Maternal and Child Health Nursing 1 Saundrs Pink Ed

8/2/2019 Maternal and Child Health Nursing 1 Saundrs Pink Ed

1/149

Maternal and Child HealthNursing


2/149

Prenatal period

1. Which of the following would occurfirst in the process of fetaldevelopment?

a. Appearance of vernix caseosa

b. Muscle contraction

c. Increased fat deposits

d. Secretion of urine by the kidneys


3/149

2. During intrauterine life, the fetusreceives O2 & excretes its wastesthrough:

a. The amniotic fluid

b. 2 umbilical arteries & 1 umbilical vein

c. 1 umbilical artery & 2 umbilical veins

d. The placenta


4/149

3. The first movements of the fetus inthe uterus are referred to as:

a. Lighteningb. Quickening

c. Involution

d. Contractions


5/149

4. The mother first feels these tomovements:

a. 2 weeks prior to deliveryb. At about 8 weeks

c. Within the first week after conception

d. Between 16 to 20 weeks of gestation


6/149

5. Normal changes that are experiencedduring pregnancy include:

a. An increase in vaginal dischargeb. Persistent vomiting for the 1st

trimester

c. Headaches & vertigo

d. Edema of fingers & ankles first thingin the morning


7/149

6. Hemoglobin & hematocrit counts varyduring the pregnancy. The normalvariations include:

a. A decrease in both, due to increasedblood volume

b. An increase in both, due to thedecreased blood volume

c. An increase in the hemoglobin & a

decrease in the hematocritd. Neither actually varies consistently

during pregnancy


8/149

7. Symptoms of placenta previa would

include:a. Spotting in the early months of

pregnancy

b. Painless bleeding in the last monthsof pregnancy

c. Sharp pains in the absence ofbleeding

d. Watery discharge prior to birth


9/149

8. Your client is admitted with adiagnosis of hyperemesisgravidarum. Your nursinginterventions will include:

a. Placing a padded tongue blade at the

head of the bed.b. Measuring I & O accurately.

c. Identification of foods especiallynauseating to your client.

d. Spending a minimum amount of timewith her so she can get plenty ofrest.


10/149

9. Fetal embodiment occurs during the

second trimester. A common sign ofthis process would be:

a. Introversion

b. An attempt to incorporate fetus intobody image as a part of self.

c. Daydreaming about self as mother &about the baby.

d. Shock & denial.


11/149

10. Endocrine changes associated with

pregnancy do not include:a. Increased estrogen levels.

b. Increased melanocyte-stimulatinghormones.

c. Increased HCG levels.

d. Decreased aldosterone.


12/149

11. Which of the following is not achange in oxygenation associatedwith pregnancy?

a. Enlargement of the heart

b. Decrease in cardiac output

c. Blood volume increases

d. Improved O2 & CO2 exchange at thecellular level


13/149

12. Which of the following is not ametabolic change associated with

pregnancy?

a. Gastric acids & pepsin levels increase

b. Nutritional requirement increases

c. Heartburn from esophageal refluxincreases

d. Better absorption of nutrients with

delayed gastric transit time


14/149

13. Which of the following is considereda presumptive sign of pregnancy?

a. Ballotementb. Uterine enlargement

c. Positive pregnancy test

d. Amenorrhea


15/149

14. Which of the following is theprobable sign of pregnancy?

a. Braxton Hicks contractionb. Breast sensitivity

c. Nausea & vomiting

d. Quickening


16/149

15. At what stage of fetal developmentdoes the fetus begin to developsubcutaneous fat?

a. 12 weeks

b. 28 weeks

c. 32 weeks

d. 36 weeks


17/149

Johna, age 20, first visits a clinic in the28th week of her pregnancy.Assessment reveal that she isoverweight for her height & stature &there is slight edema of her feet &

ankles.


18/149

1. In addition to emphasizing regular

visits for the rest of pregnancy,which goal is a priority for Johna?

a. She will report leg cramping.

b. She will include roughage in her diet.c. She will notify the clinic of

headaches.

d. She will sleep in left lateral position.


19/149

2. At Johnas next visit two weeks later,

her urine is negative for protein, herBP has increased for 110/70 to115/75 & she has gained 5 lbs. Shehas some SOB when sleeping on her

back, & reports that the fetus is veryactive at night. Which assessment ismost indicative of potentialproblems?

a. BP changes c. respiratory problems

b. Weight gain d. fetal activity


20/149

3. When discussing health habits with

Johna, you review diet, exercise, &use of OTC medications. Which of thefollowing should be avoidedconsidering her present condition?

a. Use of bicarbonate of soda forheartburn

b. Apple slices as snacks

c. Brisk walking as exercised. Skim milk with meals


21/149

4. Johnas symptoms become moresevere as pregnancy advances. At aroutine visit in the 36th week, it isnoted that her urine is 3+ for CHON,her BP is 140/110, & there is facial

edema. She is hospitalized on strictbedrest. Magnesium sulfate isordered. Which of the followingassessments are criticalwhileadministering this medicationintravenously?


22/149

a. Respirations & DTR

b. BP & temperature

c. State of consciousnessd. FHR & apical pulse


23/149

5. In addition to monitoring Johnascondition closely, which of thefollowing nursing measures is mostimportant?

a. Maintaining a quiet environment.

b. Providing sufficient oral fluids.

c. Encouraging ambulation.

d. Promoting diversional activities.


24/149

6. Which of the following is a prioritygoal for the client with severepregnancy-induced hypertension?

a. Client will comply with dietmodifications.

b. Client will report visual changes.

c. Client will remain on bedrest.

d. Client will communicate her feelings.


25/149

7. Several hours after treatment withmagnesium sulfate is begun, each ofthe following observations is noted.Which one indicates that thetreatment is effective?

a. Hourly output is 50 ml.

b. Blood pressure is 150/110.

c. Reflexes are hypotonic.

d. No seizures have occurred.


26/149

8. Johna awakens from sleep

complaining of sudden sharpabdominal pain. Assessments revealthat the uterus is hard & tender totouch. FHR is 90. Maternal pulse is

130, BP is 100/60, skin is cold &moist to the touch, & moderatevaginal bleeding is noted. The

diagnosis is abruptio placenta. Thisproblem is directly related to:


27/149

a. Infarcts caused by vasoconstriction

b. High magnesium blood levels

c. Abnormal placental positiond. Potential for eclamptic seizures


28/149

Tina, aged 30, visits the antepartalclinic with her husband after missing2 menstrual periods. Physicalassessment, date of LMP, & urineanalysis for HCG indicate that she is

probably 7 weeks pregnant. Historyincludes the information that this isher 1st pregnancy, her health hasbeen excellent, she is employed as asecretary, & she is nonsmoker.


29/149

9. Which of the following is anappropriate long term goal for Tina?

a. She will work reduced hoursthroughout her pregnancy.

b. She will comply with a regular

prenatal visit schedule.

c. She will omit sodium & fat from herdaily diet.

d. She will begin an aerobic exerciseprogram.


30/149

10. At the second prenatal visit onemonth later, Tina reports that she is

experiencing occasional nausea thatis relieved with dry foods. She is alsofeeling very tired, & she has urinaryfrequency & periods of weeping. Inreviewing the assessment data,identify a potential problem.

a. Lab data shows a hematocrit of 36

with a hemoglobin of 12.

b. Urinalysis reveals a trace of glucosewith negative bacteria.


31/149

c. Interview reveals mixed feelingsabout the pregnancy.

d. 24 hour diet recall: highcarbohydrate, high fiber vegetariandiet.


32/149

11. Tina feels much better at the 22ndweek. She expresses surprise thatthe Dr. ordered a glucose tolerancetest. Which explanation isappropriate for this order?

a. Because you are a vegetarian, it isnecessary to check carbohydratemetabolism.

b. Since there was sugar in your urineat your 2nd visit, the blood test is aprecaution.


33/149

c. Because you have little regularexercise, your metabolism may bevery slow.

d. This test of blood sugar levels is nowroutine to identify gestationaldiabetes.


34/149

12. The results of the test show an elevatedblood sugar. The problem is diagnosed as

gestational diabetes. Health teachingwould not include which of the following?

a. Review her understanding of basic fourfood sources.

b. Emphasize adequate CHON & vitaminintake.

c. Caution her to eliminate all carbohydrates.

d. Suggest that she eat 4 small meals eachday.


35/149

13. Tina follows all dietary suggestions &increases regular mild exercise. She feelswell, but the blood sugar levels remainelevated. The Dr. orders regular insulin ona sliding scale appropriate to daily glucoselevels. Which statement made by the clientshows that she understands the problem?

a. I resent that I now face a lifetime oninsulin.

b. My vegetarian diet must have caused thisdiabetes.

c. This temporary condition is frustrating to

control.d. My grandmother has diabetes, so I guess

its inevitable.


36/149

14. In the 36th week, a non-stress test isordered. The result is reactive. Select an

appropriate explanation of this result thatcould be given to a nursing student whoobserved the diagnostic procedure.

a. The result shows fetal response to

contractions.b. The FHR increased with activity.

c. The absence of decelerations shows goodoxygenation.

d. The heart rate variability is more than 15beats.


37/149

Martha is admitted with preeclampsia inher 32nd week of pregnancy. Her BP

is 160/110, she has 3+ albumin inher urine, and she is complaining ofsevere headaches.

15. Which of the following would not beappropriate in your care of Martha?

a. Keeping her on complete bedrest.

b. Monitoring the FHT every 4 hours.c. Checking her BP every7 shift.

d. Measuring I&O accurately.


38/149

16. The Dr. orders that IV magnesiumsulfate be given. Nursing

interventions required while Marthais receiving this medication mustinclude:

a. Monitoring respirations and patellarreflexes.

b. Administering calcium gluconateconcurrently.

c. Encourage her to ambulate.d. Avoiding BP measurements until

after medication has infused.


39/149

17. Martha begins to experienceconvulsions. Your priority nursingintervention will be to:

a. Leave and get help immediately.

b. Put on the call light and ask for help.

c. Yell for help.

d. Ask her roommate to get help.


40/149

18. Which of the following nursinginterventions would be inappropriatefor the nurse to implement with apregnant client during a convulsion?

a. Place a tongue blade between her

unclenched jaws.b. Put a blanket over the side rails to

protect her.

c. Monitor the FHR.d. Raise the side rails to prevent falling.


41/149

19. Which of the following expectantmothers would be at the greatest riskfor developing toxemia?

a. A 22-year-old Rh-negativemultigravida

b. A 17-year-old primigravida with apositive roll-over test

c. A 25-year-old anemic primigravida

d. A 28-year-old slightly obeseprimigravida


42/149

Gail de la Cruz is a 26-year old whitewoman who has registered at theclinic for prenatal care for herpregnancy.

20. In eliciting her health history, the

nurse discovers that Gails LMP wasJuly 10, 2007. which of the followingdates would be the appropriate EDC?

a. April 3, 2008 c. April 17, 2008b. April 10, 2008 d. April 20, 2008


43/149

21. Gail provides a maternal history,including the following data: 1 healthy

female delivered at term five years ago; 1miscarriage at 8 weeks four years ago; 1stillborn male delivered at term threeyears ago; 1 therapeutic abortion at six

weeks, two years ago; 1 premature maledelivered at 32 weeks last year. Duringthis pregnancy, Gail would be consideredas:

a. Gravida vi, para iii c. Gravida v, para iii

b. Gravida v, para ii d. Gravida vi, para ii


44/149

22. Which of the following assessmentfindings reflects Gails normalphysiological response to thepregnancy?

a. Augmented peristalsis

b. Decreased GFR

c. Increased cardiac output

d. Increased respiratory rate


45/149

23. A complete blood count is done. Theresults indicate that Gails

hemoglobin level is 11.4 gm. Whichof the following possibilities mostlikely explains this finding?

a. Pregnancy induced decreasedvitamin B12 levels

b. The presence of iron deficiencyanemia

c. Depressed bone marrow functiond. Hemodilution of pregnancy


46/149

24. What other essential screening testsshould be conducted during thecourse of Gails pregnancy?

a. Blood typing

b. Sickle cell screen

c. Chest X-ray

d. Serological test for gonorrhea


47/149

Post test: Prenatal Period

1. Marthas LMP started on October 1,2007. using Nageles rule, herexpected date of confinement will be:

a. July 1, 2008

b. July 8, 2008

c. August 1, 2008

d. July 28, 2008


48/149

2. Martha is scheduled for an ultrasoundto confirm her pregnancy. Nursingcare to prepare her for this testwould include:

a. Administering enemas until clear.

b. Keeping her NPO for 12 hours.

c. Starting an IV to maintain hydration.

d. Having her drink 8 glasses of water

and not void.


49/149

3. Martha has non-stress test done. Theresults are found to be non reactive.

Based on this, the nurse knows thatwhich of the following must haveoccurred during the test?

a. 2 FHR accelerations above base-linefor 15 seconds

b. Acceleration less than 15 bpm

c. Fetal movement in a 10 to 20 minute

periodd. FHR acceleration greater than 15

bpm


50/149

4. Because of the results of the nonstress test, Martha scheduled for an

oxytocin challenge test. The resultsshow the presence of latedeceleration of FHR with 3contractions during a 10-minute

period; positive window. This testwould be reported as:

a. Abnormal

b. Normalc. Suspicious

d. Unsatisfactory


51/149

5. The risk of amniocentesis would notinclude which of the following?

a. Fetal death

b. Infection

c. Placenta abruptio

d. Chromosomal damage


52/149

6. Which of the following treatmentswould be inappropriate for thepregnant client who is suffering fromnausea and vomiting?

a. Eat small frequent meals.

b. Maintain a low fat diet.

c. Take antiemetics before arising.

d. Drink liquids before meals.


53/149

7. Which of the following iscontraindicated in the pregnant clientwho is suffering from heartburn?

a. Take Gaviscon for the problem.

b. Drink milk between meals.

c. Sit up after meals.

d. Take Maalox occasionally.


54/149

8. Many pregnant clients suffer fromheadaches during pregnancy. Whichof the following is contraindicated intreating these headaches?

a. Change positions slowly.

b. Apply cool cloths to the forehead.

c. Take aspirin sparingly.

d. Take Tylenol sparingly.


55/149

9. Many women have leg cramps duringpregnancy. Which of the followingwould not be an appropriate way totreat leg cramps?

a. Walk regularly.

b. Elevate the legs when sitting.

c. Maintain bedrest when cramps aresevere.

d. Increase milk intake.


56/149

10. Which of the following is true aboutmost abortions?

a. They are usually caused by maternalinfections.

b. The cause of most abortions is

unknown.

c. An incompetent maternal cervical osis the common cause.

d. Most are the result of fetalabnormalities.


57/149

11. When some of the products ofconception remain in utero after fetaldeath, it is referred to as:

a. Spontaneous abortion

b. Missed abortion

c. Incomplete abortion

d. Inevitable abortion


58/149

12. Which of the following is notconsidered a typical sign of anectopic pregnancy?

a. Nausea & vomiting, especially afterrupture

b. Fever around 100F

c. Leukocytosis & an elevated ESR

d. Heavy, bright red vaginal bleeding


59/149

13. Which of the following is a typicalS/Sx of H-mole?

a. Brownish vaginal discharge arounweek 12

b. Hypotension

c. Uterus small for estimatedgestational age

d. Hard, distended lower uterine

segment


60/149

14. Which of the following is apredisposing factor for abruptioplacenta?

a. Young, primigravida

b. Hypertension

c. Multiparity

d. Presence of myomas


61/149

15. Using Whites classification, thepresence of vascular disease in aclient who became diabetic at age 8and has been a diabetic for 21 yearsplaces the client in:

a. Class Bb. Class C

c. Class D

d. Class E


62/149

16. Which of the following womenshould be screened for diabetesduring their 2nd trimester, with atwo-hour-postprandial blood sugar?

a. Obese women

b. Older women

c. Adolescents

d. All women


63/149

17. Mary is a 38-year-old multigravida with ahistory of rheumatic heart disease. She

has been classified as Class II. Which ofthe following symptoms would you expecther to exhibit?

a. Dyspnea, fatigue, and angina with normal

activity

b. Symptoms of cardiac insuficiency at rest

c. No symptoms at normal activities

d. Dyspnea, fatigue, & angina with less thannormal activity


64/149

18. Which of the following is incorrectconcerning rubella & pregnancy?

a. Women with low titers should bevaccinated 2 months beforepregnancy.

b. Rubella is extremely teratogenic inthe 1st trimester.

c. The rubella virus does not cross the

placenta.d. All women should have rubella titers

before their 1st pregnancy.


65/149

Russel, registered at the clinic forprenatal care for her pregnancy.

19. Russel reports feelings of fatigue aswell as constipation & nausea. Thehormone which most likely

contributes to these symptoms is:a. Chorionic gonadotropin

b. Relaxin

c. Prolactind. Progesterone


66/149

20. A change in vaginal mucosal colorfrom pink to violet is recorded on herchart. This referred to as:

a. Goodells sign

b. Chadwicks sign

c. Hegars sign

d. Montgomerys sign


67/149

21. When Russels pregnancy hasreached the last trimester, the nurseconducts Leopolds maneuvers duringthe course of a prenatal examination.Which step in this maneuver assists

in locating the fetal head?a. First

b. Second

c. Thirdd. Fourth


68/149

22. McDonalds measurements indicatethat Russels fundal height is 31 cm.

Which gestational age is compatiblewith this assessment?

a. 28 weeks

b. 32 weeks

c. 35 weeks

d. 39 weeks


69/149

23.Which of the following statements shouldguide the nurses understanding inpreparing a teaching plan for Russel?

a. Fetal needs for calcium causesdemineralization & loss of maternal teethduring pregnancy.

b. Calories must be regulated to 1,800

calories/day to prevent excess weight gain& difficult labor.c. Ambivalence about the pregnancy & mood

swings are evidence of rejection of thepregnancy.

d. Uterine muscles activity known as BraxtonHicks contractions occur throughout thepregnancy.


70/149

Normal Labor and Delivery:

1. When the uterus moves downwardand forward about 2 weeks prior todelivery, this is referred to as:

a. Quickening

b. Lightening

c. Braxton Hicks contractions

d. False labor


71/149

2. Which of the following is not one ofthe prodromes to labor?

a. Sudden burst of energy, nesting

b. Brownish or bloody show

c. Sudden gain of 2-3 pounds from fluidshifts

d. Increased Braxton Hicks contractions


72/149

3. Which of the following characteristicsis not typical of false labor?

a. An increase in the force & frequencyof contractions when walking

b. Contractions that do not produce

dilation, effacement or descent

c. Absence of bloody show

d. Irregular contractions


73/149

4. During the latent phase of the firststage of labor, the mother often

complains of cramps & backache.Nursing measures to decrease thesesymptoms include:

a. Medicate with Demerol as ordered.b. Encourage the client to lay on her

back.

c. Provide a pillow for clients back.d. Have the client bear down with

contractions.


74/149

5. During the transitional phase of the firststage of labor, the client is often

nauseated, hot, and sweaty. Which of thefollowing nursing interventions isappropriate for the client at this time?

a. Administer antiemetics as ordered.

b. Provide the client with cool liquids to drink.

c. Encourage open-mouthed deep breathing.

d. Set up a fan in the room to cool the client.


75/149

6. Which of the following characteristicsis typical of second stage of labor?

a. Moderately increased pain

b. Severe rectal pressure

c. Circumoral pallor

d. Decreased bloody show


76/149

Sandy is a 20-year old overweightprimigravida who suffers from pregnancy-

induced hypertension.7. Immediately following the cesarean birth

under general anesthesia of a four-poundinfant, Sandy is monitored closely. Whichof the ff is not a part of critical nursingcare?

a. Administer transfusions & IV fluids.

b. Monitor hematocrit & fibrinogen levelsclosely.

c. Allow family & clergy to remain at bedside.

d. Suggest early breast-feeding to promotebonding.


77/149

8. The disturbed father is concerned about thehealth of mother and the infant in

intensive care. Which of the followingstatements meets his needs at this time?

a. Dont worry; the doctors are doing allthey can.

b. Lets talk about what you are feelingnow.

c. It wont help your loved ones to be soupset.

d. You must remain strong to support yourfamily.


78/149

9. Several days later the mother isdischarged. Discharge teaching

should not include which of thefollowing?

a. Report strong contractions.

b. Measure I&O.

c. Observe any discomfort.

d. Note behavioral changes.


79/149

10. Several days later the mother isdischarged. Discharge teaching should not

include which of the following?a. Be sure to report any elevated

temperature.

b. Include liver & dried fruits in your diet

often .

c. Call the ICU anytime to check on yourbaby.

d. Breast-feeding the baby may causeincreased bleeding.


80/149

11. Which of the following is the desiredoutcome of the second stage of

labor?

a. The client will be fully dilated.

b. The fetal head will be fully engaged.

c. The client will deliver a healthyinfant.

d. The client will safely deliver the

placenta.


81/149

12. Which of the following is not atypical manifestation of the third

stage of labor?

a. Fundus rises

b. Uterus assumes a globular shape

c. Blood gushes from uterus

d. Perineum bulges


82/149

13. Your client is a 25-year-oldprimigravida who is attached to a

fetal monitor. The base-line FHR is145 to 150 bpm. You notice that theFHR slows every time the client has a

contraction & then returns to normal.This is best described as:

a. Type 1 deceleration

b. Type 2 decelerationc. Type 3 deceleration

d. Fetal distress


83/149

14. The treatment for the abovealteration is to:

a. Do nothing; this is a transientphenomenon

b. Prepare for emergency cesarean

sectionc. Reposition client on her side

d. Prepare the client for impending

vaginal delivery.


84/149

15. Ann, a 26-year-old multigravida, iscomplaining of severe pain during

the 1st stage of labor. Which of thefollowing measures would treat thepain without interfering with the

labor?a. Tranquilizers to calm her down

b. Amnesiacs

c. Paracervical blockd. Pudendal block


85/149

16. Part of your initial assessment on aclient admitted in labor is to perform

Leoplds maneuver to determine:

a. Contractions

b. Fetal position

c. Fetal heart rate

d. Presence of fetal distress


86/149

17. Your clients membranes rupturespontaneously and in checking, you

note that the umbilical cord hasprolapsed. Which of the following isthe priority nursing action for this

situation?a. Call the physician.

b. Administer oxygen.

c. Turn the mother to her side.d. Place the mother in Trendelenburg

position.


87/149

18. Which if the ff is the correct nursingintervention to help the client to push

down during delivery?a. Instruct the client to take 2 breaths, hold,

and bear down between contractions.

b. Turn the client to her side and use short

breaths.

c. Instruct the client to take 2 breaths, holdand bear down with contractions.

d. Encourage the client not to bear downsince it may result in tears.


88/149

19. Your client is suffering from dystociain the form of hypotonic uterine

contractions. Which of the followingis a symptom of the hypotoniccontractions?

a. Increased frequency & intensity ofcontractions.

b. Nonsynchronous uterine tension.

c. Increased muscle tonus.d. Pain out of proportion to contraction.


89/149

20. Which of the following is not a S/Sxof prolonged labor?

a. Latent phase of 22 hours inprimigravida.

b. Prolonged active phase.

c. Dilation of 1 cm per hour in amultipara.

d. Descent of less than 2 cm per hour in

multigravida.


90/149

21. Which of the following is anindication for the use of oxytocin for

your client in labor?

a. Prolapse of the cord.

b. History of the previous cesarean

section more than 5 years ago.c. Cervical dilation less than 3 cm.

d. Hypotonic uterine contractions.


91/149

22. Which of the following is not anindication for delivery of a preterm

mother in labor?

a. Placental separation withhemorrhage.

b. Severe eclampsia.c. Preterm contractions

d. Chorioamnionitis


92/149

23. Ritodrine is often used to treatpreterm labor. Which of the following

is not a side effect of this drug?

a. Palpitations

b. Nausea and vomiting

c. Alterations in maternal BP

d. Constipation


93/149

24. Which of the following is not anindication for induction of labor?

a. Premature rupture of membranes

b. Uncontrolled diabetes

c. Hypertonic uterine contractions

d. History of precipitous delivery


94/149

25. Which of the following is not apredisposing factor for rupture of the

uterus?

a. Previous cesarean section

b. Hypotonic contractions

c. Labor that is not progressing

d. Cephalopelvic disproportion


95/149

25. Which of the following is not apredisposing factor for rupture of the

uterus?

a. Previous cesarean section

b. Hypotonic contractions

c. Labor that is not progressing

d. Cephalopelvic disproportion


96/149

26. Which of the following is not arationale for using a medial

episiotomy?

a. Effective & easily repaired

b. Less painful

c. Minimizes risk of extension to rectum

d. Less blood loss


97/149

27. Nursing care of an episiotomy wouldnot include which of the following?

a. Using an icepack for 1st 24 hours.

b. Avoiding the use of analgesicointments.

c. Applying a heat lamp TID as ordered.

d. Administering a sitz bath, especiallyafter a bowel movement.

8 h h f h f ll


98/149

28. Which of the following is not amaternal predisposing factor for the

use of forceps for delivery?

a. Shortened 2nd stage of labor indystocia

b. Deficiency of expulsive effortsc. Inability to push

d. Prolapse of the cord

29 Whi h f h f ll i i


99/149

29. Which of the following is not aprerequisite to the use of forceps in a

delivery of a fetus.

a. Cephalopelvic disproportion

b. Fully dilated cervix

c. Engaged head

d. Empty bowel & bladder

30 Whi h f th f ll i i lik l t


100/149

30. Which of the following is likely tocause postpartum rectal incontinence

and continued rectal problems?

a. First degree lacerations

b. Second degree lacerations

c. Third degree lacerations

d. Mediolateral episiotomies

31 Whi h f th f ll i li ti


101/149

31. Which of the following complicationsis more likely to occur postpartum

when the client has had a cesareansection rather than a normal vaginaldelivery?

a. Abdominal distensionb. Uterine bleeding

c. Thrombophlebitis

d. Lochia rubra

Lynn Reyes aged 38 is admitted in the


102/149

Lynn Reyes, aged 38, is admitted in the39th week for a planned cesarean

delivery because of total placentaprevia.

32. Which of the following assessmentsis not routine in this situation?

a. Taking fetal heart rate

b. Checking maternal vital signs

c. Monitoring for uterine contractions

d. Checking for cervicaldilation/effacement

33 Th hi f t ti l bl f thi


103/149

33. The chief potential problem for thisfetus is:

a. Potential for impaired gas exchangerelated to impaired circulation

b. Alteration in nutrition: less than body

requirementsc. Potential for infection related to

cesarean birth

d. Potential for injury related toplacental placement

34 A i l t L d li i


104/149

34. A primary goal to Lynns delivery is:

a. Client if free from undetectedcomplications

b. Client & significant others aretogether during preparation and

surgeryc. Client expresses her fears and

concerns

d. Patient is well hydrated beforedeluivery

35 A spinal anesthesia is administered and


105/149

35. A spinal anesthesia is administered, andthe client appears relaxed. Immediately

afterwards, the BP changes from 120/88 to100/70 and FHT drops from 144 to 118.What is the probable reason for thischange?

a. Adverse response to regional anestheticb. Pressure on aorta and vena cava while

supine

c. Poor oxygenation due to placenta previa

d. Anxiety about the cesarean delivery

36 Wh t i th i t i t ti


106/149

36. What is the appropriate interventionfor the above problem at this time?

a. Elevate the feet and legs.

b. Administer oxygen by mask.

c. Increase the IV infusion rate.

d. Turn the client slightly to the left.

37 A seven pound daughter is


107/149

37. A seven-pound daughter isdelivered several minutes later.

Apgar score is 9 and 10. Which of thefollowing assessments would receivea score of 1 at the initial scoring?

a. Heart rate 128b. Cry loud

c. Feet blue

d. Body flexed

38 The total blood loss during delivery


108/149

38. The total blood loss during deliveryis 700 ml. The couple prefer to avoid

transfusion if possible. Based on herhistory and intrapartal situation,which of the following recovery room

assessments is critical in addition toobserving lochia?

a. Blood pressure

b. Pulse rate

c. Temperature

d. Level of consciousness

39 In assessing physiological adaptation to


109/149

39. In assessing physiological adaptation tothe postpartum period, which of the

following statements made by the clientindicates that she is able to be transferredto her regular room?

a. I have a little pain in the incision.

b. Id like to sleep in my own room now.c. I am thirsty and would like my lips

sponged.

d. I feel my legs again as I move them.

40 The Dr orders 1000 ml of Ringers


110/149

40. The Dr. orders 1000 ml of Ringer slactate at 124 ml per hour with

Pitocin 10 units added to the IV. Thedrip factor is 10 gtt/ml. Select theappropriate rate of infusion.

a. 17 gtt per minuteb. 21 gtt per minute

c. 27 gtt per minute

d. 31 gtt per minute


111/149

Post Partum Period

Lisa Cruz, aged 37, delivered her 5th sonthree hours ago in the birthing room.

1. Which of the following data shared at


112/149

gmorning report indicates a potential

problem?a. The fundus is firm, just above the

umbilicus.

b. The client is complaining aboutsevere uterine cramps.

c. Episiotomy is slightly swollen with asmall bruise.

d. The vital signs are temperature 98F,pulse 68, respirations 20.

2. Lisas blood type is O negative; the


113/149

yp gbaby is O positive. RhoGam is

ordered prior to discharge afterresults of the Coombs test areknown. What information is essentialbefore giving the RhoGam?

a. Isoimmunization has occurred.

b. RhoGam was given after the lastbirth.

c. No antibodies are present.

d. There are no known allergies.

3. Ms. Cruz is concerned about how herh h ld 2 3 d ll


114/149

other children, ages 2,3,5 and 15 willaccept the baby. Which response

shows an understanding of herfeelings?

a. Things will be difficult in the first

weeks.b. Their reactions will depend on howyou prepared them.

c. Lets talk about what concerns you.

d. Sometimes its better to avoidworrying too much.

4. The client, who bottle-fed her olderhild h i b


115/149

children, has many questions aboutbreast-feeding. What approach is

most helpful in this situation?a. Assess her knowledge and be

available during feedings.

b. Use pamphlets and films as a firststep in teaching.

c. Introduce her to a successful breast-feeding mother.

d. Tell her the reasons why breast-feeding is beneficial.

5. Before discharge, Lisa discussesf il l i Whi h t t t


116/149

family planning. Which statementindicates that she needs further

teaching?a. Ill start to take oral contraceptives

immediately.

b. If I want to use a diaphragm, Illneed to be checked first.

c. Well avoid intercourse whencervical mucous is stretchable.

d. I will not rely on breast-feeding ascontraception.

6. As the newborn is prepared fordi h th f th k b t


117/149

discharge, the father asks about careof the umbilical cord stump. Select

the appropriate response.a. Apply an antibiotic ointment to the

area daily.

b. Use alcohol to the cord and basewith each diaper change.

c. Let the baby soak in the bath untilthe cord falls off.

d. No special care is needed. The cordwill heal in a week.

Chita Perlas, aged 15, delivered a baby girl anh Sh h ld h i f t d ht


118/149

hour ago. She held her infant daughterand appeared joyful at her alertness. As

the initial newborn assessments are made,she asks many questions about the babyscondition.

1. Which of the ff delivery room observations

is abnormal?

a. Severe molding of the head

b. Cyanosis of the hands & feet

c. Irregular abdominal respirationsd. Temperature of 35C

2. Baby Girl Perlas is later assessed byth h d t i th t th


119/149

the nurse who determines that theinfant is small for gestational age on

the Ballard scale. Reasons forintrauterine growth retardationinclude:

a. Maternal infection and smokingb. Malnutrition and chromosomalabnormalities

c. Anemia and exposure to chemical

agentsd. Alcohol use and emotional distress

3. In observing an adolescent parent


120/149

with her first child, it is important

that the nurse assess:a. Signs that the mother is tuned in to

infant cues

b. Evidence that the mother is aware ofsafety

c. Behaviors that indicate early bonding

d. All of the above

4. Which question focuses on gathering


121/149

data about the young mothers

mastery of her developmental tasks?a. What is your relationship with the

babys father?

b. How do you feel about your parentsinterest in the baby?

c. Tell me how you feel about yourselfas a young woman?

d. Do you feel that you can give loveto an infant?

5. Which of the following is an


122/149

appropriate short-term goal for this

young mother?a. She will be aware of the

developmental needs of childhood.

b. She will feed, nurture, and providecare for her newborn.

c. She will resolve social problemswithin her family.

d. She will delay another pregnancy fora year.

6. At the time of discharge, much time isspent einfo cing teaching of self ca e &


123/149

spent reinforcing teaching of self-care &infant care. Which statement made by

Chita indicates that further teaching isnecessary?

a. If I need to, Ill use non-fat dry milk forfeedings.

b. Ill hold and love the baby even when shedoesnt cry.

c. After feeding, Ill put her to sleep on her

tummy.d. Until the cord is dry, Ill give her a sponge

bath.

Grace , a diabetic, is admitted for terminationof pregnancy in the 37th week when pelvic


124/149

of pregnancy in the 37 week when pelvicexamination shows cervical softening andeffacement. The physician and couple have

agreed on labor induction.7. The primary reason that a gestational

diabetic is delivered early is to:a. Prevent problems that may result from

placental insufficiency.b. Reduce maternal stress during the 2ndstage of labor

c. Eliminate fetal hyperglycemia in theimmediate newborn period

d. Control maternal glucose/insulin balance inintrapartum

8. During the labor induction, whichi i i l?


125/149

assessment is critical?

a. Monitoring contractions and restphase.

b. Observing maternal pain andrelaxation.

c. Measuring I&O.

d. Noting BP and pulse.

9. After a ten-hour labor, a nine-poundi d li d G P


126/149

son is delivered to Grace. Parents

and newborn enjoy early contact andbreast-feeding is initiated. Which ofthe following assessments of thenewborn indicates a need for

immediate intervention?a. Respiratory rate is 30.

b. Dextrostick (glucose) is 25.

c. Hematocrit is 48.d. Coombs test is negative.

10. Baby and mother are discharged after 24hours of hospitalization Both appear to be


127/149

hours of hospitalization. Both appear to bein good health. Which statement made by

Grace shows that discharge teaching waseffective?

a. Well bring the baby for his PKU testtomorrow.

b. Both the baby and I probably will alwaysbe diabetic.

c. Breast-feeding will help space the next

pregnancy.d. Ill start active exercise again right away.

11. Baby James, 6 pounds 1 ounce, wasj t d li d ft l l b Hi


128/149

just delivered after a long labor. His

initial Apgar is 4. Which of thefollowing is likely nursing care forJames?

a. Suction him.

b. Dry him with a dry towel.

c. Ventilate him with 100% O2 at 40 to60 breaths.

d. Place baby under warmer to maintainbody temperature.

12. Baby James is in the newbornI i hi d


129/149

nursery. In assessing his eyes and

vision, which of the following wouldbe an abnormal finding?

a. Crossed eyes

b. Absent blink reflex

c. Positive red reflex

d. Edema of the eyelids

13. Which of the following would be anb l fi di h th


130/149

abnormal finding when the nurse

assesses Jamess cardiovascularsystem?

a. Heart rate of 154

b. Irregular heartbeats

c. Acrocyanosis of the extremities

d. Circumoral cyanosis

14. James is breathing with 10 to 15d i d f Th


131/149

second periods of apnea. The nurse

knows that this means:a. Nothing, it is normal

b. Impending respiratory distress

c. James will eventually develop asthmad. James may be developing a

respiratory infection

15.When the nurse is assessing Jamessl t hi h f th f ll i


132/149

renal system, which of the following

would be considered an abnormalassessment?

a. Urine specific gravity 1.008

b. First void after first 24 hours

c. Voiding up to 20 times a day

d. Brick dust colored urine with thefirst void

16. Which of the following is not part ofthe ca e of an infant ith


133/149

the care of an infant with

hyperbilirubinemia?a. Withhold fluids during treatment.

b. Maintain neutral temperature.

c. Administer phototherapy.d. Assist with exchange transfusion if

needed.

Mrs. C., gravida i para i, and has justdelivered a 7 pound 3 ounce baby girl after


134/149

delivered a 7 pound 3 ounce baby girl aftera ten-hour labor. The baby was delivered

vaginally with no complications.17. In order to assess this newborns

adaptation to extrauterine life, the nurseshould perform which of the following

tests?

a. Apgar

b. Silverman

c. Ballard/Dubowitzd. Brazelton

18. To avoid heat loss by evaporation,the nurse should:


135/149

the nurse should:

a. Keep the baby away from draftsb. Avoid placing the baby on a cold

surface

c. Dry the baby immediately afterdelivery

d. Pad the scale before weighing thebaby

19. In order to prevent abnormalbleeding in the newborn the nurse


136/149

bleeding in the newborn, the nurseshould:

a. Keep the baby away from drafts.

b. Avoid placing the baby on a coldsurface.

c. Dry the baby immediately afterdelivery.

d. Pad the scale before weighing the

baby.

20. The newborns first stool is:

Y ll d l


137/149

a. Yellow and loose

b. Yellow and seedyc. Thick and greenish black

d. Loose and green

21. In order to rule out PKU, the nurseshould test the baby:


138/149

should test the baby:

a. Immediately after deliveryb. Prior to the first feeding

c. 2 to 3 days after birth

d. At the six-week check up

Baby Susan is a 9 pound 2 ounce infant bornto a diabetic mother. She was delivered by


139/149

to a diabetic mother. She was delivered bycesarean section 12 hours ago. Her Apgar

scores in the delivery room were 7 and 9.22. You notice that Susan is lethargic, jittery,

and has irregular respirations. Appropriatenursing interventions would include:

a. Feeding the infant glucose water (10%)

b. Administering insulin subcutaneously

c. Giving oxygen

d. Administering Phenobarbital IM

23. Ten hours later, Susan developstetany Which of the following


140/149

tetany. Which of the followingcomplications will you most likelygive IV?

a. Glucose

b. Insulin

c. Calcium gluconate

d. Valium

24. Jaundice that appears after the first48 hours of a newborns life usually


141/149

48 hours of a newborn s life usuallyindicates:

a. Rh or ABO incompatibility

b. Normal physiological adaptation

c. Breast milk intoleranced. Liver abnormality

25. Expiratory grunting is:

N l b l t it i th b


142/149

a. Normal bowel transit in the newborn

b. A sign of respiratory distressc. Common in babies of Rh negative

mothers

d. Transitory in most instances

Baby Den Rick is a 9 pound 8 ounce infantborn at 43 weeks gestation. He was


143/149

born at 43 weeks gestation. He wasdelivered vaginally ten hours ago. His

Apgar scores were 7 and 8.26. Den Ricks physical characteristics include:

a. cracked, peeling skin, and scant vernixcaseosa

b. Abundant lanugo & thin, transparent skin

c. Yellow-stained skin and abundantsubcutaneous fat

d. Ruddy complexion & flaccid extremities

27. Den Ricks gestational age puts himat risk for:


144/149

at risk for:

a. Juvenile onset diabetesb. Meconium Aspiration Syndrome

c. Hemolytic anemia

d. Hyperthermia

28. Baby Sarah, 7 pounds 8 ounces, was borntoday. She is in the newborn nursery and


145/149

y yyou are caring for her cord. Which of the

following nursing interventions isappropriate when caring for the umbilicalcord.

a. Apply a vaseline gauze dressing over the

site.

b. Apply a simple dry dressing over the site.

c. Clean the site vigorously with soap andwater everyday.

d. Apply topical triple dye or bacitracinointment initially.

29. Bowel transit time in the newborn isabout:


146/149

about:

a. 1 to 1 hoursb. 2 to 3 hours

c. 1 to 2 hours

d. 3 to 3 hours

30. The newborn needs approximatelyhow many calories per day?


147/149

how many calories per day?

a. 50 calories per kg per dayb. 75 calories per kg per day

c. 120 calories per kg per day

d. 150 calories per kg per day

31. The newborn infant exhibits anumber of reflexes at birth Which of


148/149

number of reflexes at birth. Which ofthe following is not present at birth?

a. Parachute reflex

b. Moro reflex

c. Sucking reflexd. Extrusion reflex

32. Which of the following is not a riskfactor for respiratory distress


149/149

factor for respiratory distresssyndrome?

a. Prematurity

b. Maternal diabetes

c. Birth traumad. Post term birth

Documents

Maternal and Child Health Nursing 1 Saundrs Pink Ed