Chapter 24: The Childbearing Family with Special Needs My Nursing Test Banks

Chapter 24: The Childbearing Family with Special Needs

Test Bank

MULTIPLE CHOICE

1. A pregnant woman who abuses cocaine admits to exchanging sex for her drug habit. This behavior puts her at a greater risk for

a.

Depression of the central nervous system

b.

Hypotension and vasodilation

c.

Sexually transmitted diseases

d.

Postmature birth

ANS: C

Feedback

A

Cocaine is a central nervous system stimulant.

B

Cocaine causes hypertension and vasoconstriction.

C

Sex acts exchanged for drugs place the woman at increased risk for sexually transmitted diseases because of multiple partners and lack of protection.

D

Premature delivery of the infant is one of the most common problems associated with cocaine use during pregnancy.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 558 | Table 24-1

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

2. During which phase of the cycle of violence does the batterer become contrite and remorseful?

a.

Battering phase

b.

Honeymoon phase

c.

Tension-building phase

d.

Increased drug-taking phase

ANS: B

Feedback

A

During the battering phase violence actually occurs, and the victim feels powerless.

B

During the honeymoon phase, the battered person wants to believe that the battering will never happen again, and the batterer will promise anything to get back into the home.

C

During the tension-building phase, the batterer becomes increasingly hostile, swears, threatens, throws things, and pushes the battered.

D

Often the batterer increases the use of drugs during the tension-building phase.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 571

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

3. What is a major barrier to health care for teen mothers?

a.

The hospital/clinic is within walking distance of the girls home.

b.

The institution is open days, evenings, and Saturday by special arrangement.

c.

The teen must be prepared to see a different nurse or doctor or both at every visit.

d.

The health care workers have a positive attitude.

ANS: C

Feedback

A

If the hospital/clinic were within walking distance of the girls home, it would prevent the teen from missing appointments because of transportation problems.

B

If the institution were open days, evenings, and Saturday by special arrangement, this availability would be helpful for teens who work, go to school, or have other time-of-day restrictions. Scheduling conflicts are a major barrier to health care.

C

Whenever possible, the teen should be scheduled to see the same nurses and practitioners for continuity of care.

D

A negative attitude is unfortunate, because it discourages families that would benefit most from consistent prenatal care.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 555

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

4. Of adolescents who become pregnant, what percentage have had a previous birth?

a.

10%

b.

15%

c.

19%

d.

35%

ANS: C

Feedback

A

This percentage rate is too low; it is actually 19%.

B

The percentage of teens who have had a previous birth is 19%.

C

19% of pregnant adolescents have had one or more previous births.

D

This percentage rate is too high when measuring previous adolescent births.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 551

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

5. In counseling a patient who has decided to relinquish her baby for adoption, the nurse should

a.

Affirm her decision while acknowledging her maturity in making it.

b.

Question her about her feelings regarding adoption.

c.

Tell her she can always change her mind about adoption.

d.

Ask her if anyone is coercing her into the decision to relinquish her baby.

ANS: A

Feedback

A

A supportive, affirming approach by the nurse will strengthen the patients resolve and help her to appreciate the significance of the event. The teen needs help in coping with her feelings about this decision.

B

It is important for the nurse to support and affirm the decision the patient has made. This will strengthen the patients resolve to follow through. Later the patient should be given an opportunity to express her feelings.

C

This should not be an option after the baby is born and placed with the adoptive parents.

D

It is important that the teenager is treated as an adult, with the assumption that she is capable of making an important decision on her own.

PTS: 1 DIF: Cognitive Level: Application REF: p. 551

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

6. A woman who is older than 35 years may have difficulty achieving pregnancy, because

a.

Personal risk behaviors influence fertility.

b.

She has used contraceptives for an extended time.

c.

Her ovaries may be affected by the aging process.

d.

Prepregnancy medical attention is lacking.

ANS: C

Feedback

A

The older adult participates in fewer risk behaviors than the younger adult.

B

The problem is the age of the ovaries, not the past use of contraceptives.

C

Once the mature woman decides to conceive, a delay in becoming pregnant may occur because of the normal aging of the ovaries.

D

Prepregnancy medical care is available and encouraged.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 556

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

7. What is most likely to be a concern for the older mother?

a.

The importance of having enough rest and sleep

b.

Information about effective contraceptive methods

c.

Nutrition and diet planning

d.

Information about exercise and fitness

ANS: A

Feedback

A

The woman who delays childbearing may have unique concerns, one of which is having less energy than younger mothers.

B

The older mother usually has more financial means to search out effective contraceptive methods.

C

The older mother is better off financially and can afford better nutrition.

D

Information about exercise and fitness is readily available.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 557

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

8. The most dangerous effect on the fetus of a mother who smokes cigarettes while pregnant is

a.

Genetic changes and anomalies

b.

Extensive central nervous system damage

c.

Fetal addiction to the substance inhaled

d.

Intrauterine growth restriction

ANS: D

Feedback

A

Cigarettes normally will not cause genetic changes.

B

Cigarettes normally will not cause extensive central nervous system damage.

C

Addiction is not a normal concern with the neonate.

D

The major consequences of smoking tobacco during pregnancy are low-birth-weight infants, prematurity, and increased perinatal loss.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 559

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

9. A patient at 24 weeks of gestation says she has a glass of wine with dinner every evening. The nurse will counsel her to eliminate all alcohol intake, because

a.

A daily consumption of alcohol indicates a risk for alcoholism.

b.

She will be at risk for abusing other substances as well.

c.

The fetus is placed at risk for altered brain growth.

d.

The fetus is at risk for multiple organ anomalies.

ANS: C

Feedback

A

This is not the major risk for the infant.

B

This has not been proven.

C

The brain grows most rapidly in the third trimester and is most vulnerable to alcohol exposure during this time.

D

The major concerns are mental retardation, learning disabilities, high activity level, and short attention span.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 559

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

10. As a powerful central nervous system stimulant, which of these substances can lead to miscarriage, preterm labor, placental separation (abruption), and stillbirth?

a.

Heroin

b.

Alcohol

c.

PCP

d.

Cocaine

ANS: D

Feedback

A

Heroin is an opiate. Its use in pregnancy is associated with preeclampsia, intrauterine growth restriction, miscarriage, premature rupture of membranes, infections, breech presentation, and preterm labor.

B

The most serious effect of alcohol use in pregnancy is FAS.

C

The major concerns regarding PCP use in pregnant women are its association with polydrug abuse and the neurobehavioral effects on the neonate.

D

Cocaine is a powerful CNS stimulant. Effects on pregnancy associated with cocaine use include abruptio placentae, preterm labor, precipitous birth, and stillbirth.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 558 | Table 24-1

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

11. When helping the mother, father, and other family members actualize the loss of the infant, nurses should

a.

Use the words lost or gone rather than dead or died.

b.

Make sure the family understands that it is important to name the baby.

c.

If the parents choose to visit with the baby, apply lotion to the baby and wrap the infant in a pretty blanket.

d.

Set a firm time for ending the visit with the baby so that the parents know when to let go.

ANS: C

Feedback

A

Nurses must use dead and died to assist the bereaved in accepting reality.

B

Although naming the baby can be helpful, it is important not to create the sense that parents have to name the baby. In fact, some cultural taboos and religious rules prohibit the naming of an infant who has died.

C

Presenting the baby in a nice way stimulates the parents senses and provides pleasant memories of their baby.

D

Parents need different time periods with their baby to say goodbye. Nurses need to be careful not to rush the process.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 566-567

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

12. A woman has delivered twins. The first twin was stillborn, and the second is in the intensive care nursery and is recovering quickly from respiratory distress. The woman is crying softly and says, I wish my baby could have lived. What is the most therapeutic response?

a.

Dont be sad. At least you have one healthy baby.

b.

How soon do you plan to have another baby?

c.

I have a friend who lost a twin and shes doing just fine now.

d.

I am so sorry about your loss. Would you like to talk about it?

ANS: D

Feedback

A

This is denying the loss of the other infant.

B

This is denying the loss of the infant and her grief and belittling her feelings.

C

This is belittling her feelings.

D

The nurse should recognize the womans grief and its significance.

PTS: 1 DIF: Cognitive Level: Application REF: p. 565

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

13. An appropriate nursing measure when a baby has an unexpected anomaly is to

a.

Remove the baby from the delivery area immediately.

b.

Tell the parents that the baby has to go to the nursery immediately.

c.

Inform the parents immediately that something is wrong.

d.

Explain the defect and show the baby to the parents as soon as possible.

ANS: D

Feedback

A

The parents should be able to touch and hold the baby as soon as possible.

B

This would raise anxiety levels of the parents; they should be told about the defect and allowed to see the baby.

C

They should be told immediately, but they should be told about the defect and be allowed to see the infant.

D

Parents experience less anxiety when they are told about the defect as early as possible and are allowed to touch and hold the baby.

PTS: 1 DIF: Cognitive Level: Application REF: p. 563

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

14. A woman who is 6 months pregnant has sought medical attention, saying she fell down the stairs. What scenario would cause an emergency department nurse to suspect that the woman has been battered?

a.

The woman and her partner are having an argument that is loud and hostile.

b.

The woman has injuries on various parts of her body that are in different stages of healing.

c.

Examination reveals a fractured arm and fresh bruises. Her husband asks her about her pain.

d.

She avoids making eye contact and is hesitant to answer questions.

ANS: B

Feedback

A

This is not always an indication of battering. Many times the batterer will be attentive and refuse to leave the womans bedside.

B

The battered woman often has multiple injuries in various stages of healing.

C

With battering there are injuries in various stages of healing.

D

It is more normal for the woman to have a flat affect.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 572

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

15. Despite warnings, prenatal exposure to alcohol continues to far exceed exposure to illicit drugs. A diagnosis of Fetal Alcohol Syndrome is made when there are visible markers in each of three categories. Which is not a recognized category for diagnosis of FAS?

a.

Respiratory conditions

b.

Impaired growth

c.

CNS abnormality

d.

Craniofacial dysmorphologies

ANS: A

Feedback

A

Respiratory difficulties are not a category of conditions that are related to FAS. Other abnormalities related to FAS include: organ deformities, genital malformations and kidney and urinary defects.

B

Impaired growth is a visible marker for FAS.

C

A CNS abnormality with neurologic and intellectual impairments is a category used to assist in the diagnosis of FAS.

D

An infant with FAS manifests at least two craniofacial abnormalities such as microcephaly, short palpebral fissures, poorly developed philtrum, thin upper lip or flattening of the maxillary.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 558 | Table 24-1

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

16. When the nurse is alone with a battered patient, the patient seems extremely anxious and says, It was all my fault. The house was so messy when he got home and I know he hates that. The best response by the nurse is

a.

No one deserves to be hurt. Its not your fault. How can I help you?

b.

What else do you do that makes him angry enough to hurt you?

c.

He will never find out what we talk about. Dont worry. Were here to help you.

d.

You have to remember that he is frustrated and angry so he takes it out on you.

ANS: A

Feedback

A

The nurse should stress that the patient is not at fault.

B

This is placing the blame on the woman.

C

This is false reassurance. In order to assist the woman, many times the batterer will find out about the conversation.

D

This is placing the blame on the woman and finding excuses for the batterer.

PTS: 1 DIF: Cognitive Level: Application REF: p. 572

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

17. In helping bereaved parents cope and move on, nurses should keep in mind that

a.

A perinatal or parental grief support group is more likely to be helpful if the needs of the parents are matched with the focus of the group.

b.

When pictures of the infant are taken for keepsakes, no close-ups should be taken of any congenital anomalies.

c.

No significant differences exist in grieving individuals from various cultures, ethnic groups, and religions.

d.

In emergency situations, nurses who are so disposed must resist the temptation to baptize the infant in the absence of a priest or minister.

ANS: A

Feedback

A

For example, a religious-based group may not work for nonreligious parents.

B

Close-up pictures of the baby must be taken as the infant was, congenital anomalies and all.

C

Although death and grieving are events shared by all people, mourning rituals, traditions, and taboos vary by culture, ethnicity, and religion. Differences must be respected.

D

Baptism for some religious groups can be performed by a layperson, such as a nurse, in an emergency situation when a priest is not available.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 568

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

18. A common effect of both smoking and cocaine use on the pregnant woman is

a.

Vasoconstriction

b.

Increased appetite

c.

Changes in insulin metabolism

d.

Increased metabolism

ANS: A

Feedback

A

Both smoking and cocaine use cause vasoconstriction, which results in impaired placental blood flow to the fetus.

B

Both smoking and cocaine use decrease the appetite.

C

Smoking and cocaine use do not change insulin metabolism.

D

Smoking can increase metabolism.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 558-559

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

MULTIPLE RESPONSE

1. Many teens wait until the second or even third trimester to seek prenatal care. The nurse should understand that the reasons behind this delay include (select all that apply)

a.

Lack of realization that they are pregnant

b.

Uncertainty as to where to go for care

c.

Continuing to deny the pregnancy

d.

A desire to gain control over their situation

e.

Wanting to hide the pregnancy as long as possible

ANS: A, B, C, E

Feedback

Correct

These are all valid reasons for the teen to delay seeking prenatal care. An adolescent often has little to no understanding of the increased physiologic needs that a pregnancy places on her body. Once care is sought, it is often sporadic and many appointments are missed. The nurse should formulate a diagnosis that assists the pregnant teen to receive adequate prenatal care.

Incorrect

The opposite is true. Planning for her pregnancy and impending birth actually provides some sense of control for the teen and increases feelings of competency. Receiving praise from the nurse when she attends her prenatal appointments will reinforce the young womans positive self-image.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 552

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

2. Approximately 82% of teen pregnancies are unintended. Seventy percent of teens have had sex by their 19th birthday. Factors that contribute to an increased risk for teen pregnancy include (select all that apply)

a.

High self-esteem

b.

Peer pressure

c.

Limited access to contraception

d.

Planning sexual activity

e.

Lack of role models

ANS: B, C, E

Feedback

Correct

Peer pressure to begin sexual activity is a contributing factor towards teenage pregnancy. Limited access to contraceptive devices and lack of accurate information about how to use these devices are also factors. Lack of appropriate role models, desire to alleviate or escape the present situation at home, along with feelings of invincibility, also contribute to teenage pregnancy.

Incorrect

Low self-esteem and the consequent inability to set limits on sexual activity places the adolescent at risk for teen pregnancy. Ambivalence towards sexuality, and not planning intercourse, are more likely to result in teen pregnancy.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 552 | Box 24-1

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

COMPLETION

1. The standard of care for women who are dependent on heroin or other narcotics is ___________ maintenance treatment (MMT).

ANS:

methadone

Methadone maintenance treatment should be offered as part of a comprehensive care program that includes behavior therapy and support services. MMT has been shown to decrease opioid and other drug abuse, decrease criminal activity, improve individual functioning, and decrease the HIV rate.

PTS: 1 DIF: Cognitive Level: Application REF: p. 560

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

TRUE/FALSE

1. Society tends to minimize perinatal loss because of the prevailing belief that there are no barriers to getting pregnant and the expectation that once a woman is pregnant, a healthy, live infant will result. Is this statement true or false?

ANS: T

Because of these perceptions, grieving parents often do not receive the support they need, and society often allows much too short a time for mothers to grieve (and even less for fathers).

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 565

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

2. An increasing number of women are now becoming pregnant relatively late in their reproductive lives. The birth rate for women ages 40 to 44 has increased to the highest level in 40 years. Which advances in maternity care these women are at no greater risk for obstetric complications. Is this statement true or false?

ANS: F

The older women it is definitely at an increased risk for obstetric complications, including spontaneous abortion, gestational diabetes, cesarean births, stillbirth, preeclampsia, placenta previa, abruption, preterm delivery, and low birth weight infants.

PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 556-557

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

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