Ladewig 8e TIF Ch08 PDF

Ladewig, Contemporary Maternal-Newborn Nursing, 8/E
Chapter 08
Question 1
Type: MCSA
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
Correct 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.
Global Rationale:
Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: LO01 - Describe the most appropriate nursing care for couples during preconception
counseling to help ensure their best possible health state.
Question 2
Type: MCSA
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?
Ladewig, Contemporary Maternal-Newborn Nursing, 8/E Test Bank
Copyright 2014 by Pearson Education, Inc.
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.
Correct 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.
Global Rationale:
Cognitive Level: Applying

Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Question 3
Type: MCSA
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.
Correct 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.
Global Rationale:

Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Planning
Question 4
Type: MCSA
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.”
Correct 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.
Global Rationale:

Client Need Sub:
Question 5
Type: MCSA
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.
Correct 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.
Global Rationale:

Client Need Sub:
Learning Outcome: LO02 - Assist expectant parents in making the best decisions possible in issues related to
pregnancy, labor, and birth.
Question 6
Type: MCSA
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.
Correct 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.
Global Rationale:

Client Need: Physiological Integrity
Client Need Sub:
Question 7
Type: MCSA
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?”
Correct 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.
Global Rationale:

Client Need Sub:
Question 8
Type: MCSA
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.”
Correct 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.
Global Rationale:

Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: LO03 - Explain the basic goals of childbirth education in providing care to expectant
couples and their families.
Question 9
Type: MCSA
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
Correct 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.
Global Rationale:
Cognitive Level: Understanding

Client Need Sub:
Learning Outcome: LO04 - Explain the goals and content of the various types of antepartum education programs
when providing nursing care for expectant couples and their families.
Question 10
Type: MCSA
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.
Correct 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.
Global Rationale:

Client Need Sub:
Learning Outcome: LO05 - Describe interventions that can be implemented by the childbirth educator to
decrease pregnant women’s anxiety.
Question 11
Type: MCSA
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.
Correct 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.
Global Rationale:

Client Need Sub:
Question 12
Type: MCSA
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 pain-relief 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.”
Correct 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.
Global Rationale:

Client Need Sub:
Question 13
Type: MCSA
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."
Correct 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.
Global Rationale:

Client Need Sub:
Learning Outcome: LO06 - Compare methods of childbirth preparation and the nursing interventions for each.
Question 14
Type: MCSA
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
Correct 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.
Global Rationale:

Client Need Sub:
Learning Outcome: LO06 - Compare methods of childbirth preparation and the nursing interventions for each.
Question 15
Type: MCSA
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.”
Correct 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.
Global Rationale:

Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: LO07 - Examine ways in which the nurse conveys respect for patient individuality in
preparing for childbirth.


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Ladewig, Contemporary Maternal-Newborn Nursing, 8/E

4. 29-year-old, has had two abortions, takes a multiple-vitamin supplement

Cognitive Level: Analyzing

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.

Correct Answer: 1,3

Rationale 3: Pelvic tilt and rock exercises are body-conditioning exercises.

Cognitive Level: Applying

Rationale 3: It is not a legal document.

Cognitive Level: Applying

2. “Children under 12 are not allowed to be present at the birth.”

4. “Bring some toys to keep your child occupied.”

Rationale 2: Children are allowed to be present at births.

Cognitive Level: Applying

1. You can have a certified nurse–midwife or a physician for your provider.

3. The birthing unit was remodeled and redecorated last year.

4. Some of the providers recommend circumcision for baby boys.

Cognitive Level: Analyzing

3. Take Vitamin C daily to reduce the risk of neural tube defects.

Cognitive Level: Analyzing

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?”

Rationale 1: Children’s attendance is a complement to the provider’s philosophy.

Rationale 3: A thorough understanding of the provider’s philosophy is essential to determining compatibility.

Cognitive Level: Analyzing

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.”

Cognitive Level: Analyzing

Ladewig, Contemporary Maternal-Newborn Nursing, 8/E Test Bank

1. Availability of prenatal and genetic testing

Rationale 3: Infertility counseling is not incorporated within preconception counseling.

Cognitive Level: Understanding

1. Encourage muscle tightening with each contraction.

2. Explain that patterned breathing increases anxiety and should be avoided.

Cognitive Level: Applying

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.

Rationale 2: Not all classes teach imagery.

Ladewig, Contemporary Maternal-Newborn Nursing, 8/E Test Bank

Cognitive Level: Applying

Cognitive Level: Analyzing

Cognitive Level: Understanding

Ladewig, Contemporary Maternal-Newborn Nursing, 8/E Test Bank

3. The extended McRoberts position

Rationale 2: Partner-coached childbirth is an element of the Bradley method.

Cognitive Level: Understanding

1. “Women like to be in a semi-sitting position when giving birth.”

2. “Teaching alternatives available at our hospital facilitates decision making.”

4. “Patients should be taught not to make noise during labor or birth.”

Ladewig, Contemporary Maternal-Newborn Nursing, 8/E Test Bank

Cognitive Level: Applying

Ladewig, Contemporary Maternal-Newborn Nursing, 8/E Test Bank

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