NR 327 Exam 2 Content Review Sheet | (Postpartum hemorrhage, Uterus) | Chamberlain College of Nursing.

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NR 327 Exam 2 Content Review Sheet Textbook Chapters: 14, 17, 19, 20, 21, 22 ATI Chapters: 17, 18, 19, 22, 23, 24, 25, 26 Fetal Heart Monitor (distress, interventions) FHM strips BUBBLE HER Post... partum Assessment (lochia, fundus position, etc) Maternal Adjustment Breastfeeding (breastmilk) Hypothermia Gestational Age Characteristics Newborn assessment (respirations, heart rate, labs, etc.) Jaundice (pathologic, physiologic) Vit K Umbilical cord care Circumcision care New mother Patient education Newborn Meconium aspiration Hyperbilirubinemia Chapter 17 1. Questions Immediately after birth, the nurse can anticipate the fundus to be located A. at the umbilicus. B. 2 cm above the umbilicus. C. 1 cm below the umbilicus. D. midway between the symphysis pubis and umbilicus. Correct Immediately after birth the uterus is about the size of a large grapefruit and the fundus can be palpated midway between the symphysis pubis and umbilicus. Within 12 hours the fundus rises to the level of the umbilicus. By the second day, the fundus starts to descend by approximately 1 cm/day. Awarded 0.0 points out of 1.0 possible points. 2. 2.ID: 18649223421 When reading the postpartum chart the nurse notices that the patient’s fundus is recorded as “u+1.” The nurse understands that this means the fundus is A. 1 cm above the umbilicus. Correct Descent of the fundus is documented in relation to the umbilicus and is measured in centimeters. Numbers with a plus sign mean that the fundus is above the umbilicus; numbers with a minus sign mean that the fundus is below the umbilicus. B. 1 cm below the umbilicus. C. 1 inch above the umbilicus. D. 1 inch below the umbilicus. Awarded 0.0 points out of 1.0 possible points. 3. 3.ID: 18649222873 During the second postpartum day, a woman asks the nurse, “Why are my afterpains so much worse this time than after the birth of my other child?” The best answer by the nurse would be: A. “Most women forget how strong the afterpains can be.” B. “They should not be strong with you because you are breastfeeding.” C. “You should not be feeling the pains now; I will notify the physician for you.” D. “Afterpains are more severe for women who have already given birth.” Correct Afterpains are more acute for multiparas because repeated stretching of muscle fibers leads to low muscle tone, which results in repeated contraction and relaxation of the uterus. Breastfeeding increases the severity of afterpains. The afterpains are self-limiting and will decrease rapidly after 48 hours. Awarded 0.0 points out of 1.0 possible points. 4. 4.ID: 18649222897 The nurse is assessing the patient’s vaginal discharge. It is red and has about a 2-inch stain on the peripad. The nurse will record this finding as a A. light amount of lochia rubra. Correct Lochia rubra is red in color and occurs the first 3 or 4 days after birth. A light amount of discharge is classified as a 1- to 4-inch stain on the peripad. B. scant amount of lochia alba. C. moderate amount of lochia rubra. D. heavy amount of lochia alba. Awarded 0.0 points out of 1.0 possible points. 5. 5.ID: 18649222891 The new mother is complaining of pain at the episiotomy site; however, because she is breastfeeding, she does not want any medication. What other alternatives can the nurse offer this mother to help relieve the pain? A. Ambulation B. Topical anesthetics Correct Topical anesthetics can be applied directly to the site to numb the area. This will not cause systemic effects like pain medications. Sitz baths may also be soothing. C. Hot fluids to drink D. Stool softeners Awarded 0.0 points out of 1.0 possible points. 6. 6.ID: 18649222875 A mother who is 3 days postpartum calls the clinic and complains of “night sweats.” She is afraid that she is going into early menopause. The nurse should base her answer on the fact that A. birth may put some women into early menopause; an appointment is needed to have this checked out. B. night sweats may be an indication of many other problems; an appointment is needed to assess the problem. C. diaphoresis is normal during the postpartum period, and comfort measures can be suggested to the mother. Correct Diaphoresis and diuresis rid the body of excess fluids that accumulated during the pregnancy. Diaphoresis is not clinically significant, but can be unsettling for the mother who is not prepared for it. Explanations of the cause and provision of comfort measures, such as showers and dry clothing, are generally sufficient. D. diaphoresis is normal only if the mother is breastfeeding. Awarded 0.0 points out of 1.0 possible points. 7. 7.ID: 18649223423 On the first postpartum day a patient’s white blood cell count is 25,000/mm3. The nurse’s next action should be to A. notify the physician for an antibiotic order. B. assess the patient’s temperature and blood pressure. C. request the count be repeated. D. note the results in the chart. Correct Marked leukocytosis occurs during the postpartum period. The WBC count increases to as high as 30,000/mm3. The WBC count should fall to normal values by day 7. Neutrophils, which increase in response to inflammation, pain, and stress to protect against invading organisms, account for the major increase in WBCs. Because this is a normal reading, noting the results in the chart is the appropriate action. Awarded 0.0 points out of 1.0 possible points. 8. 8.ID: 18649223431 One nursing measure that can help prevent postpartum hemorrhage and urinary tract infections is A. forcing fluids. B. perineal care. C. encouraging voiding every 2 to 3 hours. Correct Urinary retention and overdistention of the bladder may cause urinary tract infection and postpartum hemorrhage. Encouraging the mother to empty her bladder frequently will help prevent retention and overdistention. Forcing fluids and perineal care may assist with preventing urinary tract infections. Stool softeners assist with return of normal bowel elimination. D. encouraging the use of stool softeners. Awarded 0.0 points out of 1.0 possible points. 9. 9.ID: 18649223417 While doing patient teaching, the woman tells the nurse, “I don’t have to worry about contraception because I am breastfeeding.” The nurse should base her answer on the fact that A. breastfeeding can be considered a reliable system of birth control. B. breastfeeding can be used as a contraceptive method if strict guidelines are followed through. C. breastfeeding is not a reliable contraceptive method. Correct Menses in a breastfeeding mother may resume between 12 weeks and 18 months. Normally the first few cycles of menses are without ovulation; however, ovulation may occur before the first menses. Therefore other contraceptive measures are important considerations for this mother. Awarded 0.0 points out of 1.0 possible points. 10. 10.ID: 18649222865 A woman was admitted to the ED with her newborn baby. The baby was born 4 days ago at home. The woman had no prenatal care. The nurse is assessing the lab work and sees that the mother has an O- negative blood type, the baby is O-positive, and the Coombs test shows that the mother is not sensitized to the positive blood. The nurse’s next action should be A. order Rho(D) immune globulin to be given to the mother. B. order Rho(D) immune globulin to be given to the baby. C. record the findings of the lab work and not plan on any further action at this time. Correct The mother is a candidate for Rho(D) immune globulin; however, it should be given within 72 hours after childbirth to prevent the development of maternal antibodies. Because she gave birth 4 days ago, that time period as passed and she is not sensitized to the positive blood. Awarded 0.0 points out of 1.0 possible points. 11. 11.ID: 18649223415 The first time a woman ambulates after the birth of the newborn, she has a nursing diagnosis of Risk for injury because of the A. risk for developing orthostatic hypotension. Correct After birth a rapid decrease in intraabdominal pressure results in dilation of the blood vessels supplying the viscera. The resulting engorgement of abdominal blood vessels contributes to a rapid fall in blood pressure when the woman moves from a recumbent to a sitting position. The mother feels dizzy or lightheaded and may faint when she stands. Bradycardia is a normal change during the postpartum period. The cardiac output increases during the postpartum period, but does not produce orthostatic hypotension. B. development of bradycardia. C. increase in cardiac output. D. increase in circulatory volume. Awarded 0.0 points out of 1.0 possible points. 12. 12.ID: 18649222869 When assessing a woman who gave birth 2 hours ago, the nurse notices a constant trickle of lochia. The uterus is well contracted. The next nursing action should be to A. massage the fundus. B. continue to monitor. C. notify the physician. Correct Excessive lochia in the presence of a contracted uterus suggests lacerations of the birth canal. The health care provider must be notified so that lacerations can be located and repaired. The uterus is well contracted, so further massage is not necessary. D. assess the blood pressure and pulse for changes. Awarded 0.0 points out of 1.0 possible points. 13. 13.ID: 18649222885 During the early post–cesarean section phase, it is important for the woman to turn, cough, and deep breathe. The rationale for this is to prevent A. pooling of secretions in the airway. Correct The post–cesarean section woman is usually on bed rest for the first 8 to 12 hours. She is at risk for pooling of secretions in the airway. By assisting her to turn, cough, and expand her lungs by breathing deeply at least every 2 hours, the pooling of secretions will be decreased. B. thrombus formation in the lower legs. C. gas formation in the intestinal tract. D. urinary retention. Awarded 0.0 points out of 1.0 possible points. 14. 14.ID: 18649223425 As part of the postpartum assessment, the nurse examines the breasts of a primiparous breastfeeding woman who is 1 day postpartum. An expected finding would be A. Soft, nontender; colostrum is present. Correct Breasts are essentially unchanged for the first 2 or 3 days after birth. Colostrum is present and may leak from the nipples. On day 3 or 4 lactation begins and engorgement can occur, resulting in the findings of b and c. Response d indicates problems with the breastfeeding techniques used. B. Leakage of milk at let-down. C. Swollen, warm, and tender on palpation. D. A few blisters and a bruise on each areola. Awarded 0.0 points out of 1.0 possible points. 15. 15.ID: 18649222879 A birthing center is trying to balance its budget and needs to cut down on certain services they have been providing. One concern of the staff is the follow-up care for new mothers. Which of the following provides follow-up care at the least cost? A. Longer hospital stays for the mother and newborn B. Home visits after discharge C. Return clinic visits D. Telephone counseling services Correct Telephone calls are much less expensive than home or clinic visits. They can be used for follow-up calls to discharged patients or for parents to call for help with problems or questions. The major disadvantage is that the nurse cannot perform an in-person assessment of the mother, baby, or home environment. Awarded 0.0 points out of 1.0 possible points. 16. 16.ID: 18649223438 The new mother comments that the newborn “has his father’s eyes.” The nurse recognizes this as A. part of the bonding process termed claiming. Correct Claiming or binding-in begins when the mother begins to identify specific features of the newborn. She then begins to relate features to family members. B. the mother trying to find signs of the baby’s paternity. C. the mother trying to include the father in the bonding process. D. part of the letting-go phase of maternal adaptation. Awarded 0.0 points out of 1.0 possible points. 17. 17.ID: 18649222899 A new father of 1 day expresses concern to the nurse that his wife, who is normally very independent, is asking him to make all the decisions. The nurse can best explain this as a(n) A. normal occurrence because the mother is in pain. B. abnormal occurrence that needs to be assessed further. C. normal occurrence because the mother is in the taking-in phase. Correct During the taking-in phase, the mother is focused primarily on her own need for fluid, food, and sleep. She may be passive and dependent. This is normal and lasts about 2 days. D. normal occurrence because the mother is frustrated with the care of the newborn. Awarded 0.0 points out of 1.0 possible points. 18. 18.ID: 18649222881 The day after giving birth, the woman complains that she did not lose all the weight she had gained during the pregnancy. The nurse can best respond to the mother with the knowledge that A. she has lost the most of the weight and the rest will be gone within 1 week. B. she has lost some of the weight and the rest will slowly disappear within 6 weeks. C. it will take about 6 to 12 months for all the weight gained with the pregnancy to disappear. Correct Women are very concerned about regaining their normal figure. Nurses must emphasize that weight loss should be gradual and that about 6 to 12 months is usually required to lose most weight gained during pregnancy. D. most women do not lose all the weight gained with each pregnancy. Awarded 0.0 points out of 1.0 possible points. 19. 19.ID: 18649223405 A nurse is asked to do a home visit on a woman who delivered 2 weeks ago. When assessing the woman, the nurse was not able to locate the fundus. The next action would be A. massage the fundus until firm. B. monitor for bleeding. C. arrange transportation for the woman to the nearest hospital. D. document this normal finding. Correct The uterus descends at the rate of about 1 cm/day. By 10 to 14 days, it is no longer palpable above the symphysis pubis. This is a normal finding. Awarded 0.0 points out of 1.0 possible points. 20. 20.ID: 18649223440 The home care nurse is visiting a new mother who delivered 1 week ago. The mother complains about not being able to sleep and that she is tired and cries easily. The best response by the nurse would be: A. “Having a baby is difficult; it will be a long time before you get a good night’s sleep.” B. “Maybe your mother can come in and help you out.” C. “It is normal for this to happen and should go away in 2 weeks. It must be very difficult for you to feel this way with a new baby.” Correct Postpartum blues begins in the first week and usually last no longer than 2 weeks. The mother needs to be supported during this time and given accurate information about the process. Responses a and b belittle the mother and may make her feel inadequate. Response d places blame on someone else and does not deal with the problem. D. “The hospital nurses must not have taught you enough information about the changes you will experience during these first 6 weeks.” Awarded 0.0 points out of 1.0 possible points. 21. 21.ID: 18649223403 The new parents express concern that their 4-year-old son is jealous of the new baby. They are planning on going home tomorrow and are not sure how the preschooler will react when they bring the baby home. Which one of the following suggestions by the nurse will be most helpful? A. Be aware that the child may regress to an earlier stage. B. Have the mother spend time with the child while the father cares for the baby. Correct The child needs to have the mother’s love reaffirmed. By giving the child some private time with the mother, he will get the extra attention and reassurance he needs at this point. C. Have the child stay with a grandparent until the parents adjust to the new baby. D. Tell the child that he is a “big boy” now and doesn’t need his crib so the new baby will be using it for a while. Awarded 0.0 points out of 1.0 possible points. 22. 22.ID: 18649222877 A newborn is rooming-in with his teenage mother, who is watching TV. The nurse notes that the baby is awake and quiet. The best nursing action is to A. pick the baby up and point out his alert behaviors to the mother. Correct Modeling behavior by the nurse is an excellent way to teach infant care. The inexperienced teenage mother can observe the proper skills and then the nurse can encourage her to try those skills. B. tell the mother to pick up her baby and talk with him while he is awake. C. focus care on the mother, rather than the infant so she can recuperate. D. encourage the mother to feed the infant before he begins crying. Awarded 0.0 points out of 1.0 possible points. 23. 23.ID: 18649222867 When making a visit to the home of a postpartum woman 1 week after birth, the nurse should recognize that the woman would characteristically A. express a strong need to review events and her behavior during the process of labor and birth. B. exhibit a reduced attention span, limiting readiness to learn. C. attempt to meet the needs of the infant and is eager to learn about infant care. Correct One week after birth the woman should exhibit behaviors characteristic of the taking-hold phase. This stage lasts for as long as 4 to 5 weeks after birth. Responses a and b are characteristic of the taking-in stage, which lasts for the first few days after birth. Response d reflects the letting-go stage, which indicates that psychosocial recovery is complete. D. have reestablished her role as a spouse and partner. Awarded 0.0 points out of 1.0 possible points. 24. 24.ID: 18649223409 Four hours after a difficult labor and birth, a primiparous woman refuses to feed her baby, stating that she is too tired and just wants to sleep. The nurse should A. tell the woman she can rest after she feeds her baby. B. recognize this as a behavior of the taking-hold stage. C. record the behavior as ineffective maternal-newborn attachment. D. take the baby back to the nursery, reassuring the woman that her rest is a priority at this time. Correct The behavior described is typical of this stage and not a reflection of ineffective attachment unless the behavior persists. Mothers need to reestablish their own well-being to care for their baby effectively. Awarded 0.0 points out of 1.0 possible points. 25. 25.ID: 18649223444 A primiparous woman is in the taking-in stage of psychosocial recovery and adjustment following birth. The nurse, recognizing women’s needs during this stage, should A. foster an active role in the baby’s care. B. provide time for the mother to reflect on the events of the childbirth. Correct The focus of the taking-in stage is nurturing the new mother by meeting her dependency needs for rest, comfort, hygiene, and nutrition. Once they are met, she is more able to take an active role, not only in her own care but also in the care of the newborn. Women express a need to review their childbirth experience and evaluate their performance. Short teaching sessions and using written materials to reinforce the content presented are a more effective approach. C. recognize the woman’s limited attention span by giving her written materials to read when she gets home rather than doing a teaching session now. D. promote maternal independence by encouraging her to meet her own hygiene and comfort needs. Awarded 0.0 points out of 1.0 possible points. 26. 26.ID: 18649223401 After a cesarean birth, the woman needs to be assessed routinely. Select all the assessments necessary for this woman. (Select all that apply.) A. Vital signs Correct B. Return of motion and sensation (if regional block was given) Correct C. Abdominal dressing Correct D. Pupil dilation E. Uterine firmness and position Correct F. Urine output Correct G. Deep tendon reflexes H. IV infusion Correct In addition to the usual postpartum evaluation, following cesarean birth, the mother must be assessed as any other postoperative patient: vital signs including pain, uterine position, dressing, abdomen for distention, lochia, intake (IV and oral) and output (voiding or catheter). Awarded 0.0 points out of 6.0 possible points. 27. 27.ID: 18649222883 Constipation is a common problem during the postpartum period. Select all the reasons for constipation during this period. (Select all that apply.) A. Diminished bowel tone Correct B. Overhydration during labor C. Episiotomy that causes the fear of pain with elimination Correct D. Iron supplementation Correct E. Some pain medications Correct Constipation may occur from decreased food and fluid intake during labor, reduced activity, iron intake, decreased muscle and bowel tone, and fear of pain during defecation. Awarded 0.0 points out of 4.0 possible points. 28. 28.ID: 18649222871 When assessing the perineum, episiotomy site, or surgical site, the nurse should assess for specific signs. Select all the signs that are appropriate when assessing a surgical site. (Select all that apply.) A. Redness Correct B. Edema Correct C. Ecchymosis Correct D. Discharge Correct E. Asymmetry The acronym REEDA is used as a reminder that the site of an episiotomy or a perineal laceration should be assessed for five signs: redness (R), edema (E), ecchymosis (E), discharge (D), and approximation (A). Awarded 0.0 points out of 4.0 possible points. 29. 29.ID: 18649223419 To promote bonding during the first hour after birth, the nurse can do which of the following? (Select all that apply.) A. Delay procedures if appropriate. Correct B. Allow the father to hold the newborn. Correct C. Demonstrate proper bottle feeding techniques. D. Allow as much contact with the newborn as possible. Correct E. Use the time to do parent teaching on newborn characteristics. Early, unlimited and prolonged contact between parents and infants is of primary importance to facilitate the bonding and attachment process. Procedures should be delayed to allow parents uninterrupted time with the newborn. Awarded 0.0 points out of 3.0 possible points. 30. 30.ID: 18649223407 Nursing measures to promote bonding and attachment include which of the following? (Select all that apply.) A. Assist the parents in unwrapping the baby to inspect. Correct B. Point out that the infant grasping the mother's or father's finger is a natural reflex. C. Explain the physical changes in the newborn, such as molding, as being normal. D. Encourage the mother to let the infant stay in the nursery as much as possible so the mother can rest. E. Position the infant in a face to face position with the mother. Correct Nursing measures to promote bonding and attachment include: Assist the parents in unwrapping the baby to inspect the toes, fingers, and body. Inspection fosters identification and allows the parents to become acquainted with the “real” baby, which must replace the fantasy baby that many parents imagined during the pregnancy. Position the infant in an en face position and discuss the infant's ability to see the parent's face. Face-to-face and eye-to-eye contact is a first step in establishing mutual interaction between the infant and parent. Awarded 0.0 points out of 2.0 possible points. 31. 31.ID: 18649223411 The placental site heals by a process of . Incorrect Correct Responses A. exfoliation Awarded 0.0 points out of 1.0 possible points. 2. 32.ID: 18649222893 Ice causes vasoconstriction and is most effective if applied soon after the birth to the perineal area to prevent . Incorrect Correct Responses A. edema Awarded 0.0 points out of 1.0 possible points. 3. 33.ID: 18649222887 The development of a strong emotional tie of a parent to a newborn is called . Incorrect Correct Responses A. bonding Awarded 0.0 points out of 1.0 possible points. 4. 34.ID: 18649223433 The maternal adaptation phase in which the mother relinquishes her previous role as being childless and her old lifestyle is called the phase. Incorrect Correct Responses A. letting-go Awarded 0.0 points out of 1.0 possible points. 5. 35.ID: 18649223427 When the father develops a bond with the new infant and has an intense interest in how the infant looks and responds, this is called . Incorrect Correct Responses A. engrossment Awarded 0.0 points out of 1.0 possible points. Chapter 18 1. Questions The postpartum woman has a blood pressure of 150/90 mm Hg, pulse of 72 bpm, and respirations of 14 breaths per minute. She continues to bleed heavily. The order states she may have methylergonovine (Methergine), 0.2 mg IM, or oxytocin (Pitocin), 10 units IM for heavy bleeding. The nurse should administer which medication? A. Methylergonovine B. Oxytocin Correct Methylergonovine is contraindicated if the woman has an elevated blood pressure. Awarded 0.0 points out of 1.0 possible points. 2. 2.ID: 18649217793 The postpartum woman who had a long labor induced by oxytocin is at higher risk for which complication? A. Thrombophlebitis B. Hemorrhage Correct Prolonged use of oxytocin can produce uterine atony. This will increase the risk of hemorrhaging because the uterine muscle becomes fatigued and will not contract effectively to compress vessels at the placental site. The other choices are all complications of the postpartum period, but this mother is at no higher risk than other mothers. C. Lacerations of the vaginal area D. Altered urinary elimination Awarded 0.0 points out of 1.0 possible points. 3. 3.ID: 18649217763 Which patient would be at the highest risk for postpartum hemorrhage? A. Primigravida who delivered a 6 lb, 3 oz girl B. Gravida 2 who delivered a 8 lb, 6 oz boy C. Gravida 3 who delivered twins, 5 lb, 3 oz and 4 lb, 2 oz. Correct Overdistention of the uterus from any cause—multiple gestations, large infant, hydramnios—makes it more difficult for the uterus to contract with enough firmness to prevent excessive bleeding. Multiparity results in muscle fibers that have been stretched repeatedly, and these flaccid muscle fibers may not remain contracted after birth. The gravida 3 has the problems of multiparity and overdistended uterus with the twins. D. Gravida 4 who delivered a 4 lb, 3 oz boy Awarded 0.0 points out of 1.0 possible points. 4. 4.ID: 18649217791 Which newly delivered mother with an unassisted birth is at greatest risk for lacerations of the cervical area of vagina? A. Primigravida with 10-hour labor, 1-hour pushing stage B. Gravida 2 with an 8-hour labor, 30-minute pushing stage C. Gravida 2 with a 1-hour labor, 10-minute pushing stage Correct Cervical lacerations occur frequently when the cervix dilates rapidly during the first stage of labor. Lacerations of the vagina, perineum, and periurethral area usually occur during the second stage of labor, when the fetal head descends rapidly. D. Gravida 3 with a 5-hour labor, 30-minute pushing stage Awarded 0.0 points out of 1.0 possible points. 5. 5.ID: 18649217795 Late postpartum hemorrhage occurs usually at 7 to 14 days but can be as late as 12 weeks after birth. The nurse should teach the new mother about to be discharged to notify the health care provider if the A. lochia become pink or brown. B. uterine cramping (after pains) decreases. C. lochia rubra continues and increases. Correct Mothers should be taught how to assess the fundus and the normal duration of lochia to assess for late postpartum hemorrhage. They should be instructed to notify their health care provider if bleeding persists or becomes unusually heavy. D. lochia stops completely. Awarded 0.0 points out of 1.0 possible points. 6. 6.ID: 18649217779 When checking the fundus on a mother who delivered 1 hour ago, the nurse notices that it is 3 cm above the umbilicus, displaced to the right, and slightly boggy. The nurse should massage the fundus until firm and then A. assist the mother to empty her bladder. Correct If the fundus is above the level of the umbilicus and displaced, a full bladder may be the cause of the excessive bleeding and a boggy uterus. B. assist the mother to walk around in the room. C. reassess the fundus in 5 minutes. D. monitor the blood pressure and pulse for changes. Awarded 0.0 points out of 1.0 possible points. 7. 7.ID: 18649217797 When assessing a newly delivered mother, the nurse notes that the fundus is firm, 1 cm below the umbilicus, and midline. However, there is a continuous stream of blood coming from the vaginal area. The nurse is aware that these signs may indicate A. a fundus that is not properly contracting over the placental site. B. lacerations along the birth canal. Correct If the fundus is firm but bleeding is excessive, the cause may be lacerations of the cervix or birth canal. C. a full bladder interfering with the control of bleeding. D. a sign of cardiovascular compromise. Awarded 0.0 points out of 1.0 possible points. 8. 8.ID: 18649217759 A postpartum woman had excessive vaginal bleeding after the birth. The bleeding has decreased to a normal rate and the fundus has remained firm for the past 3 hours. She has requested to walk to the bathroom. The nurse should A. offer her a bedpan. B. let her ambulate to the bathroom because it has been 3 hours. C. assess for feeling in her feet before ambulation. D. slowly sit her up and allow her to dangle her legs before standing. Correct Because of the loss of blood, she is at high risk for orthostatic hypotension. The nurse should assist her in getting out of bed after dangling her legs and assessing for dizziness and low blood pressure. Awarded 0.0 points out of 1.0 possible points. 9. 9.ID: 18649217781 A nurse is assessing a new mother on her first postpartum day. The nurse notes tenderness in both legs, slight redness in the calf of the left leg, and edema in both feet, with the left foot being larger (when measured, the right ankle was 29 cm and the left ankle was 32 cm in diameter). The nurse’s next action should be to A. ask the mother to stay in bed until the physician can assess her. Correct Deep vein thrombosis (DVT) may have symptoms of leg swelling, with the affected leg larger than the opposite leg, and erythema, heat, and tenderness. The tenderness in both legs may be strained muscles from the birth. Edema in both feet is expected during the early postpartum period prior to diuresis. The treatment for DVT is bed rest and medication, which would require a physician’s assessment. B. ask the mother to walk around for the next few minutes and to ambulate once every 2 hours. C. explain to the mother that the pain is from the strain of labor and the edema will disappear in about 48 hours. D. assess the vital signs. Awarded 0.0 points out of 1.0 possible points. 10. 10.ID: 18649217769 When assessing the lochia of a new mother for the last time before discharge, the nurse notes a foul smell from the vaginal discharge. The mother states that she noticed it for the first time a couple of hours ago. The nurse should assess for A. fever. Correct With endometritis, the mother will have signs and symptoms of fever, chills, malaise, lethargy, anorexia, abdominal pain, abdominal cramping, uterine tenderness, and a purulent, foul-smelling lochia. Other signs include tachycardia and subinvolution. B. uterine atony. C. bradycardia. D. lack of proper peri care by the mother. Awarded 0.0 points out of 1.0 possible points. 11. 11.ID: 18649217771 To treat a woman with a urinary tract infection (UTI), the nurse should encourage her to A. drink 1000 mL of fluid/day. B. drink fluids such as apricot, prune, or cranberry juice. Correct To treat a UTI, the mother should be encouraged to drink at least 2500 to 3000 mL of fluid each day to help dilute the bacterial count and flush the infection from the bladder. Acidification of the urine inhibits multiplication of bacteria, and drinks that acidify urine, such as apricot, plum, prune, or cranberry juice, should be encouraged. Carbonated drinks should be avoided because they increase urine alkalinity. C. drink fluids such as ginger ale and colas. D. urinate frequently. Awarded 0.0 points out of 1.0 possible points. 12. 12.ID: 18649217761 The best position for a woman who has postpartum endometritis is A. left lateral. B. trendelenburg. C. supine. D. Fowler’s. Correct Fowler’s position aids in the drainage of the uterine cavity. Awarded 0.0 points out of 1.0 possible points. 13. 13.ID: 18649217785 A breastfeeding woman develops mastitis. She tells the nurse that she will just feed her baby formula instead of breastfeeding. The best nursing response is that A. emptying the breast is important to prevent an abscess. Correct Continued emptying of the breast by breastfeeding or a breast pump constitutes the first line of treatment for mastitis. This helps prevent a breast abscess. B. a tight breast binder or bra will help reduce engorgement. C. she should continue to drink extra fluids while weaning. D. breastfeeding can continue when her temperature is normal. Awarded 0.0 points out of 1.0 possible points. 14. 14.ID: 18649217773 Major signs of uterine atony immediately following birth include which one(s) of the following? (Select all that apply.) A. Uterine fundus that is difficult to locate Correct B. Soft fundus Correct C. Uterus that becomes firm with massage D. Excessive lochia Correct E. Excessive clots Correct F. Uterus located near the umbilicus Major signs of uterine atony include: a uterine fundus that is difficult to locate; a soft or “boggy” feel when the fundus is located; a uterus that becomes firm as it is massaged but loses its tone when massage is stopped; a fundus that is located above the expected level; excessive lochia, especially if it is bright red; and excessive clots expelled, either with or without uterine massage. Awarded 0.0 points out of 4.0 possible points. 15. 15.ID: 18649217783 A mother is at high risk for thromboembolic disease in the postpartum period. Select all the reasons that may put this mother at high risk for clot formation. (Select all that apply.) A. Walking around during labor Correct B. Prolonged period of time in the stirrups for birth and repair C. The elevated levels of coagulation factors during pregnancy Correct D. Cesarean birth Correct E. Smoking Correct F. Being a primigravida Cesarean birth, varicose veins, obesity, a history of thrombophlebitis, age over 35, and smoking are risk factors for thromboembolic disease. Prolonged time in stirrups for birth and repair of the episiotomy also may promote venous stasis and increase the risk of thrombus formation. Awarded 0.0 points out of 4.0 possible points. 16. 16.ID: 18649217775 Clinical signs and symptoms of pulmonary embolism may include which of the following? (Select all that apply.) A. Dyspnea Correct B. Sudden sharp chest pain Correct C. Bradycardia D. Syncope Correct E. Tachypnea Correct F. Hemoptysis Correct Dyspnea, chest pain, tachycardia, tachypnea, and hemoptysis are the most common signs of pulmonary embolism. Syncope is uncommon and may indicate massive emboli. Pulmonary rales, cough, abdominal pain and low-grade fever may also occur. Awarded 0.0 points out of 5.0 possible points. 17. 17.ID: 18649217755 Postpartum hemorrhage that occurs within the first 24 hours after childbirth is termed . Incorrect Correct Responses A. early Awarded 0.0 points out of 1.0 possible points. 2. 18.ID: 18649217787 One of the earliest signs of hypovolemic shock is . Incorrect Correct Responses A. tachycardia Awarded 0.0 points out of 1.0 possible points. 3. 19.ID: 18649217765 A potentially fatal complication of pregnancy that occurs when the pulmonary artery is obstructed by a blood clot that was swept into circulation from a vein or by amniotic fluid is called a . Incorrect Correct Responses A. pulmonary embolism 1. Questions At birth, which should the nurse do to prevent heat loss in the newborn? A. Dry the infant. Correct Evaporation occurs when wet surfaces are exposed to air. As the surfaces dry, heat is lost. At birth the infant loses heat when amniotic fluid on the skin evaporates. Drying the infant helps prevent excessive heat loss. B. Place the infant on a flat surface. C. Monitor the temperature. D. Rub the infant’s back. Awarded 0.0 points out of 1.0 possible points. 2. 2.ID: 18649218170 One reason that preterm infants are at higher risk for cold stress is the fact that they A. have a smaller surface area. B. have a decreased amount of brown fat. Correct The primary method of heat production in infants is the metabolism of brown fat to produce heat. Preterm infants may be born before stores of brown fat have accumulated. C. cannot nurse as effectively. D. cannot buffer the acids in the body as well. Awarded 0.0 points out of 1.0 possible points. 3. 3.ID: 18649218197 When caring for a newborn the nurse must be alert for signs of cold stress, which would include which one of the following? A. Decreased activity level B. Increased respiratory rate Correct Additional signs of cold stress include increased activity level, crying, basal metabolic rate (BMR), and heat production. Hypoglycemia occurs as glucose stores are depleted. Newborns are unable to shiver as a means to increase heat production; they increase their activity level instead. C. Hyperglycemia D. Shivering Awarded 0.0 points out of 1.0 possible points. 4. 4.ID: 18649218162 The hematocrit for a newborn is 72%. The nurse is aware that this newborn is at risk for A. blood clots. B. jaundice. Correct The hematocrit level in the normal infant is 44% to 70%. A level higher than 65% indicates polycythemia. Polycythemia increases the risk of jaundice and damage to the brain. C. anemia. D. leukocytosis. Awarded 0.0 points out of 1.0 possible points. 5. 5.ID: 18649218164 Vitamin K is given to the newborn for which one of the following reasons? A. Reduce bilirubin levels. B. Increase the production or red blood cells. C. Enhance ability of blood to clot. Correct Newborns have a deficiency of vitamin K until intestinal bacteria that produce the vitamin are formed. Vitamin K is required for the production of certain clotting factors. D. Stimulate the formation of surfactant. Awarded 0.0 points out of 1.0 possible points. 6. 6.ID: 18649218160 A new mother is bottle-feeding her newborn for the first time. The mother expresses concern to the nurse that the newborn is only drinking ½ ounce. The nurse can best answer the mother’s concerns by stating: A. “Don’t worry; the baby will drink more when he gets hungry.” B. “Yes, he should be drinking more; let me try to feed him.” C. “His stomach just holds about ½ ounce right now. By the end of the week it will have expanded and he will be drinking more.” Correct At birth the stomach capacity of a newborn is about 6 mL but will expand to about 90 mL within the first week. D. “Babies don’t drink much at the first feeding, they are tired.” Awarded 0.0 points out of 1.0 possible points. 7. 7.ID: 18649218183 The nurse helps a breastfeeding mother change the diaper of her 16-hour-old newborn after the first bowel movement. The mother expresses concern because the large amount of thick, sticky stool is dark green, almost black. She asks the nurse if something is wrong. The nurse should respond to this mother’s concern by A. telling her not to worry because all breast-fed babies have this type of stool. B. explaining that the stool is called meconium and is expected for the first few bowel movements of all newborns. Correct At this early age, this type of stool is typical of bottle- and breast-fed newborns. The mother’s nutritional intake is not responsible for the appearance of meconium stool. The nurse is fully capable of and responsible for teaching a new mother about the characteristics of her newborn, including expected stool patterns. C. asking the mother what she ate at her last meal. D. suggesting that the mother ask her pediatrician to explain newborn stool patterns to her. Awarded 0.0 points out of 1.0 possible points. 8. 8.ID: 18649218166 When doing a newborn assessment on a 2-day-old infant, the nurse notices facial jaundice. The bilirubin level was assessed and found to be 6 mg/dL. The nurse understands that this jaundice will be classified as A. physiologic jaundice. Correct With physiologic jaundice, the jaundice is not present during the first 24 hours of life. It appears on the second or third day and is considered a normal phenomenon. When jaundice is noted in the face only, the jaundice level can be estimated to be from 5 to 7 mg/dL. B. pathologic jaundice. C. breastfeeding jaundice. D. true breast mild jaundice. Awarded 0.0 points out of 1.0 possible points. 9. 9.ID: 18649218172 A new mother expresses concern that her 18-hour-old son has only voided once since birth. The nurse’s best response is: A. “We are aware of that and have notified the pediatrician.” B. “How is he eating?” C. “Newborns don’t void frequently for the first 2 days, but by the fourth day it will be about six times a day.” Correct It is appropriate to teach the mother about newborn characteristics. Newborns may not void at all for the first 24 hours; however, most will void once in the first 12 hours. Only one or two voidings may occur during the first 2 days of life. The infant voids four to six times a day by the fourth day. D. “This may be a concern, so we will continue to monitor his voidings for the next 12 hours.” Awarded 0.0 points out of 1.0 possible points. 10. 10.ID: 18649218176 The unit manager of the newborn nursery is orienting a group of nursing students. Infection control is one of the manager’s major topics. When comparing infection control in a nursery with that in an adult medical unit, one major difference is that A. all the patients in the nursery are usually in one room. B. the medical unit has many different organisms brought onto the unit. C. newborns have a decreased ability to localize infections. Correct Newborns have a decreased ability to localize infections; therefore, they have a tendency to develop generalized sepsis. This fact makes infection control in a nursery extremely important. D. adults have a weaker immune system, which makes them more prone to developing infections. Awarded 0.0 points out of 1.0 possible points. 11. 11.ID: 18649218168 If a nurse desires to promote infant–parent attachment, the best time to have the parents spend time with the infant is when the infant is going through which stage? A. Period of sleep B. Second period of reactivity Correct During the second period of reactivity, the infant is alert and interested in feeding. It is a good time for the parents to get to know the infant. During the period of sleep, the quiet sleep state, and active sleep state, the infant is asleep and will not interact with the parents. C. Quiet sleep state D. Active sleep state Awarded 0.0 points out of 1.0 possible points. 12. 12.ID: 18649218191 Select which one(s) of the following situations that could accelerate fetal lung maturation. (Select all that apply.) A. Intrauterine growth restriction Correct B. Maternal hypertension Correct C. Prolonged rupture of membranes Correct D. Maternal diabetes E. Maternal administration of steroids Correct Awarded 0.0 points out of 4.0 possible points. 13. 13.ID: 18649218180 Select which one(s) of the following that assist the newborn to initiate respirations. (Select all that apply.) A. Decrease in oxygen Correct B. Decrease in carbon dioxide C. Release of pressure on the chest at birth Correct D. Rise in environmental temperature at birth Breathing is initiated by chemical, mechanical, thermal, and sensory factors that stimulate the respiratory center in the medulla and trigger respirations. A decrease in the partial pressure of oxygen (PO2) and pH and an increase in the partial pressure of carbon dioxide (PCO2) in the blood cause impulses from these receptors to stimulate the respiratory center in the medulla. When the pressure against the chest is released at birth, recoil of the chest draws a small amount of air into the lungs and helps remove some of the viscous fluid in the airways. The temperature change that occurs with birth from the warm intrauterine environment to the cooler room air stimulates the initiation of respirations. The stimulation of the light, sound, smell, and pain at delivery may also aid in initiating respirations. Awarded 0.0 points out of 2.0 possible points. 14. 14.ID: 18649218174 Which one(s) of the newborns listed are at high risk for hypoglycemia? (Select all that apply.) A. Preterm Correct B. Small-for-gestational age Correct C. Postterm Correct D. Large-for-gestational age Correct E. Average-for-gestational age F. Infants with infections Correct G. Infants with cold stress Correct Newborns at increased risk for hypoglycemia include preterm infants, the small-for- gestational-age infant, postterm, large-for-gestational-age infants and those with diabetic mothers. Infants exposed to stressors such as asphyxia or infection and cold- stressed infants are at risk for hypoglycemia. Awarded 0.0 points out of 6.0 possible points. 15. 15.ID: 18649218185 Which one(s) of the following factors lead to the production of excessive amounts of bilirubin during the first week of life? (Select all that apply.) A. Longer red blood cell life B. Liver immaturity Correct C. Sterile intestines Correct D. Trauma during birth Correct General Feedback: A number of factors lead to the production of excessive amounts of bilirubin or interfere with the normal process of conjugation: excess production of bilirubin; fetal RBCs break down more quickly than adult erythrocytes; neonate erythrocytes are more fragile and susceptible to injury than those in an adult; at birth the intestines of the newborn are sterile and conjugated bilirubin cannot be reduced to urobilinogen or stercobilin for excretion without the action of intestinal flora; the liver is immature. Delayed feeding and birth trauma are other factors. Awarded 0.0 points out of 3.0 possible points. 16. 16.ID: 18649218187 Before excretion of bilirubin can occur, it must be changed by the liver to a water- soluble form. This process is called . Incorrect Correct Responses A. conjugation Awarded 0.0 points out of 1.0 possible points. 2. 17.ID: 18649218193 If enough unconjugated bilirubin accumulates in the blood, it may cause staining of the tissues in the brain, resulting in . Incorrect Correct Responses A. kernicterus Awarded 0.0 points out of 1.0 possible points. Submission Details • Submission Date: 1/29/2020 • Submission Time: 9:15 AM • Points Awarded: 0 • Points Missed: 27 • Number of Attempts Allowed: Unlimited • Not Scored: 0 • Percentage: 0% Send Results by Email 1. Questions 1. 1.ID: 18649224412 A new mother tells the nurse, “I’ve been told that the milk I have right after the baby is born is not good for the baby.” The nurse should base the answer on the fact that A. only the first secretion of milk should be discarded. B. the colostrum is low in vitamins and protein. C. the colostrum is high in immunoglobulin A. Correct Colostrum is high in immunoglobulin A, which helps protect the infant’s gastrointestinal tract from infection. Colostrum also helps establish the normal flora in the intestines, and its laxative effect speeds the passage of meconium. Colostrum is high in vitamins and protein. D. the mother secretes just small amounts of colostrum. Awarded 0.0 points out of 1.0 possible points. 2. 2.ID: 18649224422 A new mother has heard that breast milk may contain as much as 55% of the calories in fat. She is concerned that her infant will be getting a diet too high in fat because the American Heart Association recommends that the diet have less than 30% of its calories from fat. The nurse can best advocate for breastfeeding by stating that A. newborns need the extra fat. B. whole cow’s milk provides the same amount of fat. C. the fat in breast milk is important for vision and brain growth. Correct The fat composition of human milk differs greatly from cow’s milk. It provides the type of fat that is important for the newborn’s vision and brain growth. It is more easily digested by the newborn than cow’s milk and may have antibacterial and antiviral properties. Option a is true, but the mother needs more information to make an informed decision. Hindmilk has two to three times as much fat as the foremilk. D. the fat is only found in the hindmilk, so the newborn will not get that much. Awarded 0.0 points out of 1.0 possible points. 3. 3.ID: 18649224408 A new mother wants to breastfeed but also wants to feed her infant formula occasionally. The nurse should teach her to A. avoid using any bottles the first month to establish her milk supply. Correct If the mother chooses combination feeding, it is best to delay giving formula until lactation has been well established at 3 to 4 weeks of age. Giving formula to breastfeeding infants leads to a decrease in breastfeeding frequency and milk production, making successful breastfeeding less likely. B. make a clear choice to feed by one method or the other to avoid nipple confusion. C. limit formula feeding to once each day until her milk supply is well established. D. alternate formula and nursing to allow the infant to become accustomed to both. Awarded 0.0 points out of 1.0 possible points. 4. 4.ID: 18649224416 The amount of breast milk produced depends primarily on adequate A. amounts of estrogen and progesterone. B. stimulation of the breast. Correct The amount of milk produced depends primarily on adequate stimulation of the breast and removal of the milk by suckling or a breast pump. The stimulation causes production of prolactin, which produces the milk. Estrogen and progesterone inhibit prolactin. Oxytocin aids in the let-down reflex and contraction of the fundus. C. amounts of oxytocin. D. stimulation of the fundus. Awarded 0.0 points out of 1.0 possible points. 5. 5.ID: 18649224434 A pregnant woman complains of inverted nipples. She is planning on breastfeeding and thinks that the nipples may be a problem. The nurse should teach her to A. stretch the nipples out once a day to convert the inversion. B. roll the nipples twice a day to pull out the nipple. C. stimulate the breast. Correct A breast cup can be worn in the bra during the last several weeks of pregnancy. The cup will exert slight pressure against the areola and help the nipples protrude. Exercises for inverted nipples, such as stretching and manipulation of the nipple, are not recommended during pregnancy because they are not effective and may cause uterine contractions. D. wear a tighter-fitting bra. Awarded 0.0 points out of 1.0 possible points. 6. 6.ID: 18649224418 Which reflex normally present in full-term newborns is most helpful with the latching-on process? A. Moro B. Rooting Correct By brushing the nipple of the breast around the infant’s month, the infant will turn toward the stimulus and open the mouth. This is the rooting reflex. The Moro reflex occurs when the infant is startled and reacts. The Babinski reflex is the flaring of the toes with stimulation. The tonic neck reflex is the position of the arms, with the head turned to the side. C. Babinski D. Tonic neck Awarded 0.0 points out of 1.0 possible points. 7. 7.ID: 18649224414 A new mother wants to nurse her infant only 5 minutes at each breast to avoid sore nipples. Choose the appropriate teaching. A. Limiting time at the breast during the early days can lessen trauma to the nipples and allow them time to toughen. B. Limiting time at the breast can cause frequent infant hunger because the baby does not receive richer milk. Correct When feedings are too short, infants receive little or no colostrum or milk. It may take as long as 5 minutes for the milk-ejection reflex to occur during the early days after birth. The infant will receive mostly foremilk with these short feedings, which has a higher fluid content. The hindmilk has a higher fat content. C. Limiting time at the breast does not reduce sore nipples but does reduce engorgement. D. Limiting time at the breast delays the transition from colostrum to transitional and true milk. Awarded 0.0 points out of 1.0 possible points. 8. 8.ID: 18649224442 A mother expresses concern about breastfeeding her newborn, who is receiving phototherapy for jaundice. The nurse should teach the mother that A. breastfeeding is discontinued during phototherapy, but she should pump her breasts. B. breastfeeding can continue after the newborn has been under the light for 12 hours. C. breastfeeding should continue and the newborn can be removed from the light to be fed. Correct Jaundice need not interfere with breastfeeding. Even when infants receive phototherapy, they usually can be removed from the lights for feeding or may be able to breastfeed with a bili blanket in place. Frequent breastfeeding during phototherapy will increase the number of stools, which aids in bilirubin excretion and provides adequate intake of protein and fluid. D. breastfeeding can continue after the bilirubin level decreases. Awarded 0.0 points out of 1.0 possible points. 9. 9.ID: 18649224402 A mother who is breastfeeding puts ice packs on her breast 15 minutes before feeding to “relieve the pain.” The nurse should teach the mother that A. this is an appropriate action. B. cold packs should not be used on the breasts of breastfeeding mothers. C. cold packs can be used after feeding to reduce pain. Correct Cold packs can be used after feeding to reduce edema and pain. Heat can be applied just before feedings to increase vasodilation and milk flow; it will not decrease the pain. D. hot packs can be used before feeding to reduce pain. Awarded 0.0 points out of 1.0 possible points. 10. 10.ID: 18649224444 When seeing a new mother on her 6-week postpartum checkup, the nurse questions her about feeding techniques with the newborn. The mother confesses that because of lack of money she has been diluting the powdered formula with more water so it lasts longer. The nurse can best assist this mother by A. explaining that diluting the formula more is harmful to the newborn. B. allowing the mother to express her frustrations. C. assisting the mother to find financial assistance for purchasing formula. Correct Improper dilution of the formula may cause undernutrition in the newborn. However, that is not the best help for the mother at this point; she is in need of services that will help her purchase the formula needed. She is not able to establish breastfeeding at this time. D. teaching the mother that she can start to breastfeed the newborn and that would save some money. Awarded 0.0 points out of 1.0 possible points. 11. 11.ID: 18649224420 Which nutrients are added to formula to make it closer to the composition of breast milk? (Select all that apply.) A. Lactose B. Fatty acids Correct C. Vitamin C Correct D. Vitamin D Correct E. Iron Correct Modified cow's milk is the source of most commercial formulas. Manufacturers specifically formulate it for infants by reducing protein content to decrease renal solute load. Saturated fat is removed and replaced with vegetable fats. Vitamins and other nutrients are added to simulate the contents of breast milk. Formula with added iron should be used for all infants receiving formula. Awarded 0.0 points out of 4.0 possible points. 12. 12.ID: 18649224436 Reports and studies have shown that infants who are breast-fed for even short periods have a decreased incidence of infection. Select all the infections that may be prevented. (Select all that apply.) A. Respiratory Correct B. Cord C. Gastrointestinal Correct D. Ear Correct E. Eye Infants who are not breastfed have an increased incidence of respiratory, GI, and urinary tract infections, otitis media, asthma, diabetes, some cancers, obesity, sudden infant death syndrome (SIDS), and necrotizing enterocolitis. Awarded 0.0 points out of 3.0 possible points. 13. 13.ID: 18649224424 The nurse should teach the different ways new mothers can assess if the newborn is receiving sufficient milk. Select all that are appropriate to assess. (Select all that apply.) A. Nutritive suckling Correct B. Number of wet diapers Correct C. Number of stools Correct D. Length of time newborn is attached to the breast Ways to determine if the infant is receiving enough milk include noting nutritive suckling (sucking) during which the infant sucks with smooth, continuous movements with occasional pauses to rest. The infant may swallow after each suck or may suck several times before swallowing. Counting the number of wet and soiled diapers helps determine whether the infant is receiving enough milk. Awarded 0.0 points out of 3.0 possible points. 14. 14.ID: 18649224410 Select all the causes of decreased milk supply in a lactating mother. (Select all that apply.) A. Supplementation with formula Correct B. Multivitamin use C. Feedings that are too short Correct D. Chocolate E. Some oral contraceptives Correct F. Certain foods Common causes of decreased milk supply include ineffective suckling by the infant, feedings that are infrequent or too short, feeding formula, maternal fatigue, low maternal thyroid function, preterm or late preterm infants, and some medications including oral contraceptives containing estrogen. Awarded 0.0 points out of 3.0 possible points. 15. 15.ID: 18649224438 The breast fluid secreted during pregnancy and the first week after childbirth is called . Incorrect Correct Responses A. colostrum Awarded 0.0 points out of 1.0 possible points. 2. 16.ID: 18649224404 The hormone that causes the breasts to produce milk is . Incorrect Correct Responses A. prolactin Awarded 0.0 points out of 1.0 possible points. 3. 17.ID: 18649224430 The hormones that inhibit breast response to prolactin and prevent milk production are , , and . Incorrect Correct Responses A. estrogen; progesterone; human chorionic somatomammotropin Awarded 0.0 points out of 1.0 possible points. 4. 18.ID: 18649224426 Breast milk is produced in the of the breasts. Incorrect Correct Responses A. alveoli Awarded 0.0 points out of 1.0 possible points. Submission Details • Submission Date: 1/29/2020 • Submission Time: 9:16 AM • Points Awarded: 0 • Points Missed: 24 • Number of Attempts Allowed: Unlimited • Not Scored: 0 • Percentage: 0% Send Results by Email 1. Questions 1. 1.ID: 18649226495 An infant born at 35 weeks of gestation and weighs 4 lb, 3 oz would be classified as A. preterm, low birth weight. Correct A preterm infant is one born before the beginning of the 38th week of gestation. A low-birth-weight infant refers to infants weighing 2500 g (5 lb, 8 oz) or less at birth. A very low-birth-weight infant weighs 1500 g (3 lb, 5 oz) or less at birth. An extremely low-birth-weight infant weighs 1000 g (2 lb, 3 oz) or less at birth. Intrauterine growth restriction usually applies to a full-term infant who is smaller than normal. B. preterm, very low birth weight, with fetal growth restriction. C. preterm, extremely low birth weight. D. full term, low birth weight. Awarded 0.0 points out of 1.0 possible points. 2. 2.ID: 18649226479 The most important factor that determines the extent of respiratory problems in a preterm infant is the A. age of the infant. B. size of the infant. C. presence of surfactant in adequate amounts. Correct Problems of the respiratory system are a major concern in a preterm infant. The presence of surfactant in adequate amounts is of primary importance. Infants born before surfactant production is adequate develop respiratory distress syndrome. D. Silverman–Anderson index grade. Awarded 0.0 points out of 1.0 possible points. 3. 3.ID: 18649227005 Heat loss in a preterm infant is more significant than in a full-term infant. The nurse should assess for heat loss continually in a preterm infant. The first sign that the infant’s temperature is low may be A. hyperglycemia. B. hypoglycemia. Correct Hypoglycemia and respiratory distress may be the first signs that the infant’s temperature is low. Other signs are poor feeding, lethargy, irritability, poor muscle tone, cool skin temperature, and mottled skin. C. respiratory stability. D. increased flexion. Awarded 0.0 points out of 1.0 possible points. 4. 4.ID: 18649226487 A preterm infant is on intake and output. During the past 8 hours, the infant had used three diapers that weighed 5 g before putting them on and 6, 9, and 12 g on removal. In addition, the lab had drawn 3 mL of blood for testing. There was no emesis or stools. The output should be recorded as A. 15 mL. Correct Output from regurgitation, drainage tubes, stools, urine, and blood taken for laboratory tests should be included in a preterm infant’s output record. The urine is measured by weighing the diaper before being used and after removal from the infant. A difference of 1 g is equivalent to 1 mL of urine (12 mL urine + 3 mL blood = 15 mL total). B. 12 mL. C. 3 mL. D. unable to determine with information given. Awarded 0.0 points out of 1.0 possible points. 5. 5.ID: 18649226489 The nurse is taking care of a 30-week gestation preterm infant who is 3 days old. The infant is stable enough for a bath to remove the old blood and vernix, but has areas of cracking on the skin. During the bath, it is best for the nurse to use A. plain warm water. B. a soap especially formulated for an infant’s skin. C. warm sterile water. Correct Bathing preterm infants is not necessary on a daily basis and should be performed as necessary. Bathing can disrupt the chemistry of the skin and may be stressful. Soap should be avoided during the first week for infants less than 32 weeks’ gestational age. If there are areas of skin breakdown, sterile water is safest for cleansing. D. distilled water. Awarded 0.0 points out of 1.0 possible points. 6. 6.ID: 18649226475 During the labor of a mother who is postterm, the membranes rupture spontaneously. The nurse notes that the amniotic fluid has a greenish tint. The nurse should be aware that the infant is at high risk after birth for A. skin breakdown. B. renal malfunction. C. respiratory difficulties. Correct A postterm infant is it high risk for hypoxia before or during labor. This increases the risk of meconium passage and possible aspiration at birth. Aspiration of meconium fluid can lead to respiratory difficulties. D. cardiac difficulties. Awarded 0.0 points out of 1.0 possible points. 7. 7.ID: 18649226477 During the admission history of a mother who is in labor, the nurse ascertains that the mother smoked 1 pack of cigarettes/day during the pregnancy, and appears underweight. Because of this information, the nurse should prepare for the birth of an infant who may be A. large-for-gestational age. B. small-for-gestational age. Correct Risk factors that may cause an infant to be small-for-gestational age include poor placental function and restrictions of uteroplacental blood flow. Maternal smoking and malnutrition can produce these problems, as can drug abuse, aging, and illness in the expectant mother. C. postterm. D. appropriate-for-gestational age. Awarded 0.0 points out of 1.0 possible points. 8. 8.ID: 18649227003 A small-for-gestational age infant was born. During the initial assessment, a nurse notes that the infant’s body is in proportion and appears normally developed for the size. The nurse is aware that this infant’s problem probably occurred A. early in the pregnancy. Correct Symmetric growth restriction involves the entire body. It occurred early in the pregnancy. The infant’s body is proportionate and appears normally developed. The total number of cells as well as the cell size decreases. These infants often are small throughout their lives. B. in the middle of the pregnancy. C. late in the pregnancy. D. during labor. Awarded 0.0 points out of 1.0 possible points. 9. 9.ID: 18649227007 During the initial assessment of a large-for-gestational age (LGA) infant, it is important that the nurse assess for complications that are common for this infant, such as A. congenital defects. B. fractures of the clavicle. Correct The LGA infant is more likely to go through a longer labor, have injury during birth, or need a cesarean birth. Fractures of the clavicle or skull, damage to the brachial plexus or facial or phrenic nerves, cephalohematoma, and bruising occur more often in these infants than in those of normal size. C. thinning of the skin. D. decreased subcutaneous fat. Awarded 0.0 points out of 1.0 possible points. 10. 10.ID: 18649226493 When inserting a nasogastric feeding tube into a preterm infant, which of the following procedures is correct? A. Determine the length of catheter to insert by measuring from the mouth to the ear to the xiphoid process. B. Give the infant a pacifier prior to insertion. Correct Nonnutritive sucking helps the tube pass more easily. The length of the catheter for a nasogastric tube is measured from the tip of the nose to the base of the ear to halfway between the xiphoid process and the umbilicus. Determine the pH of the aspirate to confirm stomach contents. Gloves are important for this procedure because of the tendency of the infant to regurgitate. However, sterile gloves are not required. C. Insert 10 mL of air through the tube after insertion while listening over the stomach with a stethoscope. D. Don sterile gloves. Awarded 0.0 points out of 1.0 possible points. 11. 11.ID: 18649226491 Pain assessment is an important nursing intervention for the preterm infant. Select all of the appropriate assessment tools to determine pain in the preterm infant. (Select all that apply.) A. Heart rate Correct B. “Cry face” Correct C. Oxygen saturation Correct D. Brow bulge Correct E. Increased flexion of the arms and legs F. Eye squeeze Correct G. Nasolabial furrow Correct Pain assessment is performed whenever vital signs are taken. Assessment tools are available to evaluate physiologic and behavioral responses to pain in term and preterm infants. Some such as the Premature Infant Pain Profile (PIPP) are designed for both term and preterm infants. This tool assesses gestational age and behavior states, heart rate, oxygen saturation, brow bulge, eye squeeze, and nasolabial furrow (lines from the edge of the nostrils to beyond the corners of the mouth) to assign a pain score. Awarded 0.0 points out of 6.0 possible points. 12. 12.ID: 18649226497 There are many complications that can occur with preterm infants. Select those listed that may be directly related to the use of high oxygen content during the acute phases of care. (Select all that apply.) A. Bronchopulmonary dysplasia Correct B. Periventricular–intraventricular hemorrhage C. Retinopathy of prematurity Correct D. Necrotizing enterocolitis Common complications of preterm birth are respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage, retinopathy of prematurity, necrotizing enterocolitis, and short bowel syndrome. Bronchopulmonary dysplasia (BPD) is a chronic condition in which damage to the infant's lungs requires prolonged dependence on supplemental oxygen. Intraventricular hemorrhage is associated with increased or decreased blood pressure, asphyxia or respiratory distress requiring mechanical ventilation, and increased or fluctuating cerebral blood flow. The exact cause of retinopathy of prematurity is unknown, but high levels of oxygen in the blood are a risk factor. Although the exact causes of necrotizing enterocolitis are unknown, immaturity of the intestines is a major factor in preterm infants. Previous hypoxia of the intestines may be a causative factor. Awarded 0.0 points out of 2.0 possible points. 13. 13.ID: 18649226485 Postterm infants should be assessed for anticipated complications. The complications that are associated with postterm infants are which of the following? (Select all that apply.) A. Hyperglycemia. B. Temperature instability. Correct C. Hyperbilirubinemia. Correct D. Polycythemia. Correct E. Respiratory problems. Correct Respiratory problems may necessitate continued assessment and care. Infants with any indications of postmaturity should be tested for hypoglycemia soon after birth and again an hour later or according to hospital policy. Temperature regulation may be poor because fat stores were used for nourishment in utero. Polycythemia, resulting from hypoxia before birth, increases the risk of hyperbilirubinemia. Awarded 0.0 points out of 4.0 possible points. 14. 14.ID: 18649226481 The position appropriate for a preterm infant but not a full-term infant is , Incorrect Correct Responses A. prone Awarded 0.0 points out of 1.0 possible points. 2. 15.ID: 18649226499 The infant who has the highest risk for asphyxia during labor and birth is the infant who is . Incorrect Correct Responses A. postterm Awarded 0.0 points out of 1.0 possible points. Submission Details • Submission Date: 1/29/2020 • Submission Time: 9:16 AM • Points Awarded: 0 • Points Missed: 15 • Number of Attempts Allowed: Unlimited • Not Scored: 0 • Percentage: 0% Send Results by Email 1. Questions 1. 1.ID: 18649227023 A woman is admitted to the antepartal unit with a diagnosis of a partial abruptio placentae. Part of the plan of care for this woman should be to assess the fetus for signs of A. infection. B. asphyxia. Correct Asphyxia is a lack of oxygen and an increase of carbon dioxide in the blood. It may occur in utero and can be caused by abruptio placentae when there is a decrease in fetal blood flow. C. prematurity. D. postmaturity. Awarded 0.0 points out of 1.0 possible points. 2. 2.ID: 18649227015 At birth, a newborn has a respiratory rate of 75 breaths per minute. In 1 minute, the newborn stops breathing. The first action by the nurse should be to A. stimulate the newborn. Correct When asphyxia begins after birth, rapid respirations are followed by cessation of respirations. Stimulation of the newborn may restart respirations and should be the first intervention. If asphyxia continues and the infant loses consciousness, resuscitation may be necessary. B. initiate rescue breathing. C. administer oxygen. D. initiate cardiopulmonary resuscitation. Awarded 0.0 points out of 1.0 possible points. 3. 3.ID: 18649227037 During the labor of a 43-week-gestation gravida 2, the nurse notes meconium staining of the amniotic fluid. After birth, the newborn was diagnosed with meconium aspiration syndrome. The nurse should monitor the newborn for respiratory distress and signs of A. infection. B. skin breakdown. C. persistent pulmonary hypertension of the newborn. Correct Meconium aspiration syndrome results in obstruction of the airways and may lead to persistent pulmonary hypertension of the newborn. In persistent pulmonary hypertension, the vascular resistance of the lungs does not decrease after birth, and normal changes to neonatal circulation are impaired. D. hyperbilirubinemia. Awarded 0.0 points out of 1.0 possible points. 4. 4.ID: 18649227035 The nurse notes a yellow discoloration over the face of a 12-hour-old newborn. The nurse’s next actions should be based on prevention of A. pathologic jaundice. B. renal damage. C. skin damage. D. neurotoxicity. Correct Jaundice is considered pathologic when it appears in the first 24 hours after birth. Pathologic jaundice is a concern because it may lead to kernicterus or deposits of bilirubin on the brain cells. Kernicterus may cause acute bilirubin encephalopathy, which leads to cerebral palsy, mental retardation, and long- term neurologic and developmental problems and death. Awarded 0.0 points out of 1.0 possible points. 5. 5.ID: 18649227021 A newborn develops jaundice at 16 hours of age. The nurse notes that the Coombs test is positive. The nurse orders a total serum bilirubin test and the results are 10 mg/dL. The nurse’s next action should be to A. monitor the respiratory rate every 30 minutes. B. prepare the newborn for phototherapy. Correct A positive Coombs test indicates that antibodies from the mother have attached to the infant’s red blood cells and are causing damage that results in extra levels of bilirubin. The total serum bilirubin test of 8 mg/dL in the first 24 hours indicates that phototherapy may be indicated. C. initiate oxygen therapy. D. assess the bilirubin level in 1 hour. Awarded 0.0 points out of 1.0 possible points. 6. 6.ID: 18649227029 A full-term newborn is placed in phototherapy to decrease serum bilirubin levels. A nursing diagnosis appropriate for this infant during phototherapy would be A. risk for injury. B. risk for infection. C. risk for deficient fluid volume. Correct Side effects of phototherapy include frequent, loose green stools that result from increased bile flow and peristalsis. This causes more rapid excretion of bilirubin but may be damaging to the skin and result in fluid loss. The crib used for phototherapy should have safety mechanisms in place, such as high sides. Breastfeeding can continue during phototherapy. The infant may be wrapped in a phototherapy blanket during feedings. There is no increased risk of infection. D. ineffective breastfeeding. Awarded 0.0 points out of 1.0 possible points. 7. 7.ID: 18649227031 A newborn is receiving phototherapy for a high bilirubin level. To maintain fluid balance, the nurse should A. offer the infant water at least every 2 hours. B. offer the infant formula or breast milk every 3 to 4 hours and offer water every 2 hours. C. offer the infant formula or breast milk every 2 to 3 hours and avoid offering water. Correct The infant should receive breast or bottle feedings every 2 to 3 hours; a 25% increase in fluid intake is needed during phototherapy. Frequent feedings prevent hypoglycemia, provide protein to maintain the albumin level in the blood, promote gastrointestinal motility, and prompt emptying of bilirubin from the bowel. Avoid offering water because the infant may take less milk, which is more effective in removing bilirubin from the intestines. D. provide a continuous gavage feeding of formula. Awarded 0.0 points out of 1.0 possible points. 8. 8.ID: 18649227025 A mother was not treated prior to birth for an active case of group B streptococcal infection. The newborn developed an infection. This is considered which type of transmission of infection? A. Vertical Correct Vertical infections are acquired before or during birth from the mother. Horizontal infections occur after birth from contact with hospital staff members, contaminated equipment, or family members. B. Horizontal Awarded 0.0 points out of 1.0 possible points. 9. 9.ID: 18649227011 A newborn who is 12 hours old is having body temperature instability and respiratory difficulties. A complete blood count was ordered and shows a decrease in total neutrophils and an increase in bands. A chest x-ray shows clear lungs. The nurse is aware that the next treatment for this newborn will probably be A. antibiotic therapy. B. cultures of blood and urine. Correct Neonatal sepsis and respiratory distress syndrome have many of the same symptoms. To differentiate, lab tests are ordered. Sepsis will show a decreased total neutrophils and increased bands. X-rays will show clear lungs with sepsis. The next treatment will be cultures, and then antibiotic therapy will be started. Cultures should always be done before starting antibiotic therapy. C. respiratory therapy. D. phototherapy. Awarded 0.0 points out of 1.0 possible points. 10. 10.ID: 18649227017 A newborn of a diabetic mother has been classified as large-for-gestational age. The father is at the nursery window and expresses concern, stating, “The nurses are doing too much to my baby. I think they are just trying to increase the amount of money we will have to pay. There is nothing wrong with my baby; he is too chubby and pink. He looks healthy.” The nurse’s response to this father should be based on the knowledge that infants of diabetic mothers A. often have major renal complications that need assessing. B. are at risk for hypoglycemia and polycythemia. Correct Large-for-gestational age newborns are at high risk for hypoglycemia and need to be assessed frequently. Infants of diabetic mothers often have a plethoric coloration that is caused by polycythemia and needs assessing. In some cultures, an infant who is chubby and pink is considered healthy. C. are at high risk for transient tachypnea of newborn. D. are assessed with the same procedures for all newborns. Awarded 0.0 points out of 1.0 possible points. 11. 11.ID: 18649227033 A large-for-gestational age infant is born outside of the hospital. The infant is brought to the emergency department 5 hours after birth with tremors, diaphoresis, and respirations of 75 breaths per minute. The nurse’s next action should be to assess the A. temperature. B. cardiac status. C. bilirubin level. D. blood glucose level. Correct Large-for-gestational age infants are at high risk for low blood glucose levels. The typical symptoms of hypoglycemia are tremors, diaphoresis, and rapid respirations. Awarded 0.0 points out of 1.0 possible points. 12. 12.ID: 18649227027 An infant of a diabetic mother has a total serum calcium level of 5 mg/dL. There is an order for calcium to be given intravenously. Before administering the calcium, the nurse should assess the A. respiratory rate. B. thyroid gland for enlargement. C. infant with a cardiac monitor. Correct A cardiac monitor is necessary when IV calcium is given to a newborn because of the risk of bradycardia during administration. D. blood pressure. Awarded 0.0 points out of 1.0 possible points. 13. 13.ID: 18649227013 A newborn who is 12 hours old develops tremors. The nurse has assessed the blood glucose and calcium levels and they are both within normal limits. The next assessment by the nurse should be to assess for A. hypothermia. B. prenatal drug exposure. Correct Infants with neonatal abstinence syndrome may be irritable and have hyperactive muscle tone. Although they have tremors, the blood glucose level is normal. C. lung sounds. D. cardiac defects. Awarded 0.0 points out of 1.0 possible points. 14. 14.ID: 18649227019 A full-term infant of a diabetic mother was born by cesarean birth. The nursery nurse should include in the plan of care for this newborn to monitor for signs of (Select all that apply.) A. hyperglycemia. B. hypercalcemia. C. transient tachypnea of the newborn. Correct D. cardiac anomalies. Correct Risk factors for transient tachypnea of the newborn include cesarean birth and mothers who are diabetic. Congenital anomalies are three times more likely in infants of diabetic mothers. Cardiac, urinary tract, and gastrointestinal anomalies, neural tube anomalies, and sacral agenesis are most frequent. Awarded 0.0 points out of 2.0 possible points. Submission Details • Submission Date: 1/29/2020 • Submission Time: 9:17 AM • Points Awarded: 0 • Points Missed: 22 • Number of Attempts Allowed: Unlimited • Not Scored: 0 • Percentage: 0% Send Results by Email 1. Questions 1. 1.ID: 18649227078 A woman is requesting information concerning contraception. She is sexually active with multiple partners and is concerned about sexually transmitted diseases. When doing patient teaching, the nurse should be aware that the contraceptive method that offers the most protection against sexually transmitted diseases is A. oral hormones. B. an intrauterine device. C. a male condom. Correct The male condom offers the best protection from sexually transmitted diseases because it is a barrier. D. natural birth control. Awarded 0.0 points out of 1.0 possible points. 2. 2.ID: 18649227068 The nurse determines that teaching about contraceptives is effective when the patient makes which statement? A. “The more the contraceptives cost, the more effective they will be.” B. “The birth control pill has a medication in it to prevent most STDs.” C. “Condoms have very few side effects.” Correct Condoms will have local side effects only, such as allergic reaction. They will not produce systemic effects, as will the hormone type of contraception. Cost does not alter the effectiveness of a method. Oral hormone contraceptives do not contain other medications. The woman usually makes the final decision about her contraceptive method, and her satisfaction with the choice is crucial. D. “I will use the contraceptive method that my husband prefers.” Awarded 0.0 points out of 1.0 possible points. 3. 3.ID: 18649227074 Nurses working with adolescent women should include questions regarding sexuality when gathering data for a reproductive health history. Which one(s) of the following principles should guide the nurse when interviewing the adolescent? A. An in-depth exploration of specific sexual practices should be included for this patient. B. Sexual histories are optional. C. Misconceptions and inaccurate information expressed by the adolescent should be corrected promptly. Correct Misinformation and erroneous beliefs cause adolescents to use ineffective methods of contraception or none at all. Opportunities to provide counseling and information must not be missed. D. Questions regarding the patient’s sexual relationship are unnecessary if she is monogamous. Awarded 0.0 points out of 1.0 possible points. 4. 4.ID: 18649227076 A woman is being admitted to the outpatient surgical unit for a tubal sterilization. She states to the nurse, “I know I have to go through with the surgery since I have already signed all the papers, but I was thinking this morning how wonderful it would be to have another baby.” The nurse’s next action should be to A. inform the woman that the surgery unit has already been prepared and that it would be expensive to cancel the surgery at this time. B. inform the woman that the surgery can be reversed at a later date if she should change her mind. C. inform the surgeon of the woman’s feelings. Correct Sterilization should be considered as a permanent end to fertility because reversal surgery is difficult, expensive, not always successful, and often not covered by insurance. The nurse should act as an advocate for the woman by informing the surgeon that the woman is having second thoughts about the surgery. Even though the consent forms have been signed, the woman does not have to proceed with the surgery. D. document the conversation and continue to prepare the woman for surgery. Awarded 0.0 points out of 1.0 possible points. 5. 5.ID: 18649227041 A woman is to have an Essure procedure performed to produce sterilization. The nurse should include in the patient teaching that A. this procedure requires minor surgery and will be done in the outpatient surgical unit. B. the woman should use another form of birth control for 3 months after the procedure. Correct With the Essure procedure, a tiny coil is inserted into each fallopian tube. The tubes become permanently blocked during the next 3 months as tissue grows into the inserts. During this time, another contraceptive method is used. The procedure can be performed in the physician’s office. It is a nonsurgical method of sterilization. C. the woman should rest for 24 hours after the procedure and should not lift heavy objects for a week. D. narcotic analgesics will be prescribed for pain control after the procedure. Awarded 0.0 points out of 1.0 possible points. 6. 6.ID: 18649227050 A woman has just been diagnosed as being 2 months pregnant. She is upset and states, “This is not possible, my husband had a vasectomy 3 months ago, and he should be sterile.” The nurse should respond to this woman with the knowledge that a vasectomy A. is not effective in all men. B. can undo itself within the first 3 months after surgery. C. does not render a man sterile for about 3 months. Correct Following a vasectomy, complete sterilization does not occur until sperm are no longer present in the semen. This may be 3 months or longer. D. does result in sterility, so there should be another explanation concerning the pregnancy. Awarded 0.0 points out of 1.0 possible points. 7. 7.ID: 18649227070 A 26-year-old woman is considering medroxyprogesterone acetate (Depo-Provera) as the form of contraception that is best for her. To assist this woman with making a decision concerning this method of contraception, the nurse would tell her that Depo- Provera A. is inserted subcutaneously into the upper inner arm. B. would require that she return to the clinic every 3 months. Correct Depo-Provera is an injectable progestin that prevents ovulation for 15 weeks. This requires the woman to return to the clinic every 3 months for the injection. C. should not be used if she has a history of estrogen-sensitive cancer. D. is effective for 3 years. Awarded 0.0 points out of 1.0 possible points. 8. 8.ID: 18649227052 A woman called the clinic desiring to start on medroxyprogesterone acetate (Depo- Provera) for contraception. The nurse should make an appointment for the woman A. immediately. B. within 7 days of the beginning of a menstrual period. Correct The injection is best given within 7 days of the beginning of a menstrual period. If given later in the cycle, an additional form of contraception should be used for the first week. C. prior to her next menstrual period. D. at the time of ovulation. Awarded 0.0 points out of 1.0 possible points. 9. 9.ID: 18649227043 A woman taking an oral contraceptive as her birth control method of choice should notify her health care provider immediately if she notes which one(s) of the following? A. Breast tenderness and swelling B. Weight gain C. Swelling and pain in one of her legs Correct Leg pain and swelling (edema) may indicate thrombophlebitis and should be reported immediately. The other choices are all expected side effects of oral contraceptive pills, temporary in nature, and usually subside within a few cycles. D. Mood swings Awarded 0.0 points out of 1.0 possible points. 10. 10.ID: 18649227054 A woman comes to the clinic stating that she is going on a hiking trip that will last 2 months. She states, “I have heard there are things that can be done to prevent me from having a period during that time.” The nurse’s response should be based on the knowledge that A. there is no healthy way to skip a menstrual period. B. there is a surgery, similar to a dilation and curettage, which can be done prior to the hiking trip. C. certain oral contraceptive pills may be taken consecutively for 2 months to delay menses. Correct When women prefer extended cycles, in which menses is delayed for a few days for special occasions or for a longer time, they take two or more oral contraceptive pill packs without taking the placebo pills for several packs or indefinitely. D. there is a type of oral contraceptive pill that may result in an extended menses for 1 month and the next month’s will be lighter. Awarded 0.0 points out of 1.0 possible points. 11. 11.ID: 18649227062 A lactating woman asks the nurse about contraception. She states that she has always used a combination pill and would like to continue with that method. The nurse should advise the woman that A. oral contraceptives are contraindicated during the lactation period. B. progestin-only contraceptives may be started 4 weeks after birth. Correct Combination oral contraceptives reduce milk production in lactating women, and very small amounts may be transferred to the milk. Progestin-only contraceptives may be a better choice if a woman wishes to use a hormonal contraceptive because they do not affect milk production. They are often started 4 to 6 weeks after birth. C. combination contraceptive pills may be started 3 to 4 weeks after birth. D. only barrier methods are recommended during the lactation period. Awarded 0.0 points out of 1.0 possible points. 12. 12.ID: 18649227056 During a breast exam, the midwife notes that the woman has a transdermal contraceptive patch applied to her breast. The midwife should A. document the appropriate use of the patch. B. question the woman on her satisfaction with the patch. C. inform the woman that the patch should not be applied to the breast. Correct The patch can be applied to the abdomen, buttocks, upper torso, or upper arm. It should not be applied to the breast area or areas that are rubbed by straps or waistbands. D. remove the patch to complete the breast exam. Awarded 0.0 points out of 1.0 possible points. 13. 13.ID: 18649227047 A woman asks the nurse about the “new vaginal ring everyone is talking about for birth control.” When counseling the woman about this method of contraception, the nurse should assess for the woman’s A. ability to remember to insert the device every morning. B. feelings about having to insert the device before sexual intercourse. C. comfort level about self-insertion of the ring every 3 weeks. Correct The woman must remove the ring after 3 weeks and insert a new ring 1 week later. The woman must be comfortable inserting the device into the vagina. D. ability to return to the clinic once a month for reinsertion. Awarded 0.0 points out of 1.0 possible points. 14. 14.ID: 18649227072 A woman calls the clinic early on a Monday morning stating that she needs a prescription for emergency contraception. On questioning by the nurse, the woman states that her boyfriend’s condom was displaced during intercourse on Saturday night. The nurse should make an appointment for the woman A. on Monday. Correct The effectiveness of emergency contraception is greatest if used within 120 hours/5 days of unprotected intercourse. B. by Wednesday. C. by Thursday. D. no later than Friday. Awarded 0.0 points out of 1.0 possible points. 15. 15.ID: 18649227058 A woman who is 6 weeks postpartum and lactating is being counseled about contraception. She states that she desires to have a type of birth control that she does not have to “think about.” She has three children, so it should be effective and she is in a monogamous relationship. She has a history of blood clots. One appropriate choice of birth control that the nurse can recommend is A. a combination pill. B. male condoms. C. tubal ligation. D. an intrauterine device. Correct Once they are inserted, IUDs provide long-term, continuous contraception without the need to take pills, have injections, or do something else before or during intercourse. They are appropriate for many women who cannot use hormonal contraception because of other problems, such as a history of blood clots. They are safe for use during lactation. Tubal ligation should be considered a permanent procedure; the woman did not request that type of contraception. Awarded 0.0 points out of 1.0 possible points. 16. 16.ID: 18649227045 To increase the effective rate of male condoms, the female partner may A. douche after intercourse. B. use a spermicide. Correct Using spermicides with condoms increases lubrication, which decreases the risk of condom breakage. Effectiveness is increased when spermicides are used with condoms. C. use a female condom. D. use an oil-based lubricant. Awarded 0.0 points out of 1.0 possible points. 17. 17.ID: 18649227060 A woman is being counseled concerning the calendar method type of natural family planning. The woman states that her cycles run from 27 to 29 days. The nurse teaches the woman that ovulation will probably occur on about days A. 10 to 12. B. 13 to 15. Correct Ovulation occurs approximately 14 days before the onset of menses. C. 16 to 18. D. 18 to 20. Awarded 0.0 points out of 1.0 possible points. 18. 18.ID: 18649227066 A pregnant woman has requested a tubal ligation for contraception. The nurse is aware that this surgery can occur (Select all that apply.) A. during pregnancy. B. during the postpartum period prior to being discharged from the hospital. Correct C. 6 weeks postpartum. Correct D. 6 months postpartum. Correct A tubal ligation can be performed soon after birth. It can be done at the same time as a cesarean birth or planned before discharge or at any other time. Awarded 0.0 points out of 3.0 possible points. 19. 19.ID: 18649227064 When counseling teenagers about contraception, it is important to teach them methods that do not require a clinic visit. Which one(s) of the following methods do not require a clinic appointment or prescription? (Select all that apply.) A. Vaginal ring B. Condoms Correct C. Intrauterine device D. Diaphragm E. Spermicides Correct Spermicides and condoms may be purchased over-the-counter and do not require a prescription or clinic visit. Awarded 0.0 points out of 2.0 possible points. Submission Details • Submission Date: 1/29/2020 • Submission Time: 9:17 AM • Points Awarded: 0 • Points Missed: 14 • Number of Attempts Allowed: Unlimited • Not Scored: 0 • Percentage: 0% Send Results by Email 1. Questions 1. 1.ID: 18649228302 A couple seeking infertility counseling expresses their excitement by stating, “Now at last we can become pregnant. We are so glad to get this process started!” The response by the nurse should be based on the knowledge that A. infertility care does not always lead to a successful pregnancy. Correct Because some factors contributing to infertility remain unknown, treatment of an identified problem does not always lead to a successful pregnancy. B. a successful pregnancy chance can be increased with intervention. C. infertility counseling just looks at the cause of the infertility, not its treatment. D. a pregnancy can occur, but there is no guarantee about the successful completion of the pregnancy. Awarded 0.0 points out of 1.0 possible points. 2. 2.ID: 18649228312 A couple delivered a full-term baby girl 3 years ago. They have been attempting pregnancy for the past 2 years, without success. When taking a history from the couple, which one of the following may lead to abnormal sperm numbers and function in the male? A. His job requires him to walk most of the day, with few rest periods. B. Infertility care does not always lead to a successful pregnancy. Correct Acute or chronic illness such as mumps, cirrhosis, and renal failure can impair the number and function of the sperm. Sitting for prolonged periods will elevate the scrotal temperature and impair the numbers and function of the sperm. Antihypertensives may produce abnormal ejaculation but do not interfere with the sperm number and function. C. He was diagnosed with hypertension 2 years ago and is under medical treatment. D. His job requires him to be outside about 7 hours out of the 8 hours at work. Awarded 0.0 points out of 1.0 possible points. 3. 3.ID: 18649227998 A couple is in for fertility counseling. They have achieved pregnancy six times, but have lost each pregnancy before the 20th week of gestation. The nurse is aware that the most common cause of repeated pregnancy loss is A. lack of FSH hormone. B. tubal obstruction. C. dysfunction in the pituitary gland. D. fetal chromosome defects. Correct Errors in the fetal chromosomes may result in spontaneous abortion, usually in the first trimester. Lack of FSH and dysfunction of the pituitary gland are causes of disorders in ovulation; tubal obstruction prevents implantation. Awarded 0.0 points out of 1.0 possible points. 4. 4.ID: 18649228304 Assessment of a couple experiencing difficulty conceiving usually begins with A. a complete history and physical assessment of both partners. Correct Assessment for the origin of infertility always begins with the least costly, noninvasive testing first. A complete history and physical assessment of both the male and female recognizes that infertility can have a female or male origin, or both. This assessment will provide clues about which types of tests, if any, would be most appropriate for this couple. B. semen analysis. C. testing of cervical mucus for LH surge. D. postcoital (Sims-Huhner) test. Awarded 0.0 points out of 1.0 possible points. 5. 5.ID: 18649227994 When obtaining a reproductive health history from a female patient, the nurse should A. limit the time spent on exploration of intimate topics. B. avoid asking questions that might embarrass the patient. C. use only accepted medical terminology when referring to body parts and functions. D. explain the purpose for the question asked and how the information will be used. Correct Sufficient time must be spent on gathering relevant data, even if it may be embarrassing for the patient or the nurse or involves intimate topics. Always use terms the patient can understand. Awarded 0.0 points out of 1.0 possible points. 6. 6.ID: 18649227996 Semen analysis is a common diagnostic procedure related to infertility. When instructing a male patient about this test, the nurse would tell him to A. ejaculate into a sterile container. B. obtain the specimen after a period of abstinence from ejaculation for 3 days. Correct The male must ejaculate into a clean container or plastic sheath that does not contain a spermicide. He should avoid exposing the specimen to extremes of temperature, heat or cold. The specimen should be taken to the laboratory within 30 minutes of ejaculation. C. transport the specimen with the container packed in ice. D. ensure that the specimen arrives at the laboratory within 30 minutes of ejaculation. Awarded 0.0 points out of 1.0 possible points. 7. 7.ID: 18649228322 After an infertility assessment, a woman receives a prescription for clomiphene citrate (Clomid). The nurse should teach the woman that this medication is used to A. correct excess prolactin secretion. B. reduce endometriosis. C. stimulate the release of FSH and LH. D. induce ovulation. Correct Clomiphene citrate is used to induce ovulation in women who have specific types of ovulatory dysfunction. Bromocriptine (Parlodel) corrects excessive prolactin secretion. Gonadotropin-releasing hormone (GnRH) antagonists reduce endometriosis. GnRH stimulates the release of FSH and LH. Awarded 0.0 points out of 1.0 possible points. 8. 8.ID: 18649228306 A woman and her female partner have come to the clinic stating that they would like to have a baby. During the interview, the nurse discusses the possibilities with the couple. One possibility in which the woman may conceive and deliver her biologic child is A. egg donation. B. therapeutic insemination. Correct Therapeutic insemination may use semen of a donor. This can be used if a woman wants a biologic child without having a relationship with a male partner. C. surrogate parenting. D. ovulation induction. Awarded 0.0 points out of 1.0 possible points. 9. 9.ID: 18649227990 A woman is born without a functioning uterus but has functioning ovaries. She and her husband come to the infertility clinic requesting information on the possibility of having a baby. One possibility for this couple to have a biologic child is A. in vitro fertilization. B. therapeutic insemination. C. gestational surrogate. Correct A surrogate mother in a gestational surrogate pregnancy supplies her uterus only, with the infertile couple supplying the sperm and ovum. The other choices all require a functioning uterus in the biologic mother. D. gamete intrafallopian transfer. Awarded 0.0 points out of 1.0 possible points. 10. 10.ID: 18649228300 After a year of infertility treatment, a woman has just begun another menstrual period. She tells the nurse, “I am so tired of trying. It feels like I will never have a baby. I just am not a real woman.” The best response by the nurse would be: A. “Remember, not everyone receiving treatment will become pregnant. We told you that at the very beginning of the treatments.” B. “Don’t give up yet. You are still young and we are learning newer techniques to try every day.” C. “This must be very frustrating to you.” Correct Infertility treatment is stressful. The woman may experience depression and guilt. The best response by the nurse is to allow the woman time to express her concerns and feelings. D. “Having a baby does not make you a woman.” Awarded 0.0 points out of 1.0 possible points. 11. 11.ID: 18649227992 After 2 years of infertility treatment, a couple decides that they cannot financially go through any more treatments. When discussing this decision with the couple, the nurse can discuss with them A. the possibility that accepting the fact they may not have a child will cause them to relax and perhaps conceive. B. how to accept the fact they may never have a child. C. the possibility of adoption. Correct Not every couple who seeks treatment for infertility achieves a “take home” baby. Adoption may become an option for these couples. The nurse can assist them to explore their personal feelings about adoption, availability of newborns compared with older children, and the pros and cons of adoption. D. the possibility of accepting a niece or nephew as a surrogate child. Awarded 0.0 points out of 1.0 possible points. 12. 12.ID: 18649228314 Generally, the first test to be performed on a male when infertility issues are present is a . Incorrect Correct Responses A. semen analysis Awarded 0.0 points out of 1.0 possible points. 2. 13.ID: 18649228318 Vaginal mucus, when it resembles an egg white in consistency, possesses maximum elasticity and usually precedes or coincides with ovulation. This is known as . Incorrect Correct Responses A. Spinnbarkeit Awarded 0.0 points out of 1.0 possible points. 3. 14.ID: 18649228308 A woman who provides the use of her uterus to an infertile couple who supplies the egg and sperm is known as a . Incorrect Correct Responses A. gestational surrogate Awarded 0.0 points out of 1.0 possible points. [Show More]

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