Chapter 5 - Test questions

7/17/2019 Chapter 5 - Test questions

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Leifer: Introduction to Maternity & Pediatric Nursing, 6th Edition

Chapter 05: Nursing Care of Woen !ith Cop"ications #uring Pregnancy

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M'L$IPLE C()ICE

1. A pregnant patient tells the nurse that she has been nauseated and vomiting. The nurseexplains 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: !ehydration and electrolyte imbalances result from persistent nausea and vomiting

associated with hyperemesis gravidarum. !ehydration impairs the perfusion to the placenta.

!"#: $ognitive %evel: Analysis &'#: p. () *+: ,

T*-: yperemesis /'0: Nursing -rocess Step: "mplementationS$: N$%'2: -hysiological "ntegrity: -hysiological Adaptation

3. A woman who is ) weeks pregnant is experiencing heavy bleeding and cramping. She

reports passing some tissue. $ervical dilation is noted on examination. This woman mostlikely had a4n5 66666 abortion.

a. inevitable b. incompletec. complete

d. missed

ANS:

Signs and symptoms of an incomplete abortion are similar to those of an inevitable abortion7

but some tissue is passed.

!"#: $ognitive %evel: Analysis &'#: p. 8,7 Table 937 #igure 93

*+: , T*-: "ncomplete Abortion

/'0: Nursing -rocess Step: AssessmentS$: N$%'2: -hysiological "ntegrity: -hysiological Adaptation

,. The nurse finds a woman crying after she has undergone a dilation and evacuation 4!;'5for 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. 0ou can try to conceive on your next cycle.=

c. <">m here if you need to talk.=

d. <0ou are young and strong. " know you can have a healthy pregnancy.=

$opyright ? 3@11 by Saunders7 an imprint of 'lsevier "nc.



Test ank

ANS: $

An effective techniue when communicating with a woman experiencing pregnancy loss isto say7 <">m here if you need to talk.= The nurse listens and acknowledges the woman>s grief.

!"#: $ognitive %evel: Application &'#: p. 89 *+: ,T*-: !ilation and 'vacuation 4!;'5 /'0: Nursing -rocess Step: "mplementation

S$: N$%'2: -sychosocial "ntegrity: $oping and Adaptation

B. 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: !'ctopic pregnancy occurs when the fertiliCed ovum is implanted outside of the uterine cavity.

!"#: $ognitive %evel: Analysis &'#: p. 89 *+: ,T*-: 'ctopic -regnancy /'0: Nursing -rocess Step: 'valuation

S$: N$%'2: ealth -romotion and aintenance: -revention and 'arly !etection of

!isease

9. An ultrasound on a woman who is ,3 weeks pregnant reveals the placenta implanted over

the entire cervical os. The nurse understands that this condition is known as:

a. lowlying placenta. b. marginal placenta previa.

c. partial placenta previa.

d. total placenta previa.

ANS: !

A total placenta previa describes a condition in which the placenta completely covers the

cervical opening.

!"#: $ognitive %evel: Analysis &'#: pp. D87 D) *+: ,

T*-: -lacenta -revia /'0: Nursing -rocess Step: AssessmentS$: N$%'2: ealth -romotion and aintenance: -revention and 'arly !etection of

!isease

D. The nurse would suspect abruptio placentae when the pregnant woman presents with:

a. painless vaginal bleeding.

b. uterine irritability with contractions.

c. vaginal bleeding and back pain.


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Test ank

d. premature rupture of membranes.

ANS: $leeding accompanied by abdominal or lower back pain is a typical manifestation of

abruptio placentae.

!"#: $ognitive %evel: Analysis &'#: p. )@ *+: ,

T*-: Abruptio -lacenta /'0: Nursing -rocess Step: Assessment

S$: N$%'2: ealth -romotion and aintenance: -revention and 'arly !etection of!isease

(. &h incompatibility occurs in which situationE

a. &hnegative mother7 &hpositive fetus b. &hpositive mother7 &hnegative fetus

c. &hnegative mother7 &hnegative fetus

d. &hpositive mother7 &hpositive fetus

ANS: A

&h incompatibility can occur only if the mother is &h negative and the fetus is &h positive.

!"#: $ognitive %evel: Analysis &'#: p. )D *+: ,

T*-: &h "ncompatibility /'0: Nursing -rocess Step: NFAS$: N$%'2: ealth -romotion and aintenance: -revention and 'arly !etection of

!isease

8. A primigravida in her first trimester is &h negative. To prevent anti&h antibodies fromforming7 this woman would receive:

a. &h immune globulin during labor.

b. intrauterine transfusions with *negative blood.c. &h immune globulin at 38 weeks and within (3 hours after the birth of an &h

positive infant.

d. &h immune globulin now and again in the last trimester.

ANS: $

An &hnegative woman would receive &h immune globulin at 38 weeks of gestation and

within (3 hours after the birth of an &hpositive infant or abortion.

!"#: $ognitive %evel: Application &'#: p. )D *+: ,

T*-: &h "ncompatibility /'0: Nursing -rocess Step: "mplementationS$: N$%'2: ealth -romotion and aintenance: -revention and 'arly !etection of

!isease

). A woman seeking prenatal care relates a history of macrosomic infants7 two stillbirths7

and polyhydramnios with each pregnancy. The nurse recogniCes that these factors are

highly suggestive of:

a. toxoplasmosis.


9,



Test ank

b. abruptio placentae.

c. hydatidiform mole.

d. diabetes mellitus.

ANS: !

%arge 4macrosomic5 infants over ) pounds are linked to gestational diabetes.

!"#: $ognitive %evel: Analysis &'#: p. )8 *+: 9

T*-: !iabetes ellitus /'0: Nursing -rocess Step: AssessmentS$: N$%'2: ealth -romotion and aintenance: -revention and 'arly !etection of

!isease

1@. 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: Aormones and enCymes produced by the placenta increase the resistance of cells to insulin.

!"#: $ognitive %evel: /nowledge &'#: p. 1@@ *+: 9T*-: !iabetes ellitus /'0: Nursing -rocess Step: "mplementation

S$: N$%'2: -hysiological "ntegrity: -hysiological Adaptation

11. The nurse explains that a woman who uses oral hypoglycemic agents to control diabetesmellitus 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:

*ral hypoglycemic agents are not used during pregnancy because they can cross the

placenta7 possibly resulting in fetal birth defects or hypoglycemia.

!"#: $ognitive %evel: $omprehension &'#: p. 1@@ *+: 9

T*-: !iabetes ellitus /'0: Nursing -rocess Step: "mplementation

S$: N$%'2: -hysiological "ntegrity: -harmacological Therapies

13. The pregnant woman comes to the clinic stating that she has been exposed to hepatitis .

She is afraid that her infant will also contract hepatitis . The nurse counsels that theinfant will:

a. be given a single dose of hepatitis immune globulin after birth.

b. be able to use the antibodies from the immuniCations given to the patient before

delivery.


9B



Test ank

c. not have hepatitis because the virus does not pass through the placental barrier.

d. be immune to hepatitis because of the mother>s infection.

ANS: A

The infant will be given immune globulin immediately after birth for temporary immunity

followed by hepatitis vaccine. "mmuniCation is not recommended for women who are pregnant.

!"#: $ognitive %evel: Application &'#: p. 1@9 *+: 9T*-: epatitis /'0: Nursing -rocess Step: "mplementation


1,. Ghen the nurse asks a patient about drug use during a prenatal history7 she might beginthe uestioning with:

a. <!o you smoke7 drink alcohol7 or use drugsE=

b. <!o you ever use prescription or street drugsE=

c. <Ghat overthecounter and prescription drugs have you taken in the past ,monthsE=

d. <Ge need to know if you take drugs so we can help your baby.=

ANS: $

Screening for drug use should begin in a nonthreatening way by asking about prescriptionand *T$ medications and how the information can help provide safe and appropriate

prenatal care.

!"#: $ognitive %evel: Application &'#: p. 1@) *+: DT*-: "nterviewing &elative to !rug Hse /'0: Nursing -rocess Step: Assessment


!isease

1B. The nurse assesses a pregnant woman for pregnancyinduced 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: $

Sudden7 excessive weight gain is the first sign of fluid retentionI facial swelling and swellingof feet7 legs7 and hands follows weight gain.

!"#: $ognitive %evel: Analysis &'#: p. )3 *+: ,T*-: ypertension /'0: Nursing -rocess Step: Assessment


!isease


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Test ank

19. "f the patient with gestational hypertension has all the signs below7 the nurse immediately

should report:

a. diarrhea. b. urticaria.

c. blurred vision.

d. backache.

ANS: $

Jisual disturbances indicate worsening pregnancyinduced hypertension and must bereported promptly for effective intervention to prevent preeclampsia and convulsion.

!"#: $ognitive %evel: Analysis &'#: p. )3 *+: ,

T*-: ypertension /'0: Nursing -rocess Step: -lanningS$: N$%'2: ealth -romotion and aintenance: -revention and 'arly !etection of

!isease

1D. The patient who is 38 weeks pregnant presents with consistent hypertension. The homehealth nurse would give priority to the need for:

a. activity restriction. b. balanced nutrition.

c. increased fluid intake to ensure adeuate hydration.

d. instruction about the effect of diuretics.

ANS: A

ed rest reduces the flow of blood to skeletal muscles7 making more blood available to the

placenta and enhancing fetal oxygenation.

!"#: $ognitive %evel: Application &'#: p. ), *+: ,

T*-: ypertension /'0: Nursing -rocess Step: "mplementationS$: N$%'2: ealth -romotion and aintenance: -revention and 'arly !etection of

!isease

1(. The nurse explains that the obKective 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

agnesium sulfate is a central nervous system depressant given to prevent seiCures.

!"#: $ognitive %evel: /nowledge &'#: p. ), *+: ,

T*-: agnesium Sulfate /'0: Nursing -rocess Step: "mplementation



9D



Test ank

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 13 breathsFmin. b. count respirations and report a rate of more than 3@ breathsFmin.

c. check blood pressure and report a rate of less than 1@@FD@ mm g.

d. monitor urinary output and report a rate of less than 1@@ m%Fhr.

ANS: A

'xcessive magnesium sulfate may cause respiratory depression.

!"#: $ognitive %evel: Application &'#: p. ), *+: ,

T*-: agnesium Sulfate /'0: Nursing -rocess Step: "mplementation


1). The drug the nurse plans to have available for immediate "J administration whenever

magnesium sulfate is administered to a maternity patient is:

a. ergonovine maleate 4'rgotrate5. b. oxytocin.

c. calcium gluconate.d. hydralaCine 4Apresoline5.

ANS: $$alcium gluconate reverses the effects of magnesium sulfate and should be available for

immediate use when a woman receives magnesium sulfate.

!"#: $ognitive %evel: Analysis &'#: p. ), *+: ,T*-: $alcium Lluconate /'0: Nursing -rocess Step: -lanning


3@. A woman who is ,9 weeks pregnant has a total placenta previa. She asks the nurse7 <Gill

" be able to deliver vaginallyE= The nurse should explain:

a. <0es7 you can deliver vaginally until ,D weeks.= b. <A vaginal delivery can be attempted7 but if bleeding occurs7 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: $

A cesarean delivery is done for a partial or total placenta previa.

!"#: $ognitive %evel: Application &'#: p. 8) *+: ,

T*-: -lacenta -revia /'0: Nursing -rocess Step: "mplementationS$: N$%'2: -hysiological "ntegrity: &eduction of &isk


9(



Test ank

31. The nurse teaches a woman who is 8 weeks pregnant about how rubella can affect the

developing fetus. The nurse realiCes 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: &ubella can have devastating effects on the developing fetus. Some effects of rubella on the

embryo or fetus include microcephaly7 mental retardation7 cardiac defects7 cataracts7 and

deafness.

!"#: $ognitive %evel: Analysis &'#: p. 1@B *+: 9

T*-: &ubella /'0: Nursing -rocess Step: 'valuation


!isease

33. The nurse would suspect pyelonephritis when a pregnant woman reports:a. freuency and urgency of urination.

b. nausea and weight loss.

c. burning sensation when voiding.d. tenderness in the flank area.

ANS: !

-yelonephritis is a particularly serious infection in pregnancy. Signs and symptoms includehigh fever7 chills7 flank pain or tenderness7 nausea7 and vomiting.

!"#: $ognitive %evel: Analysis &'#: p. 1@( *+: 9T*-: -yelonephritis /'0: Nursing -rocess Step: Assessment

S$: N$%'2: -hysiological "ntegrity: &eduction of &isk

3,. To help prevent more placental damage7 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#owler>s position to prevent supine hypotension.

d. in the kneechest position to reduce pressure on placenta.

ANS:

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 supinehypotension.

!"#: $ognitive %evel: Application &'#: p. 8) *+: ,

T*-: -lacenta -revia /'0: Nursing -rocess Step: "mplementation


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Test ank


3B. The young prenatal patient with gestational diabetes mellitus 4L!5 says7 <" amfrightened that " will have to deal with insulin inKections for the rest of my life.= The

nurse>s best response would be:

a. <After delivery your doctor will prescribe oral hypoglycemic medication to controlyour disease. -ills are so much simpler than insulin inKections.=

b. <ave you considered an insulin pumpE=

c. <After a while those insulin inKections won>t seem so bad.=d. <"t will most likely resolve D weeks or so after the baby is born.=

ANS: !

L! usually resolves by D weeks after delivery.

!"#: $ognitive %evel: $omprehension &'#: p. )( *+: ,

T*-: L! /'0: Nursing -rocess Step: "mplementation

S$: N$%'2: -sychosocial "ntegrity: $oping and Adaptation

M'L$IPLE *E+P)N+E

39. ecause the mother is diabetic7 the nurse caring for a macrosomic infant will do a

focused assessment for which complication4s5E Select all that apply.a. econium ileus

b. !iarrhea

c. ypoglycemia

d. uscle tremorse. Hrine retention

ANS: $

The fetus responds to the hyperglycemia from the mother>s blood and produces increasedinsulin. This insulin may cause hypoglycemia in the infant after it is no longer exposed to the

mother>s blood.

!"#: $ognitive %evel: Application &'#: p. 1@17 ox 9B

*+: 9 T*-: ypoglycemia in acrosomic "nfant

/'0: Nursing -rocess Step: Assessment


3D. The nurse educates prenatal patients about the threat of T*&$ infections. Ghichinfections are included in this classificationE Select all that apply.

a. Toxoplasmosis

b. Toxemiac. $ytomegalovirus

d. &ubella

e. erpes simplex


9)



Test ank

ANS: A7 $7 !7 '

The T*&$ infections are toxoplasmosis7 rubella7 cytomegalovirus7 and herpes simplex.

!"#: $ognitive %evel: $omprehension &'#: p. 1@B *+: D

T*-: T*&$ "nfections /'0: Nursing -rocess Step: "mplementation


3(. The nurse emphasiCes to a patient with a highrisk pregnancy that the impact of such a pregnancy might result in which problem4s5E Select all that apply.

a. !isruption of family roles

b. #inancial pressures

c. 'xcessive attachment to infantd. #rustration with activity restriction

e. Alteration in child care practices

ANS: A7 7 !7 'ighrisk pregnancies have an impact on family roles7 financial needs7 delayed attachment to

the infant7 alteration in child care practices7 and frustration with the restricted activity.

!"#: $ognitive %evel: Application &'#: p. 113 *+: 8

T*-: "mpact of igh&isk -regnancies /'0: Nursing -rocess Step: "mplementationS$: N$%'2: -sychosocial "ntegrity: -sychosocial Adaptation

38. A patient who is ,@ weeks pregnant delivers a stillborn child in the emergency

department 4'!5. Ghat should the '! nurse offer the patientE Select all that apply.

a. -rivacy b. An opportunity to hold the infant

c. aterials about support groups

d. A memento 4footprint or lock of hair5e. An opportunity to grieve

ANS: A7 7 $7 !7 'All the listed interventions are appropriate.

!"#: $ognitive %evel: Application &'#: p. 11, *+: 8

T*-: Stillborn "nfant /'0: Nursing -rocess Step: -lanningS$: N$%'2: -sychosocial "ntegrity: $oping and Adaptation

3). Ghat would the nurse include in a teaching plan for the pregnant patient who has irondeficiency anemia and has been placed on iron supplementE Select all that apply.

a. $itrus fruits enhance absorption of iron.

b. ran products support iron deficiency.c. ilk will disguise the taste of the iron.

d. The iron therapy will continue for about , months.

e. Tea should be avoided while taking iron.


91@



Test ank

ANS: A7 !7 '

$alcium7 bran7 and tannic acid in tea interfere with the absorption of iron. The therapy

usually lasts , months7 and vitamin $ helps with the absorption of iron.

!"#: $ognitive %evel: Application &'#: p. 1@, *+: 9

T*-: "ron !eficiency Anemia /'0: Nursing -rocess Step: -lanningS$: N$%'2: -hysiological "ntegrity: -harmacological Therapies

,@. The nurse takes into consideration that the patient with placenta previa is at risk for postpartum infection for what reason4s5E Select all that apply.

a. Jaginal organisms can invade the placenta.

b. The undernourished 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: A7 !Jaginal organisms reach the placenta through the cervix. *nce there7 the organisms can

multiply in the nutrientrich environment of the placenta. The weak musculature of the lowersegment of the uterus will cause postpartum hemorrhage rather than infection.

!"#: $ognitive %evel: Application &'#: p. 8) *+: ,T*-: "nfection with -lacenta -revia /'0: Nursing -rocess Step: -lanning


!isease

C)MPLE$I)N

,1. The nurse cautions that the consumption of as few as 66666666 alcoholic drink4s5 during pregnancy can lead to the loss of fetal brain cells.

ANS:3

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 13 oC of beer7 9 oC of wine7 or 1.9 oC ofliuor.

!"#: $ognitive %evel: $omprehension &'#: p. 1@)7 Nursing Tip*+: 9 T*-: #etal Alcohol Syndrome

/'0: Nursing -rocess Step: "mplementation

S$: N$%'2: ealth -romotion and aintenance: Lrowth and !evelopment

,3. The nurse explains that 66666666666 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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Test ank

ANS:

cerclage

$erclage is the procedure that sutures the cervix closed to prevent its opening when the fetus presses against it.

!"#: $ognitive %evel: /nowledge &'#: p. 83 *+: 1T*-: $erclage /'0: Nursing -rocess Step: "mplementation



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Chapter 5 - Test questions

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