Nurs 304 Exam II - Fall 2018-19 PDF

# NURS 304 NURSING CARE OF THE EXPECTANT FAMILY ## EXAM II - FALL SEMESTER 2018-19 (Section 2) #### **INSTRUCTIONS:** For each of the following multiple choice questions, select the best answer and highlight it on the answer sheet. 1. You care for a woman in a prenatal clinic who thinks she mig...

# NURS 304 NURSING CARE OF THE EXPECTANT FAMILY ## EXAM II - FALL SEMESTER 2018-19 (Section 2) #### **INSTRUCTIONS:** For each of the following multiple choice questions, select the best answer and highlight it on the answer sheet. 1. You care for a woman in a prenatal clinic who thinks she might be pregnant. Which of the following assessments is a probable sign of pregnancy? * A. Chadwick's sign. * B. Nausea and vomiting. * C. A positive pregnancy test. * D. Amenorrhea. 2. Which of the following is a positive sign of pregnancy? * A. Positive pregnancy test. * B. Fetal movement felt by examiner. * C. Hegar's sign. * D. Uterine contractions. 3. If a woman is 3 months pregnant, which of the following findings related to breast changes would you expect to assess? * A. Slack, soft breast tissue. * B. Deeply fissured nipples. * C. Enlarged lymph nodes. * D. Darkened breast areolas. 4. Early in pregnancy, frequent urination results mainly from which of the following? * A. Pressure on the bladder from the uterus. * B. Increased concentration of urine. * C. Additional of fetal urine to maternal urine. * D. Decreased glomerular selectivity. 5. At her 16-week checkup, a client's blood pressure is slightly decreased from her prepregnancy level. You evaluate this change based on which of the following statements concerning blood pressure during pregnancy? * A. Normally, blood pressure increases steadily throughout pregnancy. * B. Blood pressure remains stable until decreasing the day of the delivery. * C. A decrease in the second trimester may occur due to placental growth. * D. Blood pressure progressively decreases throughout the entire pregnancy. 6. A pregnant woman you care for tells you she often has allergic responses to food. She is concerned that she may be allergic to her fetus or her body to drugs during pregnancy. You would base your reply to her on which of the following statements? * A. Immunologic activity is decreased during pregnancy. * B. The level of aldosterone during pregnancy reduces production of IgG antibodies. * C. The decreased corticosteroid activity during pregnancy ensures this will not happen. * D. The kidneys release a hormone during pregnancy to prevent this from happening. 7. As a pregnant woman lies on the examining table, she grows very short of breath and dizzy. This phenomenon probably happens because: * A. Her cerebral arteries are growing congested with blood. * B. The uterus requires more blood in a supine position. * C. Blood is trapped in the vena cava in a supine position. * D. Sympathetic nerve responses cause dyspnea when a woman lies supine. 8. A woman during her first trimester questions how much longer she will have urinary frequency. Based upon your knowledge, you advise her: * A. Urinary frequency is a common complaint during the first trimester and again later in the third trimester. * B. Urinary frequency is a common concern reported during the entire pregnancy. * C. Urinary frequency will subside after the first trimester. * D. Urinary frequency is a concern until the last trimester of pregnancy. 9. A woman in her 24th week of pregnancy states that she has never experienced allergies but is now experiencing nasal stuffiness. She asks what medications she can take for this ailment. The best response to this inquiry would be: * A. "You may take Tylenol." * B. "The nasal stuffiness may not be an allergy but due to increased estrogen levels." * C. "A cool mist humidifier with medication gel in it will be best." * D. "Allergy medications will be damaging to the baby and must be avoided." 10. Which of the following tasks is the most important task of the first trimester of pregnancy? * A. Accepting the pregnancy. * B. Accepting a coming child. * C. Making plans for the baby. * D. Sharing time with a significant other. 11. To prepare his 4-year-old son for a new baby, which of the following statements would you suggest a father use? * A. "The new baby will need your bed so we're buying you a new one." * C. "A new baby will make our family bigger but not change our love for you." * "It will be fun to have a sister or brother to give your old toys to." * “Mother will need to spend a lot of time with the new baby.” 12. A husband who experiences nausea and vomiting during pregnancy is most likely experiencing: * A. Shock * B. Acceptance. * C. Couvade syndrome * D. Role playing. 13. A woman tells you she knows she is pregnant because her breasts are sensitive. This is an example of a: * A. Presumptive sign. * B. Probably sign. * C. Positive sign. * D. Absolute sign. 14. Reproductive life planning refers to counseling of which of the following? * A. Adult women of legal age, not minors. * B. Couples concerning methods of contraception prior to pregnancy, not postpartum. * C. Couples with concerns related to conceiving, genetic abnormalities and child spacing needs. * D. Family members participating in group therapy. 15. A woman calls your clinic to report that she has had some cramping since the insertion of her IUD and that her present menstrual flow is heavy. You would advise her to: * A. Come to the clinic as soon as possible. * B. Consider this normal, as her IUD has been newly inserted. * C. Take her blood pressure daily for the rest of the month * D. Change her method of reproductive life planning. 16. For natural reproductive life planning, cervical mucus during ovulation can be identified because it: * A. Has a high viscosity and alkalinity. * B. Has properties of acidity and ferning. * C. Is thin and watery. * D. Is filled with increased leukocytes. 17. Tubal ligation is a common sterilization procedure. Which of the following concepts is important for a woman scheduled for this procedure to understand? * A. She will have lessened dysmenorrhea following the procedure. * B. She must think of the procedure as irreversible. * C. The procedure will reduce her menstrual flow in amount. * D. She should schedule it to be done just before a menstrual flow. 18. A woman visits your family planning clinic to request a prescription for birth control pills. Which of the following factors below would indicate that an ovulation suppressant should not be the best contraceptive method for her? * A. She is 30 years of age. * B. She has irregular menstrual cycles. * C. She has a history of allergy to foreign protein. * D. She has a family history of thromboembolism 19. Investigations by the woman and her physician to determine the time of ovulation from coitus for several days before and after the calculated date of ovulation is the basis of which method of contraception? * A. Basal body temperature * B. Rhythm Method * C. Records of menstrual cycles for at least 3 months before initiating the method * D. Fairly regular menstrual cycles in order to be useful. * E. All of the above 20. A woman tells you after taking an ovulation suppressant for 3 months she has forgotten to take her pill two mornings in a row. What would be the best advice to give her regarding this? * A. Start a new cycle of twenty-one pills immediately, plus additional estrogen for the next 3 days. * B. Take three pills immediately and avoid coitus for the remainder of the month. * C. Take two pills now and use a second method of contraception for the remainder of the month. * D. Take two pills a day for the rest of the month. 21. When do condoms need to be applied in order to be effective? * A. As soon as the penis becomes erect. * B. At least 1 hour prior to coitus. * C. Before penile-vulvar contact. * D. Immediately after ejaculation. 22. Vasectomy * A. Headache and Weight gain as side effects 23. Abstinence * B. A circular rubber disk that fits over the cervix to form a barrier against the entrance of spermatozoa. 24. Condom * C. Excision and blocking of the vas deferens to prevent passage of the spermatozoa 25. Diaphragm * D. Contraceptive method with a 0% failure rate. 26. The pill * E. Prevents pregnancy by collecting the spermatozoa instead of allowing deposit into the vagina. 27. Which of the following best defines the term "infertility"? * A. Inability of a couple to carry the fetus to term as a result of failure to conceive or of failure to achieve a pregnancy due to a factor that prevents conception. * B. Failure to achieve pregnancy following 12 months of unprotected intercourse. * C. Inability to achieve pregnancy after a previous viable pregnancy. * D. Inability to achieve pregnancy after a known fertility status. 28. Why is fertility testing initiated with sperm analysis of the male partner? * A. Asking the male partner to undergo diagnostic procedures is the best way to assess his interest in treatment of infertility. * B. The man is found to be fertile in over 75 percent of couples with infertility problems. * C. Male fertility testing is time-consuming and therefore should be initiated early. * D. Sperm analysis is one of the easiest tests to complete. 29. A "normal" semen analysis may be defined as one that shows at least 20 million sperm per milliliter, semen volume of 2 to 6 ml. Sperm motility of greater than 50% (within 2 hrs., of collection) and at least: * A. 30% normal sperm forms. * B. 40% normal sperm forms. * C. 50% normal sperms forms. * D. 80% normal sperms forms. 30. Which of the following conditions will result in a woman being infertile? * A. Absence of an ovary. * B. A dilated hymenal ring. * C. Occluded fallopian tubes. * D. An obstructed Bartholin's gland duct. 31. The methods of fertility awareness based on the woman's menstrual cycle are all of the following except: * A. Basal body temperature. * B. Calendar rhythm. * C. IUD insertion. * D. Ovulation. 32. Embryo Cryopreservation is defined as: * A. Frozen embryo transfer. * B. Frozen excess embryo conservation. * C. Total embryo transfer. * D. IVF 33. What measures may be appropriate for a man to take to increase his sperm count? * A. Increase frequency of coitus. * B. Wear clothing that does not restrict or overheat the scrotum. * C. Increase alcoholic intake. * D. Increase sport activity. #### **MATCHING:** Match the items in Column I with the appropriate statements in Column II and place your answer on the answer sheet. (1 pt/q) | **COLUMN I** | **COLUMN II** | |---|---| | 34. Transvaginal ultrasound | A. Works by increasing the secretion of LH & FHS, which stimulates follicle growth. | | 35. IVF | B. Test Tube babies | | 36. Clomiphene Citrate | C. Inspection of the uterine cavity by endoscope with access through the cervix It allows for intrauterine pathology e.g. fibroids& polyps. | | 37. Cloning | D. Production of two or more beings that are complete genetic copies of one another. | | 38. Hysteroscopy | E. The method of choice for follicular monitoring of women undergoing induction cycles. | 39. Station plus three means that the: * A. Presenting part is three centimeters above the ischial spines level * B. Biparietal diameter is at the level of the ischial spines. * C. Presenting part is three centimeters below the ischial spines * D. Biparietal diameter is three centimeters above the ischial spines. 40. The meaning of LOP when describing the position of the fetus in utero is: * A. The posterior of the occiput is turned to the left side of the fetus. * B. The posterior of the occiput is to the right of the maternal pelvis. * C. The occiput is to the left of the maternal pelvis and posterior of the mother * D. The occiput is presenting to the left 41. The term effacement during labor means: * A. Stretching and thinning of the uterine isthmus * B. Enlargement of the external cervical os and lengthening of the cervical canal * C. Shortening and thickening of the uterine isthmus * D. Shortening and thinning of the internal and external cervical os 42. The fetus of a woman you care for during labor is in a vertex presentation and at a zero station. You would interpret this to mean that: * A. The fetal head is crowning * B. The fetal head is at the symphysis pubis * C. The fetal head is dipping * D. The fetal head is engaged 43. Fatima is 22 years old, G1 P0, 40 weeks, and in labor. She has a history of sexual abuse and does not want anyone with her in labor. You anticipate that which of the following might be a unique influencing factor in her labor progress? * A. Her psyche * B. The powers of labor * C. The weeks of gestation * D. Her gravida and para status 44. Fetal lie refers to the relationship of the long axis of the fetus to: * A. A transverse lie. * B. A breech presentation. * C. The long axis of the pregnant woman. * D. A vertex presentation. 45. To assess the frequency of a woman's labor contractions, you would time: * A. The time interval between the acme (peak) of contractions * B. The end of one contraction to the beginning of the next * C. The beginning of one contraction to the beginning of the next * D. How many contractions occur in a 5 minute time span 46. Lightening which the nurse explains as a typical sign of approaching labor is BEST defined as: * A. Shortening of the cervix that occurs prior to the onset of true labor * B. Descent of the baby into the pelvic inlet * C. Intermittent painless contractions * D. Loss of weight that occurs just prior to the onset of labor 47. Position of the fetus refers to: * A. The relationship of the fetal parts to each other. * B. That portion of the fetus which engages at the superior strait. * C. The relationship of the long axis of the fetus to the mother * D. The relationship of the presenting part to the right or left side of the mother 48. Presentation of the fetus refers to: * A. The relationship of the fetal parts to one another. * B. That portion of the fetus which is felt through the cervix on vaginal examination * C. The relationship of the long axis of the fetus to the long axis of the mother. * D. The relationship of the presenting part to the right or left side of the mother 49. On what day during pregnancy does the embryo implant on the uterine surface? * A. The 14th day of a "typical" menstrual cycle. * B. Eight days after ovulation. * C. Ten days after the start of the menstrual flow. * D. Four days after ovulation. 50. In false labor: * A. Contractions are accompanied by effacement and dilatation of the cervix. * B. Contractions become progressively stronger * C. Show is usually present. * D. Contractions are mild and frequently felt as a tightening in the fundus 51. In the early, or latent, phase of the first stage of labor: * A. The cervix dilates from 0 to 4 cm. * B. The cervix dilates from 4 to 7cm. * C. Most patients request an epidural * D. This is the most difficult part of the first stage of labor 52. Primary powers is a term applied to: * A. Oxytocin drugs. * B. Abdominal muscles. * C. Uterine contractions. * D. Pelvic measures 53. Fetal implications of prolapsed cord include: * A. Intracranial hemorrhage * B. Fetal distress and fetal hypoxia * C. Bleeding * D. Shock 54. The second stage of labor is said to start: * A. When the nurse directs the patient to push. * B. When caput is visible. * C. When cervical dilatation is complete. * D. With the transitional phase. 55. A woman who has very strong contractions every 2 minutes, a feeling of a loss of control and rectal pressure is most probably in which part of labor? * A. Second stage * B. Transition * C. Latent phase * D. Active phase 56. When the feet and the legs are flexed on thighs, and thighs are flexed on the abdomen so that the buttocks and the feet present, the presentation is called: * A. Transverse. * B. Complete breech. * C. Footling. * D. Frank breech. 57. Merry is a 4-day-old, 32-week, low-birth-weight infant you care for in a neonatal intensive care unit. She develops respiratory distress syndrome. This disorder occurs because: * A. Fluid accumulates in immature bronchi. * B. Antidiuretic hormone cannot retain fluid. * C. There is lack of surfactant in her alveoli. * D. The diaphragm is too weak to expel air. 58. Merry develops an elevated indirect bilirubin level so she is placed under bilirubin lights. A precaution you would want to take with this therapy is to: * A. Be certain Merry's intake is adequate. * B. Keep her wrapped to prevent sunburn. * C. Assess her for symptoms of headache. * D. Cover her eyes and genitalia 59. Ali is a 1-day-old baby born normal delivery. Which finding in Ali's history puts him at higher risk for an increased bilirubin level than other infants? * A. He has bruising on his buttocks from birth. * B. His mother had a low Hgb during pregnancy. * C. He was born within 1 year of a sibling. * D. His father works an outside occupation. 60. Hypothermia or "cold stress" is a potential problem because newborns: * A. Tend to become hypoglycemic. * B. Have a high surface area to body mass ratio. * C. Often have tachypnea * D. Have acrocyanosis 61. Hyperbilirubenemia is a special concern in the preterm infant because of their? * A. Immature liver function. * B. Poor vascular system. * C. Decreased respiratory function. * D. Immature endocrine system. 62. A newborn infant who exhibits intrauterine growth was slowed is referred to as: * A. Low birth weight. * B. Small-for-gestational age. * C. Preterm. * D. Post mature. 63. Which of the following statements best describe the clinical characteristics of the premature infant? * A. The head is proportionally small in relation to the body. * B. Thermostability is well established. * C. The sucking reflex is absent or weak. * D. Extremities remain in an attitude of flexion. 64. A large for gestational age neonate is: * A. One whose birth weight is at or above the 90th percentile in the intrauterine growth chart. * B. A thirty-nine weeks of gestation neonate weighing 4000 g and above. * C. A thirty-four weeks of gestation neonate weighing 3000 g and above. * D. All of the above. 65. Post mature infants may exhibit which of the following characteristics? * A. Heavy vernix, little lanugo. * B. No scalp hair. * C. Increased subcutaneous fat, absent creases on feet. * D. Alert. 66. An infant of a diabetic mother is more prone for hypoglycemia which is most likely due to: * A. A reaction to the stresses of labor and the period of increased activity following delivery. * B. An interruption in the source of glucose and a continued high production of insulin by the baby. * C. An increase in the production of urine that occurs when the kidneys are ridding the body of excess glucose. * D. A physical response of the body normally occurs during transition for intra-uterine to extra-uterine life. 67. A newborn infant you were caring for was discharged 24 hours ago. The infant's mother has called alarmed that her infant's skin color is becoming very yellow, and is difficult to awaken for feeding. Which of the following is appropriate to tell the mother? * A. The baby needs an immediate blood transfusion * B. The yellowish skin is a birthmark * C. Keep the baby out of the sun and away from UV light * D. The baby's bilirubin level should be checked