Maternal-Child McKinney Ch 24: The Childbearing Family with Special Needs

1. A pregnant woman who abuses cocaine admits to exchanging sex for her drug habit. This behavior puts her at a greater risk for which of the following?

a. Depression of the central nervous system

b. Hypotension and vasodilation

c. Sexually transmitted diseases

d. Postmature birth

ANS: C Sexually transmitted diseases

Sex acts exchanged for drugs place the woman at increased risk for sexually transmitted diseases because of multiple partners and lack of protection. Cocaine is a central nervous system stimulant. Cocaine causes hypertension and vasoconstriction. Premature delivery of the infant is one of the most common problems associated with cocaine use during pregnancy.

2. During which phase of the cycle of violence does the batterer become contrite and remorseful?

a. Battering phase

b. Honeymoon phase

c. Tension-building phase

d. Increased drug-taking phase

ANS: B Honeymoon phase

During the honeymoon phase, the battered person wants to believe that the battering will never happen again, and the batterer will promise anything to get back into the home. During the battering phase violence actually occurs, and the victim feels powerless. During the tension-building phase, the batterer becomes increasingly hostile, swears, threatens, throws things, and pushes the battered. Often the batterer increases the use of drugs during the tension-building phase; however, this is not an actual phase of the cycle.

3. What is a major barrier to health care for teen mothers?

a. The hospital/clinic is within walking distance of the girl's home.

b. The institution is open days, evenings, and Saturdays by special arrangement.

c. The teen must be prepared to see a different nurse or doctor or both at every visit.

d. The health care workers have a positive attitude.

ANS: C The teen must be prepared to see a different nurse or doctor or both at every visit.

Whenever possible, the teen should be scheduled to see the same nurses and practitioners for continuity of care. If the hospital/clinic were within walking distance of the girl's home, it would prevent the teen from missing appointments because of transportation problems. If the institution were open days, evenings, and Saturdays by special arrangement, this availability would be helpful for teens who work, go to school, or have other time-of-day restrictions. Scheduling conflicts are a major barrier to health care. A negative attitude is unfortunate, because it discourages families who would benefit most from consistent prenatal care.

4. Of adolescents who become pregnant, what percentage have had a previous birth?

a. 10%

b. 15%

c. 17%

d. 35%

ANS: C 17%

Seventeen percent of pregnant adolescents have had one or more previous births.

5. In counseling a patient who has decided to relinquish her baby for adoption, the nurse should do which of the following?

a. Affirm her decision while acknowledging her maturity in making it.

b. Question her about her feelings regarding adoption.

c. Tell her she can always change her mind about adoption.

d. Ask her if anyone is coercing her into the decision to relinquish her baby.

ANS: A Affirm her decision while acknowledging her maturity in making it.

A supportive, affirming approach by the nurse will strengthen the patient's resolve and help her to appreciate the significance of the event. The teen needs help in coping with her feelings about this decision. It is important for the nurse to support and affirm the decision the patient has made. This will strengthen the patient's resolve to follow through. Later the patient should be given an opportunity to express her feelings. Telling her she can always change her mind should not be an option after the baby is born and placed with the adoptive parents. It is important that the teenager is treated as an adult, with the assumption that she is capable of making an important decision on her own.

6. A woman who is older than 35 years may have difficulty achieving pregnancy, because

a. personal risk behaviors influence fertility.

b. she has used contraceptives for an extended time.

c. her ovaries may be affected by the aging process.

d. prepregnancy medical attention is lacking.

ANS: C her ovaries may be affected by the aging process.

Once the mature woman decides to conceive, a delay in becoming pregnant may occur because of the normal aging of the ovaries. The older adult participates in fewer risk behaviors than the younger adult. The problem is the age of the ovaries, not the past use of contraceptives. Prepregnancy medical care is available and encouraged.

7. What is most likely to be a concern for the older mother?

a. The importance of having enough rest and sleep

b. Information about effective contraceptive methods

c. Nutrition and diet planning

d. Information about exercise and fitness

ANS: A The importance of having enough rest and sleep

The woman who delays childbearing may have unique concerns, one of which is having less energy than younger mothers. The older mother usually has more financial means to search out effective contraceptive methods. The older mother often is better off financially and can afford better nutrition. Information about exercise and fitness is readily available.

8. What is the most dangerous effect on the fetus of a mother who smokes cigarettes while pregnant?

a. Genetic changes and anomalies

b. Extensive central nervous system damage

c. Fetal addiction to the substance inhaled

d. Intrauterine growth restriction

ANS: D Intrauterine growth restriction

The major consequences of smoking tobacco during pregnancy are low-birth-weight infants, prematurity, and increased perinatal loss. Cigarettes normally will not cause genetic changes or extensive central nervous system damage. Addiction is not a normal concern with the neonate.

9. A patient at 24 weeks of gestation says she has a glass of wine with dinner every evening. The nurse will counsel her to eliminate all alcohol intake. What is the best rationale provided by the nurse?

a. A daily consumption of alcohol indicates a risk for alcoholism.

b. She will be at risk for abusing other substances as well.

c. The fetus is placed at risk for altered brain growth.

d. The fetus is at risk for multiple organ anomalies.

ANS: C The fetus is placed at risk for altered brain growth.

The brain grows most rapidly in the third trimester and is most vulnerable to alcohol exposure during this time. A risk for alcoholism is not the major risk for the infant. Multiple organ anomalies are not a major concern.

10. Which of these substances can lead to miscarriage, preterm labor, placental separation (abruption), and stillbirth?

a. Heroin

b. Alcohol

c. PCP

d. Cocaine

ANS: D Cocaine

Cocaine is a powerful CNS stimulant. Effects on pregnancy associated with cocaine use include abruptio placentae, preterm labor, precipitous birth, and stillbirth. Heroin is an opiate. Its use in pregnancy is associated with preeclampsia, intrauterine growth restriction, miscarriage, premature rupture of membranes, infections, breech presentation, and preterm labor. The most serious effect of alcohol use in pregnancy is FAS. The major concerns regarding PCP use in pregnant women are its association with polydrug abuse and the neurobehavioral effects on the neonate.

11. When helping the mother, father, and other family members actualize the loss of the infant, nurses should

a. use the words lost or gone rather than dead or died.

b. make sure the family understands that it is important to name the baby.

c. if the parents choose to visit the baby, apply lotion to the baby and wrap the infant

in a pretty blanket.

d. set a firm time for ending the visit with the baby so that the parents know when to

let go.

ANS: C if the parents choose to visit the baby, apply lotion to the baby and wrap the infant

Presenting the baby in a nice way stimulates the parents' senses and provides pleasant memories of their baby. Nurses must use dead and died to assist the bereaved in accepting reality. Although naming the baby can be helpful, it is important not to create the sense that parents have to name the baby. In fact, some cultural taboos and religious rules prohibit the naming of an infant who has died. Parents need different time periods with their baby to say goodbye. Nurses need to be careful not to rush the process.

12. A woman has delivered twins. The first twin was stillborn, and the second is in the intensive care nursery and is recovering quickly from respiratory distress. The woman is crying softly and says, "I wish my baby could have lived." What is the most therapeutic response?

a. "Don't be sad. At least you have one healthy baby."

b. "How soon do you plan to have another baby?"

c. "I have a friend who lost a twin and she's doing just fine now "

d. "I am so sorry about your loss. Would you like to talk about it?"

ANS: D "I am so sorry about your loss. Would you like to talk about it?"

The nurse should recognize the woman's grief and its significance and allow her to express her feelings. The other three responses belittle the woman's feelings.

13. Which of the following is an appropriate nursing measure when a baby has an unexpected anomaly?

a. Remove the baby from the delivery area immediately.

b. Tell the parents that the baby has to go to the nursery immediately.

c. Inform the parents immediately that something is wrong.

d. Explain the defect, and show the baby to the parents as soon as possible.

ANS: D Explain the defect, and show the baby to the parents as soon as possible.

Parents experience less anxiety when they are told about the defect as early as possible and are allowed to touch and hold the baby. The parents should be both informed and able to touch and hold the baby as soon as possible.

14. A woman who is 6 months pregnant has sought medical attention saying she fell down the stairs. What scenario would cause an emergency department nurse to suspect that the woman has been battered?

a. The woman and her partner are having an argument that is loud and hostile.

b. The woman has injuries on various parts of her body in different stages of

healing.

c. Examination reveals a fractured arm and fresh bruises. Her husband asks her

about her pain.

d. She loudly complains about having several injuries.

ANS: B The woman has injuries on various parts of her body in different stages of healing.

The battered woman often has multiple injuries in various stages of healing. Arguing may or may not be sign of battering; many times the batterer will be attentive and refuse to leave the woman's side. A battered woman often has a flat affect or avoids eye contact and is vague about how the injuries occurred.

15. Which of the following items are inconsistent with the nurse's knowledge of symptoms of fetal alcohol syndrome?

a. Respiratory conditions

b. Impaired growth

c. CNS abnormality

d. Facial abnormalities

ANS: A Respiratory conditions

Respiratory difficulties are not a category of conditions that are related to FAS. Abnormalities related to FAS include impaired growth (intrauterine growth restriction), CNS abnormalities, and a constellation of typical facial features.

16. When the nurse is alone with a battered patient, the patient seems extremely anxious and says, "It was all my fault. The house was so messy when he got home and I know he hates that." The best response by the nurse is

a. "No one deserves to be hurt. It's not your fault. How can I help you?"

b. "What else do you do that makes him angry enough to hurt you?"

c. "He will never find out what we talk about. Don't worry. We're here to help you."

d. "You have to remember that he is frustrated and angry so he takes it out on you."

ANS: A "No one deserves to be hurt. It's not your fault. How can I help you?"

The nurse should stress that the patient is not at fault and offer to help. Asking what else the woman does to make the partner angry or reminding her that he is frustrated is placing blame on the woman. Telling her "don't worry" is giving false reassurance.

17. In helping bereaved parents cope and move on, nurses should keep in mind that

a. a perinatal or parental grief support group is more likely to be helpful if the needs

of the parents are matched with the focus of the group.

b. when pictures of the infant are taken for keepsakes, no close-ups should be taken

of any congenital anomalies.

c. no significant differences exist in grieving individuals from various cultures,

ethnic groups, and religions.

d. calling the hospital clergy for emergency baptism is always appropriate.

ANS: A a perinatal or parental grief support group is more likely to be helpful if the needs

The nurse should try when possible to match the recommended support resources to the parents. For example, a religious-based group may not work for nonreligious parents. Close-up pictures of the baby must be taken as the infant was, congenital anomalies and all. Although death and grieving are events shared by all people, mourning rituals, traditions, and taboos vary by culture, ethnicity, and religion. Differences must be respected. Parents may or may not want the newborn to be baptized; the nurse must assess the family for their religious wishes and facilitate them.

18. A common effect of both smoking and cocaine use on the pregnant woman is

a. vasoconstriction.

b. increased appetite.

c. inactivates fetal hemoglobin.

d. euphoria.

ANS: A vasoconstriction.

Both smoking and cocaine use cause vasoconstriction, which results in impaired placental blood flow to the fetus. Both smoking and cocaine use decrease the appetite. Smoking inactivates fetal hemoglobin. Euphoria can be seen with cocaine use.

19. What information about caffeine in pregnancy does the nurse provide the prenatal class with?

a. It stays in your body twice as long as when you are not pregnant.

b. It causes vasoconstriction, which could keep the fetus from growing.

c. Caffeine depresses your heart's ability to pump and function.

d. Severe diuresis can leave you at risk for dehydration during pregnancy.

ANS: B It causes vasoconstriction, which could keep the fetus from growing.

Caffeine is a vasoconstrictor. Its half-life is 3 times as long in the pregnant woman. It stimulates cardiac function. It does cause mild but not severe diuresis.

20. The student nurse learns that the most important reason marijuana should not be used during pregnancy is which of the following?

a. Unknown effects, more research is needed

b. Causes a higher rate of spontaneous abortions

c. Leads to multiple organ dysfunction in the newborn

d. Responsible for severe cognitive deficits

ANS: A Unknown effects, more research is needed

Marijuana's effects on the fetus are largely unknown. More research is needed in this area.

21. A nurse is interviewing a pregnant woman in the clinic. She seems hostile and answers many questions with "Whatever" and "I don't really know." At her last appointment she was late and disheveled. What action by the nurse is best?

a. Ask the woman if this pregnancy was planned or is wanted.

b. Call social services to come evaluate the situation.

c. Ask the woman about drug use, including over the counter.

d. Encourage the woman to be more forthright with answers.

ANS: C Ask the woman about drug use, including over the counter.

This woman is displaying some signs of substance abuse. In a non-judgmental manner, the nurse should ask about all drugs and medications she is using. The questions will appear less confrontative if the nurse begins by asking about over-the-counter medications first. Asking if the pregnancy is planned or wanted is conveying disapproval to the woman for her choices and behavior. Social services may or may not need to be involved, but the nurse needs to assess the woman more completely first. Encouraging the woman to be more forthright implies that she is being dishonest and will not gain more cooperation.

1. Many teens wait until the second or even third trimester to seek prenatal care. The nurse should understand that the reasons behind this delay include which of the following? (Select all that apply.)

a. Lack of realization that they are pregnant

b. Uncertainty as to where to go for care

c. Continuing to deny the pregnancy

d. A desire to gain control over their situation

e. Wanting to hide the pregnancy as long as possible

ANS: A, B, C, E

Not realizing they are pregnant, uncertainty over where to get care, denial, and wanting to hide the pregnancy are all reasons some teens delay prenatal care. Wanting to gain control over the situation does not lead to delaying care.

2. Approximately 82% of teen pregnancies are unintended. Seventy percent of teens have had sex by their 19th birthday. Factors that contribute to an increased risk for teen pregnancy include which of the following? (Select all that apply.)

a. High self-esteem

b. Peer pressure

c. Limited access to contraception

d. Planning sexual activity

e. Lack of role models

ANS: B, C, E

Peer pressure to begin sexual activity is a contributing factor toward teen pregnancy. Limited access to contraceptive devices and lack of accurate information about how to use these devices are also factors. Lack of appropriate role models, desire to alleviate or escape the present situation at home along with feelings of invincibility also contribute to teen pregnancy. Low self-esteem and the consequent inability to set limits on sexual activity place the adolescent at risk for teen pregnancy. Ambivalence toward sexuality and not planning intercourse are more likely to result in teen pregnancy.