Solution Manual for Introduction to Maternity and Pediatric Nursing, 6th Edition

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Study Guide Answer KeyChapter 11Study Guide Answer Key1chapter1Learning Activities1.c, h, d, i, j, b, g, f, e, a2.a.Obstetriciansb.Family practice physiciansc.Certified nurse-midwives3.f, d, i, e, g, b, j, a, h, c4.a.American College of Nurse-Midwivesb.Association of Women’s Health, Obstetric,and Neonatal Nursesc.Division of Maternal Nursing within theAmerican Nurses Association5.a.Provides funds for maternity careb.Increases access to health care for under-privileged womenc.Designed to improve education of pre-school childrend.Provides contraceptive informatione.Provides supplemental food and educationfor the poorf.Enables employees to take 12 weeks ofunpaid leave but retain benefits and paystatus for newborns or ill family membersg.Establishes minimum working ages andled to national minimum standards forchild labor and enforcement of thesestandardsh.Provides support and public education ofhandicapped childreni.Provides a national clearinghouse for miss-ing children6.Hospital stays for births in the 1950s were usu-ally one week. Today, an uncomplicated caserequires only 2 days. Follow-up of the wellnewborn occurs within 2 weeks and a nursemay make visits to the home if a dischargedmother or infant is at high risk. Implicationsfor nurses might include the need for goodorganization of care based on research ratherthan tradition, identification of risk factors thatmay lengthen the stay for the mother and/orinfant, and teaching early after birth to helpparents best care for themselves and theirinfant. Teaching often involves other familymembers such as grandparents or siblings aswell. (Student should describe their thoughtshow these changes are likely to affect nurses.)7.Natural childbirth movement made parentsaware of their need to become educated andinvolved. Preparation for childbirth such asLamaze classes and La Leche League becameaccepted. Parents questioned routine useof anesthesia and restrictive policies suchas exclusion of fathers from birth. Today, afather’s attendance at birth, open visiting forother children and family, and extended con-tact with the newborn are encouraged.8.Technological advances and emergence ofpediatric specialties enable survival of manyinfants and children who would not have sur-vived in the past. Specialized care for prema-ture infants, specialized pediatric cardiologycare, and pediatric specialties such as pediatricsurgery and pediatric psychiatry are nowavailable. Laboratories are equipped to testpediatric specimens to identify biochemicalor chromosomal abnormalities. Identificationof genetic risk and related counseling is moreimportant.9.The number of chronically ill and disabledchildren is growing. Some are dependenton specialized equipment such as monitorsor ventilators. Parents must be educated inperforming technical skills once reserved forthe hospital, such as tracheotomy or centralvenous line care. The need for respite care forparents grows as the number of these childrenincreases.10.See Box 1-4 on p. 11 in the textbook.11.a.Assessmentb.Diagnosisc.Outcomes identificationd.Planninge.Implementationf.Evaluation12.NIC and NOC consist of standardized lan-guage for nursing interventions and outcomes.Standardization helps improve quality of care,reduce costs, enable research, and promote

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2Study Guide Answer KeyChapter 1reimbursement for nursing services. Codingthe interventions and outcomes improves qual-ity of research and direct reimbursement forservices.13.Critical thinking is the use of basic standardsof care combined with data obtained by assess-ment of the specific patient. It is purposeful,goal-directed thinking based on scientific evi-dence rather than assumptions or memoriza-tion. Critical thinking involves reflection andintegration of information to arrive at a conclu-sion or judgment.14.Healthy People 2020updates the 2010 objec-tives is a statement of national health promo-tion and disease prevention objectives. It is avision statement to achieve a nation of morehealthy people. The report identifies objectivesdesigned to use health care knowledge andtechnology developed in the twentieth centuryto improve health and quality of life.Review Questions1.Answer: 2Rationale: Because the nurse must handleequipment, dressings, and patient care activi-ties, both with and without gloves, consistenthand hygiene reduces the number of residentbacteria that can be transmitted to others whomay not be resistant to infection.2.Answer: 3Rationale: Most nurses can identify major cul-tural groups that reside in the area where theywork. Patients and their families appreciate theextra attention to incorporate cultural needsinto other nursing care.3.Answer: 3Rationale: Because statistics examine trends inlarge groups of people, they can help evaluatethe quality of care, including prenatal care.4.Answer: 4Rationale: The CNM is an advanced-practicenurse with special training in providing careto the childbearing woman. The CNM worksunder protocols that specify under what condi-tions that medical care must be sought for thewoman.5.Answer: 3Rationale: The nursing process helps nursesindividualize care for all patients, both welland ill.6.Answer: 2Rationale: Clinical pathways provide “targets”for expected progress along a time line andare often collaborative, using skills of multipleprofessionals. When the patient “falls off” theexpected course, a variance occurs.Applying KnowledgeAnswers will vary.

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Study Guide Answer KeyChapter 21Study Guide Answer Key1chapter2Learning Activities1.Puberty2.a.10, 16b.penis, testes3.a.breast developmentb.2–2.54.a.Boys: taller; more muscular; pubic, axillary,chest, and facial hair; deeper voiceb.Girls: broader hips; breast development;pubic and axillary hair5.c, f, h, b, g, e, a, d6.See Figure 2-1 on p. 21.7.a.seminiferous tubulesb.Leydig’s cells8.a.Increases muscle mass and strengthb.Promotes growth of long bonesc.Increases BMRd.Enhances red blood cell productione.Enlarges vocal cordsf.Encourages male distribution of body hair9.See Figure 2-2 on p. 23.10.gl, q, rpdc, hikjfmoab, en11.See Figures 2-3 and 2-4 on pp. 23-24.12.See Figure 2-6 on p. 26.13.See Figure 2-7 on p. 27.14.b, d, c, a15.b, a, e, c, d16.a.FSH (follicle-stimulating hormone) is pro-duced in the anterior pituitary gland andstimulates the maturation of an ovarianfollicle.b.LH (luteinizing hormone) is produced inthe anterior pituitary gland and stimulatesfinal maturation of the follicle and releaseof its ovum.c and d. Estrogen and progesterone are pro-duced in the corpus luteum and causebuildup of the endometrium to nourish afertilized ovum if it arrives. If no fertilizedovum arrives, the corpus luteum degener-ates and levels of estrogen and progester-one fall, causing the next menstrual cycle.Review Questions1.Answer: 3Rationale: Although the female growth spurtbegins earlier than the male’s, it also endssooner, limiting the girl’s mature height. Tes-tosterone is the primary male hormone. Girlsbegin puberty earlier, but they end it soonerthan boys. Onset of puberty initiates thegrowth spurt rather than stopping it. Estrogenand progesterone, which increase as the girlmatures, eventually stop her growth in height.2.Answer: 2Rationale: Although most sperm are releasedin semen with ejaculation, some semen is oftensecreted before ejaculation and can fertilize awaiting ovum. Although ejaculation can occurat any time, the penis becomes flaccid afterejaculation, preventing penetration. Spermare added to the seminal fluid by contractionsof the vas deferens before ejaculation. Sementypically enters the urethra shortly beforeejaculation.3.Answer: 3Rationale: The endometrium is the inner muco-sal layer that responds to cyclic hormonalchanges during the menstrual cycle and alsoreceives the fertilized ovum when it implants.The parametrium is the outer serosal layer andthe myometrium is the middle muscular layer.

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2Study Guide Answer KeyChapter 24.Answer: 3Rationale: The linea terminalis is at the levelof the sacroiliac joint to the front iliopubicprominence (front of the pelvis). The obstetricconjugate is a diameter from the upper part ofthe symphysis pubis to the sacral promontoryand is estimated from the diagonal conjugatebecause it cannot be directly measured. Thesediameters are measured at the inlet, but are notthe dividing line of the true from the false pel-vis. The bi-ischial is a diameter of the outlet, atthe lower end of the true pelvis.5.Answer: 3Rationale: The anteroposterior diameter ofthe pelvic outlet can enlarge slightly duringchildbirth because the coccyx is moveable.The obstetric conjugate and the right and leftoblique diameters are mostly surroundedby non-movable bone and are therefore lessflexible.6.Answer: 1Rationale: Adequate sperm productionrequires a temperature slightly lower than therest of the body. The scrotum is a skin pouchthat allows the testes to be suspended slightlyaway from the body. The epididymis and vasdeferens carry sperm from the testes to the ure-thra. The testes manufacture sperm and secretetestosterone. Contraction of muscles of theprostate gland and seminal vesicles contributeto the flow and motility of sperm and rhythmiccontractions of penile erectile tissues aid inejaculation7.Answer: 3Rationale: Alveoli contain milk-secreting cells.Lactiferous ducts carry milk from the alveolito the nipples. Montgomery’s glands secrete asubstance to lubricate and protect the nippleduring breastfeeding. The nipple is at the cen-ter of each breast and is where milk is ejectedthrough its pores.8.Answer: 2Rationale: Blood is trapped within the penis aspenile arteries relax. It becomes engorged withblood and an erection occurs. Muscles attachedto the penis do not contribute to erection. Tes-tosterone levels play a part in the male sex act,but do not fall in response to stimulation. Theprostate gland primarily functions to contrib-ute its secretion to the seminal fluid.9.Answer: 4Rationale: Breast size is unrelated to the abilityto produce milk because fatty tissues cause sizedifferences. The number of alveoli is similarin women, regardless of whether their breastsare small or large. Hormones of pregnancy docause growth in breast tissue, but this does notmake the difference in a woman’s ability tonurse.10.Answer: 2Rationale: The middle of the three muscle lay-ers of the uterus has a figure-8 design. Thecircular muscles of the inner myometriumform sphincters where the fallopian tubesenter the uterus and at the internal openingof the cervix. Longitudinal muscles form theouter muscular layer and expel the infant dur-ing labor. Oblique muscles do not exist in themyometrium.11.Answer: 4Rationale: Much of the endometrium is shedduring menstruation, and it is thinnest at theend of the menstrual period. The endometriumis thickest at ovulation, to prepare for a fertil-ized ovum. The endometrium remains thick ifa fertilized ovum implants, but begins breakingdown a few days after menstruation if none ispresent.Thinking Critically1.You can reassure your niece that early cyclesare often irregular and the young girl oftendoes not ovulate. Regular cycles are usuallyestablished within 6 months to 2 years of thefirst period.2.The vagina normally cleanses itself and main-tains a slightly acidic pH. Douching washesaway these acidic secretions, and antibioticscan alter its self-cleansing activity. The nursecan explain these factors to the woman todiscourage her from douching except whenordered by her health care practitioner.Applying KnowledgeAnswers will vary.

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Study Guide Answer KeyChapter 31Study Guide Answer Key1chapter3Learning Activities1.b, g, a, c, d, f, e2.a.4b.22, x, y3.a.1b.22, x4.a.24b.55.a.boyb.girlc.The woman does not have a direct geneticinfluence over the gender of the babybecause she only contributes an X chro-mosome. However, the pH (acidity oralkalinity) of her reproductive tract andher estrogen levels may affect the survivalof the X-bearing and Y-bearing spermdifferently and their speed of movementthrough her cervix and fallopian tubes.6.a.fallopian tubeb.upper, posterior7.a, i, d, b, h, f, g, c, e, j8.1,0009.a.Maintains an even temperatureb.prevents adherence of the amniotic sac tothe fetal skinc.allows symmetrical growthd.allows buoyancy and fetal movemente.cushions the fetus and umbilical cord frominjury10.yolk sac, liver, spleen, bone marrow11.a.fetal respirationb.fetal nutritionc.fetal excretiond.endocrine gland12.a.i.Maintains uterine liningii.Reduces uterine contractionsiii.Prepares milk-producing tissue ofbreasts for lactationiv.Stimulates testes of the male to pro-duce testosterone needed for develop-ment of the male reproductive tractb.i.Stimulates uterine growthii.Increases blood flow to uterine vesselsiii.Stimulates ducts of breasts to preparefor lactationiv.Causes changes in skin pigmentationv.Vascular changes in the skin and themucous membranes of the nose andmouthvi.Increases salivationc.Persistence of the corpus luteum so itsecretes estrogen and progesteroned.Decreases maternal insulin sensitivity andutilization of glucose so that more glucoseis available for fetal growth13.See Figure 3-7 on p. 40.14.1215.a.2 hours, 3 monthsb.15 hours, 3 weeksc.at cutting of the cord, 1 week16.e, h, a, f, g, b, c, d

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2Study Guide Answer KeyChapter 317.CharacteristicMonozygoticDizygotica.Same sex or different?Always same sexMay or may not be same sexb.Number of fertilized ova12c.Number of placentas1 (varies according to when thetwinning occurred after con-ception but most often a singleplacenta)2 (although placentas may befused)d.Number of membranesAlso varies according to whenthe twinning occurred, but usu-ally one amnion and two chori-onsTwo amnions and two chorionse.Number of umbilical cords22Review Questions1.Answer: 1Rationale: Genes are the smallest units ofheredity and are located on chromosomes.The zygote is the developing baby for the first2 weeks after conception. These structures,located in the placenta, are where the develop-ing baby exchanges oxygen, carbon dioxide,and waste products. Somatic cells are non-reproductive, or body cells.2.Answer: 2Rationale: The embryonic yolk sac produceserythrocytes until six weeks after conception,at which time the liver performs this function,followed by the bone marrow. The placentauses fetal blood cells to deliver oxygen andnutrition to the fetus and to remove fetal wasteproducts.3.Answer: 2Rationale: The chorion is the outer fetal mem-brane. The amnion is the inner membrane thatextends across the placenta and umbilical cord.Vernix is fetal skin covering.4.Answer: 1Rationale: Umbilical vessels are coiled withinthe umbilical cord. Wharton’s jelly allows themto stretch, yet keeps them from being easilycompressed with fetal movement.5.Answer: 2Rationale: Only a small amount of blood goesinto the fetal lungs to nourish them while theydevelop. Most blood goes from the right atriumto the left atrium through the foramen ovale,thus bypassing the lungs. The ductus venosusallows most blood from the placenta to bypassthe liver. The umbilical vein and umbilicalartery are structures within the umbilical cordthat carry blood from the body to the placentaand return it to the body after oxygenation andremoval of wastes.6.Answer: 2Rationale: Because the umbilical arteries carryblood from the fetus to the placenta, most ofits oxygen and nutrients have been consumedand it carries blood having a high concentra-tion of fetal wastes. The umbilical vein carriesblood with the highest concentration becauseit is returning from the placenta. The ductusvenosus and ductus arteriosus are fetal circula-tory bypasses to shunt most oxygenated bloodaway from the liver (ductus venosus) andlungs (ductus arteriosus).7.Answer: 2Rationale: After fertilization, the zygote mustreproduce cells for growth by ordinary celldivision (mitosis) to continue development.Meiosis is reduction cell division to producegametes, or reproductive cells.8.Answer: 3Rationale: Amniotic fluid has five major pur-poses that are all protective: maintainingtemperature, preventing membranes fromadhering to skin, allowing room for symmetri-cal growth, providing a cushion, and allowingbuoyancy. Amniotic fluid does not performthis function, although drugs given to themother can speed lung development. Amnioticfluid helps maintain the stability of the fetaltemperature, but will be gone after birth. Theplacenta is the pregnancy organ that produceshormones.9.Answer: 2Rationale: Among its functions, the placentaeliminates fetal waste products, substitutingfor the fetal liver, kidneys, and other organsystems. The yolk sac produces red blood cellsin early development.Endodermrefers to one ofthe embryonic cell layers.

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Study Guide Answer KeyChapter 3310.Answer: 2Rationale: One of progesterone’s effects is toreduce uterine contractions that would other-wise tend to occur with stretching by the grow-ing baby. Spontaneous abortion is likely if thereis insufficient progesterone to quiet the uterus.Release of multiple ova would result fromdevelopment and release of two or more ofthese gametes and is not controlled by proges-terone. Human chorionic gonadotropin (hCG)signals the corpus luteum to persist and con-tinue production of estrogen and progesterone.Maternal and fetal blood do not normally mixbefore birth.11.Answer: 4Rationale: Fraternal (dizygotic) twins occurwhen two ova are released and each is fertil-ized by a different sperm.12.Answer: 1Rationale: Identical twins are of the same sexbecause they have the same genetic composi-tion, including sex chromosomes. Although acouple may have more than one set of dizy-gotic twins and each set may have one child ofeach sex, it occurs by chance.Thinking Critically1.For a contraceptive technique such as naturalfamily planning to be successful, one or moretechniques help the woman to predict a likelytime of ovulation. The woman must have anidea of about when her menstrual periods usu-ally begin and understand that ovulation, orher fertile period, occurs about 14 days beforethe onset of the next menstrual period, or in themiddle of a 28-day cycle. Sperm may live up to5 days after ejaculation. The couple wishing touse natural family planning uses these facts toavoid intercourse near the time of ovulation.2.The communication should include facts thatthe father’s sperm has a 50% chance of pro-ducing a boy or a girl. However, female fac-tors such as the pH of her reproductive tractand estrogen levels also influence how longX-bearing or Y-bearing sperm survive and theirspeed of movement toward the ovum.Applying KnowledgeAnswers will vary.

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Study Guide Answer KeyChapter 41Study Guide Answer Key1chapter4Learning Activities1.a, c, g, d, e, b, f2.g, a, c, f, d, b, e3.b, h, c, e, a, l, g, i, d, j, k, f4.a.Human chorionic gonadotropin (hCG)b.urine, blood5.a.i.7.5 cm x 5 cm x 2.5 cm to a size largeenough to house the fetus, placenta,and amniotic fluidii.60 g to 1,000 giii.10 mL to 5,000 mLb.Bluish discoloration, softening; secretion ofmucus to form a mucous plugc.Do not produce ova; corpus luteum per-sists and secretes hormones to maintain thepregnancy until the placenta takes overd.Blood supply increases; mucosa thickens;rugae become prominent; connective tis-sue softens; vaginal pH becomes moreacidic; secretions have higher amounts ofglycogen6.a.Change to prepare for breastfeeding; dark-ening of the areolae; secretions of Mont-gomery’s tuberclesb.Respirations deepen to increase oxygenand carbon dioxide exchange; oxygenintake increases about 15%; upward pres-sure against the diaphragm (about 4 cm, or1.6 inches); flaring of the rib cage, increas-ing chest circumference about 6 cm (2.4inches); nasal stuffiness, nosebleeds, and adeeper voicec.Increase in blood volume; pseudoanemia;increased cardiac output; higher pulse rate;prone to supine hypotension and ortho-static hypotension; palpitationsd.Increased salivary secretions (ptyalism);bleeding of the mouth tissue; increasedappetite and thirst; reduced gastric acidity;slowed stomach emptying and intestinalperistalsis; heartburn (pyrosis); tendencyto gestational diabetes; pruritus due toincreased retention of bile saltse.Increased glomerular filtration rate; ten-dency for glucosuria and proteinuria;water retention; increased ureter diameterand bladder capacity with risk for urinarystasis and urinary tract infectionf.Skin pigment darkens; striae; increasedsweat and sebaceous gland activity; spidernevi; palmar redness; backaches; waddlinggait with softening of the joints7.a.25 to 35 pounds (11.5 to 16 kilograms)b.28 to 40 pounds (12.5 to 18 kilograms)c.11 to 25 pounds (5 to 11.5 kilograms)d.11 to 20 pounds (5 to 9 kilograms)8.3005009.a.i.60 g/day (65 g/day for the lactatingwoman)ii.meat, fish, poultry, dairy products,legumes; breads and cereals; seeds andnuts;b.i.1,200 mg/dayii.dairy products, enriched cereals,legumes, nuts, dried fruits, broccoli,green leafy vegetables, canned salmonand sardines with bones; calcium sup-plements for women who do not drinkmilk or have adequate amounts fromother foods;c.i.30 mg/day for women with adequateiron stores at beginning of pregnancyii.supplements; red and organ meats,molasses, whole grains, iron-fortifiedcereals and breads, dark green leafyvegetables, dried fruitsd.i.400 mcg (0.4 mg)/dayii.liver, kidney and lima beans, peanuts,fresh dark-green leafy vegetables, leanbeef, potatoes, whole-wheat bread,dried beans, supplements10.a.Accept that a teenager’s peer group isvitally important to her, that teens typi-cally eat many fast foods that are oftennutritionally poor, and that she may feel“fat” during pregnancy. Help her identify

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2Study Guide Answer KeyChapter 4better choices at fast-food restaurants soshe can fit in and still have adequate nutri-tion. Give her positive feedback for makinggood choices.b.Take lactase as a tablet or liquid in dairyproducts; fermented dairy products suchas aged cheese, buttermilk, and yogurt;enriched cereals; legumes, nuts, driedfruits, broccoli, green leafy vegetables;canned salmon and sardines with bones11.a.Eat dry toast or crackers before gettingout of bed in the morning; drink fluidsbetween meals instead of with meals; eatsmall, frequent meals; avoid fried, greasy,or spicy foods and foods with strong odorssuch as cabbage and onionsb.Bathe or shower daily, wear loose-fittingcotton panties, do not douche unlessordered, wipe from front to backc.Try to get 8-10 hours of sleep each night;nap during the day; and use measures suchas relaxation techniques, meditation, orchange of sceneryd.Correct posture; wear low-heeled shoes;squat to pick up objects; support arms, feet,and back when sitting; perform exercises(tailor sitting, shoulder circling, pelvicrock)e.Drink at least 8 glasses of water daily(exclude coffee, tea, and carbonated drinksfrom the total), add high-fiber foods todiet, limit cheese if this is constipating,limit sweets, consult health care providerif iron supplement causes constipation forpossible change, exercise (such as a brisk1-mile walk), keep a regular time for bowelmovements, take laxatives or enemas onlyif specifically directedf.Avoid constricting clothing or crossing legsat knees, elevate legs when sitting, applysupport hose/elastic stockings before get-ting up each morning, avoid prolongedstandingg.Anesthetic ointments, witch hazel pads,rectal suppositories, sitz baths, avoidconstipationh.Small frequent meals, avoiding fatty foods,reduce smoking and caffeine, sit upright,deep breathe and take sips of water, useantacids as recommended by health careprovideri.Keep upper torso elevated when resting,avoid exertion, use saline nasal drops orhumidifier for nasal stuffinessj.Extend leg with knee straight and flex foot,stand and apply pressure to extend mus-cles that are in spasm, elevate legs periodi-cally, reduce milk intake or take aluminumhydroxide capsules under direction ofhealth care providerk.Rest with elevation of legs, avoid restric-tive bands around legs, take water aerobicsif not contraindicated12.a.Difficulty believing the reality of preg-nancy; ambivalence; focus on self; labileemotionsb.Greater reality of fetus to woman; totalinvolvement with pregnancy and shelter-ing of her fetus; more stability of moods;“trying on” the role of mother; bodychanges that may be welcomed or not,depending on how she views them; pos-sible alteration in sexual relationshipc.Mood swings; increased sense of vulner-ability and dependence on partner; anxi-ety about approaching labor; beginningdetachment from the fetus as part of herto being a separate person; becomes verytired of being pregnantReview Questions1.Answer: 2Rationale: Quickening, fetal movement felt bythe mother, occurs at 16-20 weeks. Nausea andvomiting are most common in the first trimes-ter but diminish in the second. Burning duringurination and yellowish vaginal discharge aresigns of urinary tract and vaginal infections,respectively.2.Answer: 1Rationale: Concerns about the normality of thebaby are common during the second trimester,as are fantasies. The feelings expressed are nor-mal and do not suggest fetal rejection. A morerealistic (rather than unrealistic) image of thefetus begins in the second trimester.3.Answer: 3Rationale: As the baby becomes more real tothe woman, she often fantasizes about theappearance, sex, and other characteristics. Theother feelings and behaviors are more commonduring the third trimester.4.Answer: 1Rationale: The symptoms describe supinehypotensive syndrome: lying flat during preg-nancy causes the heavy uterus to compress theinferior vena cava. With less blood coming intothe heart, less can be pumped out, leading tofaintness. Deep breathing does not relieve com-pression of the great vessels. Sitting up wouldrelieve compression, but the woman is alreadydizzy and weak. Elevation of her feet and legsdoes not fix the primary problem of vesselcompression.5.Answer: 2

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Study Guide Answer KeyChapter 43Rationale: A pregnant woman should have aminimum of 30 mg/day of iron; 30-60 mg/day supplementation provides added ironfor increased erythrocytes. Milk provides cal-cium but little iron (it also interferes with ironabsorption). Meat and grains provide adequateprotein primarily. 18 mg of iron is inadequatefor pregnancy.6.Answer: 4Rationale: Varicose veins become more promi-nent and uncomfortable when the pressurewithin them increases with blood pooling.Elevating the legs allows blood to return morereadily to the heart rather than pooling in thelegs. Warm packs may be comforting, but donot address the problem of blood pooling.Prolonged sitting, like prolonged standing, canworsen varicosities unless the legs are elevated.7.Answer: 2Rationale: Early and regular prenatal care canidentify risk factors or complications early,when they are more readily treated. Prena-tal care itself does not reduce labor pain.Improved long-term nutrition may begin dur-ing pregnancy, but this is not the overall goalof prenatal care. Prenatal care teaches a womanhow to safely deal with pregnancy discomforts,but this is too narrow for a primary goal.8.Answer: 4Rationale: Meat provides high-quality iron;dark green vegetables also contain iron. Citrusand melons provide primarily vitamin C. Dairyproducts provide primarily calcium. Driedbeans, potatoes, and legumes provide folic acidand the beans provide inexpensive protein.9.Answer: 4Rationale: Adequate folic acid intake fromconception has been shown to reduce the inci-dence of neural tube defects. Iron supportsblood volume expansion. Nausea and vomit-ing are often relieved by dry carbohydrates,but not specifically folic acid. Calcium is notdepleted from maternal teeth.10.Answer: 2Rationale: The ultimate goal should be to gainthe minimum desired weight.11.Answer: 2Rationale: Dietary relief of constipation is best,with addition of fiber and fluids. Laxativesare not routinely recommended. Extra fluids,rather than less, are appropriate to soften thestool. Delaying defecation may worsen consti-pation, especially if it will be a long time beforehaving a quiet environment.12.Answer: 4Rationale: Excess milk intake can alter thecalcium-phosphorous balance, increasing legcramps. Iron supplements do not relate to legcramps. Adequate fluid intake is important,but not to relieve leg cramps. Flexing the footwhile extending the leg provides immediaterelief of leg cramps; it is unnecessary to do this3 times per day.13.Answer: 4Rationale: The woman may have a possiblevaginal infection that should be treated. Secre-tions increase during pregnancy, but are rela-tively clear and nonirritating. Douching shouldbe done only under the direction of a physi-cian, nurse-midwife, or nurse-practitioner,whether pregnant or nonpregnant. Avoidingsexual intercourse may be advised if an infec-tion is diagnosed, but this is not the primaryadvice. Cotton panties contribute to overallcomfort related to normal vaginal discharge,but this choice does not address the main prob-lem of possible infection.14.Answer: 4Rationale: Relaxation of the ureters and renalpelvis leads to urinary stasis, which favorsdevelopment of a urinary tract infection. Ade-quate fluid intake flushes microorganisms outof the urinary tract before they have a chanceto cause infection. Orthostatic hypotensionresults from suddenly rising from a seated orlying position, reducing blood return fromthe lower body to the heart. Lower extremityedema is primarily caused by venous pooling.The cause of nausea and vomiting is not fullyclear, but relates to sudden elevations in hor-mones and reduced gastrointestinal motility.Case Studies1.Teaching Rosa the correct information abouther voiced concerns should include:a.Recommended weight gain has graduallyincreased as presumed risks have been dis-proven. Low weight gain is associated withprematurity.b.Salt intake should be normal to provideadequate sodium to plasma, brain, bone,and muscle. High-sodium foods should belimited.c.Diuretics could reduce body fluid levels tounsafe levels.2.Non-meat sources of protein include soy milk,tofu, tempeh, and beans. Adding milk andeggs, as Lauren does now, further increases herprotein intake. The food pyramid in Chapter15, p. 371, can give further guidance to Laurenon her own diet, but also the vegetarian dietguidelines for her child as young as 2 years.Diet should be discussed on each visit toensure that Lauren is meeting her protein andother needs during pregnancy. Referral to adietitian may be needed.

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4Study Guide Answer KeyChapter 4Thinking Critically1.39 weeks2.October 14thof the previous year.3.a.Late menses is a presumptive symptombecause irregular or absent menses arecommon for early puberty, lower thannormal weight, metabolic or endocrinedysfunction, chronic disease, anorexia,premature menopause, or emotionalproblems.b.Breast tenderness is a common, but onlypresumptive, symptom along with otherbreast changes such as striae or pigmentchanges.c.“Getting fat” might describe overall weightgain or abdominal enlargement, aprobable sign of a growing fetus. Urinaryfrequency is a presumptive sign.d.A nurse cannot know if the previouspregnancy test done by the girl was doneproperly. A repeat test done properly willprovide a probable sign of pregnancy ifpositive.Applying KnowledgeAnswers will vary.

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Study Guide Answer KeyChapter 51Study Guide Answer Key1chapter5Learning Activities1.b, f, e, d, a, c2.Maintain adequate intake and output.Avoid cooking odors.Carbohydrates are best tolerated.Drink liquids between meals.Eat frequently in small quantities.Sit upright after meals to reduce gastric reflux.Keep visual reminders of nausea, such as eme-sis basins, out of sight.Provide emotional support.3.h, b, a, e, f, g, c, d4.a.Report increased bleeding.b.Report temperature of 38° C (100.4° F) orhigher.c.Take iron supplement as recommended tocorrect anemia.d.Resume sexual activity as directed.e.Return to physician for checkup and con-traceptive information and emphasize thatpregnancy can occur before the first men-strual period.5.fallopian tube6.hypovolemic shock secondary to blood loss7.a.Bleeding, possibly accompanied bycramping, that varies from spotting tohemorrhageb.Larger than usualc.Absent fetal heart activityd.Early and severe hyperemesis gravidarume.Elevated, with other signs of pregnancy-related hypertensionf.hCG levels higher than expected forgestationg.“Snowstorm” appearance on ultrasoundh.Increased risk for choriocarcinoma if allabnormal tissue is not removed8.a.Within 2–3 cm of the cervical opening, butnot covering any part of itb.Partially covering the cervical openingc.Totally covering the cervical opening

Solution Manual for Introduction to Maternity and Pediatric Nursing, 6th Edition - Page 14 preview image

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2Study Guide Answer KeyChapter 59.Placenta PreviaAbruptio Placentaea.PainNo unusual painBleeding is accompanied by painb.Characteristicsof bleedingBright red, obviousOften concealed behind placenta, withlittle external bleedingc.Fetal ane-mia and/orhypoxiaFetus may lose some blood as vesselsare disrupted with cervical dilation andeffacement; maternal hypovolemia mayreduce oxygen delivery to the fetusSome blood behind placenta is oftenfetal blood; maternal hypovolemia mayreduce oxygen delivery to the fetusd.Consistency ofthe uterusNo unusual contractions or irritabilityFrequent cramp-like contractionse.BloodcoagulationNo blood clotting abnormalities areexpectedDIC may occur due to large clot behindplacenta with consumption of clottingfactorsf.Risk forpostpartumhemorrhageHigher because lower uterus does nothave as much muscle to compress openvesselsHigher because injured muscle atplacenta site may not contract as wellg.Risk forpostpartuminfectionHigher because placenta is implantednear vagina and organisms can easilyascend and infect itHigher because injured tissue is moresusceptible to microbial invasion10.Signs that suggest a possible seizure include:a.Abdominal and/or epigastric pain (relatedto liver edema, ischemia, and necrosis;precedes seizure; abruptio placentae is alsomore likely and may be cause of pain)b.Persistent vomiting (may occur withhyperemesis gravidarum, but may also becaused by same mechanisms noted above)c.Edema of face and hands (large excess oftissue fluid, although edema is not essen-tial to diagnosis and may occur for manydifferent reasons)d.Severe persistent headache (brain edemaand small hemorrhages; often precedesseizure)e.Blurred vision or dizziness (arterial spasmand edema near retina; often precedes aconvulsion)11.See Box 5-4.First pregnancyObesityFamily history of gestational hypertensionAge under 19 or over 40 yearsMultifetal pregnancyChronic hypertensionChronic renal diseaseDiabetes mellitus12.See Table 5-6.a.Gestational hypertension (developmentof blood pressure ≥ 140/90 mm Hg in apreviously normotensive woman after 20weeks; blood pressure returns to normal by6 weeks postpartum)b.Preeclampsia (includes proteinuria withhypertension)c.Eclampsia (hypertension with ≥ 1 seizure)d.HELLP (includes proteinuria plus abnor-malities of coagulation and liver studies)e.Chronic hypertension (existence of hyper-tension before 20 weeks of gestation orpersistence for 6 weeks after birth, whengestational hypertension is expected to beresolved)f.Preeclampsia with superimposed chronichypertension (chronic hypertension thathas a new occurrence of proteinuria,thrombocytopenia, and increased liverenzymes).13.140/90 mm Hg or higher14.a.Hypertension (vasospasm)b.Edema (fluid leaves blood vessels abnor-mally and enters tissue spaces)c.Proteinuria (reduced blood flow to thekidneys)d.Central nervous system changes such assevere headache or hyperactive reflexes(brain edema and small cerebral hemor-rhages [severe])e.Visual disturbances (arterial spasm andedema around retina [severe])f.Reduced urine output (reduced blood flowto the kidneys)

Solution Manual for Introduction to Maternity and Pediatric Nursing, 6th Edition - Page 15 preview image

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Study Guide Answer KeyChapter 53g.Pulmonary edema (movement of fluidfrom vessels to lung tissue [severe])h.Epigastric pain or nausea (liver edema,ischemia, and necrosis [severe])i.Lab studies (liver enzymes elevatedbecause of decreased circulation, edema,and small hemorrhages [severe]); coagula-tion abnormalities due to low platelet lev-els and accumulation of platelets at sites ofvessel damage [severe]15.Reduces blood flow to mother’s skeletal mus-cles, making more available to her vital organsand for perfusion of the placenta16.a.Reduce central nervous system irritabilityto prevent seizuresb.Urine output <30 mL/hour, depression orloss of deep tendon reflexes, respiratorydepression, serum levels above 8 mg/dL,observation for uterine atony after birthc.Calcium gluconated.4–8 mg/dL17.a.negative; positiveb.Rh immune globulin (RhoGAM orHypRho-D)c.i.28 weeks of gestationii.Within 72 hours of birthiii.After spontaneous abortioniv.Bleeding during pregnancy18.Gestational19.The woman drinks 50 g of an oral glucosesolution and fasting is not needed. In 1 hour, ablood sample is analyzed for glucose level. Theresult should be less than 140 mg/dL. The testis done at 24–28 weeks gestation.20.a.To keep levels as near normal as possibleover the dayb.To test for ketones, which might requirean adjustment in diet or signal onset ofinfection21.Insulin; does not cross the placenta22.Insulin needs may be less during the first tri-mester due to the effect of nausea and vomit-ing on food intake. Insulin needs rise steadilythroughout pregnancy but then fall dramati-cally after birth, often below the pre-pregnancyrequirements.23.Some women with pre-existing diabetes havevascular impairment and exercise wouldreduce circulation to the placenta, resulting inpoor oxygen and nutrient delivery to the fetus.In gestational diabetes, exercise often helpsreduce the need for insulin.24.Higher heart rate, blood volume, and cardiacoutput increase the heart’s workload, possiblyresulting in congestive heart failure.25.Each labor contraction shifts 300 to 500 mL ofblood from the uterus and placenta into thewoman’s general circulation, possibly over-loading her heart. Interstitial fluid returns tothe circulation after birth and also may increasethe risk for congestive heart failure.26.a.increased blood volumeb.iron transfer to the fetusc.cushion against the blood lost naturally atbirth27.While 10.5 g/dL is the minimum acceptablevalue for the woman’s hematocrit during thesecond trimester, she will soon be entering thethird trimester when her hemoglobin shouldbe 11 g/dL or higher. The nurse might initiallydetermine whether the woman is now takingiron supplements; her most common foodsduring an average day; and if she has specificdietary needs such as food allergies, foods thatshe does not eat (specific meats or vegetables),or a therapeutic diet. Additional iron may beindicated as she enters the third trimester.28.Refer to Nutrition Considerations box, p. 104.a.Iron: meats, chicken, fish, liver, legumes,green leafy vegetables, whole or enrichedgrain products, nuts, blackstrap molasses,tofu, eggs, dried fruitsb.Folic acid: green leafy vegetables, aspara-gus, green beans, fruits, whole grains, liver,legumes, yeastc.Vitamin C: citrus, strawberries, cantaloupe,cabbage, green and red peppers, tomatoes,potatoes, green leafy vegetables29.a.Foods containing vitamin C may enhanceiron absorption.b.Milk and high-calcium products such asantacids or calcium supplements inhibitabsorption of the iron.30.Preventive folic acid should be 400 mcg (0.4mg)/day. Treatment of folic acid anemia or pre-vention of neural tube defects in the infant ofa woman who has previously had an affectedinfant should be at least 1 mg/day. The supple-ment dose may be higher than 1 mg/day toprevent recurrent neural tube defects in thefetus.31.Sickle cell crises may cause erythrocytedestruction with occlusion of small blood ves-sels, including those supplying the placenta.This may result in preterm birth, intrauterinegrowth restriction, and fetal death.32.f, c, a, b, e, d33.The CDC recommends routine immunizationat birth, 1–2 months, and 6–18 months34.a.transplacentallyb.through contact with infected maternalsecretions at birthc.through breast milk35.a.Avoid drug use or do not share needles ifthe habit is continued

Solution Manual for Introduction to Maternity and Pediatric Nursing, 6th Edition - Page 16 preview image

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4Study Guide Answer KeyChapter 5b.use a latex condomc.avoid oral sex36.Incomplete bladder emptying due to pressureon the bladder and reduced motility of the ure-ters; retained urine becomes more alkaline andfavors growth of microorganisms.37.a.Clean the vaginal-perineal area in a front-to-back direction.b.Drink at least eight glasses of liquids eachday, excluding caffeinated ones. Cranberryjuice makes the urine more acidic and lessfavorable to bacterial growth.c.Urinate before and after intercourse; use awater-soluble lubricant to reduce irritation.38.Standard precautions to reduce spread bycontactSafe food and water supply to ensure adequatenutrition and hydrationSafe air supply to reduce further transmissionVaccines or antibiotics if benefits outweighrisks to fetus39.a.Growth retardation, facial abnormalities,mental retardationb.Avoid alcohol intake from conception.40.e, f, i, c, a, b, g, h, d41.The physician or nurse-midwife will prescribethe drug that is least harmful yet is therapeuticfor her condition and will prescribe it in thelowest possible effective dose and at the besttime(s) to take the drug. A pharmacist or phy-sician who prescribed the drug may also beconsulted.42.a.Increased risk for spontaneous abortion(miscarriage), stillbirth, low birthweightbabyb.Late prenatal carec.Increased risk for homicide43.Late or erratic prenatal care; injuries in variousstages of healing; old fractures; tendency tominimize injury or its severity; assumption ofresponsibility for the trauma. The abuser maybe extremely attentive after a battering episode.Review Questions1.Answer: 2Rationale: The placenta secretes substances(estrogen, progesterone, insulinase) thatdecrease the effectiveness of insulin or breakit down more quickly. This action makes moreavailable to the fetus. (See also Chapter 4.)The pancreas secretes added insulin duringpregnancy (except in women who have type1 diabetes), but its effectiveness is less. Thefetus secretes his or her own insulin for glucosemetabolism because the hormone does notcross the placenta.2.Answer: 3Rationale: The biophysical profile includes fiveevaluations associated with placental func-tion: nonstress test, fetal breathing movements,fetal body movements, fetal tone, and volumeof amniotic fluid. Fetal lung maturity requirestests on amniotic fluid obtained by amniocen-tesis. Amniocentesis and/or ultrasound areoften used to identify serious fetal anomalies.3.Answer: 2Rationale: Rubella vaccine can cross the pla-centa and could adversely affect the fetus. Itcan be given in the immediate postpartumperiod and the woman should be advised notto become pregnant for at least 3 months. Lim-iting her contact with other pregnant womenis unnecessary unless they have an infection.Non-immunity does not mean infected. It onlymeans that her risk for infection with a virusthat could cause anomalies is present. It is notpossible to say that there is little risk for infec-tion because the risk depends on whether thewoman is infected with rubella. Minimizingthe risk to her may cause her to ignore steps toprevent infection in this or another pregnancy.4.Answer: 1Rationale: Wiping front to back after toiletingreduces introduction of anal organisms into thebladder. These foods would reduce the risk forconstipation and help prevent iron-deficiencyanemia. Citrus fruits and juices may add fiberand liquids, which reduce constipation. Non-caffeinated liquids can reduce risk for bladderinfection, but this choice does not specify anamount (should be 8 glasses/day). Not addinglubricant during vaginal intercourse if one isneeded can increase the risk for urinary tractinfection by irritation of the vaginal-perinealarea.5.Answer: 1Rationale: If the mother’s heart cannot meetthe demands of her own body, placental bloodflow will be reduced, leading to fetal hypoxia.Preterm birth by cesarean may become neces-sary if the woman’s condition worsens, but thisis not the primary risk because a term baby isalways the goal. Maternal infection is a risk toboth mother and fetus/newborn, but steps aretaken throughout the pregnancy to avoid it.The fetus may have a greater risk for congeni-tal heart defect if the mother has one, but this isstill not the primary risk and the risk is usuallysmall.6.Answer: 3Rationale: Continual vomiting reduces caloriesavailable to the fetus. Overall small size is agreater risk with persistent hyperemesis gravi-darum than are multiple vitamin and mineral

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