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Introductory Maternity and Pediatric 2nd edition Hatfield Klossner Test Bank

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Introductory Maternity and Pediatric Nursing Second Edition

ISBN-13: 978-0781785587
ISBN-10: 0781785588

Description

Introductory Maternity and Pediatric 2nd edition Hatfield Klossner Test Bank

ISBN-13: 978-0781785587
ISBN-10: 0781785588

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Chapter 7

 

 

  Client Needs:  A-1

Cognitive Level:  Application

Integrated Process:  Communication & documentation

Objective:  3

Page and Header:  136, Assessment of Maternal Well-Being During Pregnancy

1. As part of her first prenatal visit, you are taking a pregnant woman’s obstetric history. She has an 18-month-old daughter who was delivered 2 days after her estimated date of delivery and a 3-year-old son who was born at 35 weeks’ gestation. Before her son was born, she lost two pregnancies: one at 12 weeks and the other at 21 weeks. Using the GTPAL method, how would you record this history?
  A) G5 T1 P2 A1 L2
  B) G4 T1 P1 A2 L2
  C) G5 T2 P2 A1 L1
  D) G4 T1 P2 A2 L2
  Ans: A
  Feedback:
  5 pregnancies, 1 between 38–42 weeks, 2 between 20–37 weeks, 1 abortion at 12 weeks, 2 current living, 1 still in uterus

 

 

  Client Needs:  B

Cognitive Level:  Analysis

Integrated Process:  Communication & documentation

Objective:  6

Page and Header:  138, Assessment of Maternal Well-Being During Pregnancy

2. If a pregnant woman’s estimated date of delivery (EDD) is April 23, what was the first day of her last menstrual period (LMP), according to Nagele’s rule?
  A) July 13
  B) July 16
  C) July 19
  D) July 23
  Ans: B
  Feedback:
  According to Nagele’s rule, the last menstrual period was July 16th. Take the LMP and add 7 days and subtract 3 months; if finding the LMP from the EDD, subtract 7 days and add 3 months.

 

 

  Client Needs:  D-3

Cognitive Level:  Comprehension

Integrated Process:  Nursing Process

Objective:  9

Page and Header:  142, Assessment of Fetal Well-Being During Pregnancy

3. Mary Jones’s maternal serum alpha-fetoprotein (MSAFP) screening results show that her MSAFP levels are high. What is the best response by the nurse?
  A) Her child is at risk for Down syndrome
  B) Her child is at risk for neural tube defects
  C) The test may have been run during the wrong weeks gestation
  D) Further test are required based on the results
  Ans: D
  Feedback:
  Alpha-fetoprotein is a protein manufactured by the fetus. The woman’s blood contains small amounts of this protein during pregnancy. The blood test is run between 16 and 20 weeks’ gestation, an abnormal level indicates a need for further testing to determine the risks her fetus may face.

 

 

  Client Needs:  D-3

Cognitive Level:  Application

Integrated Process:  Communication & documentation

Objective:  9

Page and Header:  143, Assessment of Fetal Well-Being During Pregnancy

4. Ramona Silver, age 38, has one child with Tay-Sachs disease. She and her partner both carry the Tay-Sachs gene and did not intend to have more children, but she has just discovered that she is pregnant. She plans to have an abortion if tests show that the fetus has the Tay-Sachs gene. Which test will the primary care provider likely order?
  A) A multiple marker screening test
  B) Amniocentesis
  C) Chorionic villus sampling
  D) Percutaneous umbilical blood sampling
  Ans: C
  Feedback:
  CVS is a newer procedure and can provide information on fetal chromosomal studies similar to an amniocentesis, but earlier in pregnancy. The CVS is typically performed between 8 and 12 weeks gestation. Given the disease in question, she would be able to determine the course of the pregnancy early in gestation. Multiple marker screen tests are done later in the pregnancy, as is amniocentesis. Percutaneous umbilical blood sampling examines the blood, and is not the best source for chromosomal studies.

 

 

  Client Needs:  C

Cognitive Level:  Analysis

Integrated Process:  Communication & documentation

Objective:  7

Page and Header:  139, Assessment of Maternal Well-Being During Pregnancy

5. Charlene McCoy, who has several children already, reports for a first prenatal visit. She seems preoccupied and withdrawn, and she makes consistently negative remarks about the pregnancy. Reviewing her records, you note that she is receiving a serotonin reuptake inhibitor. What should you do?
  A) Reassure her that ambivalence is normal
  B) Refer her for drug and alcohol counseling
  C) Give her printed material to read at home
  D) Alert the RN or primary care provider
  Ans: D
  Feedback:
  A patient on an SSRI or SRI (serotonin reuptake inhibitor) might be in current treatment for a psychiatric disorder. The medication may also be one which is not safe during pregnancy. The RN and the health care provider need to be alerted to seek more information from the patient. Reassurance is good practice, but not enough in this case.  You do not have enough information to refer her for drug and alcohol counseling. She is under the care of another provider for her mental disorder, so do not confuse her with more material to read.

 

 

  Client Needs:  B

Cognitive Level:  Application

Integrated Process:  Teaching & learning

Objective:  11

Page and Header:  147, The Nurse’s Role in Prenatal Care

6. A 24-year-old pregnant woman complains of excessive vaginal discharge. The discharge is not associated with a strong odor, itching, or irritation but she finds it messy and unpleasant. What do you advise her to do?
  A) Douche and wash frequently with mild soap and warm, not hot, water
  B) See her primary care provider to be tested for STIs
  C) Use sanitary pads
  D) Decrease her fluid intake
  Ans: C
  Feedback:
  Vaginal discharge increases during pregnancy and is a concern for many women. Encourage the patient to keep clean and wear sanitary pads as needed.  Douching may be dangerous for the mother. STI’s are not indicated simply by discharge. Pregnant women should not decrease fluid intake.

 

 

  Client Needs:  B

Cognitive Level:  Application

Integrated Process:  Nursing Care

Objective:  11

Page and Header:  150, The Nurse’s Role in Prenatal Care

7. A woman accustomed to daily exercise complains late in her second trimester of pregnancy that she is experiencing “terrible” heartburn at night. What would you advise her to do?
  A) Stop or severely curtail her exercise.
  B) Take sodium bicarbonate.
  C) Seek emergency medical care.
  D) Put 6-inch blocks under the head of her bed.
  Ans: D
  Feedback:
  Heartburn is a common problem worsening as the pregnancy progresses. The pregnancy hormones relax the lower esophageal sphincter resulting in increase heartburn. Elevation of the head of the bead will help maintain the acid from rising at night, and other nonpharmacologic interventions are available if needed. Exercise does not negatively impact heartburn and should be continued. The pregnant mother should not take any medication that is not prescribed by her physician. Heartburn is not a medical emergency.

 

 

  Client Needs:  D-2

Cognitive Level:  Comprehension

Integrated Process:  Teaching & learning

Objective:  11

Page and Header:  150, The Nurse’s Role in Prenatal Care

8. A woman in her first trimester is having trouble maintaining adequate nutrition because of nausea and vomiting. She also complains that her heartburn gets worse after eating so she avoids food even when she feels hungry. To help with her nutritional deficit, she is taking a multivitamin supplement. Which substance do you caution her to avoid within 1 hour of ingesting her multivitamin supplement?
  A) Coffee or other caffeinated beverages
  B) Acetaminophen
  C) An antacid
  D) Fatty or fried foods
  Ans: C
  Feedback:
  Antacids interfere with the uptake of the vitamin contents. She needs to be encouraged to eat small frequent meals and notify the provider if she is losing weight.  Caffeine should be avoided due to increases in blood pressure and diuretic effects. Acetaminophen should be taken only when the provider has approved it. Fatty foods are not healthy, and may make the morning sickness worse.

 

 

  Client Needs:  B

Cognitive Level:  Application

Integrated Process:  Teaching & learning

Objective:  11

Page and Header:  147, The Nurse’s Role in Prenatal Care

9. You advise your pregnant patient to keep a small high-carbohydrate snack on the bedside table. This advice is given to ameliorate which condition?
  A) Heartburn
  B) Faintness
  C) Slowed GI transit time
  D) Nausea and vomiting
  Ans: D
  Feedback:
  Women will commonly experience nausea and vomiting upon awakening first thing in the morning. Patients who experience this should be encouraged to have small snacks at their bedside for eating prior to moving from the bed. Heartburn is a result of pressure and hormone action. Faintness is due to pressure on the vena cava, not blood sugar.  GI transit time is not affected.

 

 

  Client Needs:  B

Cognitive Level:  Application

Integrated Process:  Teaching & learning

Objective:  11

Page and Header:  150, The Nurse’s Role in Prenatal Care

10. You advise a pregnant woman to reduce her fluid intake with meals. Which condition is the woman trying to relieve or prevent?
  A) Nosebleeds
  B) Heartburn
  C) Blood clots
  D) Constipation
  Ans: B
  Feedback:
  Filling the stomach with heavy food and fluid can overfill and place pressure on the stomach, increasing gastric reflux. Avoid excess fluids with meals and eat small frequent meals to avoid heartburn. Nosebleeds result from increased estrogen. Blood clots can result from sitting still for too long. Constipation can result from increased progesterone.

 

 

  Client Needs:  D-3

Cognitive Level:  Comprehension

Integrated Process:  Nursing Process

Objective:  8

Page and Header:  146, The Nurse’s Role in Prenatal Care

11. A pregnant woman comes in for a routine third-trimester exam, which included a pelvic exam. She calls several hours later, very worried, to report a small amount of bleeding. What should you tell her?
  A) To return right away
  B) Not to worry but to report any heavy increase in bleeding
  C) That the bleeding, called Chadwick’s sign, is a normal part of pregnancy
  D) That her cervical mucous plug may have been expelled
  Ans: B
  Feedback:
  During the third trimester, if the provider completes a vaginal exam it can be normal to have a small amount of spotting. If the bleeding becomes active or increases the patient needs to be seen ASAP. Chadwick’s sign is a change of color in the vaginal area. The loss of the mucus plug would lead to a much greater amount of blood.

 

 

  Client Needs:  B

Cognitive Level:  Knowledge

Integrated Process:  Communication & documentation

Objective:  1

Page and Header:  135, Introduction

12. The Healthy People 2010 goal for US women to seek prenatal care during the first trimester is what percentage?
  A) 80 percent
  B) 85 percent
  C) 90 percent
  D) 95 percent
  Ans: C
  Feedback:
  The healthy people goal for percentage of women seeking prenatal care during the first trimester is 90 percent.

 

 

  Client Needs:  B

Cognitive Level:  Application

Integrated Process:  Teaching & learning

Objective:  11

Page and Header:  149, The Nurse’s Role in Prenatal Care

13. Leah is 28 weeks pregnant. In preparing for discomforts that occur during the final trimester of pregnancy, you would teach her about?
  A) Eating a well-balanced diet to prevent anemia
  B) Increased shortness of breath and dyspnea before lightening
  C) Good oral hygiene to decrease ptyalism
  D) Avoid exercise to prevent varicosities
  Ans: B
  Feedback:
  As the fetus grows inside the mother, there is more pressure on the diaphragm and more difficulty breathing, and episodes of dyspnea may occur. This tends to decrease with lightening, when the fetus drops. Eating a well balanced diet, oral hygiene, and exercise should be done throughout the entire pregnancy.

 

 

  Client Needs:  B

Cognitive Level:  Application

Integrated Process:  Teaching & Learning

Objective:  11

Page and Header:  151, The Nurse’s Role in Prenatal Care

14. When discussing rest and sleep with a pregnant woman, which of the following positions would you suggest that she use for napping?
  A) On her stomach with a pillow under her breasts
  B) On her side with the weight of the uterus on the bed
  C) On her back with a pillow under her knees and hips
  D) On her back with a pillow under her head
  Ans: B
  Feedback:
  Resting on the side prevents pressure from the uterus against the vena cava and therefore allows blood to return to the uterus. Other positions may be more uncomfortable or may exacerbate the problems associated with pressure on the vena cava.

 

 

  Client Needs:  D-3

Cognitive Level:  Application

Integrated Process:  Teaching & Learning

Objective:  11

Page and Header:  153, The Nurse’s Role in Prenatal Care

15. A pregnant woman is planning on taking a vacation that involves extensive travel by automobile. Which of the following guidelines should you give her?
  A) Travel no more than 120 miles daily
  B) Sit in the back seat with feet elevated
  C) Stop and walk every few hours
  D) Limit trips away from home, great than 200 miles
  Ans: C
  Feedback:
  Walking increases venous return and reduces the possibility of thrombophlebitis, a risk for pregnant woman who sit for extended periods of time.  Limiting mileage, sitting in the back with feet elevated, and limiting trips may help, but they are not enough to prevent phlebitis.

 

 

  Client Needs:  B

Cognitive Level:  Application

Integrated Process:  Teaching & learning

Objective:  11

Page and Header:  150, The Nurse’s Role in Prenatal Care

16. If constipation is a problem for a woman during pregnancy, which of the following measures would be best to recommend?
  A) Mineral oil
  B) Increasing fluid intake
  C) Reducing her iron supplement
  D) Increasing intake of meat in her diet to provide fiber
  Ans: B
  Feedback:
  Increasing fluid content helps relieve constipation in both pregnant and non-pregnant women. Reducing an iron supplement could lead to anemia; mineral oil can reduce absorption of fat-soluble vitamins. Meat does not contain fiber.

 

 

  Client Needs:  B

Cognitive Level:  Application

Integrated Process:  Teaching & learning

Objective:  11

Page and Header:  152, The Nurse’s Role in Prenatal Care

17. A woman who is 3 months pregnant enjoys a slow, long walk daily. Which of the following would be most appropriate for her concerning this for the remainder of her pregnancy?
  A) Reduce walking to half a block daily.
  B) Continue this as long as she enjoys it.
  C) Stop and rest every block.
  D) Engage in aerobics for greater benefits.
  Ans: B
  Feedback:
  Walking is an excellent exercise during pregnancy because it is low impact and increases venous circulation. Exercise should be maintained as long as it is comfortable, but intensity should not increase over what is normally performed.

 

 

  Client Needs:  D-3

Cognitive Level:  Application

Integrated Process:  Teaching & learning

Objective:  11

Page and Header:  153, The Nurse’s Role in Prenatal Care

18. A nurse you know is 5 weeks pregnant. She works on a unit where chemotherapy is administered. Which of the following statements would make you believe she needs additional health teaching about avoiding teratogens during pregnancy?
  A) “I care for about five clients a day.”
  B) “Latex gloves irritate my hands, so I don’t use them.”
  C) “I never accompany clients to the x-ray department.”
  D) “I find giving emotional support taxing.”
  Ans: B
  Feedback:
  Working with chemotherapeutic agents is not recommended during pregnancy. This is an identified environmental hazard and she needs to discuss this with the provider and find information on the specific chemotherapeutic agents with which she works. The number of clients seen per day is inconsequential. It is advisable to avoid x-rays when pregnant. Emotionally draining activities may be harmful, but they are not teratogenic.

 

 

  Client Needs:  B

Cognitive Level:  Analysis

Integrated Process:  Communication & documentation

Objective:  3

Page and Header:  136, Assessment of Maternal Well-Being During Pregnancy

19. Martha is pregnant and arrives for her second prenatal appointment. Her previous pregnancy ended at 19 weeks and she has 3-year-old twins born at 30 weeks gestation.  How will you document her “G” and “L” for her records?
  A) G2 L2
  B) G2 L0
  C) G3 L2
  D) G3 L0
  Ans: C
  Feedback:
  She has had 2 prior pregnancies and is pregnant now, total “G” = 3; she has twins from a prior pregnancy and one lost child for a total “L” = 2.

 

 

  Client Needs:  B

Cognitive Level:  Analysis

Integrated Process:  Nursing Process

Objective:  9

Page and Header:  144, Assessment of Fetal Well-Being During Pregnancy

20. A non-stress test is performed on a pregnant woman. The nurse informs the client the test was reactive. Which of the following statements by the patient indicates understanding of the test results?
  A) There is no evidence of congenital anomalies or deformities
  B) The fetal heart rate increases with activity and indicates fetal well-being
  C) The test is non-reactive, which is reassuring
  D) The results indicate a contraction stress test is needed for evaluation
  Ans: B
  Feedback:
  A reactive NST for non-stress test is a noninvasive way to monitor fetal well-being. A reactive NST is positive sign the fetus is tolerating pregnancy well by demonstrating heart rate increase with activity and indicates fetal well-being.

 

 

  Client Needs:  B

Cognitive Level:  Application

Integrated Process:  Nursing Process

Objective:  9

Page and Header:  143, Assessment of Fetal Well-Being During Pregnancy

21. The nurse should administer Rhogam (Rh immune globulin) to the pregnant woman who is Rho(D)-, after which of the following tests?
  A) CST (Contraction Stress Test)
  B) Amniocentesis
  C) NST (Non Stress Test)
  D) Biophysical Profile
  Ans: B
  Feedback:
  Amniocentesis is an invasive procedure whereby a needle inserted into amniotic sac to obtain a small amount of fluid. This places the pregnancy at risk for a woman with RhD-negative blood and she should receive RhoGam after the procedure. The CST,NST, and a biophysical profile are non-invasive tests.

 

 

  Client Needs:  B

Cognitive Level:  Application

Integrated Process:  Nursing Process

Objective:  11

Page and Header:  149, The Nurse’s Role in Prenatal Care

22. A patient, 31 years old, at 28 weeks gestation with her second pregnancy is in the clinic for a prenatal check-up. She informs you of frequent low back pain and ankle edema by the end of the day. What interventions should you suggest to relieve these discomforts?
  A) Soak feet every night and perform pelvic rocks.
  B) Lie on right side with feet elevated and a heating pad on her back.
  C) Sit semi-fowlers with feet below for breaks at work.
  D) Rest when possible with feet elevated at or above the heart.
  Ans: D
  Feedback:
  Rest in the recumbent position helps alleviate stress on the back and elevating the legs will help relieve the edema. Soaking the feet or lying on the right side will not alleviate the edema. Sitting semi-fowlers is not enough to alleviate the edema.

 

 

  Client Needs:  B

Cognitive Level:  Application

Integrated Process:  Nursing Process

Objective:  11

Page and Header:  150, The Nurse’s Role in Prenatal Care

23. A patient in the OB clinic is complaining of being awakened by leg cramps while sleeping. Select the appropriate nursing intervention.
  A) Use plantar flexion exercises 3 times every day
  B) Dorsiflex the foot while extending her leg during the cramp
  C) Encourage her to drink more fluids, 10 glasses a day
  D) Avoid any supplementation of vitamins or minerals
  Ans: B
  Feedback:
  Plantar flexion can make cramps worse, dorsiflexion while extending the leg can relieve the cramp; excess fluid and lack of supplementation with vitamins or minerals may worsen cramps. Performing planar flexion exercise does not prevent the cramp. Increasing fluids may help, but has never proven to eliminate cramping.

 

 

  Client Needs:  D-3

Cognitive Level:  Comprehension

Integrated Process:  Teaching & learning

Objective:  7

Page and Header:  153, The Nurse’s Role in Prenatal Care

24. The pregnant patient is asking about medications, supplements, and vaccines. Which of the following would the nurse indicate as potentially teratogenic?
  A) Penicillin
  B) Rubella vaccine
  C) Tylenol
  D) Folic Acid
  Ans: B
  Feedback:
  Most vaccines are contraindicated during pregnancy and are considered teratogenic. Penicillin and Tylenol may be taken under provider supervision. Folic acid supplementation should be encouraged.

 

 

  Client Needs:  D-3

Cognitive Level:  Comprehension

Integrated Process:  Teaching & learning

Objective:  7

Page and Header:  155, The Nurse’s Role in Prenatal Care

25. What advice should the nurse provide to a pregnant patient who admits to continuing to drink alcohol 1 to 2 times a week?
  A) She should avoid alcohol in the first trimester
  B) Alcohol should not be consumed during pregnancy
  C) The affects of alcohol on the fetus are not fully understood
  D) She may have an occasional drink after the first trimester
  Ans: B
  Feedback:
  There is no safe amount of alcohol to consume during pregnancy. If the patient refuses or has a problem, alert the health care provider for the appropriate referral.

 

 

  Client Needs:  B

Cognitive Level:  Application

Integrated Process:  Communication & documentation

Objective:  6

Page and Header:  138, Assessment of Maternal Well-Being During Pregnancy

26. The first day of the patient’s last menstrual period was December 1. Based on Naegle’s rule, the nurse determines which of the following is the estimated date of birth.
  A) October 7
  B) September 8
  C) July 7
  D) August 8
  Ans: B
  Feedback:
  Acording to Naegle’s rule, the estimated date of birth is September 8th.  Add 7 days and minus 3 months to the last LMP to determine the estimated date of delivery or birth.

 

 

  Client Needs:  D-3

Cognitive Level:  Application

Integrated Process:  Teaching & learning

Objective:  9

Page and Header:  142, Assessment of Fetal Well-Being During Pregnancy

27. A woman 8 weeks pregnant questions if she can have an amniocentesis at this time for genetic screening. The nurse should respond how to the patient?
  A) The embryo is too small to monitor on the ultrasound and thus at risk from puncture by the needle
  B) The risk of miscarriage is too high until the second trimester
  C) There is not an adequate amount of amniotic fluid at this time
  D) She can have an amniocentesis at this time if her physician orders it
  Ans: C
  Feedback:
  There is not adequate amniotic fluid until the second trimester.

 

 

  Client Needs:  B

Cognitive Level:  Application

Integrated Process:  Communication & documentation

Objective:  6

Page and Header:  138, Assessment of Maternal Well-Being During Pregnancy

28. Mrs. Smith asks you to compute her expected date of birth. Based on the fact that her last menstrual flow began on July 20, her date would be
  A) April 27.
  B) March 13.
  C) April 13.
  D) May 20.
  Ans: A
  Feedback:
  Nägele’s rule is to count backward 3 months and add 7 days from the first day of the last menstrual period to determine an expected due date, making Mrs. Smith’s due date April 27th.

 

 

  Client Needs:  B

Cognitive Level:  Application

Integrated Process:  Nursing process

Objective:  9

Page and Header:  143, Assessment of Fetal Well-Being During Pregnancy

29. Which of the following nursing interventions is appropriate when preparing a woman for an amniocentesis?
  A) Inform her that a narcotic premedication will be given to prevent pain during needle insertion
  B) Be certain she knows that there is are risks of complication, such as premature labor, from amniocentesis
  C) Instruct her not to empty her bladder prior to the procedure
  D) Suggest that she take a deep breath and hold it during needle insertion
  Ans: B
  Feedback:
  Amniocentesis carries a slight risk of beginning labor. The woman should not hold her breath because that depresses the diaphragm, shifts the contour of the uterus, and may shift the location of the placenta to the chosen needle insertion site. The bladder should be emptied to avoid accidental puncture.

 

 

  Client Needs:  B

Cognitive Level:  Knowledge

Integrated Process:  Nursing process

Objective:  4

Page and Header:  139, Assessment of Maternal Well-Being During Pregnancy

30. The first time you see a woman during pregnancy, her fundal height is palpable at the level of her umbilicus. This measurement is typical of what gestational age?
  A) 12 weeks
  B) 20 weeks
  C) 24 weeks
  D) 6 weeks
  Ans: B
  Feedback:
  The uterus expands to reach the height of the umbilicus by week 20. Before week 20 it is too low to be palpated, and after week 20 it may be beyond the umbilicus.