Contemporary Maternal Newborn Nursing 7th Edition by Patricia W. Ladewig, london, Davidson – Test Bank

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Contemporary Maternal Newborn Nursing  7th Edition by Patricia W. Ladewig – Test Bank

 

 

Sample  Questions

 

 

Chapter 05_LO 01_Q01

The clinic nurse is returning phone calls. Which call should the nurse return first?

  1. 22-year-old reporting that she has menstrual cramps and vomiting every month
  2. 17-year-old asking if there is a problem with using one tampon for a whole day
  3. 46-year-old mother of a teen wondering if her daughter should be on birth control
  4. 34-year-old requesting information on douching after intercourse

Correct Answer: 2

Rationale:

  1. Because vomiting can lead to dehydration, this client is not completely normal or stable, but is not the top priority.
  2. Using a single tampon for an entire day can lead to toxic shock syndrome, a potentially life-threatening condition. This client needs education on the danger of using one tampon more than 3–6 hours.
  3. A sexually active teen could be at risk for unintended pregnancy, as well as sexually transmitted infections. However, it is unclear whether the daughter is sexually active. This call is a low priority.
  4. Douching is not recommended, because the practice causes a change in the pH of the vagina and impacts the normal flora, predisposing clients to candidiasis and bacterial vaginosis. This client requires education, but is not a top priority.

Cognitive level: Analysis

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Implementation

Learning Outcome: 5.1 Identify appropriate nursing care based on the results of the client’s sexual history.

 

Chapter 05_LO 01_Q02

 

When taking a sexual history from a client, the nurse should:

  1. Ask questions that the client can answer with a “yes” or “no.”
  2. Ask mostly open-ended questions.
  3. Have the client fill out a comprehensive questionnaire, and review it after the client leaves.
  4. Try not to make much direct eye contact.

 

Correct Answer:  2

 

Rationale:

  1. “Yes-or-no” answers indicate closed-ended questions that will not encourage the client to share the necessary information.
  2. Open-ended questions are often useful in eliciting information because they encourage more than a one-word answer.
  3. Filling out a questionnaire and reviewing it after the client leaves is not appropriate. It should be reviewed in the presence of the client, encouraging conversation regarding the results.
  4. It is helpful to use direct eye contact as much as possible, unless culturally unacceptable. Eye contact encourages a connection between the involved parties, and shows care and concern.

Cognitive Level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Assessment

Learning Outcome: 5.1 Identify appropriate nursing care based on the results of the client’s sexual history.

 

 

Chapter 05_LO2 _Q03

Which patient would the nurse document as exhibiting signs and symptoms of primary dysmenorrhea?

  1. 17-year-old, has never had a menstrual cycle
  2. 16-year-old, had regular menses for four years, but has had no menses in four months
  3. 19-year-old, regular menses for five years that have suddenly become painful
  4. 14-year-old, irregular menses for one year, experiences cramping every cycle

Correct Answer:  4

Rationale:

  1. This is primary amenorrhea, or the lack of menses.
  2. Secondary amenorrhea is the term used when a client has had regular cycles that cease.
  3. Secondary dysmenorrheal is the sudden onset of pain and discomfort with menses.
  4. Primary dysmenorrhea is when menstruation has been painful from the first menstrual cycle, and consistently continues to be painful each month.

Cognitive level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Diagnosis

Learning Outcome: 5.2 Describe accurate information to be provided to girls and women so that they can implement effective self-care measures for dealing with menstruation.

 

Chapter 05_LO2 _Q04

 

A client asks her nurse, “Is it okay for me to take a tub bath during the heavy part of my menstrual cycle?” The correct response by the nurse is:

  1. “Tub baths are contraindicated during menstruation.”
  2. “You should shower and douche daily instead.”
  3. “Either a bath or a shower is fine at that time.”
  4. “You should limit bathing and use a feminine deodorant spray during menstruation.”

Correct Answer: 3

Rationale:

  1. Bathing, whether it is a tub bath or shower, is as important during menses as at any other time, to reduce any odor associated with menstruation.
  2. Douching should be avoided during menstruation to prevent the risk of forcing blood into the pelvic cavity, which can contribute to endometriosis.
  3. Bathing, whether it is a tub bath or shower, is as important during menses as at any other time, to reduce any odor associated with menstruation.
  4. Feminine deodorant sprays are unnecessary. Bathing is sufficient hygiene.

Cognitive Level: Application

Category of Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome: 5.2 Describe accurate information to be provided to girls and women so that they can implement effective self-care measures for dealing with menstruation.

 

Chapter 05_LO03 _Q05

What should the gynecology clinic nurse recommend for the client experiencing premenstrual syndrome?

  1. “Eat more chocolate and drink more caffeine beginning a week prior to when your menstrual cycle bleeding should begin.”
  2. “Engage in aerobic activity often throughout the month, and continue exercising when your symptoms begin.”
  3. “Decrease your dietary intake of dairy and soy slightly during the month, and especially during your days of bleeding.”
  4. “Increase your consumption of red meat when you feel symptoms, and eat three large meals per day.”

Correct Answer:  2

Rationale:

  1. Chocolate and caffeine contain methylxanthines; therefore, intake of chocolate, coffee, and colas should be limited throughout the month.
  2. Regular aerobic activity helps to decrease PMS symptoms.
  3. 1,200 mg of calcium per day can help decrease PMS symptoms. The calcium can either come from supplements or be obtained through dietary intake of dairy and soy products.
  4. Decreased red meat consumption can be beneficial to reduce PMS symptoms, as will eating several small meals per day rather than three large meals.

Cognitive level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Implementation

Learning Outcome: 5.3 Discriminate between the signs, symptoms, and nursing management of women with dysmenorrheal and premenstrual syndrome.

 

Chapter 05_LO03 _Q06

 

A client comes to the clinic complaining of severe menstrual cramps. She has never been pregnant, has been diagnosed with ovarian cysts, and has had an intrauterine device (IUD) for two years. The most likely cause for the client’s complaint is:

  1. Primary dysmenorrhea.
  2. Secondary dysmenorrhea.
  3. Menorrhagia.
  4. Hypermenorrhea.

Correct Answer: 2

Rationale:

  1. Primary dysmenorrhea is defined as cramps without underlying disease.
  2. Secondary dysmenorrhea is associated with pathology of the reproductive tract, and usually appears after menstruation has been established. Conditions that most frequently cause secondary dysmenorrhea include ovarian cysts and the presence of an intrauterine device.
  3. Menorrhagia is excessive, profuse flow.
  4. Hypermenorrhea is an abnormally long menstrual flow.

Cognitive Level: Analysis

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Diagnosis

Learning Outcome: 5.3 Discriminate between the signs, symptoms, and nursing management of women with dysmenorrheal and premenstrual syndrome.

 

 

Chapter 05_LO 04_Q07

Which issues should the nurse consider when counseling a client on contraceptive methods? Select all that apply.

  1. Cultural perspectives on menstruation and pregnancy
  2. Efficacy of the method
  3. Future childbearing plans
  4. Whether the client is a vegetarian
  5. Age at menarche

Correct Answers:  1, 2, 3

Rationale:

  1. Cultural and religious beliefs, practices, and sanctions must be considered when discussing contraception with clients in order to avoid insulting a client for whom a particular type of contraceptive method is prohibited by her background.
  2. Efficacy of contraceptive methods vary, and must be considered when discussing contraception with clients. When pregnancy is medically contraindicated, high-efficacy methods (such as an IUD, hormonal methods, or sterilization) should be discussed with the client. When the client would like to avoid pregnancy at this time, but pregnancy is not medically contraindicated, lower-efficacy methods (such as diaphragm, cervical cap, or Today sponge) could be discussed.
  3. If a client desires children in the future, sterilization methods would be inappropriate to discuss.
  4. Vegetarianism has no impact on contraceptive method use.
  5. Age at menarche has no impact on contraceptive method use.

Cognitive level:  Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Assessment

Learning Outcome: 5.4 Compare the advantages, disadvantages, and effectiveness of the various methods of contraception available today.

 

Chapter 05_LO 04_Q08

 

A client wants to use the vaginal sponge as a method of contraception. Which of the following statements indicate that she will need further instruction? Select all that apply.

  1. “I need to use a lubricant prior to insertion.”
  2. “I need to add spermicidal cream prior to intercourse.”
  3. “I need to moisten it with water prior to use.”
  4. “I need to leave it in no longer than 6 hours.”

 

Answer: 1, 2, 4

 

Rationale:

  1. A lubricant is not needed, as the sponge is moistened with water prior to insertion.
  2. Spermicidal cream is not needed, because it is already in the sponge.
  3. To activate the spermicide in the vaginal sponge, it must be moistened thoroughly with water.
  4. The sponge can remain in place for 24 hours.

Cognitive Level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Evaluation

Learning Outcome: 5.4 Compare the advantages, disadvantages, and effectiveness of the various methods of contraception available today.

 

Chapter 05_LO 04_Q09

 

Which client is not a good candidate for Depo-Provera (DMPA)?

  1. One who wishes to get pregnant within three months
  2. One who wishes to breastfeed
  3. One with a vaginal prolapse
  4. One who weighs 200 pounds

Correct Answer: 1

Rationale:

  1. Return of fertility after the use of Depo-Provera takes an average of nine months.
  2. Studies have proven there is no harm to a breastfed baby when a woman uses Depo-Provera.
  3. There is no correlation between a vaginal prolapse and use of Depo-Provera.
  4. There is no correlation between one’s weight and use of Depo-Provera.

Cognitive Level: Analysis

Category of Client Need: Physiological Integrity

Nursing Process: Assessment

Learning Outcome: 5.4 Compare the advantages, disadvantages, and effectiveness of the various methods of contraception available today.

 

Chapter 05_LO 05_Q10

The home care nurse is working with a 40-year-old developmentally delayed adult who has had no gynecologic well-woman care since her teens. What screenings are recommended for this client?

  1. STI screening and Pap smear
  2. Clinical breast exam, Pap smear, and serum calcium levels
  3. Clinical breast exam, Pap smear, and mammogram
  4. Pap smear and vaccination update

Correct Answer:  3

Rationale:

  1. A Pap smear is recommended, but STI screening might or might not be indicated, based on whether the client is sexually active and using contraception or not. Sexually transmitted infections are more common in teens and those in their early 20s.
  2. A clinical breast exam and Pap smear are recommended gynecologic examinations for women, but a serum calcium level is not part of a routine gynecologic routine physical exam. When any part of an answer is incorrect, the entire answer is incorrect.
  3. A clinical breast exam, Pap smear, and mammogram are recommended gynecologic screenings for 40-year-old women.
  4. A Pap smear is a recommended gynecologic screening for an adult woman, but a vaccination update is not considered part of gynecologic care.

Cognitive level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Assessment

Learning Outcome: 5.5 Support clients in following and partaking in basic gynecologic screening procedures indicated for well women.

 

Chapter 05_LO 05_Q11

 

A nurse is providing a client with instructions regarding breast self-examination (BSE). Which of the following statements by the client would indicate the likelihood that she understands how to detect changes such as lumps in her breast? Select all that apply.

  1. “I should perform BSE one week prior to the start of my period.”
  2. “When I reach menopause, I will perform BSE every two months.”
  3. “Knowing the texture and feel of my breasts is important.”
  4. “I should inspect my breasts in a circular manner.”
  5. “I should inspect my breasts while in a supine position, with my arms at my sides.”

Correct Answers: 3, 4

Rationale:

  1. BSE should be performed one week after the start of each menstrual period, because hormonal levels are lowest, and allow closer exam of softer breast tissue.
  2. BSE should be performed monthly, on the same day each month, during menopause.
  3. A woman who knows the texture and feel of her own breasts is far more likely to detect changes that develop.
  4. Checking breasts in a circular manner, feeling all parts of the breast, provides adequate palpation and possible detection of lumps.
  5. The breasts should be inspected while standing with arms at sides.

Cognitive Level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Evaluation

Learning Outcome: 5.5 Support clients in following and partaking in basic gynecologic screening procedures indicated for well women.

 

Chapter 05_LO 06_Q12

What is the best indicator that the client is experiencing menopause?

  1. No menses for eight consecutive months
  2. Hot flashes and night sweats
  3. High serum FSH with low serum estrogen
  4. Diagnosed with osteoporosis four months ago

Correct Answer:  3

Rationale:

  1. Menopause is defined as twelve months of amenorrhea.
  2. Although hot flashes and night sweats are common in menopause, lab values or twelve months of amenorrhea are better indicators.
  3. Examining serum levels of the hormones FSH and estrogen is a very accurate indication of menopause.
  4. Menopause is not the only cause of osteoporosis, therefore the diagnosis of osteoporosis four months ago is not an indicator of menopause.

Cognitive level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Assessment

Learning Outcome: 5.6 Explain the physical and psychologic aspects and clinical treatment options of menopause when caring for menopausal women.

 

Chapter 05_LO 06_Q13

 

A menopausal woman tells her nurse that she experiences discomfort from vaginal dryness during sexual intercourse, and asks, “What should I use as a lubricant?” The nurse should recommend:

  1. Petroleum jelly.
  2. A water-soluble lubricant.
  3. Body cream or body lotion.
  4. Less-frequent intercourse.

Correct Answer: 2

Rationale:

  1. Petroleum jelly is not water-soluble, and not recommended as a lubricant.
  2. A water-soluble lubricant should be used so it does not cause irritation.
  3. Body creams and body lotions are not water-soluble.
  4. Less-frequent intercourse does not increase vaginal lubrication.

Cognitive Level: Application

Category of Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome: 5.6 Explain the physical and psychologic aspects and clinical treatment options of menopause when caring for menopausal women.

 

Chapter 05_LO 07_Q14

The nurse is presenting a session on intimate partner violence. Which statement indicates a need for further education?

  1. “My daughter is not to blame for the violence in her marriage.”
  2. “Everyone experiences anger and hitting in a relationship.”
  3. “Abusers can be either husbands or boyfriends or girlfriends.”
  4. “The ‘honeymoon period’ follows an episode of violence.”

Correct Answer:  2

Rationale:

  1. The victims of violence are not the cause of the violence. Abusers are responsible for their violent behavior. Avoiding blaming and shaming of victims of domestic violence is important to establish a therapeutic relationship.
  2. Violence is not a normal part of intimate relationships. This statement indicates that the client has likely been a victim of domestic violence.
  3. Abusers can be spouses or boyfriends or girlfriends. Intimate partner violence can be experienced in any intimate relationship, regardless of whether the couple is straight, gay, or lesbian, and both within marriage and outside of marriage.
  4. An acute episode of battering is followed by the tranquil phase, or honeymoon period, when the abuser is often repentant and promising never to abuse the victim again. In some cases, the honeymoon period is the only time there is a lack of building tension.

Cognitive level: Analysis

Category of Client Need: Psychosocial Integrity

Nursing Process: Evaluation

Learning Outcome: 5.7 Examine the nurse’s role in screening and caring for women who have experienced domestic violence or rape.

 

Chapter 05_LO 07_Q15

 

When a woman who has been raped is admitted to the Emergency Department, which nursing intervention has priority?

  1. Explain exactly what will need to be done to preserve legal evidence.
  2. Assure the woman that everything will be all right.
  3. Create a safe, secure atmosphere for the woman.
  4. Contact family members.

Correct Answer: 3

Rationale:

  1. Explaining exactly what will need to be done to preserve legal evidence is not the top priority.
  2. Assuring the woman that everything will be all right is not the top priority, and is giving false promise.
  3. The first priority in caring for a survivor of a sexual assault is to create a safe, secure atmosphere that will allow the woman to process what has happened.
  4. Contacting family members is not the top priority, and can wait until a safe environment is established.

Cognitive Level: Analysis

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Planning

Learning Outcome: 5.7 Examine the nurse’s role in screening and caring for women who have experienced domestic violence or rape.

Chapter 07_LO01_Q01

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 what is causing your infertility after some tests are done.”

Correct Answer: 4

Rationale:

  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. However, using the term “at fault” is blaming, and should be avoided.
  2. 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.
  3. Testing will determine what the infertility issue is, but using the term “at fault” is blaming, and should be avoided.
  4. This is a factual answer that avoids using the term “at fault.” This statement is therapeutically worded, and therefore is the best answer.

Cognitive level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Planning

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

 

Chapter 07_LO02 _Q02

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 three 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.”

Correct Answer: 3

Rationale:

  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.
  2. 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 does method alone.
  3. 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 .5–1.0-degree Fahrenheit as ovulation occurs, remaining elevated if conception occurs or dropping just prior to onset of menses.
  4. 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.

Cognitive level:  Analysis

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Evaluation

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

 

Chapter 07_LO03 _Q03

The infertile couple will have ovulation induced and retrieval of ovum, followed by mixing with washed donor sperm. One day later, the fertilized ovum will be placed in the fallopian tube. The nurse knows that education has been successful if the client describes the procedure as:

  1. Zygote intrafallopian transfer (ZIFT).
  2. Gamete intrafallopian transfer (GIFT).
  3. Tubal embryo transfer (TET).
  4. In vitro fertilization (IVF).

Correct Answer: 1

Rationale:

  1. ZIFT is the return of fertilized ovum into the fallopian tube after ovum retrieval and mixing the ovum with washed sperm.
  2. GIFT is placing retrieved ovum and washed sperm into the fallopian tube.
  3. TET is placing embryos into the fallopian tube. The embryos form in a laboratory after ovum are retrieved and then mixed with washed sperm.
  4. IVF is the placement of embryos into the uterus. The embryos form in a laboratory after ovum are retrieved and then mixed with washed sperm.

Cognitive level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Evaluation

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

 

Chapter 07_LO03_Q04

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

 

Rationale:

  1. The temperature can be taken with a standard oral or rectal thermometer.
  2. In the basal body temperature method, the woman takes her temperature every day before starting any activity, including smoking.
  3. In the basal body temperature method, the woman takes her temperature every day before arising.
  4. In the basal body temperature method, the woman takes her temperature every day for five minutes.

Cognitive Level: Analysis

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Evaluation

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

 

 

Chapter 07_LO03_Q05

 

A client calls the urologist’s office to receive instructions about semen analysis. The nurse should instruct the client to:

  1. Avoid sexual intercourse 24 hours prior to obtaining specimen.
  2. Use a latex condom to collect the specimen.
  3. Expect that a repeat test might be required.
  4. Expect a small sample.

Answer: 3

Rationale:

  1. The specimen is collected after 2–3 days of abstinence, usually by masturbation.
  2. Regular condoms should not be used, because of the spermicidal agents that they contain.
  3. A repeat semen analysis might be required to adequately assess the man’s fertility potential.
  4. Instructing the client to expect a small sample is not appropriate.

 

Cognitive Level: Application

Category of Client Need:  Health Promotion and Maintenance

Nursing Process: Implementation

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

 

 

Chapter 07_LO04_Q06

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 client.
  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.

Correct Answers:  1, 2

Rationale:

  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.
  2. 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.
  3. The partner is in the anger stage of grief. Lack of acceptance would manifest as not believing that the diagnosis is correct.
  4. Being in the anger stage of grief is expected and normal, and has no bearing on parenting ability.
  5. Guilt would manifest as feelings that it is his fault that pregnancy has not yet occurred. The client is describing anger.

Cognitive level: Analysis

Category of Client Need: Psychosocial Integrity

Nursing Process: Diagnosis

Learning Outcome: 7.4 Explain the physiologic and psychologic effects of infertility on a couple in the nursing care management of the couple.

 

Chapter 07_LO05_Q07

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.”

Correct Answer: 4

Rationale:

  1. Although teaching and facilitating scheduling are important, the emotions that families deal with during treatment for infertility must also be addressed.
  2. 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.
  3. 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 clients.
  4. This answer addresses the two main aspects of the RN working with infertile clients: emotional support and education.

Cognitive level: Analysis

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Evaluation

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

 

Chapter 07_LO06_Q08

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

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

Correct Answer:  2

Rationale:

  1. This patient has no indication of having a genetic problem.
  2. 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.
  3. The risk for this client is becoming infected with HIV while attempting conception. This couple has no indication of a genetic condition.
  4. 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.

Cognitive level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Planning

Learning Outcome: 7.6 Distinguish couples who might benefit from preconceptual chromosomal analysis and prenatal testing when providing care to couples with special reproductive concerns.

 

Chapter 07_LO07_Q09

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.”

Correct Answer: 4

Rationale:

  1. Down syndrome is a trisomy, and most likely to occur in parents over 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.
  2. Galactosemia is not a sex-linked disorder; it is an autosomal recessive disorder. Both parents must carry the gene and pass that gene onhe 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.
  3. Trisomies are three copies of a specific gene, and occur most often in parents over 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.
  4. 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% chance of inheriting an autosomal dominant condition if one parent is affected. Males and females are equally affected by autosomal dominant disorders.

Cognitive level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Evaluation

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

 

Chapter 07_LO07_Q10

A 45-year-old mother gave birth to a baby boy two 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

Rationale:

  1. A single palmar crease and low-set ears are not characteristics of trisomy 13.
  2. A single palmar crease and low-set ears are not characteristics of trisomy 18.
  3. A single palmar crease and low-set ears are characteristics of trisomy 21 (Down syndrome).
  4. Trisomy 26 is not an autosomal abnormality.

Cognitive Level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Assessment

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

 

Chapter 07_LO07_Q11

 

A nurse counsels a couple who have concerns about a sex-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 affected.”
  2. “If you have a son, he will not be affected.”
  3. “There is a 25% chance that a daughter will have the disorder.”
  4. “There is a 50% chance that a son will be a carrier.”

Answer: 4

Rationale:

  1. If both parents carry a sex-linked disorder, they each have one normal sex chromosome and one abnormal female sex chromosome.
  2. There is a 50% chance of males being normal.
  3. With female offspring, there is a 50% of being a carrier, and a 50% chance of having the disorder.
  4. There is a 50% chance of male offspring being carriers.

Cognitive Level: Analysis

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Implementation

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

 

 

 

Chapter 07_LO08_Q12

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.”

Correct Answer: 1

Rationale:

  1. A genetic amniocentesis is the removal of 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.
  2. 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.
  3. 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.
  4. 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.

Cognitive level: Analysis

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Evaluation

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

 

 

Chapter 07_LO08_Q13

 

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

Rationale:

  1. Anencephaly is clearly visualized with ultrasound, and does not require genetic testing to verify a diagnosis.
  2. Genetic abnormalities in either parent are not related to anencephaly.
  3. 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.
  4. The age of either parent is not related to anencephaly.

Cognitive Level: Analysis

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Evaluation

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

 

 

Chapter 07_LO08_Q14

 

A male infant was born two 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

Rationale:

  1. The parents’ chromosomes do not need to be assessed in order to diagnose the infant.
  2. 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.
  3. The chromosome studies will be undertaken as soon as possible.
  4. It is not necessary to wait until the breast milk has come in.

Cognitive Level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Planning

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

 

 

Chapter 07_LO09_Q15

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?”

Correct Answer: 2

Rationale:

  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.
  2. This response uses therapeutic communication techniques and portrays a caring attitude towards the family. Asking if the family has questions further facilitates communication.
  3. 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.
  4. 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.

Cognitive level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Assessment

Learning Outcome: 7.9 Examine the emotional impact on a couple undergoing genetic testing or coping with the birth of a baby with a genetic disorder when providing nursing care to the family undergoing genetic counseling.

 

Chapter 07_LO09_Q16

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% chance that our baby would have sickle disease.”

Answer: 4

Rationale:

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

Cognitive Level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Assessment

Learning Outcome 7.9 Examine the emotional impact on a couple undergoing genetic testing or coping with the birth of a baby with a genetic disorder, and explain the nurse’s role in supporting the family undergoing genetic counseling.

 

 

 

Chapter 07_LO09_Q17

 

The 28-year-old husband and wife have just been told their child has trisomy 21. Their 3-year-old child has no health problems. What statement should the nurse include in counseling this family?

  1. “Don’t worry. Everything will turn out for the best.”
  2. “It can be very difficult to understand why God chose you for this problem.”
  3. “Your child’s disorder was not predictable, and not the fault of either of you.”
  4. “Your 3-year-old will need extra attention, given a sibling with special needs.”

Answer: 3

Rationale:

  1. Therapeutic communication avoids clichés.
  2. Therapeutic communication avoids philosophical answers involving God.
  3. Reassuring the couple that neither of them caused the genetic abnormality of their newborn is most important right now.
  4. The needs of the 3-year-old are not a top priority at the moment.

Cognitive Level: Analysis

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Planning

Learning Outcome 7.9 Examine the emotional impact on a couple undergoing genetic testing or coping with the birth of a baby with a genetic disorder, and explain the nurse’s role in supporting the family undergoing genetic counseling.

Chapter 11_LO01_Q01

The nurse is preparing a class for expectant fathers. Which information should the nurse include?

  1. Siblings adjust readily to the new baby.
  2. Sexual activity is safe for normal pregnancy.
  3. The expectant mother decides the feeding method.
  4. Fathers are expected to be involved in labor and birth.

Correct Answer: 2

Rationale:

  1. Siblings often have difficulty adapting to the arrival of a new baby. Regression is often seen in siblings’ behaviors.
  2. During a normal pregnancy, sexual activity is safe for both mother and baby.
  3. Often, the father wants input into the feeding method.
  4. In some cultures, labor and birth are only for women, and it is inappropriate for fathers to be involved with the labor and birth.

Cognitive level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Planning

Learning Outcome: 11.1 Describe the most appropriate nursing care to help maintain the well-being of the expectant father and siblings during a family’s pregnancy.

 

Chapter 11_LO01_Q02

The nurse is caring for a pregnant client. The client’s husband has come to the prenatal visit. Which question is best for the nurse to use to assess the adaptation to pregnancy by the father-to-be?

  1. “What kind of work do you do?”
  2. “What furniture have you gotten for the baby?”
  3. “How moody has your wife been lately?”
  4. “How are you feeling about becoming a father?”

Answer: 4

Rationale:

  1. What kind of work the husband does is not an indicator of his adaptation.
  2. What furniture has been obtained is not an indicator of his adaptation.
  3. The husband’s perception of his wife’s moodiness is not an indicator of his adaptation.
  4. The adaptation of a husband to pregnancy includes his feelings about impending fatherhood.

Cognitive Level: Application

Category of Client of Need: Health Promotion and Maintenance

Nursing Process: Planning

Learning Outcome 11.1 Describe the most appropriate nursing care to help maintain the well-being of the expectant father and siblings during a family’s pregnancy.

 

Chapter 11_LO02 _Q03

The nurse is caring for a client in the prenatal clinic. The client recently arrived in the U.S. as a refugee from a country in Africa. This is the first client from this cultural background with whom the nurse has worked. What is the best method for the nurse to provide care for this client?

  1. Ask the client about her expectations during the labor and birth.
  2. Determine if the client has been tested for tuberculosis.
  3. Help the client into the paper dressing gown prior to her exam.
  4. Look for written handouts on prenatal care in the client’s language.

Correct Answer: 1

Rationale:

  1. Women new to the S. will have little or no experience with the U.S. health care system. Culture heavily influences a client’s behaviors and attitudes during pregnancy, labor, and birth, so determining what the client wants during her labor and birth will facilitate both a better experience for the family and a calmer situation for the health care team.
  2. Although tuberculosis is pandemic in refugee camps, and testing for tuberculosis in new arrivals to the S. is important, this question is about prenatal care. Testing for tuberculosis is not related to prenatal care.
  3. The client is probably unfamiliar with paper dressing gowns, and will need some instruction (often through demonstration). But this is not the highest priority. It is more important to find out what the client expects to happen during her labor and birth.
  4. Providing written handouts in the client’s primary language is important. But a higher priority for prenatal care would be to assess what the client’s expectations for labor and birth are.

Cognitive level:  Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Planning

Learning Outcome: 11.2 Examine the significance of cultural considerations in managing nursing care during pregnancy.

 

Chapter 11_LO02 _Q04

A Navajo client who is 36 weeks pregnant meets with the tribe’s medicine man as well as her physician. The nurse understands this to mean that the client:

  1. Is seeking spiritual direction.
  2. Does not trust her physician.
  3. Will not adapt to mothering well.
  4. Is experiencing complications of pregnancy.

Answer: 1

Rationale:

  1. As a result of the introspection that develops, pregnant women often will seek spiritual guidance from their preferred spiritual leader. The nurse has a professional responsibility to promote clients’ spiritual well-being. Understanding the belief systems of the client population will facilitate intercultural communication, and will help the nurse provide appropriate information using appropriate teaching methods.
  2. This does not indicate mistrust of the provider.
  3. This does not indicate mistrust of parenting ability.
  4. This does not indicate any type of pathology or complications.

Cognitive Level: Analysis

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Assessment

Learning Outcome 11.2 Examine the significance of cultural considerations in managing nursing care during pregnancy.

 

Chapter 11_LO02 _Q05

 

A Chinese woman who is 16 weeks pregnant reports to the nurse that ginseng and bamboo leaves help to reduce her anxiety. How should the nurse respond to this client?

  1. Advise the client to avoid the use of all herbs.
  2. Assess the amount and frequency with which the client is using the remedy.
  3. Tell the client that her remedies have no scientific foundation.
  4. Assess where the client obtains her remedy, and investigate the source.

Answer: 2

Rationale:

  1. Because some herbs have negative effects on pregnancy, using a reliable reference to determine the actions of the herbs can educate both the nurse and the client.
  2. Use of herbs is a common alternative health care practice for many women. Pregnant women are often taught “secret family recipes” for avoiding or minimizing the discomforts of pregnancy. It is appropriate to assess the amount and frequency of the client’s use of the herbs.
  3. Some remedies do have scientific foundation, so it is not appropriate to instruct the client that none do.
  4. It is outside the nurse’s scope to assess the source of the herbs.

Cognitive Level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Implementation

Learning Outcome 11.2 Examine the significance of cultural considerations in managing nursing care during pregnancy.

 

 

Chapter 11_LO03_Q06

The nurse is teaching an early pregnancy class for clients in the first trimester of pregnancy. Which statement requires immediate intervention by the nurse?

  1. “When my nausea is bad, I will drink some ginger tea.”
  2. “The fatigue I am experiencing will improve in the second trimester.”
  3. “It is normal for my vaginal discharge to get green-colored.”
  4. “I will urinate less often during the middle of my pregnancy.”

Correct Answer: 3

Rationale:

  1. Ginger helps nausea, and is safe for use during pregnancy.
  2. First-trimester fatigue is common; fatigue usually improves during the second trimester.
  3. Leukorrhea is an increase in white vaginal discharge, and is an expected finding during pregnancy. Green discharge is not a normal finding, and indicates a bacterial infection. The infection can be a sexually transmitted infection, or bacterial vaginosis. Further assessment is required for a client with green vaginal discharge.
  4. As the uterus rises in the pelvis during the second trimester, urinary frequency improves. Urinary frequency increases again during the end of the third trimester as the fetal head descends into the pelvis.

Cognitive level: Analysis

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Assessment

Learning Outcome: 11.3 Explain the causes of the common discomforts of pregnancy in each of the three trimesters.

 

Chapter 11_LO03_Q07

The primiparous client has told the nurse that she is afraid that she will develop hemorrhoids during pregnancy, because her mother did. Which of the following statements would be best for the nurse to make?

  1. “It is not unusual for women to develop hemorrhoids during pregnancy.”
  2. “Most women don’t have any problem until after they’ve delivered.”
  3. “If your mother had hemorrhoids, you will get them too. Get used to the idea.”
  4. “If you get hemorrhoids, you probably will need surgery to get rid of them.”

Answer: 1

Rationale:

  1. Hemorrhoids are anal varicose veins. The increased weight of the gravid uterus, combined with constipation, can result in the varicosities prolapsing.
  2. Many pregnant women will develop hemorrhoids either during pregnancy or after delivery from the pushing efforts of the second stage of labor. Topical relief agents such as Preparation H or Tucks pads can provide relief of the itching and burning sensations.
  3. Although there is a familial tendency to develop varicosities, including hemorrhoids, a family history does not automatically mean that a client will develop the condition.
  4. Most hemorrhoids will resolve spontaneously, and will not require surgical intervention.

Cognitive Level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Implementation

Learning Outcome 11.3 Explain the causes of the common discomforts of pregnancy in each of the three trimesters.

 

 

Chapter 11_LO04_Q08

Which phone call should the prenatal clinic nurse return first?

  1. Primip at 7 weeks’ gestation reporting nasal stuffiness.
  2. Multip at 38 weeks experiencing rectal itching and hemorrhoids
  3. Primip at 15 weeks with nausea and vomiting and a 15-pound weight loss
  4. Multip at 32 weeks treating constipation with prune juice

Correct Answer: 3

Rationale:

  1. Nasal stuffiness is common in the first trimester as a result of increased estrogen.
  2. Hemorrhoids are common during pregnancy, and often cause itching.
  3. This client is the highest priority. A 15-pound weight loss is not an expected finding. A client who has frequent vomiting is at risk for dehydration and electrolyte imbalances.
  4. Constipation during the third trimester is a common finding. Prune juice is a safe and gentle way to increase peristalsis and decrease constipation.

Cognitive level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Assessment

Learning Outcome: 11.4 Describe appropriate measures interventions to alleviate the common discomforts of pregnancy.

 

Chapter 11_LO04_Q09

A 38-year-old client in her second trimester states a desire to begin an exercise program to decrease her fatigue. Which of the following would be the most appropriate nursing response?

  1. “Fatigue should resolve in the second trimester, but walking daily might help.”
  2. “Avoid a strenuous exercise regimen at your age. Drink coffee t.i.d.”
  3. “Avoid an exercise regimen due to your pregnancy. Try to nap daily.”
  4. “Fatigue will increase as pregnancy progresses, but jogging daily might help.”

Answer: 1

Rationale:

  1. Mild-to-moderate exercise during pregnancy is healthy for moms and babies. The increased stamina that correlates with physical fitness can help decrease fatigue in pregnancy, but the second trimester will bring greater fatigue, as fetal metabolism creates demands on the maternal system.
  2. The age of 38 is not too old to begin an exercise routine, but during pregnancy, a client should not begin a new type of extremely strenuous or high-impact activity.
  3. Those clients who have regularly engaged in strenuous or high-impact activities prior to pregnancy can continue that practice unless they develop pregnancy complications that contraindicate exercise.
  4. Mild-to-moderate exercise during pregnancy is healthy for moms and babies.

Cognitive Level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Implementation

Learning Outcome 11.4 Describe appropriate interventions to alleviate the common discomforts of pregnancy.

 

 

Chapter 11_LO04_Q10

 

The client in her first trimester of pregnancy is experiencing nausea. To promote self-care, the nurse should help the pregnant client understand that the nausea might be relieved by:

  1. Eating spicy foods.
  2. Not eating until two hours after rising.
  3. Eating small, frequent meals.
  4. Avoiding carbonated beverages.

Answer: 3

 

Rationale:

  1. The nausea of pregnancy can be exacerbated by ketosis, fatigue, and certain foods, such as those containing caffeine or spices.
  2. Eating dry carbohydrates prior to rising each day can help to prevent or decrease the severity of the nausea.
  3. Avoiding severe hunger by eating small, frequent meals throughout the day can help to prevent or decrease the severity of the nausea.
  4. Carbonated beverages might be helpful in decreasing nausea.

Cognitive Level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Planning

Learning Outcome 11.4 Describe appropriate measures interventions to alleviate the common discomforts of pregnancy.

 

 

Chapter 11_LO04_Q11

A client in her third trimester of pregnancy reports frequent leg cramps. What strategy would be most appropriate for the nurse to suggest?

  1. Point the toes of the affected leg.
  2. Increase intake of protein-rich foods.
  3. Limit activity for several days.
  4. Flex the foot to stretch the calf.

Answer: 4

 

Rationale:

  1. Pointing the toes will exacerbate leg cramps.
  2. Protein intake does not affect leg cramps.
  3. Limiting activity is not appropriate.
  4. Leg cramps are a common problem in pregnancy, resulting from an imbalance in the calcium–phosphorus ratio; pressure on nerves or decreased circulation in the legs from the enlarged uterus; or fatigue. Dorsiflexing the foot will stretch the calf muscles, and will help relieve the cramps.

Cognitive Level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Planning

 

Learning Outcome 11.4 Describe appropriate measures interventions to alleviate the common discomforts of pregnancy.

 

Chapter 11_LO05_Q12

The prenatal client in her third trimester tells the clinic nurse that she works eight hours a day as a cashier and stands when at work. What response by the nurse is best?

  1. “No problem. Your baby will be fine.”
  2. “Do you get regular breaks for eating?”
  3. “Your risk of preterm labor is higher.”
  4. “Standing might increase ankle swelling.”

Correct Answer: 3

Rationale:

  1. Standing more than five hours a day increases the risk of preterm labor. To be therapeutic in communication, avoid false reassurance.
  2. Although breaks for eating, drinking, and toileting are important for pregnant employees, it is more important to tell the client about the increased risk of preterm labor.
  3. Pregnant women who stand for more than five a day have an increased risk of preterm labor. Because preterm labor can put the infant’s life at risk, this statement would be the highest priority.
  4. Although this is true, it is less important than teaching the client about the risks of preterm labor when standing more than five hours a day.

Cognitive level: Analysis

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Planning

Learning Outcome: 11.5 Describe self-care measures that a pregnant woman can take to maintain and promote her well-being during pregnancy.

 

Chapter 11_LO05_Q13

The pregnant client has asked the nurse what kinds of medications cause birth defects. Which statement would best answer this question?

  1. “Birth defects are very rare. Don’t worry; your doctor will watch for problems.”
  2. “To be safe, don’t take any medication without talking to your doctor.”
  3. “Too much vitamin C is one of the most common issues, but is avoidable.”
  4. “Almost all medications will cause birth defects in the first trimester.”

Answer: 2

 

Rationale:

  1. The nurse should avoid a “don’t worry” answer to ensure therapeutic communication, but it is appropriate to instruct the client to talk to the doctor about medications.
  2. Teratogens are substances that can cause birth defects. Alcohol is one example, as are warfarin (Coumadin) and isotretinoin (Accutane). The greatest risk is during the first trimester, but not all medications are teratogenic. Those medications with clear evidence of teratogenicity are classified in pregnancy category X, and should be avoided when conception is being attempted and during the first trimester.
  3. Vitamin C can cause rebound scurvy, but is not teratogenic.
  4. Not all medications are teratogenic.

Cognitive Level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Implementation

Learning Outcome 11.5 Describe self-care measures that a pregnant woman can take to maintain and promote her well-being during pregnancy.

 

Chapter 11_LO05_Q14

A pregnant client who swims 3–5 times per week asks the nurse if she should stop this activity. What is the appropriate nursing response?

  1. “You should decrease the number of times you swim per week.”
  2. “You should continue your exercise program, because it would be beneficial.”
  3. “You should discontinue your exercise program immediately.”
  4. “You should increase the number of times you swim per week.”

Answer: 2

Rationale:

  1. Thirty minutes of moderate-intensity exercise daily is recommended for pregnant women, but even mild exercise is helpful. Women who exercise regularly have better muscle tone, self-image, bowel function, energy levels, sleep, and postpartum recovery than do those who are sedentary.
  2. Thirty minutes of moderate-intensity exercise daily is recommended for pregnant women, but even mild exercise is helpful. Women who exercise regularly have better muscle tone, self-image, bowel function, energy levels, sleep, and postpartum recovery than do those who are sedentary.
  3. Thirty minutes of moderate-intensity exercise daily is recommended for pregnant women, but even mild exercise is helpful. Women who exercise regularly have better muscle tone, self-image, bowel function, energy levels, sleep, and postpartum recovery than do those who are sedentary.
  4. Thirty minutes of moderate-intensity exercise daily is recommended for pregnant women, but even mild exercise is helpful. Women who exercise regularly have better muscle tone, self-image, bowel function, energy levels, sleep, and postpartum recovery than do those who are sedentary.

 

Cognitive Level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Implementation

Learning Outcome 11.5 Describe self-care measures that a pregnant woman can take to maintain and promote her well-being during pregnancy.

 

 

Chapter 11_LO05_Q15

The pregnant client is in her 21st week of pregnancy, and is planning a vacation with her family. She asks the nurse which method of travel would be recommended for her to use. How should the nurse respond? “The safest method of travel is to:

  1. “Take an automobile.
  2. “Fly on an airplane.
  3. “Travel by train.
  4. “Not travel this late in pregnancy.

Answer: 3

Rationale:

  1. Automobile travel does not allow for frequent enough movement.
  2. Airplane travel does not allow for frequent enough movement.
  3. In the latter half of pregnancy, frequent movement is recommended for pregnant women, both to increase comfort and to decrease venous pooling, which can lead to thrombophlebitis. The train allows the most movement for the traveling pregnant woman.
  4. It is not necessary to cease travel altogether.

Cognitive Level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Planning

Learning Outcome 11.5 Describe self-care measures that a pregnant woman can take to maintain and promote her well-being during pregnancy.

 

Chapter 11_LO05_Q16

The nurse is explaining the importance of fetal activity assessment to the client. What should the nurse do to best reinforce the significance of fetal kick counting to the client?

  1. Perform daily phone calls to the client at work or home.
  2. Review the client’s written record of fetal movement at each visit.
  3. Ask the client to remember to count the fetal movements.
  4. Explain the rationale for counting fetal movement to the client.

Answer: 2

 

Rationale:

  1. Daily phone calls would take emphasis away from the importance of the client’s counting of fetal movement.
  2. Clients should be instructed to begin counting fetal movement between 24 and 28 weeks. A fetus that has been active and has a sudden decrease in movements could be conserving energy due to hypoxia. Movements are counted in a specified time period, such as for one hour after each meal, or beginning with arising in the morning.
  3. Writing down the count is more accurate than the client’s simply remembering. When the nurse examines the written record the client has kept, it reinforces the importance of the record, and improves the likelihood of continued record keeping.
  4. Knowing the reasons for the counting will increase understanding of the process, but will not reinforce its significance of the task.

Cognitive Level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Planning

Learning Outcome 11.5 Describe self-care measures that a pregnant woman can take to maintain and promote her well-being during pregnancy.

 

 

Chapter 11_LO06_Q17

Which statement by the pregnant client indicates that teaching has been effective?

  1. “I should not have sex, because this is my first pregnancy.”
  2. “Some sexual positions should be avoided during pregnancy.”
  3. “We should quit having sex when I get to 8 months.”
  4. “I can tell my partner that having sex won’t hurt the baby.”

Correct Answer: 4

Rationale:

  1. Sexual activity is neither harmful nor contraindicated in an uncomplicated pregnancy.
  2. Although some sexual positions are more comfortable for the pregnant woman as the uterus enlarges, there are no sexual positions that are contraindicated during pregnancy.
  3. This is not necessary. Sexual activity is neither harmful nor contraindicated in an uncomplicated pregnancy.
  4. Sexual activity is neither harmful nor contraindicated in an uncomplicated pregnancy.

Cognitive level:  Analysis

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Evaluation

Learning Outcome: 11.6 Examine the concerns that the expectant couple may have about sexual activity.

 

Chapter 11_LO07_Q18

The nurse is preparing a brochure for couples considering pregnancy after the age of 35. Which statements should be included? During pregnancy after age 35: (Select all that apply’)

  1. There is a decreased risk of Down syndrome.
  2. Pre-existing medical conditions can complicate pregnancy.
  3. Very preterm births are more common.
  4. Amniocentesis can be performed to detect genetic anomalies.
  5. Gestational diabetes is no longer a risk.

Correct Answers: 2, 3, 4

Rationale:

  1. Down syndrome risk increases when maternal age exceeds 34 years.
  2. The older a woman is, the more likely she is to have developed chronic health care issues such as type II diabetes or hypertension. The presence of chronic conditions can further complicate pregnancy in women over 35.
  3. Very preterm births and low birth weight are more common in pregnancy of women over 35.
  4. Amniocentesis is offered to women over 35 due to the increased of trisomy 18 and 21. However, amniocentesis has risks, and is not performed on all women over 35. In addition, some women would not terminate a pregnancy regardless of the findings of the amniocentesis, and therefore refuse this test.
  5. The older a client is during pregnancy, the higher her risk of developing gestational diabetes.

Cognitive level: Analysis

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Evaluation

Learning Outcome: 11.7 Describe the medical risks and special concerns of the older expectant woman and her partner in managing nursing care to this population.