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Test Bank for Introduction to Maternity and Pediatric Nursing, 9th Edition (Chapters 1-34)

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    Chapter 01: The Past, Present, and Future Leifer: Introduction to Maternity and Pediatric Nursing, 9th Edition MULTIPLE CHOICE 1. A patient chooses to have the certified nurse-midwife (CNM) provide care during her pregnancy. Wha t does the CNM‘s scope of practice include? a. Practice independent from medical supervision b. Comprehensive prenatal care c. Attendance at all deliveries d. Cesarean sections ANS: B The CNM provides comprehensive prenatal and postnatal care, attends uncomplicated deliveries, and ensures that a backup physician is available in case of unforeseen problems. DIF: Cognitive Level: Comprehension REF: p. 6 OBJ: 5 TOP: Advance Practice Nursing Roles KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 2. Which medical pioneer discovered the relationship between the incidence of puerperal fever and unwashed hands? a. Karl Credé b. Ignaz Semmelweis c. Louis Pasteur d. Joseph Lister ANS: B Ignaz Semmelweis deduced that puerperal fever was septic, contagious, and transmitted by the unwashed hands of physicians and medical students. DIF: Cognitive Level: Knowledge REF: p. 2 OBJ: 1 TOP: The Past KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control 3. A pregnant woman who has recently immigrated to the United States comments to the nurse, “ I am afraid of childbirth. It is so dangerous. I am afraid I will die. ” What is the best nursing response reflecting cultural sensitivity? a. “ Maternal mortality in the United States is extremely low. ” b. “ Anesthesia is available to relieve pain during labor and chil dbirth. ” c. “ Tell me why you are afraid of chil dbirth. ” d. “ Your condition will be monitored during labor and delivery . ” ANS: C Asking the patient about her concerns helps promote understanding and individualizes patient care. DIF: Cognitive Level: Application REF: pp. 6-8 OBJ: 8 TOP: Cross-Cultural Care KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychological Adaptation

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    4. An urban area has been reported to have a high perinatal mortality rate. What information does this provide? a. Maternal and infant deaths per 100,000 live births per year b. Deaths of fetuses weighing more than 500 g per 10,000 births per year c. Deaths of infants up to 1 year of age per 1000 live births per year d. Fetal and neonatal deaths per 1000 live births per year ANS: D The perinatal mortality rate includes fetal and neonatal deaths per 1000 live births per year. DIF: Cognitive Level: Comprehension REF: p. 13 | Box 1.6 OBJ: 9 TOP: The Present-Child Care KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care 5. What is the focus of current maternity practice? a. Hospital births for the majority of women b. The traditional family unit c. Separation of labor rooms from delivery rooms d. A quality family experience for each patient ANS: D Current maternity practice focuses on a high-quality family experience for all families, traditional or otherwise. DIF: Cognitive Level: Comprehension REF: p. 6 OBJ: 5 TOP: The Present-Maternity Care KEY: Nursing Process Step: N/A MSC: NCLEX: Health Promotion and Maintenance 6. Who advocated the establishment of the Children‘s Bureau? a. Lillian Wald b. Florence Nightingale c. Florence Kelly d. Clara Barton ANS: A Lillian Wald is credited with suggesting the establishment of a federal Children‘s Bur eau. DIF: Cognitive Level: Knowledge REF: p. 4 OBJ: 1 | 2 TOP: The Past KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 7. What was the result of research done in the 1930s by the Children‘s Bureau? a. Children with heart problems are now cared for by pediatric cardiologists. b. The Child Abuse and Prevention Act was passed. c. Hot lunch programs were established in many schools. d. Children‘s asylums were founded. ANS: C School hot lunch programs were de veloped as a result of research by the Children‘s Bureau on the effects of economic depression on children. DIF: Cognitive Level: Knowledge REF: p. 4 OBJ: 2 | 3

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    TOP: The Past KEY: Nursing Process Step: N/A MSC: NCLEX: Health Promotion and Maintenance: Coordinated Care 8. What government program was implemented to increase the educational exposure of preschool children? a. WIC b. Title XIX of Medicaid c. The Children‘s Charter d. Head Start ANS: D Head Start programs were established to increase educational exposure of preschool children. DIF: Cognitive Level: Knowledge REF: p. 3 OBJ: 3 TOP: Government Influences in Maternity and Pediatric Care KEY: Nursing Process Step: N/A MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 9. What guidelines define multidisciplinary patient care in terms of expected outcome and timeframe from different areas of care provision? a. Clinical pathways b. Nursing outcome criteria c. Standards of care d. Nursing care plan ANS: A Clinical pathways, also known as critical pathways or care maps, are collaborative guidelines that define patient care across disciplines. Expected progress within a specified timeline is identified. DIF: Cognitive Level: Knowledge REF: p. 13 OBJ: 10 TOP: Health Care Delivery Systems KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care 10. A nursing student has reviewed a hospitalized pediatric patient chart, interviewed her mother, and collected admission data. What is the next step the student will take to develop a nursing care plan for this child? a. Identify measurable outcomes with a timeline. b. Choose specific nursing interventions for the child. c. Determine appropriate nursing diagnoses. d. State nursing actions related to the child‘s medical diagnosis. ANS: C The nurse uses assessment data to select appropriate nursing diagnoses. Outcomes and interventions are then developed to address the relevant nursing diagnoses. DIF: Cognitive Level: Application REF: p. 12 OBJ: 7 TOP: Nursing Process KEY: Nursing Process Step: Nursing Diagnosis MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care 11. A nursing student on an obstetric rotation questions the floor nurse about the definition of the LVN/LPN scope of practice. What resource can the nurse suggest to the student? a. American Nurses Association

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    b. State‘s Board of Nursing c. Joint Commission d. Association of Women‘s Health, Obstetric and Neonatal Nurses ANS: B The scope of practice of the LVN/LPN is published by the state‘s board of nursing. DIF: Cognitive Level: Comprehension REF: p. 16 OBJ: 2 TOP: Critical Thinking KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care 12. What was recommended by Karl Credé in 1884? a. All women should be delivered in a hospital setting. b. Chemical means should be used to combat infection. c. Podalic version should be done on all fetuses. d. Silver nitrate should be placed in the eyes of newborns. ANS: D In 1884 Karl Credé recommended the use of 2% silver nitrate in the eyes of newborns to reduce the incidence of blindness. DIF: Cognitive Level: Knowledge REF: p. 2 OBJ: 1 TOP: Use of Silver Nitrate KEY: Nursing Process Step: N/A MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 13. What is the purpose of the White House Conference on Children and Youth? a. Set criteria for normal growth patterns. b. Examine the number of live births in minority populations. c. Raise money to support well-child clinics in rural areas. d. Promote comprehensive child welfare. ANS: D White House Conferences on Children and Youth are held every 10 years to promote comprehensive child welfare. DIF: Cognitive Level: Knowledge REF: p. 4 OBJ: 2 TOP: White House Conferences KEY: Nursing Process Step: N/A MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 14. How many hours of hospital stay does legislation currently allow for a postpartum patient who has delivered vaginally without complications? a. 24 b. 48 c. 36 d. 72 ANS: B Postpartum patients who deliver vaginally stay in the hospital for an average of 48 hours; patients who have had a cesarean delivery usually stay 4 days. DIF: Cognitive Level: Knowledge REF: p. 6 OBJ: 5 TOP: Hospital Terms for Postpartum Patients KEY: Nursing Process Step: Planning

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    MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 15. How does the clinical pathway or critical pathway improve quality of care? a. Lists diagnosis-specific implementations b. Outlines expected progress with stated timelines c. Prioritizes effective nursing diagnoses d. Describes common complications ANS: B Critical pathways outline expected progress with stated timelines. Any deviation from those timelines is called a variance. DIF: Cognitive Level: Comprehension REF: p. 13 OBJ: 10 TOP: Critical Pathway KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care 16. A patient asks the nurse to explain what is meant by “ gene therapy . ” What is the nurse ‘s b est response? a. Gene therapy can replace missing genes. b. Gene therapy evaluates the parent‘s genes. c. Gene therapy can change the sex of the fetus. d. Gene therapy supports the regeneration of defective genes. ANS: A Gene therapy can replace missing or defective genes. DIF: Cognitive Level: Knowledge REF: p. 8 OBJ: 5 TOP: Gene Therapy KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 17. The nurse is clarifying information to a patient regarding diagnosis-related groups (DRGs). What is the nurse‘s best response when the patient asks how DRGs reduce medical care costs? a. By determining payment based on diagnosis b. By requiring two medical opinions to confirm a diagnosis c. By organizing HMOs d. By defining a person who will require hospitalization ANS: A DRGs determine the amount of payment and length of hospital stay based on the diagnosis. DIF: Cognitive Level: Comprehension REF: p. 8 OBJ: 3 TOP: DRGs KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care 18. How does electronic charting ensure comprehensive charting more effectively than handwritten charting? a. Provides a uniform style of chart. b. Requires certain responses before allowing the user to progress. c. All documentation is reflective of the nursing care plan. d. Requires a daily audit by the charge nurse. ANS: B

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    Comprehensive electronic documentation is ensured by requiring specific input in designated categories before the user can progress through the system. DIF: Cognitive Level: Comprehension REF: pp. 16-17 OBJ: 12 TOP: Computer Charting KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care 19. The nurse reminds family members that the philosophy of family-centered care is to provide control to the family over health care decisions. What is the appropriate term for this type of control? a. Empowerment b. Insight c. Regulation d. Organization ANS: A The term empowerment refers to the control a family has over its own health care decisions. DIF: Cognitive Level: Knowledge REF: p. 1 OBJ: 13 TOP: Empowerment KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 20. A patient in the prenatal clinic is concerned about losing her job because of her pregnancy. The nurse instructs her that the Family Medical Leave Act (FMLA) allows an employee to be absent from work without pay. How many weeks does the FMLA allow a woman to recover from childbirth or care for a sick family member without loss of benefits or pay status? a. 4 b. 6 c. 10 d. 12 ANS: D The FMLA allows for employees to leave work for up to 12 weeks to recover from childbirth or to care for an ill family member without losing benefits or pay status. DIF: Cognitive Level: Knowledge REF: p. 3 OBJ: 5 TOP: FMLA KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 21. What term appropriately describes the nurse who is able to adapt health care practices to meet the needs of various cultures? a. Culturally aware b. Culturally sensitive c. Culturally competent d. Culturally adaptive ANS: C The nurse who is able to adapt health care to meet the needs of various cultures is said to be culturally competent. DIF: Cognitive Level: Knowledge REF: p. 6 OBJ: 6 TOP: Cultural Competency KEY: Nursing Process Step: N/A

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    MSC: NCLEX: N/A 22. What is one major advantage to the application of critical thinking? a. Problem-free care b. Limitation of approaches to care c. Decreased need for assessment d. Problem prevention ANS: D Critical thinking results in problem prevention in designing nursing care. DIF: Cognitive Level: Comprehension REF: p. 15 OBJ: 11 TOP: Critical Thinking KEY: Nursing Process Step: N/A MSC: NCLEX: N/A MULTIPLE RESPONSE 1. What services are birthing centers able to provide? ( Select all that apply. ) a. Prenatal care b. Labor and delivery services c. Classes for new mothers d. Adoption referrals e. Family planning ANS: A, B, C, E Birthing centers are capable of providing full-service obstetric care, classes for new mothers, and family planning. Birthing centers do not offer adoption services. DIF: Cognitive Level: Comprehension REF: p. 6 OBJ: 5 TOP: Birthing Centers KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Coordinated Care 2. What developments in the early 20th century encouraged women to seek hospitalization for childbirth? ( Select all that apply. ) a. Use of specialized obstetric instruments b. Use of anesthesia c. Physicians‘ closer rela tionships with hospitals d. Focus on family-centered care e. Insurance coverage ANS: A, B, C In the early 1900s, the development of specialized obstetric instruments, better modes of anesthesia, and the physician‘s reliance on hospital services were instrumental in encouraging women to seek hospitalization for childbirth. DIF: Cognitive Level: Comprehension REF: pp. 2-3 OBJ: 5 TOP: Hospitalization for Childbirth KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control 3. What non – family-centered policies were prevalent in the 1960s? ( Select all that apply. ) a. Waiting room for fathers b. Sedation of mother during labor

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    c. Delay of reunion of mother and infant d. Lenient visiting hours e. Restrictions of visitations by minor children ANS: A, B, C, E Hospital policies in the 1960s provided a separate waiting room for fathers while the mother went through labor in a sedated state. The reunion of mother and infant was delayed for several hours because of the sedation. Visiting hours were rigid and disallowed the visitation of minor children. DIF: Cognitive Level: Comprehension REF: p. 3 OBJ: 5 TOP: Non – Family-Centered Practices KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control 4. The nurse is aware that there is a legal responsibility to report certain diseases and conditions to county or state health authorities. Which would be included? ( Select all that apply. ) a. Tuberculosis b. Child abuse c. Industrial accidents d. Sexually transmitted diseases e. Foodborne infections ANS: A, B, D, E The nurse has a legal responsibility to report communicable diseases (such as tuberculosis and sexually transmitted diseases), foodborne infections, child abuse, and threats of suicide. DIF: Cognitive Level: Comprehension REF: p. 4 | Legal and Ethical Considerations Box OBJ: 4 TOP: Reportable Diseases KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control 5. Practical nursing students are using critical thinking skills to study for an upcoming test. What will these students include when studying? ( Select all that apply. ) a. Memorization of facts first b. Prioritizing information c. Relating facts to other facts d. Making assumptions e. Reviewing before the test ANS: B, C, E Using critical thinking when studying involves understanding facts before memorizing, prioritizing information to be memorized, relating facts to other facts, using all five senses, reviewing before tests, and reading critically. Critical thinking does not involve assumption as does general thinking. DIF: Cognitive Level: Comprehension REF: p. 16 OBJ: 8 TOP: Critical Thinking KEY: Nursing Process Step: Evaluation MSC: NCLEX: Safe, Effective Care Environment 6. What factors have played a role in meeting the goals of Healthy People 2030 as it relates the goals for outcomes of pregnancy? ( Select all that apply. ) a. Early prenatal care

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    b. Increased number of surgical births c. NICU care d. Use of prenatal glucocorticoids e. Fetal surgery ANS: A, C, D, E Early prenatal care, fetal surgery, use of prenatal glucocorticoids, technology, and NICU care have played a role in increasing the positive outcome of pregnancy, and the goals of Healthy People 2030 may well be met. Increase in surgical births and multiple gestations do not work toward meeting the goals of Healthy People 2030. DIF: Cognitive Level: Comprehension REF: p. 17 OBJ: 13 TOP: Healthy People 2030 KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection 7. A community health nurse is providing specialized care to patients in the home setting. What kind of specialized care may this nurse be providing? ( Select all that apply. ) a. Glucose monitoring b. Heparin therapy c. Family education d. Total parenteral nutrition e. Provision of referral services ANS: A, B, D Glucose monitoring, heparin therapy, and total parenteral nutrition are categorized as specialized care that may be provided by the community health nurse. Family education and provision of referral are categorized as therapeutic care. DIF: Cognitive Level: Application REF: p. 20 OBJ: 14 TOP: Community Health KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

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    Chapter 02: Human Reproductive Anatomy and Physiology Leifer: Introduction to Maternity and Pediatric Nursing, 9th Edition MULTIPLE CHOICE 1. A 14-year-old boy is at the pediatric clinic for a checkup. What physical changes of puberty will the nurse indicate are related to the production of testosterone? a. Stimulation of production of white cells and platelets b. Promotion of growth of small bones c. Increase in muscle mass and strength d. Decrease in production of sebaceous gland secretions ANS: C Testosterone increases muscle mass, promotes strength and growth of long bones, and enhances production of red blood cells. DIF: Cognitive Level: Knowledge REF: p. 25 OBJ: 1 | 2 | 5 TOP: Male Reproductive System KEY: Nursing Process Step: Data Collection MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 2. The nurse is educating high school students about puberty. What will the nurse indicate regulates the production of sperm and secretion hormones? a. Testes b. Vas deferens c. Ejaculatory ducts d. Prostate gland ANS: A The testes have two functions: manufacture of spermatozoa and secretion of androgens. DIF: Cognitive Level: Knowledge REF: p. 24 OBJ: 3 | 5 TOP: Male Reproductive System KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 3. The nurse is speaking with a couple trying to conceive a child. What will the nurse remind the couple is a factor that can decrease sperm production? a. Infrequent sexual intercourse b. The man not being circumcised c. The penis and testes being small d. The testes being too warm ANS: D The scrotum is suspended away from the perineum to lower the temperature of the testes for sperm production. DIF: Cognitive Level: Comprehension REF: p. 25 OBJ: 3 TOP: Male Reproductive System KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk 4. When describing the female reproductive tract to a pregnant woman, the nurse would explain that which uterine layer is involved in implantation? a. Perimetrium b. Endometrium c. Myometrium d. Internal os ANS: B

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    The endometrium is the inner mucosal layer of the uterus that is governed by cyclical hormonal changes. It is functional during menstruation and during the implantation of a fertilized ovum. DIF: Cognitive Level: Knowledge REF: p. 27 OBJ: 7 TOP: Female Reproductive System KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 5. A group of nursing students plans to teach a class of sixth-grade girls about menstruation. What correct information will the nursing students teach to the class? a. Menarche usually occurs around 12 years of age. b. Ovulation occurs regularly from the very first cycle. c. A regular cycle is established by the third period. d. Typically, menstrual flow is heavy and lasts up to 10 days. ANS: A The beginning of menstruation, called menarche , occurs at about 12 years of age. Early cycles are irregular and anovulatory. DIF: Cognitive Level: Comprehension REF: p. 30 OBJ: 1 | 9 TOP: Female Reproductive Cycle and Menstruation KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 6. A 10-yea r-old girl asks the nurse, “ What is the first sign of puberty? ” What is the correct nursing response? a. An increase in height b. Breast development c. Appearance of axillary hair d. The first menstrual period ANS: B The first outward change of puberty in girls is the development of breasts at about 10 to 11 years of age. DIF: Cognitive Level: Knowledge REF: p. 24 OBJ: 1 | 2 TOP: Puberty — Female KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 7. A 12-year-old female patient experienced menarche 3 months ago. Her mother voices concern to the pediatric office nurse regarding the irregularity of her daughter‘s menstrual cycle. What is the nurse‘s best response? a. “ Worrying is not the answe r. ” b. “ I will talk to the pediatrician about a gynecological referra l. ” c. “ I can only discuss this with your daughter . ” d. “ Early cycles are often irregular. ” ANS: D Early cycles are often irregular and may be anovulatory. Regular cycles are usually established within 6 months to 2 years of the menarche. In an average cycle, the flow (menses) occurs every 28 days, plus or minus 5 to 10 days.

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    DIF: Cognitive Level: Application REF: p. 30 OBJ: 9 TOP: Menstrual Cycle KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 8. Which hormone initiates the maturation of the ovarian follicle? a. Estrogen b. Follicle-stimulating hormone c. Progesterone d. Luteinizing hormone ANS: B Follicle-stimulating hormone (FSH) stimulates the maturation of a follicle. DIF: Cognitive Level: Knowledge REF: p. 30 OBJ: 1 | 9 TOP: Female Reproductive Cycle KEY: Nursing Process Step: N/A MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 9. What statement indicates a woman has correct information about oogenesis? a. “ Women make fewer ova as they age . ” b. “ Women have all of their ova at the time they are born. ” c. “ Ova production begins at birth and continues until puberty . ” d. “ New ova are made every month from puberty to climacteric. ” ANS: B Oogenesis (formation of immature ova) does not occur after fetal development. Females are born with about 2 million immature ova, which rapidly reduce by adulthood. DIF: Cognitive Level: Comprehension REF: p. 28 OBJ: 9 TOP: Female Reproductive Cycle KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 10. A pregnant woman asks the nurse, “ Will I be able to have a vaginal delivery? ” The nurse knows that which is the most favorable pelvic type for vaginal birth? a. Gynecoid b. Android c. Anthropoid d. Platypelloid ANS: A The gynecoid pelvis is the typical female pelvis and is most favorable for vaginal birth. DIF: Cognitive Level: Knowledge REF: p. 28 OBJ: 8 TOP: Female Reproductive System KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 11. A mother is anxious about her ability to breastfeed after her child is born because of her small breast size. What would be an important point to teach this mother? a. Milk is produced in ducts and lobules regardless of breast size. b. Supplementing breastfeeding with formula allows the infant to receive adequate nutrition. c. Breast size can be increased with exercise. d. Drinking extra milk during pregnancy allows breasts to produce adequate amounts

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    of milk. ANS: A Breast size does not influence the ability to secrete milk. DIF: Cognitive Level: Comprehension REF: p. 30 OBJ: 6 TOP: Female Reproductive System KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 12. For what is the decrease in estrogen and progesterone during the menstrual cycle responsible? a. Degeneration of the corpus luteum b. Ovulation c. Follicle maturation d. Shedding of the endometrium ANS: D The fall in estrogen and progesterone causes the endometrium to break down, resulting in menstruation. DIF: Cognitive Level: Comprehension REF: p. 30 OBJ: 9 TOP: Female Reproductive Cycle KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 13. The nurse is assisting with pelvic inlet measurements on a pregnant woman. What measurement will provide the nurse with information about whether the woman can deliver vaginally? a. Diagonal conjugate b. Obstetric conjugate c. Transverse diameter d. Anteroposterior diameter ANS: B This measurement determines if the fetus can pass through the birth canal. DIF: Cognitive Level: Comprehension REF: p. 29 OBJ: 8 TOP: Female Reproductive System KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 14. The nurse has explained menstruation to a 13-year-old girl. What statement indicates the girl needs additional education? a. “ Periods last about 5 day s. ” b. “ My cycle should get regular in 6 months . ” c. “ I should expect heavy bleeding with clots . ” d. “ Periods come about every 4 weeks. ” ANS: C Clots are not normally seen in menstrual discharge. A normal menstrual flow is 30 to 40 mL blood and 30 to 50 mL serous fluid. DIF: Cognitive Level: Comprehension REF: p. 30 OBJ: 9 TOP: Female Reproductive Cycle KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

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    15. A mother asks the nurse, “ When will I know my child has entered puberty? ” What will the nurse state based on an understanding of changes associated with puberty? a. “ Your daughter will have her first period. ” b. “ You ‘ ll recognize puberty by the mood swing s. ” c. “ The child becomes interested in the opposite sex . ” d. “ Secondary sex characteristics, such as pubic hair, appear. ” ANS: D Puberty begins when the secondary sex characteristics appear. Puberty ends when mature sperm are formed in the male and when regular menstrual cycles occur in the female. DIF: Cognitive Level: Comprehension REF: p. 23 OBJ: 1 | 2 TOP: Puberty KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 16. A nurse is planning to teach couples about the physiology of the sex act. What correct information will the nurse provide? a. “ Fertilization of an ovum requires penetration by several spe rm. ” b. “ An ovum must be fertilized within 24 hours of ovulati on. ” c. “ It takes 4 to 5 days for sperm to reach the fallopian tube s. ” d. “ Sperm live for only 24 hours following ejaculati on. ” ANS: B After ovulation, the egg lives for only 24 hours. Sperm must be available during that time if fertilization is to occur. DIF: Cognitive Level: Comprehension REF: p. 32 OBJ: 6 | 7 TOP: Physiology of the Sex Act KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 17. A newly married couple tells the nurse they would like to wait a few years before starting a family. Which statement made by the man indicates an understanding about sexual activity and pregnancy? a. “ My wife can ‘ t get pregnant if I withdraw before climax . ” b. “ A man can secrete semen before ejaculati on. ” c. “ If we don ‘ t have intercourse very often, my wife won ‘ t get pregna nt. ” d. “ It is safe to ejaculate outside the vag ina. ” ANS: B Semen may be secreted during sexual intercourse before ejaculation. DIF: Cognitive Level: Comprehension REF: p. 25 OBJ: 4 TOP: Male Reproductive System KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity: Reduction of Risk 18. The nurse is aware that the diagonal conjugate is 12 cm. What is the measurement in centimeters of the obstetric conjugate? a. 10 to 10.5 b. 11 to 11.5 c. 12.5 to 13 d. 14 to 14.5

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    ANS: A The obstetric conjugate is approximately 1.5 to 2 cm shorter than the diagonal conjugate. DIF: Cognitive Level: Knowledge REF: p. 29 OBJ: 1 | 8 TOP: Obstetric Conjugate KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 19. The nurse uses a diagram to demonstrate the fimbriae when teaching nursing students about the female anatomy. What is true about fimbriae? a. They form the passageway for the sperm to meet the ovum. b. They are the site of fertilization. c. They are fingerlike projections that “ c apture ” the ovum. d. They propel the egg through the fallopian tube. ANS: C Fimbriae are the fingerlike projections from the infundibulum that “ c apture ” the ovum at ovulation and conduct it into the fallopian tube. DIF: Cognitive Level: Comprehension REF: p. 28 OBJ: 6 | 7 TOP: Fimbriae KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 20. What will the nurse explain to a 12-year-old patient when describing what characterizes nocturnal emissions? a. A drop in testosterone level b. Sexual stimulation c. Absence of sperm in ejaculate d. Association with violent dreams ANS: C Nocturnal emissions, also known as “ wet dreams, ” occur without sexual stimulation and contain no sperm. Testosterone levels are constant until midlife. DIF: Cognitive Level: Comprehension REF: p. 24 OBJ: 2 TOP: Nocturnal Emissions KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 21. The nurse is educating a pregnant patient who expects to breastfeed. The nurse knows that when a patient breastfeeds, which portions of the breast secrete milk? a. Lactiferous sinuses b. Lobes c. Montgomery‘s glands d. Alveoli lobules ANS: D The alveoli secrete milk. DIF: Cognitive Level: Knowledge REF: p. 30 OBJ: 6 | 7 TOP: Milk Secretion KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 22. Where are the secretions responsible for nourishing sperm excreted from?

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    a. Vas deferens b. Epididymis c. Cowper‘s gland d. Scrotum ANS: C The Cowper‘s gland secretions nourish the sperm. DIF: Cognitive Level: Knowledge REF: p. 25 OBJ: 4 TOP: Cowper‘s Gland KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 23. What signifies the end of puberty for a male? a. Facial hair is evident. b. Erections can be sustained. c. Ejaculate is greater than 5 mL. d. Mature sperm are formed. ANS: D Puberty ends for a male when mature sperm are formed by the testes. DIF: Cognitive Level: Knowledge REF: p. 23 OBJ: 1 | 2 TOP: End of Puberty KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 24. How long does sperm remain viable in the female reproductive tract? a. 12 hours b. 1 day c. 2 days d. 4 days ANS: D Sperm can remain viable in the reproductive tract of the female for as long as 4 to 5 days. DIF: Cognitive Level: Knowledge REF: p. 32 OBJ: 5 TOP: Viability of Sperm KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 25. The nurse encourages the members of a prenatal class to seriously consider breastfeeding. What does breast milk provide in addition to nourishment for the infant? a. Maternal antibodies b. Stimulus for red blood cell production c. Endorphins that soothe the infant d. Hormones that stimulate growth ANS: A Breast milk provides maternal antibodies to the infant that give the child acquired immunity from some diseases for several months. DIF: Cognitive Level: Comprehension REF: p. 29 OBJ: 7 TOP: Properties of Breast Milk KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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    26. A female patient reports her menstrual cycle consistently occurs every 32 days. What day of her cycle can the woman anticipate ovulation? a. 14 b. 16 c. 18 d. 20 ANS: C Ovulation occurs when a mature ovum is released from the follicle about 14 days before the onset of the next menstrual period. DIF: Cognitive Level: Analysis REF: p. 30 OBJ: 9 TOP: Menstrual Cycle KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development MULTIPLE RESPONSE 1. The nurse conducting a sex education class for junior high students describes some cultural rites celebrating the entry to adulthood. What information would the nurse include? ( Select all that apply. ) a. Bar mitzvah b. Displays of bravery c. Receiving part of their inheritance d. Ritual circumcision e. Displays of self-defense ANS: A, B, D, E Some cultures celebrate the entry to adulthood with rites such as displays of strength, bravery, self-reliance, and self-defense. Ritual circumcisions and bar and bat mitzvahs are also entry rites to adulthood. Lack of such rituals can sometimes confuse young people because there is no evidence of acceptance as an adult. DIF: Cognitive Level: Knowledge REF: p. 23 OBJ: 2 TOP: Rites of Passage KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 2. The nurse is reading a pregnant patient‘s history and physical. What information does the nurse recognize might indicate the need for a cesarean delivery? ( Select all that apply. ) a. History of childhood rickets b. Immobile coccyx c. Prepregnant weight of 100 pounds d. Avid horse rider e. Pelvic fracture 3 years ago ANS: A, B, E Pelvic conditions that may predispose to a cesarean delivery are childhood rickets, pelvic fracture, and immobile coccyx. DIF: Cognitive Level: Comprehension REF: pp. 28-29 OBJ: 8 TOP: Pelvic Conditions Predisposing Cesarean Delivery KEY: Nursing Process Step: Data Collection

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    MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 3. What are considered to be functions of the fallopian tubes? ( Select all that apply. ) a. Passage for sperm to meet ova b. Passage for ovum to uterus c. Safe environment for zygote d. Restriction for only one ovum to enter uterus e. Site for fertilization ANS: A, B, C, E The fallopian tube provides passage for both sperm and ova, offering an optimum place for fertilization and a safe environment for the zygote. DIF: Cognitive Level: Knowledge REF: p. 28 OBJ: 7 TOP: Function of Fallopian Tubes KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 4. The nurse is providing an in-service to students beginning their obstetric clinical rotation. Using a diagram, the nurse points out parts of the female pelvis. What will the nurse include? ( Select all that apply. ) a. Two innominates b. Obstetric conjugate c. Sacrum d. Perimetrium e. Coccyx ANS: A, C, E The bones of the pelvis are two innominates, the sacrum, and the coccyx. DIF: Cognitive Level: Knowledge REF: p. 28 OBJ: 6 | 8 TOP: Bones of the Pelvis KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 5. The nurse explains that testosterone is responsible for males exceeding females in which aspects? ( Select all that apply. ) a. Strength b. Height c. Mental concentration d. Hematocrit levels e. Agility ANS: A, B, D Testosterone has the following effects not directly related to sexual reproduction: increases muscle mass and strength, promotes growth of long bones, increases basal metabolic rate, enhances production of red blood cells, produces enlargement of vocal cords, and affects the distribution of body hair. These effects result in greater strength and stature and a higher hematocrit level in males than in females. DIF: Cognitive Level: Knowledge REF: p. 25 OBJ: 2 TOP: Effects of Testosterone KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

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    6. A patient is being seen by her health care provider for a suspected vaginal infection. What will the nurse include when educating this patient on factors that affect the vaginal pH? ( Select all that apply. ) a. Antibiotic therapy b. Frequent douching c. Exercise d. Jet lag e. Use of vaginal sprays ANS: A, B, E The vagina is self-cleansing and during the reproductive years maintains a normal acidic pH of 4 to 5. The self-cleansing activity may be altered by antibiotic therapy, frequent douching, and excessive use of vaginal sprays, deodorant sanitary pads, or deodorant tampons. DIF: Cognitive Level: Application REF: p. 26 OBJ: 7 TOP: Female Reproductive Organs KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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    Chapter 03: Fetal Development Leifer: Introduction to Maternity and Pediatric Nursing, 9th Edition MULTIPLE CHOICE 1. What is the total number of chromosomes contained in a mature sperm or ovum? a. 22 b. 23 c. 44 d. 46 ANS: B Gametes (sex cells) contain 23 chromosomes. DIF: Cognitive Level: Knowledge REF: p. 34 OBJ: 2 TOP: Gametogenesis KEY: Nursing Process Step: N/A MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 2. A pregnant woman states, “ M y husband hope s I w ill give him a boy beca us e we have three girls. ” What will the nurse explain to this woman? a. The sex chromosome of the fertilized ovum determines the gender of the child. b. When the sperm and ovum are united, there is a 75% chance the child will be a girl. c. When the pH of the female reproductive tract is acidic, the child will be a girl. d. If a sperm carrying a Y chromosome fertilizes an ovum, then a boy is produced. ANS: D When a Y-bearing sperm fertilizes an ovum, a male child is produced. DIF: Cognitive Level: Comprehension REF: p. 36 OBJ: 3 TOP: Sex Determination KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 3. What is the most common site for fertilization? a. Lower segment of the uterus b. Outer third of the fallopian tube near the ovary c. Upper portion of the uterus d. Area of the fallopian tube farthest from the ovary ANS: B Fertilization takes place in the outer third of the fallopian tube, which is closest to the ovary. DIF: Cognitive Level: Knowledge REF: pp. 35-36 OBJ: 3 TOP: Fertilization KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 4. The embryo is termed a fetus at which stage of prenatal development? a. 2 weeks b. 4 weeks c. 9 weeks d. 16 weeks ANS: C The fetus (third stage of prenatal development) begins at the ninth week and continues until the 40th week of gestation or until birth. DIF: Cognitive Level: Knowledge REF: p. 39 OBJ: 4

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    KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 5. The nurse is reviewing fetal circulation with a pregnant patient and explains that blood circulates through the placenta to the fetus. What vessel(s) carry blood to the fetus? a. One umbilical vein b. Two umbilical veins c. One umbilical artery d. Two umbilical arteries ANS: A The umbilical vein transports richly oxygenated blood from the placenta to the fetus. DIF: Cognitive Level: Knowledge REF: p. 43 OBJ: 7 TOP: Fetal Circulation KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 6. Where is the usual location for implantation of the zygote? a. Upper section of the posterior uterine wall b. Lower portion of the uterus near the cervical os c. Inner third of the fallopian tube near the uterus d. Lateral aspect of the uterine wall ANS: A The zygote usually implants in the upper section of the posterior uterine wall. DIF: Cognitive Level: Knowledge REF: p. 38 OBJ: 3 TOP: Implantation KEY: Nursing Process Step: N/A MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

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    7. What is the embryonic membrane that contains fingerlike projections on its surface, which attach to the uterine wall? a. Amnion b. Yolk sac c. Chorion d. Decidua basalis ANS: C The chorion is a thick membrane with fingerlike projections (villi) on its outermost surface. DIF: Cognitive Level: Knowledge REF: p. 38 OBJ: 4 TOP: Accessory Structures of Pregnancy KEY: Nursing Process Step: N/A MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 8. Which hormone is responsible for converting the endometrium into decidual cells for implantation? a. Estrogen b. Human chorionic gonadotropin c. Human placental lactogen d. Progesterone ANS: D At high levels, progesterone maintains the endometrial lining for implantation of the zygote. DIF: Cognitive Level: Knowledge REF: p. 42 OBJ: 6 TOP: Placenta KEY: Nursing Process Step: N/A MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 9. A pregnant patient asks the nurse when her infant‘s heart will begin to pump blood. What will the nurse reply? a. By the end of week 3 b. Beginning in week 8 c. By the end of week 16 d. Beginning in week 24 ANS: A The fetal heart begins to pump by week 3 of gestation. DIF: Cognitive Level: Knowledge REF: p. 43 OBJ: 5 TOP: Prenatal Development KEY: Nursing Process Step: N/A MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 10. What organ does the ductus venosus shunt blood away from in fetal circulation? a. Liver b. Heart c. Lungs d. Kidneys ANS: A Fetal blood bypasses the liver through the ductus venosus by carrying blood directly to the inferior vena cava.

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    DIF: Cognitive Level: Knowledge REF: p. 43 OBJ: 7 TOP: Prenatal Development KEY: Nursing Process Step: N/A MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 11. What complication can result from untreated respiratory distress in the newborn? a. Esophageal atresia b. Gastric dilation c. Cold stress d. Reopening of the foramen ovale ANS: D Respiratory distress can cause increased pressure in the right ventricle, causing reopening of the foramen ovale. DIF: Cognitive Level: Comprehension REF: p. 43 OBJ: 7 TOP: Fetal Circulation KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 12. During an ultrasound, two amnions and two placentas are observed. What will be the most likely result of this pregnancy? a. Dizygotic twins b. Monozygotic twins c. Conjoined twins d. High – birth weight twins ANS: A Dizygotic twins always have two amnions and two chorions (placentas). DIF: Cognitive Level: Comprehension REF: p. 45 OBJ: 8 TOP: Multifetal Pregnancy KEY: Nursing Process Step: Data Collection MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 13. A woman who is 25 weeks pregnant asks the nurse what her fetus looks like. What does the nurse explain is one physical characteristic present in a 25-week-old fetus? a. Lanugo covering the body b. Constant motion c. Skin that is pink and smooth d. Eyes that are closed ANS: A By 25 weeks, the body of the fetus is covered with lanugo, the eyes are open, the skin is wrinkled, and the fetus has definite periods of movement and sleeping. DIF: Cognitive Level: Comprehension REF: p. 41 | Table 3.1 OBJ: 5 TOP: Prenatal Development KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 14. At what point in prenatal development do the lungs begin to produce surfactant? a. 17 weeks b. 20 weeks

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    c. 25 weeks d. 30 weeks ANS: C During week 25, the alveoli begin to produce surfactant, which enables the alveoli to stay open for adequate lung oxygenation to occur. DIF: Cognitive Level: Knowledge REF: p. 41 | Table 3.1 OBJ: 5 TOP: Prenatal Development KEY: Nursing Process Step: N/A MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 15. A woman missed her menstrual period 1 week ago and has come to the doctor‘s office for a pregnancy test. Which placental hormone is measured in pregnancy tests? a. Progesterone b. Estrogen c. Human chorionic gonadotropin d. Human placental lactogen ANS: C Human chorionic gonadotropin is the basis for most pregnancy tests. It is detectable in maternal blood as soon as implantation occurs, usually 7 to 9 days after fertilization. DIF: Cognitive Level: Knowledge REF: p. 42 OBJ: 6 TOP: Accessory Structures of Pregnancy KEY: Nursing Process Step: Data Collection MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 16. When preparing to teach a class about prenatal development, the nurse would include information about folic acid supplementation. What is folic acid known to prevent? a. Congenital heart defects b. Neural tube defects c. Mental retardation d. Premature birth ANS: B It is now known that folic acid supplements can prevent neural tube defects such as spina bifida. DIF: Cognitive Level: Comprehension REF: p. 39 OBJ: 5 TOP: Prenatal Development KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 17. The nurse is educating a class of expectant parents about fetal development. What is considered fetal age of viability? a. 14 weeks b. 20 weeks c. 25 weeks d. 30 weeks ANS: B By 20 weeks of gestation, the lungs have matured enough for the fetus to survive outside the uterus (age of viability).

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    DIF: Cognitive Level: Knowledge REF: p. 39 OBJ: 5 TOP: Prenatal Developmental Milestones KEY: Nursing Process Step: N/A MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 18. The nurse is presenting a conference on gene dominance. What does the nurse report as the percentage of children carrying the dominant gene if one parent has a dominant gene and the other parent does not? a. 10% b. 25% c. 50% d. 100% ANS: C If one parent has a dominant trait and the other does not, then 50% of the children will inherit the trait. DIF: Cognitive Level: Comprehension REF: p. 37 OBJ: 4 TOP: Dominant Traits KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 19. The nurse explains that the birth weight of monozygotic twins is frequently below average. What is the most likely cause? a. Inadequate space in the uterus b. Inadequate blood supply c. Inadequate maternal health d. Inadequate placental nutrition ANS: D The single placenta may not be able to provide adequate nutrition to two fetuses. DIF: Cognitive Level: Comprehension REF: p. 45 OBJ: 8 TOP: Low Birth-Weight Twins KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 20. The school nurse is counseling a group of adolescent girls. What does the nurse explain about sperm ejaculated near the cervix? a. They are destroyed by the acidic pH of the vagina. b. They survive up to 5 days and can cause pregnancy. c. They lose their motility in about 12 hours after intercourse. d. They are usually pushed out of the vagina by the muscular action of the vaginal wall. ANS: B Sperm ejaculated near the cervix can survive up to 5 days and cause pregnancy even before ovulation. DIF: Cognitive Level: Comprehension REF: p. 36 OBJ: 3 TOP: Fertilization KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 21. What does the nurse explain can affect the survival of the X- and Y-bearing sperm after intercourse?

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    a. Age b. Estrogen level c. Body temperature d. Level of feminine hygiene ANS: B Estrogen levels and the pH of the female reproductive tract can affect the survival of the X- and Y-bearing sperm as well as their motility. DIF: Cognitive Level: Knowledge REF: p. 36 OBJ: 3 TOP: Fertilization KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 22. Of what is the normal umbilical cord comprised? a. 1 artery carrying blood to the fetus and 1 vein carrying blood away from the fetus b. 1 artery carrying blood to the fetus and 2 veins carrying blood away from the fetus c. 2 arteries carrying blood away from the fetus and 1 vein carrying blood to the fetus d. 2 arteries carrying blood to the fetus and 2 veins carrying blood away from the fetus ANS: C The umbilical cord is comprised of 2 arteries carrying blood away from the fetus and 1 vein carrying blood to the fetus. DIF: Cognitive Level: Knowledge REF: p. 43 OBJ: 6 TOP: Fetal Circulation KEY: Nursing Process Step: N/A MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 23. What part of the fetal body derives from the mesoderm? a. Nails b. Oil glands c. Muscles d. Lining of the bladder ANS: C The mesoderm is responsible for the development of muscles. Nails and oil glands derive from the ectoderm. The lining of the bladder derives from the endoderm. DIF: Cognitive Level: Knowledge REF: p. 39 | Box 3.1 OBJ: 4 TOP: Embryonic Development KEY: Nursing Process Step: N/A MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 24. A couple just learned they are expecting their first child and are curious if they are having a boy or a girl. At what point of development can the couple first expect to see the sex of their child on ultrasound? a. 4 weeks‘ gestational age b. 6 weeks‘ gestational age c. 10 weeks‘ gestational age d. 16 weeks‘ gestational age ANS: C

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    The fetal period begins at the 9th week, and by the 10th week the external genitalia are visible to ultrasound examination. DIF: Cognitive Level: Knowledge REF: p. 39 OBJ: 5 TOP: Fetal Development KEY: Nursing Process Step: Data Collection MSC: NCLEX: Health Promotion and Maintenance: Growth and Development MULTIPLE RESPONSE 1. A nurse is teaching a lesson on fetal development to a class of high school students and explains the primary germ layers. What are the germ layers? ( Select all that apply. ) a. Ectoderm b. Endoderm c. Mesoderm d. Plastoderm e. Blastoderm ANS: A, B, C The zygote transforms its embryonic disc into three layers: the ectoderm, the mesoderm, and the endoderm. DIF: Cognitive Level: Knowledge REF: p. 39 | Box 3.1 OBJ: 4 TOP: Primary Germ Layers KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 2. What are the functions of amniotic fluid? ( Select all that apply. ) a. Maintaining an even temperature b. Impeding excessive fetal movement c. Lubricating fetal skin d. Acting as a reservoir for nutrients e. Acting as a cushion for the fetus ANS: A, E The amniotic fluid provides maintenance of even temperature; prevents amnion from adhering to fetal skin; allows buoyancy, symmetrical growth, and fetal movement; and acts as a cushion for the fetus. Although the fetus does swallow amniotic fluid, it has no nutritional value. DIF: Cognitive Level: Knowledge REF: p. 38 OBJ: 6 TOP: Amniotic Fluid KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 3. A patient at the obstetric office has just learned she is pregnant with dizygotic twins. What facts will the nurse include when educating this patient? ( Select all that apply. ) a. Dizygotic twins are the same sex. b. Dizygotic twins share a placenta. c. Dizygotic pregnancies tend to repeat in families. d. Dizygotic twins have separate chorions. e. Dizygotic twin incidence decreases with maternal age.

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    ANS: C, D Dizygotic twins tend to repeat in families and have separate chorions. They can be the same sex or different sexes and have their own placenta. Incidence increases with maternal age. DIF: Cognitive Level: Comprehension REF: p. 45 OBJ: 8 TOP: Dizygotic Twins KEY: Nursing Process Step: Data Collection MSC: NCLEX: Health Promotion and Maintenance: Growth and Development COMPLETION 1. The normal volume of amniotic fluid is approximately mL at 37 weeks‘ gestation. ANS: 1000 The volume of amniotic fluid steadily increases from about 30 mL at 10 weeks of pregnancy to 350 mL at 20 weeks. The volume of fluid is about 1000 mL at 37 weeks. In the latter part of pregnancy, the fetus may swallow up to 400 mL of amniotic fluid per day and normally excretes urine into the fluid. DIF: Cognitive Level: Knowledge REF: p. 38 OBJ: 6 TOP: Amniotic Fluid KEY: Nursing Process Step: Data Collection MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

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    Chapter 04: Prenatal Care and Adaptations to Pregnancy Leifer: Introduction to Maternity and Pediatric Nursing, 9th Edition MULTIPLE CHOICE 1. A woman who is 7 weeks pregnant tells the nurse that this is not her first pregnancy. She has a 2-year-old son and had one previous spontaneous abortion. How would the nurse document the patient‘s obstetric history using the TPALM system? a. Gravida 2, para 20120 b. Gravida 3, para 10011 c. Gravida 3, para 10110 d. Gravida 2, para 11110 ANS: C Refer to Box 4-1 in the textbook for the TPALM system of identifying gravida and para. DIF: Cognitive Level: Application REF: p. 51 | Box 4.1 OBJ: 1 TOP: Definition of Terms KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 2. A woman calls her health care provider to schedule prenatal visits in an uncomplicated pregnancy. How frequently will the nurse assist the patient to schedule these appointments? a. Every 3 weeks until the 6th month, then every 2 weeks until delivery b. Every 4 weeks until the 7th month, after which appointments will become more frequent c. Monthly until the 8th month d. Every 2 to 3 weeks for the entire pregnancy ANS: B Monthly visits are scheduled up to 28 weeks, and then visits increase to every 2 weeks through 36 weeks. From 36 weeks until delivery, visits are weekly. DIF: Cognitive Level: Application REF: p. 49 OBJ: 2 | 3 TOP: Prenatal Visits KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 3. During the physical examination for the first prenatal visit, it is noted that Chadwick‘s sign is present. What is Chadwick‘s sign? a. Bluish or purplish discoloration of the vulva, vagina, and cervix b. Presence of early fetal movements c. Darkening of the areola and breast tenderness d. Palpation of the fetal outline ANS: A Chadwick‘s sign is the purplish or bluish discoloration of the cervix, vulva and vagina. DIF: Cognitive Level: Knowledge REF: p. 53 OBJ: 7 TOP: Normal Physiological Changes in Pregnancy KEY: Nursing Process Step: Data Collection MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. After the examination is completed, the patient asks the nurse why Chadwick‘s sign occurs during pregnancy. What would the nurse explain as the cause of Chadwick‘s sign? a. Enlargement of the uterus b. Progesterone action on the breasts c. Increasing activity of the fetus

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    d. Vascular congestion in the pelvic area ANS: D Chadwick‘s sign is caused by increased vascular congestion in the cervical and vaginal area. DIF: Cognitive Level: Comprehension REF: p. 53 OBJ: 6 | 7 TOP: Normal Physiological Changes in Pregnancy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. The nurse has explained physiological changes that occur during pregnancy. Which statement indicates that the woman understands the information? a. “ Blood pressure goes up toward the end of pregnancy. ” b. “ My breathing will get deeper and a little faste r. ” c. “ I ‘ll notice a decreased pigmentation in my ski n. ” d. “ There will be a curvature in the upper spine area. ” ANS: B The pregnant woman breathes more deeply, and her respiratory rate may increase slightly. DIF: Cognitive Level: Comprehension REF: p. 57 OBJ: 7 | 13 TOP: Normal Physiological Changes in Pregnancy KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 6. A woman reports that her last normal menstrual period began on August 5, 2013. What is this woman‘s expected delivery date using Nägele‘s rule? a. April 30, 2014 b. May 5, 2014 c. May 12, 2014 d. May 26, 2014 ANS: C To determine the expected date of delivery, count backward 3 months from the first day of the last menstrual period, then add 7 days and change the year if necessary. DIF: Cognitive Level: Analysis REF: p. 52 | Box 4.2 OBJ: 5 TOP: Determining Estimated Date of Delivery KEY: Nursing Process Step: Data Collection MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 7. During the second prenatal visit, the nurse attempts to locate the fetal heartbeat with an electronic Doppler device. How early might fetal heart tones be detected with an electronic Doppler device? a. 4 weeks b. 8 weeks c. 10 weeks d. 14 weeks ANS: C The fetal heartbeat can be detected as early as 10 weeks of pregnancy using a Doppler device. DIF: Cognitive Level: Knowledge REF: p. 54 OBJ: 3 | 6 TOP: Normal Physiological Changes in Pregnancy KEY: Nursing Process Step: Data Collection MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 8. In a routine prenatal visit, the nurse examining a patient who is 37 weeks pregnant notices that the fetal heart rate (FHR) has dropped to 120 beats/minute from a rate of 160 beats/minute

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