Contemporary Maternal Newborn Nursing 7th Edition by Patricia W. Ladewig, Marcia L. London, Michele C. Davidson Test Bank

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Contemporary Maternal Newborn Nursing 7th Edition by Patricia W. Ladewig, Marcia L. London, Michele C. Davidson Test Bank

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Chapter 15_LO01_Q01
The nurse is caring for a pregnant woman who admits to cocaine and ecstasy use on a regular basis. The client states, Everybody knows that alcohol is bad during pregnancy, but whats the big deal about ecstasy? The best response by the nurse is: Ecstasy:
1. Can cause a high fever in you and therefore cause the baby harm.
2. Leads to deficiencies of thiamine and folic acid, which help the baby develop.
3. Produces babies with small heads and short bodies with brain function alterations.
4. Produces intrauterine growth restriction and meconium aspiration.
Correct Answer: 1
Rationale:
1. High body temperature is a side effect of MDMA (ecstasy). Increased body temperature increases fetal oxygen needs, which can lead to hypoxia and subsequent brain and major organ damage.
2. Alcohol, not ecstasy, causes deficiencies of thiamine and folic acid. Folic acid helps prevent neural tube defects.
3. Cocaine causes these fetal effects, not ecstasy.
4. Heroin causes these fetal effects, not ecstasy.
Cognitive level: Application
Category of Client Need: Health Promotion and Maintenance
Nursing Process: Planning
Learning Outcome: 15.1 Describe the effects of alcohol and illicit drugs in the nursing care management of the childbearing woman and her fetus/newborn.

Chapter 15_LO01_Q02
The nurse is doing preconception counseling with a 28-year-old woman with no prior pregnancies. Which of the following statements made by the client indicates to the nurse that the client has understood the teaching?
1. I can continue to drink alcohol until I am diagnosed as pregnant.
2. I need to stop drinking alcohol completely when I start trying to get pregnant.
3. A beer once a week will not damage the fetus.
4. I can drink alcohol while breastfeeding, since it doesnt pass into breast milk.
Answer: 2
Rationale:
1. Women should discontinue drinking alcohol when they start to attempt pregnancy.
2. Women should discontinue drinking alcohol when they start to attempt pregnancy.
3. It is not known how much alcohol will cause fetal damage; therefore, alcohol during pregnancy is contraindicated.
4. Alcohol passes readily into breast milk; therefore, it should be avoided, or the milk should be pumped and dumped after alcohol consumption.
Cognitive Level: Application
Category of Client Need: Health Promotion and Maintenance
Nursing Process: Evaluation
Learning Outcome 15.1 Describe the effects of alcohol and illicit drugs in the nursing care management of the childbearing woman and her fetus/newborn.

Chapter 15_LO01_Q03
A womans history and appearance suggest drug abuse. The nurses best approach would be to:
1. Ask the woman directly, Do you use any street drugs?
2. ask the woman if she would like to talk to a counselor.
3. Ask some questions about over-the-counter medications and avoid mention of illicit drugs.
4. Explain how harmful drugs can be for her baby.
Answer: 1
Rationale:
1. The best method of dealing with the client that the nurse suspects of using drugs is to be direct and ask the question in a direct fashion without prejudice, bias, or negative body language. Lack of judgmental attitudes/body language typically results in honest answers.
2. It is the responsibility of the nurse to question the client.
3. It is the responsibility of the nurse not to avoid the issue.
4. When talking to clients in a therapeutic manner, it is important not to be threatening or judgmental; an example of the latter behavior would be stating that the drugs will harm the baby.
Cognitive Level: Analysis
Category of Client Need: Health Promotion and Maintenance
Nursing Process: Implementation
Learning Outcome 15.1 Describe the effects of alcohol and illicit drugs in the nursing care management of the childbearing woman and her fetus/newborn.

Chapter 15_LO01_Q04
A 20-year-old woman is at 28 weeks gestation. Her prenatal history reveals past drug abuse, and urine screening indicates that she has recently used heroin. The nurse should recognize that the woman is at increased risk for:
1. Erythroblastosis fetalis.
2. Diabetes mellitus.
3. Abruptio placentae.
4. Pregnancy-induced hypertension.
Answer: 4
Rationale:
1. Erythroblastosis fetalis is secondary to physiological blood disorders such as Rh incompatibility.
2. Diabetes is an endocrine disorder that is unrelated to drug use/abuse.
3. Abruptio placentae is seen more commonly with cocaine/crack use.
4. Women who use heroin are at risk for poor nutrition, anemia, and pregnancy-induced hypertension (or pre-eclampsia).
Cognitive Level: Application
Category of Client Need: Health Promotion and Maintenance
Nursing Process: Assessment
Learning Outcome 15.1 Describe the effects of alcohol and illicit drugs in the nursing care management of the childbearing woman and her fetus/newborn.

Chapter 15_LO02 _Q05
The client with insulin-dependent type II diabetes and an HbA1c of 5.0% is planning to become pregnant soon. What anticipatory guidance should the nurse provide this client?
1. Insulin needs decrease in the first trimester and increase during the third trimester.
2. The risk of ketoacidosis decreases during the length of the pregnancy.
3. Vascular disease that accompanies diabetes slows progression.
4. The baby is likely to have a congenital abnormality because of the diabetes.
Correct Answer: 1
Rationale:
1. In addition, insulin requirements drop suddenly after delivery of the placenta.
2. The risk of ketoacidosis increases during pregnancy.
3. Vascular disease progresses more rapidly during pregnancy, especially if blood sugar control is not good. Problems such as nephropathy and retinopathy can result.
4. Infants of diabetic mothers have a 510% greater risk of having a congenital abnormality. This risk increases to 2025% if the HbA1c is over 10%.
Cognitive level: Application
Category of Client Need: Health Promotion and Maintenance
Nursing Process: Planning
Learning Outcome: 15.2 Relate the pathology and clinical treatment of diabetes mellitus in pregnancy to the implications for nursing care.

Chapter 15_LO02 _Q06
A newly diagnosed type I, insulin-dependent diabetic with good blood sugar control is at 20 weeks gestation. She asks the nurse how her diabetes will affect her baby. The best explanation would include:
1. Your baby may be smaller than average at birth.
2. Your baby will probably be larger than average at birth.
3. As long as you control your blood sugar, your baby will not be affected at all.
4. Your baby might have high blood sugar for several days.
Answer: 2
Rationale:
1. Poorly controlled type I diabetics who have developed vascular problems will have infants who are small for gestational age (SGA) due to placental insufficiency.
2. The infant of a diabetic mother produces excessive amounts of insulin in response to the high blood sugar. This hyperinsulinism stimulates growth (or macrosomia) in the infant because the infant utilizes the glucose in the bloodstream.
3. The demands of pregnancy will make it difficult for the best of clients to control blood sugar on a regular basis.
4. Within minutes of delivery, the baby of an insulin-dependent diabetic can begin to have low blood sugar.
Cognitive Level: Application
Category of Client Need: Health Promotion and Maintenance
Nursing Process: Implementation
Learning Outcome 15.2 Relate the pathology and clinical treatment of diabetes mellitus in pregnancy to the implications for nursing care.

Chapter 15_LO02 _Q07
A 26-year-old multigravida is 28 weeks pregnant. She has developed gestational diabetes. She is following a program of regular exercise, which includes walking, bicycling, and swimming. What instructions should be included in a teaching plan for this client?
1. Exercise either just before meals or wait until two hours after a meal.
2. Carry hard candy (or other simple sugar) when exercising.
3. If your blood sugar is 120 mg/dL, eat 20 g of carbohydrate.
4. If your blood sugar is more than 120 mg/dL, drink a glass of whole milk.
Answer: 2
Rationale:
1. It is best to exercise just after the meal, in order to utilize the glucose.
2. A client should be encouraged to continue any exercise programs in which she already is involved. She should keep hard candy (simple sugar) with her at all times, just in case the exercise induces hypoglycemia.
3. A finger stick result of 120 mg/dL is considered to be normal.
4. Such clients need no additional carbohydrate or protein intake.
Cognitive Level: Analysis
Category of Client Need: Health Promotion and Maintenance
Nursing Process: Implementation
Learning Outcome 15.2 Relate the pathology and clinical treatment of diabetes mellitus in pregnancy to the implications for nursing care.

Chapter 15_LO02 _Q08
A 26-year-old multipara is 26 weeks pregnant. Her previous births include two large-for-gestational-age babies and one unexplained stillbirth. Which tests would the nurse anticipate as being most definitive in diagnosing gestational diabetes?
1. A 50 g, one-hour glucose screening test
2. A single fasting glucose level
3. A 100 g, one-hour glucose tolerance test
4. A 100 g, three-hour glucose tolerance test
Answer: 4
Rationale:
1. All women get the initial 50 g of glucose and a one-hour screening.
2. A single fasting glucose level is not an adequate indicator of the glucose level in relation to food.
3. The 100 g, one-hour tolerance test is not an adequate indicator of the glucose level in relation to food.
4. A client with a history of LGA infants or gestational diabetes will be given the 100 g of glucose and three-hour glucose tolerance test.
Cognitive Level: Application
Category of Client Need: Health Promotion and Maintenance
Nursing Process: Planning
Learning Outcome 15.2 Relate the pathology and clinical treatment of diabetes mellitus in pregnancy to the implications for nursing care.

Chapter 15_LO03 _Q09
The pregnant client at 23 weeks gestation has a hemoglobin of 9.5. Which diet choice indicates that teaching has been effective?
1. Tofu with mixed vegetables in curry, milk, whole-wheat bun
2. Roast beef, steamed spinach, tomato soup, orange juice
3. Pork chop, mashed potatoes and gravy, cauliflower, tea
4. Broiled fish, lettuce salad, grapefruit half, carrot sticks
Correct Answer: 2
Rationale:
1. This diet is high in calcium. The client has iron-deficiency anemia, and requires a high-iron diet.
2. This client is anemic, and needs iron. This meal contains iron in the beef, folic acid in the spinach, and vitamin C in the tomato soup and orange juice. Vitamin C helps absorption of the iron; folic acid is needed for production of red cells.
3. This meal has a moderate amount of protein, but no vitamin C. The meal containing beef is better.
4. This meal is high in fiber, low in fat, and moderately high in protein, but low in iron. This client is anemic, and needs iron.
Cognitive level: Analysis
Category of Client Need: Health Promotion and Maintenance
Nursing Process: Evaluation
Learning Outcome: 15.3 Distinguish among the types of anemia associated with pregnancy regarding signs, treatment, and implications for pregnancy.

Chapter 15_LO03 _Q10
The client with b-thalassemia intermedia has a hemoglobin level of 9.0. The nurse is preparing an education session for the client. Which statement should the nurse include?
1. You need to increase your intake of meat and other iron-rich foods.
2. Your low hemoglobin could put you into preterm labor.
3. Increasing your vitamin C intake will help your hemoglobin level.
4. You should not take iron or folic acid supplements.
Answer: 4
Rationale:
1. Iron supplements should be avoided to prevent iron overload.
2. Because the iron levels are normal, increasing dietary iron intake will not affect the hemoglobin.
3. Vitamin C increases iron absorption, but a client with thalassemia does not need additional iron.
4. B-thalassemia intermedia is due to an abnormal red blood cell structure, which leads to microcytic anemia with normal ferritin and iron levels.
Cognitive Level: Application
Category of Client Need: Physiological Integrity
Nursing Process: Planning
Learning Outcome 15.3 Distinguish among the types of anemia associated with pregnancy regarding signs, treatment, and implications for pregnancy.

Chapter 15_LO03 _Q11
The client at 20 weeks gestation has had an ultrasound that revealed that her fetus has a neural tube defect. The clients hemoglobin level is 8.5. The nurse should include which statement when discussing these findings with the client?
1. Your low iron intake has caused anemia, which leads to the neural tube defect.
2. You should increase your vitamin C intake to improve your anemia.
3. You are too picky about food. Your poor diet caused your babys defect.
4. You havent had enough folic acid in your diet. You should take a supplement.
Answer: 4
Rationale:
1. Low hemoglobin does not cause neural tube defects.
2. Vitamin C will increase iron absorption, but this client is deficient in folic acid.
3. Therapeutic communication must avoid judgmental statements.
4. Folic acid deficiency can cause both neural tube defects and megaloblastic anemia, in which the red cells are immature and abnormally large.
Cognitive Level: Analysis
Category of Client Need: Health Promotion and Maintenance
Nursing Process: Implementation
Learning Outcome 15.3 Distinguish among the types of anemia associated with pregnancy regarding signs, treatment, and implications for pregnancy.

Chapter 15_LO04_Q12
The client at 9 weeks gestation has been told that her HIV test was positive. The client is very upset, and tells the nurse, I didnt know I had HIV! What will this do to my baby? The nurse knows teaching has been effective when the client states:
1. I cannot take the medications that control HIV during my pregnancy because they will harm the baby.
2. My baby will probably be born with anti-HIV antibodies, but that doesnt mean it is infected.
3. The pregnancy will increase the progression of my disease and will reduce my CD4 counts.
4. The HIV wont affect my baby, and I will have a low-risk pregnancy without additional testing.
Correct Answer: 2
Rationale:
1. Most of the medications that control HIV progression are safe to take during pregnancy. Antiretroviral medications are recommended during pregnancy to prevent perinatal transmission.
2. Babies of HIV-positive women or women with AIDS are born with maternal anti-HIV antibodies. These antibodies clear over time, and an accurate test can be obtained by 15 months of age.
3. There is no evidence to indicate that pregnancy increases the progression of HIV/AIDS.
4. Pregnancy affected by HIV/AIDS is considered complicated, and the fetus is monitored closely. Fetal assessments include weekly non-stress tests beginning at 32 weeks.
Cognitive level: Application
Category of Client Need: Health Promotion and Maintenance
Nursing Process: Evaluation
Learning Outcome: 15.4 Describe acquired immunodeficiency syndrome (AIDS), including care of the pregnant woman who has tested positive for the human immunodeficiency virus (HIV), fetal/neonatal implications, and ramifications for the childbearing family.

Chapter 15_LO04_Q13
During the history, the client admits to being HIV-positive, and says she knows that she is about 16 weeks pregnant. Which statements made by the client indicate an understanding of the plan of care both during the pregnancy and postpartally? Select all that apply.
1. During labor and delivery, I can expect the zidovudine (AZT) to be given in my IV.
2. After delivery, the dose of zidovudine (AZT) will be doubled to prevent further infection.
3. My baby will be started on zidovudine (AZT) within 12 hours of delivery.
4. My babys zidovudine (AZT) will be given in a cream form.
5. My baby will not need zidovudine (AZT) if I take it during my pregnancy.
Answer: 1, 3
Rationale:
1. All HIV-positive clients are prescribed a three-part therapy after the first trimester. During the labor and delivery process, the doses will be given intravenously.
2. The mother will continue with her oral dosage of zidovudine (AZT) after delivery just as prior to delivery.
3. Within 812 hours after delivery, the infant is administered oral zidovudine (AZT), and he is kept on the medication a minimum of six weeks.
4. The initial treatment is zidovudine (AZT) orally every day. In order to keep the level consistent, it is recommended that dosages be taken consistently.
5. The infant is administered oral zidovudine (AZT) and kept on the medication a minimum of six weeks.
Cognitive Level: Analysis
Category of Client Need: Health Promotion and Maintenance
Nursing Process: Evaluation
Learning Outcome 15.4 Describe acquired immunodeficiency syndrome (AIDS), including care of the pregnant woman who has tested positive for the human immunodeficiency virus (HIV), fetal/neonatal implications, and ramifications for the childbearing family.

Chapter 15_LO04_Q14
A woman is 32 weeks pregnant. She is HIV-positive, but asymptomatic. What would be important in managing her pregnancy and delivery?
1. An amniocentesis at 30 and 36 weeks
2. Weekly non-stress testing beginning at 32 weeks gestation
3. Application of a fetal scalp electrode as soon as her membranes rupture in labor
4. Administration of intravenous antibiotics during labor and delivery
Answer: 2
Rationale:
1. All invasive procedures that would expose the uninfected infant to the HIV virus are avoided.
2. Clients who are HIV-positive are considered high-risk pregnancies. Therefore, beginning at about 32 weeks, these clients have weekly non-stress tests to assess for placental function, and an ultrasound every 23 weeks to assess for intrauterine growth retardation (IUGR).
3. All invasive procedures that would expose the uninfected infant to the HIV virus are avoided.
4. Antibiotics would be ineffective for either the mother or the infant who was HIV-positive.
Cognitive Level: Analysis
Category of Client Need: Health Promotion and Maintenance
Nursing Process: Planning
Learning Outcome 15.4 Describe acquired immunodeficiency syndrome (AIDS), including care of the pregnant woman who has tested positive for the human immunodeficiency virus (HIV), fetal/neonatal implications, and ramifications for the childbearing family.

Chapter 15_LO04_Q15
A pregnant woman is married to an intravenous drug user. She had a negative HIV screening test just after missing her first menstrual period. What would indicate that the client needs to be retested for HIV?
1. Hemoglobin of 11 g/dL and a rapid weight gain
2. Elevated blood pressure and ankle edema
3. Shortness of breath and frequent urination
4. Unusual fatigue and recurring Candida vaginitis
Answer: 4
Rationale:
1. The client would be anemic and anorexic.
2. The client would have a decrease in blood pressure, and no ankle edema.
3. Shortness of breath and frequent urination do not indicate a need to retest for HIV.
4. The client who is HIV-positive would have a suppressed immune system, and would experience symptoms of fatigue and opportunistic infections such as Candida vaginitis.
Cognitive Level: Application
Category of Client Need: Health Promotion and Maintenance
Nursing Process: Assessment
Learning Outcome 15.4 Describe acquired immunodeficiency syndrome (AIDS), including care of the pregnant woman who has tested positive for the human immunodeficiency virus (HIV), fetal/neonatal implications, and ramifications for the childbearing family.

Chapter 15_LO05_Q16
The nurse is reviewing prenatal charts. A client at 24 weeks has a history of class II heart disease secondary to rheumatic fever. What would the nurse expect to see in the chart?
1. Dyspnea and chest pain with mild exertion.
2. Elective cesarean birth scheduled for 37 weeks.
3. Discussed need for labor epidural and vacuum extraction.
4. Respiratory rate 28, pulse 110, 3+ pre-tibial edema bilaterally.
Correct Answer: 3
Rationale:
1. Dyspnea and angina with mild exertion are not expected with class II heart disease even during pregnancy, but are symptoms seen in class IV heart disease.
2. Cesarean birth is only undertaken in cardiac patients for fetal or maternal intrapartal indications, not for cardiac reasons alone.
3. Lumbar epidural analgesia decreases the stress response during labor, while vacuum extraction or forceps decreases maternal pushing efforts. Both of these decrease stress on the heart during birth.
4. 3+ pre-tibial edema is never an expected finding during pregnancy. Pulse over 100 and respiratory rate over 24 are indicators of cardiac decompensation.
Cognitive level: Application
Category of Client Need: Health Promotion and Maintenance
Nursing Process: Assessment
Learning Outcome: 15.5 Explain the effects of various heart disorders on pregnancy, including implications for nursing care management in the antepartum, intrapartum, and postpartum periods.

Chapter 15_LO06_Q17
The prenatal clinic nurse has received four phone calls. Which client should be called first?
1. Primip at 28 weeks with history of asthma reporting difficulty breathing and shortness of breath
2. Multip at 6 weeks with a seizure disorder inquiring what foods are good folic acid sources for her
3. Primip at 35 weeks with a positive HBsAG wondering what treatment her baby will receive after birth
4. Multip at 11 weeks with untreated hyperthyroidism describing the onset of vaginal bleeding
Correct Answer: 1
Rationale:
1. Asthma exacerbations are most common between 24 and 36 weeks. Asthma attacks can lead to maternal hypoxia, which can lead to fetal hypoxia. This client is the top priority.
2. Women with seizure disorders should be started on folic acid supplements prior to pregnancy, and should continue throughout pregnancy. This client is not the highest priority.
3. A client with a positive HBsAG is contagious for hepatitis B. The risk of transmission to the fetus at birth is reduced by bathing the neonate as soon as possible after birth and giving the infant immunoprophylaxis and the first HBsAG vaccine dose. The client seeking information about what will happen after delivery is a low priority when there are pregnant clients currently experiencing physiologic problems.
4. Pregnant women with untreated hyperthyroidism have an increased risk of fetal loss. Vaginal bleeding at 11 weeks could indicate that spontaneous abortion is taking place. But the majority of spontaneous abortions prior to 12 weeks gestation are complete and without complications. This client is not experiencing a normal pregnancy, but the health of both mother and fetus are not in immediate danger.
Cognitive level: Application
Category of Client Need: Health Promotion and Maintenance
Nursing Process: Assessment
Learning Outcome: 15.6 Delineate the effects of selected pregestational medical conditions on pregnancy.

Chapter 15_LO06_Q18
The client was found to have hepatitis B surface antigen (HBsAG) early in her pregnancy. The nurse is explaining to the client what will happen during labor and birth because the client is contagious for hepatitis B. Which statement by the client indicates that additional teaching is needed?
1. An internal fetal monitor will be applied as soon as possible during labor.
2. My baby will get a bath as soon as its temperature is stable.
3. Two shots will be given to my baby to prevent transmission of hepatitis B.
4. Breastfeeding is a good feeding method for my baby.
Answer: 1
Rationale:
1. An internal fetal monitor will be avoided.
2. The presence of hepatitis B surface antigen (HBsAG) indicates that the client is contagious for and capable of transmitting hepatitis B. Perinatal transmission is most likely to occur at the time of birth, thus measures are taken to prevent exposing the fetus to the mothers blood and body fluids, and to clean the babys skin thoroughly of fluids as soon as possible after birth.
3. A newborn of a mother with HBsAG will receive an injection of hepatitis B immune globulin and a hepatitis B vaccine injection.
4. Breastfeeding is not contraindicated in a client with HBsAG.
Cognitive Level: Analysis
Category of Client Need: Health Promotion and Maintenance
Nursing Process: Evaluation
Learning Outcome 15.6 Delineate the effects of selected pregestational medical conditions on pregnancy.

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