Preview Extract
Chapter 8
1) The nurse in the obstetrical clinic is setting appointments for patients seeking
preconceptual care. Which patient should be seen first?
1. 36-year-old, has never been pregnant, takes medication for a seizure disorder
2. 15-year-old, smokes one pack per day, had a miscarriage four months ago
3. 22-year-old, runs long distances, has been on the pill for six years
4. 29-year-old, has had two abortions, takes a multiple-vitamin supplement
Answer: 1
Rationale 1:
This patient is the top priority because she has multiple risk factors: She is over the age of 35
and therefore is at risk for trisomies; some medications are teratogenic and are
contraindicated during pregnancy; and pregnancy is not recommended for women with some
conditions. This patient needs to see the specialist who prescribes her anti-seizure medication,
as well with an obstetric provider, to discuss the risks her age presents to a possible
pregnancy.
Rationale 2:
Although this patient has the risks of being young and a smoker, she is not the highest
priority.
Rationale 3:
The only risk factor this patient has is a need to increase folic acid intake due to being on the
pill for six years.
Rationale 4:
This patient has no risk factors for pregnancy. A history of more than three abortions
increases the risks of preterm labor and infertility, but this patient has only had two abortions.
2) A primigravida is admitted to the labor unit with contractions every 7–8 minutes. She is 3
cm dilated, 70% effaced, and at 0 station. She is very anxious, is having difficulty coping
with contractions, and states that she did not attend prenatal classes. Which of the following
would be the most effective nursing intervention?
1. Instruct the patient in abdominal breathing and progressive relaxation.
2. Instruct the patient in patterned, paced breathing and touch relaxation.
3. Instruct the patient in pelvic tilt and pelvic rock exercises.
4. Call the physician and request a sedative.
Answer: 1,3
Rationale 1:
Abdominal breathing and progressive relaxation assist the patient in relaxing and allow the
uterine muscles to work more efficiently.
Rationale 2:
Patterned, paced breathing and touch relaxation are exercises that are taught in childbirth
preparation classes and involve the use of a partner.
Rationale 3:
Pelvic tilt and rock exercises are body-conditioning exercises.
Rationale 4:
Providing sedatives would not allow the patient to participate actively in the process.
3) The nurse is assisting an expectant couple in developing a birth plan. Which of the
following instructions would the nurse include in the teaching plan?
1. The birth plan includes only patient choices and does not take into account standard
choices of the health care provider.
2. The birth plan allows the patient to make choices about the birth process; however, these
choices cannot be altered.
3. The birth plan is a legally binding contract between the patient and the health care
provider.
4. The birth plan is a communication tool between the patient and the health care provider.
Answer: 4
Rationale 1:
The birth plan is used as a tool for communication among the expectant parents, the health
care provider, and the health care professionals at the birth setting.
Rationale 2:
The written plan identifies options that are available; thus, it can be altered.
Rationale 3:
It is not a legal document.
Rationale 4:
The birth plan is used as a tool for communication among the expectant parents, the health
care provider, and the health care professionals at the birth setting.
4) A couple would like their 5-year-old to attend the birth. Which statement by the nurse
would assist in the family’s plan to include their 5-year-old in the birth?
1. “You should let your child stay home because you will be focusing on the birth.”
2. “Children under 12 are not allowed to be present at the birth.”
3. “You should bring someone who only will tend to any specific needs of your child.”
4. “Bring some toys to keep your child occupied.”
Answer: 3
Rationale 1:
A sibling should have his own support person whose primary responsibility is to take care of
the child’s needs so that the child will have support if anxiety develops over the birth process,
and the mother can concentrate on the labor and birth.
Rationale 2:
Children are allowed to be present at births.
Rationale 3:
A sibling should have his own support person whose primary responsibility is to take care of
the child’s needs so that the child will have support if anxiety develops over the birth process,
and the mother can concentrate on the labor and birth.
Rationale 4:
Preparing the child on what to expect is beneficial. Toys will not sustain a 5-year-old’s
attention for an extended time period.
5) The nurse is presenting a prenatal class for couples beginning prenatal care. What
information is most important for the nurse to include?
1. You can have a certified nurse–midwife or a physician for your provider.
2. You can give birth in either of two different types of rooms, each with different equipment.
3. The birthing unit was remodeled and redecorated last year.
4. Some of the providers recommend circumcision for baby boys.
Answer: 1
Rationale 1:
This statement is the most important. The nurse should inform patients what their options are,
including the types of providers available.
Rationale 2:
This statement is too vague to facilitate decision making by the couple.
Rationale 3:
This information does not help patients understand their options or make decisions.
Rationale 4:
Because not all patients will be having boys, this statement is only helpful to those patients
who give birth to males and see a provider who recommends circumcision. This statement is
too narrowly focused to be helpful to all patients.
6) While teaching a preconception class, the nurse should include which of the following
recommendations concerning intake of vitamins during pregnancy?
1. Take supplemental folic acid daily to reduce the risk of trisomy 21 (Down syndrome).
2. The pregnant woman should consult the recommended dietary allowance (RDA)
guidelines regarding vitamins.
3. Take Vitamin C daily to reduce the risk of neural tube defects.
4. The pregnant woman should consume the greatest amount of vitamins possible.
Answer: 2
Rationale 1:
Folic acid supplementation prior to conception is recommended for decreasing the risk of
neural tube defects.
Rationale 2:
Intake of vitamins in greater than the recommended dietary allowance (RDA) can cause
severe fetal problems and should be avoided.
Rationale 3:
Folic acid is linked to decreased risk for neural tube defects.
Rationale 4:
Intake of vitamins in greater than the recommended dietary allowance (RDA) can cause
severe fetal problems and should be avoided.
7) An expectant couple desires to determine compatibility with a care provider. They ask the
nurse for assistance. Which of the following questions should the nurse encourage the couple
to ask first?
1. “Can my children attend the birth?”
2. “If I have a cesarean birth, can my husband attend?”
3. “What is your philosophy of birth?”
4. “What percentage of your patients have episiotomies?”
Answer: 3
Rationale 1:
Children’s attendance is a complement to the provider’s philosophy.
Rationale 2:
A husband’s presence for a cesarean birth is a complement to the provider’s philosophy.
Rationale 3:
A thorough understanding of the provider’s philosophy is essential to determining
compatibility.
Rationale 4:
Episiotomy percentages are a complement to the provider’s philosophy.
8) The prenatal clinic nurse has presented information on prenatal class options to a couple
pregnant for the first time. Which statement made by the couple indicates that additional
information is necessary? “Prenatal classes:
1. “Eliminate the risk of needing a vacuum extraction or cesarean birth.”
2. “Help parents cope with the discomforts and unknowns of childbirth.”
3. “Facilitate better communication between both partners.”
4. “Encourage participants to write a list of their requests for labor and birth.”
Answer: 1
Rationale 1:
This is false reassurance. There is no guarantee that an operative birth can be avoided, even if
a couple attends prenatal classes.
Rationale 2:
This is one of the main goals of prenatal classes: learning skills to help get through the
discomforts of childbirth. Participants also learn how the birthing process progresses. This
does not imply that students of prenatal classes don’t get epidurals. But participants will learn
new skills that will facilitate the birthing process.
Rationale 3:
A secondary goal of prenatal classes is to facilitate communication between the pregnant
woman and her partner. The primary goals are to inform participants of the birth process and
teach them skills to cope with labor and birth.
Rationale 4:
One of the strategies used in prenatal classes is to have participants write a birth plan that lists
their requests for how they want their birthing experience to be. But putting their desires
down in writing is less important than learning about the birth process and learning skills to
cope with labor and delivery.
9) A 38-year-old woman with no prior pregnancies calls the clinic to inquire about
preconception counseling. Which element of early prenatal education should the nurse expect
to facilitate?
1. Availability of prenatal and genetic testing
2. Birth choices
3. Infertility counseling
4. Nutrition classes
Answer: 1
Rationale 1:
Prenatal and genetic testing is incorporated among early prenatal classes, which often include
pre-pregnant women. Due to maternal age, this woman is at increased risk for having a child
with a chromosomal abnormality.
Rationale 2:
Birth classes are incorporated into later classes; specifically, the second and third trimester.
Rationale 3:
Infertility counseling is not incorporated within preconception counseling.
Rationale 4:
Nutrition classes are incorporated among early prenatal education; however, due the woman's
age, availability of prenatal and genetic testing is a higher priority.
10) The patient who experienced an emergency cesarean birth with her first child expresses
anxiety about her upcoming birth. How can the nurse teaching the patient’s prenatal classes
help decrease her anxiety?
1. Encourage muscle tightening with each contraction.
2. Explain that patterned breathing increases anxiety and should be avoided.
3. Instruct the patient to hire a therapeutic massage therapist for labor.
4. Practice progressive relaxation and encourage her to use the technique in labor.
Answer: 4
Rationale 1:
Relaxation, not muscle tightening, should be encouraged. Some relaxation techniques teach
patients to tighten and then release muscles to learn the difference between tension and
relaxation, but the key is to be as relaxed as possible during contractions.
Rationale 2:
Patterned breathing techniques decrease, not increase, anxiety. Practice of patterned breathing
prior to the onset of labor facilitates their use during labor.
Rationale 3:
Although some patients would enjoy a massage therapist during their labor, not all patients
enjoy massage, and not all patients have the resources to hire this type of professional for
their labor.
Rationale 4:
Progressive relaxation (and all relaxation techniques), when practiced prior to labor, is a
valuable tool to facilitate relaxation and therefore decrease anxiety during labor.
11) Regardless of the method of childbirth preparation, most childbirth classes:
1. Present ways of alleviating fear.
2. Teach imagery for relaxation.
3. Use patterned, paced breathing techniques.
4. Present the benefits of epidural anesthesia.
Answer: 1
Rationale 1:
The overall goal of prenatal classes is to decrease fear through increasing knowledge and
teaching participants skills to help cope with labor. These skills include various relaxation
methods and breathing techniques.
Rationale 2:
Not all classes teach imagery.
Rationale 3:
Not all classes use patterned, paced breathing.
Rationale 4:
Many couples will be able to avoid an epidural by using the techniques they learned in
classes.
12) The nurse assesses her patient to have mild anxiety concerning the birth process. The
patient states that she is not interested in Lamaze classes because she is single and does not
want to have natural childbirth. The nurse’s best response would be:
1. “Lamaze classes promise painless childbirth. If you learn their methods, your pain is
minimal.”
2. “Lamaze classes can teach you relaxation methods and also the benefits and risks of painrelief methods. This assists you in making the best decision for you.”
3. “You are very nervous. I think these classes would be best for you.”
4. “Lamaze classes are geared toward couples. You might want to find a different class.”
Answer: 2
Rationale 1:
This choice is inappropriate because even with Lamaze, there could be some pain.
Rationale 2:
Lamaze teaches relaxation methods by utilizing patterned breathing. Those who are able to
use the method require little if any anesthesia during delivery. The other choices are
inappropriate.
Rationale 3:
Telling a patient that she is nervous is not a reason to take the class. It would be better to
encourage the patient to take the class so she will be knowledgeable on the birth experience
and it could reduce any anxiety she may have about the experience.
Rationale 4:
Lamaze classes are geared toward teaching about the breathing and relaxation during
childbirth and often have single parents or non-couple participants.
13) A 29-year-old woman who is pregnant with her first child asks the nurse which childbirth
preparation class is most highly recommended for couples. Which nursing response is best?
1. "For couples, the International Childbirth Education Association (ICEA) recommends the
Bradley method, which is a partner-coached childbirth."
2. "Lamaze would be the ideal choice of preparation for you and your husband."
3. "Ideally, you can learn about each method, and then choose the one that's best for you.”
4. "Any of the methods will work well, as long as you and your husband do not deviate from
the instructions related to that specific method."
Answer: 3
Rationale 1:
The International Childbirth Education Association (ICEA) does not advocate a particular
method of childbirth preparation but rather promotes a philosophy of “freedom of choice
based on knowledge of alternatives."
Rationale 2:
Education regarding the various childbirth preparation classes should be provided, and the
woman should choose the option she deems best.
Rationale 3:
Education regarding the various childbirth preparation classes should be provided, and the
woman should choose the option she deems best.
Rationale 4:
International Childbirth Education Association (ICEA) educators often teach a combination
of techniques designed to meet individual needs and assist the partner in supporting the
woman during labor and birth.
14) The nurse is presenting a prenatal education class about the use of Lamaze during
childbirth. Which concept should the nurse include in his teaching?
1. Dissociative relaxation
2. Partner-coached childbirth
3. The extended McRoberts position
4. Touch relaxation
Answer: 1
Rationale 1:
Dissociative relaxation, which is specific to Lamaze, promotes relaxation of uninvolved
muscles while the uterus contracts, creating an active relaxation pattern.
Rationale 2:
Partner-coached childbirth is an element of the Bradley method.
Rationale 3:
The extended McRoberts position is a body-conditioning exercise that helps enable the
woman to stretch her hamstring muscles.
Rationale 4:
Touch relaxation is a two-person relaxation technique in which the woman learns to release
tension in the body areas that her partner touches.
15) The nurse is planning a “train the trainer” class for labor and delivery nurses learning to
teach prenatal classes. Which statement indicates that teaching has been effective?
1. “Women like to be in a semi-sitting position when giving birth.”
2. “Teaching alternatives available at our hospital facilitates decision making.”
3. “I will explain that bright lights in the room are best for moms and babies.”
4. “Patients should be taught not to make noise during labor or birth.”
Answer: 2
Rationale 1:
No one position for birth is favored by all women. Prenatal classes should teach about
alternatives and help strengthen the mind–body connection of patients.
Rationale 2:
This is a true statement. To be respectful and facilitate autonomy, prenatal classes should
teach about alternatives and help strengthen the mind–body connection of patients.
Rationale 3:
Subdued lighting and soft music are options that are easy to implement and help personalize a
family’s birth experience.
Rationale 4:
Vocalization during labor and birth should be encouraged, if that is what the patient wants to
do. It is not appropriate to expect all laboring patients to want the same things or to behave in
the same ways.
Test Bank for Contemporary Maternal-Newborn Nursing
Patricia W Ladewig, Marcia L London, Michele Davidson
9780133429862, 9780134257020
