TEST BANK OF CONTEMPORARY MATERNAL NEWBORN NURSING 9TH ED BY PATRICIA W LADEWIG

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Contemporary Maternal Newborn Nursing 9th ed by Patricia W Ladewig – 
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Contemporary Maternal-Newborn Nursing, 9e (Ladewig et al.)

Chapter 1   Contemporary Maternal-Newborn Care

 

1) During a prenatal visit, a client expresses interest in accessing community-based care and services. Which response allows the registered nurse to best describe services that are offered by way of community-based care?

  1. “Most healthcare services provided to childbearing women and their families take place in a hospital setting.”
  2. “Community-based care can provide a client with certain primary care services.”
  3. “Nurses are the sole providers of services related to home care.”
  4. “Due to lack of support from third-party payers, community-based care has decreased.”

Answer:  2

Explanation:  1. The majority of health care provided to childbearing women and their families takes place outside of hospital in clinics, offices, community-based organizations, and private homes.

  1. Primary care includes health promotion and illness prevention, and it features services that are best provided in community-based settings.
  2. While nurses are the major providers of home care services, healthcare providers in various other fields, such as physical therapy, also offer home care services.
  3. As third-party payers begin to recognize the importance of primary care in containing costs and maintaining health, community-based care has increased.

Page Ref: 3

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Implementation/Health teaching and health promotion

Learning Outcome:  LO 1.2-Describe the use of community-based nursing care in meeting the needs of childbearing families.

MNL LO:  Overview of maternal-newborn nursing.

 

2) The labor and delivery nurse and a novice nurse are admitting a client who is in labor. The client is making groaning guttural sounds during contractions and answers questions with one-word answers. The labor and delivery nurse is quickly setting up the instruments and sterile field for this delivery while asking admission questions between contractions. The labor and delivery nurse has not completed a pelvic exam. The novice nurse understands that this is an example of:

  1. An expert nurse assessing advanced labor and imminent delivery in the client.
  2. The correct order of steps when admitting a who is in labor.
  3. Inconsistencies in an individual nurse’s approach to client care.
  4. Advanced nurse practice.

Answer:  1

Explanation:  1. An expert nurse utilizes multiple aspects of a client’s behavior (including the length of each response to a question and sounds the patient produces during contractions) in addition to the more objective findings of the pelvic exam (including dilation of the cervix) in the assessment of a who is in labor. The expert nurse has identified that the grunting and guttural sounds during contractions are involuntary pushing and that the client is very close to delivery.

  1. Although most nurses have a routine when admitting a client, the order of the steps will vary according to the situation at hand.
  2. Changing the order of the steps of admission is not being inconsistent; changing the order of the steps of admission is responsive to the needs of the client at that point in time.
  3. Advanced nurse practice describes educational and certification achievement and is not used to describe the continuum from novice to expert.

Page Ref: 4, 5

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Assessment/Coordination of care

Learning Outcome:  LO 1.3-Identify the nursing roles available to the maternal-newborn and women’s healthcare nurses.

MNL LO:  Overview of maternal-newborn nursing.

 

3) Currently, one-third of children under 20 years old come from families of minority populations. The new nurse is observing her preceptor assess the client’s communication pattern, religious beliefs, level of education, and support system. The new nurse understands that the best reason for her preceptor to assess these areas is to increase the:

  1. Client’s cooperation with the plan of care.
  2. Hospitals compliance with the Joint Commission on Accreditation of Healthcare Organizations JCAHO standards.
  3. Nurse’s knowledge of cultural beliefs.
  4. Client’s satisfaction with her care.

Answer:  1

Explanation:  1. Gaining cooperation with the plan of care increases the outcome desired at discharge. When a client’s value system is not included in the plan of care, it will decrease compliance with the treatment plan and possibly increase the length of stay and decrease the desired outcome at discharge.

  1. Although compliance with JCAHO standards is very important, it is more important to gain client cooperation with the plan of care.
  2. The nurse’s knowledge of cultural beliefs increases the ability to care for the client, but without the client’s cooperation with the plan of care, the nurse’s knowledge is lost.
  3. Client satisfaction with care is important, but the prime reason for the satisfaction is the nurse’s taking time to gain patient cooperation with the plan of care.

Page Ref: 4, 5

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Planning/Health teaching and health promotion

Learning Outcome:  LO 1.3-Identify the nursing roles available to the maternal-newborn and women’s healthcare nurses.

MNL LO:  Overview of maternal-newborn nursing.

 

4) The client at 30 weeks’ gestation expresses a desire for the registered nurse to independently manage her perinatal care and the birth of her baby. When the nurse explains she is not credentialed to independently manage the client’s perinatal care and delivery, the nurse is recognizing principles related to:

  1. Standards of care.
  2. Scope of practice.
  3. Right to privacy.
  4. Informed consent.

Answer:  2

Explanation:  1. Standards of care pertain to established minimum criteria for competent, proficient actions related to delivery of nursing care.

  1. Scope of practice is defined as the limits of nursing practice set forth in state statutes.
  2. Right to privacy involves the legal right of a person to keep her or his person and property free from public scrutiny.
  3. Informed consent is a legal concept that protects a client’s right to autonomy and self-determination.

Page Ref: 4, 5

Cognitive Level:  Understanding

Client Need&Sub:  Safe and Effective Care Environment | Management of Care

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Evaluation/Coordination of care

Learning Outcome:  LO 1.3-Identify the nursing roles available to the maternal-newborn and women’s healthcare nurses.

MNL LO:  Overview of maternal-newborn nursing.

 

5) The certified nurse-midwife (CNM) role includes which of the following? Select all that apply.

  1. Prepared to independently the care of women that are at low risk for complications during pregnancy and birth
  2. Provides primary care for high-risk patients who are in hospital settings
  3. Provides primary care for healthy newborns
  4. Obtains a physician consultation for any technical procedures at delivery
  5. Formal educated in two disciplines of nursing

Answer:  1, 3, 5

Explanation:  1. A CNM is prepared to independently manage the care of women at low risk for complications during pregnancy and birth.

  1. CNMs cannot give primary care for high-risk patients who are in hospital settings. The physician provides the primary care for high-risk patients who are in hospital settings.
  2. A CNM is prepared to manage independently the care of healthy newborns.
  3. The CNM does not need to obtain a physician consultation for any technical procedures at delivery.
  4. The CNM is educated in the disciplines of nursing and midwifery.

Page Ref: 4, 5

Cognitive Level:  Understanding

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VI: Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Assessment/Coordination of care

Learning Outcome:  LO 1.3-Identify the nursing roles available to the maternal-newborn and women’s healthcare nurses.

MNL LO:  Overview of maternal-newborn nursing.

 

6) The new graduate is learning about advanced practice nursing. Which of the following situations best illustrates an advanced practice nursing role? Select all that apply.

  1. An experienced registered nurse who is the manager of a large obstetrical unit
  2. A registered nurse who is the circulating nurse at surgical (cesarean) deliveries
  3. A clinical nurse specialist who is the staff nurse on a mother—baby unit
  4. A nurse practitioner consults with a physician in the newborn nursery
  5. A nurse-midwife who attends vaginal deliveries of uncomplicated pregnancies

Answer:  4, 5

Explanation:  1. Management roles are often held by professional nurses.

  1. Unit specific skills such as circulating during cesarean births do not require additional formal education.
  2. An advanced practice nurse working as a staff nurse is not working in the role of advanced practice.
  3. Advanced practice nurses have received additional specialized education beyond registered nursing and tend to have a clinical focus. Nurse practitioners make clinical judgment and begin treatment and consult a physician as needed.
  4. It is within the scope of practice for certified nurse-midwives to attend deliveries of essentially normal patients with essentially normal pregnancies.

Page Ref: 4, 5

Cognitive Level:  Understanding

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Assessment/Coordination of care

Learning Outcome:  LO 1.3-Identify the nursing roles available to the maternal-newborn and women’s healthcare nurses.

MNL LO:  Overview of maternal-newborn nursing.

 

 

7) The major focus of the nurse practitioner (NP) is on:

  1. Leadership.
  2. Physical and psychosocial clinical assessment.
  3. Independent care of a patient with a high-risk pregnancy.
  4. Tertiary prevention.

Answer:  2

Explanation:  1. Leadership might be a quality of the NP, but it is not the major focus.

  1. Physical and psychosocial clinical assessment is the major focus of the NP, who provides care in many different clinical settings.
  2. NPs cannot provide independent care of a patient with a high-risk pregnancy, but must work under a physicians supervision.
  3. The NP cannot do tertiary prevention as a major focus.

Page Ref: 4, 5

Cognitive Level:  Understanding

Client Need&Sub:  Safe and Effective Care Environment | Management of Care

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VI: Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Assessment/Coordination of care

Learning Outcome:  LO 1.3-Identify the nursing roles available to the maternal-newborn and women’s healthcare nurses.

MNL LO:  Overview of maternal-newborn nursing.

 

8) The nurse is reviewing charts for quality improvement. A client experienced a complication during labor. The nurse is uncertain if the labor nurse took the appropriate action during the situation. What is the best method for the quality improvement nurse to determine if the action by the labor and delivery nurse was justified?

  1. Call the nurse manager of the labor and delivery unit and ask what the nurse should be doing.
  2. Ask the departmental chair of the obstetrical physicians what the best nursing action should be.
  3. Examine other charts to find cases of the same complication, and determine how it was handled in those situations.
  4. Look in the policy and procedure book. Examine the practice guidelines published by a professional nursing organization.

Answer:  4

Explanation:  1. The nurse should find the standards herself and not rely on another person, such as the labor and delivery nurse manager, to determine appropriateness of care.

  1. Physician care and nursing care are very different; physicians might not be up-to-date on nursing standards of care or nursing policies and procedures.
  2. What nursing action was undertaken in a different situation might not be based on the policies and procedures or other standards of care. The quality improvement nurse will obtain the most accurate information by examining the policies, procedures, and standards of care.
  3. Agency policies, procedures, and protocols contain guidelines for nursing action in specific situations. Professional organizations such as the Association of Womens Health, Obstetrical, and Neonatal Nurses (AWHONN) also publish standards of practice that should guide nursing care.

Page Ref: 5, 6

Cognitive Level:  Application

Client Need&Sub:  Safe and Effective Care Environment | Management of Care

Standards:  QSEN Competencies: Quality improvement | AACN Essential Competencies: Essential II: Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome:  LO 1.4-Delineate significant legal and ethical issues that influence the practice of maternal-newborn nursing.

MNL LO:  Overview of maternal-newborn nursing.

 

9) According to the 1973 United States Supreme Court decision in Roe v. Wade, abortion is legal if induced:

  1. At a federally funded clinic.
  2. Before the period of viability.
  3. To provide tissue for therapeutic research.
  4. At a military hospital overseas.

Answer:  2

Explanation:  1. At a federally funded clinic, abortions can be provided legally if under U.S. laws.

  1. Abortion can be performed legally until the period of viability; after viability, the fetus rights take precedence.
  2. Abortion is not permitted for therapeutic research.
  3. At a military hospital overseas, abortions can be provided legally if under U.S. laws.

Page Ref: 6

Cognitive Level:  Understanding

Client Need&Sub:  Safe and Effective Care Environment | Management of Care

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential V: Healthcare policy, finance, and regulatory environments | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  LO 1.4-Delineate significant legal and ethical issues that influence the practice of maternal-newborn nursing.

MNL LO:  Overview of maternal-newborn nursing.

 

 

10) The nurse is caring for a client who has delivered her first child. The client states, “My mother said that I have to have a bowel movement before I can go home, but my girlfriend said that isn’t true anymore. What caused this change?” Which response by the nurse is best?

  1. “Doctors just want clients to go home sooner these days.”
  2. “It really doesn’t matter. Don’t worry about it.”
  3. “Research indicates that it is normal for bowel function to be slow for a few days.”
  4. “We used to give all clients laxatives, but now they cost too much.”

Answer:  3

Explanation:  1. Cost containment and managed care are the driving forces behind some changes in care compared to a generation ago, not physician preference.

  1. Always address a client’s questions and avoid saying”don’t worry about it” to keep communication therapeutic.
  2. Evidence-based practice is the use of research findings to guide nursing actions, policies, and procedures. Often research findings contradict care that used to be the norm, leading to changes in policies and procedures.
  3. Although laxatives are low-cost medications, there is no evidence indicating that all clients should receive them after childbirth. The evidence indicates that bowel function slows slightly after birth and normally resumes in a few days.

Page Ref: 7, 8

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Essential III: Scholarship for evidence based practice | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Implementation/Evidence based practice and research

Learning Outcome:  LO 1.5-Discuss the role of evidence-based practice in improving the quality of nursing care for childbearing families.

MNL LO:  Overview of maternal-newborn nursing.

 

11) Which of the following practices characterize the basic competencies related to evidence-based practice? Select all that apply.

  1. Clinical practice supported by good evidence
  2. Clinical practice supported by intuitive evidence
  3. Clinical practice supported by data
  4. Clinical practice that promotes quality
  5. Clinical practice that provides a useful approach to problem solving

Answer:  1, 3, 4, 5

Explanation:  1. Clinical practice supported by good evidence is one of the hallmark characteristics of the basic competencies related to evidence-based practice.

  1. Clinical practice supported by intuitive evidence does not provide valid evidence and data for the proper actions.
  2. Clinical practice supported by data is one of the hallmark characteristics of the basic competencies related to evidence-based practice.
  3. Clinical practice that promotes quality is one of the hallmark characteristics of the basic competencies related to evidence-based practice.
  4. Clinical practice that provides a useful approach to problem solving is one of the hallmark characteristics of the basic competencies related to evidence-based practice.

Page Ref: 7, 8

Cognitive Level:  Application

Client Need&Sub:  Safe and Effective Care Environment | Management of Care

Standards:  QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Essential III: Scholarship for evidence based practice | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Assessment/Evidence based practice and research

Learning Outcome:  LO 1.5-Discuss the role of evidence-based practice in improving the quality of nursing care for childbearing families.

MNL LO:  Overview of maternal-newborn nursing.

 

12) The nurse is preparing a report on the number of births by three service providers at the facility (certified nurse—midwives, family practitioners, and obstetricians). This would be an example of:

  1. Inferential statistics.
  2. Descriptive statistics.
  3. Evidence-based practice is the use of conclusions of research to improve nursing care.
  4. Secondary use of data.

Answer:  2

Explanation:  1. Inferential statistics allow the investigator to draw conclusions from data to either support or refute causation.

  1. Descriptive statistics concisely describe phenomena such as births by providers.
  2. Evidence-based practice.
  3. Secondary use of data is analyzing data a different way than the original data analysis was undertaken or looking at different variables from a data set.

Page Ref: 8, 9

Cognitive Level:  Analyzing

Client Need&Sub:  Safe and Effective Care Environment | Management of Care

Standards:  QSEN Competencies: Quality improvement | AACN Essential Competencies: Essential II: Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Implementation/Coordination of care

Learning Outcome:  LO 1.6-Explain how nurses can use descriptive and inferential statistics in clinical practice in maternal—child health nursing.

MNL LO:  Overview of maternal-newborn nursing.

 

 

13) An example of descriptive statistics is:

  1. A positive correlation between breastfeeding and infant weight gain.
  2. The infant mortality rate in the state of Oklahoma.
  3. A causal relationship between the number of sexual partners and sexually transmitted diseases.
  4. The total number of spontaneous abortions in women who abuse drugs compared to women who do not abuse drugs.

Answer:  2

Explanation:  1. A positive correlation between two or more variables is an example of inferential statistics.

  1. The infant mortality rate in the state of Oklahoma is an example of a descriptive statistic because it describes or summarizes a set of data.
  2. A causal relationship between the number of sexual partners and sexually transmitted diseases is an example of inferential statistics.
  3. The total number of spontaneous abortions in women who abuse drugs compared to women who do not abuse drugs is an inferential statistic.

Page Ref: 8, 9

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Quality improvement | AACN Essential Competencies: Essential II: Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Assessment/Quality of practice

Learning Outcome:  LO 1.6-Explain how nurses can use descriptive and inferential statistics in clinical practice in maternal—child health nursing.

MNL LO:  Overview of maternal-newborn nursing.

 

14) The 2011 estimated infant mortality rate in the United States exceeds the infant mortality rate of several other developed countries, including Sweden, Japan, France, Germany, and Canada. Which research question most effectively explores variables that may potentially influence these statistics?

  1. What is the average age of healthcare providers in each country?
  2. What is the level of racial diversity in each country?
  3. What is the average age of children in each country?
  4. What is the level of awareness related to contraception in each country?

Answer:  2

Explanation:  1. The age of healthcare providers does provide insight as to national infant mortality rates.

  1. Racial background can impact infant mortality rates.
  2. The average age of children does not provide insight as to the rate of infant mortality.
  3. Awareness related to contraception has no direct impact on the survival of infants after birth.

Page Ref: 8, 9

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Evidence based practice | AACN Essential Competencies: Essential III: Scholarship for evidence based practice | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Evaluation/Evidence based practice and research

Learning Outcome:  LO 1.6-Explain how nurses can use descriptive and inferential statistics in clinical practice in maternal—child health nursing.

MNL LO:  Overview of maternal-newborn nursing.

 

15) The nurse knows the birth rate by age group in the state. Which research question could be developed for further study from this data?

  1. What is the average number of children per family in the United States?
  2. How does educational level affect the incidence of unplanned pregnancy?
  3. What is the overall nutritional status of adolescents?
  4. Which high schools provide day care for student parents?

Answer:  2

Explanation:  1. Determining the average number of children nationally will not yield additional information about this state.

  1. Research questions often come from a nurse’s desire to further understand an issue. How educational level affects the incidence of unplanned pregnancy is a question that flows from the known data of birth rate by age group.
  2. Studying the nutritional status of adolescents will not yield additional information about this state.
  3. Schools that provide day care might indicate the incidence of teen pregnancy in the population served by the school, but not the pregnancy rates of those who are not in high school.

Page Ref: 8, 9

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Evidence based practice | AACN Essential Competencies: Essential III: Scholarship for evidence based practice | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Planning/Evidence based practice and research

Learning Outcome:  LO 1.6-Explain how nurses can use descriptive and inferential statistics in clinical practice in maternal—child health nursing.

MNL LO:  Overview of maternal-newborn nursing.

 

16) The major focus of the clinical nurse specialist (CNS) involves:

  1. Conducting physical and psychosocial assessments, including history, physical examination, and certain diagnostic tests and procedures.
  2. Independently managing the care of women at low risk for complications during pregnancy and birth and the care of healthy newborns.
  3. Generating new research relevant to topics such as health care and administrative issues.
  4. Demonstrating leadership within his or her specialty and working to improve inpatient care both directly and indirectly.

Answer:  4

Explanation:  1. Physical and psychosocial clinical assessment is the major focus of the nurse practitioner (NP), who provides care in many different clinical settings.

  1. The certified nurse-midwife (CNM) is qualified to provide independent care of the client with a low-risk pregnancy, while seeking physician consultation as needed.
  2. Nurse researchers have an advanced doctoral degree, typically a PhD, and assume a leadership role in generating new research.
  3. The CNS assumes a leadership role within his or her specialty and works to improve inpatient care both directly and indirectly.

Page Ref: 4, 5

Cognitive Level:  Understanding

Client Need&Sub:  Safe and Effective Care Environment | Management of Care

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential II: Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Evaluation/Leadership

Learning Outcome:  LO 1.3-Identify the nursing roles available to the maternal-newborn and women’s healthcare nurses.

MNL LO:  Overview of maternal-newborn nursing.

 

17) A couple has been attempting pregnancy for the last three years and is looking for assistance from the fertility specialist. The nurse assesses the client’s emotional response to infertility. Which responses could the nurse expect? Select all that apply.

  1. Love, no matter what, they have each other
  2. Failure, they cannot conceive a child
  3. Anger, other people have children
  4. Fear, they may never experience parenthood
  5. Sadness, they may never have a child

Answer:  2, 3, 4, 5

Explanation:  1. This may be the end result of their journey if they fail in attempts to have a child.

  1. Failure is one of the many responses to infertility.
  2. Anger is one of the many responses to infertility.
  3. Fear is one of the many responses to infertility.
  4. Sadness is one of the many responses to infertility.

Page Ref: 7, 8

Cognitive Level:  Analyzing

Client Need&Sub:  Safe and Effective Care Environment | Management of Care

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential II: Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Assessment/Coordination of care

Learning Outcome:  LO 1.5-Discuss the role of evidence-based practice in improving the quality of nursing care for childbearing families.

MNL LO:  Overview of maternal-newborn nursing.

 

18) The student is reading an article that states the pregnancy-related mortality rate in the United States in the year 2011 was 17.8. Which statement(s) by the student could be an accurate explanation? Select all that apply.

  1. In 2011, there were 17.8 maternal deaths per 100,000 women of childbearing age in the United States.
  2. In 2011, there were 17.8 maternal deaths per 100,000 live births in the United States.
  3. In 2011, there were 17.8 maternal deaths per 100,000 women in the country in the United States.
  4. In 2011, there were 17.8 maternal deaths per 100,000 pregnancies in the United States.
  5. In 2011, there were 17.8 deaths of women from the United States as a result of the childbearing period per 100,000 live births.

Answer:  4, 5

Explanation:  1. This answer states only that the maternal deaths were among women of childbearing age.

  1. This answer states only that the maternal deaths were among live births.
  2. This answer states only that the maternal deaths were among women in the country.
  3. This answer clarifies that the women were within the 42 weeks of a pregnancy.
  4. This answer clarifies that the women were within the childbearing (conception to 6-weeks postpartum) period.

Page Ref: 8, 9

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Quality improvement | AACN Essential Competencies: Essential II: Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Understanding/Health teaching and health promotion

Learning Outcome:  LO 1.6-Explain how nurses can use descriptive and inferential statistics in clinical practice in maternal—child health nursing.

MNL LO:  Overview of maternal-newborn nursing.

 

Contemporary Maternal-Newborn Nursing, 9e (Ladewig et al.)

Chapter 7   Families with Special Reproductive Concerns

 

1) A client who has been unable to conceive asks the nurse if it is her fault or her husband’s fault that they have not been able to become pregnant. The best response by the nurse is:

  1. “The male infertility factors are more common than female.”
  2. “Female infertility issues are more common than male issues.”
  3. “The testing the doctor will order will determine who is at fault.”
  4. “We will know more about what is causing your infertility after some tests are done.”

Answer:  4

Explanation:  1. This statement is not true. Because of the complexity of ovulation and maintaining a pregnancy, it is more likely that a female issue is causing the infertility. Regardless, using the term “at fault” is blaming and should be avoided.

  1. Although this statement is true because of the complexity of ovulation and maintaining a pregnancy, using the term “at fault” is blaming and should be avoided.
  2. Testing will determine what the infertility issue is, but using the term “at fault” is blaming and should be avoided.
  3. This is a factual answer that avoids using the term “at fault.” This statement is therapeutically worded and therefore is the best answer.

Page Ref: 115

Cognitive Level:  Application

Client Need&Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Implementation/Health teaching and health promotion

Learning Outcome:  LO 7.1-Compare the essential components of fertility with the possible causes of infertility.

MNL LO:  Explain infertility and its associated risk factors.

 

2) The client experiencing infertility is to complete three months of documenting her basal body temperatures. Which statement by the client indicates a need for additional teaching?

  1. “I should check my temperature with this special thermometer before I get out of bed each day.”
  2. “I will track my temperatures and the consistency of my cervical mucus for the next 3 months.”
  3. “If I am ovulating, my temperature will be a smooth, even line on the graph that does not go up or down.”
  4. “The point of checking my basal body temperature is to determine whether I am ovulating regularly.”

Answer:  3

Explanation:  1. The basal body temperature is most accurate prior to arising each day. A thermometer with larger spaces between tenths of a degree is used to facilitate accurate recording.

  1. Taking the temperature each morning will help detect ovulation. Checking cervical mucus daily for changes in consistency and stretchiness is another method to detect ovulation. Combining the two methods gives better information on when ovulation is occurring than one method does alone.
  2. A flat line on the graph is a monophasic cycle indicating a lack of ovulation. An ovulating woman will have a biphasic pattern to her basal body temperature. The temperature will drop slightly prior to ovulation, and rise about .5 to 1.0°F as ovulation occurs, remaining elevated if conception occurs or dropping just prior to onset of menses.
  3. Basal body temperatures are less predictive of when ovulation occurs, but an increase in the latter half of the cycle indicates that ovulation has occurred.

Page Ref: 116, 117

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion

Learning Outcome:  LO 7.2-Describe the elements of the preliminary investigation of infertility and the nurse’s role in supporting/teaching patients during this phase.

MNL LO:  Recognize the various strategies for managing infertility.

 

3) A 31-year-old woman with normal ovaries, a normal prolactin level, and an intact pituitary gland is undergoing initial pharmacologic treatment of anovulation. Which medication would the nurse anticipate being prescribed for this client?

  1. Clomiphene citrate (Clomid or Serophene)
  2. Glucophage (Metformin)
  3. Human menopausal gonadotropins (hMGs)
  4. Bromocriptine (Parlodel)

Answer:  1

Explanation:  1. Clomiphene citrate (Clomid or Serophene) is a common first-line therapy for inducing ovulation in women with normal ovaries, normal prolactin level, and intact pituitary gland.

  1. Oral hypoglycemic agents such as glucophage (Metformin) are used for inducing ovulation in women with polycystic ovary disease (PCOS).
  2. hMGs is a second line of therapy in women who fail to ovulate or conceive with clomiphene citrate therapy.
  3. Bromocriptine (Parlodel) is used to treat hyperprolactinemia accompanied by anovulation.

Page Ref: 114, 115

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential II: Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Planning/Quality of practice

Learning Outcome:  LO 7.3-Compare the indications for the tests with the associated treatments, including assisted reproductive technologies that are done in an infertility workup.

MNL LO:  Examine the assessment process for male and female infertility.

 

 

4) A nurse is reviewing the basal body temperature method with a couple. Which of the following statements would indicate that the teaching has been successful?

  1. “I have to go buy a special type of thermometer.”
  2. “I need to wait five minutes after smoking a cigarette before I take my temperature.”
  3. “I need to take my temperature before I get out of the bed in the morning.”
  4. “I need to take my temperature for at least two minutes every day.”

Answer:  3

Explanation:  1. The temperature can be taken with a standard oral or rectal thermometer.

  1. In the basal body temperature method, the woman takes her temperature every day before starting any activity, including smoking.
  2. In the basal body temperature method, the woman takes her temperature every day before arising.
  3. In the basal body temperature method, the woman takes her temperature every day for five minutes.

Page Ref: 116. 117

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion

Learning Outcome:  LO 7.3-Compare the indications for the tests with the associated treatments, including assisted reproductive technologies that are done in an infertility workup.

MNL LO:  Recognize the various strategies for managing infertility.

 

5) A client calls his urologist’s office to clarify instructions about semen analysis. The nurse should instruct the client to:

  1. Remain abstinent for 3 days prior to collecting the specimen.
  2. Use a lubricant while obtaining the semen specimen.
  3. Immediately refrigerate the specimen for a maximum of 8 hours.
  4. Deliver the specimen to the laboratory within 1 hour of collection.

Answer:  1

Explanation:  1. To obtain accurate results of a semen analysis, the specimen is collected after 3 days of abstinence.

  1. Most lubricants also are spermicidal and should not be used unless approved by the andrology laboratory.
  2. If the specimen is obtained at home, it needs kept at body temperature and delivered to the lab within 1 hour so as not to impair motility.
  3. If the specimen is obtained at home, it needs to be delivered to the lab within 1 hour so as not to impair motility.

Page Ref: 118, 119

Cognitive Level:  Understanding

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Implementation/Quality of practice

Learning Outcome:  LO 7.3-Compare the indications for the tests with the associated treatments, including assisted reproductive technologies that are done in an infertility workup.

MNL LO:  Recognize the various strategies for managing infertility.

 

6) The client undergoing infertility treatment reports to the nurse that her partner is angry all of the time since beginning treatment and is very negative in comments made about the likelihood of their achieving pregnancy. The client states, “I was angry and depressed, but now I am dedicated to following through with treatment and hoping we get pregnant.” What is the best interpretation of these comments? The partner is (select all that apply):

  1. Exhibiting signs of the anger stage of grieving the loss of their dreams of having children.
  2. In a different stage of grief than the patient.
  3. Having difficulty accepting the reality of their infertility.
  4. Showing that he will not be a good parent.
  5. Feeling guilty about not being able to father a child.

Answer:  1, 2

Explanation:  1. The client’s description of her partner correlates with the anger stage of grief. Couples often experience the stages of grief when infertility is diagnosed because childbearing is an expected outcome in marriage; the inability to become pregnant is the loss of the dream of parenthood.

  1. The client is in acceptance stage of grief, while the partner is in the anger stage. It is common and normal for families to be in different stages of the grieving process.
  2. The partner is in the anger stage of grief. Lack of acceptance would manifest as not believing that the diagnosis is correct.
  3. Being in the anger stage of grief is expected and normal and has no bearing on parenting ability.
  4. Guilt would manifest as feelings that it is his fault that pregnancy has not yet occurred. The client is describing anger.

Page Ref: 123, 124

Cognitive Level:  Analyzing

Client Need&Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential II: Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Diagnosis/Quality of practice

Learning Outcome:  LO 7.4-Explain the physiologic and psychologic effects of infertility on a couple in relation to the nursing management of the couple.

MNL LO:  Implement the nurse’s role in caring for and supporting couples who experience infertility.

 

7) The nurse manager is interviewing nurses for a position in an infertility clinic. Which statement best indicates that the interviewee understands the role of the nurse when working with infertile clients?

  1. “My job will be teaching patients how to take their medications and scheduling tests.”
  2. “Much of my duties will involve forming therapeutic relationships with clients struggling with infertility.”
  3. “This position is an assistant to the physician during diagnostic testing for infertility.”
  4. “I will both teach and support families struggling with emotions as they attempt to become pregnant.”

Answer:  4

Explanation:  1. Although teaching and facilitating scheduling are important, the emotions that families deal with during treatment for infertility must also be addressed.

  1. Although this response addresses the emotional aspects of infertility, it does not mention providing support or teaching, which are also major components of the job.
  2. Some assisting might be a part of this position; the role of the RN in an infertility clinic involves much teaching and providing emotional support to infertile patients.
  3. This answer addresses the two main aspects of the RN working with infertile clients: emotional support and education.

Page Ref: 123, 124

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Quality Improvement | AACN Essential Competencies: Essential V: Healthcare Policy, Finance, and Regulatory Environments | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Evaluation/Quality of practice

Learning Outcome:  LO 7.5-Describe the nurse’s role as counselor, educator, and advocate for couples during infertility evaluation and treatment.

MNL LO:  Implement the nurse’s role in caring for and supporting couples who experience infertility.

 

 

8) Which client(s) should the nurse refer to a genetics practitioner prior to attempting pregnancy?

  1. A 32-year-old woman and a 29-year-old man with 3-year-old twins.
  2. A 22-year-old woman whose sister has Tay-Sachs disease.
  3. A 30-year-old woman whose husband has AIDS.
  4. A 19-year-old woman whose sister has primary infertility.

Answer:  2

Explanation:  1. This client has no indication of having a genetic problem.

  1. Tay-Sachs disease is an autosomal recessive condition; therefore, if the client’s sister has the disease, the client could be a carrier for the condition.
  2. The risk for this patient is becoming infected with HIV while attempting conception. This couple has no indication of a genetic condition.
  3. Primary infertility is not likely to be caused by a genetic defect that could be carried by a sibling. This client has no indication of a genetic condition.

Page Ref: 128

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Planning/Coordination of care

Learning Outcome:  LO 7.6-Identify couples who may benefit from pre-conceptual chromosomal analysis and prenatal testing when providing care to couples with special reproductive concerns.

MNL LO:  Recognize the various strategies for managing infertility.

 

9) The nurse has presented an in-service to nurses new to the maternal-child health care unit. Which statement indicates that teaching on genetic disorders has been successful?

  1. “Down syndrome is an autosomal recessive condition. If both parents carry the gene, there is a 1-in-4 chance that a child will be affected.”
  2. “Galactosemia is a sex-linked condition. Both parents must carry the gene, and more girls than boys will be affected by this condition.”
  3. “Sickle cell disease is a trisomy; the affected client has three copies of a gene. Trisomies are more common in pregnancies of young women than those of older women.”
  4. “Huntington’s disease is an autosomal dominant condition. Only one parent carries the gene, and males and females are equally affected by the disease.”

Answer:  4

Explanation:  1. Down syndrome is a trisomy and most likely to occur in parents older than age 35. Autosomal recessive conditions are passed along to offspring when both parents carry the affected gene and pass the affected gene to the child.

  1. Galactosemia is not a sex-linked disorder; it is an autosomal recessive disorder. Both parents must carry the gene and pass that gene on to the child. Males and females are equally affected. Sex-linked disorders are carried on the X chromosome; therefore, males are more likely to have the condition because they only have one copy of the X chromosome.
  2. Trisomies are three copies of a specific gene and occur most often in parents older than age 35. Sickle-cell disease is not a trisomy; it is an autosomal recessive condition. Both parents must carry the gene; there is a 1-in-4 chance that their child will be affected.
  3. Huntington’s disease is an autosomal dominant disease, meaning that the affected person inherited the condition from only one affected parent. A child has a 50 percent chance of inheriting an autosomal dominant condition if one parent is affected. Males and females are equally affected by autosomal dominant disorders.

Page Ref: 127

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Quality Improvement | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion

Learning Outcome:  LO 7.7-Identify the characteristics of autosomal dominant, autosomal recessive, and X-linked (sex-linked) recessive disorders.

MNL LO:  Contrast the various genetic inheritance patterns.

 

10) A 45-year-old mother gave birth to a baby boy 2 days ago. The nurse assesses a single palmar crease, poor muscle tone, and low-set ears on the newborn. The nurse understands that these signs most likely indicate the infant has which autosomal abnormalities?

  1. Trisomy 13
  2. Trisomy 18
  3. Trisomy 21
  4. Trisomy 26

Answer:  3

Explanation:  1. A single palmar crease and low-set ears are not characteristics of trisomy 13.

  1. A single palmar crease and low-set ears are not characteristics of trisomy 18.
  2. A single palmar crease and low-set ears are characteristics of trisomy 21 (Down syndrome).
  3. Trisomy 26 is not an autosomal abnormality.

Page Ref: 126

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VIII: Professionalism and professional values | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Assessment/Quality of practice

Learning Outcome:  LO 7.7-Identify the characteristics of autosomal dominant, autosomal recessive, and X-linked (sex-linked) recessive disorders.

MNL LO:  Contrast the various genetic inheritance patterns.

 

 

11) A nurse counsels a couple regarding their concerns about an X-linked disorder. Both parents are carriers of the disorder. They ask the nurse how this disorder will affect any children they might have. What is the nurse’s best response?

  1. “If you have a daughter, she will not be a carrier.”
  2. “If you have a daughter, she will not be affected.”
  3. “If you have a son, he will be a carrier.”
  4. “If you have a son, he will not be affected.”

Answer:  2

Explanation:  1. Fathers affected with an X-linked disorder cannot pass the disorder to their sons, but all their daughters become carriers of the disorder.

  1. An X-linked disorder is manifested in a male who carries the abnormal gene on his only X chromosome.
  2. There is no male-to-male transmission of an X-linked disorder. An X-linked disorder is manifested in a male who carries the abnormal gene on his only X chromosome.
  3. There is a 50 percent chance that a carrier mother will pass the abnormal gene to each of her sons, who will thus be affected.

Page Ref: 127

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VIII: Professionalism and professional values | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Implementation/Health teaching and health promotion

Learning Outcome:  LO 7.7-Identify the characteristics of autosomal dominant, autosomal recessive, and X-linked (sex-linked) recessive disorders.

MNL LO:  Examine the role of the nurse and the process involved in genetic counseling.

 

12) A child with suspected Down syndrome has been born to 32-year-old parents. The parents ask the nurse how the diagnosis will be made and if there was a way that the diagnosis could have been made during the pregnancy. The best response by the nurse is:

  1. “The baby’s genes could have been tested during pregnancy by doing an amniocentesis.”
  2. “The doctor will check the baby’s genes by doing a 24-hour urine collection on your child.”
  3. “Mom’s blood could have been tested during the pregnancy to check for genetic problems with the baby.”
  4. “A swab of the baby’s cheek or a stool sample will be used to check your baby’s chromosomes.”

Answer:  1

Explanation:  1. A genetic amniocentesis is the removal of a small amount of amniotic fluid obtained by inserting a needle through the abdominal wall into the uterus. The amniotic fluid is then processed to examine the chromosomes.

  1. Suspected genetic conditions in newborns are diagnosed by examining the baby’s chromosomes either from a blood sample or from a swab of the inside of the cheek.
  2. Mom’s blood would contain the mother’s chromosomes, not the baby’s. Prenatal genetic testing is accomplished through genetic amniocentesis. A small amount of amniotic fluid is obtained by inserting a needle through the abdominal wall into the uterus. The amniotic fluid is then processed to examine the chromosomes.
  3. Although a cheek swab can be used for genetic testing, stool samples cannot. Because part of the answer is incorrect, the whole answer is incorrect.

Page Ref: 126

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VIII: Professionalism and professional values | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion

Learning Outcome:  LO 7.8-Compare prenatal and postnatal diagnostic procedures used to determine the presence of genetic disorders and the nursing considerations for each.

MNL LO:  Examine the role of the nurse and the process involved in genetic counseling.

 

13) The couple has had an ultrasound at 19 weeks’ gestation, and their fetus was found to have anencephaly. The nurse is completing counseling for the couple on the ultrasound findings. Which statement indicates that additional teaching is needed?

  1. “We won’t know if something is wrong until the baby’s chromosomes are tested.”
  2. “This problem is not caused by one of us having a genetic problem.”
  3. “Our baby has an incomplete brain and might not be born alive.”
  4. “Waiting until our 30s did not cause this problem to develop.”

Answer:  1

Explanation:  1. Anencephaly is clearly visualized with an ultrasound and does not require genetic testing to verify a diagnosis.

  1. Genetic abnormalities in either parent are not related to anencephaly.
  2. Anencephaly is a condition in which the skull does not cover the brain completely, and the brain consists mostly of brainstem with little other brain development.
  3. The age of either parent is not related to anencephaly.

Page Ref: 126

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VIII: Professionalism and professional values | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion

Learning Outcome:  LO 7.8-Compare prenatal and postnatal diagnostic procedures used to determine the presence of genetic disorders and the nursing considerations for each.

MNL LO:  Examine the role of the nurse and the process involved in genetic counseling.

 

 

14) A male infant was born 2 days ago, and the nurse assessed the infant as having single palmar crease, poor muscle tone, and low-set ears. Genetic testing of the infant has been ordered by the physician. Which statement should the nurse include when explaining this plan to the parents?

  1. “We will draw blood from both of you to check for abnormal genes.”
  2. “Your son will have his chromosomes sampled and then studied.”
  3. “When your son is 2 years old, he will need a blood test.”
  4. “After your breast milk is in, we will draw blood from your son.”

Answer:  2

Explanation:  1. The parents’ chromosomes do not need to be assessed in order to diagnose the infant.

  1. A single palmar crease, poor muscle tone, and low-set ears could indicate trisomy 18. This diagnosis is confirmed by chromosomal analysis of the infant, using either a buccal smear or a blood specimen.
  2. The chromosome studies will be undertaken as soon as possible.
  3. It is not necessary to wait until the breast milk has come in.

Page Ref: 126, 127

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VIII: Professionalism and professional values | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Planning/Health teaching and health promotion

Learning Outcome:  LO 7.8-Compare prenatal and postnatal diagnostic procedures used to determine the presence of genetic disorders and the nursing considerations for each.

MNL LO:  Examine the role of the nurse and the process involved in genetic counseling.

 

15) The family of a 3-day-old child has just been informed that their child has cystic fibrosis. Which statement to the family should the nurse make?

  1. “I can see that you are adjusting well. I’ll leave you alone for a while.”
  2. “This must be difficult news for you. What questions do you have?”
  3. “Do you have family members or clergy you would like me to call?”
  4. “Why didn’t you have an amniocentesis during your pregnancy?”

Answer:  2

Explanation:  1. When a client is given bad news, the grieving process begins. The family is grieving the loss of a normal child. This family is most likely in the shock/disbelief stage of grief.

  1. This response uses therapeutic communication techniques and portrays a caring attitude towards the family. Asking if the family has questions further facilitates communication.
  2. Although it is good to have supportive family members or a clergy person called if the family desires, it is better for the nurse to take the initiative and establish therapeutic communication and to portray caring.
  3. It is not therapeutic to ask “why” questions. In addition, although cystic fibrosis is diagnosable prenatally, a client opposed to abortion often will not seek prenatal diagnosis, because the pregnancy would not be terminated if the child were affected by a chromosomal abnormality.

Page Ref: 128

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VIII: Professionalism and professional values | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Implementation/Communication

Learning Outcome:  LO 7.9-Examine the emotional impact on a couple undergoing genetic testing or coping with the birth of a baby with a genetic disorder.

MNL LO:  Examine the role of the nurse and the process involved in genetic counseling.

 

16) The couple at 12 weeks’ gestation has been told that their fetus has sickle cell disease. Which statement by the couple indicates that they are adequately coping?

  1. “We knew we were both carriers of sickle cell. We shouldn’t have tried to have a baby.”
  2. “If we had been healthier when we conceived, our baby wouldn’t have this disease now.”
  3. “Taking vitamins before we got pregnant would have prevented this from happening.”
  4. “The doctor told us there was a 25 percent chance that our baby would have sickle cell disease.”

Answer:  4

Explanation:  1. Self-blame and judgment do not indicate coping.

  1. Preconception health does not affect transmission of an autosomal recessive trait.
  2. Nutrition does not affect transmission of an autosomal recessive trait.
  3. A true statement indicates coping. When both the mother and father are carriers of an autosomal recessive disease like sickle cell disease, there is a 25 percent chance of a normal child, a 25 percent chance of a child with sickle-cell disease, and a 50 percent chance of a child with sickle-cell trait.

Page Ref: 128

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VIII: Professionalism and professional values | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Assessment/Communication

Learning Outcome:  LO 7.9-Examine the emotional impact on a couple undergoing genetic testing or coping with the birth of a baby with a genetic disorder.

MNL LO:  Contrast the various genetic inheritance patterns.

 

17) The parents of a child with cystic fibrosis are attending genetic counseling. After their initial visit, they ask the nurse what will happen next. How should the nurse respond?

  1. “Your genetic counseling is a medical matter that can only be discussed with your physician.”
  2. “You will have one more appointment with your genetic counselor and that will conclude your genetic counseling.”
  3. “You will receive a letter from your primary care physician that explains the results of your genetic counseling session.”
  4. “You will have a follow-up visit with your genetic counselor and you will receive additional information at that time.”

Answer:  4

Explanation:  1. The nurse should act as a liaison between the family and genetic counselor.

  1. After a follow-up visit, the family may return to the genetic counselor to ask questions and express concerns, especially if the couple is considering having more children, or if siblings want information about their affected brother or sister.
  2. Upon completion of genetic counseling, the genetic counselor sends the parent(s) and their certified nurse-midwife or physician a letter detailing the contents of the sessions.
  3. After the initial genetic counseling session, a follow-up visit is scheduled in order for the genetic counselor to provide the parents with all available information and offer additional counseling.

Page Ref: 128

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VIII: Professionalism and professional values | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Planning/Communication

Learning Outcome:  LO 7.10-Explain the nurse’s role in supporting the family undergoing genetic counseling.

MNL LO:  Examine the role of the nurse and the process involved in genetic counseling.

 

18) The nurse is planning a group session for parents who are beginning infertility evaluation. Which statement should be included in this session? Select all that apply.

  1. “Infertility can be stressful for a marriage.”
  2. “The doctor will be able to tell why you have not conceived.”
  3. “Your insurance will pay for the infertility treatments.”
  4. “Keep communicating with one another through this process.”
  5. “Taking a vacation usually results in pregnancy.”

Answer:  1, 4

Explanation:  1. Infertility is often stressful on a marriage, as a result of the need to schedule intercourse and pay for treatments and the societal expectation to have children.

  1. Some infertility cannot be explained, despite extensive treatments.
  2. Insurance often does not pay for infertility treatment.
  3. Communication is important to help cope with stress. A nurse should always encourage clients to ask questions.
  4. A common myth is that taking a vacation or just relaxing will result in conception.

Page Ref: 97

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential II: Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Planning/Health teaching and health promotion

Learning Outcome:  LO 7.5-Describe the nurse’s role as counselor, educator, and advocate for couples during infertility evaluation and treatment.

MNL LO:  Explain infertility and its associated risk factors.

 

19) A woman has had her initial infertility work-up and labs. In the next step, the nurse teaches the woman about basal body temperature (BBT) method. The nurse should explain that certain situations can disturb body temperature, which situations should the nurse instruct the client regarding?

  1. Eating
  2. Jet lag
  3. Voiding
  4. Waterbed use
  5. Shift work

Answer:  2, 4, 5

Explanation:  1. BBT is the lowest waking temperature. Clients should be cautioned against anything that would increase temperature before taking the temperature, examples include smoking, waterbed and Jacuzzi use, jet lag, and shift work.

  1. BBT is the lowest waking temperature. Clients should be cautioned against anything that would increase temperature before taking the temperature, examples include smoking, waterbed and Jacuzzi use, jet lag, and shift work.
  2. BBT is the lowest waking temperature. Clients should be cautioned against anything that would increase temperature before taking the temperature, examples include smoking, waterbed and Jacuzzi use, jet lag, and shift work.
  3. BBT is the lowest waking temperature. Clients should be cautioned against anything that would increase temperature before taking the temperature, examples include smoking, waterbed and Jacuzzi use, jet lag, and shift work.
  4. BBT is the lowest waking temperature. Clients should be cautioned against anything that would increase temperature before taking the temperature, examples include smoking, waterbed and Jacuzzi use, jet lag, and shift work.

Page Ref: 142

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Assessment/Health teaching and health promotion

Learning Outcome:  LO 7.5-Describe the nurse’s role as counselor, educator, and advocate for couples during infertility evaluation and treatment.

MNL LO:  Recognize the various strategies for managing infertility.

 

20) The first-line therapy to induce ovulation in women with normal ovaries, normal prolactin level and an intact pituitary is Clomiphene citrate. The nurse also teaches about what side effects?

  1. Dryness/loss of hair
  2. Hot flashes
  3. Visual disturbances
  4. Weight gain
  5. Hair growth

Answer:  1, 2, 3

Explanation:  1. The side effects the nurse should teach about are dryness and loss of hair, hot flashes, nausea and vomiting, visual disturbances, headaches, multiple pregnancies, pain and breast discomfort.

  1. The side effects the nurse should teach about are dryness and loss of hair, hot flashes, nausea and vomiting, visual disturbances, headaches, multiple pregnancies, pain and breast discomfort.
  2. The side effects the nurse should teach about are dryness and loss of hair, hot flashes, nausea and vomiting, visual disturbances, headaches, multiple pregnancies, pain and breast discomfort.
  3. The side effects the nurse should teach about are dryness and loss of hair, hot flashes, nausea and vomiting, visual disturbances, headaches, multiple pregnancies, pain and breast discomfort.
  4. The side effects the nurse should teach about are dryness and loss of hair, hot flashes, nausea and vomiting, visual disturbances, headaches, multiple pregnancies, pain and breast discomfort.

Page Ref: 148

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Assessment/Health teaching and health promotion

Learning Outcome:  LO 7.5-Describe the nurse’s role as counselor, educator, and advocate for couples during infertility evaluation and treatment.

MNL LO:  Recognize the various strategies for managing infertility.

Contemporary Maternal-Newborn Nursing, 9e (Ladewig et al.)

Chapter 20   Childbirth at Risk: Pre-Labor and Intrapartum Complications

 

1) The nurse is caring for a client at 30 weeks’ gestation who is experiencing preterm premature rupture of membranes (PPROM). Which statement indicates that the client needs additional teaching?

  1. “If I were having a singleton pregnancy instead of twins, my membranes would probably not have ruptured.”
  2. “If I develop a urinary tract infection in my next pregnancy, I might rupture membranes early again.”
  3. “If I want to become pregnant again, I will have to plan on being on bed rest for the whole pregnancy.”
  4. “If I have bleeding in the third trimester of my next pregnancy, I might rupture membranes again.”

Answer:  3

Explanation:  1. Multifetal gestation increases the risk for PPROM.

  1. A UTI increases the risk for PPROM.
  2. There is no evidence indicating that bed rest in a subsequent pregnancy decreases the risk for PPROM.
  3. Second- and third-trimester bleeding increases the risk for PPROM.

Page Ref: 405

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion

Learning Outcome:  LO 20.1-Explain the possible causes, risk factors, and clinical therapy for premature rupture of the membranes or preterm labor in determining the hospital-based and community-based nursing management of the woman and her fetus/newborn.

MNL LO:  Compare obstetric emergencies and their implications for nursing care.

 

2) A clinical nurse coordinator is teaching a class of nursing students about surgical and postoperative care of the woman who undergoes cerclage. Which nursing student’s statement indicates the need for further clarification of the teaching?

  1. “Sometimes cerclage can be performed on an outpatient basis.”
  2. “If cerclage is performed emergently, the woman will usually be hospitalized for at least 5 days.”
  3. “If the woman’s amniotic sac is bulging, the cerclage is contraindicated and the procedure cannot be performed.”
  4. “After 37 weeks’ gestation, the woman’s cerclage may be cut in order to allow for vaginal delivery.”

Answer:  3

Explanation:  1. An uncomplicated elective cerclage may be done on an outpatient basis or the woman may be hospitalized and discharged after 24 to 48 hours. An emergency cerclage, however, requires hospitalization for 5 to 7 days or longer.

  1. An uncomplicated elective cerclage may be done on an outpatient basis or the woman may be hospitalized and discharged after 24 to 48 hours. An emergency cerclage, however, requires hospitalization for 5 to 7 days or longer.
  2. Decompression of a bulging amniotic sac is not a contraindication to cerclage; rather, the amniotic sac must be decompressed immediately before the procedure.
  3. After 37 completed weeks’ gestation, the suture may be cut and vaginal birth permitted, or the suture may be left in place and a cesarean birth performed.

Page Ref: 418

Cognitive Level:  Evaluating

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential II: Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Evaluation/Education

Learning Outcome:  LO 20.3-Describe the clinical therapies and appropriate nursing interventions for the mother with cervical insufficiency and her fetus.

MNL LO:  Compare obstetric emergencies and their implications for nursing care.

 

3) A 26-year-old woman who is pregnant with her first child is admitted to the obstetrics unit with a diagnosis of cervical insufficiency. Based upon the client’s diagnosis, how is she most likely to describe her symptoms?

  1. “I’ve been having contractions every four hours.”
  2. “My cervical pain has gotten much worse over the past two days.”
  3. “I’m not having any pain, but my contractions are getting stronger.”
  4. “I’m not having any pain and I don’t feel any contractions.”

Answer:  4

Explanation:  1. Cervical insufficiency (formerly called incompetent cervix) is painless dilatation of the cervix without contractions due to a structural or functional defect of the cervix.

  1. Cervical insufficiency (formerly called incompetent cervix) is painless dilatation of the cervix without contractions due to a structural or functional defect of the cervix.
  2. Cervical insufficiency (formerly called incompetent cervix) is painless dilatation of the cervix without contractions due to a structural or functional defect of the cervix.
  3. Cervical insufficiency (formerly called incompetent cervix) is painless dilatation of the cervix without contractions due to a structural or functional defect of the cervix.

Page Ref: 417

Cognitive Level:  Evaluating

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Assessment/Coordination of care

Learning Outcome:  LO 20.3-Describe the clinical therapies and appropriate nursing interventions for the mother with cervical insufficiency and her fetus.

MNL LO:  Compare obstetric emergencies and their implications for nursing care.

 

4) The nurse has received an end of shift report in the high-risk maternity unit. Which client should the nurse see first?

  1. 26 weeks’ gestation with placenta previa experiencing blood on toilet tissue after a bowel movement
  2. 30 weeks’ gestation with placenta previa whose fetal monitor strip shows late decelerations
  3. 35 weeks’ gestation with grade I abruptio placentae in labor who has a strong urge to push
  4. 37 weeks’ gestation with pregnancy-induced hypertension whose membranes ruptured spontaneously

Answer:  1

Explanation:  1. Bleeding with a placenta previa is a complication that can be life-threatening to both the mother and baby. This client is the highest priority.

  1. Late decelerations are an abnormal finding, but put only the fetus at risk. This patient is not the highest priority.
  2. Grade I abruptio placentae creates slight vaginal bleeding. The urge to push indicates that delivery is near. This patient is not the highest priority.
  3. Although pregnancy-induced hypertension puts a woman at risk for developing abruptio placentae, there is no indication that this patient is experiencing this complication. This patient is not the highest priority.

Page Ref: 410

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Planning/Coordination of care

Learning Outcome:  LO 20.2-Compare placenta previa and abruptio placentae, including implications for the mother and the fetus, as well as nursing care.

MNL LO:  Contrast the bleeding disorders of late pregnancy and their implications for nursing care.

 

5) The nurse is planning an in-service educational program to talk about disseminating intravascular coagulation (DIC). The nurse should identify which of the following as risk factors for developing DIC? Select all that apply.

  1. Diabetes mellitus
  2. Abruptio placentae
  3. Prolonged retention of a fetus after demise
  4. Multiparity
  5. Preterm labor

Answer:  2, 3

Explanation:  1. Diabetes, multiparity, and preterm labor do not cause the same release of thromboplastin that triggers DIC.

  1. Abruptio placentae leave intrauterine arteries open and bleeding. This results in release of thromboplastin into the maternal blood supply and triggers the development of DIC. In prolonged retention of the fetus after demise, thromboplastin is released from the degenerating fetal tissues into the maternal bloodstream, which activates the extrinsic clotting system. This triggers the formation of multiple tiny clots, which deplete the fibrinogen and factors V and VII, and result in DIC.
  2. Abruptio placentae leave intrauterine arteries open and bleeding. This results in release of thromboplastin into the maternal blood supply and triggers the development of DIC. In prolonged retention of the fetus after demise, thromboplastin is released from the degenerating fetal tissues into the maternal bloodstream, which activates the extrinsic clotting system. This triggers the formation of multiple tiny clots, which deplete the fibrinogen and factors V and VII, and result in DIC.
  3. Diabetes, multiparity, and preterm labor do not cause the same release of thromboplastin that triggers DIC.
  4. Diabetes, multiparity, and preterm labor do not cause the same release of thromboplastin that triggers DIC.

Page Ref: 414

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential II: Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Planning/Education

Learning Outcome:  LO 20.2-Compare placenta previa and abruptio placentae, including implications for the mother and the fetus, as well as nursing care.

MNL LO:  Contrast the bleeding disorders of late pregnancy and their implications for nursing care.

 

6) The client at 30 weeks’ gestation is admitted with painless late vaginal bleeding. The nurse understands that expectant management includes:

  1. Limiting vaginal exams to only one per 24-hour period.
  2. Evaluating the fetal heart rate with an internal monitor.
  3. Monitoring for blood loss, pain, and uterine contractibility.
  4. Assessing blood pressure every 2 hours.

Answer:  3

Explanation:  1. Vaginal exams are contraindicated because the exam can stimulate bleeding.

  1. Fetal heart rate monitoring will be done with an external fetal monitor. The placenta is covering the cervical os, and therefore the fetal scalp cannot be accessed to apply an internal monitor.
  2. Blood loss, pain, and uterine contractibility need to be assessed for client comfort and safety.
  3. Blood pressure measurements every 2 hours are unnecessary. They can be done on a routine basis or when necessary.

Page Ref: 411

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Planning/Coordination of care

Learning Outcome:  LO 20.2-Compare placenta previa and abruptio placentae, including implications for the mother and the fetus, as well as nursing care.

MNL LO:  Contrast the bleeding disorders of late pregnancy and their implications for nursing care.

 

7) A multigravida client is admitted to labor and delivery in active labor. Nursing diagnoses that might apply to the client with suspected abruptio placentae include (select all that apply):

  1. Fluid volume, risk for deficit related to hypovolemia.
  2. Tissue perfusion, risk for altered related to blood loss.
  3. Anxiety related to concern for own safety.
  4. Knowledge deficit related to lack of information about inherited genetic defects.

Answer:  1, 2, 3

Explanation:  1. Maternal and perinatal fetal mortality are concerns due to blood loss and hypoxia.

  1. Maternal and perinatal fetal mortality are concerns due to blood loss and hypoxia.
  2. Maternal and perinatal fetal mortality are concerns due to blood loss and hypoxia.
  3. Abruptio placentae is a premature separation of the placenta, not a genetic abnormality.

Page Ref: 415-416

Cognitive Level:  Application

Client Need&Sub:  Physiological Integrity | Reduction of Risk Potential

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Diagnosis/Coordination of care

Learning Outcome:  LO 20.2-Compare placenta previa and abruptio placentae, including implications for the mother and the fetus, as well as nursing care.

MNL LO:  Contrast the bleeding disorders of late pregnancy and their implications for nursing care.

8) The charge nurse is reviewing the physician’s notes describing the diagnosis of abruptio placentae in a client who is currently admitted. The physician describes the woman’s placental separation as being “central.” Based upon this description, what can the nurse infer about the woman’s condition?

  1. Blood is trapped between the woman’s placenta and the uterine wall, and she may have concealed bleeding.
  2. The total separation of the woman’s placenta from the uterine wall will lead to massive hemorrhage.
  3. Blood is passing between the fetal membranes and the woman’s uterine wall, which will lead to some vaginal bleeding.
  4. The slight separation of the woman’s placenta from the uterine wall will not produce any bleeding.

Answer:  1

Explanation:  1. With the central type of placental separation, blood is trapped between the placenta and uterine wall with concealed bleeding.

  1. With marginal placental separation, blood passes between the fetal membranes and the uterine wall and escapes vaginally. With central placental separation, blood is trapped between the placenta and uterine wall, and bleeding is concealed. With complete separation, there is total separation of the placenta from the uterine wall, and massive bleeding ensues.
  2. With marginal placental separation, blood passes between the fetal membranes and the uterine wall and escapes vaginally. With central placental separation, blood is trapped between the placenta and uterine wall, and bleeding is concealed. With complete separation, there is total separation of the placenta from the uterine wall, and massive bleeding ensues.
  3. With marginal placental separation, blood passes between the fetal membranes and the uterine wall and escapes vaginally. With central placental separation, blood is trapped between the placenta and uterine wall, and bleeding is concealed. With complete separation, there is total separation of the placenta from the uterine wall, and massive bleeding ensues.

Page Ref: 413

Cognitive Level:  Evaluating

Client Need&Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Assessment/Coordination of care

Learning Outcome:  LO 20.2-Compare placenta previa and abruptio placentae, including implications for the mother and the fetus, as well as nursing care.

MNL LO:  Contrast the bleeding disorders of late pregnancy and their implications for nursing care.

 

9) The home health nurse is admitting a client at 18 weeks who is pregnant with twins. Which nursing action is most important?

  1. Teach the client about foods that are good sources of protein.
  2. Assess the client’s blood pressure in her upper right arm.
  3. Determine whether the pregnancy is a result of infertility treatment.
  4. Collect a cervicovaginal fetal fibronectin (fFN) specimen.

Answer:  1

Explanation:  1. A diet containing 3500 kcal (minimum) and 175 g protein is recommended for a woman with normal-weight twins. Teaching about protein sources facilitates adequate fetal growth.

  1. Pre-eclampsia is not diagnosed until the 20 weeks’ gestation. This client is only at 18 weeks. Further, blood pressure can be assessed in either arm when the client is in a sitting position; in a side-lying position, the blood pressure should be assessed in the upper arm.
  2. Although the incidence of multifetal pregnancy is higher in pregnancies resulting from infertility treatment than in those resulting from spontaneous pregnancies, the cause of the multifetal pregnancy does not impact nursing care.
  3. Preterm labor is not diagnosed until 20 weeks. This client is only at 18 weeks. Fetal fibronectin (fFN) testing is not indicated at this time.

Page Ref: 419

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Implementation/Coordination of care

Learning Outcome:  LO 20.4-Explain the maternal and fetal/neonatal implications and the clinical therapy in determining the community-based and hospital-based nursing care management of the woman with multiple gestation.

MNL LO:  Describe factors that present nutritional concerns during pregnancy.

 

10) In counseling a newly pregnant gravida 1 at 8 weeks’ twin gestation, the nurse teaches the woman about the need for increased caloric intake. The nurse would tell the woman that the minimum recommended intake should be:

  1. 2500 kcal and 120 g protein.
  2. 3000 kcal and 150 g protein.
  3. 3500 kcal and 175 g protein.
  4. 4000 kcal and 190 g protein.

Answer:  3

Explanation:  1. This is less than recommended for a twin-gestation pregnancy.

  1. This is less than recommended for a twin-gestation pregnancy.
  2. This is the recommended caloric and protein intake in a twin-gestation pregnancy.
  3. This is more than recommended for a twin-gestation pregnancy.

Page Ref: 419

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Implementation/Health teaching and health promotion

Learning Outcome:  LO 20.4-Explain the maternal and fetal/neonatal implications and the clinical therapy in determining the community-based and hospital-based nursing care management of the woman with multiple gestation.

MNL LO:  Recognize nutritional requirements specific to pregnancy.

 

11) When a woman who is experiencing a multiple fetal pregnancy asks, “What are the chances of having an uncomplicated pregnancy?” the nurse answers with which statement?

  1. The perinatal mortality rate for monoamniotic siblings is 50 percent.
  2. Twins are less likely to have complications than are singleton births.
  3. Primiparous women pregnant with twins are less likely to develop complications.
  4. Spontaneously conceived twins are less likely to develop complications.

Answer:  4

Explanation:  1. The perinatal mortality rate for monoamniotic siblings is 10 to 32 percent.

  1. Twins are more likely to have complications than are singleton births.
  2. Primiparous women with twin pregnancies are more likely to develop complications.
  3. This is true. Spontaneously conceived twins are less likely to develop complications.

Page Ref: 419

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Planning/Health teaching and health promotion

Learning Outcome:  LO 20.4-Explain the maternal and fetal/neonatal implications and the clinical therapy in determining the community-based and hospital-based nursing care management of the woman with multiple gestation.

MNL LO:  Implement nursing interventions that address pregnant women with special concerns.

12) The client at 38 weeks’ gestation has been diagnosed with oligohydramnios. Which statement indicates that teaching has been effective?

  1. “My gestational diabetes may have caused this problem to develop.”
  2. “When I go into labor, I should come to the hospital right away.”
  3. “This problem is common and will likely occur with my next pregnancy.”
  4. “Women with this condition usually go into labor after their due date.”

Answer:  2

Explanation:  1. Gestational diabetes can lead to polyhydramnios but does not cause oligohydramnios.

  1. The incidence of cord compression and resulting fetal distress is high when there is an inadequate amount of amniotic fluid to cushion the umbilical cord. Thus, the patient with oligohydramnios should come to the hospital in early labor to detect any fetal intolerance of labor that might develop.
  2. Oligohydramnios occurs in 1 to 3 percent of pregnancies. It rarely recurs in subsequent pregnancies.
  3. The risk of fetal demise is increased with oligohydramnios. Labor is usually induced when the patient reaches term pregnancy to prevent fetal demise.

Page Ref: 421

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion

Learning Outcome:  LO 20.5-Compare the identification, maternal and fetal/neonatal implications, clinical therapy, and nursing care management of women with hydramnios and oligohydramnios.

MNL LO:  Implement nursing interventions that address pregnant women with special concerns.

 

13) The nurse is admitting a client who was diagnosed with hydramnios. The client asks why she has developed this condition. The nurse should explain that hydramnios is sometimes associated with (select all that apply):

  1. Chest pain, dyspnea, tachycardia, and hypotension.
  2. Postmaturity syndrome.
  3. Renal malformation or dysfunction.
  4. Maternal diabetes.
  5. Large-for-gestational-age infants.

Answer:  1, 2, 4

Explanation:  1. Chest pain, dyspnea, tachycardia, and hypotension are symptoms of amniotic embolism, which occurs more commonly with hydramnios. Hydramnios occurs in 10 to 20 percent of pregnant diabetics.

  1. Renal malformation or dysfunction and postmaturity can cause oligohydramnios.
  2. Renal malformation or dysfunction and postmaturity can cause oligohydramnios.
  3. Hydramnios is not associated with maternal diabetes.
  4. Large-for-gestational-age infants and placenta previa are not associated with hydramnios.

Page Ref: 420-421

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Implementation/Health teaching and health promotion

Learning Outcome:  LO 20.5-Compare the identification, maternal and fetal/neonatal implications, clinical therapy, and nursing care management of women with hydramnios and oligohydramnios.

MNL LO:  Implement nursing interventions that address pregnant women with special concerns.

 

14) When caring for a laboring client with oligohydramnios, the nurse should be aware that (select all that apply):

  1. There is an increased risk of cord compression.
  2. There is less fluid available for the fetus to use during fetal breathing movements; therefore, pulmonary hypoplasia can develop, which could cause respiratory difficulties at birth.
  3. Labor progress is often more rapid than average.
  4. Early decelerations are more likely.

Answer:  1, 2, 4

Explanation:  1. Less amniotic fluid lessens the cushioning effect, and cord compression is more likely.

  1. There is less fluid available for the fetus to use during fetal breathing movements.
  2. Labor progress is slower than average due to the decreased fluid volume.
  3. Decreased amniotic fluid can contribute to fetal head compression, which manifests itself in early decelerations.

Page Ref: 421

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Planning/Coordination of care

Learning Outcome:  LO 20.5-Compare the identification, maternal and fetal/neonatal implications, clinical therapy, and nursing care management of women with hydramnios and oligohydramnios.

MNL LO:  Implement nursing interventions that address pregnant women with special concerns.

 

15) Hydramnios most likely would be suspected when:

  1. There is less amniotic fluid than normal for gestation.
  2. The fundal height increases disproportionately to the gestation.
  3. The woman has a twin gestation.
  4. The quadruple screen comes back positive.

Answer:  2

Explanation:  1. Hydramnios occurs when there is more amniotic fluid than normal for gestation.

  1. The increased amount of amniotic fluid will increase the fundal height disproportionately to the gestation.
  2. Hydramnios is not suspected simply by virtue of a twin gestation.
  3. A positive quadruple screen is not indicative of hydramnios.

Page Ref: 420-421

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Assessment/Coordination of care

Learning Outcome:  LO 20.5-Compare the identification, maternal and fetal/neonatal implications, clinical therapy, and nursing care management of women with hydramnios and oligohydramnios.

MNL LO:  Implement nursing interventions that address pregnant women with special concerns.

16) Matching the four types of abruptio placenta with their location of separation.

 

  1. The placenta separates at its edges, the blood passes

between the fetal membranes and the uterine wall, and the blood escapes vaginally.

  1. Massive vaginal bleeding.
  2. Separation occurs. May be minimal or moderate, can progress to complete separation.
  3. The placenta, and the blood is trapped between the placenta and the uterine wall, bleeding results in concealed bleeding.

 

________ A. Complete

________ B. Partial

________ C. Marginal

________ D. Central

Answer:  1/C, 2/A, 3/B, 4/D

Explanation:  1: C–Marginal

2: A–Complete

3: B–Partial

4: D–Central

Page Ref: 413

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Evaluation/Coordination of care

Learning Outcome:  LO 20.2-Compare placenta previa and abruptio placentae, including implications for the mother and the fetus, as well as nursing care.

MNL LO:  Implement nursing interventions that address pregnant women with special concerns.

 

17) The nurse is caring for a G3P0 woman at 13 weeks’ gestation experiencing cervical dilation and funneling. What risk factors may warrant prophylactic placement of a cerclage? Select all that apply.

  1. Two previous second trimester pregnancy losses with relatively painless, early cervical dilation.
  2. One previous third trimester pregnancy losses with painful cervical dilation.
  3. Two early preterm births not related to infection, placental bleeding, preterm labor or multiple gestation.
  4. One preterm birth (less than 36 weeks) not related to infection, placental bleeding, preterm labor or multiple gestation.
  5. Three preterm births (less than 34 weeks) not related to infection, placental bleeding, preterm labor or multiple gestation.

Answer:  1, 5

Explanation:  1. This circumstance warrants placement of cerclage.

  1. This circumstance does not warrant placement of cerclage.
  2. This circumstance does not warrant placement of cerclage.
  3. This circumstance does not warrant placement of cerclage.
  4. This circumstance warrants placement of cerclage.

Page Ref: 417

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Evaluation/Coordination of care

Learning Outcome:  LO 20.3-Describe the clinical therapies and appropriate nursing interventions for the mother with cervical insufficiency and her fetus.

MNL LO:  Implement nursing interventions that address pregnant women with special concerns.

 

 

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