Chapter 13: Adaptations to Pregnancy My Nursing Test Banks

Chapter 13: Adaptations to Pregnancy

Test bank

MULTIPLE CHOICE

1. A pregnant womans mother is worried that her daughter is not big enough at 20 weeks. The nurse palpates and measures the fundal height at 20 cm, which is even with the womans umbilicus. What should the nurse report to the woman and her mother?

a.

The body of the uterus is at the belly button level, just where it should be at this time.

b.

Youre right. Well inform the practitioner immediately.

c.

When you come for next months appointment, well check you again to make sure that the baby is growing.

d.

Lightening has occurred, so the fundal height is lower than expected.

ANS: A

Feedback

A

At 20 weeks, the fundus is usually located at the umbilical level. Because the uterus grows in a predictable pattern, obstetric nurses should know that the uterus of 20 weeks of gestation is located at the level of the umbilicus.

B

This is incorrect information. At 20 weeks the uterus should be at the umbilical level.

C

By avoiding the direction question, this might increase the anxiety of both the mother and grandmother.

D

The descent of the fetal head (lightening) occurs in late pregnancy.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 235

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

2. While you are assessing the vital signs of a pregnant woman in her third trimester, the patient complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate?

a.

Have the patient stand up and retake her blood pressure.

b.

Have the patient sit down and hold her arm in a dependent position.

c.

Have the patient lie supine for 5 minutes and recheck her blood pressure on both arms.

d.

Have the patient turn to her left side and recheck her blood pressure in 5 minutes.

ANS: D

Feedback

A

Pressures are significantly higher when the patient is standing. This option causes an increase in systolic and diastolic pressures.

B

The arm should be supported at the same level of the heart.

C

The supine position may cause occlusion of the vena cava and descending aorta, creating hypotension.

D

Blood pressure is affected by positions during pregnancy. The supine position may cause occlusion of the vena cava and descending aorta. Turning the pregnant woman to a lateral recumbent position alleviates pressure on the blood vessels and quickly corrects supine hypotension.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 237

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

3. A pregnant woman has come to the emergency department with complaints of nasal congestion and epistaxis. What is the correct interpretation of these symptoms by the practitioner?

a.

These conditions are abnormal. Refer the patient to an ear, nose, and throat specialist.

b.

Nasal stuffiness and nosebleeds are caused by a decrease in progesterone.

c.

Estrogen relaxes the smooth muscles in the respiratory tract, so congestion and epistaxis are within normal limits.

d.

Estrogen causes increased blood supply to the mucous membranes and can result in congestion and nosebleeds.

ANS: D

Feedback

A

The patient should be reassured that these symptoms are within normal limits. No referral is needed at this time.

B

Progesterone is responsible for the heightened awareness of the need to breathe in pregnancy. Progesterone levels increase during pregnancy.

C

Progesterone affects relaxation of the smooth muscles in the respiratory tract.

D

As capillaries become engorged, the upper respiratory tract is affected by the subsequent edema and hyperemia, which causes these conditions, seen commonly during pregnancy.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 238

OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

4. Which finding in the urine analysis of a pregnant woman is considered a variation of normal?

a.

Proteinuria

b.

Glycosuria

c.

Bacteria in the urine

d.

Ketones in the urine

ANS: B

Feedback

A

The presence of protein could indicate kidney disease or preeclampsia.

B

Small amounts of glucose may indicate physiologic spilling.

C

Urinary tract infections are associated with bacteria in the urine.

D

An increase in ketones indicates that the patient is exercising too strenuously or has an inadequate fluid and food intake.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 239

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

5. Which suggestion is appropriate for the pregnant woman who is experiencing nausea and vomiting?

a.

Eat only three meals a day so the stomach is empty between meals.

b.

Drink plenty of fluids with each meal.

c.

Eat dry crackers or toast before arising in the morning.

d.

Drink coffee or orange juice immediately on arising in the morning.

ANS: C

Feedback

A

Instruct the woman to eat five to six small meals rather than three full meals per day. Nausea is more intense when the stomach is empty.

B

Fluids should be taken separately from meals. Fluids overstretch the stomach and may precipitate vomiting.

C

This will assist with the symptoms of morning sickness. It is also important for the woman to arise slowly.

D

Coffee and orange juice stimulate acid formation in the stomach. It is best to suggest eating dry carbohydrates when rising in the morning.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 252

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

6. Which statement related to changes in the breasts during pregnancy is the most accurate?

a.

During the early weeks of pregnancy there is decreased sensitivity.

b.

Nipples and areolae become more pigmented.

c.

Montgomery tubercles are no longer visible around the nipples.

d.

Venous congestion of the breasts is more visible in the multiparous woman.

ANS: B

Feedback

A

Fullness, heightened sensitivity, tingling and heaviness of the breasts occur in the early weeks of gestation in response to increased levels of estrogen and progesterone.

B

Nipples and areolae become more pigmented, and the nipples become more erectile and may express colostrum.

C

Montgomery tubercles may be seen around the nipples. These sebaceous glands may have a protective role in that they keep the nipples lubricated for breastfeeding.

D

Venous congestion in the breasts is more obvious in primigravidas.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 236

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

7. Alterations in hormonal balance and mechanical stretching are responsible for several changes in the integumentary system during pregnancy. Stretch marks often occur on the abdomen and breasts. These are referred to as

a.

Chloasma

b.

Linea nigra

c.

Striae gravidarum

d.

Angiomas

ANS: C

Feedback

A

Chloasma is a facial melasma also known as the mask of pregnancy. This condition is manifested by a blotchy, hyperpigmentation of the skin over the cheeks, nose and forehead especially in dark complexioned women.

B

Linea nigra is a pigmented line extending from the symphysis pubis to the top of the fundus in the midline.

C

Striae gravidarum or stretch marks appear in 50% to 90% of pregnant women during the second half of pregnancy. They most often occur on the breasts and abdomen. This integumentary alteration is the result of separation within the underlying connective (collagen) tissue.

D

Angiomas and other changes also may appear.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 240

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

8. The maternity nurse understands that vascular volume increases 40% to 60% during pregnancy to

a.

Compensate for decreased renal plasma flow.

b.

Provide adequate perfusion of the placenta.

c.

Eliminate metabolic wastes of the mother.

d.

Prevent maternal and fetal dehydration.

ANS: B

Feedback

A

Renal plasma flow increases during pregnancy.

B

The primary function of increased vascular volume is to transport oxygen and nutrients to the fetus via the placenta.

C

Assisting with pulling metabolic wastes from the fetus for maternal excretion is one purpose of the increased vascular volume.

D

This is not the primary reason for the increase in volume.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 236

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

9. A number of cardiovascular system changes occur during pregnancy. Which finding is considered normal for a woman during pregnancy?

a.

Cardiac output rises by 25%

b.

Increased pulse rate

c.

Increased blood pressure

d.

Decreased red blood cell (RBC) production

ANS: B

Feedback

A

Cardiac output increases by 50% with half of this rise occurring in the first 8 weeks gestation.

B

The pulse increases about 15 to 20 beats/min, which persists to term.

C

In the first trimester, blood pressure usually remains the same as the prepregnancy level, but it gradually decreases up to about 20 weeks of gestation. During the second trimester, both the systolic and diastolic pressures decrease by about 5 to 10 mm Hg.

D

Production of RBCs accelerates during pregnancy.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 237

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

10. Physiologic anemia often occurs during pregnancy as a result of

a.

Inadequate intake of iron

b.

Dilution of hemoglobin concentration

c.

The fetus establishing iron stores

d.

Decreased production of erythrocytes

ANS: B

Feedback

A

Inadequate intake of iron may lead to true anemia.

B

When blood volume expansion is more pronounced and occurs earlier than the increase in red blood cells, the woman will have physiologic anemia, which is the result of dilution of hemoglobin concentration rather than inadequate hemoglobin.

C

If the woman does not take an adequate amount of iron, true anemia may occur when the fetus pulls stored iron from the maternal system.

D

There is an increased production of erythrocytes during pregnancy.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 236

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

11. While assessing her patient, what does the nurse interpret as a positive sign of pregnancy?

a.

Fetal movement felt by the woman

b.

Amenorrhea

c.

Breast changes

d.

Visualization of fetus by ultrasound

ANS: D

Feedback

A

Fetal movement is a presumptive sign of pregnancy.

B

Amenorrhea is a presumptive sign of pregnancy.

C

Breast changes are a presumptive sign of pregnancy.

D

The only positive signs of pregnancy are auscultation of fetal heart tones, visualization of the fetus by ultrasound, and fetal movement felt by the examiner.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 245

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

12. A woman is currently pregnant; she has a 5-year-old son and a 3-year-old daughter. She had one other pregnancy that terminated at 8 weeks. Her gravida and para are

a.

Gravida 3 para 2

b.

Gravida 4 para 3

c.

Gravida 4 para 2

d.

Gravida 3 para 3

ANS: C

Feedback

A

Because she is currently pregnant, she is classified as a gravida 4; the pregnancy that was terminated at 8 weeks is classified as an abortion.

B

Gravida 4 is correct, but she is a para 2. The pregnancy that was terminated at 8 weeks is classified as an abortion.

C

She has had four pregnancies, including the current one (gravida 4). She had two pregnancies that terminated after 20 weeks (para 2). The pregnancy that terminated at 8 weeks is classified as an abortion.

D

Since she is currently pregnant, she is classified as a gravida 4, not a 3. The para is correct.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 246

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

13. A womans last menstrual period was June 10. Her estimated date of delivery (EDD) is

a.

April 7

b.

March 17

c.

March 27

d.

April 17

ANS: B

Feedback

A

April 7 would be subtracting 2 months instead of 3 months and then subtracting 3 days instead of adding 7 days.

B

To determine the EDD, the nurse uses the first day of the last menstrual period (June 10), subtracts 3 months (March 10), and adds 7 days (March 17).

C

March is the correct month, but instead of adding 7 days, 17 days were added.

D

April 17 is subtracting 2 months instead of 3 months.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 247

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

14. A woman in her first trimester of pregnancy can expect to visit her physician every 4 weeks so that

a.

She develops trust in the health care team.

b.

Her questions about labor can be answered.

c.

The condition of the expectant mother and fetus can be monitored.

d.

Problems can be eliminated.

ANS: C

Feedback

A

Developing a trusting relationship should be established during these visits, but that is not the primary reason.

B

Most women do not have questions concerning labor until the last trimester of the pregnancy.

C

This routine allows monitoring of maternal health and fetal growth and ensures that problems will be identified early.

D

All problems cannot be eliminated because of prenatal visits, but they can be identified.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 249-250

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

15. A patient in her first trimester complains of nausea and vomiting. She asks, Why does this happen? The nurses best response is

a.

It is due to an increase in gastric motility.

b.

It may be due to changes in hormones.

c.

It is related to an increase in glucose levels.

d.

It is caused by a decrease in gastric secretions.

ANS: B

Feedback

A

Gastric motility decreases during pregnancy.

B

Nausea and vomiting are believed to be caused by increased levels of hormones, decreased gastric motility, and hypoglycemia.

C

Glucose levels decrease in the first trimester.

D

Gastric secretions do decrease, but this is not the main cause of nausea and vomiting.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 253

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

16. One of the most effective methods for preventing venous stasis is to

a.

Wear elastic stockings in the afternoons.

b.

Sleep with the foot of the bed elevated.

c.

Rest often with the feet elevated.

d.

Sit with the legs crossed.

ANS: C

Feedback

A

Elastic stockings should be applied before lowering the legs in the morning.

B

Elevating the legs at night may cause pressure on the diaphragm and increase breathing problems.

C

Elevating the feet and legs improves venous return and prevents venous stasis.

D

Sitting with the legs crossed will decrease circulation in the legs and increase venous stasis.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 253

OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

17. A patient notices that the doctor writes positive Chadwicks sign on her chart. She asks the nurse what this means. The nurses best response is

a.

It refers to the bluish color of the cervix in pregnancy.

b.

It means the cervix is softening.

c.

The doctor was able to flex the uterus against the cervix.

d.

That refers to a positive sign of pregnancy.

ANS: A

Feedback

A

Increased vascularity of the pelvic organs during pregnancy results in the bluish color of the cervix, vagina, and labia, called Chadwicks sign.

B

Softening of the cervix is Goodells sign.

C

The softening of the lower segment of the uterus (Hegars sign) can allow the uterus to be flexed against the cervix.

D

Chadwicks sign is a probable indication of pregnancy.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 238

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

18. Prenatal testing for the human immunodeficiency virus (HIV) is recommended for which women?

a.

All women, regardless of risk factors

b.

A woman who has had more than one sexual partner

c.

A woman who has had a sexually transmitted infection

d.

A woman who is monogamous with her partner

ANS: A

Feedback

A

An HIV test is recommended for all women, regardless of risk factors. The incidence of perinatal transmission from an HIV-positive mother to her fetus ranges from 25% to 35%. Women who test positive for HIV can then be treated.

B

All women should be tested for HIV, although this patient is at increased risk of contracting the disease.

C

Regardless of past sexual history, all women should have an HIV test completed prenatally.

D

Although this patient is apparently monogamous, an HIV test is still recommended.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 249 | Table 13-3

OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

19. To relieve a leg cramp, the patient should be instructed to

a.

Massage the affected muscle.

b.

Stretch and point the toe.

c.

Dorsiflex the foot.

d.

Apply a warm pack.

ANS: C

Feedback

A

Since she is prone to blood clots in the legs, massaging the affected leg muscle is contraindicated.

B

Pointing the toes will contract the muscle and not relieve the pain.

C

Dorsiflexion of the foot stretches the leg muscle and relieves the painful muscle contraction.

D

Warm packs can be used to relax the muscle, but more immediate relief is necessary, such as dorsiflexion of the foot.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 253

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

20. The multiple marker screen is used to assess the fetus for which condition?

a.

Down syndrome

b.

Diaphragmatic hernia

c.

Congenital cardiac abnormality

d.

Anencephaly

ANS: A

Feedback

A

The maternal serum level of alpha-fetoprotein is used to screen for Trisomy 18 or 21, neural tube defects, and other chromosomal anomalies.

B

The quadruple marker test does not detect this fetal anomaly. Additional testing, such as ultrasonography would be required to diagnose diaphragmatic hernia.

C

Congenital cardiac abnormality would most likely be identified during an ultrasound examination.

D

The quadruple marker test would not detect anencephaly.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 249 | Table 13-3

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

21. Which complaint by a patient at 35 weeks of gestation requires additional assessment?

a.

Shortness of breath when climbing stairs

b.

Abdominal pain

c.

Ankle edema in the afternoon

d.

Backache with prolonged standing

ANS: B

Feedback

A

Shortness of breath is an expected finding by 35 weeks.

B

Abdominal pain may indicate preterm labor or placental abruption.

C

Ankle edema in the afternoon is a normal finding at this stage of pregnancy.

D

Backaches while standing is a normal finding during the later stages of pregnancy.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 258

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

22. A gravida patient at 32 weeks of gestation reports that she has severe lower back pain. The nurses assessment should include

a.

Observation of posture and body mechanics

b.

Palpation of the lumbar spine

c.

Exercise pattern and duration

d.

Ability to sleep for at least 6 hours uninterrupted

ANS: A

Feedback

A

Correct posture and body mechanics can reduce lower back pain caused by increasing lordosis.

B

Pregnancy should not cause alterations in the spine. Any assessment for malformation should be done early in the pregnancy.

C

Certain exercises can help relieve back pain.

D

Rest is important for well-being, but the main concern with back pain is to assess posture and body mechanics.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 252-253

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

23. A pregnant couple has formulated a birth plan and is reviewing it with the nurse at an expectant parents class. Which aspect of their birth plan would be considered unrealistic and require further discussion with the nurse?

a.

My husband and I have agreed that my sister will be my coach since he becomes anxious with regard to medical procedures and blood. He will be nearby and check on me every so often to make sure everything is OK.

b.

We plan to use the techniques taught in the Lamaze classes to reduce the pain experienced during labor.

c.

We want the labor and birth to take place in a birthing room. My husband will come in the minute the baby is born.

d.

We do not want the fetal monitor used during labor, since it will interfere with movement and doing effleurage.

ANS: D

Feedback

A

This is an acceptable request for a laboring woman.

B

Using breathing techniques to alleviate pain is a realistic part of a birth plan.

C

Not all fathers are able to be present during the birth; however, this couple has made a realistic plan that works for their specific situation.

D

Since monitoring is essential to assess fetal well-being, it is not a factor that can be determined by the couple. The nurse should fully explain its importance. The option for intermittent electronic monitoring could be explored if this is a low risk pregnancy and as long as labor is progressing normally. The birth plan is a tool with which parents can explore their childbirth options; however, the plan must be viewed as tentative.

PTS: 1 DIF: Cognitive Level: Application REF: p. 273, Box 13-2

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

24. Centering pregnancy is an example of an alternative model of prenatal care. Which statement accurately applies to the centering model of care?

a.

Group sessions begin with the first prenatal visit.

b.

At each visit blood pressure, weight, and urine dipsticks are obtained by the nurse.

c.

Eight to 12 women are placed in gestational-age cohort groups.

d.

Outcomes are similar to traditional prenatal care.

ANS: C

Feedback

A

Group sessions begin at 12 to 16 weeks of gestation and end with an early postpartum visit. Prior to group sessions, the patient has an individual assessment, physical examination, and history.

B

At the beginning of each group meeting, patients measure their own BP, weight, and urine dips and enter these in their record. Fetal heart rate assessment and fundal height are obtained by the nurse.

C

Gestational age cohorts comprise the groups, with approximately 8 to 12 women in each group. This group remains intact throughout the pregnancy. Individual follow-up visits are scheduled as needed.

D

Results evaluating this approach have been very promising. In a recent study of adolescent patients, there was a decrease in LBW infants and an increase in breastfeeding rates.

PTS: 1 DIF: Cognitive Level: Application REF: p. 250

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

25. Which comment by a woman in her first trimester indicates ambivalent feelings?

a.

I wanted to become pregnant, but Im scared about being a mother.

b.

I havent felt well since this pregnancy began.

c.

Im concerned about the amount of weight Ive gained.

d.

My body is changing so quickly.

ANS: A

Feedback

A

Ambivalence refers to conflicting feelings.

B

This does not reflect conflicting feelings.

C

By expressing concerns over a normal occurrence, the woman is trying to confirm the pregnancy.

D

The woman is trying to confirm the pregnancy when she expresses concerns over normal pregnancy changes. She is not expressing conflicting feelings.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 259

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

26. A patient who is 7 months pregnant states, Im worried that something will happen to my baby. The nurses best response is

a.

There is nothing to worry about.

b.

The doctor is taking good care of you and your baby.

c.

Tell me about your concerns.

d.

Your baby is doing fine.

ANS: C

Feedback

A

This statement is belittling the patients concerns.

B

This statement is belittling the patients concerns by telling her she should not worry.

C

Encouraging the client to discuss her feelings is the best approach. Women during their third trimester need reassurance that such fears are not unusual in pregnancy.

D

This statement disregards the patients feelings and treats them as unimportant.

PTS: 1 DIF: Cognitive Level: Application REF: p. 261

OBJ: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

27. Mimicry refers to observing and copying the behaviors of other mothers. An example might be

a.

Babysitting for a neighbors children

b.

Wearing maternity clothes before they are needed

c.

Daydreaming about the newborn

d.

Imagining oneself as a good mother

ANS: B

Feedback

A

Babysitting other children is a form of role playing where the woman practices the expected role of motherhood.

B

Wearing maternity clothes before they are needed helps the expectant mother feel what its like to be obviously pregnant.

C

Daydreaming is a type of fantasy where the woman tries on a variety of behaviors in preparation for motherhood.

D

Imagining herself as a good mother is the womans effort to look for a good role fit. She observes behavior of other mothers and compares them with her own expectations.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 262

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

28. A step in maternal role attainment that relates to the woman giving up certain aspects of her previous life is termed

a.

Looking for a fit

b.

Roleplaying

c.

Fantasy

d.

Grief work

ANS: D

Feedback

A

This is when the woman observes the behaviors of mothers and compares them with her own expectations.

B

Roleplaying involves searching for opportunities to provide care for infants in the presence of another person.

C

Fantasies allow the woman to try on a variety of behaviors. This usually deals with how the child will look and the characteristics of the child.

D

The woman experiences sadness as she realizes that she must give up certain aspects of her previous self and that she can never go back.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 262-263

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

29. The maternal task that begins in the first trimester and continues throughout the neonatal period is called

a.

Seeking safe passage for herself and her baby

b.

Securing acceptance of the baby by others

c.

Learning to give of herself

d.

Developing attachment with the baby

ANS: D

Feedback

A

This is a task that ends with delivery. During this task the woman seeks health care and cultural practices.

B

This process continues throughout pregnancy as the woman reworks relationships.

C

This task occurs during pregnancy as the woman allows her body to give space to the fetus. She continues with giving to others in the form of food or presents.

D

Developing attachment (strong ties of affection) to the unborn baby begins in early pregnancy when the woman accepts that she is pregnant. By the second trimester, the baby becomes real and feelings of love and attachment surge.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 263

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

30. Which situation best describes a man trying on fathering behaviors?

a.

Spending more time with his siblings

b.

Coaching a Little League baseball team

c.

Reading books on newborn care

d.

Exhibiting physical symptoms related to pregnancy

ANS: B

Feedback

A

The man normally will seek closer ties with his father.

B

Interacting with children and assuming the behavior and role of a father best describes a man trying on being a father.

C

Men do not normally read information that is provided in advance. The nurse should be prepared to present the information after the baby is born, when it is more relevant.

D

This is called couvade.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 264

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

31. A 36-year-old divorcee with a successful modeling career finds out that her 18-year-old married daughter is expecting her first child. What is a major factor in determining how the woman will respond to becoming a grandmother?

a.

Her career

b.

Being divorced

c.

Her age

d.

Age of the daughter

ANS: C

Feedback

A

Career responsibilities may have demands that make the grandparents not as accessible, but it is not a major factor in determining the womans response to becoming a grandmother.

B

Being divorced is not a major factor that determines adaptation of grandparents.

C

Age is a major factor in determining the emotional response of prospective grandparents. Young grandparents may not be happy with the stereotype of grandparents as being old.

D

The age of the daughter is not a major factor that determines adaptation of grandparents. The age of the grandparent is a major factor.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 265

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

32. The nurse who practices in a prenatal clinic understands that a major concern of lower socioeconomic groups is to

a.

Maintain group health insurance on their families.

b.

Meet health needs as they occur.

c.

Practice preventive health care.

d.

Maintain an optimistic view of life.

ANS: B

Feedback

A

Lower socioeconomic groups usually do not have group health insurances.

B

Because of economic uncertainty, lower socioeconomic groups place more emphasis on meeting the needs of the present rather than on future goals.

C

They may value health care, but cannot afford preventive health care.

D

They may struggle for basic needs and often do not see a way to improve their situation. It is difficult to maintain optimism.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 267 | Table 13-6

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

33. What comment by a new mother exhibits understanding of her toddlers response to a new sibling?

a.

I cant believe he is sucking his thumb again.

b.

He is being difficult, and I dont have time to deal with him.

c.

My husband is going to stay with the baby so I can take our son to the park tomorrow.

d.

When we brought the baby home, we made our son stop sleeping in the crib.

ANS: C

Feedback

A

It is normal for a child to regress when a new sibling is introduced into the home.

B

The toddler may have feelings of jealousy and resentment toward the new baby taking the attention from him. Frequent reassurance of parental love and affection are important.

C

It is important for a mother to seek time alone with her toddler to reassure him that he is loved.

D

Changes in sleeping arrangements should be made several weeks before the birth so that the child does not feel displaced by the new baby.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 265

OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance

34. As a nurse in labor and delivery, you are caring for a Muslim woman during the active phase of labor. You note that when you touch her, she quickly draws away. You should

a.

Continue to touch her as much as you need to while providing care.

b.

Assume that she doesnt like you and decrease your time with.

c.

Limit touching to a minimum, as this may not be acceptable in her culture.

d.

Ask the charge nurse to reassign you to another patient.

ANS: C

Feedback

A

By continuing to touch her, the nurse is showing disrespect for her cultural beliefs.

B

A Muslims response to touch does not reflect like or dislike.

C

Touching is an important component of communication in various cultures, but if the patient appears to find it offensive, the nurse should respect her cultural beliefs and limit touching her.

D

This reaction may be offensive to the patient.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 269

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

35. Early pregnancy classes offered in the first and second trimesters cover

a.

Phases and stages of labor

b.

Coping with common discomforts of pregnancy

c.

Methods of pain relief

d.

Predelivery and postdelivery care of the patient having a cesarean delivery

ANS: B

Feedback

A

Phases and stages of labor are taught in childbirth preparation classes.

B

Early pregnancy classes focus on the first two trimesters and cover information on adapting to pregnancy, dealing with early discomforts, and understanding what to expect in the months ahead.

C

Pain control is part of childbirth preparation classes.

D

This is taught in cesarean birth preparation classes.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 274

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

MULTIPLE RESPONSE

1. In some Middle Eastern and African cultures, female genital mutilation is a prerequisite for marriage. Women who now live in North America need care from nurses who are knowledgeable about the procedure and comfortable with the abnormal appearance of her genitalia. When caring for this woman, the nurse can formulate a diagnosis with the understanding that the woman may be at risk for (select all that apply)

a.

Obstructed labor

b.

Increased signs of pain response

c.

Laceration

d.

Hemorrhage

e.

Infection

ANS: A, C, D, E

Feedback

Correct

The woman is at risk for all of these complications. Female genital mutilation, cutting, or circumcision involves removal of some or all of the external female genitalia. The labia majora are often stitched together over the vaginal and urethral opening as part of this practice. Enlargement of the vaginal opening may be performed before or during the birth.

Incorrect

The woman is unlikely to give any verbal or nonverbal signs of pain. This lack of response does not indicate lack of pain. In fact, pelvic examinations are likely to be very painful because the introitus is so small and inelastic scar tissue makes the area especially sensitive. A pediatric speculum may be necessary, and the patient should be made as comfortable as possible.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 269

OBJ: Nursing Process: Diagnosis MSC: Client Needs: Psychosocial Integrity

2. A pregnant woman reports that she works in a long-term care setting and is concerned about the impending flu season. She asks about receiving the flu vaccine. As the nurse, you are aware that some immunizations are safe to administer during pregnancy, whereas others are not. Which vaccines could this patient receive? Select all that apply.

a.

Tetanus

b.

Hepatitis A and B

c.

Measles, mumps, rubella (MMR)

d.

Influenza

e.

Varicella

ANS: A, B, D

Feedback

Correct

Inactivated vaccines such as those for tetanus, hepatitis A, hepatitis B, and influenza are safe to administer for women who have a risk for contracting or developing the disease.

Incorrect

Immunizations with live virus vaccines such as MMR, varicella (chickenpox), or smallpox are contraindicated during pregnancy because of the possible teratogenic effects on the fetus.

PTS: 1 DIF: Cognitive Level: Application REF: p. 257

OBJ: Nursing Process: Diagnosis MSC: Client Needs: Health Promotion and Maintenance

3. During pregnancy there are a number of changes that occur as a direct result of the presence of the fetus. Which of these adaptations meet this criteria? Select all that apply.

a.

Leukorrhea

b.

Development of the operculum

c.

Quickening

d.

Ballottement

e.

Lightening

ANS: A, C, E

Feedback

Correct

Leukorrhea is a white or slightly gray vaginal discharge that develops in response to cervical stimulation by estrogen and progesterone. Quickening is the first recognition of fetal movements or feeling life. Quickening is often described as a flutter and is felt earlier in multiparous women than in primiparas. Lightening occurs when the fetus begins to descent into the pelvis. This occurs two weeks before labor in the nullipara and at the start of labor in the multipara.

Incorrect

Mucous fills the cervical canal creating a plug otherwise known as the operculum. The operculum acts as a barrier against bacterial invasion during the pregnancy. Passive movement of the unengaged fetus is referred to asballottement.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 244-245

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

COMPLETION

1. While providing education to a primiparous woman regarding the normal changes of pregnancy, it is important for the nurse to explain that the uterus undergoes irregular contractions. These are known as _____________ contractions.

ANS:

Braxton Hicks

Irregular painless contractions occur throughout pregnancy, although many women do not notice them until the third trimester. Women who are unsure, who have 5 or 6 regular contractions within one hour, or who demonstrate other signs of labor should contact their provider.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 245

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

2. During pregnancy many women become increasingly concerned about their ability to protect and provide for the fetus. This concern is often manifested as _____________.

ANS:

narcissism

Narcissism is an undue preoccupation with ones self and introversion (concentration on ones self and ones body). Selecting the right foods and clothing may be more important than ever before, out of concern for the growing fetus.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 259

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

3. In order to prevent neural tube defects, updated recommendations include an intake of 0.4 mg to 0.8 mg of ___________________ each day from one month prior to conception until 8 to 10 weeks of pregnancy.

ANS:

folic acid

Pregnant women should take 0.6 mg of folic acid daily for the duration of their pregnancy. Women who have given birth to an infant with a neural tube defect previously should take 4 mg of folic acid in the 4 weeks prior to pregnancy and

throughout the first trimester.

PTS: 1 DIF: Cognitive Level: Application REF: p. 246

OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

TRUE/FALSE

1. Pelvic congestion during pregnancy may lead to heightened sexual interest and increased orgasmic experiences. Is this statement true or false?

ANS: T

Increased vascularity, edema, and connective tissue changes during pregnancy make the tissues of the vulva and perineum more pliable. This can lead to an increased interest in sexual activity and ease of orgasm.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 260-261

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

2. Pregnancy is a hypercoagulable state, where the mothers blood clots more readily. Is this statement true or false?

ANS: T

This is because of an increase in factors that favor coagulation and a decrease in factors that inhibit coagulation. Fibrinogen increases by 50% and factors VII, VIII, IX, and X also rise.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 238

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

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