Chapter 5 - Test questions

Leifer: Introduction to Maternity & Pediatric Nursing, 6th Edition Chapter 05: Nursing Care of Women with Complications During Pregnancy Test Bank MULTIPLE CHOICE 1. A pregnant patient tells the nurse that she has been nauseated and vomiting. The nurse explains that hyperemesis gravidarum is distinguished from morning sickness because: a. hyperemesis gravidarum usually lasts for the duration of the pregnancy. b. hyperemesis gravidarum causes dehydration and electrolyte imbalances. c. sensitivity to smells is usually the cause of vomiting in hyperemesis gravidarum. d. the woman with hyperemesis gravidarum will have persistent vomiting without weight loss. ANS: B Dehydration and electrolyte imbalances result from persistent nausea and vomiting associated with hyperemesis gravidarum. Dehydration impairs the perfusion to the placenta. DIF: Cognitive Level: Analysis REF: p. 79 OBJ: 3 TOP: Hyperemesis KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. A woman who is 9 weeks pregnant is experiencing heavy bleeding and cramping. She reports passing some tissue. Cervical dilation is noted on examination. This woman most likely had a(n) _____ abortion. a. inevitable b. incomplete c. complete d. missed ANS: B Signs and symptoms of an incomplete abortion are similar to those of an inevitable abortion, but some tissue is passed. DIF: OBJ: KEY: MSC:

Cognitive Level: Analysis REF: p. 83, Table 5-2, Figure 5-2 3 TOP: Incomplete Abortion Nursing Process Step: Assessment NCLEX: Physiological Integrity: Physiological Adaptation

3. The nurse finds a woman crying after she has undergone a dilation and evacuation (D&E) for a missed abortion. The most appropriate statement made by the nurse would be: a. “There is usually something wrong with the fetus when this happens early in pregnancy.” b. “Now there. You can try to conceive on your next cycle.” c. “I’m here if you need to talk.” d. “You are young and strong. I know you can have a healthy pregnancy.” Copyright © 2011 by Saunders, an imprint of Elsevier Inc.

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ANS: C An effective technique when communicating with a woman experiencing pregnancy loss is to say, “I’m here if you need to talk.” The nurse listens and acknowledges the woman’s grief. DIF: Cognitive Level: Application REF: p. 85 OBJ: 3 TOP: Dilation and Evacuation (D&E) KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 4. A woman who is 8 weeks pregnant becomes concerned when she has light vaginal bleeding accompanied by abdominal pain. An ectopic pregnancy is confirmed by ultrasound. The statement that indicates that the woman understands the explanation of an ectopic pregnancy is: a. “The chorionic villi develop vesicles within the uterus.” b. “The placenta develops in the lower part of the uterus.” c. “The fetus dies in the uterus during the first half of the pregnancy.” d. “The embryo is implanted in the fallopian tube.” ANS: D Ectopic pregnancy occurs when the fertilized ovum is implanted outside of the uterine cavity. DIF: Cognitive Level: Analysis REF: p. 85 OBJ: 3 TOP: Ectopic Pregnancy KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 5. An ultrasound on a woman who is 32 weeks pregnant reveals the placenta implanted over the entire cervical os. The nurse understands that this condition is known as: a. low-lying placenta. b. marginal placenta previa. c. partial placenta previa. d. total placenta previa. ANS: D A total placenta previa describes a condition in which the placenta completely covers the cervical opening. DIF: Cognitive Level: Analysis REF: pp. 68, 69 OBJ: 3 TOP: Placenta Previa KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 6. a. b. c.

The nurse would suspect abruptio placentae when the pregnant woman presents with: painless vaginal bleeding. uterine irritability with contractions. vaginal bleeding and back pain.

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d. premature rupture of membranes. ANS: C Bleeding accompanied by abdominal or lower back pain is a typical manifestation of abruptio placentae. DIF: Cognitive Level: Analysis REF: p. 90 OBJ: 3 TOP: Abruptio Placenta KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 7. a. b. c. d.

Rh incompatibility occurs in which situation? Rh-negative mother, Rh-positive fetus Rh-positive mother, Rh-negative fetus Rh-negative mother, Rh-negative fetus Rh-positive mother, Rh-positive fetus

ANS: A Rh incompatibility can occur only if the mother is Rh negative and the fetus is Rh positive. DIF: Cognitive Level: Analysis REF: p. 96 OBJ: 3 TOP: Rh Incompatibility KEY: Nursing Process Step: N/A MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 8. A primigravida in her first trimester is Rh negative. To prevent anti-Rh antibodies from forming, this woman would receive: a. Rh immune globulin during labor. b. intrauterine transfusions with O-negative blood. c. Rh immune globulin at 28 weeks and within 72 hours after the birth of an Rhpositive infant. d. Rh immune globulin now and again in the last trimester. ANS: C An Rh-negative woman would receive Rh immune globulin at 28 weeks of gestation and within 72 hours after the birth of an Rh-positive infant or abortion. DIF: Cognitive Level: Application REF: p. 96 OBJ: 3 TOP: Rh Incompatibility KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 9. A woman seeking prenatal care relates a history of macrosomic infants, two stillbirths, and polyhydramnios with each pregnancy. The nurse recognizes that these factors are highly suggestive of: a. toxoplasmosis.

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b. abruptio placentae. c. hydatidiform mole. d. diabetes mellitus. ANS: D Large (macrosomic) infants over 9 pounds are linked to gestational diabetes. DIF: Cognitive Level: Analysis REF: p. 98 OBJ: 5 TOP: Diabetes Mellitus KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 10. The nurse explains that pregnancy affects glucose metabolism because: a. placental hormones increase the resistance of cells to insulin. b. insulin cells cannot meet the body’s demands as the woman’s weight increases. c. there is a decreased production of insulin during pregnancy. d. the speed of insulin breakdown is decreased during pregnancy. ANS: A Hormones and enzymes produced by the placenta increase the resistance of cells to insulin. DIF: Cognitive Level: Knowledge REF: p. 100 OBJ: 5 TOP: Diabetes Mellitus KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 11. The nurse explains that a woman who uses oral hypoglycemic agents to control diabetes mellitus will need to take insulin during pregnancy because: a. insulin can cross the placental barrier to the fetus. b. insulin does not cross the placental barrier to the fetus. c. oral agents do not cross the placenta. d. oral agents are not sufficient to meet maternal insulin needs. ANS: B Oral hypoglycemic agents are not used during pregnancy because they can cross the placenta, possibly resulting in fetal birth defects or hypoglycemia. DIF: Cognitive Level: Comprehension REF: p. 100 OBJ: 5 TOP: Diabetes Mellitus KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 12. The pregnant woman comes to the clinic stating that she has been exposed to hepatitis B. She is afraid that her infant will also contract hepatitis B. The nurse counsels that the infant will: a. be given a single dose of hepatitis immune globulin after birth. b. be able to use the antibodies from the immunizations given to the patient before delivery.

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c. not have hepatitis B because the virus does not pass through the placental barrier. d. be immune to hepatitis B because of the mother’s infection. ANS: A The infant will be given immune globulin immediately after birth for temporary immunity followed by hepatitis B vaccine. Immunization is not recommended for women who are pregnant. DIF: Cognitive Level: Application REF: p. 105 OBJ: 5 TOP: Hepatitis B KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 13. When the nurse asks a patient about drug use during a prenatal history, she might begin the questioning with: a. “Do you smoke, drink alcohol, or use drugs?” b. “Do you ever use prescription or street drugs?” c. “What over-the-counter and prescription drugs have you taken in the past 3 months?” d. “We need to know if you take drugs so we can help your baby.” ANS: C Screening for drug use should begin in a nonthreatening way by asking about prescription and OTC medications and how the information can help provide safe and appropriate prenatal care. DIF: Cognitive Level: Application REF: p. 109 OBJ: 6 TOP: Interviewing Relative to Drug Use KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 14. The nurse assesses a pregnant woman for pregnancy-induced hypertension. The first sign of fluid retention suggestive of this complication is: a. abdominal enlargement. b. facial swelling. c. sudden weight gain. d. swelling of the feet and ankles. ANS: C Sudden, excessive weight gain is the first sign of fluid retention; facial swelling and swelling of feet, legs, and hands follows weight gain. DIF: Cognitive Level: Analysis REF: p. 92 OBJ: 3 TOP: Hypertension KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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15. If the patient with gestational hypertension has all the signs below, the nurse immediately should report: a. diarrhea. b. urticaria. c. blurred vision. d. backache. ANS: C Visual disturbances indicate worsening pregnancy-induced hypertension and must be reported promptly for effective intervention to prevent preeclampsia and convulsion. DIF: Cognitive Level: Analysis REF: p. 92 OBJ: 3 TOP: Hypertension KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 16. The patient who is 28 weeks pregnant presents with consistent hypertension. The home health nurse would give priority to the need for: a. activity restriction. b. balanced nutrition. c. increased fluid intake to ensure adequate hydration. d. instruction about the effect of diuretics. ANS: A Bed rest reduces the flow of blood to skeletal muscles, making more blood available to the placenta and enhancing fetal oxygenation. DIF: Cognitive Level: Application REF: p. 93 OBJ: 3 TOP: Hypertension KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 17. The nurse explains that the objective of magnesium sulfate therapy for the patient with preeclampsia is to: a. prevent convulsions. b. promote diaphoresis. c. increase reflex irritability. d. act as a saline cathartic. ANS: A Magnesium sulfate is a central nervous system depressant given to prevent seizures. DIF: Cognitive Level: Knowledge REF: p. 93 OBJ: 3 TOP: Magnesium Sulfate KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

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18. The nurse caring for a pregnant woman receiving an intravenous infusion with magnesium sulfate will: a. count respirations and report a rate of less than 12 breaths/min. b. count respirations and report a rate of more than 20 breaths/min. c. check blood pressure and report a rate of less than 100/60 mm Hg. d. monitor urinary output and report a rate of less than 100 mL/hr. ANS: A Excessive magnesium sulfate may cause respiratory depression. DIF: Cognitive Level: Application REF: p. 93 OBJ: 3 TOP: Magnesium Sulfate KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 19. The drug the nurse plans to have available for immediate IV administration whenever magnesium sulfate is administered to a maternity patient is: a. ergonovine maleate (Ergotrate). b. oxytocin. c. calcium gluconate. d. hydralazine (Apresoline). ANS: C Calcium gluconate reverses the effects of magnesium sulfate and should be available for immediate use when a woman receives magnesium sulfate. DIF: Cognitive Level: Analysis REF: p. 93 OBJ: 3 TOP: Calcium Gluconate KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 20. A woman who is 35 weeks pregnant has a total placenta previa. She asks the nurse, “Will I be able to deliver vaginally?” The nurse should explain: a. “Yes, you can deliver vaginally until 36 weeks.” b. “A vaginal delivery can be attempted, but if bleeding occurs, a cesarean section is done.” c. “A cesarean section is performed when the mother has a total placenta previa.” d. “There is no reason why you cannot have a vaginal delivery.” ANS: C A cesarean delivery is done for a partial or total placenta previa. DIF: Cognitive Level: Application REF: p. 89 OBJ: 3 TOP: Placenta Previa KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk

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21. The nurse teaches a woman who is 8 weeks pregnant about how rubella can affect the developing fetus. The nurse realizes the woman understands the information when she says that rubella during pregnancy can result in: a. facial abnormalities. b. mental retardation. c. liver failure. d. limb deformities. ANS: B Rubella can have devastating effects on the developing fetus. Some effects of rubella on the embryo or fetus include microcephaly, mental retardation, cardiac defects, cataracts, and deafness. DIF: Cognitive Level: Analysis REF: p. 104 OBJ: 5 TOP: Rubella KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 22. The nurse would suspect pyelonephritis when a pregnant woman reports: a. frequency and urgency of urination. b. nausea and weight loss. c. burning sensation when voiding. d. tenderness in the flank area. ANS: D Pyelonephritis is a particularly serious infection in pregnancy. Signs and symptoms include high fever, chills, flank pain or tenderness, nausea, and vomiting. DIF: Cognitive Level: Analysis REF: p. 107 OBJ: 5 TOP: Pyelonephritis KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk 23. To help prevent more placental damage, the nurse positions the prenatal patient with a placenta previa: a. flat on her back with knees flexed to help prevent hemorrhage. b. on her side to prevent supine hypotension. c. in the semi-Fowler’s position to prevent supine hypotension. d. in the knee-chest position to reduce pressure on placenta. ANS: B The prenatal patient with placenta previa is best placed on her side with a pillow for support. This position not only reduces stress on the placenta but also reduces the possibility of supine hypotension. DIF: Cognitive Level: Application TOP: Placenta Previa

REF: p. 89 OBJ: 3 KEY: Nursing Process Step: Implementation

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MSC: NCLEX: Physiological Integrity: Reduction of Risk 24. The young prenatal patient with gestational diabetes mellitus (GDM) says, “I am frightened that I will have to deal with insulin injections for the rest of my life.” The nurse’s best response would be: a. “After delivery your doctor will prescribe oral hypoglycemic medication to control your disease. Pills are so much simpler than insulin injections.” b. “Have you considered an insulin pump?” c. “After a while those insulin injections won’t seem so bad.” d. “It will most likely resolve 6 weeks or so after the baby is born.” ANS: D GDM usually resolves by 6 weeks after delivery. DIF: Cognitive Level: Comprehension REF: p. 97 OBJ: 3 TOP: GDM KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation MULTIPLE RESPONSE 25. Because the mother is diabetic, the nurse caring for a macrosomic infant will do a focused assessment for which complication(s)? Select all that apply. a. Meconium ileus b. Diarrhea c. Hypoglycemia d. Muscle tremors e. Urine retention ANS: C The fetus responds to the hyperglycemia from the mother’s blood and produces increased insulin. This insulin may cause hypoglycemia in the infant after it is no longer exposed to the mother’s blood. DIF: Cognitive Level: Application REF: p. 101, Box 5-4 OBJ: 5 TOP: Hypoglycemia in Macrosomic Infant KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 26. The nurse educates prenatal patients about the threat of TORCH infections. Which infections are included in this classification? Select all that apply. a. Toxoplasmosis b. Toxemia c. Cytomegalovirus d. Rubella e. Herpes simplex

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ANS: A, C, D, E The TORCH infections are toxoplasmosis, rubella, cytomegalovirus, and herpes simplex. DIF: Cognitive Level: Comprehension REF: p. 104 OBJ: 6 TOP: TORCH Infections KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 27. The nurse emphasizes to a patient with a high-risk pregnancy that the impact of such a pregnancy might result in which problem(s)? Select all that apply. a. Disruption of family roles b. Financial pressures c. Excessive attachment to infant d. Frustration with activity restriction e. Alteration in child care practices ANS: A, B, D, E High-risk pregnancies have an impact on family roles, financial needs, delayed attachment to the infant, alteration in child care practices, and frustration with the restricted activity. DIF: Cognitive Level: Application REF: p. 112 OBJ: 8 TOP: Impact of High-Risk Pregnancies KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 28. A patient who is 30 weeks pregnant delivers a stillborn child in the emergency department (ED). What should the ED nurse offer the patient? Select all that apply. a. Privacy b. An opportunity to hold the infant c. Materials about support groups d. A memento (footprint or lock of hair) e. An opportunity to grieve ANS: A, B, C, D, E All the listed interventions are appropriate. DIF: Cognitive Level: Application REF: p. 113 OBJ: 8 TOP: Stillborn Infant KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 29. What would the nurse include in a teaching plan for the pregnant patient who has iron deficiency anemia and has been placed on iron supplement? Select all that apply. a. Citrus fruits enhance absorption of iron. b. Bran products support iron deficiency. c. Milk will disguise the taste of the iron. d. The iron therapy will continue for about 3 months. e. Tea should be avoided while taking iron.

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ANS: A, D, E Calcium, bran, and tannic acid in tea interfere with the absorption of iron. The therapy usually lasts 3 months, and vitamin C helps with the absorption of iron. DIF: Cognitive Level: Application REF: p. 103 OBJ: 5 TOP: Iron Deficiency Anemia KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 30. The nurse takes into consideration that the patient with placenta previa is at risk for postpartum infection for what reason(s)? Select all that apply. a. Vaginal organisms can invade the placenta. b. The under-nourished placenta becomes necrotic. c. The amniotic fluid can become infected. d. The placenta is an excellent growth medium. e. The misplaced placenta weakens the uterine wall. ANS: A, D Vaginal organisms reach the placenta through the cervix. Once there, the organisms can multiply in the nutrient-rich environment of the placenta. The weak musculature of the lower segment of the uterus will cause postpartum hemorrhage rather than infection. DIF: Cognitive Level: Application REF: p. 89 OBJ: 3 TOP: Infection with Placenta Previa KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease COMPLETION 31. The nurse cautions that the consumption of as few as ________ alcoholic drink(s) during pregnancy can lead to the loss of fetal brain cells. ANS: 2 two Studies have shown that even as few as two alcoholic drinks consumed during pregnancy can cause loss of fetal brain cells. A drink is defined as 12 oz of beer, 5 oz of wine, or 1.5 oz of liquor. DIF: OBJ: KEY: MSC:

Cognitive Level: Comprehension REF: p. 109, Nursing Tip 5 TOP: Fetal Alcohol Syndrome Nursing Process Step: Implementation NCLEX: Health Promotion and Maintenance: Growth and Development

32. The nurse explains that ___________ is a procedure in which an incompetent cervix is sutured closed to prevent its opening when the fetus presses against it.

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ANS: cerclage Cerclage is the procedure that sutures the cervix closed to prevent its opening when the fetus presses against it. DIF: Cognitive Level: Knowledge REF: p. 82 OBJ: 1 TOP: Cerclage KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk

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