Provide oxygen and ventilation.
Replace surfactants.
Feed the infants. Correct
Nasogastric and orogastric tubes are used in gavage feeding, providing
breast milk or formula directly to an infant unable to nipple feed. To help maintain
body temperature, preterm infants should be placed on warmers. Oxygen,
continuous positive airway pressure (CPAP), and a ventilator are used for O2 and
ventilation. Surfactants are not replaced by using nasogastric or orogastric tubes.
7.With regard to small-for-gestational age (SGA) infants and intrauterine
growth restriction (IUGR), nurses should be aware that:
In the first trimester, diseases or abnormalities result in asymmetric IUGR.
Infants with asymmetric IUGR have the potential for normal growth and
development. Correct
In asymmetric IUGR, weight is slightly more than SGA, whereas length and head
circumference are somewhat less than SGA.
Symmetric IUGR occurs in the later stages of pregnancy.
The infant with asymmetric IUGR has the potential for normal growth and
development.
IUGR is either symmetric or asymmetric. The symmetric form occurs in the
first trimester, as a result of disease or abnormalities; SGA infants have reduced
brain capacity. The asymmetric form occurs in the later stages of pregnancy. Weight
is less than the 10th percentile, but the head circumference is greater than the 10th
percentile (within normal limits).Awarded 0.0 points out of 1.0 possible points.
8.Which priority intervention would be needed if the nurse suspected that
an infant was septic?
Administration of oxygen
Electronic monitoring of vital signs
Intravenous access Correct
A
B
C
D
A
B
C
D
E
A
B
C
D
A
B
Recorded intake and output

Establishing intravenous access for the administration of antibiotics would be
a priority intervention. The other actions described might be required but are not
the priority intervention.Awarded 0.0 points out of 1.0 possible points.
9.Which factor would contribute to depletion of weight and metabolic stores
in the high risk newborn?
Frequent breast feedings
Core temperature within normal range
Phototherapy Correct
Bathing
The use of phototherapy could lead to insensible heat loss and as a result
lead to decreased weight and metabolic stores in the high risk newborn. Frequent
breastfeedings and bathing would not have these effects. Maintaining a core
temperature would help maintain weight and metabolic stores in the high risk
newborn.Awarded 0.0 points out of 1.0 possible points.
10.Which of the following processes or findings increase the risk of preterm
infants in which hematologic problems are developing? (Select all that apply.)
Decrease in size of red blood cells
Decreased capillary fragility
Prolonged PT time Correct
Decreased red blood cell survival time Correct
Decrease in erythropoiesis Correct
Prolonged PT reflects an increased tendency to bleed in preterm
infants. Decrease in red blood cell survival time is seen in such infants. So is
decreased functional ability of erythropoietin, which limits red blood cell synthesis.
One sees an increase in the size of red blood cells in preterm infants, which affects
their survival time. Increased capillary fragility also occurs in preterm infants.
Chapter 35
1.With regard to injuries to the infants plexus during labor and birth, nurses
should be aware that:
If the nerves are stretched with no avulsion, they should recover completely in 3 to
6 months. Correct
Erb palsy is damage to the lower plexus.
Parents of children with brachial palsy are taught to pick up the child from under the
axillae.
Breastfeeding is not recommended for infants with facial nerve paralysis until the
condition resolves.
If the ganglia are disconnected completely from the spinal cord, the damage
is permanent. Erb palsy is damage to the upper plexus and is less serious than
brachial palsy. Parents of children with brachial palsy are taught to avoid picking up
the child under the axillae or by pulling on the arms. Breastfeeding is not
contraindicated in facial nerve paralysis, but both mother and infant will need help
from the nurse at the start.Awarded 0.0 points out of 1.0 possible points.
2.With regard to the classification of neonatal bacterial infection, nurses
should be aware that:
Congenital infection progresses slower than health careassociated infection.
Health careassociated infection can be prevented by effective handwashing; earlyonset infection cannot. Correct
C
D
A
B
C
D
A
B
C
D
A
B
Infections occur with about the same frequency in boy and girl infants, although
female mortality is higher.
The clinical sign of a rapid, high fever makes infection easier to diagnose.
Handwashing is an effective preventive measure for late-onset (health care
associated) infections because these infections come from the environment around
the infant. Early-onset (congenital) infections are caused by the normal flora at the
maternal vaginal tract. Congenital (early-onset) infections progress more rapidly
than health careassociated (late-onset) infections. Infection occurs about twice as
often in boys and results in higher mortality. Clinical signs of neonatal infection are
nonspecific and similar to noninfectious problems, making diagnosis difficult.
3.Which TORCH infection could be contracted by the infant because the
mother owned a cat?
Toxoplasmosis Correct
Varicella-zoster
Parvovirus B19
Rubella
Cats that eat birds infected with the Toxoplasma gondii protozoan excrete
infective oocysts. Humans (including pregnant women) can become infected if they
fail to wash their hands after cleaning a cats litter box. The infection is passed
through the placenta. The varicella-zoster virus is responsible for chickenpox and
shingles. Approximately 90% of childbearing women are immune. During
pregnancy, infection with parvovirus can result in abortion, fetal anemia, hydrops,
intrauterine growth restriction (IUGR), and stillbirth; this virus is spread by vertical
transmission, not by felines. Since vaccination for rubella was begun in 1969, cases
of congenital rubella infection have been reduced significantly. Vaccination failures,
lack of compliance, and the migration of nonimmunized persons result in periodic
outbreaks of rubella (German measles).Awarded 0.0 points out of 1.0 possible
points.
4.In caring for a mother who has abused (or is abusing) alcohol and for her
infant, nurses should be aware that:
The pattern of growth restriction of the fetus begun in prenatal life is halted after
birth, and normal growth takes over.
Two thirds of newborns with fetal alcohol syndrome (FAS) are boys.
Alcohol-related neurodevelopmental disorders (ARNDs) not sufficient to meet FAS
criteria (learning disabilities, speech and language problems) are often not detected
until the child goes to school. Correct
Both the distinctive facial features of the FAS infant and the diminished mental
capacities tend toward normal over time.
Some learning problems do not become evident until the child is in school.
The pattern of growth restriction persists after birth. Two thirds of newborns with
FAS are girls. Although the distinctive facial features of the FAS infant tend to
become less evident with growth, the mental capacities never become normal.
5.Antidepressant medication is the mainstay treatment for maternal
depression, with selective serotonin reuptake inhibitors (SSRIs) being the first line of
pharmacotherapy. Reports of cardiac defects have been associated with the use of
which SSRI?
Citalopram
Fluoxetine
C
D
A
B
C
D
A
B
C
D
A
B
C
D
A
B
C
D
Sertraline
Paroxetine Correct
The American College of Obstetricians and Gynecologists (ACOG) has issued
a recommendation that paroxetine be avoided both during pregnancy and in women
considering pregnancy. There have also been reports linking paroxetine to other
abnormalities, such as omphalocele, craniosynostosis, and anencephaly. The
absolute risk of any congenital abnormality associated with use of citalopram,
fluoxetine, or sertraline is small.Awarded 0.0 points out of 1.0 possible points.
6.An infant weighing 4.1 kg was born 2 hours ago at 37 weeks of gestation.
The infant appears chubby with a flushed complexion and is very tremulous. The
tremors are most likely the result of:
Birth injury.
Hypocalcemia.
Hypoglycemia. Correct
Seizures.
The description is indicative of a macrocosmic infant. Hypoglycemia is
common in the infant with macrosomia. The tremors are jitteriness that is
associated with hypoglycemia. Other signs of hypoglycemia are apnea, tachypnea,
and cyanosis.Awarded 0.0 points out of 1.0 possible points.
7.Which factor increases the risk of complications for infants of diabetic
mothers?
Glycemic control
Hemoglobin A1c level of 7
Duration of maternal disease Correct
Hemoglobin A1c level of 7 prior to pregnancy
The duration and severity of maternal disease are significant factors in
increasing the risk for complications in infants of diabetic mothers. Glycemic control
would be a positive factor indicating that blood glucose levels were maintained
within normal range. A hemoglobin A1c level of 7 is within normal range.Awarded
8.Preterm infants are more likely to become septic because:
IgG and IgA levels are adequate at birth.
Immune function is suppressed because of increased IgG levels.
IgG level is directly proportional to gestational age. Correct
Serum complement levels are adequate.
IgG levels are directly proportional to gestational age, being decreased in
preterm infants, and reflect immune function. Levels of IgG and IgA are not
adequate at birth and require time to become optimal. Serum complement levels
are decreased at birth in preterm infants.Awarded 0.0 points out of 1.0 possible
points.
9.Which of the following would be considered to be an intrapartum risk factor
for neonatal sepsis?
Mechanical ventilation
Chorioamnionitis Correct
Galactosemia
Meconium aspiration
Chorioamnionitis would be considered to be an intrapartum risk factor. The
other conditions described are neonatal risk factors.Awarded 0.0 points out of 1.0
possible points.
10.Which factors predispose an infant to birth injuries? (Select all that apply.)
A
B
C
D
A
B
C
D
A
B
C
D
A
B
C
D
Multip between the ages of 25 and 30

Vertex presentation
Application of an internal fetal scalp electrode Correct
Vacuum-assisted birth Correct
The use of an internal fetal scalp electrode could result in a scalp
injury, which would be evident upon birth. The use of vacuum extraction could lead
to a birth injury. Very young age (less than 16) and older age (more than 35) in a
primipara are more likely to predispose an infant to birth injuries. Vertex
presentation is a normal finding and as such would not typically lead to a birth
injury.Awarded 0.0 points out of 1.0 possible points.
Chapter 36
1.Which finding supports the diagnosis of pathologic jaundice?
Serum bilirubin concentrations greater than 2 mg/dL in cord blood
Serum bilirubin levels increasing more than 1 mg/dL in 24 hours
Serum bilirubin levels greater than 10 mg/dL in a full-term newborn
Clinical jaundice evident within 24 hours of birth Correct
Clinical jaundice evident within 24 hours of birth supports a diagnosis of
pathologic jaundice. This diagnosis is also supported by serum bilirubin
concentrations greater than 4 mg/dL in cord blood; total serum bilirubin levels that
increase by more than 5 mg/dL in 24 hours; and a serum bilirubin level in a preterm
newborn that exceeds 10 mg/dL.Awarded 0.0 points out of 1.0 possible points.
2.With regard to hemolytic diseases of the newborn, nurses should be aware
that:
Rh incompatibility matters only when an Rh-negative offspring is born to an Rhpositive mother.
ABO incompatibility is more likely than Rh incompatibility to precipitate significant
anemia.
Exchange transfusions are frequently required in the treatment of hemolytic
disorders.
The indirect Coombs test is performed on the mother before birth; the direct
Coombs test is performed on the cord blood after birth. Correct
An indirect Coombs test may be performed on the mother a few times during
pregnancy. Only the Rh-positive offspring of an Rh-negative mother is at risk. ABO
incompatibility is more common than Rh incompatibility but causes less severe
problems; significant anemia, for instance, is rare with ABO. Exchange transfers are
needed infrequently because of the decrease in the incidence of severe hemolytic
disease in newborns from Rh incompatibility.Awarded 0.0 points out of 1.0 possible
points.
3.Congenital heart defects (CHDs) are anatomic abnormalities in the heart
that are present at birth, although they may not be diagnosed immediately. The
most common type of CHD is:
Tetralogy of Fallot.
Ventricular septal defect (VSD). Correct
Pulmonary stenosis.
Transposition of the great vessels.
VSD with increased pulmonary blood flow is the most common type of heart
defect, with a prevalence of 27 per 10,000 births, and accounts for about 30% to
35% of all congenital heart defects. Tetralogy of Fallot has an incidence of 4.7 per
10,000 births and is the most common cardiac defect with decreased blood flow.
A
B
C
D
A
B
C
D
A
B
C
D
A
B
C
Pulmonary stenosis, a defect that causes obstruction to blood flow out of the heart,
is less common. Transposition of the great vessels is a complex cardiac anomaly
that involves a flow of mixed saturated and desaturated blood in the heart or great
vessels.Awarded 0.0 points out of 1.0 possible points.
4.Concerning congenital abnormalities involving the central nervous system,
nurses should be aware that:
Although the death rate from most congenital anomalies has decreased over the
past several decades, that from neural tube defects (NTDs) has gone up in the last
few years.
Spina bifida cystica usually is asymptomatic and may not be diagnosed unless
associated problems are present.
A major preoperative nursing intervention for a neonate with myelomeningocele is
to protect the protruding sac from injury. Correct
Microcephaly can be corrected with timely surgery.
The nurse protects the infant by laying the baby on his or her side. Most
congenital anomalies have had a stable neonatal death rate since the 1930s; rates
of NTDs are declining because of mandatory fortification of foods with folic acid.
Spina bifida occulta often is asymptomatic; spina bifida cystica has a visible sac.
Microcephaly is a tiny head; there is no treatment.Awarded 0.0 points out of 1.0
possible points.
5.Which statement is accurate regarding the ABO blood typing system in the
body?
If you have type O blood, then you have antigens.
If you have type AB blood, then you have antibodies.
A person with type O blood has no antibodies.
A person with type O blood has antibodies to type A and type B. Correct
A person with type O blood has antibodies to both type A and type B, but no
antigens. With type AB blood, you do not have antibodies.Awarded 0.0 points out of
6.An Rh-negative woman has a miscarriage during the 8th week of pregnancy
and a D&C is required. Which priority intervention would be required in the recovery
period following the surgical procedure?
Type and screen for two units of blood.
Maintain hydration level by increasing fluids by mouth.
Administer RhoGAM. Correct
Perform fundal massage.
Administering RhoGAM would be a priority intervention because the patient is
Rh negative and there is no way to determine the Rh status of the fetus. Type and
screen would not be indicated as if the patient were to require a blood transfusion;
this would not reflect holding blood. Although it would be important to maintain the
patients hydration level, it could be done if needed via the parenteral route. Fundal
massage would not be indicated at 8 weeks of gestation.Awarded 0.0 points out of
7.A nurse is working in the nursery and observes a nursing student
repeatedly performing an Ortolani test. What priority action should the nurse take?
Help the nursing student with performing the test to make sure that it is being done
accurately.
Document the findings of the test as performed by the nursing student after the test
has been repeated three times.
Have the nursing student explain what the test is used for in terms of clinical
A
B
C
D
A
B
C
D
A
B
C
D
assessment.
Have the student stop performing the test immediately. Correct
The Ortolani test should be performed by an experienced practitioner so as to
avoid any possible damage. It should not be performed repetitively. Although it
would be important to ascertain whether the nursing student knew the clinical
implication for the test, the priority safety action would be to intervene and stop
further testing.Awarded 0.0 points out of 1.0 possible points.
8.A nurse is performing an assessment on a newborn and notes 6 digits on
each foot. This finding is an example of:
Congenital hip dysplasia.
Hypospadias.
Polydactyly. Correct
Clubfoot.
Polydactyly is a congenital deformity associated with extra digits. Congenital
hip dysplasia indicates a dislocated hip. Hypospadias indicates an abnormality of
the external genitalia. Clubfoot can be positional or congenital in nature and is a
foot deformity.Awarded 0.0 points out of 1.0 possible points.
9.A nurse is performing a pulse oximetry reading on a newborn to test for:
PKU.
Congenital heart disease. Correct
Sickle cell disease.
Thalassemia.
Pulse oximetry can be used to determine the presence of congenital heart
disease in healthy newborns. Routine screening of newborns is done via the Guthrie
heelstick test to look for certain metabolic diseases such as PKU, sickle cell disease,
and thalassemia.Awarded 0.0 points out of 1.0 possible points.
10.In terms of Rh incompatibility, which situations would cause a potential
problem? Select all that apply:
Rh-negative mom having an Rh-positive baby Correct
Rh-negative mom having an Rh-negative baby
The infant of an Rh-negative mom with Rh-positive father who is homozygous for
the trait Correct
Rh-positive baby born to an Rh-positive mom
An Rh-negative mom having an Rh-positive baby is the classic
presentation for isoimmunization or Rh incompatibility. The infant of an Rh-negative
mom with an Rh positive father who is homozygous for the trait would have a
potential problem because the infant would be Rh-positive. The other two situations
would not cause a problem.Awarded 0.0 points out of 1.0 possible points.

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A

Positive clonus response elicited unilaterally is a cause for concern as it

1.A woman presents to the emergency department complaining of bleeding

1.In planning for the care of a 30-year-old woman with pregestational

and two or three snacks. Correct

Oxygen would be provided, antipyretics would be given to reduce

1.Appendicitis is more difficult to diagnose during pregnancy because the

Assess, assist, advise, apply, and arrange

Score of 8 on the biophysical profile

important maternal contraindications to tocolytic therapy. Tocolytic-induced edema

naturally during pregnancy, there is an increased risk for postpartum hemorrhage

The infants suck and swallow coordination

Recorded intake and output

Multip between the ages of 25 and 30

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