Description

Contemporary Maternal-Newborn 7th Edition London Ladewig Test Bank

• ISBN-10:0135025850
• ISBN-13:978-0135025857

 Table of Contents

Part 1    Introductory Concepts

1          Contemporary Maternal-Newborn Care

2          Culture and the Childbearing Family

3          Reproductive Anatomy and Physiology

4          Conception and Fetal Development

 

Part 2    Women’s Health: The Reproductive Years

5          Health Promotion for Women

6          Common Gynecologic problems

7          Families with Special Reproductive Concerns

8          Preparation of Pregnancy

 

Part 3    Pregnancy and Family

9          Physical and Psychologic Changes of Pregnancy

10        Antepartal Nursing Assessment

11        The Expectant Family: Needs and Care

12        Maternal Nutrition

13        Adolescent Pregnancy

14        Assessment of Fetal Well-Being

15        Pregnancy at Risk: Pregestational Problems

16        Pregnancy at Risk: Gestational Onset

 

Part 4    Birth and the Family

17        Processes and Stages of Labor and Birth

18        Intrapartal Nursing Assessment

19        Family in Childbirth: Needs and Care

20        Pharmacologic Management of Pain

21        Childbirth at Risk:  Prelabor Complications

22        Childbirth at Risk: Labor-Related Complications

23        Birth-Related Procedures

 

Part 5    The Newborn

24        The Physiologic Responses of the Newborn to Birth

25        Nursing Assessment of the Newborn

26        Normal Newborn: Needs and Care

27        Newborn Nutrition

28        The Newborn at Risk: Conditions Present at Birth

29        The Newborn at Risk: Birth Related Stressors

 

Part 6    Postpartum

30        Pospartal Adaptations and Nursing Assessment

31        The Postpartal Family: Needs and Care

32        Home Care of the Postpartal Family

33        The Postpartal Family at Risk

 

 

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Chapter 17_LO01_Q01

The nurse is caring for laboring clients. Which women are experiencing problems related to a critical factor of labor? Select all that apply.

1. Primip at 7 cm, fetus in military attitude
2. Multip at 3 cm, fetus in longitudinal lie
3. Primip at 4 cm, fetus with macrocephaly due to hydrocephalus
4. Multip at 6 cm, fetus at −2 station, mild contractions
5. Primip at 5 cm, fetal presenting part is right shoulder.

Correct Answers: 1, 3, 4, 5

Rationale:

1. Attitude refers to the relationship of the fetal parts to one another. Military attitude is an unflexed neck; normal fetal attitude is flexion of the neck. Military attitude creates a larger diameter of the head fitting through the pelvis. This client is experiencing a problem between the maternal pelvis and the presenting part.
2. Lie refers to the relationship between the cephalocaudal axis of the mother to the cephalocaudal axis of the fetal body; longitudinal lie is normal.
3. Hydrocephalus can lead to macrocephaly, or an abnormally large head. Macrocephalic babies might not fit through the bony pelvis, and could require birth by cesarean. This client is experiencing a problem between the maternal pelvis and the presenting part.
4. Station refers to how low in the pelvis the baby’s presenting part is; −2 station is high in the pelvis. Contractions should be strong to cause fetal descent and cervical dilation. Mild contractions will not move the baby down or open the cervix. This client is experiencing a problem between the maternal pelvis and the presenting part.
5. The presenting part is the fetal part coming through the cervix. The occiput or back of the baby’s head is the most common and most effective presenting part. A shoulder presentation cannot deliver vaginally, and will require a cesarean birth. This client is experiencing a problem between the maternal pelvis and the presenting part.

Cognitive level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Assessment

Learning Outcome: 17.1 Describe the five critical factors that influence labor in the assessment of an expectant woman and fetus’s progress in labor and birth.

 

Chapter 17_LO02 _Q02

The charge nurse has received shift change report. Which patient requires immediate intervention?

1. Multip at 6 cm undergoing induction of labor, strong contractions every three minutes
2. Primip at 4 cm whose fetus is in a longitudinal lie with an cephalic presentation
3. Multip at 10 cm and fetus at +2 station experiencing a strong expulsion urge
4. Primip at 3 cm screaming in fear because her mother died during childbirth

Correct Answer: 4

Rationale:

1. Strong contractions every three minutes are an adequate labor pattern during induction of labor. This client is experiencing no complications.
2. Longitudinal lie with cephalic presentation is a head-down position. This is expected.
3. 10 cm is fully dilated; a +2 station is low in the pelvis. A strong expulsion urge is the urge to push, which will facilitate the birth of the child. These are expected.
4. This client is most likely fearful that she will die during labor if her mother died during childbirth. It is very rare to die during childbirth in developing countries. The extreme fear this client is experiencing could stimulate the fight-or-flight mechanism and hormone cascade, which can significantly slow the progress of her labor; screaming and muscle tension increase the body’s oxygen consumption, and in extreme cases can lead to fetal hypoxia. This client requires education and a great deal of support, and is therefore the top priority.

Cognitive level: Assessment

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Analysis

Learning Outcome: 17.2 Summarize the implications of abnormalities present in each of the five critical factors on the outcome of labor and the health of the expectant woman and the fetus.

 

Chapter 17_LO03 _Q03

The primiparous client has asked the nurse why her cervix has only changed from 1 to 2 cm in three hours of contractions occurring every five minutes. The best response by the nurse is:

1. “Your cervix has also effaced, or thinned out, and that change in the cervix is also labor progress.”
2. “When your perineal body thins out, your cervix will begin to dilate much faster than it is now.”
3. “What did you expect? You’ve only had contractions for a few hours. Labor takes time.”
4. “The hormones that cause labor to begin are just getting to be at levels that will change your cervix.”

Correct Answer: 1

Rationale:

1. Cervical effacement must be nearly complete before cervical dilation takes place in primips. This is why the labor and birth of a first baby usually take much less time than for subsequent labor and births.
2. The perineal body thinning primarily occurs during the second stage of labor; it is not expected now.
3. This reply is not therapeutic. Although it is true that this client has only been in early labor for a short time, and it is true that labor for a primip averages 12–24 hours, the nurse must always be therapeutic in all communication.
4. The hormones that cause labor contractions do not directly cause cervical change; the contractions cause the cervix to change.

Cognitive level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Evaluation

Learning Outcome: 17.3 Examine an expectant woman’s and fetus’s response to labor based on the physiological processes that occur during labor.

 

Chapter 17_LO04_Q04

The primiparous client at 40 weeks’ gestation reports to the nurse that she has had increased pelvic pressure and increased urinary frequency. Which response by the nurse is best?

1. “Unless you have pain with urination, we don’t need to worry about it.”
2. “These symptoms usually mean the baby’s head has descended further.”
3. “Come in for an appointment today and we’ll check everything out.”
4. “This might indicate that the baby is no longer in a head down position.”

Correct Answer: 2

Rationale:

1. Increased pelvic pressure and urinary frequency are premonitory signs of labor. These are not signs of a urinary tract infection.
2. This is the best response because it most directly addresses what the client has reported. Increased pelvic pressure and urinary frequency are premonitory signs of labor.
3. There is no need for an additional appointment, as increased pelvic pressure and urinary frequency are premonitory signs of labor.
4. The client is experiencing premonitory signs of labor; the fetus changing to a breech presentation would be experienced as fetal movement that was formerly felt in the upper abdomen but now is down in the pelvis.

Cognitive level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Planning

Learning Outcome: 17.4 Assess for the premonitory signs of labor when caring for the expectant woman.

 

Chapter 17_LO04_Q05

The primiparous client at 39 weeks’ gestation calls the clinic and reports increased bladder pressure but easier breathing and irregular, mild contractions. She also states that she just cleaned the entire house. Which statement should the nurse make?

1. “You shouldn’t work so much at this point in pregnancy.”
2. “What you are describing is not commonly experienced in the last weeks.”
3. “Your body may be telling you it is going into labor soon.”
4. “If the bladder pressure continues, come in to the clinic tomorrow.”

Answer: 3

Rationale:

1. There is no indication that the client should decrease her work schedule.
2. Lightening is a common and expected finding.
3. One of the premonitory signs of labor includes lightening: The baby drops lower into the pelvis, which creates increased pelvic and bladder pressure but less pressure on the diaphragm, which makes breathing easier.
4. Lightening does not indicate pathology, and therefore there is no need to come to the clinic if the symptoms continue.

Cognitive Level: Analysis

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Implementation

Learning Outcome: 17.4 Assess for the premonitory signs of labor when caring for the expectant woman.

 

 

Chapter 17_LO05_Q06

The nurse is preparing a patient education handout on the differences between false labor and true labor. What information is most important for the nurse to include?

1. True labor contractions begin in the back and sweep toward the front.
2. False labor often feels like abdominal tightening, or “balling up.”
3. True labor can be diagnosed only if cervical change occurs.
4. False labor contractions do not increase in intensity or duration.

Correct Answer: 1

Rationale:

1. Although this is a true statement, it is more important to inform clients that true labor can be determined only if the cervix changes than it is to describe the sensations of true and false labor.
2. Although this is a true statement, it is more important to inform clients that true labor can be determined only if the cervix changes than it is to describe the sensations of true and false labor.
3. Cervical change is the only factor that actually distinguishes false from true labor.
4. Although this is a true statement, it is more important to inform clients that true labor can be determined only if the cervix changes than it is to describe the sensations of true and false labor.

Cognitive level:  Analysis

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Planning

Learning Outcome: 17.5 Differentiate between false and true labor in an expectant woman.

 

Chapter 17_LO05_Q07

The nurse is teaching a prenatal class about false labor. The nurse should teach clients that false labor most likely will include which of the following? Select all that apply.

1. Contractions that do not intensify while walking
2. An increase in the intensity and frequency of contractions
3. Progressive cervical effacement and dilatation
4. Pain in the abdomen that does not radiate
5. Increased thin vaginal secretions

Answer: 1, 4

Rationale:

1. True labor contractions intensify while walking.
2. True labor results in increased intensity and frequency of contractions.
3. True labor results in progressive dilation.
4. True labor results in pain beginning low in the abdomen and radiating upward or into the back.
5. True labor results in an increase in vaginal secretions.

 

Cognitive Level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Assessment

Learning Outcome: 17.5 Differentiate between false and true labor in an expectant woman.

 

Chapter 17_LO06_Q08

The nurse is caring for a laboring client. A cervical exam indicates 8 cm dilation. The client is restless, frequently changing position in an attempt to get comfortable. Which nursing action is most important?

1. Leave the client alone so she can rest.
2. Ask the family to take a coffee-and-snack break.
3. Encourage the client to have an epidural for pain.
4. Reassure the client that she will not be left alone.

Correct Answer: 4

Rationale:

1. The client is in the transitional phase of the first stage of labor, and will not want to be alone.
2. The client is in the transitional phase of the first stage of labor. The family members might want to take a break, but the client will not want to be alone.
3. The client is in the transitional phase of the first stage of labor. There is no indication that the client wants pain relief.
4. Because the client is in the transitional phase of the first stage of labor, she will not want to be left alone; staying with the client and reassuring her that she will not be alone are the highest priorities at this time.

Cognitive level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Implementation

Learning Outcome: 17.6 Describe the physiologic and psychologic changes occurring in an expectant woman during each stage of labor.

 

Chapter 17_LO06_Q09

During the fourth stage of labor, your client’s assessment includes a BP of 110/60, pulse 90, and the fundus is firm midline and halfway between the symphysis pubis and the umbilicus. The priority action of the nurse should be to:

1. Turn the client onto her left side.
2. Place the bed in Trendelenburg position.
3. Massage the fundus.
4. Continue to monitor.

Answer: 4

Rationale:

1. A left lateral position is not necessary with a BP of 110/60 and a pulse of 90.
2. Trendelenburg position is not necessary with a BP of 110/60 and a pulse of 90.
3. The uterus should be midline and firm; massage is not necessary.
4. The client’s assessment data are normal for the fourth stage of labor, so monitoring is the only action necessary. During the fourth stage of labor, the mother experiences a slight drop in blood pressure and a slightly increased pulse.

Cognitive Level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Implementation

Learning Outcome: 17.6 Describe the physiologic and psychologic changes occurring in an expectant woman during each stage of labor.

 

Chapter 17_LO06_Q10

The nurse has just palpated a laboring woman’s contractions. The uterus cannot be indented during a contraction. The nurse compares the consistency of the uterus during a contraction with that of the forehead. The intensity of these contractions would best be characterized as:

1. Weak.
2. Mild.
3. Moderate.
4. Strong.

Answer: 4

Rationale:

1. Weak contractions are not identified.
2. Mild contractions are easily indented during the peak of the contraction, and are similar to the consistency of the nose.
3. Moderate are similar to the consistency of the chin.
4. Strong contractions are not indentable, and feel similar to the forehead.

Cognitive Level: Analysis

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Assessment

Learning Outcome: 17.6 Describe the physiologic and psychologic changes occurring in an expectant woman during each stage of labor in the nursing care management of the expectant woman.

 

 

Chapter 17_LO07_Q11

The labor and delivery nurse is reviewing charts. Of which client should the nurse inform the supervisor?

1. Multip at 5 cm requesting labor epidural analgesia
2. Primip whose cervix remains at 6 cm for four hours
3. Multip who has developed nausea and vomiting
4. Primip requesting her partner to stay with her

Correct Answer: 2

Rationale:

1. Contacting the supervisor is required when an abnormal situation is present. A multip requesting an epidural at 5 cm is not abnormal.
2. Average cervical change among primips in the active phase of the first stage of labor is 1.2 cm/hour; thus this client’s lack of cervical change is unexpected, and should be reported to the supervisor.
3. Nausea and vomiting are common during the transitional phase of the first stage of labor. Contacting the supervisor is required only when an abnormal situation is present.
4. Clients in the transitional phase of the first stage of labor often fear being left alone; this is an expected finding. Contacting the supervisor is required only when an abnormal situation is present.

Cognitive level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Assessment

Learning Outcome: 17.7 Predict an expectant mother’s progression through the various stages of labor based on assessment data.

 

Chapter 17_LO08_Q12

Which client requires immediate intervention by the Labor and Delivery nurse?

1. Multip at 8 cm, systolic blood pressure has increased 35 mm Hg.
2. Primip that delivered one hour ago with WBC of 50,000
3. Multip at 5 cm with a respiratory rate of 22 between contractions
4. Primip in active labor with urine output of 100 ml/hour

Correct Answer: 2

Rationale:

1. The systolic blood pressure will change by up to 35 mm Hg during the first stage of labor, and can increase further in the second stage of labor.
2. A white count of 25,000–30,000 is normal at the end of labor and during the early postpartum period. This white count is abnormally high, and requires further assessment and provider notification.
3. The respiratory rate increases during labor because uterine contractions increase oxygen requirements. This client requires no further intervention.
4. This is a normal urine output, and requires no further intervention.

Cognitive level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Evaluation

Learning Outcome: 17.8 Explain the maternal systemic response to labor in the nursing care of an expectant woman.

 

Chapter 17_LO08_Q13

The Labor and Delivery nurse is preparing a prenatal class about facilitating the progress of labor. Which of the following frequent responses to pain should the nurse indicate is most likely to impede progress in labor?

1. Increased pulse
2. Elevated blood pressure
3. Muscle tension
4. Increased respirations

Answer: 3

Rationale:

1. Increased pulse is a manifestation of pain, but does not impede labor.
2. Elevated blood pressure is a manifestation of pain, but does not impede labor.
3. Muscle tension can impede labor progress by increased oxygen and calorie consumption, and by creating a mechanical obstruction that the uterine contractions must overcome to achieve labor progress.
4. Increased respiration is a manifestation of pain, but does not impede labor.

Cognitive Level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Planning

Learning Outcome: 17.8 Explain the maternal systemic response to labor in the nursing care of an expectant woman.

 

Chapter 17_LO08_Q14

A client is admitted to the labor unit with contractions 1.5–2 minutes apart and lasting 60–90 seconds. The client is apprehensive and irritable. This nurse understands this information to indicate that the client is most likely in what phase of labor?

1. Active
2. Transition
3. Latent
4. Second

Answer: 2

Rationale:

1. The active phase is characterized by contractions every 2–3 minutes; there is a sense of fear of loss of control during this phase, but it’s not as pronounced as in the transition stage.
2. During the transition phase of labor, contractions have a frequency of about every 1.5–2 minutes with a duration of 60–90 seconds. The woman might become apprehensive and irritable during this stage.
3. The latent phase is characterized by mild contractions that progress from a frequency of 10–20 minutes to 5–7 minutes. In the latent stage, the woman is excited that labor has begun.
4. The second stage is the pushing stage, and the woman might feel relieved that the birth is near and she can push. The second stage is not a phase of labor.

Cognitive Level: Analysis

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Assessment

Learning Outcome: 17.8 Explain the maternal systemic response to labor in the nursing care of an expectant woman.

 

Chapter 17_LO09_Q15

While caring for a labor client, the nurse determines during a vaginal exam that the baby’s head has internally rotated. This information is given to the family. The labor support person asks the nurse, “What other position changes will the baby undertake during labor and birth?” How should the nurse describe the rest of the cardinal movements for a baby in a vertex presentation?

1. Flexion, extension, restitution, external rotation, and expulsion
2. Expulsion, external rotation, and restitution
3. Restitution, flexion, external rotation, and expulsion
4. Extension, restitution, external rotation, and expulsion

Answer: 4

Rationale:

1. The fetus changes position in the following order: descent, engagement, flexion, internal rotation, extension, restitution, external rotation, expulsion.
2. The fetus changes position in the following order: descent, engagement, flexion, internal rotation, extension, restitution, external rotation, expulsion.
3. The fetus changes position in the following order: descent, engagement, flexion, internal rotation, extension, restitution, external rotation, expulsion.
4. The fetus changes position in the following order: descent, engagement, flexion, internal rotation, extension, restitution, external rotation, expulsion.

Cognitive Level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Planning

Learning Outcome: 17.9 Examine fetal responses to labor.

 

Chapter 17_LO09_Q16

A nurse is aware that labor and birth will most likely proceed normally when the fetal position is:

1. Occiput posterior.
2. Mentum anterior.
3. Occiput anterior.
4. Mentum posterior.

Answer: 3

Rationale:

1. Positions other than occiput anterior are more frequently associated with problems during labor, and are called malpositions.
2. Positions other than occiput anterior are more frequently associated with problems during labor, and are called malpositions.
3. The most common fetal position is occiput anterior. When this position occurs, labor and birth are likely to proceed normally.
4. Positions other than occiput anterior are more frequently associated with problems during labor, and are called malpositions.

Cognitive Level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Planning

Learning Outcome: 17.9 Examine fetal responses to labor.