Contemporary Maternal Newborn Nursing Care Maternal Newborn Nursing Care Nurse, Family, 8th Edition By Patricia W. Ladewig-Test Bank

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Contemporary Maternal Newborn Nursing Care Maternal Newborn Nursing Care Nurse, Family, 8th Edition By Patricia W. Ladewig-Test Bank

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WITH ANSWERS
Contemporary Maternal Newborn Nursing Care Maternal Newborn Nursing Care Nurse, Family, 8th Edition By Patricia W. Ladewig-Test Bank

Ladewig, Contemporary Maternal-Newborn Nursing, 8/E
Chapter 02

Question 1

Type: MCSA

While conducting a family assessment, the nurse determines that a particular familys structure is binuclear. Some potential challenges inherently faced by binuclear families include:

  1. Challenges related to co-parenting and joint custody, including negotiation and compromise between the parents about childrearing decisions.
  2. Issues related to both parents being employed, including child care, household chores, and spending time together.
  3. Challenges related to children interacting with peers and when revealing their parents sexual orientation.
  4. Issues related to single parenting, including lack of social and emotional support, need for assistance with childrearing, and financial strain.

Correct Answer: 1

Rationale 1: Because both parents have equal responsibility and legal rights regarding their biologic child, binuclear families may inherently face challenges related to co-parenting and joint custody, including negotiation and compromise between the parents about childrearing decisions.

Rationale 2: Issues inherently faced by the dual-career/dual-earner family include child care, household chores, and spending time together.

Rationale 3: Children raised in gay and lesbian families may face challenges related to interacting with peers and when revealing their parents sexual orientation.

Rationale 4: Binuclear families incorporate co-parenting, whereas with single parenting, one parent is responsible for child care. Issues inherently related to single parenting may include lack of social and emotional support, need for assistance with childrearing, and financial strain.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO01 Describe how family type may influence nursing care of the childbearing family.

 

Question 2

Type: MCSA

The nurse is preparing a community presentation on family development. Which of the following statements should the nurse include?

  1. The youngest childs age determines the familys current stage.
  2. A family does not experience overlapping of stages.
  3. Family development ends when the youngest child leaves home.
  4. The stages describe the familys progression over time.

Correct Answer: 4

Rationale 1: The oldest childs age is the marker for which stage the family is in, except for the two last stages, which occur after the children have left home.

Rationale 2: Families with more than one child can experience multiple stages simultaneously.

Rationale 3: Families with more than one child can experience multiple stages simultaneously.

Rationale 4: Family development stages describe the changes and adaptations that a family goes through over time as children are added to the family.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO02 Explain the changes that a childbearing family will undergo based on the developmental tasks to be completed.

 

Question 3

Type: MCSA

The nurse is preparing to assess the development of a family new to the clinic. The nurse understands that the primary use of a family assessment tool is to:

  1. Obtain a comprehensive medical history of family members.
  2. Determine which clinic the patient should be referred to.
  3. Predict how a family will likely change with the addition of children.
  4. Understand the physical, emotional, and spiritual needs of members.

Correct Answer: 4

Rationale 1: The focus of a family assessment is the family as one entity. Health of the family is one area that is explored using a family assessment tool.

Rationale 2: The family assessment tool facilitates understanding of the physical, emotional, and spiritual needs of members. Although referrals might take place as a result of the family assessment findings, understanding of the family is the primary reason the tool is used.

Rationale 3: The family assessment tool facilitates understanding of the physical, emotional, and spiritual needs of members. Family development models help predict how a family will likely change with the addition of children.

Rationale 4: This is the main reason for using a family assessment tool.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO03 Identify information that would be useful to collect when performing a family assessment.

 

Question 4

Type: MCSA

The registered nurse is caring for a pregnant Muslim patient who is anticipating delivery within the next few days. The nurse asks if she and her husband have chosen a name for their baby. The patient quietly shakes her head, no. Based upon the patients response, the nurse understands that:

  1. The patient is not happily anticipating the arrival of her baby.
  2. Cultural beliefs may require the couple to choose the babys name following the birth.
  3. The patient does not speak English.
  4. Cultural beliefs may require that the babys name be kept secret until after the delivery.

Correct Answer: 2

Rationale 1: There is no evidence to support that the patient is not happily anticipating her babys arrival.

Rationale 2: In the Muslim culture, it is common to avoid naming the baby until after the baby is born.

Rationale 3: The patient has been conversing with the nurse; no prior interaction suggested a language barrier.

Rationale 4: Rather than keeping the babys name secret, in the Muslim culture, it is common to avoid naming the baby until the baby is born.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: LO04 Integrate the prevalent cultural norms that affect childbearing and childrearing when providing care to that family.

 

Question 5

Type: MCSA

A woman of Korean descent has just given birth to a son. Her partner wishes to give her sips of hot broth from a thermos he brought from home. The patient has refused your offer of ice chips or other cold drinks. The nurse should:

  1. Explain to the patient that she can have the broth if she will also drink cold water or juice.
  2. Encourage the partner to feed the patient sips of broth. Ask if the patient would like you to bring her some warm water to drink as well.
  3. Explain to the couple that food cant be brought from home but that the nurse will make hot broth for the patient.
  4. Encourage the patient to have the broth after the nurse takes it to the kitchen and boils it first.

Correct Answer:

Rationale 1: Explaining to the patient that she can have broth if she will drink cold water or juice first does not show cultural sensitivity and does not respect the patients beliefs.

Rationale 2: Encouraging the partner to feed the patient sips of broth and asking if the patient would like you to bring her some warm water to drink as well is an approach that shows cultural sensitivity. The equilibrium model of health, based on the concept of balance between light and dark, heat and cold, is the foundation for this belief and practice.

Rationale 3: Explaining to the couple that the hospital does not allow food brought from home but that you will make hot broth for them is an incorrect response.

Rationale 4: Encouraging the patient to have broth after you take it the kitchen and boil it first is an incorrect response because boiling first would make the broth too hot to drink.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: LO04 Integrate the prevalent cultural norms that affect childbearing and childrearing when providing care to that family.

 

Question 6

Type: MCSA

The nurse works in a facility that cares for patients from a broad range of racial, ethnic, cultural, and religious backgrounds. Which statement should the nurse include in a presentation for nurses new to the facility on the patient population of the facility?

  1. Our patients come from a broad range of backgrounds, but we have a good interpreter service.
  2. Many of our patients come from backgrounds different from your own, but it doesnt cause problems for the nurses.
  3. Because most of the doctors are bilingual, we dont have to deal with the differences in cultural backgrounds of our patients.
  4. Understanding the common values and health practices of our diverse patients will facilitate better care and health outcomes.

Correct Answer: 4

Rationale 1: The role of a foreign language interpreter is to facilitate communication. The interpreter might or might not be able to interpret the cultural practices of patients. An example is a Spanish interpreter: The interpreter might be from Spain but interprets language for patients from Guatemala and Nicaragua, countries about which the interpreter might know virtually nothing.

Rationale 2: Racial, ethnic, cultural, and religious backgrounds of patients have significant implications for how they perceive health, illness, and health care. It is important for nurses to understand the backgrounds of the patient population that attend that facility.

Rationale 3: Bilingual physicians, like all physicians, have very busy schedules and often do not understand nursing care. It is the responsibility of the nurse to become familiar with the backgrounds of the patient population.

Rationale 4: Because of the implications for care based on cultural background, it is important for nurses to understand the backgrounds of the patient population that attend the facility.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: LO05 Explain the importance of cultural competency in providing nursing care to the childbearing family.

 

Question 7

Type: MCSA

The nurse manager in a hospital with a large immigrant population is planning an in-service. The nurse manager is aware of how ethnocentrism affects nursing care. Which statement should the nurse manager include? The belief that ones own values and beliefs are the only or the best values:

  1. Means that newcomers to the United States should adopt U.S. norms and values.
  2. Can create barriers to communication through misunderstanding.
  3. Leads to an expectation that patients will exhibit pain the same way.
  4. Improves the quality of care provided to culturally diverse patient bases.

Correct Answer: 2

Rationale 1: Although acculturation involves adoption of some of the majority cultures practices and beliefs, each cultural group will continue to hold and express its own set of values and beliefs.

Rationale 2: Ethnocentrism is the conviction that ones own values and beliefs either are the only ones that exist or are the best. When the nurse assumes that a patient has the same values and beliefs as the nurse, misunderstanding will frequently occur, which in turn can negatively impact nursepatient communication.

Rationale 3: Expression of pain is one area that varies greatly from one culture to another.

Rationale 4: The belief that ones own values and beliefs are the best will not improve the quality of care provided to culturally diverse patient bases.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: LO05 Explain the importance of cultural competency in providing nursing care to the childbearing family.

 

Question 8

Type: MCSA

When preparing to teach a culturally diverse group of childbearing families about hospital birthing options, in order to be culturally competent, the nurse should:

  1. Understand that the families have the same values as the nurse.
  2. Teach the families how childbearing takes place in the United States.
  3. Insist that the clients answer questions instead of their husbands.
  4. Learn about the cultural groups that are likely to attend the class.

Correct Answer: 4

Rationale 1: Assuming that the families have the same values is ethnocentrism.

Rationale 2: Although it is important to explain health care during pregnancy and childbearing, this is not the top priority.

Rationale 3: The husbands answering questions might be a cultural norm, and insisting that the patient answer could decrease the familys trust in the healthcare system.

Rationale 4: Cultural competence is the development of skills and knowledge necessary to appreciate, understand, and work with individuals from other cultures than the culture of the nurse. Through gaining knowledge of the cultures that are likely to be encountered professionally, the nurse is able to understand the aspects of the patients culture that might impact how care should best be given to be accepted by the patient.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: LO05 Explain the importance of cultural competency in providing nursing care to the childbearing family.

 

Question 9

Type: MCSA

The nurse is admitting a Mexican woman scheduled for a cholecystectomy. The nurse uses a cultural assessment tool during the admission. Which question would be most important for the nurse to ask?

  1. What other treatments have you used for your abdominal pain?
  2. What is your country of origin; where were you were born?
  3. When you talk to family members, how close do you stand?
  4. How would you describe your role within your family?

Correct Answer: 1

Rationale 1: This question is most important because some traditional or folk remedies include the use of herbs. Because some herbs have medication interactions, this physiologic question is imperative to ask.

Rationale 2: Although this information is helpful, it is not a physiological issue. Asking about other treatments is a higher priority.

Rationale 3: Although understanding the patients perception of appropriate personal space is helpful, it is not a physiological issue. Asking about other treatments is a higher priority.

Rationale 4: Although understanding the patients family roles is helpful, it is not a physiological issue. Asking about other treatments is a higher priority.

Global Rationale:

 

Cognitive Level: Evaluating

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: LO06 Interpret the information collected from a cultural assessment to provide culturally sensitive care.

 

Question 10

Type: MCSA

The labor and delivery nurse is caring for a laboring patient who has asked for a priest to visit her during labor. The patients mother died during childbirth, and although there are no complications during the patients pregnancy, she is fearful of her own death during labor. What is the best response of the nurse?

  1. Nothing is going to happen to you. Well take very good care of you during your birth.
  2. Would you like to have an epidural so that you wont feel the pain of the contractions?
  3. The priest wont be able to prevent complications and might get in the way of your providers.
  4. Would you like me to contact your parish or our hospital chaplain to come see you?

Correct Answer: 4

Rationale 1: Avoid statements of false reassurance, as there are no guarantees in the outcomes during health care. Using these statements shuts down effective communication, as the patients concern is downplayed.

Rationale 2: The patients expressed concern is not about pain; it is a fear of death and a desire to see a priest. Address the patients concerns directly.

Rationale 3: Although this statement is true, it is not therapeutic. It downplays the patients concerns and will shut down effective communication. Address the concerns the patient expresses.

Rationale 4: When the patient states she wants to see a priest, the nurse should attempt to make arrangements for this visit to occur in a timely manner. Most hospitals have a chaplaincy department that can provide assistance in obtaining the services of a wide variety of religious leaders. Depending on the day of the week and the time of day, the patients own home parish church might be able to provide a priest for pastoral care at the bedside.

Global Rationale:

 

Cognitive Level: Evaluating

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: LO07 Identify ways a nurse might accommodate the religious rituals and practices of the childbearing family.

 

Question 11

Type: MCSA

A pregnant patient reports experiencing occasional gastroesophageal reflux. She explains that she relieves her symptoms through acupressure treatments, as well as by taking an over-the-counter medication recommended by her obstetrician. The nurse recognizes acupressure to be a form of:

  1. Homeopathy.
  2. Alternative therapy.
  3. Biofeedback.
  4. Complementary therapy.

Correct Answer: 4

Rationale 1: Homeopathy entails using diluted amounts of substances that, if ingested in larger amounts, would produce effects similar to the symptoms of the disorder being treated.

Rationale 2: Alternative therapy involves the use of a procedure or substance in place of conventional medicine.

Rationale 3: Biofeedback control pertains to using the mind to control physiologic responses based on the concept that the mind controls the body.

Rationale 4: Complementary therapy incorporates the use of a procedure or product as an adjunct to conventional medical treatment.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: LO08 Distinguish among complementary and alternative therapies.

 

Question 12

Type: MCSA

A patient reports using homeopathic remedies to ease her back pain. In order to more fully explore the patients use of complementary and alternative medicine (CAM), the nurse should ask:

  1. Will you tell me more about the homeopathic remedies youre using?
  2. Are you aware that some complementary and alternative therapies can be dangerous?
  3. Does your physician approve of your use of homeopathic remedies?
  4. Have you prioritized your need for comfort above your concern for your babys health?

Correct Answer: 1

Rationale 1: The nurse should ask direct, nonjudgmental questions when seeking to gain information about a patients use of CAM.

Rationale 2: While tactful warnings regarding the use of CAM may be appropriate, the nurse should first explore the patients use of CAM in a nonjudgmental manner.

Rationale 3: Patients may be reluctant to discuss their use of CAM with their healthcare providers; the nurse should explore the topic using nonjudgmental language.

Rationale 4: Additional information is needed in order to evaluate the patients use of CAM, and the topic should be approached without use of disparaging comments.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: LO08 Distinguish between complementary and alternative therapies.

 

Question 13

Type: MCSA

The patient pregnant with her first child reports that her husband wants her to visit a homeopath for help with her nausea and vomiting. The patient asks what the nurses opinion of homeopathy is. The best response by the nurse is:

  1. Homeopathy is unproven and potentially dangerous. Avoid using homeopathic remedies.
  2. The FDA has approved homeopathic remedies, and practitioners undergo education and certification.
  3. I cant give you advice about what alternatives to try. Go online and do some research to get information.
  4. Homeopathy is the same as herbal remedies. Some are safe during pregnancy and some are not.

Correct Answer: 2

Rationale 1: Homeopathic remedies are not dangerous. Homeopathic remedies are FDA-approved and have been proven to be effective in treating a wide range of chronic and acute illnesses and conditions.

Rationale 2: Homeopathic remedies are FDA-approved and have been proven to be effective in treating a wide range of chronic and acute illnesses and conditions.

Rationale 3: It is appropriate for the nurse to provide factual information to educate a patient who has asked a question. Not all patients have access to computers, nor do they know how to do an internet search.

Rationale 4: Herbalism and homeopathy are not the same. Herbs are available in many stores and preparations; some have been proven to be dangerous during pregnancy. Homeopathy is a system of like curing like, in which the symptom being treated would be a symptom of taking too much of the substance in a non-homeopathic form.

Global Rationale:

 

Cognitive Level: Evaluating

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: LO09 Describe the benefits and risks of the various complementary and alternative therapies to the childbearing family.

 

Question 14

Type: MCMA

Complementary and alternative therapies have many benefits for the childbearing family and others. However, many of these remedies have associated risks. Which of the following situations would be considered risks?

Standard Text: Select all that apply.

  1. Getting a massage from a licensed massage therapist for back pain, prescribed by the primary caregiver
  2. Trying out a homeopathic medicine from a friend to reduce swelling in the legs
  3. Getting a chiropractic treatment for low back pain due to discomforts of pregnancy without telling the primary health care provider
  4. Taking an herbal preparation suggested by a health food store worker for treatment of leg pain
  5. Joining a group that practices tai chi weekly to help with physical fitness and movement

Correct Answer: 2,3,4

Rationale 1: Getting a massage from a licensed massage therapist for back pain, prescribed by the primary caregiver, is a perfectly good use of complementary therapies.

Rationale 2: Trying out a homeopathic medicine from a friend to reduce swelling in your legs is a risk factor when considering these therapies. Lack of standardization, lack of regulation and research to substantiate their safety and effectiveness, and inadequate training and certification of some healers make some therapies risky.

Rationale 3: Getting a chiropractic treatment for low back pain due to discomforts of pregnancy without telling the primary health care provider is a risk factor when considering these therapies. Lack of standardization, lack of regulation and research to substantiate their safety and effectiveness, and inadequate training and certification of some healers make some therapies risky.

Rationale 4: Taking an herbal preparation suggested by a health food store worker for treatment of leg pain is a risk factor when considering these therapies. Lack of standardization, lack of regulation and research to substantiate their safety and effectiveness, and inadequate training and certification of some healers make some therapies risky.

Rationale 5: Joining a group that practices tai chi weekly to help with physical fitness and movement is a perfectly good use of complementary therapies.

Global Rationale:

 

Cognitive Level: Evaluating

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: LO09 Describe the benefits and risks of the various complementary and alternative therapies to the childbearing family.

 

Question 15

Type: MCSA

The labor and delivery unit nurse manager is incorporating complementary and alternative therapies into the units policies and procedures. Which statement should the nurse manager include during an in-service educational presentation for the nursing staff?

  1. Policies have been developed for using massage and aromatherapy.
  2. When patients ask questions you dont know, tell them to look online.
  3. Because herbs are dangerous during pregnancy, we will not use them.
  4. Be sure to ask patients what alternative therapies they have used.

Correct Answer: 1

Rationale 1: The development of written policies and procedures facilitates safe nursing practice, which in turn promotes patient safety.

Rationale 2: Online information can vary in its accuracy. Reputable sources (electronic or print) should be recommended for further patient education.

Rationale 3: This statement is false. Many herbs can be safely used during pregnancy.

Rationale 4: What the patient has used in the past does not predict what she is open to using at present. It is more important to develop written policies and procedures.

Global Rationale:

 

Cognitive Level: Evaluating

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: LO10 Formulate nursing care within the nurse practice act and with the informed consent of the patient when using appropriate complementary therapies with childbearing families.

Ladewig, Contemporary Maternal-Newborn Nursing, 8/E
Chapter 10

Question 1

Type: MCSA

The pregnant patient has completed the prenatal questionnaire and asks the nurse why this form had to be completed. The best response by the nurse is:

  1. Some people have things that have happened in the past that could impact their current pregnancy.
  2. The doctor wants all of the pregnant patients to complete the form so that our records are complete.
  3. We occasionally identify a health problem that puts the current pregnancy at higher risk.
  4. This form is designed to predict who will develop problems with their pregnancy or delivery.

Correct Answer: 3

Rationale 1: Although this is true, this statement is too vague to be the best response. It is best to explain specifically that the impact on the current pregnancy might put the pregnancy at higher risk.

Rationale 2: The purpose of the form is to identify which patients have risk factors; the fact that records are complete is less important than identifying at risk pregnancies.

Rationale 3: This is the reason for risk assessment during pregnancy, whether it is a patient-completed questionnaire or a nurse assessment form.

Rationale 4: The form will identify those patients who have risk factors based on their medical history; prediction implies seeing into the future without a basis for the concern.

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO01 Use information provided on a prenatal history to identify risk factors for the mother and/or fetus.

 

Question 2

Type: MCSA

The pregnant patients prenatal record indicates that she is a gravida 4 para 2022. The nurse understands that this indicates the patient had four pregnancies and:

  1. Has four living children.
  2. Delivered two infants preterm.
  3. Is pro-abortion.
  4. Delivered two term infants.

Correct Answer: 4

Rationale 1: In the four digit number, the fourth number indicates the number of living children, which is 2.

Rationale 2: In the four digit number, the second digit indicates the number of preterm births, so the patient has had no preterm births.

Rationale 3: In the four digit number, the third digit indicates the number of abortions the patient has experienced. Because abortion may be spontaneous or therapeutic, this number does not does not necessarily reflect a womans stance on surgical abortion.

Rationale 4: In the four digit number, the first digit indicates the number of term infants born, which is two.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO02 Define common obstetric terminology found in the history of maternity patients.

 

Question 3

Type: MCSA

A multigravida gave birth to an 18-week fetus last week. She is in the clinic for follow-up and notices that her chart states she has had one abortion. The patient is upset over the use of this word. How can the nurse best explain this terminology to the patient?

  1. Abortion is the medical term for all pregnancies that end before 28 weeks.
  2. Abortion is the word we use when someone has miscarried.
  3. Abortion is how we label pregnancies that end in the second trimester.
  4. Abortion is what we call all babies who are stillborn.

Correct Answer: 1

Rationale 1: Abortions are fetal losses prior to the onset of the third trimester and include elective induced (medical or surgical) abortions, ectopic pregnancies, and spontaneous abortions or miscarriages.

Rationale 2: Abortions are fetal losses prior to the onset of the third trimester and include elective induced (medical or surgical) abortions, ectopic pregnancies, and spontaneous abortions or miscarriages.

Rationale 3: Abortions are fetal losses prior to the onset of the third trimester and include elective induced (medical or surgical) abortions, ectopic pregnancies, and spontaneous abortions or miscarriages.

Rationale 4: Third-trimester losses are considered fetal death in utero, and the term abortion is not used.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: LO02 Define common obstetric terminology found in the history of maternity patients.

 

Question 4

Type: MCSA

Which of the following patients would be considered a multipara?

  1. A patient at 34 weeks gestation who previously had one spontaneous abortion
  2. A patient at 13 weeks gestation who previously delivered two term infants
  3. A patient at 28 weeks gestation with no previous pregnancies
  4. A patient at 32 weeks gestation who previously delivered one term infant

Correct Answer: 2

Rationale 1: A woman who has had no births at more than 20 weeks gestation is considered a nullipara.

Rationale 2: A woman who has had two or more births at more than 20 weeks gestation is considered a multipara.

Rationale 3: A woman who has had no births at more than 20 weeks gestation is considered a nullipara.

Rationale 4: A woman who has had one birth at more than 20 weeks gestation, regardless of whether the infant was born alive or dead, is considered a primipara.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO02 Define common obstetric terminology found in the history of maternity patients.

 

Question 5

Type: MCSA

The patient has delivered her first child at 39 weeks. The nurse would explain this to the patient as what type of delivery?

  1. Preterm
  2. Post-term
  3. Term
  4. Near term

Correct Answer: 3

Rationale 1: Preterm deliveries are those that occur prior to 37 completed weeks gestation.

Rationale 2: Post-term applies to birth that occur after 42 weeks gestation.

Rationale 3: Term births are those that occur from between gestation weeks 38 and 42.

Rationale 4: Near term is not terminology used to describe birth.

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: LO02 Define common obstetric terminology found in the history of maternity patients.

 

Question 6

Type: MCSA

The prenatal clinic nurse is designing a new prenatal intake information form for pregnant patients. Which question is best to include on this form?

  1. Where was the father of the baby born?
  2. Do genetic diseases run in the family of the babys father?
  3. What is the name of the babys father?
  4. Are you married to the father of the baby?

Correct Answer: 2

Rationale 1: This is not important information for pregnancy.

Rationale 2: This question has the highest priority because it gets at the physiologic issue of inheritable genetic diseases that might directly impact the baby.

Rationale 3: Although it is helpful for the nurse to know the name of the fathers baby to include him in the prenatal care, this is psychosocial information and much less important than possible genetic diseases that the baby might have inherited.

Rationale 4: Although the marital status of the patient might have cultural significance, this is psychosocial information and much less important than possible genetic diseases that the baby might have inherited.

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: LO03 Identify factors related to the fathers health that are generally recorded on the prenatal record in assessing risk factors for the mother and/or fetus.

 

Question 7

Type: MCSA

The nurse is assessing a primiparous patient. The patient indicates that her religion is Judaism. This information is important for the nurse to assess because:

  1. Religious and cultural background can impact what a patient eats during pregnancy.
  2. It provides a baseline from which to ask questions about the patients religious and cultural background.
  3. Knowing what the patients beliefs and behaviors regarding pregnancy are is important.
  4. Patients sometimes encounter problems in their pregnancies based on what religion they practice.

Correct Answer: 2

Rationale 1: Although this is true, much more than diet is impacted by religious and cultural background; values, beliefs, expectations for the birth, and acceptance or refusal of medical treatment are also influenced by religious or cultural background.

Rationale 2: This is the best explanation because not all people interpret or live out their religious or cultural backgrounds the same way. It is imperative to avoid stereotyping patients. Thus, the nurse should use the information on the patients background as an educated starting point from which to base further questions about how this specific patient enacts her religious or cultural background.

Rationale 3: Not all people interpret or live out their religious or cultural backgrounds the same way. It is imperative to avoid stereotyping patients based on what their background is. The nurse must use the information on the patients background as an educated starting point from which to base further questions about how this specific patient enacts her religious or cultural background.

Rationale 4: How a patient enacts her religion occasionally will cause problems with pregnancy. But the most important reason for asking a patient for her religious or cultural background is to have a starting point from which to base further questions on the specifics of how this patient is impacted by or enacts her cultural or religious background as a unique individual.

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: LO04 Evaluate those areas of the initial assessment that reflect the psychosocial and cultural factors related to a womans pregnancy.

 

Question 8

Type: MCSA

The clinic nurse is assisting with an initial prenatal assessment. The following findings are present: spider nevi present on lower legs; dark pink, edematous nasal mucosa; mild enlargement of the thyroid gland; mottled skin and pallor on palms and nail beds; heart rate 88 with murmur present. What is the best action for the nurse to take based on these findings?

  1. Document the findings on the prenatal chart.
  2. Have the physician see the patient today.
  3. Instruct the patient to avoid direct sunlight.
  4. Analyze previous thyroid hormone lab results.

Correct Answer: 2

Rationale 1: These abnormalities must be reported to the physician immediately.

Rationale 2: Mottling of the skin is indicative of poor oxygenation and a circulation problem. Skin and nail bed pallor can indicate either hypoxia or anemia. These abnormalities must be reported to the physician immediately.

Rationale 3: Spider nevi are common in pregnancy due to the increased vascular volume and high estrogen levels. Nasal passages can be inflamed during pregnancy from edema, caused by increased estrogen levels.

Rationale 4: The thyroid gland increases in size during pregnancy due to hyperplasia.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO05 Predict the normal physiologic changes a nurse would expect to find when performing a physical assessment of a pregnant woman.

 

Question 9

Type: MCSA

A 25-year-old primigravida is 20 weeks pregnant. At the clinic, her nurse begins a prenatal assessment and obtains the following vital signs. Which finding would require the nurse to contact the physician?

  1. Pulse 88/min
  2. Respirations 30/min
  3. Temperature 37.4C (99.3F)
  4. Blood pressure 134/82

Correct Answer: 2

Rationale 1: A slight increase in pulse is an expected finding during pregnancy due to the increased oxygen consumption to support fetal metabolism.

Rationale 2: Tachypnea is not a normal finding and requires medical care.

Rationale 3: Temperature is an expected finding during pregnancy due to the increased oxygen consumption to support fetal metabolism.

Rationale 4: The blood pressure is within normal limits.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO05 Predict the normal physiologic changes a nurse would expect to find when performing a physical assessment of a pregnant woman.

 

Question 10

Type: MCSA

The nurse is seeing prenatal patients in the clinic. Which patient is exhibiting expected findings?

  1. Primip at 12 weeks with fetal heart tones heard by Doppler fetoscope
  2. Multip at 22 weeks who reports no fetal movement felt yet
  3. Primip at 26 weeks with fundal height of 30 cm
  4. Multip at 12 weeks reports bright red vaginal bleeding.

Correct Answer: 1

Rationale 1: This is an expected finding because fetal heart tones should be heard by 12 weeks using an ultrasonic Doppler fetoscope.

Rationale 2: This is an abnormal finding. Fetal movement should be felt by 20 weeks.

Rationale 3: This is an abnormal finding. Beginning in the second trimester, the fundal height should correlate with weeks of gestation; thus, at 26 weeks gestation, the fundal height should be about 26 cm.

Rationale 4: This is an abnormal finding. Bright red bleeding during pregnancy is never expected.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO05 Predict the normal physiologic changes a nurse would expect to find when performing a physical assessment of a pregnant woman.

 

Question 11

Type: MCSA

The nurse receives a phone call from a patient who thinks she is pregnant. The patient reports that she has regular menses that occur every 28 days and last 5 days. The first day of her last menses was April 10. What is the patients estimated date of delivery (EDD)?

  1. November 13
  2. January 17
  3. January 10
  4. December 3

Correct Answer: 2

Rationale 1: Naegeles rule is to add 7 days to the last menstrual period and subtract 3 months. The LMP is April 10; therefore, January 17 is the EDD.

Rationale 2: Naegeles rule is to add 7 days to the last menstrual period and subtract 3 months. The LMP is April 10; therefore, January 17 is the EDD.

Rationale 3: Naegeles rule is to add 7 days to the last menstrual period and subtract 3 months. The LMP is April 10; therefore, January 17 is the EDD.

Rationale 4: Naegeles rule is to add 7 days to the last menstrual period and subtract 3 months. The LMP is April 10; therefore, January 17 is the EDD.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO06 Calculate the estimated date of birth using the common methods.

 

Question 12

Type: MCSA

The nurse explains to a pregnant woman that her antepartum assessment will include assessment of clinical pelvimetry. Which patient response reflects understanding of the reason for this test?

  1. It will help understand how big a baby I can have.
  2. It will be used to find out whether my baby has a chromosomal abnormality.
  3. It will help tell whether my pelvis is big enough to deliver my baby vaginally.
  4. It will be used to screen for gestational diabetes.

Correct Answer: 3

Rationale 1: Clinical pelvimetry is performed to estimate the adequacy of pelvic size for the purpose of vaginal delivery; delivery of larger infants may be accommodated via Cesarean section.

Rationale 2: Clinical pelvimetry involves estimating the adequacy of pelvic size for facilitating vaginal birth.

Rationale 3: Clinical pelvimetry is performed to estimate the ease or difficulty associated with vaginal delivery of an infant.

Rationale 4: Screening for maternal gestational diabetes requires some form of glucose screening.

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: LO07 Describe the essential measurements that can be determined by clinical pelvimetry.

 

Question 13

Type: MCSA

The nurse is assisting a physician during a prenatal examination. The physician seeks to estimate the adequacy of the patients pelvis for birth. The nurse understands that the physician will need to perform which measurement vaginally?

  1. True conjugate
  2. Diagonal conjugate
  3. Transverse outlet diameter
  4. Obstetrical conjugate

Correct Answer: 2

Rationale 1: The true conjugate is a measurement of the pelvic inlet and cannot be directly measured.

Rationale 2: The diagonal conjugate is measured from the lower edge of the symphysis to the sacral promontory.

Rationale 3: The transverse outlet diameter is measured externally.

Rationale 4: The obstetrical is a measurement of the pelvic inlet and cannot be directly measured.

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: LO07 Describe the essential measurements that can be determined by clinical pelvimetry.

 

Question 14

Type: MCSA

The nurse is working with a prenatal patient. Which statement indicates that additional teaching is necessary?

  1. I will have Rh testing, even though this is my first pregnancy.
  2. My vagina will be cultured at 36 weeks for group B strep.
  3. Because I am married, I wont have the STI screening.
  4. My blood will be checked for hemoglobin level.

Correct Answer: 3

Rationale 1: This is a true statement. All patients are screened for blood type, Rh factor, and Rh antibodies, regardless of how many previous pregnancies (if any) they have had.

Rationale 2: This is a true statement. Women are tested for group B strep to prevent neonatal infection.

Rationale 3: All women should be screened for syphilis, gonorrhea, and hepatitis B.

Rationale 4: This is a true statement. All women will have their hemoglobin assessed.

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: LO08 Describe the major screening tests used during the prenatal period in the assessment of the prenatal patient.

 

Question 15

Type: MCSA

Which phone call should the prenatal clinic nurse return first?

  1. Primip at 32 weeks, reports headache and blurred vision
  2. Multip at 18 weeks, reports no fetal movement this pregnancy
  3. Primip at 16 weeks, reports increased urinary frequency
  4. Multip at 40 weeks, reports sudden gush of fluid and contractions

Correct Answer: 1

Rationale 1: Headache and blurred vision are signs of pre-eclampsia, which is potentially life-threatening for both mother and fetus. This patient has top priority.

Rationale 2: Fetal movement should be felt by 1920 weeks. Multips sometimes feel fetal movement prior to 19 weeks, but the lack of fetal movement prior to 20 weeks is considered normal. This patient is a lower priority.

Rationale 3: Increased urinary frequency is common during pregnancy as the increased size of the uterus puts pressure on the urinary bladder. Urinary frequency is expected. If the patient were reporting dysuria or hematuria, a UTI would be suspected, but this patient is only reporting increased urinary frequency. This patient is a lower priority.

Rationale 4: A term patient who is experiencing contractions and a sudden gush of fluid is in labor. Although laboring patients should be in contact with their provider for advice on when to go to the hospital, labor at term is an expected finding. This patient is a lower priority.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO09 Assess the prenatal patient for the danger signs of pregnancy.

 

Question 16

Type: MCSA

The nurse is completing an assessment for a prenatal visit. Which statement indicates that further teaching is necessary?

  1. Because Im in my third trimester, I should return to the clinic in a month.
  2. Now that Ive felt fetal movement, I should feel movement regularly.
  3. Before I take any over-the-counter medications, I should contact my doctor.
  4. Alcohol is possibly harmful to my baby, even at the end of my pregnancy.

Correct Answer: 1

Rationale 1: This statement is incorrect because prenatal visits during the third trimester are every two weeks from 26 to 36 weeks, and every week from 36 weeks to delivery.

Rationale 2: This is a true statement. Once fetal movement is perceived, it should be felt regularly. Initially, this might not be every day, but in the third trimester, fetal movement should be noticeable several times per day.

Rationale 3: This is a true statement. Regardless of the gestational age, over-the-counter medications can have deleterious effects on mom or baby; thus, it is important for a pregnant woman to consult her provider prior to taking any over-the-counter medications throughout the pregnancy.

Rationale 4: This is a true statement. Alcohol should be avoided throughout pregnancy and lactation.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: LO10 Relate the components of the subsequent prenatal history and assessment to the progress of pregnancy and the nursing care of the prenatal patient.

Ladewig, Contemporary Maternal-Newborn Nursing, 8/E
Chapter 20

Question 1

Type: MCSA

The laboring patient has rated her pain at 9 on a scale of 110, and she requests IV pain medication. She has refused epidural anesthesia, but her certified nurse-midwife (CNM) has ordered butorphanol tartrate (Stadol) for administration to the patient. Which action should the nurse complete next?

  1. Advise the woman as to the actions and contraindications associated with butorphanol tartrate and obtain her consent for administration of the medication.
  2. Offer the woman epidural anesthesia once more and describe the effectiveness of this method of labor pain control.
  3. Obtain maternal vital signs and assess the fetal heart rate (FHR).
  4. Administer oxygen via face mask at 6 to 10 liters per minute.

Correct Answer: 1

Rationale 1: Prior to administration of medication, the nurse must explain the pharmacologic effects of the medication and obtain consent for administration.

Rationale 2: The woman has refused epidural anesthesia but is authorized to receive butorphanol tartrate. The nurses next step is to advise the woman as to the actions and contraindications associated with butorphanol tartrate and obtain her consent for administration of the medication.

Rationale 3: Prior to obtaining maternal vital signs and assessing FHR, the nurse should advise the woman as to the actions and contraindications associated with butorphanol tartrate and obtain her consent for administration of the medication.

Rationale 4: Routine oxygen administration is not indicated for administration of butorphanol tartrate to an asymptomatic patient in labor. The nurses next step is to advise the woman as to the actions and contraindications associated with butorphanol tartrate and obtain her consent for administration of the medication.

Global Rationale:

 

Cognitive Level: Evaluating

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: LO01 Describe the use, administration, dose, onset of action, adverse effects, and contraindications of systemic drugs that promote pain relief during labor in determining the nursing care management of the woman in labor and her fetus.

 

Question 2

Type: MCSA

A patient has just been admitted for labor and delivery. She is having mild contractions every 15 minutes lasting 30 seconds. The patient wants to have a medication-free birth. When discussing medication alternatives, the nurse should be sure the patient understands that:

  1. In order to respect her wishes, no medication will be given.
  2. Pain relief will allow a more enjoyable birth experience.
  3. The use of medications allows the patient to rest and be less fatigued.
  4. Maternal pain and stress can have a more adverse effect on the fetus than would a small amount of analgesia.

Correct Answer: 4

Rationale 1: It is important to respect the patients wishes when possible. Once the effects are explained, it is still the patients choice whether to receive medication.

Rationale 2: While pain relief can lead to a more enjoyable experience, it might be the view of the nurse but not the mother.

Rationale 3: While pain relief can allow the mother to be less fatigued, it might be the view of the nurse but not the mother.

Rationale 4: The decision not to medicate should be an informed one, and it is possible that the patient does not know about the effects pain and stress can have on the fetus. Once the effects are explained, it is still the patients choice whether to receive medication.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: LO01 Describe the use, administration, dose, onset of action, adverse effects, and contraindications of systemic drugs that promote pain relief during labor in determining the nursing care management of the woman in labor and her fetus.

 

Question 3

Type: MCSA

The nurse has presented a teaching session on pain relief options to a prenatal class. Which patient statement indicates that additional teaching is needed?

  1. An epidural can be continuous or one dose.
  2. General anesthesia is usually recommended for a patient who delivers by way of cesarean section.
  3. Narcotics can be given through a patients epidural infusion catheter.
  4. A pudendal block usually works well to control pain during episiotomy repair.

Correct Answer: 2

Rationale 1: Epidural anesthesia can be administered in a single dose or via continuous infusion.

Rationale 2: Compared to general anesthesia, spinal anesthesia is usually the anesthetic of choice indicated in the management of patients undergoing cesarean section.

Rationale 3: To provide analgesia for approximately 24 hours after the birth, the analgesia provider may inject an opioid, such as morphine sulfate (Duramorph) or fentanyl (Sublimaze), into the epidural space immediately after the birth

Rationale 4: A pudendal block technique is given in the second stage of labor for the provision of p

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