Chapter 11: The Childbearing Family with Special Needs NCLEX

1. A pregnant client who abuses cocaine admits to exchanging sex for her drug habit. This behavior puts her at a greater risk for:

a.

postmature birth.

b.

Sexually transmitted diseases.

c.

Hypotension and vasodilation.

d.

Depression of the central nervous system.

ANS: B

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

PTS: 1 DIF: Cognitive Level: Understanding REF: 487

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

a.

Battering

b.

Honeymoon

c.

Tension-building

d.

Increased drug taking

ANS: B

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 person. Often, the batterer increases the use of drugs during the tension-building phase.

PTS: 1 DIF: Cognitive Level: Understanding REF: 499

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

a.

Health care workers have a positive attitude.

b.

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

c.

Seeing a different nurse and/or health care provider at every visit.

d.

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

ANS: C

Whenever possible, the teen should be scheduled to see the same nurses and practitioners for continuity of care. A positive attitude of the health care providers is important in teen pregnancy care. If the hospital or 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 Saturday by special arrangement, this 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.

PTS: 1 DIF: Cognitive Level: Understanding REF: 480, 482

4. In planning sex education classes for the 12- to 15-year-old age group, more emphasis should be placed on which?

a.

How to set limits for sexual behavior

b.

The inaccuracy of information from peers

c.

The use of oral contraceptives to prevent unwanted pregnancy

d.

The use of condoms to prevent sexually transmitted diseases as well as pregnancy

ANS: A

Setting limits for sexual behavior is particularly important for younger teenagers who may be pressured to become sexually active before they are physically and emotionally ready. Oral contraceptives are not the preferred method of birth control for teenagers because they forget to take them, and they do not protect against STIs. The use of condoms is appropriate and an important concept to discuss but should not be the emphasis.

PTS: 1 DIF: Cognitive Level: Understanding REF: 477

5. Which should the nurse do when counseling a teenage client who has decided to relinquish her baby for adoption?

a.

Question her about her feelings regarding adoption.

b.

Tell her she can always change her mind about adoption.

c.

Affirm her decision while acknowledging her maturity in making it.

d.

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

ANS: C

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

PTS: 1 DIF: Cognitive Level: Application REF: 496

6. A client who is older than 35 years may have difficulty achieving pregnancy because:

a.

prepregnancy medical attention is lacking.

b.

personal risk behaviors influence fertility.

c.

she has used contraceptives for an extended time.

d.

her ovaries may be affected by the aging process.

ANS: D

Once the mature woman decides to conceive, a delay in becoming pregnant may occur because of the normal aging of the ovaries. Prepregnancy medical care is available and encouraged. 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.

PTS: 1 DIF: Cognitive Level: Understanding REF: 484

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

a.

Nutrition and diet planning

b.

Exercise and fitness

c.

Having enough rest and sleep

d.

Effective contraceptive methods

ANS: C

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

PTS: 1 DIF: Cognitive Level: Understanding REF: 484, 485

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

a.

Intrauterine growth restriction

b.

Genetic changes and anomalies

c.

Extensive central nervous system damage

d.

Fetal addiction to the substance inhaled

ANS: A

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.

PTS: 1 DIF: Cognitive Level: Understanding REF: 486

9. A client at 24 weeks of gestation says she has a glass of wine with dinner every evening. Which is the reason the nurse should give to counsel her to eliminate all alcohol intake?

a.

The fetus is placed at risk for altered brain growth.

b.

The fetus is at risk for severe nervous system injury.

c.

The client will be at risk for abusing other substances as well.

d.

A daily consumption of alcohol indicates a risk for alcoholism.

ANS: A

The brain grows most rapidly in the third trimester and is most vulnerable to alcohol exposure during this time. The major concerns are mental retardation, learning disabilities, high activity level, and short attention span. The risk to the client for abusing other substances is not the major risk for the infant. It has not been proven that daily consumption of alcohol indicates a risk for alcoholism.

PTS: 1 DIF: Cognitive Level: Application REF: 487

10. Which is an example of healthy grieving?

a.

The mother exhibits an absence of crying or expression of feelings.

b.

The parents do not mention the baby in conversation with family members.

c.

The mother asks that the baby be taken away from the delivery area quickly.

d.

While holding the baby, the mother says to her husband, "He has your eyes and nose."

ANS: D

Attachment behaviors are necessary for healthy grieving. Absence of crying and not mentioning the baby may be signs of denial. By not seeing the baby, attachment and therefore healthy grieving will not occur.

PTS: 1 DIF: Cognitive Level: Understanding REF: 482

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

a.

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

b.

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

The nurse should recognize the woman's grief and its significance. Asking her about plans for another baby is denying the loss of the other infant. Pointing out the health of another baby is belittling her feelings. Stating that the nurse has a friend who lost a twin is denying the loss of the infant and her grief and belittling her feelings.

PTS: 1 DIF: Cognitive Level: Application REF: 492

12. Which is an appropriate nursing measure when a baby has an unexpected defect?

a.

Remove the baby from the delivery area immediately.

b.

Inform the parents immediately that something is wrong.

c.

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

d.

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

ANS: D

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 able to touch and hold the baby as soon as possible. The nurse should not take the baby away; this would raise anxiety levels of the parents. They should be told about the defect and allowed to see the baby.

PTS: 1 DIF: Cognitive Level: Application REF: 492

13. Which statement correctly describes the incidence of intimate partner violence (IPV) in the United States?

a.

Intimate partner violence seldom occurs during pregnancy.

b.

Each year about 42.4 million women experience intimate partner violence.

c.

The largest number of intimate partner violence is in the lower socioeconomic classes.

d.

Intimate partner violence is second only to automobile accidents as the most frequent cause of injury to women.

ANS: B

IPV occurs to approximately 42.4 million women each year. IPV occurs frequently during pregnancy. IPV victims come from all different backgrounds and socioeconomic classes. Intimate partner violence is a more common cause of injury than automobile accidents.

PTS: 1 DIF: Cognitive Level: Understanding REF: 497

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

a.

She avoids making eye contact and is hesitant to answer questions.

b.

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

c.

The woman has injuries on various parts of her body that are in different stages of healing.

d.

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

ANS: C

The battered woman often has multiple injuries in various stages of healing. It is more normal for the woman to have a flat affect. A loud and hostile argument is not always an indication of battering. Often the batterer will be attentive and refuse to leave the woman's bedside.

PTS: 1 DIF: Cognitive Level: Analysis REF: 500

15. When the nurse is alone with a battered client, the client 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." Which is the best response by the nurse?

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

The nurse should stress that the client is not at fault. Asking what the woman did to make him angry enough to hurt the client is placing the blame on the woman. The nurse cannot promise that the batterer will not learn of the conversation. Often the batterer will find out about the conversation. Explaining the batterer's actions is placing the blame on the woman and finding excuses for the batterer.

PTS: 1 DIF: Cognitive Level: Application REF: 501

16. Which environment can assist a pregnant teen to achieve the task of establishing a stable identity?

a.

Home schooling

b.

Alternative education program

c.

School-based mothers' program

d.

Continuing mainstream high school classes

ANS: C

A school-based mothers' program that provides peer support is important. Home schooling, alternative education, and continuing mainstream high school classes would not provide as much peer support.

PTS: 1 DIF: Cognitive Level: Analysis REF: 478

17. Which complication of adolescent pregnancy should the nurse plan to monitor?

a.

Anemia

b.

Placenta previa

c.

Abruptio placenta

d.

Incompetent cervix

ANS: A

Adolescent pregnancies are at increased risk for anemia, nutritional deficiencies, pregnancy-associated hypertension, HIV and other STDs, short interval until next pregnancy, and depression. They do not have a higher incidence of placenta previa, abruptio placentae, or incompetent cervix.

PTS: 1 DIF: Cognitive Level: Application REF: 479

18. Which antidepressant is no longer recommended for use during pregnancy?

a.

Sertraline (Zoloft)

b.

Paroxetine (Paxil)

c.

Fluoxetine (Prozac)

d.

Citalopram (Celexa)

ANS: B

Paroxetine (Paxil) is no longer recommended for use during pregnancy because there have been reports of congenital malformations. Zoloft, Prozac, and Celexa are antidepressants used during pregnancy, if indicated that without the medication the pregnant client would be at risk for severe depression.

PTS: 1 DIF: Cognitive Level: Analysis REF: 487, 488

19. Women who become pregnant after the age of 35 are more likely to:

a.

have multiple births because of increased fertility rates.

b.

be hypotensive during the pregnancy.

c.

have fewer obstetric complications due to stronger pelvic structure.

d.

have a child who has a trisomy 21 abnormality.

ANS: D

Mature woman who become pregnant often have issues with conception and can experience infertility. There is no causal relationship between maternal age and hypotension during pregnancy. Women older than 35 are more likely to have obstetric complications for a variety of reasons. Women older than 35 are more likely to develop chromosomal abnormalities, specifically Down syndrome, which is trisomy 21.

PTS: 1 DIF: Cognitive Level: Application REF: 484

20. A pregnant client tells you during a clinic visit that she is concerned about her significant other's change in behavior during the course of the pregnancy. She relates feelings of being afraid but emphatically denies any physical or verbal threats. She confides in you that she has been using her mobile phone to find out more information about this subject. What is the most appropriate nursing response?

a.

Tell her that all relationships change during pregnancy and give herself and her significant other some time to adapt to this situation by spending quality time with one another.

b.

Tell the client that you are concerned for her and the baby; provide her with a phone number for a safe house just in case she needs to act quickly and leave the home situation.

c.

Explore in more detail the client's feelings but tell her that you are concerned about searching information on the Internet as a stimulus trigger for potential abuse.

d.

Do not let the client leave the clinic office and call the domestic abuse hotline number to report the incident.

ANS: C

All health care providers should take comments of potential abuse seriously. Because there is no confirmation of abuse by the client's admission, additional investigation is warranted. Based on the facts presented, the nurse should be concerned that the client's significant other might be alerted to a potential trigger of violent behavior.

PTS: 1 DIF: Cognitive Level: Application REF: 499

21. The nurse is seeing a 17-year-old female in the clinic for complaints of acne. The nurse plans on taking advantage of this teachable moment with the teen. What topics will the nurse include in the teen's teaching plan?

a.

Smoking habits, folic acid intake, and heart disease

b.

Hyperlipidemia, distracted driving, and menstrual history

c.

Sexual activity, contraception, and screening for violence

d.

Optimum weight, hypothyroidism, and sexually transmitted diseases

ANS: C

All the topics mentioned are worthy of discussion. However, sexual activity, contraception, and screening for violence have priority related to the age and gender of the patient. Because adolescents are often seen by a health care provider for various reasons before they become pregnant, counseling to improve health for a future pregnancy should be offered to them during any health care visit. Smoking cessation, attaining optimum weight, folic acid intake, and screening for violence are topics that should be discussed with all young women so that any future pregnancy has the most positive outcome.

PTS: 1 DIF: Cognitive Level: Analysis REF: 477

22. A patient has just acknowledged that she is 20 weeks pregnant and confides to the nurse that she has a daily heroin habit. The nurse discusses treatment options for the patient. Which patient statement requires follow-up?

a.

"My plan is to visit the outpatient clinic daily for treatment."

b.

"I will see my health care provider at least every 2 weeks."

c.

"My baby will not have to go through withdrawal when I take methadone."

d.

"With oral methadone, my baby and I are at decreased risk of infection."

ANS: C

Pregnant women who use heroin are often prescribed an alternative drug such as methadone, a synthetic opiate. Methadone can be taken orally once daily and is long- acting, providing consistent blood levels to decrease the adverse fetal effects of wide swings in blood levels found with heroin use. Methadone also reduces the risk of infections from contaminated needles and drug-seeking behavior, such as prostitution. At therapeutic levels, it does not produce the euphoria or sedation of heroin and allows the woman to have a relatively normal lifestyle. The woman who receives a daily dose of methadone in a drug treatment program is more likely to receive prenatal care. However, the newborn must withdraw from methadone after birth.

PTS: 1 DIF: Cognitive Level: Application REF: 488

23. Which nursing diagnoses may apply to the childbearing family with special needs? (Select all that apply.)

a.

Risk for spiritual distress

b.

Risk for injury

c.

Readiness for enhanced nutrition

d.

Ineffective breathing pattern

e.

Situational low self-esteem

ANS: A, B, E

A childbearing family with special needs may be at risk to develop spiritual distress, experience injury, and exhibit situational low self-esteem. There are no supportive data to hypothesize an ineffective breathing pattern and/or readiness for enhanced nutrition.

PTS: 1 DIF: Cognitive Level: Application REF: 501

24. 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.

Continuing to deny the pregnancy

b.

Uncertainty about where to go for care

c.

Lack of realization that they are pregnant

d.

A desire to gain control over their situation

e.

Wanting to hide the pregnancy as long as possible

ANS: A, B, C, E

Denying the pregnancy, uncertainty about where to go for care, lack of realization of pregnancy, and wanting to hide the pregnancy are all valid reasons for the teen to delay seeking prenatal care. A desire to gain control is not a reason to delay seeking health care.

PTS: 1 DIF: Cognitive Level: Analysis REF: 480

25. Which characteristics of fetal alcohol syndrome (FAS) should the nurse expect to assess in affected neonates? (Select all that apply.)

a.

Hydrocephaly

b.

Low activity

c.

Epicanthal folds

d.

Short palpebral fissures

e.

Flat midface, with a low nasal bridge

ANS: C, D, E

Common facial anomalies associated with FAS include microcephaly, short palpebral fissures (the openings between the eyelids), epicanthal folds, flat midface with a low nasal bridge, indistinct philtrum (groove between the nose and upper lip), and a thin upper lip. Microcephaly is present, not hydrocephaly. Central nervous system impairment includes a high activity level, not a low one.

PTS: 1 DIF: Cognitive Level: Understanding REF: 487

26. Which congenital defects in a newborn are associated with long-term parenting problems? (Select all that apply.)

a.

Polydactyl

b.

Cleft lip and palate

c.

Ventral septal defect

d.

Ambiguous genitalia

ANS: B, D

Although any defect in a newborn produces extreme concern and anxiety, certain defects are associated with long-term parenting problems. Accepting an infant with facial or genital anomalies is particularly difficult for the family and community. Polydactyl and ventral septal defects are reparable, with good outcomes.

PTS: 1 DIF: Cognitive Level: Analysis REF: 492