Maternal And Child Health
This contains 25 items Questions about Maternal and Child Health Nursing
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Maternal and Child Health Nursing Test II - Set A: Answer with Rationale
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- 1.
When assessing the adequacy of sperm for conception to occur, which of the following is the most useful criterion?
- A.
Sperm count
- B.
Sperm motility
- C.
Sperm maturity
- D.
Semen volume
Correct Answer
B. Sperm motilityExplanation
Sperm motility is the most useful criterion when assessing the adequacy of sperm for conception to occur. Sperm motility refers to the ability of sperm to move and swim effectively. It is important because it determines whether the sperm can reach and penetrate the egg for fertilization. Even if a man has a high sperm count or volume, if the sperm are not able to move properly, it can greatly reduce the chances of conception. Therefore, assessing sperm motility is crucial in determining the fertility potential of a man.Rate this question:
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- 2.
Which of the following urinary symptoms does the pregnant woman most frequently experience during the first trimester?
- A.
Dysuria
- B.
Frequency
- C.
Incontinence
- D.
Burning
Correct Answer
B. FrequencyExplanation
During the first trimester of pregnancy, the pregnant woman most frequently experiences the symptom of frequency. This refers to the need to urinate more often than usual. This can be attributed to hormonal changes and increased blood flow to the kidneys, which leads to increased urine production. Additionally, the growing uterus can put pressure on the bladder, further increasing the need to urinate frequently.Rate this question:
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- 3.
Heartburn and flatulence, common in the second trimester, are most likely the result of which of the following?
- A.
Increased plasma HCG levels
- B.
Decreased intestinal motility
- C.
Decreased gastric acidity
- D.
Elevated estrogen levels
Correct Answer
C. Decreased gastric acidityExplanation
Heartburn and flatulence during the second trimester of pregnancy are likely the result of decreased gastric acidity. This is because the hormone progesterone, which is elevated during pregnancy, relaxes the muscles in the digestive tract, including the lower esophageal sphincter. This relaxation allows stomach acid to flow back into the esophagus, causing heartburn. Additionally, decreased gastric acidity can lead to slower digestion, which can contribute to the buildup of gas in the intestines and result in flatulence.Rate this question:
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- 4.
On which of the following areas would the nurse expect to observe chloasma?
- A.
Breast, areola, and nipples
- B.
Chest, neck, arms, and legs
- C.
Abdomen, breast, and thighs
- D.
Cheeks, forehead, and nose
Correct Answer
D. Cheeks, forehead, and noseExplanation
Chloasma, also known as melasma, is a common skin condition characterized by dark patches on the face. These patches typically appear on the cheeks, forehead, and nose, which are areas that are commonly exposed to sunlight. The increased pigmentation is often a result of hormonal changes, such as during pregnancy or with the use of certain medications. Therefore, the nurse would expect to observe chloasma on the cheeks, forehead, and nose of the patient.Rate this question:
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- 5.
A pregnant client states that she “waddles” when she walks. The nurse’s explanation is based on which of the following as the cause?
- A.
The large size of the newborn
- B.
Pressure on the pelvic muscles
- C.
Relaxation of the pelvic joints
- D.
Excessive weight gain
Correct Answer
C. Relaxation of the pelvic jointsExplanation
During pregnancy, the hormone relaxin is released, which causes the ligaments and joints in the pelvic area to become more flexible and loose. This relaxation of the pelvic joints allows for the baby to pass through the birth canal during delivery. As a result, the client may experience a waddling gait when walking due to the increased mobility and instability of the pelvic joints. This explanation is based on the understanding of the physiological changes that occur during pregnancy and their impact on the musculoskeletal system.Rate this question:
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- 6.
Which of the following represents the average amount of weight gained during pregnancy?
- A.
12 to 22 lb
- B.
15 to 25 lb
- C.
24 to 30 lb
- D.
25 to 40 lb
Correct Answer
C. 24 to 30 lbExplanation
During pregnancy, it is normal for women to gain weight due to the growth of the baby, placenta, and increased blood volume. The average amount of weight gained during pregnancy is typically between 24 to 30 pounds. This range takes into account factors such as the mother's pre-pregnancy weight and overall health. Gaining too much or too little weight during pregnancy can have potential health risks for both the mother and the baby.Rate this question:
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- 7.
Which of the following would the nurse identify as a presumptive sign of pregnancy?
- A.
Hegar sign
- B.
Nausea and vomiting
- C.
Skin pigmentation changes
- D.
Positive serum pregnancy test
Correct Answer
B. Nausea and vomitingExplanation
Nausea and vomiting are commonly experienced by pregnant women and are considered presumptive signs of pregnancy. These symptoms are caused by hormonal changes in the body and are often referred to as morning sickness. While they are not definitive proof of pregnancy, they are often one of the earliest signs experienced by women. The Hegar sign, skin pigmentation changes, and positive serum pregnancy test are considered probable or positive signs of pregnancy, which provide more conclusive evidence.Rate this question:
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- 8.
During which of the following would the focus of classes be mainly on physiologic changes, fetal development, sexuality, during pregnancy, and nutrition?
- A.
Prepregnant period
- B.
First trimester
- C.
Second trimester
- D.
Third trimester
Correct Answer
B. First trimesterExplanation
During the first trimester of pregnancy, the focus of classes would mainly be on physiologic changes, fetal development, sexuality, and nutrition. This is because the first trimester is a critical period in which the body undergoes significant changes to support the growing fetus. It is important for expectant parents to understand these changes and how they can affect both the mother and the baby. Additionally, nutrition plays a crucial role in the development of the fetus during this time, and understanding proper dietary choices is essential for a healthy pregnancy.Rate this question:
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- 9.
Which of the following would be disadvantage of breast feeding?
- A.
Involution occurs more rapidly
- B.
The incidence of allergies increases due to maternal antibodies
- C.
The father may resent the infant’s demands on the mother’s body
- D.
There is a greater chance for error during preparation
Correct Answer
C. The father may resent the infant’s demands on the mother’s bodyExplanation
Breastfeeding is a natural and beneficial way to nourish a newborn, providing numerous advantages for both the mother and the baby. However, a potential disadvantage could be that the father may feel resentful towards the infant's demands on the mother's body. This could stem from feelings of exclusion or jealousy, as the mother's attention and physical connection with the baby may increase. It is important for both parents to communicate and support each other during this period to ensure a healthy and harmonious family dynamic.Rate this question:
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- 10.
A client LMP began July 5. Her EDD should be which of the following?
- A.
January 2
- B.
March 28
- C.
April 12
- D.
October 12
Correct Answer
C. April 12Explanation
The client's estimated due date (EDD) can be determined by adding 280 days (40 weeks) to the start date of her last menstrual period (LMP). In this case, if the LMP began on July 5, adding 280 days would give us April 12 as the EDD.Rate this question:
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- 11.
Which of the following fundal heights indicates less than 12 weeks’ gestation when the date of the LMP is unknown?
- A.
Uterus in the pelvis
- B.
Uterus at the xiphoid
- C.
Uterus in the abdomen
- D.
Uterus at the umbilicus
Correct Answer
A. Uterus in the pelvisExplanation
The fundal height is a measurement taken during pregnancy to assess the growth and development of the fetus. The fundus is the top portion of the uterus, and its height can indicate the gestational age of the fetus. In this case, if the uterus is in the pelvis, it suggests that the gestation is less than 12 weeks. This is because during the first trimester, the uterus is still low in the pelvis and has not yet risen to the abdominal area. Therefore, a fundal height indicating the uterus in the pelvis would be consistent with a gestation of less than 12 weeks.Rate this question:
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- 12.
Which of the following prenatal laboratory test values would the nurse consider as significant?
- A.
Hematocrit 33.5%
- B.
Rubella titer less than 1:8
- C.
White blood cells 8,000/mm3
- D.
One hour glucose challenge test 110 g/dL
Correct Answer
B. Rubella titer less than 1:8Explanation
A rubella titer less than 1:8 is considered significant because it indicates that the pregnant woman is not immune to rubella. Rubella is a viral infection that can cause serious birth defects if contracted during pregnancy. Therefore, if a pregnant woman has a rubella titer less than 1:8, it is important for her to receive the rubella vaccine to protect herself and her baby. The other laboratory test values mentioned (hematocrit, white blood cells, and glucose challenge test) are within normal ranges and would not be considered significant in this context.Rate this question:
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- 13.
Which of the following characteristics of contractions would the nurse expect to find in a client experiencing true labor?
- A.
Occurring at irregular intervals
- B.
Starting mainly in the abdomen
- C.
Gradually increasing intervals
- D.
Increasing intensity with walking
Correct Answer
D. Increasing intensity with walkingExplanation
During true labor, contractions become more intense and frequent as the labor progresses. This is because walking and movement can help to stimulate and strengthen contractions. Therefore, the nurse would expect to find increasing intensity with walking in a client experiencing true labor.Rate this question:
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- 14.
During which of the following stages of labor would the nurse assess “crowning”?
- A.
First stage
- B.
Second stage
- C.
Third stage
- D.
Fourth stage
Correct Answer
B. Second stageExplanation
During the second stage of labor, the nurse would assess "crowning." This is the stage when the baby's head starts to emerge from the birth canal and becomes visible at the vaginal opening. The nurse would closely monitor this stage to ensure the safe delivery of the baby and provide support to the mother.Rate this question:
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- 15.
Which of the following actions demonstrates the nurse’s understanding about the newborn’s thermoregulatory ability?
- A.
Placing the newborn under a radiant warmer.
- B.
Suctioning with a bulb syringe
- C.
Obtaining an Apgar score
- D.
Inspecting the newborn’s umbilical cord
Correct Answer
A. Placing the newborn under a radiant warmer.Explanation
Placing the newborn under a radiant warmer demonstrates the nurse's understanding about the newborn's thermoregulatory ability because it helps to maintain the baby's body temperature. Newborns have limited ability to regulate their body temperature, and placing them under a radiant warmer helps to prevent heat loss and keep them warm. This action shows that the nurse understands the importance of maintaining the newborn's body temperature within a normal range to promote their well-being and prevent complications.Rate this question:
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- 16.
Immediately before expulsion, which of the following cardinal movements occur?
- A.
Descent
- B.
Flexion
- C.
Extension
- D.
External rotation
Correct Answer
D. External rotationExplanation
During the process of childbirth, the baby undergoes a series of movements known as cardinal movements. These movements help the baby navigate through the birth canal. External rotation occurs immediately before expulsion, where the baby's head rotates to align its shoulders with the mother's pelvis. This movement allows for easier passage through the birth canal and is a crucial step in the birthing process.Rate this question:
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- 17.
Which of the following when present in the urine may cause a reddish stain on the diaper of a newborn?
- A.
Mucus
- B.
Uric acid crystals
- C.
Bilirubin
- D.
Excess iron
Correct Answer
B. Uric acid crystalsExplanation
Uric acid crystals, when present in the urine of a newborn, can cause a reddish stain on the diaper. Uric acid is a waste product that is normally excreted in the urine, and its crystals can sometimes form and be passed out with the urine. These crystals can cause a reddish discoloration on the diaper, indicating their presence in the urine. This is a common occurrence in newborns and is not usually a cause for concern.Rate this question:
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- 18.
Which of the following is true regarding the fontanels of the newborn?
- A.
The anterior is triangular shaped; the posterior is diamond shaped.
- B.
The posterior closes at 18 months; the anterior closes at 8 to 12 weeks.
- C.
The anterior is large in size when compared to the posterior fontanel.
- D.
The anterior is bulging; the posterior appears sunken.
Correct Answer
C. The anterior is large in size when compared to the posterior fontanel.Explanation
The correct answer states that the anterior fontanel is large in size compared to the posterior fontanel. Fontanels are soft spots on a newborn's skull where the bones have not yet fused together. The anterior fontanel is located at the top front of the skull, while the posterior fontanel is located at the back. The anterior fontanel is typically larger and diamond-shaped, while the posterior fontanel is smaller and triangular-shaped. This is important for healthcare providers to assess the growth and development of the newborn's skull.Rate this question:
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- 19.
Which of the following statements best describes hyperemesis gravidarum?
- A.
Severe anemia leading to electrolyte, metabolic, and nutritional imbalances in the absence of other medical problems.
- B.
Severe nausea and vomiting leading to electrolyte, metabolic, and nutritional imbalances in the absence of other medical problems.
- C.
Loss of appetite and continuous vomiting that commonly results in dehydration and ultimately decreasing maternal nutrients
- D.
Severe nausea and diarrhea that can cause gastrointestinal irritation and possibly internal bleeding
Correct Answer
B. Severe nausea and vomiting leading to electrolyte, metabolic, and nutritional imbalances in the absence of other medical problems.Explanation
Hyperemesis gravidarum is a condition characterized by severe nausea and vomiting during pregnancy. It is different from normal morning sickness as it leads to electrolyte, metabolic, and nutritional imbalances in the absence of other medical problems. This condition can result in dehydration and weight loss, and may require medical intervention to manage symptoms and prevent complications.Rate this question:
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- 20.
In which of the following types of spontaneous abortions would the nurse assess dark brown vaginal discharge and a negative pregnancy tests?
- A.
Threatened
- B.
Imminent
- C.
Missed
- D.
Incomplete
Correct Answer
C. MissedExplanation
In a missed spontaneous abortion, the fetus has died but has not been expelled from the uterus. This can result in the presence of dark brown vaginal discharge as the body attempts to expel the fetal tissue. A negative pregnancy test would indicate that the pregnancy hormones have decreased, further supporting the diagnosis of a missed abortion.Rate this question:
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- 21.
Which of the following would the nurse assess in a client experiencing abruptio placenta?
- A.
Bright red, painless vaginal bleeding
- B.
Concealed or external dark red bleeding
- C.
Palpable fetal outline
- D.
Soft and nontender abdomen
Correct Answer
B. Concealed or external dark red bleedingExplanation
In a client experiencing abruptio placenta, the nurse would assess for concealed or external dark red bleeding. Abruptio placenta is a condition where the placenta separates from the uterine wall before delivery, leading to bleeding. This bleeding can be concealed, meaning it is trapped between the placenta and the uterine wall, or it can be external, meaning it is visible outside the body. The dark red color of the bleeding indicates that it is venous blood, which is a characteristic of abruptio placenta.Rate this question:
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- 22.
Which of the following is described as premature separation of a normally implanted placenta during the second half of pregnancy, usually with severe hemorrhage?
- A.
Placenta previa
- B.
Ectopic pregnancy
- C.
Incompetent cervix
- D.
Abruptio placentae
Correct Answer
D. Abruptio placentaeExplanation
Abruptio placentae is described as the premature separation of a normally implanted placenta during the second half of pregnancy, usually with severe hemorrhage. This condition can be life-threatening for both the mother and the baby. Placenta previa refers to the abnormal implantation of the placenta in the lower part of the uterus, causing bleeding during pregnancy. Ectopic pregnancy is a condition where the fertilized egg implants outside the uterus, typically in the fallopian tube. Incompetent cervix refers to a weak cervix that may lead to premature birth or miscarriage.Rate this question:
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- 23.
When PROM occurs, which of the following provides evidence of the nurse’s understanding of the client’s immediate needs?
- A.
The chorion and amnion rupture 4 hours before the onset of labor.
- B.
PROM removes the fetus most effective defense against infection
- C.
Nursing care is based on fetal viability and gestational age.
- D.
PROM is associated with malpresentation and possibly incompetent cervix
Correct Answer
B. PROM removes the fetus most effective defense against infectionExplanation
PROM, or premature rupture of membranes, refers to the rupture of the amniotic sac before the onset of labor. This rupture removes the fetus's most effective defense against infection, which is the intact amniotic sac. When the amniotic sac is intact, it acts as a barrier against bacteria and other pathogens, reducing the risk of infection for the fetus. However, once the sac ruptures, the risk of infection increases significantly. Therefore, the statement "PROM removes the fetus most effective defense against infection" provides evidence of the nurse's understanding of the client's immediate needs in terms of infection prevention and management.Rate this question:
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- 24.
Which of the following amounts of blood loss following birth marks the criterion for describing postpartum hemorrhage?
- A.
More than 200 ml
- B.
More than 300 ml
- C.
More than 400 ml
- D.
More than 500 ml
Correct Answer
D. More than 500 mlExplanation
Postpartum hemorrhage is defined as excessive bleeding following childbirth. The criterion for diagnosing postpartum hemorrhage is when the amount of blood loss exceeds 500 ml. This is because a blood loss of more than 500 ml is considered abnormal and can lead to complications such as anemia, hypovolemic shock, and organ damage. Therefore, the correct answer is "More than 500 ml".Rate this question:
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- 25.
Which of the following assessment findings would the nurse expect if the client develops DVT?
- A.
Midcalf pain, tenderness and redness along the vein
- B.
Chills, fever, malaise, occurring 2 weeks after delivery
- C.
Muscle pain the presence of Homans sign, and swelling in the affected limb
- D.
Chills, fever, stiffness, and pain occurring 10 to 14 days after delivery
Correct Answer
C. Muscle pain the presence of Homans sign, and swelling in the affected limbExplanation
The nurse would expect the client to have muscle pain, the presence of Homans sign, and swelling in the affected limb if they develop DVT. Homans sign refers to pain in the calf or popliteal region when the foot is dorsiflexed, which can be an indication of DVT. Swelling in the affected limb is also a common symptom of DVT.Rate this question:
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