12/6/2011 Maternal-Newborn Nursing Chapter 06: NCLEX RN Review Practice Test

You got 17 out of 30 questions correct 1. The client has come to the clinic for her first prenatal visit and tells the nurse that she eats only vegetables. To assess for a problem related to thi s information, the nurse should assess what part of the CBC? You answered correctly: Hemoglobin Rationale: The client who is not eating meat may have a problem with decreased i ron intake which could impact her hemoglobin level. Polymorphonuclear cells, lym phocytes, and platelets are unrelated to iron intake. Cognitive Level: Application Client Need: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process: Assessment Content Area: Maternal-Newborn Strategy: Recall that iron deficiency anemia is a risk for vegetarians. Eliminat e options 2, 3, and 4 because polymorphonuclear cells, lymphocytes, and platelet s are unrelated to iron intake. References: Olds, S., London, M., Ladewig, P., & Davidson, M. (2004). Maternal-N ewborn Nursing & Women's Health Care (7th ed.). Upper Saddle River, N. J.: Pears on Education, Inc. p. 447-448. Kee, J. L. (2005). Laboratory and diagnostic tests with nursing implications (7t h ed.). Upper Saddle River, NJ: Pearson Education, Inc., pp. 718-719. 2. The pregnant client has been diagnosed with toxoplasmosis. The nurse rea lizes that this infection places the fetus at risk for which of the following? S elect all that apply. You answered incorrectly: Central nervous system damage; Microcephaly and hydroc ephalus; Raised, red skin rash The correct answers were: Central nervous system damage; Microcephaly and hydroc ephalus Rationale: Toxoplasmosis can result in fetal convulsions, coma, microcephaly, an d hydrocephalus. Cognitive Level: Application Client Need: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process: Analysis Content Area: Maternal-Newborn Strategy: Knowledge of the complications of toxoplasmosis is essential to answer the question correctly. Reference: Olds, S.B., London, M.L., Ladewig, P.A. & Davidson, M.R. (2004). Mate rnal-Newborn Nursing & Women's Health Care (7th ed.). Upper Saddle River, NJ: Pe arson Education, Inc., p. 514-515. 3. Which of the following would indicate to the nurse a need for client tea ching about avoiding infection with the rubella virus? You answered incorrectly: Rubella titer 1:10 The correct answer was: Rubella titer 1:8 Rationale: Rubella titer of >1:10 is indicative of immunity to rubella. Rubella is a mild illness and the client may or may not be aware of past infection. A r

ubella titer of 1:8 or less does not demonstrate immunity and avoidance of those with rubella infection is indicated. Cognitive Level: Analysis Client Need: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Maternal-Newborn Strategy: Knowledge of the required titer level that indicates immunity is neces sary to answer this question. Reference: Olds, S.B., London, M.L., Ladewig, P.A. & Davidson, M.R. (2004). Mate rnal-Newborn Nursing & Women's Health Care (7th ed.). Upper Saddle River, NJ: Pe arson Education, Inc., p. 337, 515-516. 4. Which of the following, if revealed in a prenatal interview, would indic ate to the nurse that the client has an increased risk for exposure to cytomegal ovirus? You answered incorrectly: Caring for a cat and litter box The correct answer was: Working at a day care center Rationale: Day care workers are frequently exposed to the virus. Exposure to cat litter can result in toxoplasmosis exposure. IV drug use increases the risk for HIV or hepatitis. Giving blood does not increase the client's risk. Cognitive Level: Analysis Client Need: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process: Assessment Content Area: Maternal-Newborn Strategy: Knowledge of cytomegalovirus and how it is transmitted will help to an swer this question. Reference: Olds, S., London, M., Ladewig, P., & Davidson, M. (2004). Maternal-Ne wborn Nursing & Women's Health Care (7th ed.). Upper Saddle River, N. J.: Pearso n Education, Inc. p. 516-517. 5. Which of the following, if found during prenatal care, would indicate a need for delivery by Cesarean section? You answered incorrectly: Positive herpes culture at the first prenatal visit; c lient asymptomatic at the time of delivery The correct answer was: History of genital herpes lesions; prodromal symptoms pr esent but no lesions at the time of delivery Rationale: Indications for Cesarean section are presence of a herpes lesion or p rodromal symptoms. If there are no herpes symptoms or lesions, a vaginal deliver y is recommended. Cognitive Level: Analysis Client Need: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process: Assessment Content Area: Maternal-Newborn Strategy: Knowledge of the risks of herpes lesions transmitted at the time of de livery will aid in answering the question. Reference: Olds, S.B., London, M.L., Ladewig, P.A. & Davidson, M.R. (2004). Mate rnal-Newborn Nursing & Women's Health Care (7th ed.). Upper Saddle River, NJ: Pe arson Education, Inc., p. 517-518. 6. The nurse explains to a pregnant client who is diagnosed with a sexually transmitted disease that follow-up includes which of the following? You answered correctly: Contacting and treating all sexual partners Rationale: All partners have been exposed and should be made aware, tested, and treated as indicated. Cesarean section would be appropriate only if there were s

ymptoms of a herpes lesion or prodromal symptoms. Genetic assessment and more th an routine assessment of hematocrit and hemoglobin are not indicated. Cognitive Level: Application Client Need: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Content Area: Maternal-Newborn Strategy: Recall that diagnostic screening and referral for treatment are needed for all partners exposed to a sexually transmitted infection. Eliminate option 2 because Cesarean section would be appropriate only if there were symptoms of a herpes lesion or prodromal symptoms. Eliminate options 3 and 4 because genetic assessment and more than routine assessment of hematocrit and hemoglobin are not indicated. Reference: Olds, S.B., London, M.L., Ladewig, P.A. & Davidson, M.R. (2004). Mate rnal-Newborn Nursing & Women's Health Care (7th ed.). Upper Saddle River, NJ: Pe arson Education, Inc., p. 112. 7. The nurse should plan for Group B streptococcus screening if the pregnan t client meets which of the following criteria? You answered correctly: 36-37 weeks gestation Rationale: Carrier status of Group B Streptococcus is variable, so identificatio n several weeks before delivery may not identify a woman who is positive at the time of delivery. The current recommendation is screening during the 36-37th wee k of gestation. Rash and history of STI do not alter this recommendation. Cognitive Level: Application Client Need: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process: Planning Content Area: Maternal-Newborn Strategy: Recall that Group B streptococcus screening is time sensitive; the gre atest risk to the fetus is at the time of delivery. Eliminate options 1, 3, and 4 because rash, time of initial prenatal visit and history of STI do not alter the recommendation for screening at 36 to 37 weeks gestation. Reference: Olds, S., London, M., Ladewig, P., & Davidson, M. (2004). Maternal-Ne wborn Nursing & Women's Health Care (7th ed.). Upper Saddle River, N. J.: Pearso n Education, Inc. p. 518-519. 8. Which of the following, if revealed prior to collection of a gonorrhea c ulture, would result in postponing specimen collection? The client: You answered incorrectly: Reports douching 3 days ago. The correct answer was: Is currently menstruating. Rationale: Menstrual blood can affect the results of a gonorrheal culture. Other factors listed here would not affect the results. However, douching within 24 h ours can affect results. Cognitive Level: Application Client Need: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process: Assessment Content Area: Maternal-Newborn Strategy: Recall that results of a gonorrhea culture can be affected by menstrua l blood. Eliminate options 1, 3, and 4 because other factors identified would no t affect the results of the gonorrhea culture. However, douching within 24 hours can affect results. Reference: Olds, S., London, M., Ladewig, P., & Davidson, M. (2004). Maternal-Ne wborn Nursing & Women's Health Care (7th ed.). Upper Saddle River, N. J.: Pearso n Education, Inc. p. 114. 9. The client has come to the prenatal clinic complaining of repeated nause a and vomiting. The nurse would assess which of the following items that would p

rovide information regarding client hydration status? You answered correctly: Urine specific gravity Rationale: Urine specific gravity is a measure of the concentration of particles in the urine. Urine specific gravity rises when the client is dehydrated. The o ther answers are not related to hydration status. Cognitive Level: Analysis Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process, Assessment Content Area: Maternal-Newborn Strategy: Knowledge of tests to determine hydration status will be necessary to determine the correct answer to the question. References: Olds, S., London, M., Ladewig, P., & Davidson, M. (2004). Maternal-N ewborn Nursing & Women's Health Care (7th ed.). Upper Saddle River, N. J.: Pears on Education, Inc. p. 787. Kee, J. L. (2005). Laboratory and diagnostic tests with nursing implications (7t h ed.). Upper Saddle River, NJ: Pearson Education, Inc., p. 433. 10. During a routine prenatal visit, the presence of ketones is noted during a dipstick analysis of the client's urine. This finding would indicate to the n urse the possibility of what complication of pregnancy? You answered correctly: Diabetes Rationale: Normally, ketones are not found in the urine. Presence of ketones may indicate diabetes and hyperglycemia with fatty acid catabolism. The other answe rs are unrelated to the presence of ketones in the urine. Cognitive Level: Analysis Client Need: PHYS Integrated Process: Nursing Process, Diagnosis Content Area: Diagnostic Tests Strategy: Recall that the presence of ketones may indicate diabetes and hypergly cemia with fatty acid catabolism. Eliminate options 2, 3, and 4 because urine ke tones are not associated with these conditions. References: Olds, S., London, M., Ladewig, P., & Davidson, M. (2004). Maternal-N ewborn Nursing & Women's Health Care (7th ed.). Upper Saddle River, N. J.: Pears on Education, Inc. p. 437-438. Kee, J. L. (2005). Laboratory and diagnostic tests with nursing implications (7t h ed.). Upper Saddle River, NJ: Pearson Education, Inc., p. 434. 11. The client has completed a three-hour oral glucose tolerance test. The n urse interprets that which of the following results would require follow-up for gestational diabetes? You answered correctly: 1-hour level of 210 mg/dL Rationale: A 3-hour oral glucose tolerance test involves assessment of glucose l evels prior to ingestion of glucose followed by 3 assessments at 1-hour interval s after ingestion of 100 gm of oral glucose. Abnormal results include a fasting level greater than 105 mg/dL and a 1-hour level greater than 190 mg/dL. Urine gl ucose and assessment of 6-hour glucose levels are not part of this test. Cognitive Level: Analysis Client Need: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process: Evaluation Content Area: Maternal-Newborn Strategy: Recall that abnormal results include a fasting level greater than 105 mg/dL and a 1-hour level greater than 190 mg/dL. Eliminate option 1 because it c ontains normal assessment findings. Eliminate options 3 and 4 because urine gluc

ose and assessment of 6-hour glucose levels are not part of this test. Reference: Olds, S.B., London, M.L., Ladewig, P.A. & Davidson, M.R. (2004). Mat ernal-Newborn Nursing & Women's Health Care (7th ed.). Upper Saddle River, NJ: P earson Education, Inc., p. 440. 12. A pregnant client has come to the clinic for a triple screen test. Which of the following statements by the client indicate the nurse's teaching about t he test has been effective? Select all that apply. You answered incorrectly: "I kept my 24-hour urine sample refrigerated and broug ht it with me today."; "I am having this test to determine if my baby has Down s yndrome."; "When will I know my blood levels of serum alpha-fetoprotein, estriol , and hCG?" The correct answers were: "When will I know my blood levels of serum alpha-fetop rotein, estriol, and hCG?"; "I am having this test to determine if my baby has D own syndrome." Rationale: The triple screen test determines serum levels of serum alpha-fetopro tein, estriol, and human chorionic gonadotropin (hCG), markers for neural tube d efects and trisomies 18 and 21 (Down syndrome.) Maternal serum, not urine, is a ssessed in this test. A 3-day high carbohydrate diet would be recommended prior to a 3-hour glucose tolerance test. Cognitive Level: Analysis Client Need: Physiological Integrity: Reduction of Risk Potential Integrated Process: Teaching/Learning Content Area: Maternal-Newborn Strategy: Recall that the triple screen test relies on evaluation of 3 serum mar kers to screen for neural tube defects and chromosomal trisomies. Eliminate opti ons 1, 3, and 4 because urine, diet alterations and sound waves are not part of this test. Reference: Olds, S.B., London, M.L., Ladewig, P.A. & Davidson, M.R. (2004). Mate rnal-Newborn Nursing & Women's Health Care (7th ed.). Upper Saddle River, NJ: Pe arson Education, Inc., p. 349. 13. The client is a 37-year-old gravida one at 38 weeks gestation. She was d iagnosed with diabetes at age 17 and is scheduled for an amniocentesis. The nurs e interprets that the procedure is probably being done to assess for the presenc e of: You answered incorrectly: Neural tube defects. The correct answer was: Lung maturity. Rationale: Amniocentesis done for genetic testing is usually done early in the s econd trimester. This test, being done on a client who has diabetes and is at 38 weeks gestation, is probably being done to assess lung maturity in anticipation of delivery. Cognitive Level: Analysis Client Need: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process: Analysis Content Area: Maternal-Newborn Strategy: This question is time sensitive. Recall that amniocentesis done late i n pregnancy is used to assess fetal lung maturity. Eliminate options 1 and 2 bec ause testing for genetic disorders is performed in the second trimester. Elimina te option 3 because amniocentesis is not used to assess TORCH infections. Reference: Olds, S.B., London, M.L., Ladewig, P.A. & Davidson, M.R. (2004). Mate rnal-Newborn Nursing & Women's Health Care (7th ed.). Upper Saddle River, NJ: Pe arson Education, Inc., p. 547, 553. 14. A client has been scheduled for an amniocentesis. Nursing interventions should include which of the following?

You answered correctly: Arrange for access to an ultrasound machine for use duri ng the procedure. Rationale: The test, completed on an outpatient basis, is done under guidance of ultrasound visualization. The test is done without anesthetic or with a local a nesthetic. The client is positioned on her back with a wedge under her left hip to avoid hypotension from pressure of the uterus on the vena cava. Cognitive Level: Application Client Need: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process: Planning Content Area: Maternal-Newborn Strategy: Eliminate options 1 and 4 because amniocentesis is an outpatient proce dure performed with the client awake. Eliminate option 3 because a supine positi on is avoided to reduce the risk of vena cava syndrome. Reference: Olds, S.B., London, M.L., Ladewig, P.A. & Davidson, M.R. (2004). Mate rnal-Newborn Nursing & Women's Health Care (7th ed.). Upper Saddle River, NJ: Pe arson Education, Inc., pp. 547-550. 15. The client is scheduled to have an amniocentesis for assessment of lung maturity. She seems upset and says that she doesn't understand how this test cou ld tell if a baby's lungs are mature. The nurse's best response is: You answered correctly: "A chemical called lecithin is made by the fetal lungs. The amount of it increases as gestation continues. It flows out into the amnioti c fluid where we can measure it to determine lung maturity." Rationale: The amount of lecithin increases as the fetal lungs mature. The ratio of lecithin to sphingomyelin is used to assess lung maturity. The other answers are incorrect. Cognitive Level: Application Client Need: Physiological Integrity: Reduction of Risk Potential Integrated Process: Communication and Documentation Content Area: Maternal-Newborn Strategy: Knowledge of the procedure and what it is used for will aid in choosin g the correct answer. Reference: Olds, S.B., London, M.L., Ladewig, P.A. & Davidson, M.R. (2004). Mate rnal-Newborn Nursing & Women's Health Care (7th ed.). Upper Saddle River, NJ: Pe arson Education, Inc., p. 547, 553. 16. The nurse would choose which of the following as an appropriate nursing diagnosis for a client about to undergo an amniocentesis? You answered correctly: Anxiety related to concern for fetal well-being Rationale: Most women view invasive antenatal testing with anxiety because of th e reason for the test, the impending results, and concern about maternal and fet us complications. The other diagnosis are not necessarily related to undergoing an amniocentesis. Cognitive Level: Analysis Client Need: Psychosocial Integrity Integrated Process: Nursing Process: Diagnosis Content Area: Maternal-Newborn Strategy: Recall that an amniocentesis is an invasive test commonly accompanied by client anxiety related to the procedure or the findings. Eliminate option 1 b ecause the client does not need to be NPO for the procedure. Eliminate option 2 because only local anesthesia is used. Eliminate option 4 because only a small a mount of amniotic fluid is removed for assessment. Reference: Olds, S.B., London, M.L., Ladewig, P.A. & Davidson, M.R. (2004). Mate rnal-Newborn Nursing & Women's Health Care (7th ed.). Upper Saddle River, NJ: Pe

arson Education, Inc., p. 550. 17. The nurse would report which of the following assessment findings in a p regnant client as a contraindication for conducting a contraction stress test? You answered correctly: Marginal abruptio placentae Rationale: Contractions elicited during the test could cause increased bleeding if an abruption is present. Intrauterine growth restriction, diabetes mellitus, and post term pregnancy are all indications for completing a contraction stress test. Cognitive Level: Analysis Client Need: Physiological Integrity: Reduction of Risk Potential Integrated Process: Communication and Documentation Content Area: Maternal-Newborn Strategy: The core issue of the question is determining when contractions would present an increased risk to client or fetal safety. Recall that contractions co uld increase placental abruption and bleeding. Eliminate options 1, 2, and 3 bec ause intrauterine growth restriction, diabetes mellitus, and post term pregnancy are all indications for completing a contraction stress test. Reference: Olds, S.B., London, M.L., Ladewig, P.A. & Davidson, M.R. (2004). Mate rnal-Newborn Nursing & Women's Health Care (7th ed.). Upper Saddle River, NJ: Pe arson Education, Inc., p. 538. 18. The nurse notes that which of the following findings on a biophysical pr ofile would result in a decrease in the score? You answered correctly: 1 episode of body movement in a 30-minute time period Rationale: Normal findings would include 3 or more discrete body/limb movements in 30 minutes; this abnormal finding would result in a score of 0 for this crite rion of the test. Findings in options 2, 3, and 4 are normal findings and would receive scores of 2 respectively. Cognitive Level: Analysis Client Need: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process: Evaluation Content Area: Maternal-Newborn Strategy: Recall that decreased fetal movement is an abnormal finding on a bioph ysical profile. Eliminate options 2, 3, and 4 because they are normal findings a nd would receive scores of 2 respectively. Reference: Olds, S.B., London, M.L., Ladewig, P.A. & Davidson, M.R. (2004). Mate rnal-Newborn Nursing & Women's Health Care (7th ed.). Upper Saddle River, NJ: Pe arson Education, Inc., pp. 541-542. 19. In taking a history from a pregnant client, the nurse would recognize wh ich of the following as a risk factor for contraction of sexually transmitted di sease? You answered incorrectly: Use of oral contraceptives The correct answer was: Report of anal intercourse Rationale: Because it frequently involves tissue trauma that facilitates invasio n of pathogens, anal intercourse is considered a high-risk sexual behavior. The other factors listed here do not increase the client's risk for contractions of a sexually transmitted infection. Cognitive Level: Analysis Client Need: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process: Assessment Content Area: Maternal-Newborn Strategy: Recall that anal intercourse increases the risk of tissue trauma and p

athogen invasion. Eliminate options 2, 3, and 4 because these factors do not inc rease the client's risk for acquiring a sexually transmitted infection. Reference: Olds, S.B., London, M.L., Ladewig, P.A. & Davidson, M.R. (2004). Mate rnal-Newborn Nursing & Women's Health Care (7th ed.). Upper Saddle River, NJ: Pe arson Education, Inc., p. 112. 20. In interviewing a pregnant client concerning sexually transmitted infect ions, the nurse should recognize which of the following as a barrier to client d isclosure? You answered correctly: Use of only yes or no questions Rationale: Use of open-ended questions, framed in a culturally sensitive and non judgmental approach, tends to establish a trusting and open relationship for inf ormation exchange. Asking only questions with a yes and no response do no elicit information but may close the conversation. Cognitive Level: Application Client Need: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Maternal-Newborn Strategy: Key words are "barrier to client disclosure." This indicates that you are looking for an answer that will discourage the client from elaborating. Thus the yes and no answers to questions would be the correct response. Reference: Olds, S., London, M., Ladewig, P., & Davidson, M. (2004). Maternal-Ne wborn Nursing & Women's Health Care (7th ed.). Upper Saddle River, N. J.: Pearso n Education, Inc. p. 118. 21. A female client seeks medical care after noticing multiple soft, grayish -pink, cauliflower-like lesions in her genital area. The nurse anticipates that the client should have diagnostic testing for which of the following sexually tr ansmitted infections? You answered correctly: Human papilloma virus Rationale: The client's symptoms suggest an infection of human papilloma virus o n her vulva. A biopsy is needed for a definitive diagnosis. Cognitive Level: Analysis Client Need: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process: Planning Content Area: Maternal-Newborn Strategy: Knowledge of the diagnostic tests used to determine human papilloma vi rus will be necessary to choose the correct answer. Reference: Olds, S.B., London, M.L., Ladewig, P.A. & Davidson, M.R. (2004). Mat ernal-Newborn Nursing & Women's Health Care (7th ed.). Upper Saddle River, NJ: P earson Education, Inc., p. 115. 22. The nurse expects that which of the following specimens will be obtained to provide a noninvasive, reliable screen for cocaine use in the pregnant clien t? You answered correctly: Urine Rationale: Cocaine metabolites may be present in the urine of a pregnant woman f or 4-7 days following use. The other choices are inappropriate and do not meet t he criterion of being noninvasive. Cognitive Level: Analysis Client Need: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process: Assessment Content Area: Maternal-Newborn Strategy: The critical word in the question is noninvasive. Eliminate options 2,

3, and 4 as they require invasive testing. Reference: Olds, S.B., London, M.L., Ladewig, P.A. & Davidson, M.R. (2004). Mat ernal-Newborn Nursing & Women's Health Care (7th ed.). Upper Saddle River, NJ: P earson Education, Inc., p. 385. 23. The nurse explains to a pregnant client that maternal screening for Grou p B streptococcus is important because the microorganism can result in: You answered correctly: Neonatal sepsis. Rationale: Group B streptococcus, considered normal vaginal flora for many women , is usually transmitted to the fetus during labor and delivery and can result i n neonatal sepsis. The other answers do not provide correct information about di seases that can result from this organism. Cognitive Level: Application Client Need: Physiological Integrity: Reduction of Risk Potential Integrated Process: Teaching/Learning Content Area: Maternal-Newborn Strategy: Recall that the Group B streptococcus is a bacteria with risk for infe ction in the fetus. Eliminate options 1 and 3 because this organism does not cau se these maternal infections. Eliminate option 4 because it does not focus on an infectious process. Reference: Olds, S.B., London, M.L., Ladewig, P.A. & Davidson, M.R. (2004). Mat ernal-Newborn Nursing & Women's Health Care (7th ed.). Upper Saddle River, NJ: P earson Education, Inc., p. 518. 24. The pregnant client, a cat owner, has called the office complaining of f lu-like symptoms. The nurse suspects that the client might have contracted toxop lasmosis. Which of the following would best be used as a diagnostic tool when th e client is asked to come into the office to be seen? You answered correctly: Indirect florescent antibody test Rationale: Toxoplasmosis can be diagnosed by indirect florescent antibody test. If a culture were desired, it would be obtained from blood, however, cultures of toxoplasmosis are difficult to obtain. The VDRL is a test for syphilis. Urine t oxicology is used to screen for drug use. Cognitive Level: Application Client Need: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process: Planning Content Area: Maternal-Newborn Strategy: The core issue of the question is a diagnostic test for toxoplasmosis. Eliminate option 4 because a cervical culture would not be specific for this di sease. Eliminate option 3 because the VDRL is a test for syphilis. Eliminate opt ion 1 because urine toxicology is used to screen for drug use. Reference: Olds, S.B., London, M.L., Ladewig, P.A. & Davidson, M.R. (2004). Mat ernal-Newborn Nursing & Women's Health Care (7th ed.). Upper Saddle River, NJ: P earson Education, Inc., pp. 514-515. 25. A client has come to the clinic for her first prenatal visit. In talking with her, the nurse discovers that the client frequently eats undercooked meat. A priority nursing diagnosis for the client would be: You answered correctly: Risk for ineffective heath maintenance related to lack o f knowledge about ways in which a pregnant woman can contract toxoplasmosis. Rationale: Toxoplasmosis can be contracted by eating undercooked and infected me at. Meat consumption would increase iron intake. There is no indication that she is consuming too many calories or that other family members will need to change their eating habits.

Cognitive Level: Analysis Client Need: Health Promotion and Maintenance Integrated Process: Nursing Process: Analysis Content Area: Maternal-Newborn Strategy: The focus of the question is client risk from eating undercooked meat, toxoplasmosis. Eliminate option 2 because meat consumption would increase iron intake. Eliminate options 1 and 4 because there is no indication that the client is consuming too many calories or that other family members will need to change their eating habits. Reference: Olds, S.B., London, M.L., Ladewig, P.A. & Davidson, M.R. (2004). Mat ernal-Newborn Nursing & Women's Health Care (7th ed.). Upper Saddle River, NJ: P earson Education, Inc., pp. 514-515. 26. The nurse has just completed teaching a client who is to have a maternal serum alpha-fetoprotein screening. Which of the following statements by the cli ent would indicate a need for further teaching? Select all that apply. You answered incorrectly: "I understand that if this test is normal I won't have to worry about having a baby with a birth defect."; "I understand that this tes t will be done on amniotic fluid." The correct answers were: "I understand that if this test is normal I won't have to worry about having a baby with a birth defect."; "I understand that this tes t will let us know if my baby has Down Syndrome."; "I understand that this test will be done on amniotic fluid." Rationale: Maternal serum alpha-fetoprotein is a screening test not a diagnostic test that uses a maternal blood test, and does not rule out or prove that an in fant has a neural tube defect. There are false positive results. If elevated, it is an indicator that further testing is warranted to establish a diagnosis. Cognitive Level: Application Client Need: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process: Evaluation Content Area: Maternal-Newborn Strategy: Knowledge of the use of maternal serum alpha-fetoprotein screening tes t will aid in choosing the correct answer. Reference: Olds, S.B., London, M.L., Ladewig, P.A. & Davidson, M.R. (2004). Mat ernal-Newborn Nursing & Women's Health Care (7th ed.). Upper Saddle River, NJ: P earson Education, Inc., pp. 545-547. 27. The client is 37 weeks pregnant. In reviewing the client's chart, the nu rse notes that an amniocentesis was performed to assess fetal lung maturity. Whi ch of the following findings would indicate that the fetus's lungs are mature? You answered incorrectly: L/S ratio 1:1 The correct answer was: Phosphatidylglycerol Rationale: Phosphatidylglycerol, when present in amniotic fluid, is associated w ith very low risk for respiratory distress syndrome. An L/S ratio of 2:1 indicat es lung maturity. Optical density is used to assess bilirubin concentrations. Hu man chorionic gonadotrophin is part of the triple screen used to assess for cert ain birth defects. Cognitive Level: Analysis Client Need: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process: Assessment Content Area: Maternal-Newborn Strategy: The core focus of the question is a normal assessment finding for feta l lung maturity. Eliminate option 2 because it contains a finding of fetal lung immaturity. Eliminate options 3 and 4 because they are not findings related to l ung maturity. Reference: Olds, S.B., London, M.L., Ladewig, P.A. & Davidson, M.R. (2004). Mat

ernal-Newborn Nursing & Women's Health Care (7th ed.). Upper Saddle River, NJ: P earson Education, Inc., pp. 552-553. 28. The nurse is assessing the fetal heart monitor strip of a client having a contraction stress test. Which of the following, if noted by the nurse, would indicate a negative test? You answered incorrectly: Late decelerations after one contraction on a strip wi th three contractions within a 10-minute time frame. The correct answer was: No late decelerations after any contractions on a strip with three contractions within a 10-minute time frame. Rationale: The contraction stress test is an assessment of the respiratory funct ion of the placenta. A negative test indicates that uteroplacental function is a dequate to allow the fetus to withstand the stress of labor at this time. Cognitive Level: Analysis Client Need: PHYS Integrated Process: Nursing Process, Evaluation Content Area: Diagnostic Tests Strategy: Knowledge of the contraction stress test and the interpretation of the results will aid in choosing the correct answer. Recall that a negative test ha s no late decelerations. Eliminate options 2 and 3 because late decelerations ar e present. Eliminate option 4 because accelerations are described. Reference: Olds, S.B., London, M.L., Ladewig, P.A. & Davidson, M.R. (2004). Mat ernal-Newborn Nursing & Women's Health Care (7th ed.). Upper Saddle River, NJ: P earson Education, Inc., p. 538, 540-541. 29. The client, who is to have transcervical chorionic villus sampling (CVS) , has completed her teaching session concerning the test and its potential compl ications. Which of the following statements by the client to the nurse would ind icate understanding of the information? You answered incorrectly: "This test will be done when I am between 16 and 18 we eks pregnant." The correct answer was: "In very rare cases, this test can cause fetal limb redu ction defects." Rationale: Chorionic villus sampling, usually completed between 10 and 12 weeks gestation, can rarely result in loss of a portion of the fetus's finger or toe. Transcervical sampling is done with the use of a catheter that is inserted throu gh the endocervix not through the abdomen. Cognitive Level: Application Client Need: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process: Evaluation Content Area: Maternal-Newborn Strategy: Knowledge of the use of CVS and the procedure will enable the selectio n of the correct answer. Reference: Olds, S.B., London, M.L., Ladewig, P.A. & Davidson, M.R. (2004). Mat ernal-Newborn Nursing & Women's Health Care (7th ed.). Upper Saddle River, NJ: P earson Education, Inc., pp. 550-551. 30. A client, who is 28 weeks pregnant, has had an abnormal Doppler blood fl ow assessment. The nurse interprets that the client will need to be carefully mo nitored for which of the following? You answered incorrectly: Insufficient maternal oxygen levels The correct answer was: Inadequate fetal growth Rationale: An abnormal Doppler blood flow indicates impaired uteroplacental or u mbilical blood flow and places the infant at risk for intrauterine growth restri

ction. The other answers are incorrect. Cognitive Level: Application Client Need: PHYS Integrated Process; Nursing Process, Assessment Content Area: Diagnostic Tests Strategy: The core focus of the question is blood flow. The correct answer woul d be the option that contains a true statement about the risk of uteroplacental insufficiency. Eliminate options 1, 3, and 4 because they are not related to ute roplacental blood flow. Reference: Olds, S.B., London, M.L., Ladewig, P.A. & Davidson, M.R. (2004). Mat ernal-Newborn Nursing & Women's Health Care (7th ed.). Upper Saddle River, NJ: P earson Education, Inc., pp. 542-543.