MATERNAL & CHILDHEALTH nursing MCQ 8

1.     To decrease the pain associated with an episiotomy immediately after birth, the nurse would:

A) Offer warm blankets
B) Encourage the woman to void
C) Apply an ice pack to the site
D) Offer a warm sitz bath

ANS;C
An ice pack is the first measure used after a vaginal birth to provide perineal comfort from edema, an episiotomy, or lacerations. Warm blankets would be helpful for the chills that the woman may experience. Encouraging her to void promotes urinary elimination and uterine involution. A warm sitz bath is effective after the first 24 hours.

2.   A postpartum client has a fourth-degree perineal laceration. The nurse would expect which of the following medications to be ordered?

A) Ferrous sulfate (Feosol)
B) Methylergonovine (Methergine)
C) Docusate (Colace)
D) Bromocriptine (Parlodel)

ANS;C
A stool softener such as docusate (Colace) may promote bowel elimination in a woman with a fourth-degree laceration, who may fear that bowel movements will be painful. Ferrous sulfate would be used to treat anemia. However, it is associated with constipation and would increase the discomfort when the woman has a bowel movement. Methylergonovine would be used to prevent or treat postpartum hemorrhage. Bromocriptine is used to treat hyperprolactinemia.

3.   Which statement would alert the nurse to the potential for impaired bonding between mother and newborn?

A) "You have your daddy's eyes."
B) "He looks like a frog to me."
C) "Where did you get all that hair?"
D) "He seems to sleep a lot."

ANS;B
Negative comments may indicate impaired bonding. Pointing out commonalities such as "daddy's eyes" and expressing pride such as "all that hair" are positive attachment behaviors. The statement about sleeping a lot indicates that the mother is assigning meaning to the newborn's actions, another positive attachment behavior.

4.   After a normal labor and birth, a client is discharged from the hospital 12 hours later. When the community health nurse makes a home visit 2 days later, which finding would alert the nurse to the need for further intervention?

A) Presence of lochia serosa
B) Frequent scant voidings
C) Fundus firm, below umbilicus
D) Milk filling in both breasts

ANS;B
Infrequent or insufficient voiding may be a sign of infection and is not a normal finding on the second postpartum day. Lochia serosa, a firm fundus below the umbilicus, and milk filling the breasts are expected findings.

5.    A primipara client who is bottle feeding her baby begins to experience breast engorgement on her third postpartum day. Which instruction would be most appropriate to aid in relieving her discomfort?

A) "Express some milk from your breasts every so often to relieve the distention."
B) "Remove your bra to relieve the pressure on your sensitive nipples and breasts."
C) "Apply ice packs to your breasts to reduce the amount of milk being produced."
D) "Take several warm showers daily to stimulate the milk let-down reflex."

ANS;C
For the woman with breast engorgement who is bottle feeding her newborn, encourage the use of ice packs to decrease pain and swelling. Expressing milk from the breasts and taking warm showers would be appropriate for the woman who was breast-feeding. Wearing a supportive bra 24 hours a day also is helpful for the woman with engorgement who is bottle feeding.

6.   The nurse administers RhoGAM to an Rh-negative client after delivery of an Rh-positive newborn based on the understanding that this drug will prevent her from:

A) Becoming Rh positive
B) Developing Rh sensitivity
C) Developing AB antigens in her blood
D) Becoming pregnant with an Rh-positive fetus

ANS;B
The woman who is Rh-negative and whose infant is Rh-positive should be given Rh immune globulin (RhoGAM) within 72 hours after childbirth to prevent sensitization.

7.    Which of the following factors in a client's history would alert the nurse to an increased risk for postpartum hemorrhage?

A) Multiparity, age of mother, operative delivery
B) Size of placenta, small baby, operative delivery
C) Uterine atony, placenta previa, operative procedures
D) Prematurity, infection, length of labor

ANS;C
Risk factors for postpartum hemorrhage include a precipitous labor less than three hours, uterine atony, placenta previa or abruption, labor induction or augmentation, operative procedures such as vacuum extraction, forceps, or cesarean birth, retained placental fragments, prolonged third stage of labor greater than 30 minutes, multiparity, and uterine overdistention such as from a large infant, twins, or hydramnios.

8.   When teaching parents about their newborn, the nurse describes the development of a close emotional attraction to a newborn by the parents during the first 30 to 60 minutes after birth, which is termed:

A) Reciprocity
B) Engrossment
C) Bonding
D) Attachment

ANS;C
The development of a close emotional attraction to the newborn by parents during the first 30 to 60 minutes after birth describes bonding. Reciprocity is the process by which the infant's capabilities and behavioral characteristics elicit a parental response. Engrossment refers to the intense interest during early contact with a newborn. Attachment refers to the process of developing strong ties of affection between an infant and significant other.

9.   Which practice would be least effective in promoting bonding and attachment?

A) Allowing unlimited visiting hours on maternity units
B) Offering round-the-clock nursery care for all infants
C) Promoting rooming-in
D) Encouraging infant contact immediately after birth

ANS;B
Factors that can affect attachment include separation of the infant and parents for long times during the day, such as if the infant was being cared for in the nursery throughout the day. Unlimited visiting hours, rooming-in, and infant contact immediately after birth promote bonding and attachment.

10.                      Which instructions would the nurse include in discharge teaching for parents of a newborn?

A) Introducing solid foods immediately to increase sleep cycle
B) Demonstrating comfort measures to quiet a crying infant
C) Encouraging daily outings to the shopping mall with the newborn
D) Allowing the infant to cry for at least an hour before picking him or her up

ANS;B
Discharge teaching typically would focus on several techniques to comfort a crying newborn. The nurse needs to emphasize the importance of responding to the newborn's cues, not allowing the infant to cry for an hour before being comforted. Information about solid foods is inappropriate for a newborn because solid foods are not introduced at this time. The mother and newborn need rest periods. Therefore, daily outings to a shopping mall would be inappropriate. Information about newborn sleep-wake cycles and measures for sensory enrichment and stimulation would be more appropriate.

11.When developing the plan of care for the parents of a newborn, the nurse identifies interventions to promote bonding and attachment based on the rationale that bonding and attachment are most supported by which measure?

A) Early parent-infant contact following birth
B) Expert medical care for the labor and birth
C) Good nutrition and prenatal care during pregnancy
D) Grandparent involvement in infant care after birth

ANS; A
Optimal bonding requires a period of close contact between the parents and newborn within the first few minutes to a few hours after birth. Expert medical care, nutrition and prenatal care, and grandparent involvement are not associated with the promotion of bonding.

12.                       Which method would be most effective in evaluating the parents' understanding about their newborn's care?

A) Demonstrate all infant care procedures
B) Allow the parents to state the steps of the care
C) Observe the parents performing the procedures
D) Routinely assess the newborn for cleanliness

ANS;C
The most effective means to evaluate the parents' learning is to observe them performing the procedures. Parental roles develop and grow through interaction with their newborn. The nurse would involve both parents in the newborn's care and praise them for their efforts. Demonstrating the procedures to the parents and having the parents state the steps are helpful but do not guarantee that the parents understand them. Assessing the newborn for cleanliness would provide little information about parental learning.

13.                       A postpartum woman is having difficulty voiding for the first time after giving birth. Which of the following would be least effective in helping to stimulate voiding?

A) Pouring warm water over her perineal area
B) Having her hear the sound of water running nearby
C) Placing her hand in a basin of cool water
D) Standing her in the shower with the warm water on

ANS;C
Helpful measures to stimulate voiding include placing her hand in a basin of warm water, pouring warm water over her perineal area, hearing the sound of running water nearby, blowing bubbles through a straw, standing in the shower with the warm water turned on, and drinking fluids.

14. The nurse is assisting a postpartum woman out of bed to the bathroom for a sitz bath. Which of the following would be a priority?

A) Placing the call light within her reach
B) Teaching her how the sitz bath works
C) Telling her to use the sitz bath for 30 minutes
D) Cleaning the perineum with the peri-bottle

ANS;A
Tremendous hemodynamic changes are taking place within the woman, and safety must be a priority. Therefore, the nurse makes sure that the emergency call light is within her reach should she become dizzy or lightheaded. Teaching her how to use the sitz bath, including using it for 15 to 20 minutes, is appropriate but can be done once the woman's safety is ensured. The woman should clean her perineum with a peri-bottle before using the sitz bath, but this can be done once the woman's safety needs are met.

15.Review of a primiparous woman's labor and birth record reveals a prolonged second stage of labor and extended time in the stirrups. Based on an interpretation of these findings, the nurse would be especially alert for which of the following?

A) Retained placental fragments
B) Hypertension
C) Thrombophlebitis
D) Uterine subinvolution

ANS;C
The woman is at risk for thrombophlebitis due to the prolonged second stage of labor, necessitating an increased amount of time in bed, and venous pooling that occurs when the woman's legs are in stirrups for a long period of time. These findings are unrelated to retained placental fragments, which would lead to uterine subinvolution, or hypertension.

16.                       The nurse is describing a transient, self-limiting mood disorder that affects mothers after childbirth, identifying this as postpartum:

A) Depression
B) Psychosis
C) Bipolar disorder
D) Blues

ANS;D
Postpartum blues are manifested by mild depressive symptoms of anxiety, irritability, mood swings, tearfulness, increased sensitivity, feelings of being overwhelmed, and fatigue. They are usually self-limiting and require no formal treatment other than reassurance and validation of the woman's experience as well as assistance in caring for herself and her newborn. Postpartum depression is a major depressive episode associated with childbirth. Postpartum psychosis is at the severe end of the continuum of postpartum emotional disorders. Bipolar disorder refers to a mood disorder typically involving episodes of depression and mania.

17.A woman who is 2 weeks postpartum calls the clinic and says, "My left breast hurts." After further assessment on the phone, the nurse suspects the woman has mastitis. In addition to pain, the nurse would assess for which of the following?

A) An inverted nipple on the affected breast
B) No breast milk in the affected breast
C) An ecchymotic area on the affected breast
D) Hardening of an area in the affected breast

ANS;D
Mastitis is characterized by a tender, hot, red, painful area on the affected breast. An inverted nipple is not associated with mastitis. With mastitis, the breast is distended with milk, the area is inflamed (not ecchymotic), and there is breast tenderness.

18.                      When reviewing the causes of late postpartum hemorrhage, which of the following would the nurse identify as the most common cause?

A) Retained placental fragments
B) Uterine atony
C) Cervical or vaginal lacerations
D) Uterine inversion

ANS;A
Late postpartum hemorrhage is typically due to subinvolution secondary to retained placental fragments, distended bladder, uterine myoma, and infection. Uterine atony, lacerations, and uterine inversion would most likely lead to early postpartum hemorrhage.

19.                       Which of the following would be essential to implement to prevent late postpartum hemorrhage?

A) Administering broad-spectrum antibiotics
B) Inspecting the placenta after delivery for intactness
C) Manually removing the placenta at delivery
D) Applying pressure to the umbilical cord to remove the placenta

ANS;B
After the placenta is expelled, a thorough inspection is necessary to confirm its intactness because tears or fragments left inside may indicate an accessory lobe or placenta accreta. These can lead to profuse hemorrhage because the uterus is unable to contract fully. Administering antibiotics would be appropriate for preventing infection, not postpartum hemorrhage. Manual removal of the placenta or excessive traction on the umbilical cord can lead to uterine inversion, which in turn would result in hemorrhage.

20.                     A multipara client develops thrombophlebitis after delivery. Which of the following would alert the nurse to the need for immediate intervention?

A) Dyspnea, diaphoresis, hypotension, and chest pain
B) Dyspnea, bradycardia, hypertension, and confusion
C) Weakness, anorexia, change in level of consciousness, and coma
D) Pallor, tachycardia, seizures, and jaundice

ANS;A
Sudden unexplained shortness of breath and complaints of chest pain along with diaphoresis and hypotension suggest pulmonary embolism, which requires immediate action. Other signs and symptoms include tachycardia, apprehension, hemoptysis, syncope, and sudden change in the woman's mental status secondary to hypoxemia. Anorexia, seizures, and jaundice are unrelated to a pulmonary embolism.

21.                       A client experienced prolonged labor with prolonged premature rupture of membranes. The nurse would be alert for which of the following in the mother and the newborn?

A) Infection
B) Hemorrhage
C) Trauma
D) Hypovolemia

ANS;A
Although hemorrhage, trauma, and hypovolemia may be problems, the prolonged labor with the prolonged premature rupture of membranes places the client at high risk for a postpartum infection. The rupture of membranes removes the barrier of amniotic fluid so bacteria can ascend.

22.                     When assessing the postpartum woman, the nurse uses indicators other than pulse rate and blood pressure for postpartum hemorrhage because:

A) These measurements may not change until after the blood loss is large
B) The body's compensatory mechanisms activate and prevent any changes
C) They relate more to change in condition than to the amount of blood lost
D) Maternal anxiety adversely affects these vital signs

ANS;A
The typical signs of hemorrhage do not appear in the postpartum woman until as much as 1,800 to 2,100 mL of blood has been lost. In addition, accurate determination of actual blood loss is difficult because of blood pooling inside the uterus and on perineal pads, mattresses, and the floor.

23.                     The nurse would be alert for which of the following immediately after a woman with abruptio placentae gives birth?

A) Severe uterine pain
B) Board-like abdomen
C) Appearance of petechiae
D) Inversion of the uterus

ANS;C
A complication of abruptio placentae is disseminated intravascular coagulation (DIC), which is manifested by petechiae, ecchymoses, and other signs of impaired clotting. Severe uterine pain, a board-like abdomen, and uterine inversion are not associated with abruptio placentae.

24.                     Which of the following assessment findings in a postpartum client would be most alarming?

A) Leg pain on ambulation with mild ankle edema
B) Calf pain with dorsiflexion of the foot.
C) Perineal pain with swelling along the episiotomy
D) Sharp stabbing chest pain with shortness of breath

ANS; D
Sharp stabbing chest pain with shortness of breath suggests pulmonary embolism, an emergency that requires immediate action. Leg pain on ambulation with mild edema suggests superficial venous thrombosis. Calf pain on dorsiflexion of the foot may indicate deep vein thrombosis or a strained muscle or contusion. Perineal pain with swelling along the episiotomy might be a normal finding or suggest an infection. Of the conditions, pulmonary embolism is the most urgent..

25.                      Which of the following would the nurse least expect to administer to a woman experiencing postpartum hemorrhage?

A) Oxytocin
B) Methylergonovine
C) Carboprost
D) Terbutaline

ANS;D
Terbutaline is a tocolytic agent used to halt preterm labor. It would not be used to treat postpartum hemorrhage. Oxytocin, methylergonovine, and carboprost are drugs used to manage postpartum hemorrhage.

26 .A client asks the nurse what a third degree laceration is. She was informed that she had one. The nurse explains that this is: 

a. that extended their anal sphincter 
b. through the skin and into the muscles
c. that involves anterior rectal wall
d. that extends through the perineal muscle.

ANS; (A) 

that extended their anal sphincter 

Third degree laceration involves all in the second degree laceration and the external sphincter of the rectum. Options B, C and D are under the second degree laceration.

27. Betina 30 weeks AOG discharged with a diagnosis of placenta previa. The nurse knows that the client understands her care at home when she says: 

a. I am happy to note that we can have sex occasionally when I have no bleeding.
b. I am afraid I might have an operation when my due comes
c. I will have to remain in bed until my due date comes
d. I may go back to work since I stay only at the office.

ANS; (C) 

I will have to remain in bed until my due date comes

Placenta previa means that the placenta is the presenting part. On the first and second trimester there is spotting. On the third trimester there is bleeding that is sudden, profuse and painless.

28. The uterus has already risen out of the pelvis and is experiencing farther into the abdominal area at about the: 

a. 8th week of pregnancy
b. 10th week of pregnancy
c. 12th week of pregnancy
d. 18th week of pregnancy

ANS; (D)

 18th week of pregnancy

On the 8th week of pregnancy, the uterus is still within the pelvic area. On the 10th week, the uterus is still within the pelvic area. On the 12th week, the uterus and placenta have grown, expanding into the abdominal cavity. On the 18th week, the uterus has already risen out of the pelvis and is expanding into the abdominal area.

29. Which of the following urinary symptoms does the pregnant woman most frequently experience during the first trimester: 

a. frequency
b. dysuria
c. incontinence
d. burning

ANS; (A)

 frequency

Pressure and irritation of the bladder by the growing uterus during the first trimester is responsible for causing urinary frequency. Dysuria, incontinence and burning are symptoms associated with urinary tract infection
5. Mrs. Jimenez went to the health center for pre-natal check-up. the student nurse took her weight and revealed 142 lbs. She asked the student nurse how much should she 30.gain weight in her pregnancy. 

a. 20-30 lbs
b. 25-35 lbs
c. 30- 40 lbs
d. 10-15 lbs

ANS; (B) 25-35 lbs

A weight gain of 11. 2 to 15.9 kg (25 to 35 lbs) is currently recommended as an average weight gain in pregnancy. This weight gain consists of the following: fetus- 7.5 lb; placenta- 1.5 lb; amniotic fluid- 2 lb; uterus- 2.5 lb; breasts- 1.5 to 3 lb; blood volume- 4 lb; body fat- 7 lb; body fluid- 7 lb.

31. The nurse is preparing Mrs. Jordan for cesarean delivery. Which of the following key concept should the nurse consider when implementing nursing care? 

a. Explain the surgery, expected outcome and kind of anesthetics.
b. Modify preoperative teaching to meet the needs of either a planned or emergency cesarean birth.
c. Arrange for a staff member of the anesthesia department to explain what to expect post-operatively.
d. Instruct the mother’s support person to remain in the family lounge until after the delivery.

ANS; (B)

 Modify preoperative teaching to meet the needs of either a planned or emergency cesarean birth.

A key point to consider when preparing the client for a cesarean delivery is to modify the preoperative teaching to meet the needs of either planned or emergency cesarean birth, the depth and breadth of instruction will depend on circumstances and time available.

32. Bettine Gonzales is hospitalized for the treatment of severe preecplampsia. Which of the following represents an unusual finding for this condition? 

a. generalized edema
b. proteinuria 4+
c. blood pressure of 160/110
d. convulsions

ANS; (D) 

convulsions

Options A, B and C are findings of severe preeclampsia. Convulsions is a finding of eclampsia—an obstetrical emergency.

33. Nurse Geli explains to the client who is 33 weeks pregnant and is experiencing vaginal bleeding that coitus: 

a. Need to be modified in any way by either partner
b. Is permitted if penile penetration is not deep.
c. Should be restricted because it may stimulate uterine activity.
d. Is safe as long as she is in side-lying position.

ANS; (C)

 Should be restricted because it may stimulate uterine activity.

Coitus is restricted when there is watery discharge, uterine contraction and vaginal bleeding. Also those women with a history of spontaneous miscarriage may be advised to avoid coitus during the time of pregnancy when a previous miscarriage occurred.

34. Mrs. Precilla Abuel, a 32 year old mulripara is admitted to labor and delivery. Her last 3 pregnancies in short stage one of labor. The nurses decide to observe her closely. The physician determines that Mrs. Abuel’s cervix is dilated to 6 cm. Mrs. Abuel states that she is extremely uncomfortable. To lessen Mrs. Abuel’s discomfort, the nurse can advise her to: 

a. lie face down
b. not drink fluids
c. practice holding breaths between contractions
d. assume Sim’s position

ANS; (D) 

assume Sim’s position

When the woman is in Sim’s position, this puts the weight of the fetus on bed, not on the woman and allows good circulation in the lower extremities
35. Which is true regarding the fontanels of the newborn? 

a. The anterior is large in shape when compared to the posterior fontanel.
b. The anterior is triangular shaped; the posterior is diamond shaped.
c. The anterior is bulging; the posterior appears sunken.
d. The posterior closes at 18 months; the anterior closes at 8 to 12 months.

ANS; (A) 

The anterior is large in shape when compared to the posterior fontanel.

The anterior fontanel is larger in size than the posterior fontanel. Additionally, the anterior fontanel, which is diamond shaped closes at 18 month, whereas the posterior fontanel, which is triangular in shape closes at 8 to 12 weeks. Neither fontanel should appear bulging, which may indicate increases ICP or sunken, which may indicate hydration.

36. Mrs. Quijones gave birth by spontaneous delivery to a full term baby boy. After a minute after birth, he is crying and moving actively. His birth weight is 6.8 lbs. What do you expect baby Quijones to weigh at 6 months? 

a. 13 -14 lbs
b. 16 -17 lbs
c. 22 -23 lbs
d. 27 -28 lbs 

ANS; (A)

 13 -14 lbs

The birth weight of an infant is doubled at 6 months and is tripled at 12 months

37. During the first hours following delivery, the post partum client is given IVF with oxytocin added to them. The nurse understands the primary reason for this is: 

a. To facilitate elimination
b. To promote uterine contraction
c. To promote analgesia
d. To prevent infection

ANS; (B)

 To promote uterine contraction

Oxytocin is a hormone produced by the pituitary gland that produces intermittent uterine contractions, helping to promote uterine involution.
38. Nurse Luis is assessing the newborn’s heart rate. Which of the following would be considered normal if the newborn is sleeping? 

a. 80 beats per minute
b. 100 beats per minute
c. 120 beats per minute
d. 140 beats per minute 

ANS; (B)

 100 beats per minute

The normal heart rate for a newborn that is sleeping is approximately 100 beats per minute. If the newborn was awake, the normal heart rate would range from 120 to 160 beats per minute.

.39. The infant with Down Syndrome should go through which of the Erikson’s developmental stages first? 

a. Initiative vs. Self doubt
b. Industry vs. Inferiority
c. Autonomy vs. Shame and doubt
d. Trust vs. Mistrust 

ANS; (D) 

Trust vs. Mistrust 

The child with Down syndrome will go through the same first stage, trust vs. mistrust, only at a slow rate. Therefore, the nurse should concentrate on developing on bond between the primary caregiver and the child

40. The child with phenylketonuria (PKU) must maintain a low phenylalanine diet to prevent which of the following complications? 

a. Irreversible brain damage
b. Kidney failure
c. Blindness
d. Neutropenia

ANS; (A) 

Irreversible brain damage

The child with PKU must maintain a strict low phenylalanine diet to prevent central nervous system damage, seizures and eventual death
41. Which age group is with imaginative minds and creates imaginary friends? 

a. Toddler
b. Preschool
c. School
d. Adolescence

ANS;  (B)

 Preschool

During preschool, this is the time when children do imitative play, imaginative play—the occurrence of imaginative playmates, dramatic play where children like to act, dance and sing

42. Which of the following situations would alert you to a potentially developmental problem with a child? 

a. Pointing to body parts at 15 months of age.
b. Using gesture to communicate at 18 months.
c. Cooing at 3 months.
d. Saying “mama” or “dada” for the first time at 18 months of age. 

ANS;  (D)

 Saying “mama” or “dada” for the first time at 18 months of age. 

A child should say “mama” or “dada” during 10 to 12 months of age. Options A, B and C are all normal assessments of language development of a child.

43. Isabelle, a 2 year old girl loves to move around and oftentimes manifests negativism and temper tantrums. What is the best way to deal with her behavior? 

a. Tell her that she would not be loved by others is she behaves that way..
b. Withholding giving her toys until she behaves properly.
c. Ignore her behavior as long as she does not hurt herself and others.
d. Ask her what she wants and give it to pacify her.

ANS;  (C) 

Ignore her behavior as long as she does not hurt herself and others.

If a child is trying to get attention or trying to get something through tantrums—ignore his/her behavior
44. Baby boy Villanueva, 4 months old, was seen at the pediatric clinic for his scheduled check-up. By this period, baby Villanueva has already increased his height by how many inches? 

a. 3 inches
b. 4 inches
c. 5 inches
d. 6 inches

ANS; (B) 

4 inches

From birth to 6 months, the infant grows 1 inch (2.5 cm) per month. From 6 to 12 months, the infant grows ½ inch (1.25 cm) per month

45. Alice, 10 years old was brought to the ER because of Asthma. She was immediately put under aerosol administration of Terbutaline. After sometime, you observe that the child does not show any relief from the treatment given. Upon assessment, you noticed that both the heart and respiratory rate are still elevated and the child shows difficulty of exhaling. You suspect: 

a. Bronchiectasis
b. Atelectasis
c. Epiglotitis
d. Status Asthmaticus

ANS; (D)

 Status Asthmaticus

Status asthmaticus leads to respiratory distress and bronchospasm despite of treatment and interventions. Mechanical ventilation maybe needed due to respiratory failure.

46. Nurse Jonas assesses a 2 year old boy with a tentative diagnosis of nephroblastoma. Symptoms the nurse observes that suggest this problem include: 

a. Lymphedema and nerve palsy
b. Hearing loss and ataxia
c. Headaches and vomiting
d. Abdominal mass and weakness

ANS; (D)

 Abdominal mass and weakness

Nephroblastoma or Wilm’s tumor is caused by chromosomal abnormalities, most common kidney cancer among children characterized by abdominal mass, hematuria, hypertension and fever
47. Which of the following danger sings should be reported immediately during the antepartum period? 

a. blurred vision
b. nasal stuffiness
c. breast tenderness
d. constipation

ANS; (A)

 blurred vision

Danger signs that require prompt reporting are leaking of amniotic fluid, blurred vision, vaginal bleeding, rapid weight gain and elevated blood pressure. Nasal stuffiness, breast tenderness, and constipation are common discomforts associated with pregnancy.

48. Nurse Jacob is assessing a 15 month old child with acute otitis media. Which of the following symptoms would the nurse anticipate finding? 

a. periorbital edema, absent light reflex and translucent tympanic membrane
b. irritability, purulent drainage in middle ear, nasal congestion and cough
c. diarrhea, retracted tympanic membrane and enlarged parotid gland
d. Vomiting, pulling at ears and pearly white tympanic membrane

ANS; (B)

 irritability, purulent drainage in middle ear, nasal congestion and cough

Irritability, purulent drainage in middle ear, nasal congestion and cough, fever, loss of appetite, vomiting and diarrhea are clinical manifestations of otitis media. Acute otitis media is common in children 6 months to 3 years old and 8 years old and above. Breast fed infants have higher resistance due to protection of Eustachian tubes and middle ear from breast milk.

49. Which of the following is the most appropriate intervention to reduce stress in a preterm infant at 33 weeks gestation? 

a. Sensory stimulation including several senses at a time
b. tactile stimulation until signs of over stimulation develop
c. An attitude of extension when prone or side lying
d. Kangaroo care

ANS; (D) 

Kangaroo care

Kangaroo care is the use of skin-to-skin contact to maintain body heat. This method of care not only supplies heat but also encourages parent-child interaction

50. The parent of a client with albinism would need to be taught which preventive healthcare measure by the nurse: 

a.  Ulcerative colitis diet
b. Use of a high-SPF sunblock
c. Hair loss monitoring
d. Monitor for growth retardation

ANS; (B)

Use of a high-SPF sunblock

Without melanin production, the child with albinism is at risk for severe sunburns. Maximum sun protection should be taken, including use of hats, long sleeves, minimal time in the sun and high-SPF sunblock, to prevent any problems

maternal and child health nursing MCQ 7

1.     The nurse in charge is caring for a patient who is in the first stage of labor. What is the shortest but most difficult part of this stage?

a. Active phase
b. Complete phase
c. Latent phase
d. Transitional phase

Answer D
The transitional phase, which lasts 1 to 3 hours, is the shortest but most difficult part of the first stage of labor. This phase is characterized by intense uterine contractions that occur every 1 ½ to 2 minutes and last 45 to 90 seconds. The active phase lasts 4 ½ to 6 hours; it is characterized by contractions that starts out moderately intense, grow stronger, and last about 60 seconds. The complete phase occurs during the second, not first, stage of labor. The latent phase lasts 5 to 8 hours and is marked by mild, short, irregular contractions.

2.   The nurse is teaching a pregnant woman with type 1 diabetes about her diet during pregnancy. Which client statement indicates that the nurse's teaching was successful?

A) "I'll basically follow the same diet that I was following before I became pregnant."
B) "Because I need extra protein, I'll have to increase my intake of milk and meat."
C) "Pregnancy affects insulin production, so I'll need to make adjustments in my diet."
D) "I'll adjust my diet and insulin based on the results of my urine tests for glucose."

ANS;C
In pregnancy, placental hormones cause insulin resistance at a level that tends to parallel growth of the fetoplacental unit. Nutritional management focuses on maintaining balanced glucose levels. Thus, the woman will probably need to make adjustments in her diet. Protein needs increase during pregnancy, but this is unrelated to diabetes. Blood glucose monitoring results typically guide therapy.

3.   Which factor would the nurse identify as being most important in helping to reduce the maternal/fetal/neonatal complications associated with pregnancy and diabetes?

A) Stability of the woman's emotional and psychological status
B) Degree of glycemic control achieved during the pregnancy
C) Evaluation of retinopathy by an ophthalmologist
D) Blood urea nitrogen level (BUN) within normal limits

ANS;B
Therapeutic management for the woman with diabetes focuses on tight glucose control, thereby minimizing the risks to the mother, fetus, and neonate. The woman's emotional and psychological status is highly variable and may or may not affect the pregnancy. Evaluating for long-term diabetic complications such as retinopathy or nephropathy, as evidenced by laboratory testing such as BUN levels, is an important aspect of preconception care to ensure that the mother enters the pregnancy in an optimal state.

4.   Because a pregnant client's diabetes has been poorly controlled throughout her pregnancy, the nurse would be alert for which of the following in the neonate at birth?

A) Macrosomia
B) Hyperglycemia
C) Low birthweight
D) Hypobilirubinemia

ANS;A
Poorly controlled diabetes during pregnancy can result in macrosomia due to hyperinsulinemia stimulated by fetal hyperglycemia. Typically the neonate is hypoglycemic due to the ongoing hyperinsulinemia that occurs after the placenta is removed. Infants of diabetic women typically are large and are at risk for hyperbilirubinemia due to excessive red blood cell breakdown.

5.    A woman with diabetes is considering becoming pregnant. She asks the nurse whether she will be able to take oral hypoglycemics when she is pregnant. The nurse's response is based on the understanding that oral hypoglycemics:

A) Can be used as long as they control serum glucose levels
B) Can be taken until the degeneration of the placenta occurs
C) Are usually suggested primarily for women who develop gestational diabetes
D) Show promising results but more studies are needed to confirm their effectiveness

ANS;D
Several studies have used glyburide an oral hypoglycemic agent with promising results. However, more intensive research is needed to establish the drug's safety and efficacy during pregnancy.

6.   A 10-week pregnant woman with diabetes has a glycosylated hemoglobin (HbA1c) level of 13%. At this time the nurse should be most concerned about which of the following possible fetal outcomes?

A) Congenital anomalies
B) Incompetent cervix
C) Placenta previa
D) Abruptio placentae

ANS;A
A HbA1c level of 13% indicates poor glucose control. This, in conjunction with the woman being in the first trimester, increases the risk for congenital anomalies in the fetus. Elevated glucose levels are not associated with incompetent cervix, placenta previa, or abruptio placentae.

7.    After teaching a group of students about the use of antiretroviral agents in pregnant women who are HIV-positive, the instructor determines that the teaching was successful when the group identifies which of the following as the underlying rationale?

A) Reduction in viral loads in the blood
B) Treatment of opportunistic infections
C) Adjunct therapy to radiation and chemotherapy
D) Can cure acute HIV/AIDS infections

ANS;A
Drug therapy is the mainstay of treatment and is important in reducing the viral load as much as possible. Antiretroviral agents do not treat opportunistic infections and are not adjunctive therapy. There is no cure for HIV/AIDS.

8.   Assessment of a pregnant woman and her fetus reveals tachycardia and hypertension. There is also evidence suggesting vasoconstriction. The nurse would question the woman about use of which substance?

A) Marijuana
B) Alcohol
C) Heroin
D) Cocaine

ANS;D
Cocaine use produces vasoconstriction, tachycardia, and hypertension in both the mother and fetus. The effects of marijuana are not yet fully understood. Alcohol ingestion would lead to cognitive and behavioral problems in the newborn. Heroin is a central nervous system depressant.

9.   When teaching a class of pregnant women about the effects of substance abuse during pregnancy, which of the following would the nurse include?

A) Low-birth weight infants
B) Excessive weight gain
C) Higher pain tolerance
D) Longer gestational periods

ANS;A
Substance abuse during pregnancy is associated with low-birthweight infants, preterm labor, abortion, intrauterine growth restriction, abruptio placentae, neurobehavioral abnormalities, and long-term childhood developmental consequences. Excessive weight gain, higher pain tolerance, and longer gestational periods are not associated with substance abuse.

10.   A client who is HIV-positive is in her second trimester and remains asymptomatic. She voices concern about her newborn's risk for the infection. Which of the following statements by the nurse would be most appropriate?

A) "You'll probably have a cesarean birth to prevent exposing your newborn."
B) "Antibodies cross the placenta and provide immunity to the newborn."
C) "Wait until after the infant is born and then something can be done."
D) "Antiretroviral medications are available to help reduce the risk of transmission."

ANS;D
Drug therapy is the mainstay of treatment for pregnant women infected with HIV. The goal of therapy is to reduce the viral load as much as possible; this reduces the risk of transmission to the fetus. Decisions about the method of delivery should be based on the woman's viral load, duration of ruptured membranes, progress of labor, and other pertinent clinical factors. The newborn is at risk for HIV because of potential perinatal transmission. Waiting until after the infant is born may be too late.

11.When assessing a pregnant woman with heart disease throughout the antepartal period, the nurse would be especially alert for signs and symptoms of cardiac decompensation at which time?

A) 16 to 20 weeks' gestation
B) 20 to 24 weeks' gestation
C) 24 to 28 week's gestation
D) 28 to 32 week's gestation

ANS;D
A pregnant woman with heart disease is most vulnerable for cardiac decompensation from 28 to 32 weeks' gestation.

12.   When preparing a schedule of follow-up visits for a pregnant woman with chronic hypertension, which of the following would be most appropriate?

A) Monthly visits until 32 weeks, then bi-monthly visits
B) Bi-monthly visits until 28 weeks, then weekly visits
C) Monthly visits until 20 weeks, then bi-monthly visits
D) Bi-monthly visits until 36 weeks, then weekly visits

ANS;B
For the woman with chronic hypertension, antepartum visits typically occur every 2 weeks until 28 weeks' gestation and then weekly to allow for frequent maternal and fetal surveillance.

13.   Which medication would the nurse question if ordered to control a pregnant woman's asthma?

A) Budesonide
B) Albuterol
C) Salmeterol
D) Oral prednisone

ANS;D
Oral corticosteroids such as prednisone are not preferred in the treatment of asthma during pregnancy. However, they can be used to treat severe asthma attacks during pregnancy. Budesonide, albuterol, and salmeterol are recommended for use during pregnancy to control asthma.

14. After teaching a pregnant woman with iron deficiency anemia about her prescribed iron supplement, which statement indicates successful teaching?

A) "I should take my iron with milk."
B) " I should avoid drinking orange juice."
C) "I need to eat foods high in fiber."
D) "I'll call the doctor if my stool is black and tarry."

ANS; C
Iron supplements can lead to constipation, so the woman needs to increase her intake of fluids and high-fiber foods. Milk inhibits absorption and should be discouraged. Vitamin C-containing fluids such as orange juice are encouraged because they promote absorption. Ideally the woman should take the iron on an empty stomach to improve absorption, but many women cannot tolerate the gastrointestinal discomfort it causes. In such cases, the woman should take it with meals. Iron typically causes the stool to become black and tarry; there is no need for the woman to notify her doctor.

15. At which time should the nurse screen a pregnant woman for group B streptococcus infection?

A) 16 weeks' gestation
B) 28 week' gestation
C) 32 weeks' gestation
D) 36 weeks' gestation

ANS; D
All pregnant women should be screened for group B streptococcus infection at 35 to 37 weeks' gestation.

16.                       The nurse is assessing a newborn of a woman who is suspected of abusing alcohol. Which newborn finding would provide additional evidence to support this suspicion?

A) Wide large eyes
B) Thin upper lip
C) Protruding jaw
D) Elongated nose

ANS;B
Newborn characteristics suggesting fetal alcohol spectrum disorder include thin upper lip, small head circumference, small eyes, receding jaw, and short nose. Other features include a low nasal bridge, short palpebral fissures, flat midface, epicanthal folds, and minor ear abnormalities.

17.                       A nurse in the labor room is caring for a client in the active phases of labor. The nurse is assessing the fetal patterns and notes a late deceleration on the monitor strip. The most appropriate nursing action is to:

1.Place the mother in the supine position
2.Document the findings and continue to monitor the fetal patterns
3.Administer oxygen via face mask
4.Increase the rate of pitocin IV infusion

Ans: 3

Late decelerations are due to uteroplacental insufficiency as the result of decreased blood flow and oxygen to the fetus during the uterine contractions. This causes hypoxemia; therefore oxygen is necessary. The supine position is avoided because it decreases uterine blood flow to the fetus. The client should be turned to her side to displace pressure of the gravid uterus on the inferior vena cava. An intravenous pitocin infusion is discontinued when a late deceleration is noted.

18. After spontaneous rupture of membranes, the nurse notices a prolapsed cord. The nurse immediately places the woman in which position?

A) Supine
B) Side-lying
C) Sitting
D) Knee-chest

ANS;D
Pressure on the cord needs to be relieved. Therefore, the nurse would position the woman in a modified Sims, Trendelenburg, or knee-chest position. Supine, side-lying, or sitting would not provide relief of cord compression.

19.  A primigravida whose labor was initially progressing normally is now experiencing a decrease in the frequency and intensity of her contractions. The nurse would assess the woman for which condition?

A) A low-lying placenta
B) Fetopelvic disproportion
C) Contraction ring
D) Uterine bleeding

ANS;B
The woman is experiencing dystocia most likely due to hypotonic uterine dysfunction and fetopelvic disproportion associated with a large fetus. A low-lying placenta, contraction ring, or uterine bleeding would not be associated with a change in labor pattern.

20.  The nurse would be alert for possible placental abruption during labor when assessment reveals which of the following?

A) Macrosomia
B) Gestational hypertension
C) Gestational diabetes
D) Low parity

ANS;B
Risk factors for placental abruption include preeclampsia, gestational hypertension, seizure activity, uterine rupture, trauma, smoking, cocaine use, coagulation defects, previous history of abruption, domestic violence, and placental pathology. Macrosomia, gestational diabetes, and low parity are not considered risk factors.

21.  Assessment of a woman in labor who is experiencing hypertonic uterine dysfunction would reveal contractions that are:

A) Well coordinated
B) Poor in quality
C) Rapidly occurring
D) Erratic

ANS;D
Hypertonic contractions occur when the uterus never fully relaxes between contractions, making the contractions erratic and poorly coordinated because more than one uterine pacemaker is sending signals for contraction. Hypotonic uterine contractions are poor in quality and lack sufficient intensity to dilate and efface the cervix. Contractions of precipitous labor occur rapidly such that labor is completed in less than three hours.

22.  A woman in labor is experiencing hypotonic uterine dysfunction. Assessment reveals no fetopelvic disproportion. Which group of medications would the nurse expect to administer?

A) Sedatives
B) Tocolytics
C) Oxytocins
D) Corticosteroids

ANS;C
For hypotonic labor, a uterine stimulant such as oxytocin may be ordered once fetopelvic disproportion is ruled out. Sedatives might be helpful for the woman with hypertonic uterine contractions to promote rest and relaxation. Tocolytics would be ordered to control preterm labor. Corticosteroids may be given to enhance fetal lung maturity for women experiencing preterm labor.

23.  The fetus of a woman in labor is determined to be in persistent occiput posterior position. Which of the following would the nurse identify as the priority intervention?

A) Position changes
B) Pain relief measures
C) Immediate cesarean birth
D) Oxytocin administration

ANS;B
Intense back pain is associated with persistent occiput posterior position. Therefore, a priority is to provide pain relief measures. Counterpressure and backrubs may be helpful. Position changes that can promote fetal head rotation are important after the nurse institutes pain relief measures. Additionally, the woman's ability to cooperate and participate in these position changes is enhanced when she is experiencing less pain. Immediate cesarean birth is not indicated unless there is evidence of fetal distress. Oxytocin would add to the woman's already high level of pain.

24.  A woman gave birth to a newborn via vaginal delivery with the use of a vacuum extractor. The nurse would be alert for which of the following in the newborn?

A) Asphyxia
B) Clavicular fracture
C) Caput succedaneum
D) Central nervous system injury

ANS;C
Use of forceps or a vacuum extractor poses the risk of tissue trauma, such as ecchymoses, facial and scalp lacerations, facial nerve injury, cephalhematoma, and caput succedaneum. Asphyxia may be related to numerous causes but it is not associated with use of a vacuum extractor. Clavicular fracture is associated with shoulder dystocia. Central nervous system injury is not associated with the use of a vacuum extractor.

25. A pregnant client undergoing labor induction is receiving an oxytocin infusion. Which of the following findings would require immediate intervention?

A) Fetal heart rate of 150 beats/minute
B) Contractions every 2 minutes, lasting 45 seconds
C) Uterine resting tone of 14 mm Hg
D) Urine output of 20 mL/hour

ANS;D
Oxytocin can lead to water intoxication. Therefore, a urine output of 20 mL/hour is below acceptable limits of 30 mL/hour and requires intervention. FHR of 150 beats/minute is within the accepted range of 120 to 160 beats/minutes. Contractions should occur every 2 to 3 minutes, lasting 40 to 60 seconds. A uterine resting tone greater than 20 mm Hg would require intervention.

26. A woman with a history of crack cocaine abuse is admitted to the labor and birth area. While caring for the client, the nurse notes a sudden onset of fetal bradycardia. Inspection of the abdomen reveals an irregular wall contour. The client also complains of acute abdominal pain that is continuous. Which of the following would the nurse suspect?

A) Amniotic fluid embolism
B) Shoulder dystocia
C) Uterine rupture
D) Umbilical cord prolapse

ANS;C
Uterine rupture is associated with crack cocaine use, and generally the first and most reliable sign is sudden fetal distress accompanied by acute abdominal pain, vaginal bleeding, hematuria, irregular wall contour, and loss of station in the fetal presenting part. Amniotic fluid embolism often is manifested with a sudden onset of respiratory distress. Shoulder dystocia is noted when continued fetal descent is obstructed after the fetal head is delivered. Umbilical cord prolapse is noted as the protrusion of the cord alongside or ahead of the presenting part of the fetus.

27.  When assessing several women for possible VBAC, which woman would the nurse identify as being the best candidate?

A) One who has undergone a previous myomectomy
B) One who had a previous cesarean birth via a low transverse incision
C) One who has a history of a contracted pelvis
D) One who has a vertical incision from a previous cesarean birth

B
VBAC is an appropriate choice for women who have had a previous cesarean birth with a lower abdominal transverse incision. It is contraindicated in women who have a prior classic uterine incision (vertical), prior transfundal surgery, such as myomectomy, or a contracted pelvis.

28. A woman is to undergo an amnioinfusion. Which statement would be most appropriate to include when teaching the woman about this procedure?

A) "You'll need to stay in bed while you're having this procedure."
B) "We'll give you an analgesic to help reduce the pain."
C) "After the infusion, you'll be scheduled for a cesarean birth."
D) "A suction cup is placed on your baby's head to help bring it out."

ANS;A
An amnioinfusion involves the instillation of a volume of warmed, sterile normal saline or Ringer's lactate into the uterus via an intrauterine pressure catheter. The client must remain in bed during the procedure. The use of analgesia is unrelated to this procedure. A cesarean birth is necessary only if the FHR does not improve after the amnioinfusion. Application of a suction cup to the head of the fetus refers to a vacuum-assisted birth.

29.  Which finding would indicate to the nurse that a woman's cervix is ripe in preparation for labor induction?

A) Posterior position
B) Firm
C) Closed
D) Shortened

ANS;D
A ripe cervix is shortened, centered (anterior), softened, and partially dilated. An unripe cervix is long, closed, posterior, and firm.

30. A woman with preterm labor is receiving magnesium sulfate. Which finding would require the nurse to intervene immediately?

A) Respiratory rate of 16 breaths per minute
B) Diminished deep tendon reflexes
C) Urine output of 45 mL/hour
D) Alert level of consciousness

ANS;B
Diminished deep tendon reflexes suggest magnesium toxicity, which requires immediate intervention. Additional signs of magnesium toxicity include a respiratory rate less than 12 breaths/minute, urine output less than 30 mL/hour, and a decreased level of consciousness.

31. A woman who is 42 weeks pregnant comes to the clinic. Which of the following would be most important?

A) Determining an accurate gestational age
B) Asking her about the occurrence of contractions
C) Checking for spontaneous rupture of membranes
D) Measuring the height of the fundus

ANS; A
Incorrect dates account for the majority of postterm pregnancies; many women have irregular menses and thus cannot identify the date of their last menstrual period accurately. Therefore, accurate gestational dating via ultrasound is essential. Asking about contractions and checking for ruptured membranes, although important assessments, would be done once the gestational age is confirmed. Measuring the height of the fundus would be unreliable because after 36 weeks, the fundal height drops due to lightening and may no longer correlate with gestational weeks.

32.  After teaching a couple about what to expect with their planned cesarean birth, which statement indicates the need for additional teaching?

A) "Holding a pillow against my incision will help me when I cough."
B) "I'm going to have to wait a few days before I can start breast-feeding."
C) "I guess the nurses will be getting me up and out of bed rather quickly."
D) "I'll probably have a tube in my bladder for about 24 hours or so."

ANS;B
Typically, breast-feeding is initiated early as soon as possible after birth to promote bonding. The woman may need to use alternate positioning techniques to reduce incisional discomfort. Splinting with pillows helps to reduce the discomfort associated with coughing. Early ambulation is encouraged to prevent respiratory and cardiovascular problems and promote peristalsis. An indwelling urinary catheter is typically inserted to drain the bladder. It usually remains in place for approximately 24 hours.

33. A client arrives at a birthing center in active labor. Her membranes are still intact, and the nurse-midwife prepares to perform an amniotomy. A nurse who is assisting the nurse-midwife explains to the client that after this procedure, she will most likely have:

1.Less pressure on her cervix
2.Increased efficiency of contractions
3.Decreased number of contractions
4.The need for increased maternal blood pressure monitoring

Answer: 2

Amniotomy can be used to induce labor when the condition of the cervix is favorable (ripe) or to augment labor if the process begins to slow. Rupturing of membranes allows the fetal head to contact the cervix more directly and may increase the efficiency of contractions.

34. A nurse is monitoring a client in labor. The nurse suspects umbilical cord compression if which of the following is noted on the external monitor tracing during a contraction?

1.Early decelerations
2.Variable decelerations
3.Late decelerations
4.Short-term variability

Ans: 2

Variable decelerations occur if the umbilical cord becomes compressed, thus reducing blood flow between the placenta and the fetus. Early decelerations result from pressure on the fetal head during a contraction. Late decelerations are an ominous pattern in labor because it suggests uteroplacental insufficiency during a contraction. Short-term variability refers to the beat-to-beat range in the fetal heart rate.

35.  A primipara client gave birth vaginally to a healthy newborn girl 12 hours ago. The nurse palpates the client's fundus, expecting it to be:

A) Two fingerbreadths above the umbilicus
B) At the level of the umbilicus
C) Two fingerbreadths below the umbilicus
D) Four fingerbreadths below the umbilicus

ANS;B
During the first few days after birth, the uterus typically descends downward from the level of the umbilicus at a rate of 1 cm (1 fingerbreadth) per day so that by 3 days, the fundus lies 2 to 3 fingerbreadths below the umbilicus.

36.  When caring for a mother who has had a cesarean birth, the nurse would expect the client's lochia to be:

A) Greater than after a vaginal delivery
B) About the same as after a vaginal delivery
C) Less than after a vaginal delivery
D) Saturated with clots and mucus

ANS;C
Women who have had cesarean births tend to have less flow because the uterine debris is removed manually along with delivery of the placenta.

37.  The nurse is developing a teaching plan for a client who has decided to bottle feed her newborn. Which of the following would the nurse include in the teaching plan to facilitate suppression of lactation?

A) Encouraging the woman to manually express milk
B) Suggesting that she take frequent warm showers to soothe her breasts
C) Telling her to limit the amount of fluids that she drinks
D) Instructing her to apply ice packs to both breasts every other hour

ANS;D
If the woman is not breast-feeding, relief measures for engorgement include wearing a tight supportive bra 24 hours daily, applying ice to her breasts for approximately 15 to 20 minutes every other hour, and not stimulating her breasts by squeezing or manually expressing milk. Warm showers enhance the let-down reflex and would be appropriate if the woman was breast-feeding. Limiting fluid intake is inappropriate. Fluid intake is important for all postpartum women, regardless of the feeding method chosen.

38.  The nurse is making a follow-up home visit to a woman who is 12 days postpartum. Which of the following would the nurse expect to find when assessing the client's fundus?

A) Cannot be palpated
B) 2 cm below the umbilicus
C) 6 cm below the umbilicus
D) 10 cm below the umbilicus

ANS;A
By the end of 10 days, the fundus usually cannot be palpated because it has descended into the true pelvis.

39.  A client who is breast-feeding her newborn tells the nurse, "I notice that when I feed him, I feel fairly strong contraction-like pain. Labor is over. Why am I having contractions now?" Which response by the nurse would be most appropriate?

A) "Your uterus is still shrinking in size; that's why you're feeling this pain."
B) "Let me check your vaginal discharge just to make sure everything is fine."
C) "Your body is responding to the events of labor, just like after a tough workout."
D) "The baby's sucking releases a hormone that causes the uterus to contract."

ANS;D
The woman is describing afterpains, which are usually stronger during breast-feeding because oxytocin released by the sucking reflex strengthens uterine contractions. Afterpains are associated with uterine involution, but the woman's description strongly correlates with the hormonal events of breast-feeding. All women experience afterpains, but they are more acute in multiparous women secondary to repeated stretching of the uterine muscles.

40  When the nurse is assessing a postpartum client approximately 6 hours after delivery, which finding would warrant further investigation?

A) Deep red, fleshy-smelling lochia
B) Voiding of 350 cc
C) Heart rate of 120 beats/minute
D) Profuse sweating

ANS;C
Tachycardia in the postpartum woman warrants further investigation. It may indicate hypovolemia, dehydration, or hemorrhage. Deep red, fleshy-smelling lochia is a normal finding 6 hours postpartum. Voiding in small amounts such as less than 150 cc would indicate a problem, but 350 cc would be appropriate. Profuse sweating also is normal during the postpartum period.

41  A postpartum client who is bottle feeding her newborn asks, "When should my period will return?" Which response by the nurse would be most appropriate?

A) "It's difficult to say, but it will probably return in about 2 to 3 weeks."
B) "It varies, but you can estimate it returning in about 7 to 9 weeks."
C) "You won't have to worry about it returning for at least 3 months."
D) "You don't have to worry about that now. It'll be quite a while."

ANS;B
For the nonlactating woman, menstruation resumes 7 to 9 weeks after giving birth, with the first cycle being anovulatory. For the lactating woman, menses can return anytime from 2 to 18 months after childbirth.

42. The nurse interprets which of the following as evidence that a client is in the taking-in phase?

A) Client states, "He has my eyes and nose."
B) Client shows interest in caring for the newborn.
C) Client performs self-care independently.
D) Client confidently cares for the newborn.

ANS;A
During the taking-in phase, new mothers when interacting with their newborns spend time claiming the newborn and touching him or her, commonly identifying specific features in the newborn such as "he has my nose" or "his fingers are long like his father's." Independence in self-care and interest in caring for the newborn are typical of the taking-hold phase. Confidence in caring for the newborn is demonstrated during the letting-go phase.

43. Which of the following would the nurse interpret as being least indicative of paternal engrossment?

A) Demonstrating pleasure when touching or holding the newborn
B) Identifying imperfections in the newborn's appearance
C) Being able to distinguish his newborn from others in the nursery
D) Showing feelings of pride with the birth of the newborn

ANS;B
Identifying imperfections would not be associated with engrossment. Engrossment is characterized by seven behaviors: visual awareness of the newborn, tactile awareness of the newborn, perception of the newborn as perfect, strong attraction to the newborn, awareness of distinct features of the newborn, extreme elation, and increased sense of self-esteem.

44. A postpartum client comes to the clinic for her 6-week postpartum check-up. When assessing the client's cervix, the nurse would expect the external cervical os to appear:

A) Shapeless
B) Circular
C) Triangular
D) Slit-like

ANS;D
The external cervical os is no longer shaped like a circle but instead appears as a jagged slit-like opening, often described as a "fish mouth."

45. The nurse teaches a postpartum client how to do Kegel exercises for which reason?

A) Reduce lochia
B) Promote uterine involution
C) Improve pelvic floor tone
D) Alleviate perineal pain

ANS;C
Kegel exercises help to improve pelvic floor tone, strengthen perineal muscles, and promote healing, ultimately helping to prevent urinary incontinence later in life. Kegel exercises have no effect on lochia, involution, or pain.

46. A father of a newborn tells the nurse, "I may not know everything about being a dad, but I'm going to do the best I can for my son." The nurse interprets this as indicating the father is in which stage of adaptation?

A) Expectations
B) Transition to mastery
C) Reality
D) Taking-in

ANS;B
The father's statement reflects transition to mastery because he is making a conscious decision to take control and be at the center of the newborn's life regardless of his preparedness. The expectations stage involves preconceptions about how life will be with a newborn. Reality occurs when fathers realize their expectations are not realistic. Taking-in is a phase of maternal adaptation.

47.  A postpartum client is experiencing subinvolution. When reviewing the woman's labor and birth history, which of the following would the nurse identify as being least significant to this condition?

A) Early ambulation
B) Prolonged labor
C) Large fetus
D) Use of anesthetics

ANS;A
Factors that inhibit involution include prolonged labor and difficult birth, incomplete expulsion of amniotic membranes and placenta, uterine infection, overdistention of uterine muscles (such as by multiple gestation, hydramnios, or large singleton fetus), full bladder (which displaces the uterus and interferes with contractions), anesthesia (which relaxes uterine muscles), and close childbirth spacing. Factors that facilitate uterine involution include complete expulsion of amniotic membranes and placenta at birth, complication-free labor and birth process, breast-feeding, and early ambulation.

48.  Which of the following would lead the nurse to suspect that a postpartum woman is having a problem?

A) Elevated white blood cell count
B) Acute decrease in hematocrit
C) Increased levels of clotting factors
D) Pulse rate of 60 beats/minute

ANS;B
Despite a decrease in blood volume after birth, hematocrit levels remain relatively stable and may even increase. An acute decrease is not an expected finding. 
The WBC count remains elevated for the first 4 to 6 days and clotting factors remain elevated for 2 to 3 weeks. Bradycardia (50 to 70 beats per minute) for the first two weeks reflects the decrease in cardiac output.

49. A woman who gave birth 24 hours ago tells the nurse, "I've been urinating so much over the past several hours." Which response by the nurse would be most appropriate?

A) "You must have an infection, so let me get a urine specimen."
B) "Your body is undergoing many changes that cause your bladder to fill quickly."
C) "Your uterus is not contracting as quickly as it should."
D) "The anesthesia that you received is wearing off and your bladder is working again."

ANS;B
Postpartum diuresis occurs as a result of several mechanisms: the large amounts of IV fluids given during labor, a decreasing antidiuretic effect of oxytocin as its level declines, the buildup and retention of extra fluids during pregnancy, and a decreasing production of aldosterone—the hormone that decreases sodium retention and increases urine production. All these factors contribute to rapid filling of the bladder within 12 hours of birth. Diuresis begins within 12 hours after childbirth and continues throughout the first week postpartum.

50.  A woman who is 12 hours postpartum had a pulse rate around 80 beats per minute during pregnancy. Now, the nurse finds a pulse of 60 beats per minute. Which of these actions should the nurse take?

A) Document the finding, as it is a normal finding at this time.
B) Contact the physician, as it indicates early DIC.
C) Contact the physician, as it is a first sign of postpartum eclampsia.
D) Obtain an order for a CBC, as it suggests postpartum anemia.

ANS;A
As a result of the changes in blood volume and cardiac output after delivery, relative bradycardia may be noted. The woman's pulse rate may range from 50 to 70 beats per minute.