Leifer Ch 5 Text Bank questions for this Chapter RE: Leifer 8th Edition PDF

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Text Bank questions for this Chapter RE: Leifer 8th Edition...

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Chapter 05: Nursing Care of Women with Complications During Pregnancy Leifer: Introduction to Maternity and Pediatric Nursing, 8th Edition MULTIPLE CHOICE 1. A pregnant patient tells the nurse that she has been nauseated and vomiting. How will the

nurse explain that hyperemesis gravidarum is distinguished from morning sickness? Hyperemesis gravidarum usually lasts for the duration of the pregnancy. Hyperemesis gravidarum causes dehydration and electrolyte imbalances. Sensitivity to smells is usually the cause of vomiting in hyperemesis gravidarum. The woman with hyperemesis gravidarum will have persistent vomiting without weight loss.

a. b. c. d.

ANS: B

Dehydration and electrolyte imbalances result from persistent nausea and vomiting associated with hyperemesis gravidarum. Dehydration impairs the perfusion to the placenta. DIF: Cognitive Level: Comprehension REF: p. 88 OBJ: 3 TOP: Hyperemesis KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. A woman is 9 weeks pregnant and experiencing heavy bleeding and cramping. She reports

passing some tissue. Cervical dilation is noted on examination. What is the most likely cause of these symptoms? a. Inevitable abortion b. Incomplete abortion c. Complete abortion d. Missed abortion ANS: B

Signs and symptoms of an incomplete abortion are similar to those of an inevitable abortion, but some tissue is passed. DIF: OBJ: KEY: MSC:

Cognitive Level: Comprehension REF: p. 90|Table 5-2|Figure 5-2 3 TOP: Incomplete Abortion Nursing Process Step: Data Collection NCLEX: Physiological Integrity: Physiological Adaptation

3. The nurse finds a woman crying after she has undergone a dilation and evacuation (D&E) for

a missed abortion. What is the most appropriate statement by the nurse? a. “There is usually something wrong with the fetus when this happens early in

pregnancy.” b. “Now there. You can try to conceive on your next cycle.” c. “I’m here if you need to talk.” d. “You are young and strong. I know you can have a healthy pregnancy.” ANS: C

An effective technique when communicating with a woman experiencing pregnancy loss is to say, “I’m here if you need to talk.” The nurse listens and acknowledges the woman’s grief. DIF: Cognitive Level: Application

REF: pp. 91-92

OBJ: 3

TOP: Dilation and Evacuation (D&E) KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 4. A woman who is 8 weeks pregnant becomes concerned when she has light vaginal bleeding

accompanied by abdominal pain. An ectopic pregnancy is confirmed by ultrasound. Which statement indicates that the woman understands the explanation of an ectopic pregnancy? a. “The chorionic villi develop vesicles within the uterus.” b. “The placenta develops in the lower part of the uterus.” c. “The fetus dies in the uterus during the first half of the pregnancy.” d. “The embryo is implanted in the fallopian tube.” ANS: D

Ectopic pregnancy occurs when the fertilized ovum is implanted outside of the uterine cavity. DIF: Cognitive Level: Comprehension REF: p. 93 OBJ: 3 TOP: Ectopic Pregnancy KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 5. An ultrasound on a woman who is 32 weeks pregnant reveals the placenta implanted over the

entire cervical os. What does the nurse understand best describes this condition? Low-lying placenta Marginal placenta previa Partial placenta previa Total placenta previa

a. b. c. d.

ANS: D

A total placenta previa describes a condition in which the placenta completely covers the cervical opening. DIF: Cognitive Level: Comprehension REF: p. 95 OBJ: 3 TOP: Placenta Previa KEY: Nursing Process Step: Data Collection MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 6. What symptom presented by a pregnant women is indicative of abruptio placentae? a. Painless vaginal bleeding b. Uterine irritability with contractions c. Vaginal bleeding and back pain d. Premature rupture of membranes ANS: C

Bleeding accompanied by abdominal or lower back pain is a typical manifestation of abruptio placentae. DIF: Cognitive Level: Knowledge REF: p. 96 OBJ: 3 TOP: Abruptio Placenta KEY: Nursing Process Step: Data Collection MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 7. What situation would concern the nurse about the presence of Rh incompatibility? a. Rh-negative mother, Rh-positive fetus b. Rh-positive mother, Rh-negative fetus c. Rh-negative mother, Rh-negative fetus d. Rh-positive mother, Rh-positive fetus

ANS: A

Rh incompatibility can occur only if the mother is Rh negative and the fetus is Rh positive. DIF: Cognitive Level: Analysis REF: p. 101 OBJ: 3 TOP: Rh Incompatibility KEY: Nursing Process Step: N/A MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 8. A primigravida in her first trimester is Rh negative. What will this woman receive to prevent

anti-Rh antibodies from forming? a. Rh immune globulin during labor b. Intrauterine transfusions with O-negative blood c. Rh immune globulin at 28 weeks and within 72 hours after the birth of an Rh-

positive infant d. Rh immune globulin now and again in the last trimester ANS: C

An Rh-negative woman would receive Rh immune globulin at 28 weeks of gestation and within 72 hours after the birth of an Rh-positive infant or abortion. DIF: Cognitive Level: Comprehension REF: p. 101 OBJ: 3 TOP: Rh Incompatibility KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 9. A woman seeking prenatal care relates a history of macrosomic infants, two stillbirths, and

polyhydramnios with each pregnancy. What does the nurse recognize these factors highly suggest? a. Toxoplasmosis b. Abruptio placentae c. Hydatidiform mole d. Diabetes mellitus ANS: D

Large (macrosomic) infants over 9 pounds are linked to gestational diabetes. DIF: Cognitive Level: Comprehension REF: p. 102 OBJ: 4 TOP: Diabetes Mellitus KEY: Nursing Process Step: Data Collection MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 10. A nurse is providing prenatal education. The nurse will explain that pregnancy affects glucose

metabolism in what way? Placental hormones increase the resistance of cells to insulin. Insulin cells cannot meet the body’s demands as the woman’s weight increases. There is a decreased production of insulin during pregnancy. The speed of insulin breakdown is decreased during pregnancy.

a. b. c. d.

ANS: A

Hormones and enzymes produced by the placenta increase the resistance of cells to insulin. DIF: Cognitive Level: Knowledge REF: pp. 102-103 OBJ: 4 TOP: Diabetes Mellitus KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation

11. Why does the woman taking oral hypoglycemic agents to control diabetes mellitus need to

take insulin during pregnancy? Insulin can cross the placental barrier to the fetus. Insulin does not cross the placental barrier to the fetus. Oral agents do not cross the placenta. Oral agents are not sufficient to meet maternal insulin needs.

a. b. c. d.

ANS: B

Oral hypoglycemic agents are not used during pregnancy, because they can cross the placenta, possibly resulting in fetal birth defects or hypoglycemia. DIF: Cognitive Level: Comprehension REF: pp. 104-105 OBJ: 4 TOP: Diabetes Mellitus KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 12. A pregnant woman comes to the clinic stating that she has been exposed to hepatitis B. She is

afraid that her infant will also contract hepatitis B. What will the nurse explain to this woman? a. The infant will be given a single dose of hepatitis immune globulin after birth. b. The infant will be able to use the antibodies from the immunizations given to the

patient before delivery. c. The infant will not have hepatitis B because the virus does not pass through the

placental barrier. d. The infant will be immune to hepatitis B because of the mother’s infection. ANS: A

The infant will be given immune globulin immediately after birth for temporary immunity followed by hepatitis B vaccine. Immunization is not recommended for women who are pregnant. DIF: Cognitive Level: Comprehension REF: p. 109 OBJ: 4 TOP: Hepatitis B KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 13. What will the nurse begin with when asking a patient about drug use during a prenatal

history? a. “Do you smoke, drink alcohol, or use drugs?” b. “Do you ever use prescription or street drugs?” c. “What over-the-counter and prescription drugs have you taken in the past 3

months?” d. “We need to know if you take drugs so we can help your baby.” ANS: C

Screening for drug use should begin in a nonthreatening way by asking about prescription and OTC medications and how the information can help provide safe and appropriate prenatal care. DIF: Cognitive Level: Application REF: p. 114 OBJ: 5 TOP: Interviewing Relative to Drug Use KEY: Nursing Process Step: Data Collection MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 14. The nurse assesses a pregnant woman for pregnancy-induced hypertension. What is the first

sign of fluid retention suggestive of this complication?

a. b. c. d.

Abdominal enlargement Facial swelling Sudden weight gain Swelling of the feet and ankles

ANS: C

Sudden, excessive weight gain is the first sign of fluid retention; facial swelling and swelling of the feet, legs, and hands follow weight gain. DIF: Cognitive Level: Knowledge REF: p. 98 OBJ: 3 TOP: Hypertension KEY: Nursing Process Step: Data Collection MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 15. A patient with gestational hypertension is exhibiting all of the signs below. What should the

nurse report immediately? Diarrhea Urticaria Blurred vision Backache

a. b. c. d.

ANS: C

Visual disturbances indicate worsening pregnancy-induced hypertension and must be reported promptly for effective intervention to prevent preeclampsia and convulsion. DIF: Cognitive Level: Application REF: p. 99 OBJ: 3 TOP: Hypertension KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 16. A patient who is 28 weeks pregnant presents with consistent hypertension. What need would

the home health nurse make the first priority? Activity restriction Balanced nutrition Increased fluid intake to ensure adequate hydration Instruction about the effect of diuretics

a. b. c. d.

ANS: A

Bed rest reduces the flow of blood to skeletal muscles, making more blood available to the placenta and enhancing fetal oxygenation. DIF: Cognitive Level: Application REF: p. 99 OBJ: 3 TOP: Hypertension KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 17. The nurse is caring for a pregnant woman diagnosed with preeclampsia. What will the nurse

explain is the objective of magnesium sulfate therapy for this patient? To prevent convulsions To promote diaphoresis To increase reflex irritability To act as a saline cathartic

a. b. c. d.

ANS: A

Magnesium sulfate is a central nervous system depressant given to prevent seizures.

DIF: OBJ: KEY: MSC:

Cognitive Level: Knowledge REF: p. 97|pp. 99-100 3 TOP: Magnesium Sulfate Nursing Process Step: Implementation NCLEX: Physiological Integrity: Pharmacological Therapies

18. The nurse is caring for a pregnant woman receiving an intravenous infusion with magnesium

sulfate. What is the highest priority nursing intervention? Count respirations and report a rate of less than 12 breaths/minute. Count respirations and report a rate of more than 20 breaths/minute. Check blood pressure and report a rate of less than 100/60 mm Hg. Monitor urinary output and report a rate of less than 100 mL/hr.

a. b. c. d.

ANS: A

Excessive magnesium sulfate may cause respiratory depression. DIF: Cognitive Level: Application REF: p. 100 OBJ: 3 TOP: Magnesium Sulfate KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 19. What drug will the nurse plan to have available for immediate IV administration whenever

magnesium sulfate is administered to a maternity patient? Ergonovine maleate (Ergotrate) Oxytocin Calcium gluconate Hydralazine (Apresoline)

a. b. c. d.

ANS: C

Calcium gluconate reverses the effects of magnesium sulfate and should be available for immediate use when a woman receives magnesium sulfate. DIF: Cognitive Level: Comprehension REF: p. 100 OBJ: 3 TOP: Calcium Gluconate KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 20. A woman who is 35 weeks pregnant has a total placenta previa. She asks the nurse, “Will I be

able to deliver vaginally?” What explanation by the nurse is the most appropriate? a. “Yes, you can deliver vaginally until 36 weeks.” b. “A vaginal delivery can be attempted, but if bleeding occurs, a cesarean section

will be done.” c. “A cesarean section is performed when the mother has a total placenta previa.” d. “There is no reason why you cannot have a vaginal delivery.” ANS: C

A cesarean delivery is done for a partial or total placenta previa. DIF: Cognitive Level: Application REF: p. 96 OBJ: 3 TOP: Placenta Previa KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk 21. The nurse teaches a woman who is 8 weeks pregnant about how rubella can affect the

developing fetus. What can result from maternal rubella during pregnancy?

a. b. c. d.

Facial abnormalities Mental retardation Liver failure Limb deformities

ANS: B

Rubella can have devastating effects on the developing fetus. Some effects of rubella on the embryo or fetus include microcephaly, mental retardation, cardiac defects, cataracts, and deafness. DIF: Cognitive Level: Knowledge REF: p. 109 OBJ: 4 TOP: Rubella KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 22. What symptom reported by a pregnant patient would lead the nurse to suspect pyelonephritis? a. Frequency and urgency of urination b. Nausea and weight loss c. Burning sensation when voiding d. Tenderness in the flank area ANS: D

Pyelonephritis is a particularly serious infection in pregnancy. Signs and symptoms include high fever, chills, flank pain or tenderness, nausea, and vomiting. DIF: Cognitive Level: Comprehension REF: p. 112 OBJ: 4 TOP: Pyelonephritis KEY: Nursing Process Step: Data Collection MSC: NCLEX: Physiological Integrity: Reduction of Risk 23. The nurse is caring for a prenatal patient diagnosed with a placenta previa. What is the best

position for this patient? Flat on her back with knees flexed to help prevent hemorrhage On her side to prevent supine hypotension In the semi-Fowler’s position to prevent supine hypotension In the knee-chest position to reduce pressure on the placenta

a. b. c. d.

ANS: B

The prenatal patient with placenta previa is best placed on her side with a pillow for support. This position not only reduces stress on the placenta but also reduces the possibility of supine hypotension. DIF: Cognitive Level: Application REF: p. 96 OBJ: 3 TOP: Placenta Previa KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk 24. The young prenatal patient with gestational diabetes mellitus (GDM) says, “I am frightened

that I will have to deal with insulin injections for the rest of my life.” What is the best response by the nurse? a. “After delivery your doctor will prescribe oral hypoglycemic medication to control your disease. Pills are so much simpler than insulin injections.” b. “Have you considered an insulin pump?” c. “After a while those insulin injections won’t seem so bad.” d. “It will most likely resolve 6 weeks or so after the baby is born.”

ANS: D

GDM usually resolves by 6 weeks after delivery. DIF: Cognitive Level: Application REF: p. 103 OBJ: 3 TOP: GDM KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 25. The nurse is preparing a pregnant patient for an abdominal ultrasound at 8 weeks’ gestation.

What intervention will the nurse implement before this diagnostic test? a. Instruct the patient to take nothing by mouth after midnight the night before the

test. b. Initiate an IV. c. Encourage the patient to drink 1 to 2 quarts of water before the test. d. Instruct the patient to remove all jewelry. ANS: C

Ultrasound uses high-frequency sound waves to visualize structures within the body; the examination may use a transvaginal probe or an abdominal transducer; abdominal ultrasound during early pregnancy requires a full bladder for proper visualization (have the woman drink 1 to 2 quarts of water before the examination). DIF: OBJ: KEY: MSC:

Cognitive Level: Application REF: p. 85|Table 5.1 2 TOP: Diagnostic Tests Nursing Process Step: Implementation NCLEX: Health Promotion and Maintenance: Prenatal Care

26. The nurse is caring for a macrosomic newborn of a diabetic patient. What complications will

the nurse assess for in the newborn? Meconium ileus Diarrhea Hypoglycemia Muscle tremors

a. b. c. d.

ANS: C

The fetus responds to the hyperglycemia from the mother’s blood and produces increased insulin. This insulin may cause hypoglycemia in the infant after it is no longer exposed to the mother’s blood. DIF: OBJ: KEY: MSC:

Cognitive Level: Application REF: p. 103|Box 5-4 4 TOP: Hypoglycemia in Macrosomic Infant Nursing Process Step: Data Collection NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

MULTIPLE RESPONSE 1. The nurse educates prenatal patients about the threat of TORCH infections. Which infections

are included in this classification? (Select all that apply.) Toxoplasmosis Toxemia Cytomegalovirus Rubella

a. b. c. d.

e. Herpes simplex ANS: A, C, D, E

The TORCH infections are toxoplasmosis, rubella, cytomegalovirus, and herpes simplex. DIF: Cognitive Level: Knowledge REF: p. 106 OBJ: 5 TOP: TORCH Infections KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 2. The nurse emphasizes to a patient with a high-risk pregnancy that the impact of such a

pregnancy might result in which problems? (Select all that apply.) Disruption of family roles Financial pressures Excessive attachment to infant Frustration with activity restriction Alteration in child care practices

a. b. c. d. e.

ANS: A, B, D, E

High-risk pregnancies may produce problems such as disruption of family roles, financial pressures, delayed attachment to the infant, alteration in child care practices, and frustration with activity restriction. DIF: Cognitive Level: Comprehension REF: pp. 117-118 OBJ: 7 TOP: Impact of High-Risk Pregnancies...