Foundations of Maternal Newborn and Women’s Health Nursing, 6th edition by Murray – Test Bank

Foundations of Maternal Newborn and Women’s Health Nursing, 6th edition by Murray – Test Bank

Chapter 06: Conception and Prenatal Development

MULTIPLE CHOICE

1. An expectant father asks the nurse, “Which part of the mature sperm contains the male chromosomes?” What is the best response by the nurse?
a. X-bearing sperm
b. The tail of the sperm
c. The head of the sperm
d. The middle portion of the sperm

ANS: C
The head of the sperm contains the male chromosomes that will join the chromosomes of the ovum. If an X-bearing sperm fertilizes the ovum, the baby will be female. The tail of the sperm helps propel the sperm toward the ovum. The middle portion of the sperm supplies energy for the tail’s whiplike action.

PTS: 1 DIF: Cognitive Level: Application REF: 75
OBJ: Nursing Process Step: Implementation
MSC: Client Needs: Health Promotion and Maintenance

2. One of the assessments performed in the birth room is checking the umbilical cord for blood vessels. Which finding is considered to be within normal limits?
a. One artery and one vein
b. Two veins and one artery
c. Two arteries and one vein
d. Two arteries and two veins

ANS: C
The umbilical cord contains two arteries and one vein to transport blood between the fetus and the placenta. Any option other than two arteries and one vein is considered abnormal and requires further assessment. Two veins and one artery is abnormal and may indicate an anomaly. Two arteries instead of one is considered normal; this infant would require further assessment for other anomalies.

PTS: 1 DIF: Cognitive Level: Understanding REF: 86
OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

3. Which is the purpose of the ovum’s zona pellucida?
a. Prevents multiple sperm from fertilizing the ovum
b. Stimulates the ovum to begin mitotic cell division
c. Allows the 46 chromosomes from each gamete to merge
d. Makes a pathway for more than one sperm to reach the ovum

ANS: A
Fertilization causes the zona pellucida to change its chemical composition so that multiple sperm cannot fertilize the ovum. Miotic cell division begins when the nuclei of the sperm and ovum unite. Each gamete (sperm and ovum) has only 23 chromosomes; there will be 46 chromosomes when they merge. Once sperm has entered the ovum, the zona pellucida changes to prevent other sperm from entering.

PTS: 1 DIF: Cognitive Level: Understanding REF: 75
OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

4. The nurse is explaining the process of cell division during the preembryonic period to a group of nursing students. Which describes the morula?
a. Fertilized ovum before mitosis begins
b. Double layer of cells that becomes the placenta
c. Flattened, disk-shaped layer of cells within a fluid-filled sphere
d. Solid ball composed of the first cells formed after fertilization

ANS: D
The morula is so named because it resembles a mulberry. It is a solid ball of 12 to 16 cells that develops after fertilization. The fertilized ovum is called the zygote. The placenta is formed from two layers of cells—the trophoblast, which is the other portion of the fertilized ovum, and the decidua, which is the portion of the uterus where implantation occurs. The flattened, disk-shaped layer of cells is the embryonic disk; it will develop into the body.

PTS: 1 DIF: Cognitive Level: Understanding REF: 77
OBJ: Nursing Process Step: Implementation
MSC: Client Needs: Health Promotion and Maintenance

5. The upper uterus is the best place for the fertilized ovum to implant because the:
a. maternal blood flow is lower.
b. placenta attaches most firmly.
c. uterine endometrium is softer.
d. developing baby is best nourished.

ANS: D
The uterine fundus is richly supplied with blood and has the thickest endometrium, both of which promote optimum nourishment of the fetus. The blood supply is rich in the fundus, which allows for optimal nourishment of the fetus. If the placenta attaches too deeply, it does not easily detach. Softness is not a concern with implantation; attachment and nourishment are the major concerns.

PTS: 1 DIF: Cognitive Level: Understanding REF: 77, 78
OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

6. Some of the embryo’s intestines remain within the umbilical cord during the embryonic period because the:
a. intestines need this time to grow until week 15.
b. nutrient content of the blood is higher in this location.
c. abdomen is too small to contain all the organs while they are developing.
d. umbilical cord is much larger at this time than it will be at the end of pregnancy.

ANS: C
The abdominal contents grow more rapidly than the abdominal cavity, so part of their development takes place in the umbilical cord. By 10 weeks, the abdomen is large enough to contain them. The intestines remain within the umbilical cord only until about week 10. Blood supply is adequate in all areas; intestines stay in the umbilical cord for about 10 weeks because they are growing faster than the abdomen. Intestines begin their development within the umbilical cord, but only because the liver and kidneys occupy most of the abdominal cavity, not because of the size of the umbilical cord.

PTS: 1 DIF: Cognitive Level: Understanding REF: 83
OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

7. A client who is 16 weeks pregnant with her first baby asks how long it will be before she feels the baby move. Which is the nurse’s best answer?
a. “You should have felt the baby move by now.”
b. “The baby is moving, but you can’t feel it yet.”
c. “Some babies are quiet and you don’t feel them move.”
d. “Within the next month you should start to feel fluttering sensations.”

ANS: D
Maternal perception of fetal movement (quickening) usually begins between 17 and 20 weeks after conception. Because this is her first pregnancy, movement is felt toward the later part of the 17 to 20 weeks. “The baby is moving, but you can’t feel it yet” may be alarming to the woman. “Some babies are quiet and you don’t feel them move” is a true statement; the fetus’ movements are not strong enough to be felt until 17 to 20 weeks. However, this statement does not answer the woman’s concern. Fetal movement should be felt between 17 and 20 weeks; if movement is not felt by the end of that time, further assessment will be necessary.

PTS: 1 DIF: Cognitive Level: Application REF: 84
OBJ: Nursing Process Step: Implementation
MSC: Client Needs: Health Promotion and Maintenance

8. Which best describes what occurs during the fetal period of development?
a. Maturation of organ systems
b. Development of basic organ systems
c. Resistance of organs to damage from external agents
d. Development of placental oxygen–carbon dioxide exchange

ANS: A
During the fetal period, the body systems grow in size and mature in function to allow independent existence after birth. Basic organ systems are developed during the embryonic period. The organs are always at risk for damage from external sources; however, the older the fetus, the more resistant will be the organs. The greatest risk is when the organs are developing. The placental system is complete by week 12, but that is not the best description of the fetal period.

PTS: 1 DIF: Cognitive Level: Understanding REF: 83
OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

9. An expectant parent says to the nurse, “When my sister’s baby was born, it was covered in a cheeselike coating. What is the purpose of this coating?” The correct response by the nurse is to explain that the purpose of vernix caseosa is to:
a. regulate fetal temperature.
b. protect the fetal skin from amniotic fluid.
c. promote normal peripheral nervous system development.
d. allow the transport of oxygen and nutrients across the amnion.

ANS: B
Prolonged exposure to amniotic fluid during the fetal period could result in breakdown of the skin without the protection of the vernix caseosa. The amniotic fluid aids in maintaining fetal temperature. Normal peripheral nervous system development is dependent on the nutritional intake of the mother. The amnion is the inner membrane that surrounds the fetus. It is not involved in the oxygen and nutrient exchange.

PTS: 1 DIF: Cognitive Level: Application REF: 84
OBJ: Nursing Process Step: Implementation
MSC: Client Needs: Health Promotion and Maintenance

10. An expectant client, diagnosed with oligohydramnios, asks the nurse about what this condition means for the baby. Which statement should the nurse give to the client?
a. Oligohydramnios can cause poor fetal lung development.
b. Oligohydramnios means that the fetus is excreting excessive urine.
c. Oligohydramnios could mean that the fetus has a gastrointestinal blockage.
d. Oligohydramnios is associated with fetal central nervous system abnormalities.

ANS: A
Because an abnormally small amount of amniotic fluid restricts normal lung development, the fetus may have poor fetal lung development. Oligohydramnios may be caused by a decrease in urine secretion. Excessive amniotic fluid production may occur when the gastrointestinal tract prevents normal ingestion of amniotic fluid. Excessive amniotic fluid production may occur when the fetus has a central nervous system abnormality.

PTS: 1 DIF: Cognitive Level: Application REF: 88
OBJ: Nursing Process Step: Implementation
MSC: Client Needs: Health Promotion and Maintenance

11. The nurse is conducting a staff in-service on multifetal pregnancy. Which statement about dizygotic twin development should the nurse include in the teaching session?
a. Dizygotic twins arise from two fertilized ova and are the same sex.
b. Dizygotic twins arise from a single fertilized ovum and are always of the same sex.
c. Dizygotic twins arise from two fertilized ova and may be the same sex or different sexes.
d. Dizygotic twins arise from a single fertilized ovum and may be the same sex or different sexes.

ANS: C
Dizygotic twins arise from two ova that are fertilized by different sperm. They may be the same or different gender, and they may not have similar physical traits. Monozygotic twins are always the same sex. A single fertilized ovum that produces twins is called monozygotic. Dizygotic twins are from two fertilized ova and may or may not be the same sex.

PTS: 1 DIF: Cognitive Level: Application REF: 90
OBJ: Nursing Process Step: Implementation
MSC: Client Needs: Health Promotion and Maintenance

12. Which medication would the nurse anticipate administering to the labor client who is delivering a premature infant?
a. Phytonadione (AquaMEPHYTON)
b. Betamethasone
c. Bromocriptine (Parlodel)
d. Newborn eye prophylaxis

ANS: B
Betamethasone (a corticosteroid) is given to the labor client who will be delivering a premature infant to promote surfactant production in the fetus to maximize lung function. Vitamin K, also known as phytonadione, is administered postbirth to the infant to prevent hemorrhagic disease of the newborn. Parlodel has been used historically to stop milk production in a client postbirth. Newborn eye prophylaxis is given to the baby to prevent the transmission of certain sexually transmitted diseases.

PTS: 1 DIF: Cognitive Level: Analysis REF: 84
OBJ: Nursing Process Step: Planning
MSC: Client Needs: Physiologic Integrity/ Pharmacologic and Parenteral Therapies

13. An infant is diagnosed with fetal anemia. What information would support that clinical diagnosis?
a. Presence of excess maternal hormones
b. Maternal blood type O-negative, Rh-negative, and infant blood type O-negative, Rh- negative
c. Passive immunity
d. Rh-negative mother and Rh-positive baby

ANS: C
Passive immunity provides temporary protection to the baby based on the transfer of maternal antibodies. Maternal hormones would not lead to a clinical diagnosis of fetal anemia. These blood types and Rh factors are the same; therefore, no antibodies will be created. In this situation, an Rh-negative mother and Rh-positive baby will result in stimulation of antibodies that will stimulate a reaction leading to hemolysis.

PTS: 1 DIF: Cognitive Level: Analysis REF: 87
OBJ: Nursing Process Step: Assessment
MSC: Client Needs: Physiologic Integrity/Reduction of Risk Potential

14. The nurse is explaining the function of the placenta to a pregnant client. Which statement indicates to the nurse the need for further client teaching?
a. “My baby gets oxygen from the placenta.”
b. “The placenta functions to help excrete waste products.”
c. “The nourishment that I take in passes through the placenta.”
d. “The placenta helps maintain a stable temperature for my baby.”

ANS: D
Amniotic fluid and not the placenta helps with thermoregulation. The remaining statements are correct regarding placental function.

PTS: 1 DIF: Cognitive Level: Application REF: 84
OBJ: Nursing Process Step: Evaluation MSC: Client Needs: Health Promotion and Maintenance

15. The nurse is assessing a newborn immediately after birth. After assigning the first Apgar score of 9, the nurse notes two vessels in its umbilical cord. What is the nurse’s next action?
a. Assess for other abnormalities of the infant.
b. Note the assessment finding in the infant’s chart.
c. Notify the health care provider of the assessment finding.
d. Call for the neonatal resuscitation team to attend the infant immediately.

ANS: A
The normal finding in the umbilical cord is two arteries and one vein. Two vessels may indicate other fetal anomalies. Notation of the finding is the appropriate next step when the finding is expected. The health care provider will need to be notified; however, the infant is the nurse’s primary concern and must be assessed for abnormalities first. The initial Apgar score is 9, indicating no signs of distress or need of resuscitation.

PTS: 1 DIF: Cognitive Level: Application REF: 86
OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance