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Maternity & Women’s Health Care 10th Edition by Kathryn Rhodes – ‎Deitra Leonard Lowdermilk – Test Bank
Sample  Questions      

Lowdermilk: Maternity & Women’s Health Care, 10th Edition

 

Chapter 01: 21st Century Maternity and Women’s Health Nursing

 

Test Bank

 

MULTIPLE CHOICE

 

  1. To assess a mother’s risk of having a low-birth-weight (LBW) infant, what is the most important factor for the nurse to consider?
a. African-American race
b. Cigarette smoking
c. Poor nutritional status
d. Limited maternal education

 

ANS: A

For African-American births, the incidence of LBW infants is twice that of Caucasian births. Race is a nonmodifiable risk factor.

Cigarette smoking is an important factor in potential infant mortality rates, but it is not the most important. Additionally, smoking is a modifiable risk factor.

Poor nutrition is an important factor in potential infant mortality rates, but it is not the most important. Additionally, nutritional status is a modifiable risk factor.

Maternal education is an important factor in potential infant mortality rates, but it is not the most important. Additionally, maternal education is a modifiable risk factor.

 

DIF:   Cognitive Level: Comprehension             REF:  5

OBJ:  Client Needs: Health Promotion and Maintenance: Antepartum Care

TOP:  Nursing Process: Assessment

 

  1. What is the primary role of practicing nurses in the research process?
a. Designing research studies
b. Collecting data for other researchers
c. Identifying researchable problems
d. Seeking funding to support research studies

 

ANS: C

When problems are identified, research can be conducted properly. Research of health care issues leads to evidence-based practice guidelines.

Designing research studies is only one factor of the research process.

Data collection is one factor of research.

Financial support is necessary to conduct research, but it is not the primary role of the nurse in the research process.

 

DIF:   Cognitive Level: Comprehension             REF: 14

OBJ:  Client Needs: Safe and Effective Care Environment

TOP:  “Nursing Process: Diagnosis, Evaluation”

  1. The nurse should be aware that a statistic widely used to compare the health status of different populations is the:
a. Incidence of specific infections, such as acquired immunodeficiency syndrome (AIDS) and tuberculosis
b. Infant mortality rate
c. Maternal morbidity rate
d. Incidence of low-birth-weight (LBW) infants

 

ANS: B

City, county, and state health departments provide annual reports of births and deaths. Maternal and infant death rates are particularly important because they reflect health outcomes that may be preventable. Infant mortality continues to be a concern in all populations.

AIDS and tuberculosis may be the target of research studies; however, maternal and infant mortality rates are particularly important in the evaluation of the health of a population.

The number of maternal deaths in the United States is small; however, worldwide many women die each year from problems related to pregnancy and childbirth.

The incidence of LBW infants is monitored in order to determine risk factors such as racial disparity. It is not as widely used as infant mortality.

 

DIF:   Cognitive Level: Knowledge        REF:  5

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Assessment

 

  1. Alternative and complementary therapies:
a. Replace conventional Western modalities of treatment
b. Are used by only a small number of American adults
c. Allow for more client autonomy
d. Focus primarily on the disease an individual is experiencing

 

ANS: C

City, county, and state health departments provide annual reports of births and deaths. Maternal and infant death rates are particularly important because they reflect health outcomes that may be preventable. Infant mortality continues to be a concern in all populations.

Alternative and complementary therapies are part of an integrative approach to health care.

An increasing number of American adults are seeking alternative and complementary health care options.

Alternative healing modalities offer a holistic approach to health, focusing on the whole person and not just the disease.

 

DIF:   Cognitive Level: Comprehension             REF: 3

OBJ:  Client Needs: Physiologic Integrity

TOP:  Nursing Process: Planning

  1. The nurses working at a newly established birthing center have begun to compare their performance in providing maternal-newborn care against clinical standards. This comparison process, designed to improve the quality of client care, is called:
a. Best practices network
b. Clinical benchmarking
c. Outcomes-oriented care
d. Evidence-based practice

 

ANS: C

Outcomes-oriented care measures effectiveness of interventions and quality of care against benchmarks or standards.

The term best practice refers to a program or service that has been recognized for excellence.

Clinical benchmarking is a process used to compare one’s own performance against the performance of the best in an area of service.

The term evidence-based practice refers to the provision of care based on evidence gained through research and clinical trials.

 

DIF:   Cognitive Level: Comprehension             REF: 11

OBJ:  Client Needs: Safe and Effective Care Environment

TOP:  Nursing Process: Evaluation

 

  1. Contemporary maternity nursing is exemplified by:
a. The use of midwives for all vaginal deliveries
b. Family-centered care
c. Free-standing birth clinics
d. Physician-driven care

 

ANS: B

Contemporary maternity nursing focuses on the family’s needs and desires.

Midwives and physicians both perform vaginal deliveries.

Free-standing clinics are an example of alternative birth options.

Contemporary maternity nursing is driven by the relationship between nurses and their clients.

 

DIF:   Cognitive Level: Comprehension             REF:  8

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Planning

 

  1. A 38-year-old Hispanic woman delivered a 9-lb, 6-oz baby girl vaginally after being in labor for 43 hours. The baby died 3 days later from sepsis. On what grounds could the woman have a legitimate legal case for negligence?
a. She is Hispanic.
b. She delivered a girl.
c. If the standards of care were not met.
d. She refused fetal monitoring.

ANS: C

Not meeting the standards of care is a legitimate factor for a case of negligence.

The client’s race is not a factor for a case of negligence.

The infant’s gender is not a factor for a case of negligence.

Although fetal monitoring is the standard of care, the client has the right to refuse treatment. This refusal is not a case for negligence, but informed consent should be properly obtained, and the client should sign an against medical advice form for refusal of any treatment that is within the standard of care.

 

DIF:   Cognitive Level: Analysis             REF:  “11, 12”

OBJ:  Client Needs: Safe and Effective Care Environment

TOP:  Nursing Process: Implementation

 

  1. The National Quality Forum has issued a list of “never events” pertaining specifically to maternal and child health. These include all except:
a. Infant discharged to the wrong person
b. Kernicterus associated with failure to identify and treat hyperbilirubinemia
c. Artificial insemination with wrong donor sperm or egg
d. Foreign object retained after surgery

 

ANS: D

Although a foreign object retained after surgery is a never event, this does not pertain specifically to obstetric clients. A client undergoing any type of surgery may be at risk for this event.

An infant discharged to the wrong person pertains specifically to postpartum care.

Death or serious disability as a result of kernicterus pertains to newborn assessment and care.

Artificial insemination affects families seeking care for infertility.

 

DIF:   Cognitive Level: Knowledge        REF:  4

OBJ:  Client Needs: Safe and Effective Care Environment

TOP:  Nursing Process: Implementation

 

  1. An important development that concerns maternity nursing is integrative health care, which:
a. Seeks to provide the same health care for all racial and ethnic groups
b. Blends complementary and alternative therapies with conventional Western treatment
c. Focuses on the disease or condition rather than the client’s background
d. Has been mandated by Congress

 

ANS: B

Integrative health care tries to mix the old with the new at the discretion of the client and health care providers.

Integrative health care is a blending of new and traditional practices.

Integrative health care focuses on the whole person, not just the disease or condition.

U.S. law supports complementary and alternative therapies but does not mandate them.

 

DIF:   Cognitive Level: Knowledge        REF:  3

OBJ:  Client Needs: Physiologic Integrity

TOP:  Nursing Process: Planning

 

  1. A nurse caring for a pregnant client should be aware that the U.S. birth rate shows what trend?
a. Births to unmarried women are more likely to have less favorable outcomes.
b. Birth rates for women 40 to 44 years of age are declining.
c. Cigarette smoking among pregnant women continues to increase.
d. The rates of pregnancy and abortion among teens are lower in the United States than in any other industrialized country.

 

ANS: A

Low-birth-weight infants and preterm birth are more likely because of the large number of teenagers in the unmarried group.

Birth rates for women in their early 40s continue to increase.

Fewer pregnant women smoke.

Teen pregnancy and abortion rates are higher in the United States than in any other industrial country.

 

DIF:   Cognitive Level: Comprehension             REF:  5

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Assessment

 

  1. The high cost of health care in the United States is most likely a result of:
a. Early postpartum discharge policies
b. Midwifery care
c. The involvement of nurses in the politics of cost containment
d. An emphasis on the use of advanced technology in care

 

ANS: D

The use of advanced technology in care increases costs. Caring for the increased number of low-birth-weight infants in neonatal intensive care unit (NICU) settings contributes significantly to increased health care costs.

Early discharges reduce costs.

Midwifery care reduces costs.

Involvement of nurses should ameliorate costs.

 

DIF:   Cognitive Level: Comprehension             REF:  4

OBJ:  Client Needs: Safe and Effective Care Environment

TOP:  Nursing Process: Assessment

 

 

 

  1. Maternity nursing care that is based on knowledge gained through research and clinical trials is:
a. Derived from the Nursing Intervention Classification
b. Known as evidence-based practice
c. At odds with the Cochrane School of traditional nursing
d. An outgrowth of telemedicine

 

ANS: B

Evidence-based practice is based on knowledge gained from research and clinical trials.

The Nursing Intervention Classification is a method of standardizing language and categorizing care.

Dr. Cochrane systematically reviewed research trials and is part of the evidence-based practice movement.

Telemedicine uses communication technologies to support health care.

 

DIF:   Cognitive Level: Comprehension             REF:  9

OBJ:  Client Needs: Safe and Effective Care Environment

TOP:  Nursing Process: Diagnosis

 

  1. The level of practice a reasonably prudent nurse provides is called:
a. The standard of care
b. Risk management
c. A sentinel event
d. Failure to rescue

 

ANS: A

Guidelines for standards of care are published by various professional nursing organizations.

Risk management identifies risks and establishes preventive practices, but it does not define the standard of care.

Sentinel events are unexpected negative occurrences. They do not establish the standard of care.

Failure to rescue is an evaluative process for nursing, but it does not define the standard of care.

 

DIF:   Cognitive Level: Knowledge        REF:  12

OBJ:  Client Needs: Safe and Effective Care Environment

TOP:  Nursing Process: Implementation

 

 

 

 

 

 

 

 

  1. During a prenatal intake interview, the client informs the nurse that she would prefer a midwife to provide both her care during pregnancy and deliver her infant. What information is most appropriate for the nurse to share with this client?
a. Midwifery care is only available to clients who are uninsured because their services are less expensive than an obstetrician. Costs are often lower than an obstetric provider.
b. The client will receive fewer interventions during the birth process.
c. She should be aware that midwives are not certified.
d. Her delivery can take place only at home or in a birth center.

ANS: B

This client will be able to participate actively in all decisions related to the birth process and is likely to receive fewer interventions during the birth process.

Midwifery services are available to all low risk pregnant women, regardless of the type of insurance they have.

Midwifery care in all developed countries is strictly regulated by a governing body that ensures that core competencies are met. In the United States, this body is the American College of Nurse-Midwives (ACNM).

Midwives can provide care and delivery at home, in freestanding birth centers, and in community and teaching hospitals.

 

DIF:   Cognitive Level: Comprehension             REF:  8

OBJ:  Client Needs: Safe and Effective Care Environment

TOP:  Nursing Process: Planning

 

  1. While obtaining a detailed history from a woman who has recently immigrated from Somalia, the nurse realizes that the client has undergone female genital mutilation. The nurse’s best response to this client is:
a. “This is a very abnormal practice and rarely seen in the United States.”
b. “Are you aware of who performed this so that it can be reported to the authorities?”
c. “We will be able to fully restore your circumcision after delivery.”
d. “The extent of your circumcision will affect the potential for complications.”

 

ANS: D

The extent of the circumcision is important. The client may experience pain, bleeding, scarring, or infection and may require surgery prior to childbirth.

Although this practice is not prevalent in the United States, it is very common in many African and Middle Eastern countries for religious reasons. Mentioning that the practice is abnormal and rarely seen in the United States is culturally insensitive.

The infibulation may have occurred during infancy or childhood. The client will have little to no recollection of the event. She would have considered this to be a normal milestone during her growth and development.

The International Council of Nurses has spoken out against this procedure as harmful to a woman’s health.

 

 

DIF:   Cognitive Level: Analysis             REF:  “8, 9”

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Assessment

 

  1. In order to ensure client safety, the practicing nurse must have knowledge of The Joint Commission’s current “Do Not Use” list of abbreviations. Which term is acceptable for use regarding medication administration?
a. q.o.d. or Q.O.D
b. MSO4 or MgSO4
c. International Unit
d. Lack of a leading zero

 

ANS: C

I.U. and i.u. are no longer acceptable because they could be misread as “I.V.” or the number 10.

Q.O.D. should be written out as “every other day.” The period after the “Q” could be mistaken for an “I” and the “o” could also be mistaken for an “i.”

It is too easy to confuse one medication for another. These medications are used for very different purposes and could put a client at risk for an adverse outcome. They should be written as morphine sulfate and magnesium sulfate.

The decimal point should never be missed before a number, to avoid confusion; i.e., 0.4 rather than .4. A leading zero is the preferred term.

 

DIF:   Cognitive Level: Knowledge        REF:  13

OBJ:  Client Needs: Safe and Effective Care Environment

TOP:  Nursing Process: Implementation

 

  1. Maternity nurses can enhance communication among health care providers by utilizing the SBAR technique. This acronym stands for:
a. Situation, Background, Assessment, Recommendation
b. Situation, Baseline, Assessment, Recommendation
c. Subjective, Background, Analysis, Recommendation
d. Subjective, Background, Analysis, Review

 

ANS: A

SBAR is an easy to remember, useful, concrete mechanism for communicating important information that requires a clinician’s immediate attention.

Baseline is not discussed as part of SBAR.

Subjective and analysis are not specific to the SBAR acronym.

Subjective, analysis, and review are not specific to the SBAR acronym.

 

DIF:   Cognitive Level: Application        REF:  “13, 14”

OBJ:  Client Needs: Safe and Effective Care Environment

TOP:  Nursing Process: Implementation

 

 

 

MULTIPLE RESPONSE

 

  1. Examples of alternative healing modalities include (choose all that apply):
a. Acupuncture
b. Meditation
c. Yoga
d. Antibiotics
e. Chelation therapy

 

ANS: A, B, C, E

Acupuncture, meditation, yoga, and chelation therapy are examples of alternative healing modalities.

Western medicine uses antibiotics. Macrobiotics are commonly used as an alternative therapy.

 

DIF:   Cognitive Level: Comprehension             REF:  3

OBJ:  Client Needs: Physiologic Integrity

TOP:  “Nursing Process: Planning, Intervention”

 

  1. Which methods help alleviate the problems associated with access to health care for the maternity client? Choose all that apply.
a. Provide transportation to prenatal visits.
b. Provide child care so that a pregnant woman may keep prenatal visits.
c. Increase the number of providers that will care for Medicaid clients.
d. Provide low-cost or no-cost health care insurance.
e. Provide job training.

 

ANS: A, B, C, D

Lack of transportation to visits, lack of child care, access to skilled obstetric providers, and lack of affordable health insurance are prohibitive factors associated with lack of prenatal care.

Although job training may result in employment and income, the likelihood of significant changes during the time frame of the pregnancy is remote.

 

DIF:   Cognitive Level: Evaluation          REF:  4

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Planning

 

TRUE/FALSE

 

  1. Researchers have found that most client education materials used are written at too high a reading level for the average adult. Is this true or false?

 

ANS: T

As a result of the increasing multicultural U.S. population, there is an urgent need to address health literacy as a component of culturally and linguistically competent care. Health care providers contribute to health literacy by using simple common words, avoiding jargon, and developing appropriate written materials.

 

DIF:   Cognitive Level: Evaluation          REF:  5

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Planning

Lowdermilk: Maternity & Women’s Health Care, 10th Edition

 

Chapter 03: Clinical Genetics

 

Test Bank

 

MULTIPLE CHOICE

 

  1. A father and mother are carriers of phenylketonuria (PKU). Their 2-year-old daughter has PKU. The couple tells the nurse that they are planning to have a second baby. Because their daughter has PKU, they are sure that their next baby won’t be affected. What response by the nurse is most accurate?
a. “Good planning; you need to take advantage of the odds in your favor.”
b. “I think you’d better check with your doctor first.”
c. “You are both carriers, so each baby has a 25% chance of being affected.”
d. “The ultrasound indicates a boy, and boys are not affected by PKU.”

 

ANS: C

The chance is one in four that each child produced by this couple will be affected by PKU disorder.

This couple still has an increased likelihood of having a child with PKU. Having one child already with PKU does not guarantee that they will not have another.

These parents need to discuss their options with their physician. However, an opportune time has presented itself for the couple to receive correct teaching about inherited genetic risks.

No correlation exists between gender and inheritance of the disorder, because PKU is an autosomal recessive disorder.

 

DIF:   Cognitive Level: Application        REF:  53

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Planning

 

  1. A woman is 5 months pregnant. On a routine ultrasound scan, the physician discovers that the fetus has a diaphragmatic hernia. The woman becomes distraught and asks the nurse what she should do. What action by the nurse is most appropriate?
a. Talk to the woman and refer her to a genetic counselor.
b. Suggest that the woman travel to a fetal treatment center for intrauterine surgery.
c. Tell her that everything is going to be fine.
d. Sit with her and calmly suggest that she consider terminating this pregnancy.

 

ANS: A

Before the woman makes any decisions, she should discuss this newly discovered information with a genetic counselor. Genetic counselors can help with the diagnosis and management of families affected by genetic conditions.

The discussion of potential surgery should be pursuant to genetic counseling.

Telling the woman that everything is going to be fine may give her false hope and is not accurate.

All options should be discussed with the genetic counselor. Furthermore, the guiding principle for genetic counseling is nondirectiveness. This respects the right of the individual or family being counseled to make autonomous decisions.

 

DIF:   Cognitive Level: Application        REF:  56

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Planning

 

  1. A woman who is gravida 2 and 16 GW comes in for her prenatal appointment. Her 2-year-old daughter is with her and is wearing a sleeveless top. While interacting with her daughter, you note axillary freckling and several café-au-lait spots (>2 cm). In reviewing her chart, you would assess for documentation of which genetic disease?
a. Tay-Sachs disease
b. Galactosemia
c. Neurofibromatosis (NF)
d. Phenylketonuria

 

ANS: C

Clinical manifestations of NF may include axillary freckling and café-au-lait spots.

Tay-Sachs disease is not associated with café-au-lait spots. Tay-Sachs is an incurable lipid-storage disorder.

Galactosemia is not associated with café-au-lait spots; rather it is an inborn error of metabolism.

Phenylketonuria is not associated with café-au-lait spots. This child would have difficulty manufacturing the liver enzyme phenylalanine.

 

DIF:   Cognitive Level: Knowledge        REF:  52

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Assessment

 

  1. A new father has just been told that his child has trisomy 18. He asks the nurse what made her suspect a problem after the birth. The nurse explains that during the infant’s newborn assessment, she noted:
a. Microcephaly and capillary hemangiomas
b. Epicanthal folds and a simian crease
c. Oblique palpebral fissures and Cri du chat syndrome
d. Rocker-bottom feet and clenched hands with overlapping fingers

 

ANS: D

Rocker-bottom feet and clenched hands with overlapping fingers are associated with trisomy 18.

Microcephaly and capillary hemangiomas are associated with trisomy 13.

Epicanthal folds and a simian crease are associated with trisomy 21 (Down syndrome).

Deletion of the short arm of chromosome number 5 is manifested by Cri du chat syndrome.

 

DIF:   Cognitive Level: Comprehension             REF:  “50, 51”

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Assessment

 

  1. A nurse is assessing the knowledge of new parents with a child born with maple syrup urine disease (MSUD). This is an autosomal recessive inherited disorder, which means that:
a. Both genes of a pair must be abnormal for the disorder to be expressed
b. Only one copy of the abnormal gene is required for the disorder to be expressed
c. The disorder occurs in males and heterozygous females
d. The disorder is carried on the X chromosome

 

ANS: A

MSUD is a type of autosomal recessive inheritance disorder in which both genes of a pair must be abnormal for the disorder to be expressed.

MSUD is an autosomal recessive inheritance disorder that cannot be expressed when only one copy of the abnormal gene is present.

MSUD is not an autosomal dominant inheritance disorder. The disorder would not be present with this genetic presentation.

MSUD is not an X- linked disorder; it is an autosomal recessive inheritance disorder in which both genes of a pair must be abnormal for the disorder to be present.

 

DIF:   Cognitive Level: Comprehension             REF:  53

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Assessment

 

  1. In presenting to obstetric nurses interested in genetics, the genetic nurse identifies the primary risk(s) associated with genetic testing as:
a. Anxiety and altered family relationships
b. Denial of insurance benefits
c. High false positives associated with genetic testing
d. Ethnic and socioeconomic disparity associated with genetic testing

 

ANS: B

Decisions about genetic testing are shaped by socioeconomic status and the ability to pay for the testing. Some types of genetic testing are expensive and are not covered by insurance benefits.

Anxiety and altered family relationships are often the result of genetic testing; however, they are not the primary risk.

False-negative results are more likely to affect an individual or family because they will fail to seek necessary follow-up.

Caucasian middle-class families have greater access to genetic screening, so this is less of a risk for this population.

DIF:   Cognitive Level: Comprehension             REF:  47

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Implementation

 

  1. A man’s wife is pregnant for the third time. One child was born with cystic fibrosis, and the other child is healthy. The man wonders what the chance is that this child will have cystic fibrosis. This type of testing is known as:
a. Occurrence risk
b. Recurrence risk
c. Predictive testing
d. Predisposition testing

 

ANS: B

The couple already has a child with a genetic disease; therefore, they will be given a recurrence risk test.

If a couple has not yet had children but are known to be at risk for having children with a genetic disease, they are given an occurrence risk test. This couple already has a child with a genetic disorder.

Predictive testing is used to clarify the genetic status of an asymptomatic family member.

Predisposition testing differs from presymptomatic testing in that a positive result does not indicate 100% risk of a condition developing.

 

DIF:   Cognitive Level: Comprehension             REF:  56

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Planning

 

  1. Cancer is genetic and begins with one or more genetic mutations. A cancer specifically being investigated in this regard is:
a. Lung cancer
b. Liver cancer
c. Colorectal cancer
d. Oral cancer

 

ANS: C

Colorectal cancer usually results from one or more predisposing genes and is the third leading cause of cancer deaths in women.

Tobacco smoke is a known causative factor for lung cancer. There may also be an acquired mutation of an oncogene present.

Liver cancer is not being investigated in this regard.

Oral cancer may be caused by an inherited mutation of one or more oncogenes.

 

DIF:   Cognitive Level: Knowledge        REF:  55

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Assessment

 

 

 

  1. In practical terms regarding genetic health care, nurses should be aware that:
a. Genetic disorders affect equally people of all socioeconomic backgrounds, races, and ethnic groups
b. Genetic health care is more concerned with populations than individuals
c. The most important of all nursing functions is providing emotional support to the family during counseling
d. Taking genetic histories is the province of large universities and medical centers

 

ANS: C

Nurses should be prepared to help with a variety of stress reactions from a couple facing the possibility of a genetic disorder.

Although anyone may have a genetic disorder, certain disorders appear more often in certain ethnic and racial groups.

Genetic health care is highly individualized because treatments are based on the phenotypic responses of the individual.

Individual nurses at any facility can take a genetic history, although larger facilities may have better support services.

 

DIF:   Cognitive Level: Comprehension             REF:  57

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Planning

 

  1. The Human Genome Project, which began in 1990:
a. Expected to complete a map of the entire human genome by 2010
b. Found that all human beings are 99.9% identical at the DNA level
c. Has not yet been able to translate the accumulating raw research into anything medically practical
d. Put its research relevant to nursing in a document published by the International Society of Nurses in Genetics (ISONG)

 

ANS: B

The majority of the 0.1% genetic variations are found within and not among populations.

The project completed its map ahead of schedule, in 2000.

The project’s research has been very valuable in the identification of genes involved in disease and in the development of genetic tests.

The ISONG document, the “Statement of the Scope and Standards of Genetics Clinical Nursing Practice,” is very useful but not directly related to the Human Genome Project.

 

DIF:   Cognitive Level: Knowledge        REF:  44

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Assessment

 

 

 

 

 

  1. With regard to prenatal genetic testing, nurses should be aware that:
a. Maternal serum screening can determine whether a pregnant woman is at risk of carrying a fetus with Down syndrome
b. Carrier screening tests look for gene mutations of people already showing symptoms of a disease
c. Predisposition testing predicts with near certainty that symptoms will appear
d. Presymptomatic testing is used to predict the likelihood of breast cancer

 

ANS: A

Maternal serum screening identifies the risk for the neural tube defect and the specific chromosome abnormality involved in Down syndrome.

Carriers of some diseases, such as sickle cell disease, do not display symptoms.

Predisposition testing determines susceptibility, such as for breast cancer.

Presymptomatic testing indicates that if the gene is present, symptoms are certain to appear.

 

DIF:   Cognitive Level: Knowledge        REF:  45

OBJ:  Client Needs: Physiologic Integrity

TOP:  Nursing Process: Planning

 

  1. A nurse must be cognizant that an individual’s genetic makeup is known as his/her:
a. Genotype
b. Phenotype
c. Karyotype
d. Chromotype

 

ANS: A

The genotype comprises all the genes the individual can pass on to a future generation.

The phenotype is the observable expression of an individual’s genotype.

The karyotype is a pictorial analysis of the number, form, and size of an individual’s chromosomes.

Genotype refers to an individual’s genetic makeup.

 

DIF:   Cognitive Level: Knowledge        REF:  47

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Assessment

 

  1. The U.S. Department of Health and Human Services has designated Thanksgiving Day as National Family History Day. The Surgeon General encourages family members to discuss important family health information while sharing in holiday gatherings. This initiative is significant to nurses because:
a. There are few genetic tests available to identify this information
b. Only physicians should obtain this detailed information
c. Clients cannot accurately complete these histories on their own
d. This is the single most cost effective source of genetic information

 

ANS: D

Although there are more than 1000 genetic tests available, the single most cost-effective piece of genetic information is the family history.

Although there are more than 1000 genetic tests available, the single most cost-effective piece of genetic information is the family history.

Nurses are ideally suited to take the lead in ongoing efforts to recognize the significance of the family history as an important source of genetic information.

A computerized tool called My Family Health Portrait is available free of charge (www.hhs.gov/familyhistory/download.html). Other tools to aid the lay community in completing their family histories are available to the public.

 

DIF:   Cognitive Level: Comprehension             REF:  45

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Assessment

 

MULTIPLE RESPONSE

 

  1. Which congenital malformations result from multifactorial inheritance? Choose all that apply.
a. Cleft lip
b. Congenital heart disease
c. Cri du chat syndrome
d. Anencephaly
e. Pyloric stenosis

 

ANS: A, B, D, E

Cleft lip, congenital heart disease, anencephaly, and pyloric stenosis are associated with multifactorial inheritance.

Cri du chat syndrome is related to a chromosomal deletion.

 

DIF:   Cognitive Level: Knowledge        REF:  52

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Diagnosis

 

  1. Which activities are included in the role of a nurse practicing in the field of genetics? Choose all that apply.
a. Assessing the responses of family members to a genetic disorder
b. Performing genetic testing, such as amniocentesis
c. Constructing a family pedigree of three or more generations
d. Advising a pregnant mother whose fetus has a genetic disorder to have an abortion
e. Offering parents information about genetics

 

ANS: A, C, E

Assessing the responses of family members, constructing a family pedigree, and offering parents information about genetics are activities that a genetics nurse would carry out in caring for a family undergoing genetic counseling.

Physicians perform amniocentesis; the nurse may assist in this procedure. It is important for nurses to be aware of their own values and beliefs and to refrain from attempting to influence the family. The nurse must respect the right of the individual or family to make autonomous decisions.

 

DIF:   Cognitive Level: Comprehension             REF:  44

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Planning

 

COMPLETION

 

  1. The karyotype designated as female is ___________________.

 

ANS: 46 XX

 

DIF:   Cognitive Level: Comprehension             REF:  48

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Diagnosis

 

TRUE/FALSE

 

  1. BRCA1 and BRCA2 mutations account for approximately 50% of hereditary breast and ovarian cancer. Is this statement true or false?

 

ANS: F

These mutations account for about 70% to 85% of hereditary breast and ovarian cancers. The mutation is inherited as an autosomal dominant pattern; thus each offspring of an individual found to carry a BRCA mutation has a 50% chance of inheriting the same mutation. According to estimations of lifetime risk, 12% of women in the general population will develop breast cancer compared with about 60% of women who have inherited a deleterious mutation in their BRCA genes.

 

DIF:   Cognitive Level: Knowledge        REF:  55

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Planning

Lowdermilk: Maternity & Women’s Health Care, 10th Edition

 

Chapter 11:  Structural Disorders and Neoplasms of the Reproductive System

 

Test Bank

 

MULTIPLE CHOICE

 

  1. The nurse should be aware that a pessary would be most effective in the treatment of what disorder?
a. Cystocele
b. Uterine prolapse
c. Rectocele
d. Stress urinary incontinence

 

ANS: B

A fitted pessary may be inserted into the vagina to support the uterus and hold it in the correct position.

A pessary is not used for the client with a cystocele.

A rectocele cannot be corrected by the use of a pessary.

It is unlikely that a pessary is the most effective treatment for stress incontinence.

 

DIF:   Cognitive Level: Knowledge        REF:  237

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Diagnosis

 

  1. A postmenopausal woman who is 54 years old has been diagnosed with two leiomyomas. What assessment finding is most commonly associated with the presence of leiomyomas?
a. Abnormal uterine bleeding
b. Diarrhea
c. Weight loss
d. Acute abdominal pain

 

ANS: A

Most women are asymptomatic. Abnormal uterine bleeding is the most common symptom of leiomyomas (fibroids).

Diarrhea is not commonly associated with leiomyomas (fibroids).

Weight loss does not usually occur in the woman with leiomyomas (fibroids).

The client with leiomyomas (fibroids) is unlikely to experience abdominal pain.

 

DIF:   Cognitive Level: Comprehension             REF:  240

OBJ:  Client Needs: Physiologic Integrity

TOP:  Nursing Process: Assessment

 

 

  1. Which woman is at high risk for psychologic complications after hysterectomy?
a. A 55-year-old woman who has been having abnormal bleeding and pain for 3 years
b. A 46-year-old woman who has three children and has just been promoted at work
c. A 62-year-old widow who has three friends who have had uncomplicated hysterectomies
d. A 19-year-old woman who had a ruptured uterus after giving birth to her first child

 

ANS: D

The 19-year-old woman is still in her childbearing years. Often the uterus is related to self-concept in women of this age-group, and they may feel that sexual functioning is related to having a uterus.

The 55-year-old woman is past her childbearing years and has had bleeding and pain for 3 years. The surgery may be well received as a method of pain relief.

The 46-year-old woman has a family and has positive events occurring in her life (job promotion).

The 62-year-old woman is past her reproductive years and has relationships with others who have had positive outcomes.

 

DIF:   Cognitive Level: Comprehension             REF:  243

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Diagnosis

 

  1. A 48-year-old woman has just had a hysterectomy for endometrial cancer. Which statement alerts the nurse that further teaching is needed?
a. “I can’t wait to go on the cruise that I have planned for this summer.”
b. “I know that the surgery saved my life, but I will miss having sexual intercourse with my husband.”
c. “I have asked my daughter to come and stay with me next week after I am discharged from the hospital.”
d. “Well, I don’t have to worry about getting pregnant anymore.”

 

ANS: B

Stating that she will miss having sexual intercourse with her husband indicates that further teaching is needed for this client regarding sexual activities after a hysterectomy. Intercourse may be uncomfortable initially. The use of water-soluble lubricants, relaxation exercises, and changes in position may be helpful.

Expressing plans for a vacation is a positive psychologic state with plans for the future.

Stating that her daughter will stay with her indicates the client understands that she may need assistance during her acute recovery period.

Stating that she no longer needs to worry about getting pregnant indicates knowledge related to the reproductive cycle and a positive outlook.

 

DIF:   Cognitive Level: Application        REF:  244

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Evaluation

 

  1. The nurse knows that teaching about external radiation therapy is effective when the woman:
a. Uses ointment to keep her skin from drying out
b. Washes the irradiated area with deodorant soap
c. Eats a diet high in protein and drinks at least 2000 ml of fluid a day
d. Washes off the markings for the radiation site after each treatment

 

ANS: C

To maintain good nutrition, the woman should eat high-protein meals or use protein supplements and should have a high daily fluid intake of 2 to 3 L.

The woman is counseled about good skin care and taught to avoid soaps, ointments, cosmetics, and deodorants because these may contain metals that would alter the radiation dose she receives.

The woman is counseled about good skin care and taught to avoid soaps, ointments, cosmetics, and deodorants because these may contain metals that would alter the radiation dose she receives.

Markings may be made to indicate the exact location needed for irradiation. These should remain until treatment is complete.

 

DIF:   Cognitive Level: Comprehension             REF:  257

OBJ:  Client Needs: Physiologic Integrity

TOP:  Nursing Process: Planning

 

  1. With regard to planning treatment for a pregnant woman with breast cancer, which statement about timing or type of treatment is correct?
a. The fetus is most at risk during the first trimester.
b. The fetus is most at risk during the second trimester.
c. The fetus is most at risk during the third trimester.
d. Surgery is more risky than chemotherapy in the first trimester.

 

ANS: A

The first trimester is the most vulnerable period for the growing fetus. Women may be faced with making a decision about terminating the pregnancy, depending on the stage and extent of the disease.

For advanced disease in the second trimester, alkylating agents, 5-fluorouracil (5-FU), and vincristine are relatively safe for the fetus.

For advanced disease in the third trimester, alkylating agents, 5-FU, and vincristine are relatively safe for the fetus.

Surgery is less risky than chemotherapy in the first trimester.

 

DIF:   Cognitive Level: Application        REF:  265

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Planning

 

 

 

  1. During internal radiation therapy for cervical cancer, the nurse should:
a. Wear gloves when assessing the cervical intracavity implant
b. Instruct the client to urinate in the lead-lined bedpan or “hat” every 2 hours
c. Prepare the client for an enema before insertion
d. Limit staff or visitor exposure to 30 minutes or less per 8 hours

 

ANS: D

Staff and visitor exposure should be limited to 30 minutes or less in an 8-hour period to reduce the risk of overexposure to radiation.

Nurses need to protect themselves from overexposure to radiation. Wearing a shield is one method of protection.

An indwelling catheter is inserted to prevent urinary distention that could dislodge the applicator.

No bowel prep is necessary.

 

DIF:   Cognitive Level: Comprehension             REF:  258

OBJ:  Client Needs: Safe and Effective Care Environment

TOP:  Nursing Process: Implementation

 

  1. What is the most common reproductive tract cancer associated with pregnancy?
a. Cervical cancer
b. Uterine cancer
c. Ovarian cancer
d. Fallopian tube cancer

 

ANS: A

The incidence of cervical cancer concurrent with pregnancy is reported to be 3%, making it the most common reproductive tract cancer associated with pregnancy.

Uterine cancer is rarely diagnosed during pregnancy.

Ovarian cancer is the second most frequent cancer diagnosis in pregnancy. At approximately 1% it remains a rare occurrence.

The peak incidence of tubal cancer is between the ages of 50 and 55. For this cancer to be concurrent with pregnancy is only a remote possibility.

 

DIF:   Cognitive Level: Knowledge        REF:  263

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Assessment

 

 

 

 

 

 

 

 

 

  1. From the age of menarche to menopause, women remain at risk for structural disorders and neoplasms of the reproductive system. When caring for these clients the nurse must begin by assessing the woman’s knowledge of the disorder, its management, and prognosis. This assessment should be followed by a nursing diagnosis. Which diagnosis does not address the psychologic effect of these disorders?
a. Anxiety related to surgical procedures
b. Disturbed body image as a result of changes in anatomy
c. Risk for injury related to lack of skill for self-care
d. Interrupted family processes

ANS: C

Although risk for injury related to lack of skill for self-care is appropriate to the client’s condition, it is more suited to the client’s learning needs than the psychologic effect.

Anxiety related to surgical procedures is appropriate for addressing psychosocial concerns. The client may also develop anxiety related to the diagnosis and prognosis, whether or not surgery is required.

Disturbed body image is an applicable diagnosis. Changes in anatomy and function may also result in low self-esteem and ineffective coping skills.

Interrupted family processes is a possible acceptable diagnosis. Functional and anatomic changes may result in the client’s inability to fulfill her familial role. Depending on the severity of her condition, it could also lead to social isolation.

 

DIF:   Cognitive Level: Analysis             REF:  234

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Diagnosis

 

  1. The prevalence of urinary incontinence (UI) increases as women age, with more than one third of women in the United States suffering from some form of this disorder. The symptoms of mild to moderate UI can be successfully decreased by a number of strategies. Which of these should the nurse instruct the client to use first?
a. Pelvic floor support devices
b. Bladder training and pelvic muscle exercises
c. Surgery
d. Medications

 

ANS: B

Pelvic muscle exercises, known as Kegel exercises, along with bladder training can significantly decrease or entirely relieve stress incontinence in many women.

Pelvic floor support devices also known as pessaries come in a variety of shapes and sizes. Pessaries may not be effective for all women and require scrupulous cleaning to prevent infection.

Anterior and posterior repairs and even a hysterectomy may be performed. If surgical repair is performed, the nurse must focus her care on preventing infection and helping the woman avoid putting stress on the surgical site.

Pharmacologic therapy includes selective serotonin-norepinephrine reuptake inhibitors or vaginal estrogen therapy. These are not the first action a nurse should recommend.

 

DIF:   Cognitive Level: Application        REF:  237

OBJ:  Client Needs: Physiologic Integrity

TOP:  Nursing Process: Implementation

 

  1. A woman presents with a possible diagnosis of polycystic ovary syndrome (PCOS). While completing the initial assessment of the client, the nurse understands that clinical manifestations of PCOS might include all except:
a. Anorexia
b. Hirsutism
c. Irregular menses
d. Infertility

 

ANS: A

These clients often present with obesity rather than anorexia and weight loss. 40% of these women also display glucose intolerance and hyperinsulinemia.

Excessive hair growth is often present with PCOS.

This client is likely to have irregular menses or even amenorrhea.

Infertility as a result of decreased levels of follicle-stimulating hormone is common with this syndrome.

 

DIF:   Cognitive Level: Comprehension             REF:  239

OBJ:  Client Needs: Physiologic Integrity

TOP:  Nursing Process: Assessment

 

MULTIPLE RESPONSE

 

  1. Your client is undergoing treatment for ovarian cancer. Please identify which common nutritional problems are related to gynecologic cancers and the treatment thereof.
a. Stomatitis
b. Constipation
c. Anorexia
d. Diarrhea
e. Nausea and vomiting

 

ANS: A, B, C, D, E

Stomatitis, constipation, anorexia, diarrhea, and nausea and vomiting are all possible nutritional complications related to gynecologic cancers and their treatment. The nurse must assess accordingly and adapt the client’s plan of care. To ensure recovery these women should consume a diet high in iron and protein, drink plenty of fluids, and eat foods high in vitamins C, B and K.

 

 

DIF:   Cognitive Level: Application        REF:  250

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  “Nursing Process: Assessment, Planning”

 

COMPLETION

 

  1. A ____________________ cyst is a germ cell tumor that contains substances such as hair, teeth, sebaceous secretions, and bones.

 

ANS:

Dermoid

Dermoid cysts are germ cell tumors, usually occurring in childhood.

 

DIF:   Cognitive Level: Knowledge        REF:  239

OBJ:  Client Needs: Physiologic Integrity

TOP:  Nursing Process: Diagnosis

 

  1. Tumors that are on pedicles (stalks) and present in either the endometrium or cervix are more commonly known as ________________ ______________.

 

ANS:

Uterine polyps

The etiology of this type of tumor is unknown, although they may develop in response to hormonal stimulus or be the result of inflammation. Polyps are benign lesions that can be removed surgically.

 

DIF:   Cognitive Level: Knowledge        REF:  240

OBJ:  Client Needs: Physiologic Integrity

TOP:  Nursing Process: Diagnosis

 

TRUE/FALSE

 

  1. Structural disorders of the uterus and vagina related to pelvic relaxation and urinary incontinence are a delayed result of childbearing. These defects do not appear in women who have never been pregnant. Is this statement true or false?

 

ANS: F

These problems are associated with older mothers; however, women who have never been pregnant can experience them as well. Incontinence is the direct result of congenital or acquired weakness of the pelvic support structures. This condition often appears during menopause when ovarian hormones and pelvic tissue are lost. The incidence does tend to remain higher in women who have given birth.

 

DIF:   Cognitive Level: Knowledge        REF:  236

OBJ:  Client Needs: Physiologic Integrity

TOP:  Nursing Process: Assessment

 

  1. Nurses who work with clients in hospitals that receive federal funding must know that all clients must be asked if they have knowledge of advance directives and be provided with information if so desired. Is this statement true or false?

 

ANS: T

This is a component of the Patient Self-Determination Act. This is important for nurses working in gynecology-oncology settings, where decisions about living wills and “no codes” may be an issue.

 

DIF:   Cognitive Level: Application        REF:  251

OBJ:  Client Needs: Safe and Effective Care Environment

TOP:  Nursing Process: Implementation

Lowdermilk: Maternity & Women’s Health Care, 10th Edition

 

Chapter 21: Nursing Care of the Family During the Postpartum Period

 

Test Bank

 

MULTIPLE CHOICE

 

  1. A woman gave birth vaginally to a 9-lb, 12-oz girl yesterday. Her primary health care provider has written orders for perineal ice packs, use of a sitz bath tid, and a stool softener. What information is most closely correlated with these orders?
a. The woman is a gravida 2, para 2
b. The woman had a vacuum-assisted birth
c. The woman received epidural anesthesia
d. The woman has an episiotomy

 

ANS: D

These orders are typical interventions for a woman who has had an episiotomy, lacerations, and hemorrhoids.

A multiparous classification is not an indication for these orders.

A vacuum-assisted birth may be used in conjunction with an episiotomy, which would indicate these interventions.

Use of epidural anesthesia has no correlation with these orders.

 

DIF:   Cognitive Level: Comprehension             REF:  492

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Planning

 

  1. The laboratory results for a postpartum woman are as follows: blood type, A; Rh status, positive; rubella titer, 1:8 (EIA 0.8); hematocrit, 30%. How would the nurse best interpret these data?
a. Rubella vaccine should be given
b. A blood transfusion is necessary
c. Rh immune globulin is necessary within 72 hours of birth
d. A Kleihauer-Betke test should be performed

 

ANS: A

This client’s rubella titer indicates that she is not immune and that she needs to receive a vaccine.

These data do not indicate that the client needs a blood transfusion.

Rh immune globulin is indicated only if the client has a negative Rh status and the infant has a positive Rh status.

A Kleihauer-Betke test should be performed if a large fetomaternal transfusion is suspected, especially if the mother is Rh negative. The data do not provide any indication for performing this test.

 

DIF:   Cognitive Level: Comprehension             REF:  499

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Planning

 

  1. A woman gave birth 48 hours ago to a healthy infant girl. She has decided to bottle-feed. During your assessment you notice that both her breasts are swollen, warm, and tender on palpation. The woman should be advised that this condition can best be treated by:
a. Running warm water on her breasts during a shower
b. Applying ice to the breasts for comfort
c. Expressing small amounts of milk from the breasts to relieve pressure
d. Wearing a loose-fitting bra to prevent nipple irritation

 

ANS: B

Applying ice to the breasts for comfort is an appropriate intervention for treating engorgement in a mother who is bottle feeding. Ice should be applied for 15 minutes on and 45 minutes off to avoid rebound engorgement.

This woman is experiencing engorgement, which can be treated by using ice packs (since she is not breastfeeding) and cabbage leaves.

A bottle-feeding mother should avoid any breast stimulation, including pumping or expressing milk.

A bottle-feeding mother should wear a well-fitted support bra or breast binder continuously for at least the first 72 hours after giving birth. A loose-fitting bra will not aid lactation suppression. Furthermore, the shifting of the bra against the breasts may stimulate the nipples and thereby stimulate lactation.

 

DIF:   Cognitive Level: Application        REF:  499

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Implementation

 

  1. A 25-year-old multiparous woman gave birth to an infant boy 1 day ago. Today her husband brings a large container of brown seaweed soup to the hospital. When the nurse enters the room, the husband asks for help with warming the soup so that his wife can eat it. The nurse’s most appropriate response is to ask the woman:
a. “Didn’t you like your lunch?”
b. “Does your doctor know that you are planning to eat that?”
c. “What is that anyway?”
d. “I’ll warm the soup in the microwave for you.”

 

ANS: D

Offering to warm the food shows cultural sensitivity to the dietary preferences of the woman and is the most appropriate response.

Cultural dietary preferences must be respected.

Women may request that family members bring favorite or culturally appropriate foods to the hospital.

Asking the woman to identify her food does not show cultural sensitivity.

 

DIF:   Cognitive Level: Application        REF:  502

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Implementation

 

  1. A primiparous woman is to be discharged from the hospital tomorrow with her infant girl. Which behavior indicates a need for further intervention by the nurse before the woman can be discharged?
a. The woman is disinterested in learning about infant care.
b. The woman continues to hold and cuddle her infant after she has fed her.
c. The woman reads a magazine while her infant sleeps.
d. The woman changes her infant’s diaper and then shows the nurse the contents of the diaper.

 

ANS: A

The client should be excited, happy, and interested or involved in infant care. A woman who is sad, tearful, or disinterested in caring for her infant may be exhibiting signs of depression or postpartum blues and require further intervention.

Holding and cuddling her infant after feeding is an appropriate parent-infant interaction.

Taking time for herself while the infant is sleeping is an appropriate maternal action.

Showing the nurse the contents of the diaper is appropriate because the mother is seeking approval from the nurse and notifying the nurse of the infant’s elimination patterns.

 

DIF:   Cognitive Level: Comprehension             REF:  501

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Evaluation

 

  1. What will prevent early discharge of a postpartum woman?
a. Hgb <10 g
b. Birth at 38 weeks of gestation
c. Voids about 200 to 300 ml per void
d. Episiotomy that shows slight redness and edema and is dry and approximated

 

ANS: A

The mother’s hemoglobin should be greater than 10 g for early discharge.

The birth of an infant at term is not a criterion that prevents early discharge.

A voiding volume of 200 to 300 ml per void is normal and does not indicate that the woman should not be discharged early.

An episiotomy that shows slight redness and edema and is dry and approximated is a normal finding and does not prevent a woman from being discharged early.

 

DIF:   Cognitive Level: Comprehension             REF:  488

OBJ:  Client Needs: Physiologic Integrity

TOP:  Nursing Process: Evaluation

 

 

  1. Which finding could prevent early discharge of a newborn who is now 12 hours old?
a. Birth weight of 3000 g
b. One meconium stool since birth
c. Voided, clear, pale urine three times since birth
d. Infant breastfed once with some difficulty with latch and sucking and once with some success for about 5 minutes on each breast

 

ANS: D

An infant needs to complete at least two successful feedings (normal sucking and swallowing) before an early discharge.

Birth weight of 3000 g is a normal infant finding that does not prevent early discharge.

Passage of one meconium stool is a normal infant finding that does not prevent early discharge.

Having voided three times since birth is a normal infant finding that does not prevent early discharge.

 

DIF:   Cognitive Level: Comprehension             REF:  488

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Evaluation

 

  1. The trend in the United States is for women to remain hospitalized no longer than 1 or 2 days after giving birth for all of the following reasons except:
a. A wellness orientation rather than a sick-care model
b. A desire to reduce health care costs
c. Consumer demand for fewer medical interventions and more family-focused experiences
d. Less need for nursing time as a result of more medical and technologic advances and devices available at home that can provide information

 

ANS: D

Nursing time and care are in demand as much as ever; the nurse just has to do things more quickly.

A wellness orientation seems to focus on getting clients out the door sooner.

In most cases less hospitalization results in lower costs.

People believe the family gives more nurturing care than the institution.

 

DIF:   Cognitive Level: Comprehension             REF:  486

OBJ:  Client Needs: Safe and Effective Care Environment

TOP:  “Nursing Process: Planning, Implementation”

 

 

 

 

 

 

 

 

  1. Under the Newborns’ and Mothers’ Health Protection Act, all health plans are required to allow new mothers and newborns to remain in the hospital for a minimum of _____ hours after a normal vaginal birth and for _____ hours after a cesarean birth.
a. 24; 72
b. 24; 96
c. 48; 96
d. 48; 120

 

ANS: C

The specified stays are 48 hours (2 days) for a vaginal birth and 96 hours (4 days) for a cesarean birth. The attending provider and the mother together can decide on an earlier discharge.

The specified stays are 48 hours (2 days) for a vaginal birth and 96 hours (4 days) for a cesarean birth. A client may be discharged either 24 hours after a vaginal birth or 72 hours after a cesarean birth if she is stable and her provider is in agreement.

The specified stays are 48 hours (2 days) for a vaginal birth and 96 hours (4 days) for a cesarean birth. A client may be discharged 24 hours after a vaginal birth if she is stable and her provider is in agreement.

The specified stays are 48 hours (2 days) for a vaginal birth and 96 hours (4 days) for a cesarean birth. A client is unlikely to remain in the hospital for 120 hours after a cesarean birth unless there are complications.

 

DIF:   Cognitive Level: Knowledge        REF:  488

OBJ:  Client Needs: Safe and Effective Care Environment

TOP:  Nursing Process: Planning

 

  1. Nursing care in the fourth trimester includes an important intervention sometimes referred to as taking the time to mother the mother. Specifically, this expression refers to:
a. Formally initializing individualized care by confirming the woman’s and infant’s ID numbers on their respective wrist bands (“This is your baby”)
b. Teaching the mother to check the identity of any person who comes to remove the baby from the room (“It’s a dangerous world out there”)
c. Including other family members in the teaching of self-care and child care (“We’re all in this together”)
d. Nurturing the woman by providing encouragement and support as she takes on the many tasks of motherhood

 

ANS: D

Many professionals believe that the nurse’s nurturing and support function is more important than providing physical care and teaching.

Matching ID wrist bands is more of a formality but also a get-acquainted procedure. Mothering the mother is more a process of encouraging and supporting the woman in her new role.

Having the mother check IDs is a security measure for protecting the baby from abduction. Mothering the mother is more a process of encouraging and supporting the woman in her new role.

Teaching the whole family is just good nursing practice. Mothering the mother is more a process of encouraging and supporting the woman in her new role.

 

DIF:   Cognitive Level: Comprehension             REF:  492

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Implementation

 

  1. What is not a postpartum practice for preventing infections?
a. Not letting the mother walk barefoot at the hospital
b. Educating the client to wipe from back to front after voiding
c. Having staff members with conditions such as strep throat, conjunctivitis, and diarrhea stay home
d. Instructing the mother to change her perineal pad from front to back each time she voids or defecates

 

ANS: B

Proper perineal care helps to prevent infection and aids in the healing process. Educating the woman to wipe from front to back (urethra to anus) after voiding or defecating is a simple first step.

Walking barefoot and getting back into bed can contaminate the linens.

Staff members with infections need to stay home until they are no longer contagious.

She should also wash her hands before and after these functions.

 

DIF:   Cognitive Level: Comprehension             REF:  493

OBJ:  Client Needs: Safe and Effective Care Environment

TOP:  Nursing Process: Implementation

 

  1. A hospital has a number of different perineal pads available for use. A nurse is observed soaking several of them and writing down what she sees. This activity indicates that the nurse is trying to:
a. Improve the accuracy of blood loss estimation, which usually is a subjective assessment
b. Determine which pad is best
c. Demonstrate that other nurses usually underestimate blood loss
d. Reveal to the nurse supervisor that one of them needs some time off

 

ANS: A

Saturation of perineal pads is a critical indicator of excessive blood loss, and anything done to aid in assessment is valuable. The nurse is noting the saturation volumes and soaking appearances.

Instead of determining which pad is best, the nurse is more likely noting saturation volumes and soaking appearances to improve the accuracy of blood loss estimation.

Nurses usually overestimate blood loss.

Soaking perineal pads and writing down results does not indicate the need for time off from work.

 

DIF:   Cognitive Level: Application        REF:  493

OBJ:  Client Needs: Physiologic Integrity

TOP:  Nursing Process: Assessment

 

  1. What is not a reliable indicator of impending shock from early hemorrhage?
a. Respirations
b. Blood pressure
c. Skin condition
d. Urinary output

 

ANS: B

Blood pressure is not a reliable indicator; several more sensitive signs are available.

Respiratory rate is a more sensitive and reliable indicator than blood pressure.

Skin condition is a more sensitive and reliable indicator than blood pressure.

Urinary output is a more sensitive and reliable indicator than blood pressure.

 

DIF:   Cognitive Level: Knowledge        REF:  494

OBJ:  Client Needs: Physiologic Integrity

TOP:  Nursing Process: Planning

 

  1. Because a full bladder prevents the uterus from contracting normally, nurses intervene to help the woman empty her bladder spontaneously as soon as possible. If all else fails, the last thing the nurse might try is:
a. Pouring water from a squeeze bottle over the woman’s perineum
b. Placing oil of peppermint in a bedpan under the woman
c. Asking the physician to prescribe analgesics
d. Inserting a sterile catheter

 

ANS: D

Invasive procedures usually are the last to be tried, especially with so many other simple and easy methods available (e.g., water, peppermint vapors, pain pills).

Pouring water over the perineum may stimulate voiding. It is easy, noninvasive, and should be tried early on.

The oil of peppermint releases vapors that may relax the necessary muscles. It is easy, noninvasive, and should be tried early on.

If the woman is anticipating pain from voiding, pain medications may be helpful. Other nonmedical means could be tried first, but medications still come before insertion of a catheter.

 

DIF:   Cognitive Level: Comprehension             REF:  494

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Implementation

 

  1. If a woman is at risk for thrombus and is not ready to ambulate, nurses might intervene by doing all of these interventions except:
a. Putting her in antiembolic stockings (TED hose) and/or sequential compression device (SCD) boots
b. Having her flex, extend, and rotate her feet, ankles, and legs
c. Having her sit in a chair
d. Notifying the physician immediately if a positive Homans’ sign occurs

 

ANS: C

Sitting immobile in a chair does not help. Bed exercise and prophylactic footwear might.

Antiembolic stockings (TED hose) and SCD boots are recommended. Just sitting in a chair will not help.

Bed exercises such as these are useful. Just sitting in a chair does not help.

A positive Homans’ sign (calf muscle pain or warmth, redness, or tenderness) requires the physician’s immediate attention.

 

DIF:   Cognitive Level: Comprehension             REF:  496

OBJ:  Client Needs: Physiologic Integrity

TOP:  Nursing Process: Implementation

 

  1. With regard to rubella and Rh issues, nurses should be aware that:
a. Breastfeeding mothers cannot be vaccinated with the live attenuated rubella virus
b. Women should be warned that the rubella vaccination is teratogenic and they must avoid pregnancy for at least 1 month after vaccination
c. Rh immune globulin is safely administered intravenously because it cannot harm a nursing infant
d. Rh immune globulin boosts the immune system and thereby enhances the effectiveness of vaccinations

 

ANS: B

Women should understand they must practice contraception for at least 1 month after being vaccinated.

Because the live attenuated rubella virus is not communicable in breast milk, breastfeeding mothers can be vaccinated.

Rh immune globulin is administered IM; it should never be given to an infant.

Rh immune globulin suppresses the immune system and therefore might thwart the rubella vaccination.

 

DIF:   Cognitive Level: Comprehension             REF:  499

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Planning

 

 

 

 

 

 

  1. A recently delivered mother and her baby are at the clinic for a 6-week postpartum checkup. The nurse should be concerned that psychosocial outcomes are not being met if the woman:
a. Discusses her labor and birth experience excessively
b. Feels that her baby is more attractive and clever than any others
c. Has not given the baby a name
d. Has a partner or family members who react very positively about the baby

 

ANS: C

If the mother is having difficulty naming her new infant, it may be a signal that she is not adapting well to parenthood. Other red flags include refusal to hold or feed the baby, lack of interaction with the infant, and becoming upset when the baby vomits or needs a diaper change.

A new mother who is having difficulty is unwilling to discuss her labor and birth experience. An appropriate nursing diagnosis might be impaired parenting related to a long, difficult labor or unmet expectations of birth. A mother who is willing to discuss her birth experience is making a healthy personal adjustment.

The mother who is not coping well finds her baby unattractive and messy. She may also be overly disappointed in the baby’s sex. The client might voice concern that the baby reminds her of a family member whom she does not like.

Having a partner and/or other family members react positively is an indication that this new mother has a good support system in place. This support system helps reduce anxiety related to her new role as a mother.

 

DIF:   Cognitive Level: Synthesis            REF:  501

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Evaluation

 

MULTIPLE RESPONSE

 

  1. Many new mothers experience some type of nipple pain during the first weeks of initiating breastfeeding. Should this pain be severe or persistent, it may discourage or inhibit breastfeeding altogether. The nurse should be aware of a variety of factors that may contribute to nipple pain. These include:
a. Improper feeding position
b. Large-for-gestational age infant
c. Fair skin
d. Progesterone deficiency
e. Flat or retracted nipples

 

ANS: A, C, E

Nipple lesions may manifest as chapped, cracked, bleeding, sore, erythematous, edematous, or blistered. Factors that contribute to nipple pain include improper positioning or failure to break suction before removing the baby from the breast. Flat or retracted nipples along with the use of nipple shields, breast shells, or plastic breast pads also contribute. Women with fair skin are more likely to develop sore and cracked nipples. Prevention of nipple soreness is preferable to treatment after it appears.

Vigorous feeding may be a contributing factor. This may be the case with any size infant, not just those who are large for gestational age. Estrogen or dietary deficiencies can contribute to nipple soreness.

 

DIF:   Cognitive Level: Knowledge        REF:  495

OBJ:  Client Needs: Physiologic Integrity

TOP:  Nursing Process: Assessment

 

  1. Infant abduction from hospitals in the United States has increased over the past few years. As a result many maternity units have put practices into place to protect infants from possible abduction. These practices include:
a. Limited-entry systems
b. Photo identification badges
c. Fingerprint identification of all newborns
d. Infant should always be transported in a bassinet
e. Staff wear special scrubs or unique ID badges

 

ANS: A, B, C, D, E

Limited-entry systems, photo identification badges, fingerprint identification of all newborns, transport of the infant in a bassinet, and special staff scrubs or unique identification badges are all practices that limit the ability of an abductor to remove an infant from the hospital. Nurses must also teach new parents to check the identity of any person attempting to remove an infant from the room and question the reason why. Clients and staff must work together to ensure the safety of newborns in the hospital environment.

 

DIF:   Cognitive Level: Application        REF:  492

OBJ:  Client Needs: Safe and Effective Care Environment

TOP:  “Nursing Process: Planning, Implementation”

 

COMPLETION

 

  1. The _________________________ test is used to detect the amount of fetal blood in the maternal circulation.

 

ANS:

Kleihauer-Betke

This test is ordered if a large fetomaternal transfusion is suspected. If more than 15 ml of fetal blood is present in maternal circulation, a higher dose of Rh immune globulin must be given.

 

DIF:   Cognitive Level: Comprehension             REF:  500

OBJ:  Client Needs: Physiologic Integrity

TOP:  Nursing Process: Evaluation

 

  1. During the immediate postpartum period, saturation of one pad within 1 hour or less is considered ____________________ blood loss.

 

ANS:

Heavy

Any estimation of lochial flow is inaccurate and incomplete without consideration of the time factor. The woman who saturates a perineal pad in 1 hour or less is bleeding much more heavily than the woman who saturates a pad in 8 hours.

 

DIF:   Cognitive Level: Comprehension             REF:  493

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Assessment

 

TRUE/FALSE

 

  1. Regardless of her obstetric status, no woman should be discharged from the recovery area until she has completely recovered from the effects of anesthesia and has been cleared by a member of the anesthesia care team. Is this statement true or false?

 

ANS: T

It takes several hours to recover from anesthesia. Obstetric recovery areas are held to the same standard of care expected for any postanesthesia recovery.

 

DIF:   Cognitive Level: Comprehension  REF:  486

OBJ:  Client Needs: Safe and Effective Care Environment

TOP:  Nursing Process: Implementation

 

  1. If a mother and her family have freely chosen early discharge from the hospital, the nurse and the health care provider are not legally responsible if complications occur and her condition had not been stabilized within normal limits. Is this statement true or false?

 

ANS: F

Even if the mother chose to leave, the medical and nursing staffs still could be sued for abandonment.

 

DIF:   Cognitive Level: Comprehension             REF:  489

OBJ:  Client Needs: Safe and Effective Care Environment

TOP:  Nursing Process: Evaluation