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

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    Study Guide Answer Key Chapter 1 1 Study Guide Answer Key 1 chapter 1 Learning Activities 1. c, h, d, i, j, b, g, f, e, a 2. a. Obstetricians b. Family practice physicians c. Certified nurse-midwives 3. f, d, i, e, g, b, j, a, h, c 4. a. American College of Nurse-Midwives b. Association of Women’s Health, Obstetric, and Neonatal Nurses c. Division of Maternal Nursing within the American Nurses Association 5. a. Provides funds for maternity care b. Increases access to health care for under - privileged women c. Designed to improve education of pre - school children d. Provides contraceptive information e. Provides supplemental food and education for the poor f. Enables employees to take 12 weeks of unpaid leave but retain benefits and pay status for newborns or ill family members g. Establishes minimum working ages and led to national minimum standards for child labor and enforcement of these standards h. Provides support and public education of handicapped children i. Provides a national clearinghouse for miss - ing children 6. Hospital stays for births in the 1950s were usu - ally one week. Today, an uncomplicated case requires only 2 days. Follow-up of the well newborn occurs within 2 weeks and a nurse may make visits to the home if a discharged mother or infant is at high risk. Implications for nurses might include the need for good organization of care based on research rather than tradition, identification of risk factors that may lengthen the stay for the mother and/or infant, and teaching early after birth to help parents best care for themselves and their infant. Teaching often involves other family members such as grandparents or siblings as well. (Student should describe their thoughts how these changes are likely to affect nurses.) 7. Natural childbirth movement made parents aware of their need to become educated and involved. Preparation for childbirth such as Lamaze classes and La Leche League became accepted. Parents questioned routine use of anesthesia and restrictive policies such as exclusion of fathers from birth. Today, a father’s attendance at birth, open visiting for other children and family, and extended con - tact with the newborn are encouraged. 8. Technological advances and emergence of pediatric specialties enable survival of many infants and children who would not have sur - vived in the past. Specialized care for prema - ture infants, specialized pediatric cardiology care, and pediatric specialties such as pediatric surgery and pediatric psychiatry are now available. Laboratories are equipped to test pediatric specimens to identify biochemical or chromosomal abnormalities. Identification of genetic risk and related counseling is more important. 9. The number of chronically ill and disabled children is growing. Some are dependent on specialized equipment such as monitors or ventilators. Parents must be educated in performing technical skills once reserved for the hospital, such as tracheotomy or central venous line care. The need for respite care for parents grows as the number of these children increases. 10. See Box 1-4 on p. 11 in the textbook. 11. a. Assessment b. Diagnosis c. Outcomes identification d. Planning e. Implementation f. Evaluation 12. 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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    2 Study Guide Answer Key Chapter 1 reimbursement for nursing services. Coding the interventions and outcomes improves qual - ity of research and direct reimbursement for services. 13. Critical thinking is the use of basic standards of 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 and integration of information to arrive at a conclu - sion or judgment. 14. Healthy People 2020 updates the 2010 objec - tives is a statement of national health promo - tion and disease prevention objectives. It is a vision statement to achieve a nation of more healthy people. The report identifies objectives designed to use health care knowledge and technology developed in the twentieth century to improve health and quality of life. Review Questions 1. Answer: 2 Rationale: Because the nurse must handle equipment, dressings, and patient care activi - ties, both with and without gloves, consistent hand hygiene reduces the number of resident bacteria that can be transmitted to others who may not be resistant to infection. 2. Answer: 3 Rationale: Most nurses can identify major cul - tural groups that reside in the area where they work. Patients and their families appreciate the extra attention to incorporate cultural needs into other nursing care. 3. Answer: 3 Rationale: Because statistics examine trends in large groups of people, they can help evaluate the quality of care, including prenatal care. 4. Answer: 4 Rationale: The CNM is an advanced-practice nurse with special training in providing care to the childbearing woman. The CNM works under protocols that specify under what condi - tions that medical care must be sought for the woman. 5. Answer: 3 Rationale: The nursing process helps nurses individualize care for all patients, both well and ill. 6. Answer: 2 Rationale: Clinical pathways provide “targets” for expected progress along a time line and are often collaborative, using skills of multiple professionals. When the patient “falls off” the expected course, a variance occurs. Applying Knowledge Answers will vary.

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    Study Guide Answer Key Chapter 2 1 Study Guide Answer Key 1 chapter 2 Learning Activities 1. Puberty 2. a. 10, 16 b. penis, testes 3. a. breast development b. 2–2.5 4. a. Boys: taller; more muscular; pubic, axillary, chest, and facial hair; deeper voice b. Girls: broader hips; breast development; pubic and axillary hair 5. c, f, h, b, g, e, a, d 6. See Figure 2-1 on p. 21. 7. a. seminiferous tubules b. Leydig’s cells 8. a. Increases muscle mass and strength b. Promotes growth of long bones c. Increases BMR d. Enhances red blood cell production e. Enlarges vocal cords f. Encourages male distribution of body hair 9. See Figure 2-2 on p. 23. 10. g l, q, r p d c, h i k j f m o a b, e n 11. 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, a 15. b, a, e, c, d 16. a. FSH (follicle-stimulating hormone) is pro - duced in the anterior pituitary gland and stimulates the maturation of an ovarian follicle. b. LH (luteinizing hormone) is produced in the anterior pituitary gland and stimulates final maturation of the follicle and release of its ovum. c and d. Estrogen and progesterone are pro - duced in the corpus luteum and cause buildup of the endometrium to nourish a fertilized ovum if it arrives. If no fertilized ovum arrives, the corpus luteum degener - ates and levels of estrogen and progester - one fall, causing the next menstrual cycle. Review Questions 1. Answer: 3 Rationale: Although the female growth spurt begins earlier than the male’s, it also ends sooner, limiting the girl’s mature height. Tes - tosterone is the primary male hormone. Girls begin puberty earlier, but they end it sooner than boys. Onset of puberty initiates the growth spurt rather than stopping it. Estrogen and progesterone, which increase as the girl matures, eventually stop her growth in height. 2. Answer: 2 Rationale: Although most sperm are released in semen with ejaculation, some semen is often secreted before ejaculation and can fertilize a waiting ovum. Although ejaculation can occur at any time, the penis becomes flaccid after ejaculation, preventing penetration. Sperm are added to the seminal fluid by contractions of the vas deferens before ejaculation. Semen typically enters the urethra shortly before ejaculation. 3. Answer: 3 Rationale: The endometrium is the inner muco - sal layer that responds to cyclic hormonal changes during the menstrual cycle and also receives the fertilized ovum when it implants. The parametrium is the outer serosal layer and the myometrium is the middle muscular layer.

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    2 Study Guide Answer Key Chapter 2 4. Answer: 3 Rationale: The linea terminalis is at the level of the sacroiliac joint to the front iliopubic prominence (front of the pelvis). The obstetric conjugate is a diameter from the upper part of the symphysis pubis to the sacral promontory and is estimated from the diagonal conjugate because it cannot be directly measured. These diameters are measured at the inlet, but are not the dividing line of the true from the false pel - vis. The bi-ischial is a diameter of the outlet, at the lower end of the true pelvis. 5. Answer: 3 Rationale: The anteroposterior diameter of the pelvic outlet can enlarge slightly during childbirth because the coccyx is moveable. The obstetric conjugate and the right and left oblique diameters are mostly surrounded by non-movable bone and are therefore less flexible. 6. Answer: 1 Rationale: Adequate sperm production requires a temperature slightly lower than the rest of the body. The scrotum is a skin pouch that allows the testes to be suspended slightly away from the body. The epididymis and vas deferens carry sperm from the testes to the ure - thra. The testes manufacture sperm and secrete testosterone. Contraction of muscles of the prostate gland and seminal vesicles contribute to the flow and motility of sperm and rhythmic contractions of penile erectile tissues aid in ejaculation 7. Answer: 3 Rationale: Alveoli contain milk-secreting cells. Lactiferous ducts carry milk from the alveoli to the nipples. Montgomery’s glands secrete a substance to lubricate and protect the nipple during breastfeeding. The nipple is at the cen - ter of each breast and is where milk is ejected through its pores. 8. Answer: 2 Rationale: Blood is trapped within the penis as penile arteries relax. It becomes engorged with blood and an erection occurs. Muscles attached to 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. The prostate gland primarily functions to contrib - ute its secretion to the seminal fluid. 9. Answer: 4 Rationale: Breast size is unrelated to the ability to produce milk because fatty tissues cause size differences. The number of alveoli is similar in women, regardless of whether their breasts are small or large. Hormones of pregnancy do cause growth in breast tissue, but this does not make the difference in a woman’s ability to nurse. 10. Answer: 2 Rationale: The middle of the three muscle lay - ers of the uterus has a figure-8 design. The circular muscles of the inner myometrium form sphincters where the fallopian tubes enter the uterus and at the internal opening of the cervix. Longitudinal muscles form the outer muscular layer and expel the infant dur - ing labor. Oblique muscles do not exist in the myometrium. 11. Answer: 4 Rationale: Much of the endometrium is shed during menstruation, and it is thinnest at the end of the menstrual period. The endometrium is thickest at ovulation, to prepare for a fertil - ized ovum. The endometrium remains thick if a fertilized ovum implants, but begins breaking down a few days after menstruation if none is present. Thinking Critically 1. You can reassure your niece that early cycles are often irregular and the young girl often does not ovulate. Regular cycles are usually established within 6 months to 2 years of the first period. 2. The vagina normally cleanses itself and main - tains a slightly acidic pH. Douching washes away these acidic secretions, and antibiotics can alter its self-cleansing activity. The nurse can explain these factors to the woman to discourage her from douching except when ordered by her health care practitioner. Applying Knowledge Answers will vary.

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    Study Guide Answer Key Chapter 3 1 Study Guide Answer Key 1 chapter 3 Learning Activities 1. b, g, a, c, d, f, e 2. a. 4 b. 22, x, y 3. a. 1 b. 22, x 4. a. 24 b. 5 5. a. boy b. girl c. The woman does not have a direct genetic influence over the gender of the baby because she only contributes an X chro - mosome. However, the pH (acidity or alkalinity) of her reproductive tract and her estrogen levels may affect the survival of the X-bearing and Y-bearing sperm differently and their speed of movement through her cervix and fallopian tubes. 6. a. fallopian tube b. upper, posterior 7. a, i, d, b, h, f, g, c, e, j 8. 1,000 9. a. Maintains an even temperature b. prevents adherence of the amniotic sac to the fetal skin c. allows symmetrical growth d. allows buoyancy and fetal movement e. cushions the fetus and umbilical cord from injury 10. yolk sac, liver, spleen, bone marrow 11. a. fetal respiration b. fetal nutrition c. fetal excretion d. endocrine gland 12. a. i. Maintains uterine lining ii. Reduces uterine contractions iii. Prepares milk-producing tissue of breasts for lactation iv. Stimulates testes of the male to pro - duce testosterone needed for develop - ment of the male reproductive tract b. i. Stimulates uterine growth ii. Increases blood flow to uterine vessels iii. Stimulates ducts of breasts to prepare for lactation iv. Causes changes in skin pigmentation v. Vascular changes in the skin and the mucous membranes of the nose and mouth vi. Increases salivation c. Persistence of the corpus luteum so it secretes estrogen and progesterone d. Decreases maternal insulin sensitivity and utilization of glucose so that more glucose is available for fetal growth 13. See Figure 3-7 on p. 40. 14. 1 2 15. a. 2 hours, 3 months b. 15 hours, 3 weeks c. at cutting of the cord, 1 week 16. e, h, a, f, g, b, c, d

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    2 Study Guide Answer Key Chapter 3 17. Characteristic Monozygotic Dizygotic a. Same sex or different? Always same sex May or may not be same sex b. Number of fertilized ova 1 2 c. Number of placentas 1 (varies according to when the twinning occurred after con - ception but most often a single placenta) 2 (although placentas may be fused) d. Number of membranes Also varies according to when the twinning occurred, but usu - ally one amnion and two chori - ons Two amnions and two chorions e. Number of umbilical cords 2 2 Review Questions 1. Answer: 1 Rationale: Genes are the smallest units of heredity and are located on chromosomes. The zygote is the developing baby for the first 2 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: 2 Rationale: The embryonic yolk sac produces erythrocytes until six weeks after conception, at which time the liver performs this function, followed by the bone marrow. The placenta uses fetal blood cells to deliver oxygen and nutrition to the fetus and to remove fetal waste products. 3. Answer: 2 Rationale: The chorion is the outer fetal mem - brane. The amnion is the inner membrane that extends across the placenta and umbilical cord. Vernix is fetal skin covering. 4. Answer: 1 Rationale: Umbilical vessels are coiled within the umbilical cord. Wharton’s jelly allows them to stretch, yet keeps them from being easily compressed with fetal movement. 5. Answer: 2 Rationale: Only a small amount of blood goes into the fetal lungs to nourish them while they develop. Most blood goes from the right atrium to the left atrium through the foramen ovale, thus bypassing the lungs. The ductus venosus allows most blood from the placenta to bypass the liver. The umbilical vein and umbilical artery are structures within the umbilical cord that carry blood from the body to the placenta and return it to the body after oxygenation and removal of wastes. 6. Answer: 2 Rationale: Because the umbilical arteries carry blood from the fetus to the placenta, most of its oxygen and nutrients have been consumed and it carries blood having a high concentra - tion of fetal wastes. The umbilical vein carries blood with the highest concentration because it is returning from the placenta. The ductus venosus and ductus arteriosus are fetal circula - tory bypasses to shunt most oxygenated blood away from the liver (ductus venosus) and lungs (ductus arteriosus). 7. Answer: 2 Rationale: After fertilization, the zygote must reproduce cells for growth by ordinary cell division (mitosis) to continue development. Meiosis is reduction cell division to produce gametes, or reproductive cells. 8. Answer: 3 Rationale: Amniotic fluid has five major pur - poses that are all protective: maintaining temperature, preventing membranes from adhering to skin, allowing room for symmetri - cal growth, providing a cushion, and allowing buoyancy. Amniotic fluid does not perform this function, although drugs given to the mother can speed lung development. Amniotic fluid helps maintain the stability of the fetal temperature, but will be gone after birth. The placenta is the pregnancy organ that produces hormones. 9. Answer: 2 Rationale: Among its functions, the placenta eliminates fetal waste products, substituting for the fetal liver, kidneys, and other organ systems. The yolk sac produces red blood cells in early development. Endoderm refers to one of the embryonic cell layers.

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    Study Guide Answer Key Chapter 3 3 10. Answer: 2 Rationale: One of progesterone’s effects is to reduce uterine contractions that would other - wise tend to occur with stretching by the grow - ing baby. Spontaneous abortion is likely if there is insufficient progesterone to quiet the uterus. Release of multiple ova would result from development and release of two or more of these 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 mix before birth. 11. Answer: 4 Rationale: Fraternal (dizygotic) twins occur when two ova are released and each is fertil - ized by a different sperm. 12. Answer: 1 Rationale: Identical twins are of the same sex because they have the same genetic composi - tion, including sex chromosomes. Although a couple may have more than one set of dizy - gotic twins and each set may have one child of each sex, it occurs by chance. Thinking Critically 1. For a contraceptive technique such as natural family planning to be successful, one or more techniques help the woman to predict a likely time of ovulation. The woman must have an idea of about when her menstrual periods usu - ally begin and understand that ovulation, or her fertile period, occurs about 14 days before the onset of the next menstrual period, or in the middle of a 28-day cycle. Sperm may live up to 5 days after ejaculation. The couple wishing to use natural family planning uses these facts to avoid intercourse near the time of ovulation. 2. The communication should include facts that the 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 tract and estrogen levels also influence how long X-bearing or Y-bearing sperm survive and their speed of movement toward the ovum. Applying Knowledge Answers will vary.

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    Study Guide Answer Key Chapter 4 1 Study Guide Answer Key 1 chapter 4 Learning Activities 1. a, c, g, d, e, b, f 2. g, a, c, f, d, b, e 3. b, h, c, e, a, l, g, i, d, j, k, f 4. a. Human chorionic gonadotropin (hCG) b. urine, blood 5. a. i. 7.5 cm x 5 cm x 2.5 cm to a size large enough to house the fetus, placenta, and amniotic fluid ii. 60 g to 1,000 g iii. 10 mL to 5,000 mL b. Bluish discoloration, softening; secretion of mucus to form a mucous plug c. Do not produce ova; corpus luteum per - sists and secretes hormones to maintain the pregnancy until the placenta takes over d. Blood supply increases; mucosa thickens; rugae become prominent; connective tis - sue softens; vaginal pH becomes more acidic; secretions have higher amounts of glycogen 6. a. Change to prepare for breastfeeding; dark - ening of the areolae; secretions of Mont - gomery’s tubercles b. Respirations deepen to increase oxygen and carbon dioxide exchange; oxygen intake increases about 15%; upward pres - sure against the diaphragm (about 4 cm, or 1.6 inches); flaring of the rib cage, increas - ing chest circumference about 6 cm (2.4 inches); nasal stuffiness, nosebleeds, and a deeper voice c. Increase in blood volume; pseudoanemia; increased cardiac output; higher pulse rate; prone to supine hypotension and ortho - static hypotension; palpitations d. Increased salivary secretions (ptyalism); bleeding of the mouth tissue; increased appetite and thirst; reduced gastric acidity; slowed stomach emptying and intestinal peristalsis; heartburn (pyrosis); tendency to gestational diabetes; pruritus due to increased retention of bile salts e. Increased glomerular filtration rate; ten - dency for glucosuria and proteinuria; water retention; increased ureter diameter and bladder capacity with risk for urinary stasis and urinary tract infection f. Skin pigment darkens; striae; increased sweat and sebaceous gland activity; spider nevi; palmar redness; backaches; waddling gait with softening of the joints 7. 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. 300 500 9. a. i. 60 g/day (65 g/day for the lactating woman) ii. meat, fish, poultry, dairy products, legumes; breads and cereals; seeds and nuts; b. i. 1,200 mg/day ii. dairy products, enriched cereals, legumes, nuts, dried fruits, broccoli, green leafy vegetables, canned salmon and sardines with bones; calcium sup - plements for women who do not drink milk or have adequate amounts from other foods; c. i. 30 mg/day for women with adequate iron stores at beginning of pregnancy ii. supplements; red and organ meats, molasses, whole grains, iron-fortified cereals and breads, dark green leafy vegetables, dried fruits d. i. 400 mcg (0.4 mg)/day ii. liver, kidney and lima beans, peanuts, fresh dark-green leafy vegetables, lean beef, potatoes, whole-wheat bread, dried beans, supplements 10. a. Accept that a teenager’s peer group is vitally important to her, that teens typi - cally eat many fast foods that are often nutritionally poor, and that she may feel “fat” during pregnancy. Help her identify

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    2 Study Guide Answer Key Chapter 4 better choices at fast-food restaurants so she can fit in and still have adequate nutri - tion. Give her positive feedback for making good choices. b. Take lactase as a tablet or liquid in dairy products; fermented dairy products such as aged cheese, buttermilk, and yogurt; enriched cereals; legumes, nuts, dried fruits, broccoli, green leafy vegetables; canned salmon and sardines with bones 11. a. Eat dry toast or crackers before getting out of bed in the morning; drink fluids between meals instead of with meals; eat small, frequent meals; avoid fried, greasy, or spicy foods and foods with strong odors such as cabbage and onions b. Bathe or shower daily, wear loose-fitting cotton panties, do not douche unless ordered, wipe from front to back c. Try to get 8-10 hours of sleep each night; nap during the day; and use measures such as relaxation techniques, meditation, or change of scenery d. Correct posture; wear low-heeled shoes; squat to pick up objects; support arms, feet, and back when sitting; perform exercises (tailor sitting, shoulder circling, pelvic rock) e. Drink at least 8 glasses of water daily (exclude coffee, tea, and carbonated drinks from the total), add high-fiber foods to diet, limit cheese if this is constipating, limit sweets, consult health care provider if iron supplement causes constipation for possible change, exercise (such as a brisk 1-mile walk), keep a regular time for bowel movements, take laxatives or enemas only if specifically directed f. Avoid constricting clothing or crossing legs at knees, elevate legs when sitting, apply support hose/elastic stockings before get - ting up each morning, avoid prolonged standing g. Anesthetic ointments, witch hazel pads, rectal suppositories, sitz baths, avoid constipation h. Small frequent meals, avoiding fatty foods, reduce smoking and caffeine, sit upright, deep breathe and take sips of water, use antacids as recommended by health care provider i. Keep upper torso elevated when resting, avoid exertion, use saline nasal drops or humidifier for nasal stuffiness j. 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 aluminum hydroxide capsules under direction of health care provider k. Rest with elevation of legs, avoid restric - tive bands around legs, take water aerobics if not contraindicated 12. a. Difficulty believing the reality of preg - nancy; ambivalence; focus on self; labile emotions b. Greater reality of fetus to woman; total involvement with pregnancy and shelter - ing of her fetus; more stability of moods; “trying on” the role of mother; body changes that may be welcomed or not, depending on how she views them; pos - sible alteration in sexual relationship c. Mood swings; increased sense of vulner - ability and dependence on partner; anxi - ety about approaching labor; beginning detachment from the fetus as part of her to being a separate person; becomes very tired of being pregnant Review Questions 1. Answer: 2 Rationale: Quickening, fetal movement felt by the mother, occurs at 16-20 weeks. Nausea and vomiting are most common in the first trimes - ter but diminish in the second. Burning during urination and yellowish vaginal discharge are signs of urinary tract and vaginal infections, respectively. 2. Answer: 1 Rationale: Concerns about the normality of the baby are common during the second trimester, as are fantasies. The feelings expressed are nor - mal and do not suggest fetal rejection. A more realistic (rather than unrealistic) image of the fetus begins in the second trimester. 3. Answer: 3 Rationale: As the baby becomes more real to the woman, she often fantasizes about the appearance, sex, and other characteristics. The other feelings and behaviors are more common during the third trimester. 4. Answer: 1 Rationale: The symptoms describe supine hypotensive syndrome: lying flat during preg - nancy causes the heavy uterus to compress the inferior vena cava. With less blood coming into the heart, less can be pumped out, leading to faintness. Deep breathing does not relieve com - pression of the great vessels. Sitting up would relieve compression, but the woman is already dizzy and weak. Elevation of her feet and legs does not fix the primary problem of vessel compression. 5. Answer: 2

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    Study Guide Answer Key Chapter 4 3 Rationale: A pregnant woman should have a minimum of 30 mg/day of iron; 30-60 mg/ day supplementation provides added iron for increased erythrocytes. Milk provides cal - cium but little iron (it also interferes with iron absorption). Meat and grains provide adequate protein primarily. 18 mg of iron is inadequate for pregnancy. 6. Answer: 4 Rationale: Varicose veins become more promi - nent and uncomfortable when the pressure within them increases with blood pooling. Elevating the legs allows blood to return more readily to the heart rather than pooling in the legs. Warm packs may be comforting, but do not address the problem of blood pooling. Prolonged sitting, like prolonged standing, can worsen varicosities unless the legs are elevated. 7. Answer: 2 Rationale: Early and regular prenatal care can identify 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 goal of prenatal care. Prenatal care teaches a woman how to safely deal with pregnancy discomforts, but this is too narrow for a primary goal. 8. Answer: 4 Rationale: Meat provides high-quality iron; dark green vegetables also contain iron. Citrus and melons provide primarily vitamin C. Dairy products provide primarily calcium. Dried beans, potatoes, and legumes provide folic acid and the beans provide inexpensive protein. 9. Answer: 4 Rationale: Adequate folic acid intake from conception has been shown to reduce the inci - dence of neural tube defects. Iron supports blood volume expansion. Nausea and vomit - ing are often relieved by dry carbohydrates, but not specifically folic acid. Calcium is not depleted from maternal teeth. 10. Answer: 2 Rationale: The ultimate goal should be to gain the minimum desired weight. 11. Answer: 2 Rationale: Dietary relief of constipation is best, with addition of fiber and fluids. Laxatives are not routinely recommended. Extra fluids, rather than less, are appropriate to soften the stool. Delaying defecation may worsen consti - pation, especially if it will be a long time before having a quiet environment. 12. Answer: 4 Rationale: Excess milk intake can alter the calcium-phosphorous balance, increasing leg cramps. Iron supplements do not relate to leg cramps. Adequate fluid intake is important, but not to relieve leg cramps. Flexing the foot while extending the leg provides immediate relief of leg cramps; it is unnecessary to do this 3 times per day. 13. Answer: 4 Rationale: The woman may have a possible vaginal infection that should be treated. Secre - tions increase during pregnancy, but are rela - tively clear and nonirritating. Douching should be done only under the direction of a physi - cian, nurse-midwife, or nurse-practitioner, whether pregnant or nonpregnant. Avoiding sexual intercourse may be advised if an infec - tion is diagnosed, but this is not the primary advice. Cotton panties contribute to overall comfort related to normal vaginal discharge, but this choice does not address the main prob - lem of possible infection. 14. Answer: 4 Rationale: Relaxation of the ureters and renal pelvis leads to urinary stasis, which favors development of a urinary tract infection. Ade - quate fluid intake flushes microorganisms out of the urinary tract before they have a chance to cause infection. Orthostatic hypotension results from suddenly rising from a seated or lying position, reducing blood return from the lower body to the heart. Lower extremity edema is primarily caused by venous pooling. The cause of nausea and vomiting is not fully clear, but relates to sudden elevations in hor - mones and reduced gastrointestinal motility. Case Studies 1. Teaching Rosa the correct information about her voiced concerns should include: a. Recommended weight gain has gradually increased as presumed risks have been dis - proven. Low weight gain is associated with prematurity. b. Salt intake should be normal to provide adequate sodium to plasma, brain, bone, and muscle. High-sodium foods should be limited. c. Diuretics could reduce body fluid levels to unsafe levels. 2. Non-meat sources of protein include soy milk, tofu, tempeh, and beans. Adding milk and eggs, as Lauren does now, further increases her protein intake. The food pyramid in Chapter 15, p. 371, can give further guidance to Lauren on her own diet, but also the vegetarian diet guidelines for her child as young as 2 years. Diet should be discussed on each visit to ensure that Lauren is meeting her protein and other needs during pregnancy. Referral to a dietitian may be needed.

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    4 Study Guide Answer Key Chapter 4 Thinking Critically 1. 39 weeks 2. October 14 th of the previous year. 3. a. Late menses is a presumptive symptom because irregular or absent menses are common for early puberty, lower than normal weight, metabolic or endocrine dysfunction, chronic disease, anorexia, premature menopause, or emotional problems. b. Breast tenderness is a common, but only presumptive, symptom along with other breast changes such as striae or pigment changes. c. “Getting fat” might describe overall weight gain or abdominal enlargement, a probable sign of a growing fetus. Urinary frequency is a presumptive sign. d. A nurse cannot know if the previous pregnancy test done by the girl was done properly. A repeat test done properly will provide a probable sign of pregnancy if positive. Applying Knowledge Answers will vary.

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    Study Guide Answer Key Chapter 5 1 Study Guide Answer Key 1 chapter 5 Learning Activities 1. b, f, e, d, a, c 2. 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, d 4. a. Report increased bleeding. b. Report temperature of 38° C (100.4° F) or higher. c. Take iron supplement as recommended to correct anemia. d. Resume sexual activity as directed. e. Return to physician for checkup and con - traceptive information and emphasize that pregnancy can occur before the first men - strual period. 5. fallopian tube 6. hypovolemic shock secondary to blood loss 7. a. Bleeding, possibly accompanied by cramping, that varies from spotting to hemorrhage b. Larger than usual c. Absent fetal heart activity d. Early and severe hyperemesis gravidarum e. Elevated, with other signs of pregnancy- related hypertension f. hCG levels higher than expected for gestation g. “Snowstorm” appearance on ultrasound h. Increased risk for choriocarcinoma if all abnormal tissue is not removed 8. a. Within 2–3 cm of the cervical opening, but not covering any part of it b. Partially covering the cervical opening c. Totally covering the cervical opening

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    2 Study Guide Answer Key Chapter 5 9. Placenta Previa Abruptio Placentae a. Pain No unusual pain Bleeding is accompanied by pain b. Characteristics of bleeding Bright red, obvious Often concealed behind placenta, with little external bleeding c. Fetal ane - mia and/or hypoxia Fetus may lose some blood as vessels are disrupted with cervical dilation and effacement; maternal hypovolemia may reduce oxygen delivery to the fetus Some blood behind placenta is often fetal blood; maternal hypovolemia may reduce oxygen delivery to the fetus d. Consistency of the uterus No unusual contractions or irritability Frequent cramp-like contractions e. Blood coagulation No blood clotting abnormalities are expected DIC may occur due to large clot behind placenta with consumption of clotting factors f. Risk for postpartum hemorrhage Higher because lower uterus does not have as much muscle to compress open vessels Higher because injured muscle at placenta site may not contract as well g. Risk for postpartum infection Higher because placenta is implanted near vagina and organisms can easily ascend and infect it Higher because injured tissue is more susceptible to microbial invasion 10. Signs that suggest a possible seizure include: a. Abdominal and/or epigastric pain (related to liver edema, ischemia, and necrosis; precedes seizure; abruptio placentae is also more likely and may be cause of pain) b. Persistent vomiting (may occur with hyperemesis gravidarum, but may also be caused by same mechanisms noted above) c. Edema of face and hands (large excess of tissue fluid, although edema is not essen - tial to diagnosis and may occur for many different reasons) d. Severe persistent headache (brain edema and small hemorrhages; often precedes seizure) e. Blurred vision or dizziness (arterial spasm and edema near retina; often precedes a convulsion) 11. See Box 5-4. First pregnancy Obesity Family history of gestational hypertension Age under 19 or over 40 years Multifetal pregnancy Chronic hypertension Chronic renal disease Diabetes mellitus 12. See Table 5-6. a. Gestational hypertension (development of blood pressure ≥ 140/90 mm Hg in a previously normotensive woman after 20 weeks; blood pressure returns to normal by 6 weeks postpartum) b. Preeclampsia (includes proteinuria with hypertension) 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 or persistence for 6 weeks after birth, when gestational hypertension is expected to be resolved) f. Preeclampsia with superimposed chronic hypertension (chronic hypertension that has a new occurrence of proteinuria, thrombocytopenia, and increased liver enzymes). 13. 140/90 mm Hg or higher 14. a. Hypertension (vasospasm) b. Edema (fluid leaves blood vessels abnor - mally and enters tissue spaces) c. Proteinuria (reduced blood flow to the kidneys) d. Central nervous system changes such as severe headache or hyperactive reflexes (brain edema and small cerebral hemor - rhages [severe]) e. Visual disturbances (arterial spasm and edema around retina [severe]) f. Reduced urine output (reduced blood flow to the kidneys)

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    Study Guide Answer Key Chapter 5 3 g. Pulmonary edema (movement of fluid from vessels to lung tissue [severe]) h. Epigastric pain or nausea (liver edema, ischemia, and necrosis [severe]) i. Lab studies (liver enzymes elevated because of decreased circulation, edema, and small hemorrhages [severe]); coagula - tion abnormalities due to low platelet lev - els and accumulation of platelets at sites of vessel damage [severe] 15. Reduces blood flow to mother’s skeletal mus - cles, making more available to her vital organs and for perfusion of the placenta 16. a. Reduce central nervous system irritability to prevent seizures b. Urine output <30 mL/hour, depression or loss of deep tendon reflexes, respiratory depression, serum levels above 8 mg/dL, observation for uterine atony after birth c. Calcium gluconate d. 4–8 mg/dL 17. a. negative; positive b. Rh immune globulin (Rh o GAM or HypRho-D) c. i. 28 weeks of gestation ii. Within 72 hours of birth iii. After spontaneous abortion iv. Bleeding during pregnancy 18. Gestational 19. The woman drinks 50 g of an oral glucose solution and fasting is not needed. In 1 hour, a blood sample is analyzed for glucose level. The result should be less than 140 mg/dL. The test is done at 24–28 weeks gestation. 20. a. To keep levels as near normal as possible over the day b. To test for ketones, which might require an adjustment in diet or signal onset of infection 21. Insulin; does not cross the placenta 22. 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 steadily throughout pregnancy but then fall dramati - cally after birth, often below the pre-pregnancy requirements. 23. Some women with pre-existing diabetes have vascular impairment and exercise would reduce circulation to the placenta, resulting in poor oxygen and nutrient delivery to the fetus. In gestational diabetes, exercise often helps reduce the need for insulin. 24. Higher heart rate, blood volume, and cardiac output increase the heart’s workload, possibly resulting in congestive heart failure. 25. Each labor contraction shifts 300 to 500 mL of blood from the uterus and placenta into the woman’s general circulation, possibly over - loading her heart. Interstitial fluid returns to the circulation after birth and also may increase the risk for congestive heart failure. 26. a. increased blood volume b. iron transfer to the fetus c. cushion against the blood lost naturally at birth 27. While 10.5 g/dL is the minimum acceptable value for the woman’s hematocrit during the second trimester, she will soon be entering the third trimester when her hemoglobin should be 11 g/dL or higher. The nurse might initially determine whether the woman is now taking iron supplements; her most common foods during an average day; and if she has specific dietary needs such as food allergies, foods that she does not eat (specific meats or vegetables), or a therapeutic diet. Additional iron may be indicated 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 enriched grain products, nuts, blackstrap molasses, tofu, eggs, dried fruits b. Folic acid: green leafy vegetables, aspara - gus, green beans, fruits, whole grains, liver, legumes, yeast c. Vitamin C: citrus, strawberries, cantaloupe, cabbage, green and red peppers, tomatoes, potatoes, green leafy vegetables 29. a. Foods containing vitamin C may enhance iron absorption. b. Milk and high-calcium products such as antacids or calcium supplements inhibit absorption of the iron. 30. Preventive folic acid should be 400 mcg (0.4 mg)/day. Treatment of folic acid anemia or pre - vention of neural tube defects in the infant of a woman who has previously had an affected infant should be at least 1 mg/day. The supple - ment dose may be higher than 1 mg/day to prevent recurrent neural tube defects in the fetus. 31. Sickle cell crises may cause erythrocyte destruction with occlusion of small blood ves - sels, including those supplying the placenta. This may result in preterm birth, intrauterine growth restriction, and fetal death. 32. f, c, a, b, e, d 33. The CDC recommends routine immunization at birth, 1–2 months, and 6–18 months 34. a. transplacentally b. through contact with infected maternal secretions at birth c. through breast milk 35. a. Avoid drug use or do not share needles if the habit is continued

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    4 Study Guide Answer Key Chapter 5 b. use a latex condom c. avoid oral sex 36. Incomplete bladder emptying due to pressure on the bladder and reduced motility of the ure - ters; retained urine becomes more alkaline and favors growth of microorganisms. 37. a. Clean the vaginal-perineal area in a front- to-back direction. b. Drink at least eight glasses of liquids each day, excluding caffeinated ones. Cranberry juice makes the urine more acidic and less favorable to bacterial growth. c. Urinate before and after intercourse; use a water-soluble lubricant to reduce irritation. 38. Standard precautions to reduce spread by contact Safe food and water supply to ensure adequate nutrition and hydration Safe air supply to reduce further transmission Vaccines or antibiotics if benefits outweigh risks to fetus 39. a. Growth retardation, facial abnormalities, mental retardation b. Avoid alcohol intake from conception. 40. e, f, i, c, a, b, g, h, d 41. The physician or nurse-midwife will prescribe the drug that is least harmful yet is therapeutic for her condition and will prescribe it in the lowest possible effective dose and at the best time(s) to take the drug. A pharmacist or phy - sician who prescribed the drug may also be consulted. 42. a. Increased risk for spontaneous abortion (miscarriage), stillbirth, low birthweight baby b. Late prenatal care c. Increased risk for homicide 43. Late or erratic prenatal care; injuries in various stages of healing; old fractures; tendency to minimize injury or its severity; assumption of responsibility for the trauma. The abuser may be extremely attentive after a battering episode. Review Questions 1. Answer: 2 Rationale: The placenta secretes substances (estrogen, progesterone, insulinase) that decrease the effectiveness of insulin or break it down more quickly. This action makes more available to the fetus. (See also Chapter 4.) The pancreas secretes added insulin during pregnancy (except in women who have type 1 diabetes), but its effectiveness is less. The fetus secretes his or her own insulin for glucose metabolism because the hormone does not cross the placenta. 2. Answer: 3 Rationale: The biophysical profile includes five evaluations associated with placental func - tion: nonstress test, fetal breathing movements, fetal body movements, fetal tone, and volume of amniotic fluid. Fetal lung maturity requires tests on amniotic fluid obtained by amniocen - tesis. Amniocentesis and/or ultrasound are often used to identify serious fetal anomalies. 3. Answer: 2 Rationale: Rubella vaccine can cross the pla - centa and could adversely affect the fetus. It can be given in the immediate postpartum period and the woman should be advised not to become pregnant for at least 3 months. Lim - iting her contact with other pregnant women is unnecessary unless they have an infection. Non-immunity does not mean infected. It only means that her risk for infection with a virus that could cause anomalies is present. It is not possible to say that there is little risk for infec - tion because the risk depends on whether the woman is infected with rubella. Minimizing the risk to her may cause her to ignore steps to prevent infection in this or another pregnancy. 4. Answer: 1 Rationale: Wiping front to back after toileting reduces introduction of anal organisms into the bladder. These foods would reduce the risk for constipation and help prevent iron-deficiency anemia. Citrus fruits and juices may add fiber and liquids, which reduce constipation. Non- caffeinated liquids can reduce risk for bladder infection, but this choice does not specify an amount (should be 8 glasses/day). Not adding lubricant during vaginal intercourse if one is needed can increase the risk for urinary tract infection by irritation of the vaginal-perineal area. 5. Answer: 1 Rationale: If the mother’s heart cannot meet the demands of her own body, placental blood flow will be reduced, leading to fetal hypoxia. Preterm birth by cesarean may become neces - sary if the woman’s condition worsens, but this is not the primary risk because a term baby is always the goal. Maternal infection is a risk to both mother and fetus/newborn, but steps are taken 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 is still not the primary risk and the risk is usually small. 6. Answer: 3 Rationale: Continual vomiting reduces calories available to the fetus. Overall small size is a greater risk with persistent hyperemesis gravi - darum than are multiple vitamin and mineral

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